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Resumo No Brasil oitocentista evidenciou-se a emergência de instituições assistenciais. Por meio delas, os estados provinciais projetaram membros das elites políticas e econômicas nomeando-os grandes benfeitores. Homens de notoriedade local desempenharam papel na construção de determinados espaços asilares por meio de práticas que ratificaram seu prestígio social não apenas entre seus pares e para sua época, mas também para a memória e a história das instituições às quais estavam vinculadas. O artigo problematiza a construção de três instituições assistenciais no Ceará: Asilo de Mendicidade, Colônia Orfanológica Cristina e Asilo de Alienados São Vicente de Paula, cuja tônica discursiva e ações filantrópicas estavam inseridas no cenário da grande seca de 1877-1879.

Background Breastfeeding provides benefits for children, mothers, society and the environment. The promotion of optimal breastfeeding, from an early stage in life is, therefore, a public health priority. Infant feeding can be influenced by maternal country of birth. However, studies carried out in European settings point to inconsistent findings. This study aims to compare first day in-hospital exclusive breastfeeding among migrant and native women in Portugal. Methods This study is based on a national project on perinatal health among migrants and natives in Portugal (baMBINO). Out of 39 public maternity units in mainland Portugal, 32 were enrolled. Women aged 18 years old or older with a live birth were recruited. The final sample included 5109 participants (2431 natives and 2678 migrants). Logistic regression was used to assess the association between maternal country of birth and in-hospital exclusive breastfeeding. Results Migrant participants included women from Portuguese-speaking African countries (PSAC) (49,7%), Brazil (18%), Eastern Europe (10.2%), other European countries (9.6%), Asia (5.5%) and other countries (7.0%). No differences were found between migrants and natives, with the exception of women from PSAC who were more likely to exclusively breastfeed during the first day of hospital stay (aOR 1.34 CI95% 1.05-1.72), irrespective of maternal age, education, parity, type of pregnancy, reproductive assistance, tobacco use, gestational age, newborn birth weight, mode of delivery and antenatal care. Conclusions In Portugal, women from PSAC are more likely to exclusively breastfeed their babies during the first day of hospital stay when compared to native women. Strategies to maintain healthy breastfeeding practices in this population are fundamental. Key messages Women from PSAC are more likely to breastfeed exclusively in the first day after delivery than Portuguese natives. They should be supported in the maintenance of optimal breastfeeding practices.

Introduction: Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are major events with negative impact on the course of the disease that need to be properly evaluated. COPD Assessment Test (CAT) has been showed to be responsive to AECOPD. Aims: To evaluate CAT responsiveness to AECOPD recovery and to investigate the influence of patients characteristics on CAT recovery. Methods: Patients previously diagnosed with COPD who were admitted in emergency department of a tertiary hospital due to AECOPD were included. CAT was performed at admission and 30 days after discharge. Clinical data and readmissions were recorded. Results: 111 patients were enrolled. 77.4% were male, mean of forced expiratory volume in one second (FEV1) was 49.2 ± 15.2% and majority of patients were GOLD D (36.0%) or C (21.6%). 63.5% were treated as inpatients and mean length of hospitalization was 11.5±11.1 days. 19.8% were readmitted 30 days after discharge due to AECOPD and from these, the majority needed hospitalization for treatment. Mean CAT score at admission was 22.0±6.2, 30 days after discharge was 18.4±6.8 and mean CAT recovery was 3.6±3.7 (p Conclusions: CAT is an useful tool to evaluate AECOPD recovery. CAT score recovery following AECOPD is influenced by BMI.

Carlos Chagas discovered American trypanosomiasis, also named Chagas disease (CD) in his honor, just over a century ago. He described the clinical aspects of the disease, characterized by its etiological agent (Trypanosoma cruzi) and identified its insect vector. Initially, CD occurred only in Latin America and was considered a silent and poorly visible disease. More recently, CD became a neglected worldwide disease with a high morbimortality rate and substantial social impact, emerging as a significant public health threat. In this context, it is crucial to better understand better the epidemiological scenarios of CD and its transmission dynamics, involving people infected and at risk of infection, diversity of the parasite, vector species, and T. cruzi reservoirs. Although efforts have been made by endemic and non-endemic countries to control, treat, and interrupt disease transmission, the cure or complete eradication of CD are still topics of great concern and require global attention. Considering the current scenario of CD, also affecting non-endemic places such as Canada, USA, Europe, Australia, and Japan, in this review we aim to describe the spread of CD cases worldwide since its discovery until it has become a global public health concern.

This study aims to assess the quality of online health information about gamete donation based on a quantitative analysis of websites from fertility-clinics in Portugal. All websites providing information about gamete donation were comprehensively screened in June 2017. The reliability and usability of 43 webpages were assessed through the Website Information Evaluation Instrument from the Office of Disease Prevention and Health Promotion (ODPHP). None of the webpages met the purpose, content development, and updating criteria set by the ODPHP. Several shortcomings were observed: limited accessibility for users with disabilities, lack of simplified user experiences and easy search functionality, and lack of users’ interaction with content. The quality of online information on gamete donation in fertility-clinics’ websites requires improvement to become user-friendly. The development of specific guidelines and periodic evaluations of these websites using sensitive instruments, merging quantitative and qualitative assessments, is required to guarantee the quality of information that aims to improve reproductive health literacy through people-centered communication., Este estudo pretende avaliar a qualidade da informação online sobre doação de gametas em sites de clínicas de fertilidade em Portugal. Todos os sites com informação sobre doação de gametas foram escrutinados em junho de 2017. A confiabilidade e usabilidade de 43 páginas web foram avaliadas usando o instrumento Website Information Evaluation do Office of Disease Prevention and Health Promotion. Nenhuma página cumpriu os critérios de propósito, desenvolvimento e atualização de conteúdo. Encontraram-se várias lacunas na usabilidade: acessibilidade limitada para usuários com incapacidade, falta de clareza e de simplicidade de utilização, e impossibilidade de interagir com os conteúdos. Importa melhorar a qualidade da informação online sobre doação de gametas em clínicas de fertilidade, tornando-a mais amigável para o usuário. É necessário desenvolver guias específicos e avaliar periodicamente estes sites, usando instrumentos sensíveis que contemplem análises quantitativas e qualitativas, garantindo a sua qualidade para promover literacia em saúde reprodutiva através da comunicação centrada nas pessoas., Este estudio evaluó la calidad de la información sobre la donación de gametos en sitios web de clínicas-defertilidad. Todos los sitios web de clínicas en Portugal fueron examinados (junio 2017). La confiabilidad y usabilidad de 43 páginas web fueron evaluadas con el Website Information Evaluation do Office of Disease Prevention and Health Promotion. Ninguna de las páginas cumplió con los criterios de propósito, desarrollo de contenido y actualización. Se observaron deficiencias: accesibilidad limitada para los usuarios con discapacidades, falta de una experiencia del usuario simplificada y baja funcionalidad de búsqueda fácil, y falta de interacción de los usuarios con el contenido. Importa mejorar la calidad de la información online sobre la donación de gametos en clínicas de fertilidad, para convertirse en fácil de usar. Es necesario el desarrollo de guías específicas y evaluaciones periódicas de los sitios web, utilizando instrumentos sensibles que combinen evaluaciones cuantitativas y cualitativas, promoviendo la alfabetización en salud reproductiva., PTDC/IVC-ESCT/6294/2014; SFRH/BD/111686/2015; DL57/2016/CP1336/CT0001; DL57/2016/CP1336/CT0001

The major capsid protein L1 constitutes the entire exterior surface of the stabilized mature human papillomavirus (HPV), mediating initial attachment to host tissues or cells, and become pliable enough to ultimately allow release of the viral genome into a new target cell. The purpose of this study was to infer evolutionary relationships among different variable-risk HPV genotypes from comparative alignments of multiple sequences of the protein L1 deposited previously in biological information database. First, sequences of the protein L1 of 20 HPV genotypes were searched and selected from a non-redundant protein sequence database UniProtKB/Swiss-Prot. Next, a phylogenetic dendogram was constructed by comparing multiple sequences of the protein L1 using molecular evolutionary genetics analyses by Mega software. The dendogram generated from comparative alignments of the L1 protein sequences of different HPV types revealed the presence of two main clusters: a first cluster containing 12 HPV types linked intimately in several sub-branches and a second cluster grouping 8 HPV types linked in another sub-branches. Evolutionary groupings generated from L1 capsid protein sequences of variable-risk HPV genotypes demonstrated weak association between pathogenicity and phylogenetic proximity in the types analyzed, accompanied by low identity among their amino acid residues. The findings described herein reveal important insights into evolutionary patterns and phylogenetic relationships among variable-risk HPV genotypes for malignant conversion of virally infected cells from multiple alignments of the major viral capsid protein L1.

O presente estudo teve como objetivo maximizar a amplificação in vitro de amostras de DNA genômico extraídas a partir de micro-organismos típicos da microbiota ruminal. Diferentes concentrações de amostras de DNA genômico isoladas a partir líquido ruminal foram empregadas como fitas moldes em reações de amplificação na presença de iniciadores específicos para o gene do RNA ribossomal 16S. Um produto amplificado de aproximadamente 500pb foi visualizado em eletroforese em géis de agarose. Baixa eficiência de amplificação com a presença de produtos não-específicos de amplificação foi verificada nas PCRs realizadas na presença de DNA genômico variando de 19,2 a 40ng. Produtos de amplificação foram exclusivamente detectados com maior intensidade e alta especificidade nas amostras de DNA genômico contendo as menores quantidades de fita-molde de 0,8 a 1,6ng. Ausência de sinal de amplificação foi verificada nas reações de PCRs contendo maiores quantidades de DNA genômico variando de 98 a 200ng. Assim, amostras de DNA mais concentradas demonstraram baixa eficiência e especificidade de amplificação em comparação às amostras menos concentradas de fitas moldes. Desta forma, os resultados descritos nesse estudo evidenciam que concentrações de DNA inferiores às quantidades geralmente recomendadas nos protocolos convencionais produziram amplicon com alta especificidade nas reações de amplificação, empregando como fitas moldes DNA genômico isolado a partir de microbiota ruminal. As descobertas descritas nesse estudo apresentam uma estratégia acessível para amplificar in vitro fragmentos de DNAs genômicos ruminais provenientes de complexas comunidades microbianas.

Background: Assessing parental stress during infants' hospitalization in Neonatal Intensive Care Units (NICU) is essential to identify parents at risk for immediate and extended physical and emotional burden. Aims: To identify sources of stress in mothers and fathers of very preterm infants hospitalized in NICU, and their association with sociodemographic, obstetric and infants' characteristics. Study design: Observational and cross-sectional study conducted between July 2013 and June 2014. Subjects: Parents of very preterm infants hospitalized in all level III NICU in the Northern Health Region of Portugal were consecutively and systematically invited to participate in this study, being included 120 mothers and 91 fathers (participation rate: 98.6%). Outcome measures: The Portuguese version of the Parental Stressor Scale: Neonatal Intensive Care Unit was used. Results: The overall experience of hospitalization was classified as more stressful than the median for the sub scales. "Change in parental role" was classified as the most stressful subscale by mothers (Median (P25-P75): 4.1(32-4.7)) and fathers (Median (P25-P75): 32(2.4-4.0)). Mothers scored significantly higher in all subscales. For mothers, multiple pregnancy was associated with lower levels of stress regarding "change in parental role" (beta = -0.597; 95% CI = 1.020 to -0.174) and "overall stress" (beta = 0.603; 95% CI = 1.052 to 0.153). Being >= 30 years old was found to be a significant predictor for decreased fathers' stress. Conclusions: This study raises awareness for the need to develop sensitive instruments that take notice of gender, social support and family -centered care. The implementation of interventions focused on reducing parental stress is crucial to diminish disparities in family health. info:eu-repo/semantics/publishedVersion

Lung cancer is still the leading cause of cancer death in the world. For this reason, novel approaches for early and more accurate diagnosis are needed. Computer-aided decision (CAD) can be an interesting option for a noninvasive tumour characterisation based on thoracic computed tomography (CT) image analysis. Until now, radiomics have been focused on tumour features analysis, and have not considered the information on other lung structures that can have relevant features for tumour genotype classification, especially for epidermal growth factor receptor (EGFR), which is the mutation with the most successful targeted therapies. With this perspective paper, we aim to explore a comprehensive analysis of the need to combine the information from tumours with other lung structures for the next generation of CADs, which could create a high impact on targeted therapies and personalised medicine. The forthcoming artificial intelligence (AI)-based approaches for lung cancer assessment should be able to make a holistic analysis, capturing information from pathological processes involved in cancer development. The powerful and interpretable AI models allow us to identify novel biomarkers of cancer development, contributing to new insights about the pathological processes, and making a more accurate diagnosis to help in the treatment plan selection.

Lung cancer late diagnosis has a large impact on the mortality rate numbers, leading to a very low five-year survival rate of 5%. This issue emphasises the importance of developing systems to support a diagnostic at earlier stages. Clinicians use Computed Tomography (CT) scans to assess the nodules and the likelihood of malignancy. Automatic solutions can help to make a faster and more accurate diagnosis, which is crucial for the early detection of lung cancer. Convolutional neural networks (CNN) based approaches have shown to provide a reliable feature extraction ability to detect the malignancy risk associated with pulmonary nodules. This type of approach requires a massive amount of data to model training, which usually represents a limitation in the biomedical field due to medical data privacy and security issues. Transfer learning (TL) methods have been widely explored in medical imaging applications, offering a solution to overcome problems related to the lack of training data publicly available. For the clinical annotations experts with a deep understanding of the complex physiological phenomena represented in the data are required, which represents a huge investment. In this direction, this work explored a TL method based on unsupervised learning achieved when training a Convolutional Autoencoder (CAE) using images in the same domain. For this, lung nodules from the Lung Image Database Consortium and Image Database Resource Initiative (LIDC-IDRI) were extracted and used to train a CAE. Then, the encoder part was transferred, and the malignancy risk was assessed in a binary classification&mdash, benign and malignant lung nodules, achieving an Area Under the Curve (AUC) value of 0.936. To evaluate the reliability of this TL approach, the same architecture was trained from scratch and achieved an AUC value of 0.928. The results reported in this comparison suggested that the feature learning achieved when reconstructing the input with an encoder-decoder based architecture can be considered an useful knowledge that might allow overcoming labelling constraints.

In the nineteenth century, Brazil witnessed the emergence of the first welfare institutions. These became the platforms for provincial states to raise the status of their political and economic elite, naming them great benefactors. Men of local repute played active roles in building certain institutional spaces, employing practices that reinforced their social prestige not just among their peers and for their time, but also for the memory and history of the institutions with which they were involved. The building of three welfare institutions in the province of Ceará is problematized: Asilo de Mendicidade, Colônia Orfanológica Cristina, and Asilo de Alienados São Vicente de Paula, whose discourse and philanthropic actions were entangled with the great drought of 1877-1879.No Brasil oitocentista evidenciou-se a emergência de instituições assistenciais. Por meio delas, os estados provinciais projetaram membros das elites políticas e econômicas nomeando-os grandes benfeitores. Homens de notoriedade local desempenharam papel na construção de determinados espaços asilares por meio de práticas que ratificaram seu prestígio social não apenas entre seus pares e para sua época, mas também para a memória e a história das instituições às quais estavam vinculadas. O artigo problematiza a construção de três instituições assistenciais no Ceará: Asilo de Mendicidade, Colônia Orfanológica Cristina e Asilo de Alienados São Vicente de Paula, cuja tônica discursiva e ações filantrópicas estavam inseridas no cenário da grande seca de 1877-1879.

Objetivo: Analisar o perfil epidemiológico dos pacientes internados por HIV no Brasil, no período de 2010 a 2019. Métodos: Trata-se de um estudo, retrospectivo, descritivo, quantitativo, de base documental. Os dados foram obtidos do Sistema de Informações Hospitalares do Sistema Único de Saúde (SIH/SUS), pelo Departamento de informática do SUS (DATASUS). Resultados: No período avaliado, foram registradas 338.966 internações por HIV no Brasil. A região Sudeste (37,6%) e Nordeste (25,5%), apresentaram maiores internações. No entanto, as taxas de mortalidade se concentraram nas regiões Norte (17,06) e Sul (12,19). A prevalência média de internações por HIV, foi maior na região Sul (26,6 casos) e menor na região Sudeste (15,8 casos). Houve predomínio no sexo masculino (63,9%), na faixa etária entre 30-39 anos (31,50%) e na cor/raça branca (37,76%). A respeito do regime e caráter das internações, 51,35% foram em hospitais públicos e 80,65%) foi por urgência. Observou-se um total de 41.101 óbitos (12,12%). A maior prevalência ocorreu entre pacientes do sexo masculino (51,48%) e a maior taxa de mortalidade ocorreu na faixa etária acima dos 70 anos (21,82%). Conclusão: A infecção pelo HIV e, consequentemente as internações em decorrência desse fator, ainda proporcionam altos custos para a saúde pública do país.

Conhecer a discussão em torno dos desafios sociais e éticos da doação de gametas é fundamental para a boa governança das técnicas de reprodução assistida. Neste artigo, analisam-se os tópicos que orientaram o debate nas organizações de ética portuguesas, discutindo as suas conexões com os temas abordados internacionalmente. Para tal, em março de 2018, pesquisamos sistematicamente os websites do Conselho Nacional de Procriação Medicamente Assistida e do Conselho Nacional de Ética para as Ciências da Vida. Procedemos à análise de conteúdo temática de 25 documentos. Os resultados indicam que o debate se centrou na acessibilidade, no anonimato e na compensação de doadores e, em menor extensão, nas responsabilidades profissionais. Observaram-se posicionamentos heterogêneos e tensões entre múltiplos direitos e princípios éticos associados a receptores, a pessoas nascidas com recurso à doação de gametas e a doadores. Esses têm em comum três alegações: a escassez de evidência científica; as experiências de outros países; e regulamentações oriundas de entidades internacionais. Na literatura abordam-se tópicos adicionais, nomeadamente: uma via dupla que conjugue anonimato/identificação de doadores; implementação de sistemas de registo reprodutivo para receptores e doadores; limites do rastreio genético a doadores; doação por familiares/conhecidos; e o papel dos doadores na decisão quanto ao destino de embriões criopreservados e na escolha das características dos receptores dos seus gametas. Há espaço para expandir o debate e promover a pesquisa em torno das implicações sociais e éticas da doação de gametas, considerando a participação de todos os cidadãos., Awareness of the discussion surrounding the social and ethical challenges regarding gamete donation is crucial for good governance of assisted reproduction techniques. In this article, we analyze the topics that guided the debate in the Portuguese ethics organizations, discussing their connections with themes addressed internationally. To that end, in March 2018, we systematically searched the websites of the National Council of Medically Assisted Procreation and of the National Ethics Council for Life Sciences. We carried out a thematic content analysis of 25 documents. Results indicate that the debate was focused on accessibility, anonymity and donors’ compensation and, to a lesser extent, on professional responsibilities. We observed heterogeneous positions and tensions between multiple rights and ethical principles associated with recipients, donor-conceived individuals and donors. These invoke three similar arguments: the scarcity of scientific evidence; experiences from other countries; and regulations from in international entities. Literature addressed additional topics, namely: a double track that combines donor anonymity/identification; the implementation of reproduction registries for recipients and donors; limits to the genetic screening of donors; donations by family members/acquaintances; and donors’ role in decisions regarding the fate of cryopreserved embryos and in choosing the characteristics of recipients of their gametes. There is room to expand the debate and to promote research on the social and ethical implications of gamete donation, considering the participation of all citizens., Conocer la discusión en torno a los desafíos sociales y éticos de la donación de gametos es fundamental para el buen gobierno de las técnicas de reproducción asistida. En este artículo se analizan los temas que orientaron el debate en las organizaciones de ética portuguesas, discutiendo sus conexiones con los temas abordados internacionalmente. Para este fin, en marzo de 2018, investigamos sistemáticamente las páginas webs del Conselho Nacional de Procriação Medicamente Assistida y del Conselho Nacional de Ética para as Ciências da Vida. Asimismo, procedimos al análisis de contenido temático de 25 documentos. Los resultados indican que el debate se centró en la accesibilidad, anonimato y compensación de donadores y, en menor extensión, en las responsabilidades profesionales. Se observaron posicionamientos heterogéneos y tensiones entre múltiples derechos y principios éticos, asociados a receptores, a personas nacidas gracias a la donación de gametos y a donadores. Estos tienen en común tres alegaciones: la escasez de evidencias científicas; las experiencias de otros países; y las regulaciones procedentes de entidades internacionales. En el literatura se abordan temas adicionales, en particular: una vía doble que conjugue anonimato/identificación de donadores; implementación de sistemas de registro reproductivo para receptores y donadores; límites del rastreo genético a donadores; donación por familiares/conocidos; y el papel de los donadores en la decisión respecto al destino de embriones criopreservados y en la elección de las características de los receptores de sus gametos. Existe espacio para abrir más el debate y promover la investigación en torno de las implicaciones sociales y éticas de la donación de gametos, considerando la participación de todos los ciudadanos, PTDC/IVC-ESCT/6294/2014; SFRH/BD/122603/2016; SFRH/ BD/111686/2015; UID/CCI/00736/2019; Fundação para a Ciência e a Tecnologia (FCT) por intermédio dos Programas COMPETE 2020, POCH e Portugal 2020, e à União Europeia, por meio do FEDER e do FSE, no âmbito do projeto POCH-01-0145-FEDER-016762 (Ref. FCT PTDC/IVC-ESCT/6294/2014), da Unidade de Investigação em Epidemiologia - ISPUP (EPIUnit - POCH-01-0145-FEDER-006862; Ref. FCT UID/DTP/04750/2013), das bolsas de doutorado SFRH/BD/122603/2016 (S. Pinto da Silva) e SFRH/BD/111686/2015 (I. Baía), do DL57/2016/CP1336/CT0001 (C. De Freitas), e do contrato Investigador FCT IF/01674/2015 (S. Silva)

O objetivo deste estudo foi estimar o polimorfismo genético de populações nativas de lambaris Astyanax sp. B oriundos de quatro localidades do Rio Iguaçu (Estado do Paraná, Brasil): areal Água Azul (AA: 25º47´34´´S/50º11´34´´W), Rio Piraquara (PIR: 25º30´10´´S/49º01´25´´W), Rio Passaúna (PAS: 25015’20´´S/49025’15´´W) e Zoológico Municipal de Curitiba (ZOO: 25º33´12´´S/49º13´58´´N). Polimorfismos genéticos foram estimados a partir do DNA genômico extraído de espécimes de cada localidade na presença de primers universais em reações de amplificação aleatória PCR-RAPD. Com o auxílio do programa NTSYS versão 2.02 foram construídas matrizes de similaridade a partir do coeficiente de Jaccard (J), além da construção de um fenograma empregando o algoritmo de agrupamento UPGMA. A caracterização molecular das populações de lambaris de diferentes localizações do Rio Iguaçu demonstrou um padrão eletroforético altamente polimórfico nas análises de PCR-RAPD, totalizando 165 caracteres, sendo 157 polimórficos (95,2%) e 8 monomórficos (4,8%). O fenograma de similaridade genética gerou a separação dos indivíduos em quatro grupos distintos com indivíduos do ZOO, PAS e AA agrupados em uma similaridade variando de 27 a 90%; e os do PIR apresentando o maior distanciamento genético (25%) em relação ao demais. O uso desses marcadores permitiu caracterizar polimorfismos suficientes para discriminar populações de lambaris com intensa diferenciação genética, sem estarem fortemente conectadas por fluxo gênico nem mesmo apresentarem tendência de homogeneização genética entre as mesmas. Os resultados apresentados no presente estudo reforçam a importância do uso da técnica de PCR-RAPD como uma ferramenta eficaz para estimar a diferenciação molecular entre populações nativas de lambaris.

Chagas disease (CD), caused by infection with the parasite Trypanosoma cruzi, leads to severe cardiomyopathy in 20–30% of patients, whereas the remainder may stay asymptomatic and never develop cardiomyopathy or other clinical manifestations. The underlying cause for this variable outcome is not fully characterized, although previous studies have found high levels of circulating mannose-binding lectin (MBL) to be associated with cardiac failure echocardiographic changes. We report three indeterminate (asymptomatic) chronic Chagas patients who were followed up for 10 years. Two of these patients developed chronic chagasic cardiomyopathy (CCC) during this follow-up period and, when genotyped, were found to be carriers of the high MBL producer HYPA/HYPA genotype, suggesting that genetically determined high MBL serum might be associated with the risk of CCC development. These results suggest the use of MBL quantification and MBL2 genotyping as tools for clinical assessment in patients with chronic CD.

Pulmonary alveolar proteinosis (PAP) is a rare pathology characterized by accumulation of phospholipoproteinaceous material within the alveoli. The evolution of PAP is variable and treatment modalities are limited. Pharmacological therapeutic targets are being actively developed, but whole-lung lavage (WLL), first described in the 1960s, remains the cornerstone of therapy. The preferential treatment for PAP in our center is sequential WLL, where each lung is separately and sequentially perfused with warmed saline. However, some patients do not tolerate single lung ventilation (SLV), as there is a greater risk of severe hypoxemia with this method. Extracorporeal membrane oxygenation (ECMO), referring to an extracorporeal circuit that directly oxygenates and removes carbon dioxide from the blood, may be considered in highly selected patients with severe respiratory failure who otherwise would not be able to undergo WLL. In this context, veno-venous ECMO is most often utilized. We describe a case of a 44-year-old male diagnosed with silicosis five years earlier who presented with severe hypoxemic respiratory failure not amenable to WLL under general anesthesia with SLV, which was successfully managed with ECMO-assisted WLL.

A partir da cartografia corporal da cidade (Corpografia), do artista Ricardo Alvarenga, em sua ação direta denominada Jesus 3:30pm – One Year Performance, no fito de entender a micropolítica dos afetos, do desejo, do cotidiano e das resistências moleculares incursas em seu fazer, aventuro conceber a noção de corpo-na-rua, por meio de analogias em uma trama teórico-filosófica. Verão, portanto, espelhos curatoriais de uma seleção de foto-performances do Ricardo, que refletem a potência comunicacional provinda da alteridade entre um corpo que traceja lugar e um espaço corporado, numa experiência de si que desagua na criação de cidades subjetivas. Aposto na corpografia como caminho metodológico para tornar inteligível os contornos conceituais do que chamo corpo-na-rua – objetivo central desta investigação.

The complement system is a key component of the innate immune system, participating in the surveillance against infectious agents. Once activated by one of the three different pathways, complement mediates cell lysis, opsonization, signalizes pathogens for phagocytosis and induces the adaptive immune response. The lectin pathway is constituted by several soluble and membrane bound proteins, called pattern recognition molecules (PRM), including mannose binding lectin (MBL), Ficolins-1, -2, and -3, and Collectin 11. These PRMs act on complement activation as recognition molecules of pathogen-associated molecular patterns (PAMPs) such as N-acetylated, found in glycoproteins of viral envelopes. In this study, Ficolin-1 and Ficolin-3 plasma levels were evaluated in 178 HIV patients (93 HIV; 85 HIV/HCV) and 85 controls from southern Brazil. Demographic and clinical-laboratory findings were obtained during medical interview and from medical records. All parameters were assessed by logistic regression, adjusted for age, ancestry, and sex. Significantly lower levels of Ficolin-1 were observed in HIV/HCV coinfected when compared to HIV patients (p = 0.005, median = 516 vs. 667 ng/ul, respectively) and to controls (p < 0.0001, 1186 ng/ul). Ficolin-1 levels were lower in males than in females among HIV patients (p = 0.03) and controls (p = 0.0003), but no association of Ficolin-1 levels with AIDS was observed. On the other hand, Ficolin-3 levels were significantly lower in controls when compared to HIV (p < 0.0001, medians 18,240 vs. 44,030 ng/ml, respectively) and HIV/HCV coinfected (p < 0.0001, 40,351 ng/ml) patients. There was no correlation between Ficolin-1 and Ficolin-3 levels and age, HIV viral load or opportunistic infections. However, Ficolin-3 showed a positive correlation with T CD4 cell counts in HIV monoinfected patients (p = 0.007). We provide here the first assessment of Ficolin-1 and-3 levels in HIV and HIV/HCV coinfected patients, which indicates a distinct role for these pattern recognition molecules in both viral infections.

Como conclusão do Mestrado em Gestão de Marketing, é realizado um relatório de estágio de modo a descrever a minha atividade durante o decurso do estágio na empresa Webco-mum Consultoria, Lda. A questão central deste relatório será perceber quanto traz de benefícios financeiros para a empresa Carmo trabalhar com a empresa Webcomum, tendo em conta as vendas e a noto-riedade da marca. A empresa Webcomum faz consultoria para diversas empresas, no entanto a Carmo foi a empresa escolhida pela autora deste relatório, uma vez que é a empresa maior com que a Webcomum trabalha facilitando assim uma análise promonorizada. De modo a tornar mais rica a exposição do trabalho desenvolvido ao longo do estágio cur-ricular, começo este relatório com uma revisão de literatura tendo em conta os conceitos de Marketing Digital, ROI, notoriedade da marca, entre outros. Nesta primeira fase é essencial a compreensão de cada conceito, e apresentar abordagens de vários autores relacionados com os vários temas e adaptá-las à realidade do caso em questão. De seguida será apresentada a metodologia que se enquadra melhor neste projeto, a me-todologia quantitativa e qualitativa de forma sucinta, sendo baseada em diversos autores. Uma vez que o objetivo é perceber de que maneira a estratégia da Webcomum, ou seja, as suas ações de Marketing Digital terão influência no ROI e na notoriedade da empresa Carmo é essencial o estudo da Webcomum bem como da Carmo. A Carmo é a empresa pioneira no desenvolvimento e tratamento de madeira e está incluída em outros setor. Para terminar, a conclusão reflete uma análise geral e crítica sobre o retorno pessoal e profissional do estágio curricular.

portuguesO objectivo deste artigo e reunir e sintetizar o conhecimento existente sobre o impacto da crise economica e das consequentes politicas de austeridade no estado de saude e no acesso aos cuidados de saude das populacoes migrantes em paises do sul da Europa, nomeadamente Portugal, Espanha, Italia e Grecia. Os resultados analisados indicam que a crise economica e as politicas de austeridade tiveram um impacto negativo na saude e no acesso aos cuidados de saude dos migrantes em tres paises, ja que nao se encontraram dados relativos a Portugal. Os seus efeitos negativos espelham-se na saude mental, saude ocupacional, doencas transmissiveis e nao transmissiveis, saude infantil e na percecao subjetiva de saude. A acessibilidade dos cuidados de saude tornou-se mais limitada em Espanha, especialmente para a populacao de imigrantes em situacao irregular. EnglishThe aim of this article is to gather and synthesize existing knowledge about the impact of the economic crisis and the consequent austerity policies on health condition and health care access of migrant populations in southern European countries, namely Portugal, Spain, Italy and Greece. The results analyzed indicate that the economic crisis and the austerity policies had a negative impact on health and health care access of migrants in three countries, since no data were found about Portugal. The negative effects are reflected in mental health, occupational health, communicable and noncommunicable diseases, child health and in the subjective perception of health. Health care accessibility has become more limited in Spain, especially for irregular immigrants population.

Chagas disease (CD), a neglected tropical disease caused by the protozoan Trypanosoma cruzi, affects around six million individuals in Latin America. Currently, CD occurs worldwide, becoming a significant public health concern due to its silent aspect and high morbimortality rate. T. cruzi presents different escape strategies which allow its evasion from the host immune system, enabling its persistence and the establishment of chronic infection which leads to the development of chronic Chagas cardiomyopathy (CCC). The potent immune stimuli generated by T. cruzi persistence may result in tissue damage and inflammatory response. In addition, molecular mimicry between parasites molecules and host proteins may result in cross-reaction with self-molecules and consequently in autoimmune features including autoantibodies and autoreactive cells. Although controversial, there is evidence demonstrating a role for autoimmunity in the clinical progression of CCC. Nevertheless, the exact mechanism underlying the generation of an autoimmune response in human CD progression is unknown. In this review, we summarize the recent findings and hypotheses related to the autoimmune mechanisms involved in the development and progression of CCC.

With this study, we aimed to describe the interaction within the therapeutic dyads involved in dropout cases of narrative therapy, once the quality of interaction in therapy appears to constitute a critical factor in clients’ decisions regarding its discontinuation. Seven dropout cases of narrative therapy, which were conducted by the same therapist, were analysed using the Therapeutic Collaboration Coding System. The coding procedure required two trained and independent judges along with an auditing process. Overall, the findings demonstrated that independent of the clients’ responses, the therapist tended to increase the challenging interventions and decrease the supporting interventions over time. In turn, the clients oscillated between having experiences of safety and experiences of intolerable risk. The results will be discussed in terms of their theoretical and empirical relevance in relation to clinical implications., Con este estudio se ha pretendido describir la interacción entre díadas terapéuticas en casos de abandono en terapia narrativa, una vez que la calidad de la interacción terapéutica parece ser un factor crítico en las decisiones de los clientes para abandonar sus procesos. Siete casos de abandono en terapia narrativa, acompañados por el mismo terapeuta, fueron analizados utilizando el Sistema de Codificación de la Colaboración Terapéutica. El procedimiento ha incluido la codificación de todas las sesiones de los casos por dos jueces independientes con formación sobre el sistema, así como su posterior auditoría. En general, los resultados mostraron que, independiente de las respuestas de los clientes, el terapeuta ha tendido a aumentar sus intervenciones de desafío y a reducir las de apoyo, a lo largo del tiempo. A su vez, los clientes oscilaron en presentar experiencias de seguridad y experiencias de riesgo intolerable. Los resultados serán debatidos de acuerdo con su relevancia teórica y empírica y sus implicaciones clínicas., This work was supported by the Portuguese Foundation for Science and Technology (FCT) under the PhD Grant with the reference SFRH/BD/82583/2011. This study was conducted at Psychology Research Centre (PSI/01662), University of MInho, and supported by the Portuguese Foundation for Science and Technology and the Portuguese Ministry of Science, Technology and Higher Education through national funds, and co-financed by FEDER through COMPETE2020 under the PT2020 Partnership Agreement (POCI-01-0145-FEDER007653), info:eu-repo/semantics/publishedVersion

The simultaneous effect of oxygen availability and carbon source concentration on yeast lipid and carotenoid production has never been studied before. In this work, a Doehlert distribution design was used to study the simultaneous effect of carbon concentration and oxygen availability on Rhodosporidium toruloides NCYC 921 carotenoid and lipid production. A cheap industrial byproduct was used as carbon source (carob pulp syrup). A total sugar concentration of 106.3 g/L and a medium volume of 0.120 L induced the highest total carotenoid and total fatty acid productivities (4.60 ìg/Lh and 0.029 g/Lh, respectively). Flow cytometry was used to assess yeast stress response under different cultivation conditions. The highest proportion of cells with permeabilised membrane (>20%) was induced when the cultivations were carried out at the highest sugar concentration studied (130.0 g/L) or when the culture reached the minimum final medium pH (4.60). The results showed that the total sugar concentration had a positive influence on the yeast biomass and carotenoid content, while the oxygen availability had little influence on the biomass concentration, but had a slight positive influence on the carotenoid content. Regarding the fatty acids, the two factors had a negative impact on the synthesis of these compounds.

Introduction:Hemoglobin S (HbS) is one of the most common inherited hematological disorders in humans. In Brazil, the sickle-cell disease (SCD) has significant epidemiological importance due to its prevalence and the morbidity-mortality and, therefore, it has been identified as a matter of public health.Objective:To determine the prevalence of HbS among Asian Brazilian, Afro Brazilian, and Euro Brazilian individuals of a blood bank in Curitiba.Material and method:The study was conducted from January 2008 to December 2009, and included 83,213 donors seen at the Instituto Paranaense de Hemoterapia e Hematologia.Results and discussion:The prevalence of HbS in the studied population was 0.9%, among them, 0% Asian Brazilians, 2.7% Afro Brazilians, and 0.7% Euro Brazilians. There was a positive association, statistically significant for the sickle cell trait in Afro-descendants, with odds ratio (OR) 4.01; confidence interval (CI) 3.42-4.72; and 95% confidence.Conclusion:This study showed higher rates of sickle cell trait in Afro Brazilians, which corroborates data published in other Brazilian regions and states. RESUMOIntrodução:A hemoglobina S (HbS) é uma das alterações hematológicas hereditárias de maior frequência na espécie humana. No Brasil, a anemia falciforme (AF) tem importância epidemiológica significativa em virtude da prevalência e da morbimortalidade que apresenta e por isso tem sido apontada como uma questão de saúde pública.Objetivo:Determinar a prevalência de HbS entre indivíduos de origem asiática, afro e euro-brasileira de um banco de sangue de Curitiba.Material e método:O estudo foi realizado no período de janeiro de 2008 a dezembro de 2009, no qual foram incluídos 83.213 doadores atendidos no Instituto Paranaense de Hemoterapia e Hematologia.Resultados e discussão:A prevalência geral de HbS na população estudada foi de 0,9%, sendo 0% entre asiático-brasileiros, 2,7% entre afro-brasileiros e 0,7% entre euro-brasileiros. Houve associação positiva, significativa estatisticamente, para o traço falcêmico nos afrodescendentes, com odds ratio (OR) de 4,01 e intervalo de confiança (IC) 3,42-4,72, com 95% de confiança.Conclusão:O presente trabalho demonstrou maiores índices de traço falcêmico em afro-brasileiros, o que corrobora dados publicados em outras regiões e estados brasileiros.

We aimed to investigate the association between plasma levels of complement Factor H (FH) with cardiac involvement, inflammatory and cardiometabolic parameters in patients with chronic Chagas' disease (CD). FH plasmatic levels were determined in 80 chronic CD patients. Glycaemic index, lipidogram (high-density lipoprotein cholesterol HDL-C, low-density lipoprotein cholesterol LDL-C, triglycerides and total cholesterol) and Ultrasensitive C-Reactive Protein (uCRP) values were obtained from medical records. Height, weight, body mass index (BMI) blood pressure and left ventricular ejection fraction (LVEF) were obtained from echocardiography examinations. Comparisons between chronic CD clinical forms were performed using Mann-Whitney test and correlation Spearman's test. FH levels were correlated positively with triglycerides (P = .001, r = .39), LDL-C (P = .009, r = .3), cholesterol (P = .02, r = .28), uCRP (P = .029, r = .31) and BMI (P = .008, r = .34); and negatively with HDL-C (P = .03, r = -.25) levels. Dyslipidemic patients showed higher FH levels compared to normolipidemic, although no difference for FH levels was observed between chronic CD clinical forms. Alternative pathway of complement may be a link between immune response and metabolic disorders, with important immunoregulatory role in chronic CD.

Complement is an essential element in both innate and acquired immunity contributing to the immunopathogenesis of many disorders, including Chagas Disease (CD). Human complement receptor 1 (CR1) plays a role in the clearance of complement opsonized molecules and may facilitate the entry of pathogens into host cells. Distinct CR1 exon 29 variants have been found associated with CR1 expression levels, increased susceptibility and pathophysiology of several diseases. In this study, CR1 plasma levels were assessed by ELISA and CR1 variants in exon 29 by sequencing in a Brazilian cohort of 232 chronic CD patients and 104 healthy controls. CR1 levels were significantly decreased in CD patients compared to controls (p CR1 rs1704660G, rs17047661G and rs6691117G variants were significantly associated with CD and in high linkage disequilibrium. The CR1*AGAGTG haplotype was associated with T. cruzi infection (p = 0.035, OR 3.99, CI 1.1-14.15) whereas CR1*AGGGTG was related to the risk of chagasic cardiomyopathy (p = 0.028, OR 12.15, CI 1.13-113). This is the first study that provides insights on the role of CR1 in development and clinical presentation of chronic CD.

Orientadora: Prof. Dra. Iara T. de Messias-Reason Co-orientadora: Dra. Marcia Holsbach Beltrame Tese (doutorado) - Universidade Federal do Paraná, Setor de Ciências da Saúde, Programa de Pós-Graduação em Medicina Interna e Ciências da Saúde. Defesa : Curitiba, 30/10/2017 Inclui referências: p.132-154 Resumo: A Doença de Chagas (DC) é uma doença infecciosa crônica causada pelo Trypanosoma cruzi que acomete aproximadamente cerca de 5 milhões de pessoas na América Latina. Embora a maioria dos infectados permaneça assintomática na forma indeterminada ao longo da vida, 30-40% dos pacientes podem desenvolver cardiopatia chagásica crônica (CCC). A relação de mediadores do sistema imune com o tecido adiposo tem sido reconhecida como fundamental para o entendimento do processo inflamatório em doenças cardíacas, o que torna a Pentraxina (PTX3), o Fator H (FH) e a ficolina-3 do complemento; e as adipocinas (leptina e adiponectina) potenciais marcadores de risco cardiovascular na DC crônica. Nesse sentido, o presente trabalho objetivou investigar a associação entre concentrações séricas de PTX3, ficolina-3, leptina e adiponectina; e plasmáticas de FH com as formas clínicas da DC e controles, com avaliação do risco cardiovascular (RCV) a partir do Score de Framingham. Foram incluídos no estudo até 178 pacientes com DC crônica, com avaliação de prontuários para obtenção de parâmetros inflamatórios e cardiometabólicos, além de dados de eletrocardiograma e ecocardiograma; e até 208 controles. Os resultados demonstraram RCV aumentado para os pacientes com DC crônica quando comparados aos controles; assim como para a forma indeterminada quando comparada aos controles. Não foi observada diferença significativa para o RCV entre a forma indeterminada e a cardíaca, porém houve correlação positiva com a fração de ejeção ventricular esquerda (FEVE). As concentrações de leptina e adiponectina apresentaram-se menores nos pacientes que nos controles, sem correlação entre as concentrações de leptina e adiponectina. Além disso, PTX3 e FH foram associados à parâmetros cardiometabólicos dos pacientes. A concentração sérica de ficolina-3 se mostrou reduzida na insuficiência cardíaca chagásica, com correlação positiva com a FEVE. Os resultados sugerem que a ativação do complemento pode ser um elo entre doença inflamatória e desordens metabólicas, com importante papel imunoregulatório da PTX3, FH, ficolina-3, leptina e adiponectina na DC crônica. Palavras-chave: Doença de Chagas. Ativação do complemento. Adipocinas. Abstract: Chagas disease (DC) is a chronic infectious disease caused by Trypanosoma cruzi that affects approximately 5 million people in Latin America. Although most infected individuals remain asymptomatic with the indeterminate form of disease throughout life, 30-40% of them may develop chronic chagasic cardiomyopathy (CCC). The interplay of the immune system with adipose tissue has been recognized as crucial for understanding the inflammatory process in cardiac diseases, being components of complement [Pentraxin (PTX3), H-Factor (FH) and ficolin-3] and adipokines (leptin and adiponectin) potential cardiovascular risk markers in CCC. The present study aimed to investigate the association between serum levels of PTX3, ficolin-3, leptin and adiponectin and plasma levels of FH with the clinical forms of CD and controls, using Framingham risk score to evaluate cardiovascular risk assessment in up to 178 patients with chronic CD and 208 controls. The clinic-laboratorial evaluation included inflammatory and cardiometabolic parameters, as well as data of electrocardiogram and echocardiogram from patients. The results demonstrated increased cardiovascular risk for patients with chronic CD when compared to controls; as well as for the indeterminate form when compared to controls. No significant difference was observed for the cardiovascular risk between the indeterminate and the CCC, but there was a positive correlation with the left ventricular ejection fraction (LVEF). Leptin and adiponectin levels were lower in patients than in the controls, with no correlation between leptin and adiponectin concentrations. In addition, PTX3 and FH were associated with cardiometabolic parameters of patients. Serum concentrations of ficolin-3 were reduced in patients with heart failure, with a positive correlation with LVEF. These results suggest that complement activation may be a link between inflammatory disease and metabolic disorders, with an important immunoregulatory role of PTX3, FH, ficolin-3, leptin and adiponectin in chronic CD. Key-words: Chagas disease. Complement activation. Adipokines.

Este artigo apresenta um modelo de Balanced Scorecard (BSC) proposto para laboratório de análises clínicas, baseado na estratégia de Kaplan e Norton, que apresenta um modelo de gestão em laboratório clínico para empresas de qualquer porte. De acordo com esse modelo, a estratégia é definida em relação a perspectivas financeiras, clientes, processos internos, aprendizado e crescimento. O BSC é um instrumento direcionado para o sistema de gestão estratégica que utiliza indicadores de desempenho baseados em variáveis capazes de interferir direta e indiretamente nas ações da empresa.

Background The risk-benefit of contraception with Essure® is being readdressed due to an increase of reports of adverse effects with this device. Our aim was to proceed to an internal quality evaluation and to identify opportunities for protocol improvement. We proceeded to a one-center, retrospective consecutive case series of women admitted for Essure® placement, from 1 January 2012 until 31 December 2016 (5 years). Results In a total of 274 women, technical difficulties were mainly unilateral, with no acute or short-term severe complications. The procedure was brief (median 3.2 min, IQR 2.5–5.2) and moderately painful (median of 4 in a 0–10 scale; IQR 3–5). At 3 months, the failure rate was 2%, with no pregnancies. Second surgery indication ( Conclusions We identified high patient satisfaction and low failure rates, both at short and long term. Investigation about whether some women still have patent tubes at the 3-month follow-up could lead to protocol improvement. It is important that clinicians look for second causes for adverse effects related to Essure® and avoid the erroneous indication for implant removal. Long follow-up allowed for both internal quality evaluation and clarification of misconception; it could possibly also have contributed to patient satisfaction.

Background: Public and patient involvement in the design of people-centred care and research is vital for communities whose needs are underserved, as are people with rare diseases. Innovations devised collectively by patients, caregivers, professionals and other members of the public can foster transformative change toward more responsive services and research. However, attempts to involve lay and professional stakeholders in devising community-framed strategies to address the unmet needs of rare diseases are lacking. In this study, we engaged with the community of Congenital Disorders of Glycosylation (CDG) to assess its needs and elicit social innovations to promote people-centred care and research. Methods: Drawing on a qualitative study, we conducted three think tanks in France with a total of 48 participants, including patients/family members (n = 18), health care professionals (n = 7), researchers (n = 7) and people combining several of these roles (n = 16). Participants came from 20 countries across five continents. They were selected from the registry of the Second World Conference on CDG through heterogeneity and simple random sampling. Inductive and deductive approaches were employed to conduct interpretational analysis using open, axial and selective coding, and the constant-comparison method to facilitate the emergence of categories and core themes. Results: The CDG community has unmet needs for information, quality health care, psychosocial support and representation in decision-making concerned with care and research. According to participants, these needs can be addressed through a range of social innovations, including peer-support communities, web-based information resources and a CDG expertise platform. Conclusion: This is one of the few studies to engage lay and professional experts in needs assessment and innovation for CDG at a global level. Implementing the innovations proposed by the CDG community is likely to have ethical, legal and social implications associated with the potential donation of patients’ clinical and biological material that need to be assessed and regulated with involvement from all stakeholders. To promote people-centred care for the CDG community, and increase its participation in the governance of care and research, it is necessary to create participatory spaces in which the views of people affected by CDG can be fully expressed. FCT - Foundation for Science and Technology (Portuguese Ministry of Science, Technology and Higher Education), the Social European Fund and the POPH Programme supported this study with research grants: SFRH/BPD/111344/2015 (CF) and IF/01674/2015 (SS).

Trypanosoma cruzi is a protozoan parasite known to cause Chagas disease (CD), a neglected sickness that affects around 6–8 million people worldwide. Originally, CD was mainly found in Latin America but more recently, it has been spread to countries in North America, Asia, and Europe due the international migration from endemic areas. Thus, at present CD represents an important concern of global public health. Most of individuals that are infected by T. cruzi may remain in asymptomatic form all lifelong, but up to 40% of them will develop cardiomyopathy, digestive mega syndromes, or both. The interaction between the T. cruzi infective forms and host-related immune factors represents a key point for a better understanding of the physiopathology of CD. In this context, the complement, as one of the first line of host defense against infection was shown to play an important role in recognizing T. cruzi metacyclic trypomastigotes and in controlling parasite invasion. The complement consists of at least 35 or more plasma proteins and cell surface receptors/regulators, which can be activated by three pathways: classical (CP), lectin (LP), and alternative (AP). The CP and LP are mainly initiated by immune complexes or pathogen-associated molecular patterns (PAMPs), respectively, whereas AP is spontaneously activated by hydrolysis of C3. Once activated, several relevant complement functions are generated which include opsonization and phagocytosis of particles or microorganisms and cell lysis. An important step during T. cruzi infection is when intracellular trypomastigotes are release to bloodstream where they may be target by complement. Nevertheless, the parasite uses a sequence of events in order to escape from complement-mediated lysis. In fact, several T. cruzi molecules are known to interfere in the initiation of all three pathways and in the assembly of C3 convertase, a key step in the activation of complement. Moreover, T. cruzi promotes secretion of plasma membrane-derived vesicles from host cells, which prevent the activity of C3 convertase C4b2a and thereby may hinder complement. In this review, we aim to present an overview on the strategies used by T. cruzi in order to circumvent the activation of complement and, consequently, its biological effects.

Dissertação de mestrado em Optometria Avançada, A asfericidade é uma característica morfológica muito importante da córnea humana pela sua relação com a qualidade ótica deste elemento ótico do olho. De facto, existe uma relação intrínseca entre a asfericidade e a aberração esférica da córnea, uma das aberrações de alta ordem que mais afetam a qualidade ótica do olho. Estima-se que para neutralizar a aberração esférica positiva média inerente ao olho humano para uma pupila de 5 a 6mm, será necessário que a córnea se aplane do centro para a periferia com uma asfericidade de aproximadamente -0,50 (valor adimensional). No entanto, segundo a literatura consultada, a asfericidade média da superfície anterior da córnea é próxima de -0,25 compensando apenas parte da dita aberração. Ainda varia com a distância ao centro tomada como referência o que normalmente não é considerado para referenciar os valores ou quando se comparam diferentes dispositivos. Considerando a importância que assume este parâmetro na avaliação da qualidade ótica do olho, na programação e avaliação pós-operatória de procedimentos cirúrgicos e na adaptação de lentes de contacto torna-se necessário realizar estudos populacionais que visem um melhor conhecimento do mesmo. Objetivo: Pretendeu-se com este estudo validar um Autorrefratómetro/Keratometro na medida da asfericidade, avaliar o valor da asfericidade corneal numa população do norte de Portugal e analisar se a mesma sofre alterações num período entre 5 a 10 anos. Métodos: Foram inicialmente analisados 107 olhos na comparação de valores de asfericidade e queratometrias num Autorrefratómetro/Keratometro-NIDEK_ARK-700A e num vídeoqueratoscopio. Foram posteriormente analisados em termos retrospetivos os registos clínicos de pacientes submetidos a uma consulta de optometria. Registaram-se os valores da refração subjetiva e os valores centrais da queratometria corneal, bem como, 4 medidas periféricas (asfericidade) com um Autorrefratómetro/Keratometro-NIDEK_ARK-700A. O estudo longitudinal da asfericidade foi feito a partir da comparação entre duas consultas (intervalo entre 5 a 10anos). Resultados: Em termos clínicos a diferença encontrada para as queratometrias foi de 0,03x120º // 0,02x30º e o valor de asfericidade que mais se aproxima entre os instrumentos foi para um diâmetro de 7mm. Na caraterização do valor da asfericidade, para uma população de 1484 olhos direitos (58,6% do sexo feminino) com uma idade média de 40,2±18,4anos o valor médio da asfericidade foi de -0,24±0,12. Não foram encontradas diferenças estatisticamente significativas da asfericidade entre sexo (p=0,424), idade (p=0,268), grupos refrativos (p=0,107) e orientação do astigmatismo corneal (p=0,559). Numa análise longitudinal (5,9±1,3anos) de 190 olhos (62,1% do sexo feminino) os valores das diferenças encontradas para o erro refrativo médio foram de +0,16-0,01x136º (p>0,050), para o valor da asfericidade de 0,00±0,08 (p>0,813) e da curvatura central média de 0,06x14º//0,06x104º (p>0,084). Observou-se uma forte correlação positiva e estatisticamente significativa (r=0,790; p, Asphericity is a very important morphological characteristic of the human cornea due to its relation with the optical quality of this optical element of the eye. In fact, there is an intrinsic relationship between asphericity and the corneal spherical aberration, one of the high order aberrations most affecting the optical quality of the eye. It is estimated that to neutralize the mean positive spherical aberration inherent to the human eye for a pupil of 5 to 6 mm, it would be necessary a flattening of the cornea from the center to the periphery with an asphericity of about -0.50 (dimensionless value). However, according to the literature, the mean asphericity of the anterior surface of the cornea is about -0.25 which only compensates part of this aberration. Asphericity varies with the distance to the center (reference value) which is not usually considered to refer the values or when comparing different devices. Considering the importance of this parameter in the evaluation of the optical quality of the eye, it is required to carry out population studies aimed at a better knowledge of the corneal asphericity in the planning and postoperative evaluation of surgical procedures and in the adaptation of contact lenses. Objectives: This study aimed to validate an Auto- refractometer / Keratometer in the measurement of corneal asphericity, to evaluate its value in a population from the north of Portugal and to analyze if the asphericity change within a 5-10 years period. Methods: 107 eyes were initially analyzed in the comparison of asphericity and keratometry values with an Autorefractometer /Keratometer-NIDEK_ARK-700A and with a videokeratoscope. The clinical records of patients undergoing optometry consultation were retrospectively analyzed. Subjective refraction and central keratometry values were recorded, as well as 4 peripheral measurements of the asphericity with an Autorefractometer / Keratometer-NIDEK_ARK-700A. The longitudinal study of the asphericity was made from the comparison of the values of another posterior consultation (interval of 5 to 10 years). Results: In clinical terms the difference found for keratometry was 0.03x120º // 0.02x30º and the most consistent value between the two instruments was that relative to a diameter of 7mm. In the characterization of the asphericity value, for a population of 1484 right eyes (58.6% females) with a mean age of 40.2 ± 18.4 years the mean value of asphericity was -0.24 ± 0.12. No statistically significant differences were found in the asphericity between sex (p = 0.424), age (p = 0.268), refractive groups (p = 0.107) and orientation of corneal astigmatism (p = 0.559). In a longitudinal analysis (5.9 ± 1.3 years) of 190 eyes (62.1% of females), the differences found for the mean refractive error were +/- 0.16-0.01x136º (p> 0.050), for the asphericity were 0.00 ± 0.08 (p> 0.813) and for the mean central curvature was 0.06x14 ° / 0.06x104 ° (p> 0.084). There was a strong positive and statistically significant correlation (r = 0.790, p

Background Bariatric surgery has been shown to improve many obesity related co-morbidities, including gestational diabetes mellitus (GDM). Recently, new diagnostic criteria for GDM following the International Association of Diabetes and Pregnancy Study Group recommendations were implemented. The objective of this study was to compare the use of 2 different GDM criteria in diagnostic and pregnancy outcome after Roux-en-Y gastric bypass (RYGB). Methods Pregnant women who had previously undergone RYGB (n = 30) were screened for GDM with Carpenter and Coustan (C&C) criteria (n = 18) or the new diagnostic criteria (n = 12). Results None of the patients screened using C&C criteria where diagnosed with GDM, while 50% of the patients screened with the new criteria had GDM. Among women that underwent oral glucose tolerance tests (OGTT) (n = 19) as required for the new diagnostic criteria, 57.9% developed reactive hypoglycemia. All women diagnosed with GDM had excellent metabolic control during pregnancy and comparing the outcome of these pregnancies and those of women without GDM, there were no significant differences regarding the age at time of surgery or at pregnancy, body mass index before surgery and pregnancy, parity, previous history of GDM, time from surgery to conception, weight lost until pregnancy, weight gain during pregnancy, gestational age at delivery, and birth weight adjusted for gestational age. Conclusion New GDM diagnostic criteria in post-RYGB pregnant women increased the prevalence of GDM diagnostic without changing pregnancy outcomes. In addition, OGTTs were associated with a high rate of reactive hypoglycemia. These data suggest that alternative GDM diagnostic criteria are needed for these postbariatric patients.

Introdução: A diabetes mellitus é responsável por 70% das amputações não traumáticas do membro inferior e 85% destas são precipitadas por úlceras. Objetivo - caracterização epidemiológica e resultado da intervenção dos utentes da consulta multidisciplinar do pé diabético. Materiais e métodos: Estudo observacional retrospetivo das primeiras consultas realizadas no âmbito da consulta multidisciplinar do pé diabético, durante um semestre. Revisão do processo clínico e avaliação das características epidemiológicas, investigação clínica realizada, meios complementares de diagnóstico e o resultado final (cicatrização da lesão, amputação major, não cicatrização em um ano ou morte). Resultados: Realizaram-se 361 primeiras consultas do pé diabético no período em estudo, 82,3% por ulceração (31,3% neuropáticos e 68,7% neuroisquémicos). Dos doentes seguidos, 78% obtiveram cicatrização das lesões (com ou sem amputação minor), 7,7% não obtiveram cicatrização da lesão após um ano de seguimento, 10,1% foram submetidos à amputação major e 4,2% faleceram durante o seguimento. Os doentes com doença arterial periférica apresentaram menor probabilidade de cicatrização (70,6 vs. 89,4%, p = 0,004) e risco aumentado de amputação major (15,7 vs. 1,5%, p = 0,003). A nefropatia diminuiu a probabilidade de cicatrização (50 vs. 82,6%, p = 0,008) e aumentou o risco de amputação major (29,1 vs. 6,9%, p = 0,008). Os doentes com dependência de terceiros apresentaram maior risco de amputação major (22,9 vs. 6,8%, p = 0,008). Conclusões: O tratamento eficaz das úlceras do pé diabético necessita uma abordagem multidisciplinar, intervindo nos vários componentes etiológicos. A doença arterial periférica, a insuficiência renal e a dependência de terceiros são fatores de mau prognóstico das úlceras do pé diabético. © 2014 Sociedade Portuguesa de Angiologia e Cirurgia Vascular. Publicado por Elsevier España, S.L.U. Todos os direitos reservados. Introduction: Diabetes mellitus is responsible for 70% of non-traumatic lower limb amputations and 85% of these are precipitated by ulcers. Objective -epidemiological characterization and revision of the outcome of patients observed in a multidisciplinary outpatient clinic of diabetic foot. Matherials and methods: A retrospective observational study with review of the first consultation of the multidisciplinary outpatient clinic of diabetic foot ulcer, during one semester. Review of the clinical process and evaluation of the epidemiological characteristics, clinical investigation, diagnostic tests, and outcome (healing, major amputation, non-healing after 1 year or death). Results: There were 361 first consultations during the study period, 82.3% due to ulceration (31.3% with neuropathic etiology and 68.7% with neuroischemic foot ulcers). Of the patients followed, 78% achieved complete wound healing (with or without minor amputation), 7.7% did not heal after one year of follow up, 10.1% underwent major limb amputation, and 4.2% died during the follow-up. Patients with peripheral arterial disease were less likely to heal (70.6% vs. 89.4%, p = 0.004) and had greater risk of major amputation (15.7% vs. 1.5%, p = 0.003). Nephropathy decreases the likelihood of healing (50% vs. 82.6%, p = 0.008) and increases the risk of major amputation (29.1% vs. 6.9%, p = 0.008). Non-ambulatory patients have a higher risk of major amputation (22.9% vs. 6.8%, p = 0.008). Conclusions: Successful treatment of diabetic foot ulcers requires a multidisciplinary approach, intervening in all etiological components. Peripheral arterial disease, renal failure and non ambulatory status are factors related to poor prognosis of diabetic foot ulcers. © 2014 Sociedade Portuguesa de Angiologia e Cirurgia Vascular. Published by Elsevier España, S.L.U. All rights reserved.

The aim of the present study was to detect natural infection by Leishmania (Leishmania) infantum in Lutzomyia longipalpis captured in Barcarena, state of Pará, Brazil, through the use of three primer sets. With this approach, it is unnecessary to previously dissect the sandfly specimens. DNA of 280 Lu. longipalpis female specimens were extracted from the whole insects. PCR primers for kinetoplast minicircle DNA (kDNA), the mini-exon gene and the small subunit ribosomal RNA (SSU-rRNA) gene of Leishmania were used, generating fragments of 400 bp, 780 bp and 603 bp, respectively. Infection by the parasite was found with the kDNA primer in 8.6% of the cases, with the mini-exon gene primer in 7.1% of the cases and with the SSU-rRNA gene primer in 5.3% of the cases. These data show the importance of polymerase chain reaction as a tool for investigating the molecular epidemiology of visceral leishmaniasis by estimating the risk of disease transmission in endemic areas, with the kDNA primer representing the most reliable marker for the parasite.

Designing and implementing equitable health policies requires the involvement of all stakeholders. However, disadvantaged groups are under-represented in European health participatory mechanisms. Migrants and ethnic minorities (MEMs), for example, are consistently left out of policy-making fora. Additionally, MEMs lack a voice on the programmes that are intended to benefit them. This can jeopardize the responsiveness of health policies to MEM needs and undermine the development of diversity sensitive care, making way for increased inequities in health. It is necessary therefore to investigate innovative strategies capable of fostering MEMs’ participation. Community psychology is particularly promising in this respect as it aims to mobilize the resources that communities possess, rather than simply teaching people to use services developed by others. Moreover, it highlights collaborative/participatory research approaches, which privilege the involvement of all stakeholders. By employing a community psychology approach, this paper looks at three European countries –the Netherlands, Norway and Spain– and summarizes lessons learnt from their experiences with migrant user involvement. The cases reported address different aspects of involvement, including: community mobilization, sociopolitical development, and creation of community alliances and coalitions. Its analysis offers several insights that can transform policy-making into a more inclusive process. Diseñar y poner en práctica políticas sanitarias justas precisa de la participación de todos los interesados. No obstante, los grupos desfavorecidos están infrarrepresentados en los mecanismos europeos de participación sanitaria. Por ejemplo, los inmigrantes y minorías étnicas quedan sistemáticamente apartados de los foros de diseño de políticas. Además, estos grupos carecen de opinión sobre los programas pensados en su beneficio, lo cual impide una respuesta de las políticas sanitarias a sus necesidades a la par que frena el desarrollo de una asistencia que tenga en cuenta la diversidad, dando origen a mayores injusticias en sanidad. Es necesario pues investigar en estrategias innovadoras que impulsen la participación de los inmigrantes y minorías étnicas. La psicología comunitaria es especialmente prometedora al respecto ya que busca movilizar los recursos propios de las comunidades más que enseñar a la gente a utilizar los servicios desarrollados por terceros. Además, recalca los enfoques de investigación colaboradores/participativos que privilegian la implicación de los interesados. A través de un enfoque de psicología comunitaria, este trabajo contempla tres países europeos –Holanda, Noruega y España– y resume las lecciones aprendidas de su experiencia con la participación de los usuarios inmigrantes. Los casos aportados abordan diversos aspectos de la participación, como la movilización comunitaria, el desarrollo sociopolítico y la creación de alianzas y coaliciones comunitarias. El análisis ofrece algunas ideas que pueden transformar el diseño de las políticas en un proceso más integrador. Ministerio de Ciencia e Innovación PSI2011-25554 Fundação para a Ciência e a Tecnologia (Portugal) SFRH/BPD/80530/2011

Rhodosporidium toruloides NCYC 921 batch growth was monitored as a means to evaluate the yeast biomass potential as a source for the production of carotenoids and other lipids. Carotenoid content, cell viability and size were assessed by multiparameter flow cytometry. The saponifiable lipid fraction was assayed by gas–liquid chromatography. The carotenoid production increased during the stationary phase, reaching 78 μg/g while the total fatty acid content attained 32% (w/w) at the end of the fermentation. The fatty acid profile was suitable for biodiesel purposes. As the yeast cells entered the stationary phase, the proportion of cells with depolarised mitochondrial membrane and cells with permeabilised cytoplasmic membrane increased, attaining 65% and 14%, respectively. Nevertheless, a high proportion of cells (82%) showed esterase activity. These results demonstrated that flow cytometry can be a powerful at-line technique to monitor the total carotenoids and cell viability during the yeast growth, being useful for the yeast process optimisation at lab and pilot scales.