Search

Introduction and objectives: Deliberate self-poisoning (DSP) is a frequent cause of admission at the emergency department during adolescence. Since the beginning of the COVID-19 pandemic, a higher number of cases was reported. This retrospective study aimed to determine DSP prevalence, between 2018 and 2022, as well as the medication used and the method for obtaining it, within the catchment area of a Tertiary Pediatric Hospital Emergency Department (ED) in Portugal. Methods: Retrospective study, including patients aged 10 to 17 that lived in the catchment area of the ED and were admitted for DSP less than 7 days prior. By searching with the keywords “DSP” and “deliberate self-poisoning”, 2975 records were found, of which 1403 cases were included. Statistical analysis was performed in SPSS with a significance level of 0.01. Results: Out of 1403 cases, 87.9% were female, mostly in mid-adolescence and with a previous follow-up appointment with a child and adolescent psychiatrist. The patient’s own psychotropic medication were the most used drugs. Episodes with no suicidal intention were more frequent. After the ED, most cases were discharged with a referral for psychiatric follow-up. There was a higher number of DSP in 2021 (p < 0.01), with a prevalence of 123.8/100,000. Discussion: DSP is growing among adolescents. Cases increased significantly in 2021. We highlight the need for prevention campaigns and vigilance systems to monitor and modify this trend.

The aim of this paper is to analyze the bioarchaeological material from ten sites of the lower basin of the Uruguay River, stored in the Museo Arqueológico Manuel Almeida (Gualeguaychú, Entre Ríos). The bioarchaeological analyses focused on estimating the anatomical composition, the MNI and the sex-age structure for each site of the collection. Based on analyzing catalogue data the precedence of some skeletons was defined and mortuary practices were inferred. A minimum number of 80 individuals of both sexes and different ages have been estimated. It was also possible to recognize primary and secondary burial modalities. At the areal level, bioarchaeological research had little development, so this work provides new information that will extend the discussion on the pre-Hispanic occupations of southern Entre Ríos. [ABSTRACT FROM AUTHOR]

The field of Cardio-Oncology has grown significantly, especially during the last decade. While awareness of cardiotoxicity due to cancer disease and/or therapies has greatly increased, much of the attention has focused on myocardial systolic disfunction and heart failure. However, coronary and structural heart disease are also a common issue in cancer patients and encompass the full spectrum of cardiotoxicity. While invasive percutaneous or surgical intervention, either is often needed or considered in cancer patients, limited evidence or guidelines are available for dealing with coronary or structural heart disease. The Society for Cardiovascular Angiography and Interventions consensus document published in 2016 is the most comprehensive document regarding this particular issue, but relevant evidence has emerged since, which render some of its considerations outdated. In addition to that, the recent 2022 ESC Guidelines on Cardio-Oncology only briefly discuss this topic.As a result, the Portuguese Association of Cardiovascular Intervention and the Cardio-Oncology Study Group of the Portuguese Society of Cardiology have partnered to produce a position paper to address the issue of cardiac intervention in cancer patients, focusing on percutaneous techniques. A brief review of available evidence is provided, followed by practical considerations. These are based both on the literature as well as accumulated experience with these types of patients, as the authors are either interventional cardiologists, cardiologists with experience in the field of Cardio-Oncology, or both. Resumo: A Cardio-Oncologia cresceu consideravelmente, particularmente ao longo da última década. Não obstante o aumento de sensibilização relativamente à cardiotoxicidade secundária ao cancro e/ou a terapêuticas oncológicas, muita da atenção tem-se focado na disfunção sistólica e insuficiência cardíaca. Todavia, a doença coronária e estrutural cardíaca representam também um desafio comum em doentes oncológicos, fazendo assim parte do abrangente conceito de Cardio-Oncologia. Apesar da necessidade de intervenção invasiva, percutânea ou cirúrgica ser frequentemente necessária ou considerada em doentes com cancro, é escassa a evidência ou recomendações relativas à doença coronária ou estrutural neste subgrupo. O documento de consenso da Society for Cardiovascular Angiography and Interventions, publicado em 2016, é a referência mais completa relativamente a esta problemática. Contudo, alguma evidência que entretanto surgiu torna necessária uma atualização. Adicionalmente, as recentes recomendações de 2022 em Cardio-Oncologia da Sociedade Europeia de Cardiologia abordam este assunto somente de forma muito sucinta.Por este motivo, a Associação Portuguesa de Intervenção Cardiovascular e o Grupo de Estudos de Cardio-Oncologia associaram-se para produzir um Artigo de Posição sobre Intervenção Cardíaca em doentes com cancro, com foco nas técnicas percutâneas. Procedeu-se a uma breve revisão da literatura, seguida de considerações práticas. Estas baseiam-se na evidência disponível, bem como na experiência acumulada dos autores, que são Cardiologistas de Intervenção, Cardiologistas dedicados à área da Cardio-Oncologia, ou ambos.

N/a.

New iron and cobalt bis(dithiolene) complexes [M(3cbdt)2] (3cbdt = 3-cyanobenzene-1,2-dithiolate) were prepared as tetraphenylphosphonium (Ph4P+) salts for Fe in the monoanionic state and for Co in both the dianionic and monoanionic states: (Ph4P)2[Fe(III)(3cbdt)2]2 (1); (Ph4P)2[Co(III)(3cbdt)2]2 (2); (Ph4P)2[Co(II)(3cbdt)2] (3). These compounds were characterized by single-crystal X-ray diffraction, cyclic voltammetry, EPR, and static magnetic susceptibility. Their properties are discussed in comparison with the corresponding complexes based on the isomer ligand 4-cyanobenzene-1,2-dithiolate (4cbdt) and 4,5-cyanobenzene-1,2-dithiolate (dcbdt), previously described by us. The Fe(III) and the Co(III) compounds (1 and 2) are isostructural, crystallizing in the triclinic P1¯ space group, with cis [M(III)(3cbdt)2] complexes dimerized in a trans fashion, and the transition metal (M = Fe, Co) has a distorted 4+1 square pyramidal coordination geometry. The Co(II) compound (3) crystallizes in the triclinic P1¯ space group, with the unit cell containing one cis and three trans inequivalent [Co(II)(3cbdt)2] complexes with the transition metal (Co) and having a square planar coordination geometry. The Fe(III) complex (1) is EPR-silent, and the static magnetic susceptibility shows a temperature dependence typical of dimers of antiferromagnetically coupled S = 3/2 spins with −J/kB = 233.6 K and g = 1.8. Static magnetic susceptibility measurements of compound (3) show that this Co(II) complex is paramagnetic, corresponding to an S = ½ state with g = 2, in agreement with EPR spectra showing in solid state a hyperfine structure typical of the I(59Co) = 7/2. Static susceptibility measurements of Co(III) complex (2) showed an increase in the paramagnetic susceptibility upon warming above 100 K, which is consistent with strong AFM coupling between dimerized S = 1 units with a constant −J/kB ~1286 K.

Spontaneous coronary artery dissection (SCAD) is an increasingly recognized cause of acute coronary syndrome, especially among young to middle-aged women with few traditional cardiovascular risk factors and low pretest probability for atherosclerotic coronary artery disease. Diagnosis by invasive coronary angiography is the gold standard and conservative therapy is generally recommended, with percutaneous or surgical revascularization being reserved for cases of clinical instability, high-risk anatomy or as bailout. Unlike atherothrombotic coronary artery disease, strong evidence on optimal medical therapy is scarce, posing unique challenges in cases of pregnancy-associated SCAD. The follow-up strategy is also of major importance, as recurrent SCAD is not infrequent, lifestyle changes and pharmacological therapy should be planned for the long term, and SCAD-associated conditions need to be addressed. This review aims to provide a practical management approach to SCAD patients for both clinical and interventional cardiologists. Resumo: A dissecção coronária espontânea é uma causa cada vez mais reconhecida de síndrome coronária aguda, especialmente entre mulheres jovens ou de meia-idade com poucos fatores de risco cardiovascular tradicionais e baixa probabilidade pré-teste de doença coronária aterosclerótica. O diagnóstico por coronariografia invasiva é o gold standard e a terapêutica conservadora é geralmente recomendada, optando pela revascularização percutânea ou cirúrgica em casos de instabilidade clínica, anatomia de alto risco ou como bailout. Ao contrário da doença coronária aterotrombótica, não existe evidência científica robusta sobre a terapêutica médica mais adequada nestes casos, representando ainda desafios particulares em casos de dissecção coronária espontânea associada à gravidez. A estratégia de seguimento é também fundamental, dado que a recorrência de dissecção coronária espontânea não é rara, as alterações de estilo de vida e terapêutica farmacológica devem ser planeados em longo prazo e devem ser investigadas as condições subjacentes associadas à dissecção coronária espontânea. Esta revisão pretende oferecer um guia de abordagem prática ao doente com dissecção coronária espontânea, do ponto de vista do cardiologista clínico e do cardiologista de intervenção.

Introduction: Proportionality of secondary mitral regurgitation (sMR) may be a key factor in deciding whether a patient may benefit from mitral intervention. The aim of this study was to evaluate the prognostic value of two different concepts of proportionality and assess their ability to improve MR stratification proposed by the American Society of Echocardiography (ASE) guidelines. Methods: We conducted a retrospective analysis in patients with reduced left ventricular ejection fraction (LVEF) (0.14; b) Lopes et al. – disproportionate sMR whenever measured EROA>theoretical EROA (determined as 50%×LVEF×LVEDVMitralVTI). Primary endpoint was all-cause mortality. Results: A total of 572 patients (69±12 years; 76% male) were included. Mean LVEF was 33±9%, with a median left ventricular end-diastolic volume of 174 mL [136;220] and a median effective regurgitant orifice area of 14 mm2 [8;22]. During mean follow-up of 4.1±2.7 years, there were 254 deaths. There was considerable disagreement (p0.14; b) Lopes et al. – sMR desproporcional quando o EROA medido>EROA teórico (determinado por 50%×LVEF×LVEDVMitralVTI). O endpoint primário foi mortalidade por qualquer causa. Resultados: Foram incluídos 572 pacientes (69±12 anos; 76% sexo masculino). LVEF média foi de 33±9%, com um LVEDV mediano de 174 mL [136;220] e um EROA mediano de 14 mm2 [8;22]. Após um follow-up médio de 4,1±2,7 anos, ocorreram 254 mortes. Verificou-se marcada discordância (p

Introduction: During the Covid-19 pandemic there has been a general belief that hospital admissions for non-infectious causes, especially cardiovascular diseases, have fallen. Objectives: To assess the impact of the pandemic on admissions for ST-elevation myocardial infarction (STEMI) during the first pandemic wave. Methods: We performed a multicenter retrospective analysis of consecutive patients presenting with STEMI in two Portuguese hospital centers in two sequential periods – P1 (March 1 to April 30) and P2 (May 1 to June 30). Patient's clinical data and hospital outcomes were compared between the years 2017 to 2019 and 2020 for both periods. Results: During P1 in 2020, a reduction in the number of STEMI patients was observed in comparison with previous years (26.0±4.2 vs. 16.5±4.9 cases per month; p=0.033), as well as an increase in the number of mechanical complications (0.0% vs. 3.0%; p=0.029). Percutaneous coronary interventions in the setting of failed thrombolysis were more frequent (1.9% vs. 9.1%; p=0.033). An overall trend for longer delays in key timings of STEMI care bundles was noted. Mortality was higher during P1 compared to previous years (1.9% vs. 12.1%; p=0.005). Conclusions: During the first Covid-19 wave fewer patients presented with STEMI at the catheterization laboratory for percutaneous coronary intervention. These patients presented more mechanical complications and higher mortality. Resumo: Introdução: Recentemente durante a pandemia por Covid-19 houve uma perceção global de uma diminuição de admissões hospitalares por causas não infeciosas, em particular por doenças cardiovasculares. Objetivos: Avaliar o impacto da pandemia nas admissões por enfarte agudo do miocárdio com supradesnivelamento de ST (STEMI), na primeira onda da pandemia. Métodos: Análise multicêntrica e retrospetiva de doentes consecutivos admitidos em dois hospitais portugueses por STEMI em dois períodos sequenciais - P1 (1 de março a 30 de abril) e P2 (1 de maio a 30 de junho). Foi realizada uma comparação dos dados clínicos e de evolução hospitalar entre 2017 a 2019 e 2020 para os dois períodos. Resultados: No P1 de 2020 observou-se, relativamente a anos prévios, uma redução do número de doentes com STEMI (26,0±4,2 versus 16,5±4,9 casos por mês; p=0,033) e um aumento do número de complicações mecânicas (0,0% versus 3,0%; p=0,029). Os casos de angioplastia após trombólise falhada foram mais frequentes (1,9% versus 9,1%; p=0,033). Observou-se uma tendência global para um maior atraso nos tempos-chave de abordagem de doentes com STEMI. A taxa de mortalidade destes doentes no P1 foi superior comparativamente a anos prévios (1,9% versus 12,1%; p=0,005). Conclusões: Durante a primeira onda da pandemia Covid-19 houve uma redução do número de doentes submetidos a angioplastia coronária por STEMI. Esses apresentaram mais complicações mecânicas e uma maior mortalidade.

Cancer is one of the leading causes of death worldwide. Conventional treatments such as surgery, chemotherapy, and radiotherapy have limitations and severe side effects. Magnetic hyperthermia (MH) is an alternative method that can be used alone or in conjunction with chemotherapy or radiotherapy to treat cancer. Cobalt ferrite particles were synthesized using an innovative biogenic sol–gel method with powder of coconut water (PCW). The obtained powders were subjected to heat treatments between 500 °C and 1100 °C. Subsequently, they were characterized by thermal, structural, magnetic, and cytotoxic analyses to assess their suitability for MH applications. Through X-ray diffraction and Raman spectroscopy, it was possible to confirm the presence of the pure phase of CoFe2O4 in the sample treated at 1100 °C, exhibiting a saturation magnetization of 84 emu/g at 300 K and an average grain size of 542 nm. Furthermore, the sample treated at 1100 °C showed a specific absorption rate (SAR) of 3.91 W/g, and at concentrations equal to or below 5 mg/mL, is non-cytotoxic, being the most suitable for biomedical applications.

The non-surgical treatments are being required to reconstruct damaged tissue, prioritizing our body’s natural healing process. Thus, the use of bioactive materials such as bioactive glass has been studied to support the repair and restoration of hard and soft tissue. Thus, in this work Bioglass 45S5 was developed, adding 1 and 2%mol of SrO or MgO and the physical and biological properties were evaluated. The addition of MgO and SrO at the studied concentrations promoted the slight increase in non-bridging oxygens number, observed through the temperature shift in phase transitions to lower values compared to Bioglass 45S5. The insertion of the ions also showed a positive effect on Saos-2 cell viability, decreasing the cytotoxic of Bioglass 45S5. Besides the Ca/P ratio on the pellets surface demonstrating no evidence of higher reactivity between Bioglass 45S5 and Bioglass with Sr and Mg, micrographs show that at 24 h the Ca/P rich layer is denser than in Bioglass 45S5 after the contact with simulated body fluid. The samples with Sr and Mg show a higher antibacterial effect compared to Bioglass 45S5. The addition of the studied ions may benefit the biological response of Bioglass 45S5 in dental applications as scaffolds or coatings.

Introduction and Objectives: Use of invasive physiological assessment in patients with coronary artery disease varies widely and is perceived to be low. We aimed to examine adoption rates as well as patterns and determinants of use in an unselected population undergoing invasive coronary angiography over a long time frame. Methods: We retrospectively determined the per-procedure prevalence of physiological assessment in 40 821 coronary cases performed between 2007 and 2018 in two large-volume centers. Adoption was examined according to procedure type and patient- and operator-related variables. Its association with relevant scientific landmarks, such as the release of clinical trial results and practice guidelines, was also assessed. Results: Overall adoption was low, ranging from 0.6% in patients undergoing invasive coronary angiography due to underlying valve disease, to 6% in the setting of stable coronary artery disease (CAD); it was 3.1% in patients sustaining an acute coronary syndrome. Of scientific landmarks, FAME 1, the long-term results of FAME 2 and the 2014 European myocardial revascularization guidelines were associated with changes in practice. Publication of instantaneous wave-free ratio (iFR) trials had no influence on adoption rates, except for a higher proportion of iFR use. In 42.9% of stable CAD patients undergoing percutaneous coronary intervention there was no objective non-invasive evidence of ischemia, nor was physiological assessment performed. Younger operator age (4.5% vs. 4.0% vs. 0.9% for ages 55 years, respectively; p 55 anos, respetivamente; p < 0,001) e a hora de realização do procedimento (2,9% entre as 6-8PM versus 4,4% durante o restante dia) relacionaram-se inversamente com a utilização de fisiologia durante os procedimentos. Conclusões: Esta análise confirma a baixa de utilização da avaliação funcional invasiva na prática clínica. A disponibilidade de evidência sobre o uso de índices não hiperémicos não aumentou a adoção. São necessárias estratégias dirigidas que potenciem a implantação das recomendações, de forma que o manejo dos doentes com doença coronária e os benefícios clínicos da estratificação invasiva possam ser aprimorados.

Biofilm-related implant infections pose a substantial threat to patients, leading to inflammation in the surrounding tissue, and often resulting in implant loss and the necessity for additional surgeries. Overcoming this implantology challenge is crucial to ensure the success and durability of implants. This study shows the development of antibacterial materials for implant coatings by incorporating copper into 45S5 Bioglass®. By combining the regenerative properties of Bioglass® with the antimicrobial effects of copper, this material has the potential to prevent infections, enhance osseointegration and improve the long-term success of implants. Bioglasses modified with various concentrations of CuO (from 0 to 8 mol%) were prepared with the melt-quenching technique. Structural analysis using Raman and FTIR spectroscopies did not reveal significant alterations in the bioglasses structure with the addition of Cu. The antibacterial activity of the samples was assessed against Gram-positive and Gram-negative bacteria, and the results demonstrated significant inhibition of bacterial growth for the bioglass with 0.5 mol% of CuO. Cell viability studies indicated that the samples modified with up to 4 mol% of CuO maintained good cytocompatibility with the Saos-2 cell line at extract concentrations up to 25 mg/mL. Furthermore, the bioactivity assessment demonstrated the formation of a calcium phosphate (CaP)-rich layer on the surfaces of all bioglasses within 24 h. Our findings show that the inclusion of copper in the bioglass offers a significant enhancement in its potential as a coating material for implants, resulting in notable advancements in both antibacterial efficacy and osteointegration properties.

Resumo: A angina refratária define‐se como a persistência de sintomas superior a três meses apesar da terapêutica médica otimizada e revascularização. É uma entidade em crescimento, resultado da melhoria do prognóstico da doença coronária com a terapêutica farmacológica e com as técnicas de revascularização contemporâneas. A mortalidade a longo prazo enquadra‐se no espetro prognóstico da doença estável assintomática, contudo interfere com a qualidade de vida do doente e tem um impacto significativo nos sistemas de saúde.Múltiplos alvos terapêuticos têm sido investigados, contudo, a maioria com resultados dececionantes. Muitas das técnicas foram abandonadas por ausência de eficácia, problemas de segurança e limitações tanto logísticas como económicas à sua implantação.Esta revisão incide essencialmente sobre o dispositivo de redução do seio coronário, cuja evidência, embora ainda escassa, é promissora relativamente à segurança e eficácia na redução dos sintomas anginosos e na melhoria da qualidade de vida. Para além do seu efeito terapêutico, é uma opção virtualmente acessível a todos os serviços de cardiologia de intervenção. Abstract: Refractory angina is defined as persistent angina (≥3 months) despite optimal medical and interventional therapies. It is increasing in frequency, due to the success of current medical and interventional therapies in improving the prognosis of coronary artery disease. Long‐term mortality is similar to that of patients with asymptomatic stable disease, but it affects patients’ quality of life, and has a significant impact on health care resources.Several therapeutic targets have been investigated, most with disappointing results. Many of the techniques have been abandoned because of lack of efficacy, safety issues, or economic and logistic limitations to wider applicability.The primary focus of this review is the coronary sinus Reducer, supporting evidence for which, although scarce, is promising regarding safety and efficacy in improving anginal symptoms and quality of life. It is also accessible to virtually all interventional cardiology departments.

Introduction: Compared to bare-metal stents (BMS), drug-eluting stents reduce stent restenosis and improve subsequent revascularization rates. The impact on patients’ survival has been the subject of debate. Objective: To assess the long-term (10-year) survival of patients undergoing percutaneous coronary intervention (PCI) with first-generation sirolimus-eluting stents (SES) in comparison with BMS. Methods: In a single-center registry, 600 consecutive patients who underwent successful PCI with SES between April 2002 and February 2003 were compared to 594 patients who underwent PCI with BMS between January 2002 and April 2002, just before the introduction of SES. Clinical and procedural data were collected at the time of intervention and 10-year survival status was assessed via the national life status database. Results: All baseline characteristics were similar between groups except for smaller stent diameter (2.84±0.38 vs. 3.19±0.49 mm; p

Abstract Aims Right heart catheterization (RHC) is indicated in all candidates for heart transplantation (HT). An acute vasodilator challenge is recommended for those with pulmonary hypertension (PH) to assess its reversibility. The effects of inhaled nitric oxide (iNO) on pulmonary and systemic haemodynamics have been reported only in small series. Our purpose was to describe the response to iNO in a larger population and its potential clinical implications. Methods and results From 210 RHC procedures performed between 2010 and 2019, vasodilator challenge with iNO was used in 108 patients, of which 66 had advanced heart failure undergoing assessment for HT (55±11 years old; 74.2% male gender; 43.9% ischaemic cardiomyopathy; left ventricular ejection fraction 28.4 ± 11,4%; and peak VO2 12.1 ± 3.0 mL/kg/min). iNO was administered through a tight‐fitting facial mask regardless of baseline pulmonary pressures. Clinical endpoints (all‐cause mortality and acute right heart failure) were assessed according to baseline haemodynamic findings over the available follow‐up period. There were no side effects from iNO administration. Typical response consisted of a reduction in pulmonary vascular resistance, consequent to an increase in left ventricular filling pressures, no significant change in mean pulmonary artery pressure (resulting in a lower mean transpulmonary gradient) and a mild increase in cardiac ouput. Pulmonary arterial compliance increased significantly, whereas systemic vascular resistance was only mildly affected. In five cases (7.6%), pulmonary vascular resistance increased paradoxically. All‐cause mortality and post‐HT right heart failure events were overall low and similar in patients without PH or reversible PH. Conclusions Vasodilator challenge with iNO is safe in advanced heart failure patients undergoing RHC prior to HT listing. It produces a reasonably predictable haemodynamic response, which occurs predominantly at the pulmonary circulation level. Clinical implications of iNO‐induced reversibility may be relevant, but further systematic validation is warranted in larger cohorts.

Gold(III) bisdithiolate complexes have been reported as potential antimicrobial and antitumoral agents. The complex [Au(cdc)2]− (cdc=cyanodithioimido carbonate) displayed antimicrobial and outstanding antitumor activity against the ovarian cancer cells A2780 and A2780cisR, which are sensitive and resistant to cisplatin, respectively. However, poor water solubility may hamper its clinical use. Block copolymer micelles (BCMs) may solubilize hydrophobic drugs, improving their bioavailability and circulation time in blood. Aiming to provide water solubility, prolonged availability, and enhanced therapeutic indexes, BCMs loaded with [Au(cdc)2]− were synthesized and characterized. The BCM-[Au(cdc)2] micelles were prepared with a loading efficiency of 64.6% and a loading content of 35.3 mg [Au(cdc)2]−/gBCM. A hydrodynamic diameter of 77.31 ± 27.00 nm and a low polydispersity index of 0.18 indicated that the micelles were homogenous and good candidates for drug delivery. Cytotoxic activity studies against A2780/A2780cisR cells showed that BCM-[Au(cdc)2] maintained relevant cytotoxic activity comparable to the cytotoxicity observed for the same concentration of gold complexes. The Au uptake in A2780 cells, determined by PIXE, was ca. 17% higher for BCMs-[Au(cdc)2] compared to [Au(cdc)2]−. The BCMs-[Au(cdc)2] presented antimicrobial activity against S. aureus Newman and C. glabrata CBS138. These results evidenced the potential of BCM-[Au(cdc)2] for drug delivery and its promising anticancer and antimicrobial activities.

Os estilos de vida e o bem-estar psicológico são determinantes da saúde dos professores. São objetivos do estudo caraterizar os estilos de vida e bem-estar psicológico dos professores de 3º ciclo e secundário e analisar a relação entre os estilos de vida e bem-estar psicológico. Trata-se de um estudo transversal e correlacional, utilizou-se um questionário que inclui: i) variáveis de caracterização sociodemográfica e profissional; ii) FANTÁSTICO para avaliação do estilo de vida; e iii) QBEP-R para avaliar o bem-estar psicológico. Dos 174 professores a maioria era do sexo feminino (68.40%), casada (75.30%), a média de idades era de 49.10 anos e (64.90%) detinha a licenciatura. Os resultados evidenciam que os professores apresentavam estilo de vida Muito Bom e que existe correlação positiva e estatisticamente significativa entre estilos de vida e bem-estar psicológico, verificando-se a mesma relação quanto aos domínios, que integram o FANTÁSTICO, exceto para tabaco, álcool e outros comportamentos. Constata-se uma relação positiva e significativa entre estilos de vida e bem-estar psicológico. Sublinha-se a necessidade de programas de promoção de saúde e bem-estar dirigidos a professores no sentido de contribuírem para o desenvolvimento de ambientes educativos estimulantes e criativos.

This study aims at describing and comparing the prevalence of bullying behaviours and the perspective of victims, bystanders, and aggressors in team, individual, and combat sports. The survey involved 664 athletes of both genders (13-18 years old) from sports school and federated of several sports (team n=451, individual n=173, combat n=40), who filled in the Prevention of Violence in Sport Questionnaire. The prevalence of bullying (victims, bullies, and bystanders) was 26.7% in team sports; 19.1% in individual sports, and 23.1% in combat. Through the Chi-square test, it was verified that there were no significant differences between different sports in what concerns the prevalence of bullying behaviours; neither was there a difference in the perspective of victims, bystanders, and aggressors. The percentage was bigger in victims (7.7%) and bystanders (17.4%) in combat sports, and aggressors (3.3%) in team sports. There are not aggressors in combat sports. Further studies are needed in order to achieve a deeper knowledge of the problem and plan strategies to prevent this sort of behaviour. Keywords: bullying, individual-sports, team-sports, combat-sports, youth

The goal of this Special Issue, entitled “Soil, Water and Nitrates Management in Horticultural Production”, is to examine recent advances in horticultural practices and strategies that can contribute to maintaining or increasing soil fertility and the efficiency of water and nitrogen use [...]

Introdução: A fístula espontânea de líquido cefalorraquidiano é uma doença rara e de etiologia pouco esclarecida, havendo alguma associação com hipertensão intracraniana benigna. O diagnóstico nem sempre é imediato, podendo constituir um desafio, por poder ser uma doença facilmente confundida com causas mais comuns de rinorreia. A sua deteção atempada pelo médico de família é essencial para prevenir complicações potencialmente graves, como as infeções do sistema nervoso central. Descrição do caso: Mulher de 64 anos, apresenta-se com rinorreia aquosa e tosse, com meses de evolução. Foram pedidos exames auxiliares de diagnóstico para despiste de patologia neoplásica, infeciosa e alérgica, cujo resultado foi negativo. A tosse desapareceu com a cessação do inibidor da enzima conversora da angiotensina, com o qual a doente estava medicada. A rinorreia aquosa permaneceu e meses mais tarde veio a assumir características que fizeram suspeitar de fístula espontânea de líquido cefalorraquidiano. A tomografia computorizada não revelou a fístula, mas a pesquisa de glicose no líquido nasal foi compatível com esse diagnóstico. Enquanto aguardava por consulta urgente de neurocirurgia, a doente desenvolveu meningite complicada com abcesso cerebral. A presença de solução de continuidade foi confirmada em ressonância magnética cerebral, associada a sinais de hipertensão intracraniana benigna. A doente recuperou sem sequelas e a fístula encerrou espontaneamente. Apresenta-se assintomática até à data, sem rinorreia ou recorrência de infeções do sistema nervoso central. Comentário: A suspeita de fístula espontânea de líquido cefalorraquidiano foi levantada com base na clínica apresentada pela doente, ainda antes de esta desenvolver complicações. Os exames de diagnóstico mais fidedignos para a confirmação desta entidade não estão facilmente acessíveis nos cuidados de saúde primários. No entanto, e apesar da medição da glicose no líquido nasal não ser o método mais recomendado atualmente, neste caso cumpriam-se os critérios para a sua fiabilidade, tendo sido um elemento fundamental para a orientação do caso. Perante uma entidade clínica rara, mas potencialmente grave, o conhecimento da semiologia e a correta utilização de recursos simples podem ser suficientes para a confirmação diagnóstica.

An 80-year-old woman with rheumatic valve disease and two previous cardiac surgeries was admitted for heart failure exacerbation. The patient presented stenotic aortic 19-mm Mitroflow and mitral 31-mm Carpentier-Edwards bioprostheses, and was deemed inoperable due to frailty and prohibitive surgical risk. The heart team decided on a compassionate double valve-in-valve procedure, with transfemoral implantation of a 23-mm aortic CoreValve Evolut R and transapical implantation of a 29-mm mitral Edwards SAPIEN 3. During the procedure, after extreme difficulty in retrograde crossing of the aortic valve, a transapical-transfemoral loop was successfully performed. The procedure was without complications and the patient was discharged in NYHA class II with normally functioning valves. Resumo: Uma mulher de 80 anos com valvulopatia reumática e duas cirurgias cardíacas prévias foi internada por insuficiência cardíaca agudizada. A doente apresentava estenose de biopróteses Mitroflow 19 em posição aórtica e Carpentier-Edwards 31 em posição mitral, sendo considerada inoperável devido a fragilidade e a risco cirúrgico proibitivo. A Heart Team decidiu por um duplo procedimento valve-in-valve compassionate: implantação de Corevalve Evolut R 23 em posição aórtica via transfemoral e de Edwards Sapiens 3 29 em posição mitral por via apical. Durante o procedimento e após dificuldades extremas na progressão por via retrógrada aórtica, uma ansa transapical-femoral foi bem-sucedida. O procedimento correu sem complicações. A doente teve alta em classe NYHA II com biopróteses normofuncionantes.

Implantology is crucial for restoring aesthetics and masticatory function in oral rehabilitation. Despite its advantages, certain issues, such as bacterial infection, may still arise that hinder osseointegration and result in implant rejection. This work aims to address these challenges by developing a biomaterial for dental implant coating based on 45S5 Bioglass® modified by zirconium insertion. The structural characterization of the glasses, by XRD, showed that the introduction of zirconium in the Bioglass network at a concentration higher than 2 mol% promotes phase separation, with crystal phase formation. Impedance spectroscopy was used, in the frequency range of 102–106 Hz and the temperature range of 200–400 K, to investigate the electrical properties of these Bioglasses, due to their ability to store electrical charges and therefore enhance the osseointegration capacity. The electrical study showed that the presence of crystal phases, in the glass ceramic with 8 mol% of zirconium, led to a significant increase in conductivity. In terms of biological properties, the Bioglasses exhibited an antibacterial effect against Gram-positive and Gram-negative bacteria and did not show cytotoxicity for the Saos-2 cell line at extract concentrations up to 25 mg/mL. Furthermore, the results of the bioactivity test revealed that within 24 h, a CaP-rich layer began to form on the surface of all the samples. According to our results, the incorporation of 2 mol% of ZrO2 into the Bioglass significantly improves its potential as a coating material for dental implants, enhancing both its antibacterial and osteointegration properties. [ABSTRACT FROM AUTHOR]

Introduction: Aortic stenosis is the most prevalent type of valvular disease in Europe. Surgical aortic valve replacement (SAVR) is the standard therapy, while transcatheter aortic valve implantation (TAVI) is an alternative in patients at unacceptably high surgical risk. Assessment by a heart team is recommended by the guidelines but there is little published evidence on this subject. The purpose of this paper is to describe the experience of a multidisciplinary TAVI program that began in 2008. Methods: The heart team prospectively assessed 473 patients using a standardized approach. A total of 214 patients were selected for TAVI and 80 for SAVR. Demographic, clinical and procedural characteristics and long-term success rates were compared between the groups. Results: TAVI patients were older than the SAVR group (median 83 vs. 81 years), and had higher surgical risk scores (median EuroSCORE II 5.3 vs. 3.6% and Society of Thoracic Surgeons score 5.1 vs. 3.1%), as did the patients under medical treatment only. These scores were unable to assess multiple comorbidities. Patients’ outcomes were different between the three groups (mortality with SAVR 25% vs. TAVI 37.6% vs. conservative therapy 57.6%, p=0.001). Conclusions: The heart team program was able to select candidates appropriately for TAVI, SAVR and conservative treatment, taking into account the risk of both invasive treatments. The use of a prospective standardized heart team approach is recommended, but requires continuous monitoring to ensure effectiveness in a timely manner. Resumo: Introdução: A estenose aórtica é atualmente a doença valvular mais prevalente na Europa. A substituição valvular aórtica cirúrgica (SVAC) é atualmente considerada a terapêutica de primeira linha, a implantação de válvula aórtica percutânea (VAP) é considerada uma opção em doentes com elevado risco cirúrgico. A avaliação dos doentes pelo Heart Team encontra-se preconizada pelas recentes guidelines publicadas de doenças valvulares, contudo existem poucas publicações acerca dessa temática. O objetivo deste manuscrito é descrever a experiência de um programa multidisciplinar VAP, iniciado em 2008. Métodos: O Heart Team avaliou de forma prospetiva e padronizada 473 doentes. Desses, 214 foram selecionados para VAP e 80 para SVAC. Os grupos foram comparados no que respeita às suas características demográficas, clínicas, de procedimento e quanto à sua evolução (mortalidade). Resultados: O grupo VAP apresentou maior idade do que o grupo SVAC (mediana 83 versus 81 anos) e apresentou scores de risco cirúrgico mais elevados (mediana Euroscore II 5,3 versus 3,6% e STS 5,1 versus 3,1%), tal como o grupo de doentes apenas sob terapêutica médica. Esses scores não foram capazes de avaliar múltiplas comorbilidades. A mortalidade entre os três grupos apresentou diferenças com significado estatístico (SVAC 25% versus VAP 37,6% versus terapêutica conservadora 57,6%, p=0,001). Conclusões: O programa Heart Team foi capaz de selecionar de forma adequada os doentes para as diversas estratégias terapêuticas tendo em conta o risco de ambos os procedimentos invasivos. Uma abordagem eficiente e standardizada pela Heart Team deve ser estimulada, necessitando de reavaliação continua. Keywords: Severe aortic stenosis, Transcatheter aortic valve implantation, Surgical aortic valve replacement, Heart team, Standardization, Palavras-chave: Estenose aórtica grave, Válvula aórtica percutânea, Substituição valvular aórtica cirúrgica, Heart Team, Standardização

Methyl-ethylenedithio-tetrathiafulvalene (Me-EDT-TTF (1) and dimethyl-ethylenedithio-tetrathiafulvalene (DM-EDT-TTF (2) are valuable precursors for chiral molecular conductors, which are generally obtained by electrocrystallization in the presence of various counter-ions. The number of the stereogenic centers, their relative location on the molecule, the nature of the counter-ion and the electrocrystallization conditions play a paramount role in the crystal structures and conducting properties of the resulting materials. Here, we report the preparation and detailed structural characterization of the following series of radical cation salts: (i) mixed valence (1)2AsF6 as racemic, and (S) and (R) enantiomers; (ii) [(S)-1]AsF6·C4H8O and [(R)-1]AsF6·C4H8O where a strong dimerization of the donors is observed; (iii) (1)I3 and (2)I3 as racemic and enantiopure forms and (iv) [(meso)-2]PF6 and [(meso)-2]XO4 (X = Cl, Re), based on the new donor (meso)-2. In the latter, the two methyl substituents necessarily adopt axial and equatorial conformations, thus leading to a completely different packing of the donors when compared to the chiral form (S,S)/(R,R) of 2 in its radical cation salts. Single crystal resistivity measurements, complemented by thermoelectric power measurements in the case of (1)2AsF6, suggest quasi-metallic conductivity for the latter in the high temperature regime, with σRT ≈ 1–10 S cm–1, while semiconducting behavior is observed for the (meso)-2 based salts.

Listeria monocytogenes has been referred to as a concern microorganism in cheese making due to its ability to survive and grow in a wide range of environmental conditions, such as refrigeration temperatures, low pH and high salt concentration at the end of the production process. Since cheese may be a potential hazard for consumers, especially high-risk consumers (e.g., pregnant, young children, the elderly, people with medical conditions), efforts of the dairy industry have been aimed at investigating new conservation techniques based on natural additives to meet consumers’ demands on less processed foods without compromising the food safety. Thus, the aim of this study was to evaluate the efficacy of Myrtus communis L. (myrtle) and Rosmarinus officinalis L. (rosemary) essential oils (EO) against Listeria monocytogenes ATCC 679 spiked in sheep cheese before ripening. After the cheesemaking process, the samples were stored at 8 °C for 2 h, 1 d, 3 d, 14 d and 28 d. The composition of EO was identified by gas chromatography-mass spectrometry (GC-MS) analysis. Constituents such as 1,8-cineole, limonene, methyl-eugenol, α-pinene, α-terpineol, α-terpinolene and β-pinene were present in both EO, accounting for 44.61% and 39.76% from the total of chemical compounds identified for myrtle and rosemary EO, respectively. According to the chemical classification, both EO were mainly composed of monoterpenes. Minimum inhibitory concentration (MIC) against L. monocytogenes was obtained at 31.25 μL/mL to myrtle EO and at 0.40 μL/mL to rosemary EO. Then, cheeses were inoculated with L. monocytogenes (Ca. 6 log CFU/mL) and EO was added at MIC value. The addition of rosemary and myrtle EO displayed lower counts of L. monocytogenes (p < 0.01) (about 1–2 log CFU/g) during the ripening period compared to control samples. Ripening only influences (p < 0.001) the growth of L. monocytogenes in control samples. Since rosemary and myrtle EO do not exert any negative impact on the growth of native microflora (p > 0.05), their use as natural antimicrobial additives in cheese demonstrated a potential for dairy processors to assure safety against L. monocytogenes.

The physical properties of the cubic and ferrimagnetic spinel ferrite LiFe5O8 has made it an attractive material for electronic and medical applications. In this work, LiFe5O8 nanosized crystallites were synthesized by a novel and eco-friendly sol-gel process, by using powder coconut water as a mediated reaction medium. The dried powders were heat-treated (HT) at temperatures between 400 and 1000 °C, and their structure, morphology, electrical and magnetic characteristics, cytotoxicity, and magnetic hyperthermia assays were performed. The heat treatment of the LiFe5O8 powder tunes the crystallite sizes between 50 nm and 200 nm. When increasing the temperature of the HT, secondary phases start to form. The dielectric analysis revealed, at 300 K and 10 kHz, an increase of ε′ (≈10 up to ≈14) with a tanδ almost constant (≈0.3) with the increase of the HT temperature. The cytotoxicity results reveal, for concentrations below 2.5 mg/mL, that all samples have a non-cytotoxicity property. The sample heat-treated at 1000 °C, which revealed hysteresis and magnetic saturation of 73 emu g−1 at 300 K, showed a heating profile adequate for magnetic hyperthermia applications, showing the potential for biomedical applications.

Resumo: Introdução e objetivos: Foi nosso objetivo reportar a evolução da angioplastia coronária no tratamento do enfarte agudo do miocárdio com supradesnivelamento do segmento ST (EAMCST), entre 2002‐2013. Métodos: Os dados prospetivos multicêntricos do Registo Nacional de Cardiologia de Intervenção (RNCI) e os dados oficiais da Direção Geral de Saúde (DGS) foram conjugados para estudar os procedimentos no EAMCST entre 2002 e 2013. Resultados: Em 2013 realizaram‐se 3524 angioplastias primárias (ICP‐P), representando um crescimento de 315% relativamente ao ano de 2002. Em 2002 a ICP‐P representava 16% do total de angioplastias coronárias, passando a representar 25% nos anos de 2012‐2013. Entre 2002‐2013 o número de procedimentos por milhão de habitantes aumentou de 106 para 338 e a angioplastia de recurso decresceu de 70,7 para 2%. Durante o período em análise, a utilização de stents eluidores de fármaco cresceu de 9,9 para 69,5%. Após 2008, observou‐se uma utilização crescente da trombectomia de aspiração, atingindo 46,7% em 2013. Os inibidores das glicoproteínas IIb/IIIa registaram um decréscimo no seu uso, sendo de 73,2% em 2002 e de 23,6% em 2013. O acesso radial cresceu de 8,3% em 2008 até 54,6% em 2013. Conclusões: Durante o período em análise, a taxa de angioplastia coronária por milhão de habitantes triplicou. A angioplastia de recurso foi ultrapassada pela angioplastia primária a partir de 2006. Observaram‐se novas tendências no tratamento do enfarte agudo do miocárdio com supradesnivelamento do segmento ST, salientando‐se a utilização de stents eluidores de fármacos e o acesso radial. Abstract: Introduction and Objectives: The aim of the present paper was to report trends in coronary angioplasty for the treatment of ST‐elevation myocardial infarction (STEMI) in Portugal. Methods: Prospective multicenter data from the Portuguese National Registry of Interventional Cardiology (RNCI) and official data from the Directorate‐General for Health (DGS) were studied to analyze percutaneous coronary intervention (PCI) procedures for STEMI from 2002 to 2013. Results: In 2013, 3524 primary percutaneous coronary intervention (p‐PCI) procedures were performed (25% of all procedures), an increase of 315% in comparison to 2002 (16% of all interventions). Between 2002 and 2013 the rate increased from 106 to 338 p‐PCIs per million population per year. Rescue angioplasty decreased from 70.7% in 2002 to 2% in 2013. During this period, the use of drug‐eluting stents grew from 9.9% to 69.5%. After 2008, the use of aspiration thrombectomy increased, reaching 46.7% in 2013. Glycoprotein IIb‐IIIa inhibitor use decreased from 73.2% in 2002 to 23.6% in the last year of the study. Use of a radial approach increased steadily from 8.3% in 2008 to 54.6% in 2013. Conclusion: During the reporting period there was a three‐fold increase in primary angioplasty rates per million population. Rescue angioplasty has been overtaken by p‐PCI as the predominant procedure since 2006. New trends in the treatment of STEMI were observed, notably the use of drug‐eluting stents and radial access as the predominant approach. Palavras‐chave: Registo, Cardiologia de intervenção, Enfarte do miocárdio, Coronariografia, Angioplastia primária, Stent, Keywords: Registry, Interventional cardiology, Myocardial infarction, Coronary angiography, Primary angioplasty, Stent

Abstract Background: The revascularization strategy of the left main disease is determinant for clinical outcomes. Objective: We sought to 1) validate and compare the performance of the SYNTAX Score 1 and 2 for predicting major cardiovascular events at 4 years in patients who underwent unprotected left main angioplasty and 2) evaluate the long-term outcome according to the SYNTAX score 2-recommended revascularization strategy. Methods: We retrospectively studied 132 patients from a single-centre registry who underwent unprotected left main angioplasty between March 1999 and December 2010. Discrimination and calibration of both models were assessed by ROC curve analysis, calibration curves and the Hosmer-Lemeshow test. Results: Total event rate was 26.5% at 4 years.The AUC for the SYNTAX Score 1 and SYNTAX Score 2 for percutaneous coronary intervention, was 0.61 (95% CI: 0.49-0.73) and 0.67 (95% CI: 0.57-0.78), respectively. Despite a good overall adjustment for both models, the SYNTAX Score 2 tended to underpredict risk. In the 47 patients (36%) who should have undergone surgery according to the SYNTAX Score 2, event rate was numerically higher (30% vs. 25%; p=0.54), and for those with a higher difference between the two SYNTAX Score 2 scores (Percutaneous coronary intervention vs. Coronary artery by-pass graft risk estimation greater than 5.7%), event rate was almost double (40% vs. 22%; p=0.2). Conclusion: The SYNTAX Score 2 may allow a better and individualized risk stratification of patients who need revascularization of an unprotected left main coronary artery. Prospective studies are needed for further validation.

In this paper we present the impedance spectroscopy of ternary solid solutions of BiFeO3, TbFeO3 and PbTiO3, prepared by solid-state reaction method. The preliminary structural studies were carried out by x-ray diffraction technique, showing the formation of polycrystalline sample with ABO3 type of perovskite structure with hexagonal symmetry for Bi0.8Tb0.1Pb0.1Fe0.9Ti0.1O3system at room temperature. Dielectric and impedance study of this ceramic has been characterized in the temperature range 175 - 325 0C and frequency range 100 Hz - 1 MHz. The maximum ferroelectric transition temperature (Tc) of this system was in the range 210 - 225 0C with the dielectric constant having maximum value ~2480 at 1 kHz. The complex impedance graph exhibited one impedance semicircle arc at all reported temperatures, which indicates that the impedance response is a Cole-Cole type relaxation. Single semicircle indicate that the grain effect of the bulk in ceramic. The bulk resistance of the material decreases with increasing temperature showing negative temperature showing a typical semiconducting property, i.e. negative temperature coefficient of resistance (NTCR) behavior.

Some dialectologists reject the idea that the language spoken in the Canary Islands can be considered a dialect. The reasons given to support this thesis are two: the first one is that such a variety has no exclusive language features, and the second is that this speech variety is characterised by a great internal variation. This article explores these arguments, but at the same time puts forward some other arguments which oppose this idea; in others words, it is held that the Canary Island speech variety can be viewed as a dialect.

Introduction of chirality in the field of molecular conductors has received increasing interest in recent years in the frame of modulation of the crystal packing, and hence conducting properties, with the number of stereogenic centers and absolute configuration, e.g., racemic or enantiopure forms. Here, we describe the preparation by electrocrystallization of chiral radical cation salts, based on the donors methyl-ethylenedithio-tetrathiafulvalene (Me-EDT-TTF) 1 and ethyl-ethylenedithio-tetrathiafulvalene (Et-EDT-TTF) 2 containing one stereogenic center, with the perchlorate anion. Donor 1 provided the series of crystalline materials [(rac)-1]ClO4, [(S)-1]2ClO4 and [(R)-1]2ClO4, while for donor 2 only the 1:1 salts [(rac)-2]ClO4 and [(R)-2]ClO4 could be prepared as suitable single crystals for X-ray analysis. The enantiopure salts of 1 show β-type packing and metallic conductivity in the high temperature regime, with room temperature conductivity values of 5–10 S cm−1, whereas compound [(rac)-2]ClO4 is a very poor semiconductor. Tight-binding extended Hückel band structure calculations support the metallic conductivity of the enantiopure salts of 1 and suggest that small structural changes, possibly induced by thermal contraction or pressure, could lead to a pseudo-elliptic closed Fermi surface, typical for a 2D metal.

Resumo: Introdução e objetivos: Foi nosso objetivo estudar as tendências da intervenção coronária percutânea entre 2004‐2013 e comparar Portugal com outros países europeus. Métodos: Análise dos procedimentos coronários efetuados entre 2004‐2013 com base num registo prospetivo, multicêntrico, voluntário, doente a doente – Registo Nacional de Cardiologia de Intervenção (RNCI) da Associação Portuguesa de Intervenção Cardiovascular da Sociedade Portuguesa de Cardiologia (APIC‐SPC) – e dos dados oficiais publicados pela Direção Geral de Saúde (DGS). Resultados: Em 2013 realizaram‐se 36 810 cateterismos diagnósticos (3529 coronariografias por milhão de habitantes), representando um aumento significativo de 34% relativamente ao ano de 2007 (p