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The concern of colistin-resistant bacteria in animal-food-environmental-human ecosystems prompted the poultry sector to implement colistin restrictions and explore alternative trace metals/copper feed supplementation. The impact of these strategies on the selection and persistence of colistin-resistantKlebsiella pneumoniae(Kp) in the whole poultry-production chain needs clarification. We assessed colistin-resistant and copper-tolerant Kp occurrence in chicken raised with inorganic and organic copper-formulas from one-day-old chicks to meat (7 farms/2019-2020), after long-term colistin withdrawal (>2-years). Clonal diversity and Kp adaptive features were characterized by cultural, molecular, and whole-genome-sequencing (WGS) approaches. Most chicken-flocks (75%) carried Kp at early+pre-slaughter stages, with a significant decrease (p50%) of colistin-resistant/mcr-negative Kp were observed among faecal samples, independently of feed. Most samples carried multidrug-resistant (90%) and copper-tolerant isolates (81%;pco+sil/MICCuSO4≥16mM). WGS revealed accumulation of colistin resistance associated mutations and F-type multireplicon plasmids carrying antibiotic resistance and metal/copper-tolerance genes. The Kp population was polyclonal, with various lineages dispersed throughout poultry production. ST15-KL19, ST15-KL146 and ST392-KL27, and IncF plasmids were similar to those from global human clinical isolates, suggesting chicken-production as a reservoir/source of clinically-relevant Kp lineages and genes with potential risk to humans through food and/or environmental exposure. Despite long-term colistin ban limitedmcrspread, it was ineffective in controlling colistin-resistant/mcr-negative Kp, regardless of feed. This study provides crucial insights into the persistence of clinically-relevant Kp in the poultry-production chain and highlights the need for continued surveillance and proactive food safety actions within a ’One-Health’ perspective.IMPORTANCEThe spread of bacteria resistant to last-resort antibiotics such as colistin throughout the food chain is a serious concern for public health. The poultry sector has responded by restricting colistin use and exploring alternative trace metals/copper feed supplements. However, it is unclear how and to which extent these changes impact the selection and persistence of clinically-relevantKlebsiella pneumoniae(Kp) throughout poultry chain. We found a high occurrence of copper-tolerant and colistin-resistant/mcr-negative Kp in chicken flocks, regardless of inorganic and organic copper-formulas and long-term colistin ban. Despite the high Kp diversity, the occurrence of identical lineages and plasmids across samples and/or clinical isolates suggests poultry as a potential source of human Kp exposure. This study highlights the need for continued surveillance and proactive farm-to-fork actions to mitigate the risks to public health, relevant for stakeholders involved in food industry and policymakers tasked with regulating food safety.

Background: Patients undergoing carotid endarterectomy (CEA) may experiment intraoperative neurologic deficits (IND) during carotid cross-clamping. This work aimed to assess the impact of the Gupta Perioperative Myocardial Infarct or Cardiac Arrest (MICA) risk calculator in the IND. Methods: From January 2012 to April 2021, patients undergoing CEA with regional anaesthesia for carotid stenosis with IND and consecutively control operated patients without IND were selected. A regressive predictive model was created, and a receiver operating characteristic (ROC) curve was applied for comparison. A multivariable dependence analysis was conducted using a classification and regression tree (CRT) algorithm. Results: A total of 97 out of 194 included patients developed IND. Obesity showed aOR = 4.01 (95% CI: 1.66–9.67) and MICA score aOR = 1.21 (1.03–1.43). Higher contralateral stenosis showed aOR = 1.29 (1.08–1.53). The AUROC curve was 0.656. The CRT algorithm differentiated obese patients with a MICA score ≥ 8. Regarding non-obese patients, the model identified the presence of contralateral stenosis ≥ 55% with a MICA ≥ 10. Conclusion: MICA score might play an additional role in stratifying patients for IND in CEA. Obesity was determined as the best discrimination factor, followed by a score ≥ 8. A higher ipsilateral stenosis degree is suggested to have a part in avoiding procedure-related IND. Larger studies might validate the benefit of MICA score regarding the risk of IND. info:eu-repo/semantics/publishedVersion

The physical status classification of the American Society of Anaesthesiology (ASA) is the most used score in the preoperative evaluation, but inconsistent evaluations and low reliability have been reported. The aim of this study is to evaluate the variability in the evaluation of ASA physical status classification among Portuguese anaesthesiologists.Cross-sectional study, in which an electronic questionnaire, was distributed to Portuguese anaesthesiologists with questions regarding their demographic characteristics, professional experience, place of work and how they would categorise 15 clinical cases regarding ASA classification. Three anaesthesiologists and a medicine student wrote the cases. Data analyses were done using R suite version 1.0.143 and IBM SPSS Statistics. The agreement among participants was evaluated through intraclass correlation coefficient (ICC). A value of P.05 was assumed as statistically significant.1,850 e-mails were sent, and 259 answers were obtained. Median age of participants was 47 years. 172 were female and 87 males. Ninety percent of work is in the public sector, and 99.6% use this classification on their daily practice. Participants' agreement ranged from 3 to 15 responses, with a mean of 9.2 (SD 6 2.4). In none of the cases was observed a total agreement with the author's classification. The ICC among the participants was 0.726 (0.585; 0.869; P.001), showing a moderate degree of agreement.The results of this sample revealed that the agreement among Portuguese anaesthetists is satisfactory and similar to the values observed in other countries where there were no significant differences between trainees and specialists.

Expansion of mcr-carrying Enterobacteriaceae (MCR-E) is a well-recognized problem affecting animals, humans and the environment. Ongoing global control actions involve colistin restrictions among food-animal production, but their impact on poultry-derived products is largely unknown, justifying comprehensive farm-to-fork studies. Occurrence of MCR-E among 53 chicken-meat batches supplied from 29 Portuguese farms shortly after colistin withdrawal was evaluated. Strains (FT-IR/MLST/WGS), mcr plasmids and their adaptive features were characterized by cultural, molecular and genomic approaches. We found high rates of chicken-meat batches (80%-100% - 4 months; 12% - the last month) with multiple MDR + mcr-1-carrying Escherichia coli (Ec-including ST117 and ST648-Cplx) and Klebsiella pneumoniae (Kp-ST147-O5:K35) clones, some of them persisting over time. The mcr-1 was located in the chromosome (Ec-ST297/16-farms) or dispersed IncX4 (Ec-ST602/ST6469/5-farms), IncHI2-ST2/ST4 (Ec-ST533/ST6469/5 farms and Kp-ST147/6-farms) or IncI2 (Ec-ST117/1-farm) plasmids. WGS revealed high load and diversity in virulence, antibiotic resistance and metal tolerance genes. This study supports colistin withdrawal potential efficacy in poultry production and highlights both poultry-production chain as a source of mcr-1 and the risk of foodborne transmission to poultry-meat consumers. Finally, in the antibiotic reduction/replacement context, other potential co-selective pressures (e.g., metals-Cu as feed additives) need to be further understood to guide concerted, effective and durable actions under 'One Health' perspective.

Introduction and objectives Anaesthetic techniques have been reported as having an impact on acute kidney injury (AKI) incidence in the postoperative period in patients undergoing transcatheter aortic valve implantation (TAVI). This study aimed to assess whether exists an association between anaesthetic approach in patients undergoing TAVI and the post-operative AKI incidence. The existence of association between anaesthetic approach and mortality was also assessed. Materials and methods A retrospective, single-centre, observational study was conducted at the Centro Hospitalar Universitario de Sao Joao, a Portuguese reference centre. All patients undergoing TAVI from January 2015 to June 2018 were recruited and were divided into two groups for analysis: general anaesthesia (GA) and sedation. Results One hundred and seven patients underwent TAVI (GA: n = 24; sedation: n = 83) and the overall incidence of AKI was 14.02%. We found a higher incidence of intraoperative hypotension in the GA group (83.3 vs. 33.7%, p Conclusions It was not possible to established association between the anaesthetic approach for TAVI procedures and postoperative AKI and mortality. Our study reinforces the importance of preventing AKI incidence, considering its impact on the worsening of baseline CKD and on the length of stay, leading to higher hospitalization costs.

Resumen Introduccion y objetivos Se ha reportado que las tecnicas anestesicas tienen un impacto en la incidencia de la lesion renal aguda (LRA) postoperatoria, en pacientes sometidos a implante de valvula aortica transcateter (TAVI). Este estudio tuvo como objetivo evaluar si existe una asociacion entre la tecnica anestesica en pacientes sometidos a TAVI y la incidencia postoperatoria de LRA. Tambien se evaluo la existencia de asociacion entre la tecnica anestesica y la mortalidad. Materiales y metodos Se realizo un estudio observacional retrospectivo en el Centro Hospitalar Universitario de Sao Joao, un centro de referencia portugues. Se recluto a todos los pacientes sometidos a TAVI desde enero de 2015 hasta junio de 2018, dividiendose en dos grupos para analisis: anestesia general (AG) y sedacion. Resultados Ciento siete pacientes fueron sometidos a TAVI (AG: n = 24; sedacion: n = 83) y la incidencia de LRA fue del 14,02%. Encontramos una mayor incidencia de hipotension intraoperatoria en el grupo AG (83,3 vs. 33,7%, p Conclusiones No fue posible establecer una asociacion entre la tecnica anestesica en los procedimientos TAVI y la LRA postoperatoria y la mortalidad. Nuestro estudio refuerza la importancia de prevenir la incidencia de LRA, considerando su impacto en el empeoramiento de la ERC basal y la estancia hospitalaria, incrementando los costes de hospitalizacion.

There has recently been increasing evidence that the use of perioperative intravenous lidocaine infusion possesses analgesic, opioid-sparing and anti-inflammatory effects in surgical patients. Although opioid-sparing and analgesic properties have been strongly supported, the anti-inflammatory features are not well established in elective surgery. Therefore, the aim of this systematic review is to examine the effect of perioperative intravenous lidocaine infusion on postoperative anti-inflammatory status in patients undergoing elective surgery. A search strategy was created to identify suitable randomised clinical trials (RCTs) in PubMed, Scopus, Web of Science and Clinicaltrials.gov databases until January 2023. RCTs that evaluated the effect of intravenous lidocaine infusion, compared with placebo, on adult patients who underwent elective surgery, in inflammatory markers response were included. Exclusion criteria consisted of paediatric patients, animal studies, non-RCT methodology, intervention without intravenous lidocaine, inadequate control group, duplicated samples, ongoing studies and lack of any relevant clinical outcome measures. The following inflammatory markers—interleukin (IL)-6, tumour necrosis factor (TNF)-α, IL-1RA, IL-8, IL-10, C-reactive protein (CRP), IL-1, IL-1β, interferon (IFN)-γ, cortisol, IL-4, IL-17, high-mobility group protein B1 (HMGB1) and transforming growth factor (TGF)-β—were evaluated as outcomes in this review. A total of 21 studies, including 1254 patients, were identified. Intravenous lidocaine infusion significantly reduced the change from IL-6 baseline levels at the end of surgery compared to a placebo (standardised mean difference [SMD]: −0.647, 95% confidence interval [CI]: −1.034 to −0.260). Usage of lidocaine was associated with a significant reduction in other postoperative pro-inflammatory markers, such as TNF-α, IL-1RA, IL-8, IL-17, HMGB-1 and CRP. There was no significant difference in other markers, such as IL-10, IL-1β, IL-1, IFN-γ, IL-4, TGF-β and cortisol. This systematic review and meta-analysis provide support for the administration of perioperative intravenous lidocaine infusion as an anti-inflammatory strategy in elective surgery.

A violência doméstica é atualmente um problema que gera imensa preocupação social, tanto para as vítimas, seus familiares e sociedade, por isso deve ser um tema diariamente discutido e analisado, porque apesar de existir uma grande evolução ao nível do combate deste tipo de crime, o mesmo não se considera ainda suficiente, nomeadamente, na resposta do sistema judicial. A finalidade deste trabalho é revelar quais os aspetos materiais e processuais da violência doméstica. Pata tal, vamos analisar a sua evolução legislativa, designadamente no facto da violência doméstica passar de crime particular a crime público. Além disso, outro objetivo é evidenciar as principais discussões e temas discutidos, tanto na jurisprudência, como na doutrina, e até por diversos autores, neste tipo de crime, como a suspensão provisória do processo, regulação das responsabilidades parentais e o homicídio. O sistema judicial afigura-se noutra forma de preocupação social, pois deveria existir mais celeridade processual na justiça das vítimas, bem como o estudo de estatísticas para a prevenção da violência doméstica. Todos os anos o número de casos arquivados em Portugal mantém-se demasiado alto, por isso, a produção de prova torna-se importante no estudo dos casos, pois a sua ausência levará à absolvição do processo judicial, e consequentemente na maioria dos casos à morte da vítima. Assim, torna-se necessário que a justiça seja imperativa, e consiga resolver urgentemente esta situação para que as vítimas deixem de sofrer e o ciclo da violência possa terminar. Domestic violence is currently a problem that generates social concern, both for the victims, their families and society, so it must be a topic that is discussed and analyzed daily, because although there has been great progress in combating this type of crime, it is still not considered sufficient, particularly in the response of the judicial system. The purpose of this work is to reveal the material and procedural aspects of domestic violence. To that, we will analyze the legislative evolution, namely the fact that domestic violence has changed from a private crime to public crime. In addition, another objective is to highlight the main discussions and topics discussed, both in jurisprudence, as in doctrine, and even by several authors, in this type of crime, such as the provisional suspension of the process, regulation of parental responsibilities and homicide. The judicial system appears in another form of social concern, as there should be more procedural speed in the justice of victims, as well as the study of statistics for the prevention of domestic violence. Every year the number of cases filed in Portugal remains too high, so the production of evidence becomes important in the study of cases, because its absence will lead to the acquittal of the judicial process, and consequently in most cases to the death of the victim. It is necessary for justice to be imperative, and to urgently solve this situation so that the victims no longer suffer and the cycle of violence can end. To demonstrate this problem, I will analyze legal cases that have become final, in order to reflect on the means of evidence that are collected, as well as what they used to justify their decisions, so that we can see what can be improved in the fight against this type of crime.

Emergence and expansion of frequent multidrug-resistant (MDR) major Salmonella clones/serotypes has been a significant threat in the last years. Metal compounds, such as copper, commonly used in animal-production settings, have been pointed out as possible contributors for the selection of such strains/clones. However, the scarcity of studies limits our understanding of the impact of other metal environmental contaminants as arsenic (used in insecticides/herbicides/coccidiostats). We analysed arsenic tolerance (AsT) dispersion by phenotypic and genotypic (PCR/sequencing/I-CeuI/S1/XbaI-PFGE/hybridization) assays among Salmonella with diverse epidemiological and genetic backgrounds. Then, to better understand ars operon genetic contexts, the whole genome of five representative strains was sequenced. We found a high dispersion of ars operons conferring AsT, especially among copper-tolerant and relevant serotypes/clones related to pig-production setting. The acr3-type was found dispersed in the chromosome of diverse serotypes, including the emergent S. Rissen. Conversely, arsBII was almost confined to the MDR ST34 European clone of S. Typhimurium/S. 4,[5],12:i:-, always along with copper/silver tolerance sil + pco clusters in an integrative conjugative element. These data suggest that AsT is an essential adaptive feature for the ecological success of these epidemic clones/serotypes and alerts for global strategies to reduce arsenic-based compounds' impact thus preventing environmental/food contamination with frequent MDR foodborne pathogens.

Summary: Background: Cardiac complications represent the main cause of mortality after non-cardiac surgery and the Revised Cardiac Risk Index (RCRI) was created to estimate the perioperative risk of these events. It considers history of ischaemic heart disease, congestive heart failure, diabetes requiring preoperative insulin, stroke or transient ischaemic attack and renal impairment. We aim to describe the accuracy of the RCRI for predicting perioperative major adverse cardiovascular events (MACE) - a composite of heart failure, ischemic events and all-cause death. Also, the authors aimed to review the score for better prediction of cardiovascular outcomes. Patients and methods: From January 2012 to January 2020, patients who underwent Carotid endarterectomy (CEA) with regional anaesthesia (RA) were selected. RCRI was calculated for each case. Estimated and reported cardiovascular complications were compared using multivariate logistic regression and cox proportional hazards. An alternative and optimized carotid-RCRI (CtRCRI) was obtained. Overall predictive accuracy was assessed and compared by measuring model discrimination. Adjustments for overfitting and evaluation of the new model were performed by bootstrap. Results: 186 patients were selected, of which 80% were male with a mean age of 70.0±9.05 years old. The median follow-up was 50 months, interquartile range 21–69 months. None of the scores were able to predict MACE in the perioperative period. Both were associated with 30-day Clavien-Dindo ≥2 (p=0.022 and p=0.041, respectively). Regarding long-term prognosis, both were able to predict MACE (RCRI: hazard ratio (HR) 3.54 (95% confidence interval [CI] 1.04–11.48) vs. CtRCRI: HR 2.08 (95%CI 1.08–3.98) and all-cause mortality (RCRI: HR 3.33, 95%CI 0.99–11.11 vs. CtRCRI: HR 1.57, 95%CI 1.14–7.04). Conclusions: RCRI and CtRCRI did not predict MACE in the perioperative period but are good predictors of 30-day complications (Clavien-Dindo ≥2). Both RCRI and CtRCRI have good prognostic value as predictors of long-term cardiovascular events.

The expansion of mcr-carrying bacteria is a well-recognized public health problem. Measures to contain mcr spread have mainly been focused on the food-animal production sector. Nevertheless, the spread of MCR producers at the environmental interface particularly driven by the increasing population of gulls in coastal cities has been less explored. Occurrence of mcr-carrying Escherichia coli in gull's colonies faeces on a Portuguese beach was screened over 7 months. Cultural, molecular and genomic approaches were used to characterize their diversity, mcr plasmids and adaptive features. Multidrug-resistant mcr-1-carrying E. coli were detected for 3 consecutive months. Over time, multiple strains were recovered, including zoonotic-related pathogenic E. coli clones (e.g. B2-ST131-H22, A-ST10 and B1-ST162). Diverse mcr-1 genetic environments were mainly associated with ST2/ST4-HI2 (ST10, ST131, ST162, ST354 and ST4204) but also IncI2 (ST12990) plasmids or in the chromosome (ST656). Whole-genome sequencing revealed enrichment of these strains on antibiotic resistance, virulence and metal tolerance genes. Our results underscore gulls as important spreaders of high-priority bacteria and genes that may affect the environment, food-animals and/or humans, potentially undermining One-Health strategies to reduce colistin resistance. info:eu-repo/semantics/publishedVersion

O presente projeto de investigação pretende avaliar as potencialidades e impactos decorrentes da implementação do projeto NAPOCTEP que visa a criação de rotas transfronteiriças entre Portugal e Espanha associadas às Invasões francesas, num território que une a região de Castela e Leão, em Espanha, ao centro de Portugal, integrando municípios como Almeida, Penacova, Mortágua e Mealhada, até às linhas de Torres. O referido projeto teve por base uma candidatura aprovada ao Programa europeu POCTEP V, INTERREG, cuja entidade gestora é a Comunidade Intermunicipal da Região de Coimbra. Assim, através deste trabalho fica evidenciada a importância da existência de uma forte base histórica a qual é fundamental no desenho deste produto turístico inovador. Fica igualmente evidenciada a importância da integração nas Rotas certificadas do Conselho da Europa (Destination Napoleon) pela possibilidade de utilização da marca identificadora do CE. Assim, conclui-se que se trata de uma expressão do turismo militar como instrumento de desenvolvimento e de criação de produtos de qualidade e sustentáveis que enriquecem a oferta de destinos com recursos patrimoniais relevantes. This project intends to assess the potential and impacts arising from the implementation of the Napoctep project, which aims to create cross-border routes between Portugal and Spain associated with the French invasions, in a territory that unites the region of Castile and León, in Spain, with the centre of Portugal, integrating municipalities such as Almeida, Penacova, Mortágua and Mealhada, up to the Torres’ lines. This project was based on an approved application to the European Program POCTEP V, INTERREG, whose managing entity is the Intermunicipal Community of Coimbra Region. Thus, through this work, the importance of the existence of a strong historical base is evidenced, which is fundamental in the design of this innovative tourist product. The importance of integrating the route into the certified Routes of the Council of Europe (Destination Napoleon) is also evidenced by the possibility of using the EC identifying mark. Thus, it is concluded that this is an expression of military tourism as an instrument for the development and creation of quality and sustainable products that enriches the offer of destinations with relevant heritage resources. Mestrado em Gestão e Planeamento em Turismo

Dexmedetomidine (DEX) is an α2-adrenergic receptor agonist used for its sedative, analgesic, and anxiolytic effects. Non-Operating Room Anesthesia (NORA) is a modality of anesthesia that can be done under general anesthesia or procedural sedation or/and analgesia. In this particular setting, a level-2 sedation, such as the one provided by DEX, is beneficial. We aimed to study the effects and safety of DEX in the different NORA settings in the adult population.A systematic review with meta-analysis of randomized controlled trials was conducted. Interventions using DEX only or DEX associated with other sedative agents, in adults (18 years old or more), were included. Procedures outside the NORA setting and/or without a control group without DEX were excluded. MEDLINE, ClinicalTrials.gov, Scopus, LILACS, and SciELO were searched. The primary outcome was time until full recovery. Secondary outcomes included hemodynamic and respiratory complications and other adverse events, among others.A total of 97 studies were included with a total of 6,706 participants. The meta-analysis demonstrated that DEX had a higher time until full recovery (95% CI = [0.34, 3.13] minutes, a higher incidence of hypotension (OR = 1.95 [1.25, 3.05], p = 0.003, IDEX in NORA procedures in adults was associated with a lower incidence of amnesia and respiratory effects but had a long time to recovery and more hemodynamic complications.

In this review, we aim to discuss the use and effect of five different drugs used in the induction of anesthesia in cancer patients. Propofol, fentanyl, rocuronium, sugammadex, and dexamethasone are commonly used to induce anesthesia and prevent pain during surgery. Currently, the mechanisms of these drugs to induce the state of anesthesia are not yet fully understood, despite their use being considered safe. An association between anesthetic agents and cancer progression has been determined; therefore, it is essential to recognize the effects of all agents during cancer treatment and to evaluate whether the treatment provided to the patients could be more precise. We also highlight the use of in silico tools to review drug interaction effects and safety, as well as the efficacy of the treatment used according to different subgroups of patients.

Membrane proteins (MPs) encompass a large family of proteins with distinct cellular functions, and although representing over 50% of existing pharmaceutical drug targets, their structural and functional information is still very scarce. Over the last years, in silico analysis and algorithm development were essential to characterize MPs and overcome some limitations of experimental approaches. The optimization and improvement of these methods remain an ongoing process, with key advances in MPs' structure, folding, and interface prediction being continuously tackled. Herein, we discuss the latest trends in computational methods toward a deeper understanding of the atomistic and mechanistic details of MPs.

Nos últimos anos as obras em edifícios urbanos existentes tornaram-se mais frequentes e mais profundas, transformando parte significativa do parque edificado habitacional urbano. Entre 2014 e 2019 este tipo de obras decorreu ao abrigo de um regime excecional e temporário com a isenção do cumprimento de alguns requisitos da construção. Este regime foi recentemente revogado pelo novo regime aplicável à reabilitação de edifícios e frações autónomas (DL 95/2019) que estabelece princípios e exigências específicas para a reabilitação. Para melhorar a qualidade e a adequação das obras de reabilitação de edifícios, e para assegurar a coerência com os princípios e exigências do novo quadro regulamentar, a reabilitação de edifícios requer apoio técnico-científico complementar. Este apoio deve permitir avaliar edifícios e projetos com critérios estabilizados, no projeto e no controlo prévio de obras. Neste âmbito, instrumentos que apoiem a preservação do património edificado com valor cultural e considerem a otimização do consumo de materiais e de energia, ao longo do ciclo de vida dos edifícios e das suas componentes, são especialmente necessários e oportunos. Este artigo apresenta um instrumento de diagnóstico de valores e de avaliação de impactes destinado ao apoio à decisão em matéria de reabilitação de edifícios habitacionais urbanos, designado método IMPACTE REHURB. Este instrumento permite avaliar e classificar o contributo da reabilitação de edifícios habitacionais para a preservação do valor cultural do património edificado (impacte técnico-cultural) e para a sua eficiência ambiental (impacte energético-ambiental), visando melhorar a cultura e as práticas de reabilitação de edifícios habitacionais urbanos. O artigo descreve a estruturação e procedimento de aplicação do método multicritério proposto, apresenta uma aplicação-piloto e identifica desenvolvimentos futuros, sugerindo a aplicação do método para a operacionalização dos princípios enunciados pelo novo quadro regulamentar em vigor.

Buildings’ refurbishment is becoming a major trend in civil construction in Europe. At the same time European environmental and cultural commitments are being transposed to building and urban regulations. Energy efficiency and heritage safeguarding are two objectives of buildings’ refurbishment policies which do not always lead to the same refurbishment options. Energy efficiency assessment is not always suitable to existing buildings in different local contexts and, while focusing on operational energy, it does not include embodied energy in buildings. This article calculates and combines embodied energy and operational energy, proposing a methodology for the assessment of building components life-cycle energy, suitable for the assessment of repairing and replacing scenarios. The methodology is applied to a case study, comparing walls repair or replacement and considering different scenarios of users’ requirements of thermal comfort. Results show the advantages of preserving building components and materials in terms of whole life cycle energy demand.

Introdução: O consentimento informado é um processo ativo na relação médico-doente, assente em valores éticos e legais. O ato anestésico tem riscos inerentes, que devem ser alvo de consentimento específico. O objetivo deste estudo foi avaliar o grau de implementação do consentimento informado escrito para o ato anestésico no contexto de cirurgia eletiva.Material e Métodos: Estudo observacional prospetivo, num hospital terciário e universitário, em 230 doentes com idade igual ou superior a 60 anos submetidos a cirurgia eletiva entre maio e julho de 2017. Aos doentes elegíveis que consentiram participar, foi realizada entrevista clínica no dia prévio à cirurgia. No pós-operatório, foi averiguada a técnica anestésica realizada, e a existência do consentimento informado por escrito para o ato anestésico e cirúrgico. Doentes incapazes de dar consentimento informado ou admitidos na unidade de cuidados intensivos após cirurgia foram excluídos.Resultados: Em 225 (97,8%) dos doentes, verificou-se a obtenção, por escrito, do consentimento informado para o ato cirúrgico, mas apenas em 96 (41,7%) verificou-se a obtenção por escrito do consentimento informado para o ato anestésico. De entre os doentes sem registo de consentimento informado para o ato anestésico, foram mais prevalentes antecedentes de acidente vascular cerebral, anemia e scores de Charlson e de estado físico conforme à Sociedade Americana de Anestesiologia mais elevados.Discussão: Identificámos uma baixa implementação do consentimento informado escrito para o ato anestésico. Esta situação pode ter importantes implicações em contexto de responsabilidade disciplinar, civil ou penal.Conclusão: Apesar da sua importância, a prática do consentimento informado escrito para o ato anestésico nesta instituição não está implementada regularmente.

Introduction. Patients proposed to vascular noncardiac surgery (VS) have several comorbidities associated with major adverse cardiac events (MACE). We evaluated incidence, predictors, and outcomes, and compared different scores to predict MACE after VS. Methods. We included all patients admitted from 2006 to 2013. Perioperative MACE included cardiac arrhythmias, myocardial infarction (MI), cardiogenic pulmonary edema (CPE), acute heart failure (AHF), and cardiac arrest (CA). Lee Revised Cardiac Risk Index (RCRI), Vascular Quality Initiative (VQI-CRI), Vascular Study Group of New England (VSG-CRI), and South African Vascular Surgical (SAVS-CRI) Cardiac Risk Indexes were calculated and analyzed. We performed multivariate logistic regression to assess independent predictors with calculation of odds ratio (OR) and 95% confidence interval (CI). To reduce overfitting, we used leave-one-out cross-validation approach. The Predictive ability of scores was tested using area under receiver operating characteristic curve (AUROC). Results. A total of 928 patients were included. We observed 81 MACE (28 MI, 22 arrhythmias, 10 CPE, 9 AHF, 12 CA) in 60 patients (6.5%): 3.3% in intermediate-risk surgery and 9.8% in high-risk surgery. Previous history of coronary artery disease (OR = 3.2, CI = 1.8-5.7), atrial fibrillation (OR = 5.1, CI = 2.4-11.0), insulin-treated diabetes mellitus (OR = 3.26, CI = 1.51-7.06), mechanical ventilation (OR = 2.75, CI = 1.41-4.63), and heart rate (OR = 1.02, CI = 1.01-1.03) at admission were considered independent risk factors in multivariate analysis. The AUROC of our model was 0.79, compared with RCRI (0.66), VSG-CRI (0.69), VQI-CRI (0.71), and SAVS-CRI (0.73). Conclusions. Observed MACE were within predicted range (1% to 5% after intermediate-risk surgery and >5% after high-risk surgery). SAVS-CRI and VQI-CRI had slightly better predictive capacity than VSG-CRI or RCRI.

Due to the advances in anesthetics and surgery, ambulatory surgery plays an increasingly important role. This regimen, despite showing several advantages, still instills fear in patients. The aim of this was to evaluate the level of knowledge and the perspective of patients regarding ambulatory surgery.A prospective study was carried out for two months in patients with pre-anesthetic consultation at a University Hospital Center. Demographic information, educational level, and previous ambulatory surgery were surveyed. Patients' level of knowledge about surgery, satisfaction, and the perceived advantages and fears regarding this regimen were evaluated. The analysis was performed with SPSS, and p0.05 was considered statistically significant.Two hundred and fifty-one patients were included. One hundred and twenty-eight (51%) patients disclosed having knowledge about ambulatory surgery. The main advantages perceived by patients were more peaceful recovery (44.7%), avoiding being surrounded by other patients (43.1%), and avoiding infection (37.2%). The main fears shown by patients were poor pain control (20.7%), having other health problems (13.1%), and poor control of nausea or vomiting (10%).Patients may benefit from being more informed about the ambulatory surgical regimen in order to decrease their fears and increase their acceptance of the regimen. Providing more information to patients may result in increased satisfaction with this regimen.Introdução: Com os avanços observados a nível anestésico e cirúrgico, a cirurgia em regime de ambulatório tem cada vez mais expressão. Este regime, apesar das várias vantagens para os doentes, acarreta também vários receios. Os objetivos deste estudo foram avaliar o nível de conhecimento e a perspetiva dos doentes sobre a cirurgia em ambulatório. Material e Métodos: Estudo prospetivo decorrido durante dois meses em doentes com consulta pré-anestésica num Centro Hospitalar Universitário. Foi inquirida informação demográfica, nível educacional e existência de cirurgia prévia em regime de ambulatório. Foram avaliados o nível de conhecimento dos doentes, a satisfação, as vantagens e receios relativos à cirurgia em regime de ambulatório. A análise foi feita com SPSS (v 27.0) e p0,05 foi considerado como estatisticamente significativo. Resultados: Foram incluídos 251 doentes. Destes, 128 (51%) doentes demostraram ter conhecimento sobre a cirurgia de ambulatório. As principais vantagens percebidas pelos doentes foram ter uma recuperação mais sossegada (44,7%), evitar estar rodeado de outros doentes (43,1%) e evitar infeção (37,2%). Os principais receios mostrados pelos doentes foram o mau controlo da dor (20,7%) e de náuseas/vómitos (10%) e ter outros problemas de saúde (13,1%). Conclusão: Os doentes poderão beneficiar de ser mais informados sobre o regime cirúrgico em ambulatório de forma a diminuir os seus receios e aumentar a sua satisfação. Investir na informação do doente poderá aumentar a aceitação do regime de ambulatório.

High-throughput screening technologies continues to produce large amounts of multiomics data from different populations and cell types for various diseases, such as cancer. However, analysis of such data encounters difficulties due to cancer heterogeneity, further exacerbated by human biological complexity and genomic variability. There is a need to redefine the drug discovery development pipeline, bringing an Artificial Intelligence (AI)-powered informational view that integrates relevant biological information and explores new ways to develop effective anticancer approaches. Here, we show SynPred, an interdisciplinary approach that leverages specifically designed ensembles of AI-algorithms, links omics and biophysical traits to predict synergistic anticancer drug synergy. SynPred exhibits state-of-the-art performance metrics: accuracy – 0.85, precision – 0.77, recall – 0.75, AUROC – 0.82, and F1-score - 0.76 in an independent test set. Moreover, data interpretability was achieved by deploying the most current and robust feature importance approaches. A simple web-based application available online at http://www.moreiralab.com/resources/synpred/ was constructed to predict synergistic anticancer drug combinations requiring only the upload of the two drug SMILES to be tested, allowing easy access by non-expert researchers.

Antimicrobial resistance (AMR) is a global societal challenge requiring the contribution of professionals along with general community citizens for their containment. Portugal is one of the European countries where a lack of knowledge on the correct use of antimicrobials and AMR problematic is preeminent. Moreover, youth demotivation to pursue science careers is emerging. To address these problems an innovative experimental service-learning pedagogical strategy, MicroMundo@UPorto, was implemented in Portugal during 2018 through University of Porto as a partner of the global Citizen Science project ‘Tiny Earth’ responding to the AMR crisis. In this first edition of MicroMundo@UPorto, university students (n = 41; Pharmaceutical Sciences and Nutrition Sciences) organized in eight teams tutored by university professors/researchers (n = 13) on Microbiology and AMR theoretical and practical aspects as well on communication skills to enable their guidance of younger school students (n = 140/3 schools) in experiments to discover antimicrobial-producing microorganisms while exploring the soil microbial diversity. Post-survey-based evaluation revealed that this project allowed university students to acquire diverse personal, social and scientific skills while increasing AMR awareness, in the One-Health perspective, and interest for science in school students. This University to Society approach can be successfully extended across Portugal and for education in Microbiology in general, with benefits for the future generations contributing to socially responsible and scientifically-literate citizens.

Membrane proteins (MPs) encompass a large family of proteins with distinct cellular functions, and although representing over 50% of existing pharmaceutical drug targets, their structural and functional information is still very scarce. Over the last years, in silico analysis and algorithm development were essential to characterize MPs and overcome some limitations of experimental approaches. The optimization and improvement of these methods remain an ongoing process, with key advances in MPs' structure, folding, and interface prediction being continuously tackled. Herein, we discuss the latest trends in computational methods toward a deeper understanding of the atomistic and mechanistic details of MPs.

Arsenic (As), mercury (Hg), and copper (Cu) are among the major historical and contemporary metal pollutants linked to global anthropogenic activities. Enterococcus have been considered indicators of fecal pollution and antibiotic resistance for years, but its largely underexplored metallome precludes understanding their role as metal pollution bioindicators as well. Our goal was to determine the occurrence, diversity, and phenotypes associated with known acquired genes/operons conferring tolerance to As, Hg or Cu among Enterococcus and to identify their genetic context (381 field isolates from diverse epidemiological and genetic backgrounds; 3547 enterococcal genomes available in databases representing a time span during 1900 & ndash;2019). Genes conferring tolerance to As (arsA), Hg (merA) or Cu (tcrB) were used as biomarkers of widespread metal tolerance operons. Different variants of metal tolerance (MeT) genes (13 arsA, 6 merA, 1 tcrB) were more commonly recovered from the food-chain (arsA, tcrB) or humans (merA), and were shared with 49 other bacterial taxa. Comparative genomics analysis revealed that MeT genes occurred in heterogeneous operons, at least since the 1900s, with an increasing accretion of antibiotic resistance genes since the 1960's, reflecting diverse antimicrobial pollution. Multiple MeT genes were co-located on the chromosome or conjugative plasmids flanked by elements with high potential for recombination, often along with antibiotic resistance genes. Phenotypic analysis of some isolates carrying MeT genes revealed up to 128 & times; fold increase in the minimum inhibitory concentrations to metals. The main distribution of functional MeT genes among Enterococcus faecium and Enterococcus faecalis from different sources, time spans, and clonal lineages, and their ability to acquire diverse genes from multiple taxa bacterial communities places these species as good candidates to be used as model organisms in future projects aiming at the identification and quantification of bioindicators of metal polluted environments by anthropogenic activities.

Carbapenemases inactivate most β-lactam antibiotics, including carbapenems, and have frequently been reported among Enterobacteriaceae , Acinetobacter spp. and Pseudomonas spp. Traditionally, the horizontal gene transfer of carbapenemase-encoding genes (CEGs) has been linked to plasmids. However, given that integrative and conjugative elements (ICEs) are possibly the most abundant conjugative elements among prokaryotes, we conducted an in silico analysis to ascertain the likely role of ICEs in the spread of CEGs among all bacterial genomes (n=182 663). We detected 17 520 CEGs, of which 66 were located within putative ICEs among several bacterial species (including clinically relevant bacteria, such as Pseudomonas aeruginosa , Klebsiella pneumoniae and Escherichia coli ). Most CEGs detected within ICEs belong to the IMP, NDM and SPM metallo-beta-lactamase families, and the serine beta-lactamase KPC and GES families. Different mechanisms were likely responsible for acquisition of these genes. The majority of CEG-bearing ICEs belong to the MPFG, MPFT and MPFF classes and often encode resistance to other antibiotics (e.g. aminoglycosides and fluoroquinolones). This study provides a snapshot of the different CEGs associated with ICEs among available bacterial genomes and sheds light on the underappreciated contribution of ICEs to the spread of carbapenem resistance globally.

Poultry products are still an important cause of Salmonella infections worldwide, with an increasingly reported expansion of less-frequent serotypes or atypical strains that are frequently multidrug-resistant. Nevertheless, the ability of Salmonella to survive antimicrobials promoted in the context of antibiotic reducing/replacing and farming rethinking (e.g., organic acids and copper in feed/biocides) has been scarcely explored. We investigated Salmonella occurrence (conventional and molecular assays) among chicken meat at the processing stage (n = 53 batches/29 farms) and characterized their tolerance to diverse stress factors (antibiotics, copper, acid pH, and peracetic acid). Whole-genome sequencing was used to assess adaptive features and to perform comparative analysis. We found a low Salmonella occurrence (4%) and identified S. Enteritidis/ST11 plus atypical non-H2S-producing S. 1,4,[5],12:i:-/ST3478. The ST3478 presented the ability to grow under diverse stresses (antibiotics, copper, and acid-pH). Comparative genomics among ST3478 isolates showed similar antibiotic/metal resistance gene repertoires and identical nonsense phsA thiosulfate reductase mutations (related to H2S-negative phenotype), besides their close phylogenetic relationship by cgMLST and SNPs. This study alerts for the ongoing national and international spread of an emerging monophasic Salmonella Typhimurium clonal lineage with an enlarged ability to survive to antimicrobials/biocides commonly used in poultry production, being unnoticed by conventional Salmonella detection approaches due to an atypical non-H2S-producing phenotype.

Targeting protein-protein interactions is a challenge and crucial task of the drug discovery process. A good starting point for rational drug design is the identification of hot spots (HS) at protein-protein interfaces, typically conserved residues that contribute most significantly to the binding. In this chapter, we depict point-by-point an in-house pipeline used for HS prediction using only sequence-based features from the well-known SpotOn dataset of soluble proteins (Moreira et al., Sci Rep 7:8007, 2017), through the implementation of a deep neural network. The presented pipeline is divided into three steps: (1) feature extraction, (2) deep learning classification, and (3) model evaluation. We present all the available resources, including code snippets, the main dataset, and the free and open-source modules/packages necessary for full replication of the protocol. The users should be able to develop an HS prediction model with accuracy, precision, recall, and AUROC of 0.96, 0.93, 0.91, and 0.86, respectively.

Targeting protein-protein interactions is a challenge and crucial task of the drug discovery process. A good starting point for rational drug design is the identification of hot spots (HS) at protein-protein interfaces, typically conserved residues that contribute most significantly to the binding. In this chapter, we depict point-by-point an in-house pipeline used for HS prediction using only sequence-based features from the well-known SpotOn dataset of soluble proteins (Moreira et al., Sci Rep 7:8007, 2017), through the implementation of a deep neural network. The presented pipeline is divided into three steps: (1) feature extraction, (2) deep learning classification, and (3) model evaluation. We present all the available resources, including code snippets, the main dataset, and the free and open-source modules/packages necessary for full replication of the protocol. The users should be able to develop an HS prediction model with accuracy, precision, recall, and AUROC of 0.96, 0.93, 0.91, and 0.86, respectively.