Search

Introduction and objectives: Heart failure (HF) is a clinical syndrome associated with substantial morbidity, mortality, and healthcare costs. Dapagliflozin has proven efficacy in reducing the risk of death and hospitalization in HF patients, regardless of left ventricular ejection fraction (LVEF). This paper aimed to project the potential impact of dapagliflozin on healthcare costs related to HF subsequent hospitalizations (HFHs) in Portuguese hospitals. Methods: The total number of HF-related hospitalizations (hHF), HFHs, and the average length of stay for patients with a primary diagnosis of HF from six Portuguese hospitals, between January 2019 and December 2021, were collected and aggregated by hospital classification. Costs associated with HFHs were calculated according to Portuguese legislation and considering conservative, average, and complex approaches. Cost-saving projections were based on extrapolations from hHF risk reductions reported in dapagliflozin clinical trials. Results: Considering a 26% risk reduction in hHF reported on pooled-analysis of DAPA-HF and DELIVER as the expected reduction in HFHs, the use of dapagliflozin would be associated with cost savings ranging from EUR 1 612 851.54 up to EUR 6 587 360.09, when considering all hospitals and the different approaches, between 2019 and 2021. A similar projection is observed based on 24% RRR derived by weighting DAPA-HF and DELIVER sub-analyses and PORTHOS epidemiological data. Conclusions: In this projection, dapagliflozin use in all eligible hHF patients is associated with a significant reduction in direct costs. Our data support that, in addition to the improvements in HF-related outcomes, dapagliflozin may have a significant economic impact on healthcare costs in Portuguese hospitals. Resumo: Introdução e objetivos: A insuficiência cardíaca (IC) é uma síndrome clínica associada a uma elevada morbidade, mortalidade e despesa com custos de saúde. A dapagliflozina demonstrou ser eficaz na redução do risco de morte e hospitalização em doentes com IC, independentemente da fração de ejeção do ventrículo esquerdo. Este artigo visa projetar o potencial impacto da dapagliflozina na redução dos custos relacionados com hospitalizações subsequentes por IC em hospitais portugueses. Métodos: Foi recolhido, e posteriormente analisado de forma agregada em clusters, o número total de hospitalizações por IC, hospitalizações subsequentes por IC e duração média de internamento dos doentes com diagnóstico primário de IC em seis hospitais portugueses, entre janeiro de 2019 e dezembro de 2021. Os custos relacionados com hospitalizações subsequentes por IC foram calculados de acordo com a legislação portuguesa e tendo em consideração três abordagens – conservadora, média e complexa. A projeção da redução de custos teve por base as reduções do risco relativo (RRR) de hospitalizações por IC (hIC) reportadas nos ensaios clínicos com dapagliflozina. Resultados: Considerando uma RRR de 26% do risco de hospitalização subsequente por IC, com base no valor reportado na análise agregada dos estudos DAPA-HF e DELIVER relativa à RRR de hIC, a nossa projeção indica que a utilização da dapagliflozina resulta numa redução de custos. De acordo com a nossa projeção a redução de custos oscila entre €1,612,851.54 e €6,587,360.09, entre 2019 e 2021, ao considerar todos os hospitais envolvidos e as diferentes abordagens metodológicas. A projeção aponta para um resultado similar tendo por base uma RRR de 24%, resultante da ponderação das subanálises de DAPA-HF e DELIVER, juntamente com dados epidemiológicos do estudo PORTHOS. Conclusões: Nesta projeção, a utilização de dapagliflozina, em todos os doentes hospitalizados por IC que sejam elegíveis, está associada a uma redução direta significativa nos custos hospitalares. Estes dados reforçam a ideia de que, para além da melhoria nos resultados de saúde relacionados com a IC, a dapagliflozina pode ter um impacto significativo nos hospitais portugueses ao nível dos custos de saúde.

Background and aims: The balm of Gilead, steeped in cultural significance, remains enigmatic due to its undefined composition and preparation methods. This study aims to recreate a formulation inspired by this elusive balm, combining historical insights with modern botanical knowledge. Methods: The study employed Populus balsamifera seeds infused with organic olive oil, mirroring historical practices. Essential oils—myrrh, frankincense, and cedar—were selected. Evaluation encompassed appearance, texture, aroma, and pH alignment with historical context and dermatological compatibility. Results: The formulated balm exhibited a smooth texture, earthy aroma, and a pH of 5.5, akin to skin’s natural acidity. These attributes echoed historical practices and holistic approaches. Conclusion: While the formulation mirrors historical attributes, challenges persist due to the genuine balm’s undefined composition. The study highlights the potential of employing Populus balsamifera due to limitations. Future directions include chemical analyses and clinical studies to validate therapeutic potential, bridging historical wisdom with contemporary science.

IntroductionIn “Do-It-Yourself” (DIY) stores, workers from the wood department are considered woodworkers. Given the health risks associated with woodworking, particularly from fungi and their metabolites, this study aims to assess microbial contamination and health risks for both workers and customers.MethodsThe study was developed in 13 DIY stores in Lisbon Metropolitan Area, Portugal. It employed a comprehensive sampling approach combining active (MAS-100, Andersen six-stage, Coriolis μ, and SKC Button Aerosol Sampler) and passive (electrostatic dust collectors, surface swabs, e-cloths, settled dust, filters from vacuumed dust, filtering respiratory protection devices, and mechanical protection gloves) methods to assess microbial contamination. A Lighthouse Handheld Particle Counter HH3016- IAQ was used to monitor the particulate matter size, temperature, and humidity.ResultsThe wood exhibition area presented the highest fungal load, while the payment area exhibited the highest bacterial load. MAS-100 detected the highest fungal load, and surface swabs had the highest bacterial load. Penicillium sp. was the most frequently observed fungal species, followed by Aspergillus sp. Mycotoxins, namely mycophenolic acid, griseofulvin, and aflatoxin G1, were detected in settled dust samples and one filter from the vacuum cleaner from the wood exhibition area. Cytotoxicity evaluation indicates the wood-cutting area has the highest cytotoxic potential. Correlation analysis highlights relationships between fungal contamination and particle size and biodiversity differences among sampling methods.DiscussionThe comprehensive approach applied, integrating numerous sampling methods and laboratory assays, facilitated a thorough holistic analysis of this specific environment, enabling Occupational and Public Health Services to prioritize interventions for accurate exposure assessment and detailed risk management.

Introduction and objectives: Current epidemiological data on heart failure (HF) in Portugal derives from studies conducted two decades ago. The main aim of this study is to determine HF prevalence in the Portuguese population. Using current standards, this manuscript aims to describe the methodology and research protocol applied. Methods: The Portuguese Heart Failure Prevalence Observational Study (PORTHOS) is a large, three-stage, population-based, nationwide, cross-sectional study. Community-dwelling citizens aged 50 years and older will be randomly selected via stratified multistage sampling. Eligible participants will be invited to attend a screening visit at a mobile clinic for HF symptom assessment, anthropomorphic assessment, N-terminal pro-B-type natriuretic peptide (NT-proBNP) testing, one-lead electrocardiogram (ECG) and a sociodemographic and health-related quality of life questionnaire (EQ-5D). All subjects with NT-proBNP ≥125 pg/mL or with a prior history of HF will undergo a diagnostic confirmatory assessment at the mobile clinic composed of a 12-lead ECG, comprehensive echocardiography, HF questionnaire (KCCQ) and blood sampling. To validate the screening procedure, a control group will undergo the same diagnostic assessment. Echocardiography results will be centrally validated, and HF diagnosis will be established according to the European Society of Cardiology HF guidelines. A random subsample of patients with an equivocal HF with preserved ejection fraction diagnosis based on the application of the Heart Failure Association preserved ejection fraction diagnostic algorithm will be invited to undergo an exercise echocardiography. Conclusions: Through the application of current standards, appropriate methodologies, and a strong research protocol, the PORTHOS study will determine the prevalence of HF in mainland Portugal and enable a comprehensive characterization of HF patients, leading to a better understanding of their clinical profile and health-related quality of life. Resumo: Introdução e objetivos: Os dados epidemiológicos atuais sobre insuficiência cardíaca (IC) em Portugal provêm de estudos realizados há mais de duas décadas. O objetivo principal deste estudo é determinar a prevalência da síndrome de IC na população portuguesa com 50 ou mais anos, sendo, especificamente, objetivo deste artigo descrever as abordagens metodológicas e o protocolo de investigação aplicados. Métodos: O Estudo de Prevalência de Insuficiência Cardíaca em Portugal (PORTHOS) é um estudo observacional transversal de grande dimensão, de base populacional, nacional, constituído por três fases. Serão selecionados aleatoriamente por amostragem estratificada multietapas cidadãos com 50 ou mais anos residentes na comunidade em Portugal. Os participantes elegíveis serão convidados a participar numa visita de triagem, que decorrerá numa clínica móvel, durante a qual serão submetidos a avaliação de sintomas de IC, avaliação antropomórfica, um teste de N-terminal pró-peptídeo natriurético tipo B (NT-proBNP), eletrocardiograma de 1 derivação, questionários sociodemográficos e questionário de qualidade de vida relacionada à saúde (EQ-5D). Todos os participantes com NT-proBNP ≥125 pg/mL ou história prévia de IC serão submetidos a uma avaliação diagnóstica confirmatória composta por eletrocardiograma de 12 derivações, ecocardiografia completa, questionário de IC (KCCQ) e colheita de sangue. Para validar o procedimento de triagem, um grupo controlo passará pela mesma avaliação diagnóstica. Os resultados dos ecocardiogramas realizados serão validados centralmente e o diagnóstico de IC será confirmado de acordo com as recomendações de IC da Sociedade Europeia de Cardiologia. Uma subamostra aleatória de participantes com diagnóstico questionável de IC com fração de ejeção preservada (ICFEp), após a aplicação do algoritmo de diagnóstico de fração de ejeção preservada da Heart Failure Association (HFA-PEFF) será convidada a realizar ecocardiografia de esforço. Conclusão: Através da aplicação das recomendações atuais e abordagens metodológicas adequadas, o estudo PORTHOS irá determinar a prevalência da IC em Portugal Continental e permitir uma caracterização abrangente dos doentes com IC, para melhor compreensão do seu perfil clínico e qualidade de vida relacionada com a saúde.

Elderberry (Sambucus nigra L.) hydrolate, derived from domestic steam distillation, holds promise as a multifunctional ingredient for skincare and cosmetic applications. This study investigates the chemical composition and biological activities of elderberry hydrolate obtained through steam distillation. Despite the growing interest in elderberry hydrolate, there has been a lack of comprehensive studies elucidating its chemical composition and potential bioactive constituents. To address this gap, we conducted a detailed analysis of elderberry hydrolate’s composition, antioxidant activity, and antigenotoxicity. Genotoxic evaluation and antioxidant assays (ABTS, DPPH) were conducted to assess its biological properties. We obtained elderberry hydrolate with a notable transfer of aromatic compounds through the steam distillation process, highlighting its efficacy and sustainability. The chemical characterization identified vital compounds, including phenylacetaldehyde, 2-acetyl-pyrrole, and an unidentified major component, collectively contributing to the hydrolate’s aromatic and biological properties. The genotoxic evaluation using the Comet assay demonstrated the hydrolate’s protective effects against DNA damage induced by hydrogen peroxide and streptonigrin. The optimal DNA protection was observed at 10% (w/v), attributed to the antioxidant activity of the identified compounds. The hydrolate exhibited significant antioxidant potential, demonstrating concentration-dependent responses and correlating higher concentrations with increased antioxidant activity. These findings underscore the multifaceted attributes of elderberry hydrolate, positioning it as a promising natural ingredient for skincare. This study supports elderberry hydrolate as a valuable natural and sustainable product development resource.

Scissor bite does not correct spontaneously. It gradually worsens by overeruption, negatively affecting masticatory function. It is intended with this manuscript to evaluate the different treatment strategies to correct this malocclusion in adult patients, exploring treatment with clear aligners, bite ramps, and MS (miniscrews), especially in this case of a patient with unilateral right scissor bite, with high dental compensation in the three planes of space, asymmetrical sagittal dental position, overeruption on the scissor bite condition, and a high mandibular arch constriction and maxillary expansion. A comprehensive literature research was performed from 2002 until March 2023. PubMed and BVS databases were used, with the following keywords: “scissor bite OR brodie bite” AND “malocclusion” AND “treatment OR correction OR therapeutics”. Since correcting skeletal asymmetries after the growth completion is challenging, adult patient cases often involve a combined orthodontic-surgical approach. In the present clinical case, the severe limitations to decompensating tooth positions for a surgical treatment, with the necessity to perform lower asymmetric extraction and a must longer orthodontic treatment, were the major reasons to avoid the surgical approach, after the scissor bite correction. In spite of this, the efficiency of the clear aligners and auxiliaries like bite ramps, MS, and elastics in successfully correcting a complex scissor bite in an adult patient was demonstrated, with significant esthetic and functional commitment, demonstrated by the case reliability PAR (peer assessment rating) index.

Lemon essential oil, derived from Citrus limon, possesses diverse health-promoting properties, including antioxidant, antimicrobial, and mood-enhancing effects. Despite its traditional use in aromatherapy and complementary medicine, there is a need for comprehensive investigations into its therapeutic potential, particularly in mitigating DNA damage and supporting health in palliative care settings. This study aimed to evaluate the antigenotoxic effects of lemon essential oil in human peripheral blood mononuclear cells and to explore its potential applications in palliative care. Treatment with lemon essential oil significantly reduced DNA damage, with 1% w/v with 3.13% DNA in tail demonstrating greater efficacy. Furthermore, lemon essential oil attenuated streptonigrin-induced DNA damage, suggesting a potential protective effect against oxidative stress, especially at 3% w/v, with 11.81% DNA in tail. Compared to olive oil treatment, the DNA damage was significantly lower with streptonigrin treatment alone, which had 47.06% DNA in tail, while the olive oil treatment resulted in 36.88% DNA in tail. These results can be attributed to the main constituents: limonene in lemon essential oil and oleic acid in olive oil. These results suggest a potential role in mitigating oxidative stress and supporting genomic stability. Further research is warranted to elucidate the mechanisms of action and clinical applications in palliative care.

Na obra intitulada Vésperas (2002), a autora Adriana Lunardi traz ao leitor os últimos momentos da vida de grandes escritoras da literatura mundial, como Virginia Woolf, Dorothy Parker, Katherine Mansfield, Sylvia Plath, Zelda Fitzgerald, dentre outras, entretanto os contos não são uma biografia destas. Os fatos ocorridos na vida das autoras, aliados à realidade, são transpassados por situações, recortes e personagens que existiram nas obras de cada uma delas, o que chamamos de curadoria polifônica (RABELO, 2021). No conto “Dottie”, que retoma a autora americana Dorothy Parker, vemos uma relação entre a vida da autora, tanto em seus roteiros e contos publicados, quanto com particularidades da vida. Assim, em um processo curatorial polifônico, que tem em Lunardi sua autora curadora, este artigo pretende analisar o conto “Dottie”, principalmente seus aspectos relacionados com a solidão e a morte, temas recorrentes também nas obras e na vida da autora americana, e em diálogo com Michel Schneider, no ensaio “Desculpem-me pelo pó”, publicado no livro Mortes Imaginárias (2005). Serão usados como aporte teórico os estudos de Ariés (2003), Bakhtin (2018), Bloom (1991), Minois (2019), Morin (1997), Villa-Forte (2019) e outros que se mostrarem relevantes.

Urinary tract infection is an important cause of hospitalization, morbidity and mortality, being responsible for an important fraction of health expenses. The main risk factors are urine flow obstruction, urinary catheters, immunosuppression and diabetes mellitus. We present a case of pyelonephritis that culminated in nephrectomy, finally unravelling an unexpected diagnosis. A 52-year-old male presented in the emergency department with two weeks of pain in the left iliac fossa that irradiated to the lumbar region and cloudy urine. Lab work revealed severe anaemia (4.9 g/dL), inflammatory markers elevation, leucoerythrocyturia, serum creatinine of 4.33 mg/dL and metabolic acidosis. Computed tomography scan showed a swollen left kidney with a staghorn calculus and intraparenchymal hypodensities. After a failed trial of large spectrum antibiotics, he was submitted to left radical nephrectomy with significant clinical improvement. Gross examination showed a markedly dilated pyelocalicial tree, filled with several staghorn calculi and purulent secretions with associated parenchymal atrophy. Histopathologic evaluation revealed exuberant chronic pyelonephritis with an acute inflammatory infiltrate that extended into the perinephric fat and multiple Schistosoma ova, predominantly calcified. The authors describe the case of a severe pyelonephritis with exuberant clinical and imagiological features and rare microbiological findings, suggesting previous genitourinary Schistosomiasis that predisposed to nephrolithiasis and chronic pyelonephritis.

Chemotherapy-associated cardiotoxicity is a common adverse event. Immune checkpoint inhibitors (ICI) – a new class of monoclonal antibodies – have revolutionized the management of various diseases. Their use is expected to increase in the near future and their cardiac side effects have been increasingly recognized. Clinical case: We describe a case of a 67-year-old female patient with urothelial carcinoma undergoing treatment with pembrolizumab who presented to the emergency department with progressive fatigue, retrosternal pain and palpitations for three days. On admission she was diagnosed with acute heart failure (HF). The electrocardiogram revealed a right bundle branch block and ventricular bigeminy. Blood tests showed elevated troponin I, while transthoracic echocardiography revealed severe left ventricular dysfunction. Coronary angiography excluded coronary artery disease. Cardiac magnetic resonance revealed moderate left ventricular dysfunction and late gadolinium enhancement typical of myocarditis. Endomyocardial biopsy confirmed the diagnosis of lymphocytic myocarditis. In the first 48h of hospitalization, she developed transient complete AV block. Corticoid and HF therapy were initiated, leading to symptom improvement and disappearance of the rhythm disturbances. She was discharged on the 12th day, maintaining moderate LV dysfunction, which improved only mildly at a subsequent outpatient assessment. She died suddenly 35 days after discharge. Conclusion: Lymphocytic myocarditis is a serious cardiac side effect of ICI therapy. Pembrolizumab is increasingly used, so it is important to be aware of its effects, in order to perform an early diagnosis and provide adequate treatment. Corticosteroid therapy seems to be crucial in preventing disease progression and enabling ventricular remodeling. Resumo: Introdução: A cardiotoxicidade associada à quimioterapia é um evento adverso comum. Uma nova classe de anticorpos monoclonais – inibidores dos checkpoints imunes – tem revolucionado o tratamento de várias neoplasias, é expectável num futuro próximo o aumento da sua prescrição. Os efeitos colaterais cardíacos são cada vez mais reconhecidos. Caso clínico: Descrevemos o caso de uma doente de 67 anos com carcinoma urotelial sob pembrolizumab, admitida no serviço de urgência (SU) por fadiga, dor retrosternal e palpitações com três dias de evolução. No SU foi diagnosticada com insuficiência cardíaca aguda. O ECG relevou bloqueio completo de ramo direito e bigeminismo ventricular e na avaliação analítica com elevação dos biomarcadores de necrose miocárdica.O ecocardiograma transtorácico revelou disfunção ventricular esquerda grave. A coronariografia excluiu doença coronária. A ressonância cardíaca evidenciou disfunção moderada e padrão sugestivo de miocardite. A biópsia do miocárdio confirmou o diagnóstico de miocardite linfocítica. Nas primeiras 48 h de internamento apresentou períodos de bloqueio AV completo. Foi iniciada corticoterapia e terapêutica neuro-humoral, com rápida melhoria clínica e maior estabilidade elétrica. A doente teve alta ao 12.° dia, mantendo disfunção ventricular moderada. Em ambulatório, foi avaliada apresentando uma ligeira melhoria da fração de ejeção. Ao 35.° dia após alta, a doente faleceu. Conclusão: A miocardite linfocítica é um evento adverso grave associado à imunoterapia. O uso do pembrolizumab tem aumentado, é importante conhecer os seus efeitos adversos, para permitir um diagnóstico precoce e uma adequada terapêutica. A corticoterapia parece ser crucial na prevenção da progressão da doença e no remodeling ventricular.

Background: Thigh fat is associated with high cardiometabolic risks, attenuate risk for dyslipidemia, and glucose intolerance. Aerobic exercise has been linked to fat metabolization due to the increase of free fatty acid oxidation and the preservation of muscle glycogen. Plaster therapy, a beauty treatment that allows the quick elimination or reduction of cellulite, flaccid skin, and localized fat, eliminating liquid from the body, producing improvements that are not only aesthetic but also health-wise, may be used to maximize fat loss in the thigh area and complement exercise. The aim of this study was to analyze the effect of plaster therapy in combination with aerobic exercise on thigh fat. Methods: Six female volunteers were randomly divided into an intervention group (TG; n = 3) performing an aerobic exercise with plaster therapy and a control group (CG; n = 3) performing only aerobic exercise. Subcutaneous fat was estimated by the analysis of skinfolds and thigh perimeters. Results: The treatment group demonstrated a significant decrease (p ≤ 0.05) in subcutaneous fat at the left and right perimeters and thigh skinfold measurements at the end of the 10-session protocol. Conclusion: Comparing skinfold measurements, both groups revealed a statistically significant decrease in the perimeter of both left and right thighs. Furthermore, skinfold measurements showed, for the treatment groups, significant statistical results in the thigh area. Exercise is indeed one of the most critical components for the metabolism of fat. Plaster therapy in combination with aerobic exercise seems to be effective for thigh fat reduction.

Context: Premature ventricular contractions (PVCs) originating in the right ventricular outflow tract (RVOT) are traditionally considered idiopathic and benign. Echocardiographic conventional measurements are typically normal. Aims: To assess whether right ventricle longitudinal strain, determined by two-dimensional speckle tracking echocardiography, differ between RVOT PVCs patients (treated with catheter ablation) and healthy controls. Methods: We retrospectively selected patients with PVCs from the RVOT who underwent electrophysiological study and catheter ablation between 2016 and 2019. Patients with documented structural heart disease were excluded. Transthoracic echocardiography was performed and right ventricle global longitudinal strain (RV-GLS), free wall longitudinal strain (RVFW-LS) and left ventricle global longitudinal strain (LV-GLS) were determined as well as conventional ultrasound measurements of RV and LV function. Results: We studied 21 patients with RVOT PVCs and 13 controls. Patients with PVCs from the RVOT had lower values of RV-GLS and RVFW-LS compared with the control group (−19.4% versus −22.5%, P = 0.015 and −22.1% versus −25.5, P = 0.041, respectively). They also had lower values of LV-GLS, although still within the normal range (−19.1% versus −20.9%, P = 0.047). Regarding RVOT PVCs patients only, RV-GLS and RVFW-LS had no correlation with the PVCs burden prior to catheter ablation and they did not differ between the patients in whom the catheter ablation was successful and those in whom it was not. RV-GLS also had a positive correlation with RVOT proximal diameter (r = 0.487, P = 0.025). Conclusions: In this group of RVOT PVCs patients, we found worse RV longitudinal strain values (and therefore sub-clinical myocardial dysfunction) when compared to healthy controls.

The aim of this work was to assess the natural microbiota of packed fresh-cut apples during refrigerated storage. Two different films were tested for the package, a biodegradable (PLA) film and a conventional and commercial one (OPP). Two antioxidant additives were applied, a natural olive pomace extract and the commercial ascorbic acid used by the industries. The results revealed lower bacteria counts in samples with olive pomace extract and PLA films than in those with ascorbic acid and OPP films after 5 and 12 days of storage. These findings suggest that the use of such natural extracts as additives in fruits could delay the growth of mesophilic bacteria. The characterization and identification of the bacterial isolates from fresh-cut apple samples showed that the most prevalent species were Citrobacter freundii, Staphylococcus warneri, Pseudomonas oryzihabitans, Alcalinogenes faecalis, Corynebacterium jeikeium, Micrococcus spp., Pantoea aglomerans and Bacillus spp. Furthermore, an increase in the microbial diversity during the storage time at refrigerated temperatures was observed, except for the sample treated with olive pomace extract and packaged in OPP film. The highest microbial diversity was found for samples with ascorbic acid as an additive. This could indicate a negative effect of ascorbic acid on the microbial inhibition of apple slices. The natural olive pomace extract demonstrated potential as an antimicrobial additive for fresh-cut apples.

Brewer’s spent yeast (BSY) mannoproteins have been reported to possess thickening and emulsifying properties. The commercial interest in yeast mannoproteins might be boosted considering the consolidation of their properties supported by structure/function relationships. This work aimed to attest the use of extracted BSY mannoproteins as a clean label and vegan source of ingredients for the replacement of food additives and protein from animal sources. To achieve this, structure/function relationships were performed by isolating polysaccharides with distinct structural features from BSY, either by using alkaline extraction (mild treatment) or subcritical water extraction (SWE) using microwave technology (hard treatment), and assessment of their emulsifying properties. Alkaline extractions solubilized mostly highly branched mannoproteins (N-linked type; 75%) and glycogen (25%), while SWE solubilized mannoproteins with short mannan chains (O-linked type; 55%) and (1→4)- and (β1→3)-linked glucans, 33 and 12%, respectively. Extracts with high protein content yielded the most stable emulsions obtained by hand shaking, while the extracts composed of short chain mannans and β-glucans yielded the best emulsions by using ultraturrax stirring. β-Glucans and O-linked mannoproteins were found to contribute to emulsion stability by preventing Ostwald ripening. When applied in mayonnaise model emulsions, BSY extracts presented higher stability and yet similar texture properties as the reference emulsifiers. When used in a mayonnaise formulation, the BSY extracts were also able to replace egg yolk and modified starch (E1422) at 1/3 of their concentration. This shows that BSY alkali soluble mannoproteins and subcritical water extracted β-glucans can be used as replacers of animal protein and additives in sauces.

Anthropogenic noise, which is part of an urban soundscape, can negatively affect the behaviour of wild animals. Here we investigated how biophony (animal sounds) was affected by noise in an urban Brazilian forest fragment. Our hypothesis was that noise and biophony would differ between the border and the centre of the forest fragment (i.e., lower biophony predicted in noisy areas). Two passive acoustic monitoring devices were used to record soundscapes one week per month, 24 hour per day, from May to July 2012. The Acoustic Complexity Index (ACI) was used to quantify biophony and the Power Spectral Density (PSD) to quantify urban noise. PSD and ACI were higher on the border than in the centre of the fragment. PSD was lower in July, while the ACI did not significantly vary between months. Noise levels were also higher on the border. Conversely, potential species richness was higher in the centre of the forest fragment. Higher biophony at noisy sites can be interpreted as behavioural responses of species for communicating in noisy areas. Alternatively, they could be the result of species segregation by degree of vocal plasticity or due to differences in composition of communities.

Serotonin is a phylogenetically ancient compound found in animals, plants, and some bacteria. In eukaryotes, serotonin is synthesized from the aromatic amino acid tryptophan via the key enzymes aromatic amino acid hydroxylase (AAAH) and aromatic amino acid decarboxylase (AAAD). Serotonin is also an intermediate in the melatonin biosynthetic pathway and is involved in several vital functions. In humans, serotonin is produced in the gut and in the brain, is critical in the regulation of multiple body functions, and its depletion has been implicated in multiple neurological disorders including depression and Alzheimer’s disease, as well as other peripheral conditions namely irritable bowel syndrome and fibromyalgia. The serotonin biosynthetic pathway is well described in eukaryotes, but very little is known about this pathway in bacteria. Evidence points to similar pathways since eukaryote-like AAAH and AAAD (and their genes) have been identified in multiple bacteria, even though serotonin production has not yet been detected in most species. Although data on bacterial tryptophan decarboxylase genes are very limited and no bacterial tryptophan hydroxylase genes have been identified to date, evidence suggests that serotonin production in bacteria might occur through different AAAH and AAAD. Substrate promiscuity in these enzymes has been previously reported and seems to be the key aspect in bacterial serotonin synthesis. Considering the human gut microbiota as a potential source of serotonin, further investigation on its biosynthetic pathways in microbes might lead to important discoveries, which may ultimately foster the development of new therapeutic strategies to treat serotonin depletion-related disorders in humans.

Scissor bite (SB.) is a rare malocclusion that is challenging to diagnose and is often associated with a retrognathic mandible and a series of functional and structural abnormalities that negatively affect the patient. This article intends to analyze the treatment approaches applied to growing patients younger than 16 years old, comparing the conventional appliances described in the literature and a clinical case treated with clear aligners with mandibular advancement (MA.). SB is primarily related to skeletal Class I and II, according to Angle classification. In the various cases analyzed, it can also be mentioned as a significant number of cases with SB of dental origin (seven of dental and four of skeletal) in young patients. In children and adolescents who still have growth potential, the therapeutic possibilities are numerous. A comprehensive literature search was manually performed from 2002 until January 2023, in PubMed and BVS databases with the following conjugated keywords: “scissor bite OR brodie bite” AND “malocclusion” AND “treatment OR correction OR therapeutics”. The present case report on a young patient demonstrated the efficiency of the clear aligners with MA to correct an SB, associated with several functional and structural anomalies such as Class II division 1 with an increased overjet and overbite as well as a severe curve of Spee in a hypodivergent biotype.

Resumo: Introdução: Na bradidisrritmia (BD), associada a iatrogenia medicamentosa ou potenciais causas reversíveis, está recomendada a suspensão ou correção das mesmas, antes da implantação de pacemaker definitivo (PM). No entanto, estes doentes (dts) apresentam frequentemente doença do sistema de condução, existindo poucos dados relativos à recorrência de BD e à necessidade futura de PM. Objetivo: Avaliação da necessidade de colocação de PM em dts com BD iatrogénica ou associada a outra causa potencialmente reversível. Métodos: Foram avaliados dts consecutivos sintomáticos admitidos no serviço de urgência com o diagnóstico de BD (Doença do nódulo AV – bloqueio auriculoventricular e bloqueio auriculoventricular 2.° grau (2:1); Bradicardia Sinusal (BS) e Bradifibrilhação auricular (BFA)) no contexto de iatrogenia medicamentosa ou alterações metabólicas. Foi avaliada a percentagem de dts com necessidade de colocação de PM. Resultados: Estudaram‐se 153 dts (47% sexo masculino) admitidos com BS 16%; bloqueio auriculoventricular 63%; bloqueio auriculoventricular 2.° grau 12%; BFA 10%. Verificou‐se iatrogenia medicamentosa em 85% dos dts, hipercaliemia em 3% e etiologia combinada em 12%. Após suspensão da «iatrogenia», 55% dos dts (n = 84) colocou PM, sendo o bloqueio auriculoventricular o tipo de bradidisrritmia mais frequente, presente em 77% (n = 65) destes doentes. Conclusão: Em dts admitidos com BD associada a uma potencial causa reversível, elevada percentagem de dts apresentam persistência ou recorrência do quadro com necessidade de PM. Os dts com iatrogenia associada a doença do nódulo AV constituem um subgrupo com risco de recorrência mais elevado, necessitando de maior vigilância durante o follow‐up, devendo‐se ponderar PM no primeiro episódio. Abstract: Introduction: In iatrogenic or potentially reversible bradyarrhythmia, drug discontinuation or metabolic correction is recommended before permanent cardiac pacemaker (PM) implantation. These patients often have conduction system disease and there are few data on recurrence or the need for a permanent PM. Objective: To analyze the need for PM implantation in patients with iatrogenic bradyarrhythmia or bradyarrhythmia associated with other potentially reversible causes. Methods: We assessed consecutive symptomatic patients admitted to the emergency department with a primary diagnosis of bradyarrhythmia (atrioventricular [AV] node disease – complete or second‐degree AV block (AVB) [CAVB: 2nd‐degree AVB – 2:1], sinus bradycardia [SB] and atrial fibrillation [AF] with slow ventricular response [SVR]) in the context of iatrogenic causes or metabolic abnormalities. We determined the percentage of patients who required PM implantation. Results: We studied 153 patients (47% male) admitted for iatrogenic or potentially reversible bradyarrhythmia. Diagnoses were SB 16%, CAVB 63%, second‐degree AVB 12%, and AF with SVR 10%. Eighty‐five percent of patients were under negative chronotropic therapy, 3% had hyperkalemia and 12% had a combined etiology. After correction of the cause, 55% of patients (n=84) needed a PM. In these patients the most common type of bradyarrhythmia was CAVB, in 77% (n=65) patients. Conclusion: In a high percentage of patients with bradyarrhythmia associated with a potentially reversible cause, the arrhythmia recurs or does not resolve during follow‐up. Patients with AV node disease constitute a subgroup with a higher risk of recurrence who require greater vigilance during follow‐up and should be considered for PM implantation after the first episode. Palavras‐chave: Bradidisrritmia iatrogénica, Pacemaker definitivo, Keywords: Iatrogenic bradyarrhythmia, Permanent cardiac pacing

BackgroundMost long-term heavy drinkers do not have clinically evident chronic liver disease (CLD). However, at any time-point, their risk of developing CLD remains unknown. We aimed to evaluate the long-term outcomes of a group of heavy drinkers, without evidence of CLD at baseline.MethodsA cohort of 123 long-term heavy drinkers without CLD were prospectively recruited in 2002 and retrospectively followed until 2018.ResultsAt baseline (2002), median alcohol consumption was 271±203g/day during 21.5±20 years, 65% being abstinent during the previous 1.75±5 months. Patients were followed for 14±3 years. During follow-up, 53% reported any alcohol intake. Alcohol consumption during follow-up associated weakly with either 1- or 6-months previous abstinence at baseline. Until 2018, progression to CLD occurred in 6%, associating with years of alcohol intake during follow-up (OR 1.15 [1.01-1.31]) and baseline alkaline-phosphatase (OR 1.05 [1.01-1.10]). During follow-up, being abstinent for at least 1 year positively associated with CLD-free survival. 27% died (55% of cancer-mostly oropharyngeal cancer, 27% of cardiovascular disease, and 9% of liver disease), with a mean age of 71 years [69-74] (10 years less than the expected in the Portuguese population). Achieving abstinence for at least 1 year positively associated with overall survival, while smoking, and hepatic steatosis at baseline associated negatively.ConclusionLong-term heavy drinkers seemed to have a decreased life expectancy compared with the overall Portuguese population. Cancer was the main cause of death. Our results suggest that progression to CLD depends mostly on continued alcohol intake. Alcohol abstinence, even if temporary, seems to decrease the risks of CLD and mortality.

A Educação do Campo prioriza o ensino de qualidade e defende o respeito às especificidades dos sujeitos e dos seus territórios. Sob essa perspectiva, a disciplina de Ciências apresenta desafios em sua prática, já que exige conhecimentos e ferramentas adequadas de intervenção, no intuito de avalizar significações sociais, políticas, econômicas e culturais. Em busca de atender às referidas expectativas, descrevemos o presente relato de experiência, desenvolvido a partir da temática “Quintais”, com ações que envolvem o ensino de Ciências (foco em Agroecologia) e que utilizam, como recurso pedagógico, a Facilitação Gráfica. Assim, destacamos uma proposta pedagógica motivadora e participativa, havendo grande satisfação por parte dos envolvidos, além de possibilitar reflexões sobre a produção de conhecimentos, que, por sua vez, visa superar a educação fragmentada e descontextualizada. Ainda, salientamos certas significações acerca do papel do docente, da importância da Agroecologia e da valorização do campo.

Abstract Background: Iron metabolism disorders have been associated with an increased risk of cardiovascular events. However, the prognostic impact on patients (pts) with acute coronary syndrome (ACS) has yet to be clarified. Objective: To determine the prognostic value of serum iron and ferritin levels in pts with ACS in the short and long-term. Methods: Consecutive pts admitted to a coronary care unit with a diagnosis of ACS, for a period of 2 years, were evaluated. The population was divided into tertiles of serum iron and ferritin distribution. The primary adverse events were the occurrence of in-hospital death or heart failure (HF) and death or HF at 1 year of follow-up. Results: We studied 280 pts (73% males; mean age 68 ± 13 years). The mean levels of serum iron and ferritin were 59 ± 34 mcg/dL and 205 ± 185 ng/mL, respectively. Patients included in the 1st tertile of serum iron (≤ 40 mcg/dL) had a higher rate of adverse events, in-hospital and after 1 year. Lower and higher levels of ferritin (1st and 3rd tertiles, ≤ 110; >219 ng/ml, respectively) were associated with a higher incidence of HF during hospitalization and death at 1 year. A ferritin value >316 ng /mL was an independent risk factor for death at 1 year (adjusted OR: 14; 95%CI: 2.6 to 75.9). Conclusion: In this population, iron metabolism alterations were associated with a higher rate of adverse events and higher ferritin levels constituted an independent mortality predictor in the long-term.

Tendo em conta a premente necessidade de elaboração de material didático destinado ao desenvolvimento da competência comunicativa oral em português língua estrangeira/ adicional, apresenta-se uma proposta pedagógica orientada para a ação (Conselho da Europa 2001), que pressupõe que, através da realização de tarefas, são acionados processos cognitivos que possibilitam a aquisição da língua. Neste trabalho, são selecionados exemplos de tarefas pedagógicas para o desenvolvimento das capacidades da oralidade do público chinês aprendente de português língua estrangeira (PLE).Numa perspetiva holística e analítica (Ellis 2003; Long 2007, 2015; Samuda e Bygate 2008), a proposta pedagógica descrita baseia-se nos princípios metodológicos de uma abordagem por tarefas, definidos por Doughty e Long (2003) e Long (2009, 2015), e nos princípios subjacentes à aprendizagem de uma língua estrangeira num contexto de instrução, estabelecidos por Ellis (2005) e Ellis e Shintani (2014). Neste projeto, está subjacente a utilização de documentos áudio e audiovisuais autênticos, por fornecerem um input rico e significativo da língua alvo. Ao nível da produção, são integradas tarefas que privilegiam a interação e a negociação de sentido (Long 1983, 1985) para uma aprendizagem colaborativa (Swain 2000, 2005; Swain e Suzuki 2008). Espera-se que as tarefas apresentadas promovam a automatização e também o estabelecimento de novas relações entre forma/ significado, permitindo o desenvolvimento da proficiência linguística e da competência intercultural do aprendente.

Resumo: Introdução: Os perfis tensionais noturnos non‐dipper e extreme‐dipper têm sido associados a lesões de órgão‐alvo. A relação entre a pressão arterial (PA) e retinopatia hipertensiva (RH) está pouco esclarecida. Objetivo: Avaliar em doentes (dts) hipertensos a relação entre os valores noturnos de pressurometria em ambulatório de 24 h (MAPA) e prevalência e a gravidade da RH. Métodos: Foram avaliados prospectivamente dts hipertensos submetidos à realização de MAPA de 24 h. Foram determinadas características basais, PA sistólica (PAS) e diastólica (PAD) médias noturnas, e os dts classificados pelo perfil tensional noturno em dipper; non‐dipper; inverted‐dipper e extreme‐dipper. O diagnóstico de RH foi estabelecido por fundoscopia e a gravidade definida pela classificação de Scheie. Foi estabelecida a relação entre valores de PAS e PAD noturnos e o perfil tensional noturno com a prevalência e gravidade da RH. Resultados: Foram avaliados 46 dts (46% sexo masculino [n = 21]; idade média 63 ± 12 anos). Noventa e um por cento dos dts estavam sob terapêutica anti‐hipertensora (n = 42); destes, 30% apresentavam PA controlada (n = 13). A presença de RH foi observada em 83% dos dts (n = 38). Os dts com RH apresentaram níveis de PAS noturna mais elevados (151 ± 23 versus 130 ± 13, p = 0,008). A PAS noturna esteve ainda associada a uma maior gravidade de RH (153 ± 25 versus 140 ± 16, p = 0,04). Não existiu relação entre a PAD noturna ou o perfil tensional noturno e presença de RH. Conclusão: Níveis mais elevados de PAS noturna estiveram associados a RH. Não se verificou relação entre o perfil tensional noturno e a presença de RH. Abstract: Introduction: Non‐dipper and extreme dipper blood pressure (BP) profiles are associated with a worse cardiovascular prognosis. The relationship between nocturnal BP profile and hypertensive retinopathy (HR) is not fully established. Aim: To assess the association between the prevalence and severity of HR and nocturnal BP. Methods: We prospectively studied hypertensive patients who underwent 24‐hour ambulatory BP monitoring. The population was divided into two groups according to the presence or absence of lesions and compared according to baseline characteristics, nocturnal BP profile (dippers, non‐dippers, inverted dippers/risers and extreme dippers) and mean nocturnal systolic (SBP) and diastolic (DBP) BP values. The presence and severity of HR were assessed using the Scheie classification. The relationship between nocturnal SBP and DBP values (and nocturnal BP profile) and the prevalence and severity of HR was determined. Results: Forty‐six patients (46% male, aged 63 ± 12 years) were analyzed, of whom 91% (n = 42) were under antihypertensive treatment. Seventy percent (n = 33) had uncontrolled BP. HR was diagnosed in 83% (n = 38). Patients with HR had higher mean systolic nocturnal BP (151 ± 23 vs. 130 ± 13 mmHg), p = 0.008). Patients with greater HR severity (Scheie stage ≥ 2) had higher nocturnal BP (153 ± 25 vs. 140 ± 16 mmHg, p = 0.04). There was no statistically significant association between DBP and nocturnal BP patterns and HR. Conclusions: The prevalence and severity of HR were associated with higher nocturnal SBP. No relationship was observed between nocturnal BP profile and the presence of HR. Palavras‐chave: Perfil dipper, MAPA, Retinopatia hipertensiva, Keywords: Dipper profile, Ambulatory blood pressure monitoring, Hypertensive retinopathy

The natural cosmetics market has grown since consumers became aware of the concept of natural-based ingredients. A significant number of cosmetics have an ecological impact on the environment and carry noxious and chemically potent substances. Thus, the use of natural and organic cosmetics becomes increasingly important since it is clear that topical treatment with cosmeceuticals can help improve skin rejuvenation. A substantial investigation into the benefits that fruits and plants can bring to health is required. Studies have shown that antigenotoxic properties are linked to anti-aging properties. Several studies have shown potential antigenotoxicity in natural ingredients such as Almonds (Prunus dulcis), Elderberry (Sambucus nigra), Olives (Olea europaea), and Grapes (Vitis vinifera). This review presents an overview of research conducted on these natural ingredients, the most common in the Northeast of Portugal. This region of Portugal possesses the most organic farmers, and ingredients are easily obtained. The Northeast of Portugal also has climatic, topographic, and pedological differences that contribute to agricultural diversity.

[This corrects the article DOI: 10.1371/journal.pgen.1007386.].

Recent evidence suggests that the presence of more than one pathogenic mutation in a single patient is more common than previously anticipated. One of the challenges hereby is to dissect the contribution of each gene mutation, for which animal models such as Drosophila can provide a valuable aid. Here, we identified three families with mutations in ADD3, encoding for adducin-γ, with intellectual disability, microcephaly, cataracts and skeletal defects. In one of the families with additional cardiomyopathy and steroid-resistant nephrotic syndrome (SRNS), we found a homozygous variant in KAT2B, encoding the lysine acetyltransferase 2B, with impact on KAT2B protein levels in patient fibroblasts, suggesting that this second mutation might contribute to the increased disease spectrum. In order to define the contribution of ADD3 and KAT2B mutations for the patient phenotype, we performed functional experiments in the Drosophila model. We found that both mutations were unable to fully rescue the viability of the respective null mutants of the Drosophila homologs, hts and Gcn5, suggesting that they are indeed pathogenic in flies. While the KAT2B/Gcn5 mutation additionally showed a significantly reduced ability to rescue morphological and functional defects of cardiomyocytes and nephrocytes (podocyte-like cells), this was not the case for the ADD3 mutant rescue. Yet, the simultaneous knockdown of KAT2B and ADD3 synergistically impaired kidney and heart function in flies as well as the adhesion and migration capacity of cultured human podocytes, indicating that mutations in both genes may be required for the full clinical manifestation. Altogether, our studies describe the expansion of the phenotypic spectrum in ADD3 deficiency associated with a homozygous likely pathogenic KAT2B variant and thereby identify KAT2B as a susceptibility gene for kidney and heart disease in ADD3-associated disorders.

Several vegetation indices (VI) derived from handheld spectroradiometer reflectance data in the visible spectral region were tested for modelling grapevine water status estimated by the predawn leaf water potential (Ψpd). The experimental trial was carried out in a vineyard in Douro wine region, Portugal. A statistical approach was used to evaluate which VI and which combination of wavelengths per VI allows the best correlation between VIs and Ψpd. A linear regression was defined using a parameterization dataset. The correlation analysis between Ψpd and the VIs computed with the standard formulation showed relatively poor results, with values for squared Pearson correlation coefficient (r2) smaller than 0.67. However, the results of r2 highly improved for all VIs when computed with the selected best combination of wavelengths (optimal VIs). The optimal Visible Atmospherically Resistant Index (VARI) and Normalized Difference Greenness Vegetation Index (NDGI) showed the higher r2 and stability index results. The equations obtained through the regression between measured Ψpd (Ψpd_obs) and optimal VARI and between Ψpd_obs and optimal NDGI when using the parameterization dataset were adopted for predicting Ψpd using a testing dataset. The comparison of Ψpd_obs with Ψpd predicted based on VARI led to R2 = 0.79 and a regression coefficient b = 0.96. Similar R2 was achieved for the prediction based on NDGI, but b was smaller (b = 0.93). Results obtained allow the future use of optimal VARI and NDGI for estimating Ψpd, supporting vineyards irrigation management.

Resumo: A síndrome de Kounis (SK) define‐se como a ocorrência simultânea de uma síndrome coronária aguda (SCA) e de um insulto anafilático ou alérgico. Resulta da desgranulação de mastócitos e subsequente libertação de mediadores inflamatórios, responsáveis pelo vasospasmo coronário ou rutura da placa de ateroma. O diagnóstico é clínico e baseia‐se na relação temporal entre os dois eventos. Apesar do número crescente de casos descritos, principalmente nos países do sul da Europa, o desconhecimento médico pode levar ao subdiagnóstico em Portugal. O reconhecimento da SK, mesmo realizado a posteriori, tem implicações clínicas, nomeadamente na investigação da atopia e medidas de dessensibilização, se possíveis, com vista à prevenção de novos eventos. Os autores relatam o caso clínico de um doente de 70 anos, que recorreu ao serviço de urgência por exantema generalizado e pruriginoso e iniciou dor torácica enquanto estava em observação. A angiografia confirmou SCA com evidência de doença coronária e subsequente diagnóstico de SK tipo II. Abstract: Kounis syndrome (KS) is the coincidental occurrence of acute coronary syndrome (ACS) and anaphylactic or allergic insult. It results from mast cell degranulation with subsequent release of numerous inflammatory mediators, leading to coronary vasospasm or atheromatous plaque rupture. Diagnosis is clinical and based on the temporal relationship between the two events. Despite the growing number of reported cases, especially in southern Europe, the lack of awareness of this association may lead to under‐reporting in Portugal. Recognition of KS, even if retrospective, has clinical implications since individual atopy must be investigated and desensitization measures should be employed, if possible, to prevent future events. We report the case of a 70‐year‐old man who was admitted to hospital because of generalized exanthema and itching and onset of chest pain while under observation. Coronary angiography confirmed coronary artery disease and ACS and he was diagnosed as having type II KS. Palavras‐chave: Síndrome de Kounis, Enfarte agudo do miocárdio, Reação alérgica, Atopia, Keywords: Kounis syndrome, Acute miocardial infarction, Allergic reaction, Atopy

Resumo: Introdução: Níveis elevados de índice de dispersão eritrocitária (RDW) têm sido recentemente associados a um pior prognóstico em doentes com doença cardiovascular. A sua relação com o risco de eventos hemorrágicos em doentes com síndrome coronária aguda sem supradesnivelamento do segmento ST não está, no entanto, estabelecida. Objetivo: Determinar o valor prognóstico do RDW em doentes com síndrome coronária aguda sem supradesnivelamento do segmento ST em particular sobre o risco de hemorragia major. Métodos: Foram estudados 513 doentes consecutivos internados com o diagnóstico de síndrome coronária aguda sem supradesnivelamento do segmento ST. A população foi agrupada segundo os tercis da distribuição do RDW e caracterizada de acordo com as características clínicas, laboratoriais e eventos adversos. O evento primário foi definido como a presença de hemorragia major durante o internamento (definida pela classificação do registo Crusade). Determinou-se o valor preditor do RDW sobre o risco de hemorragia major. Resultados: O RDW médio foi de 15,13 ± 1,62%. Os doentes incluídos no terceiro tercil apresentaram uma idade mais avançada e mais frequentemente disfunção renal ou antecedentes de revascularização coronária. Valores crescentes de RDW associaram-se a um aumento do risco de hemorragia major e de mortalidade hospitalar. Um valor de RDW > 15,7% foi um preditor independente de eventos hemorrágicos (odds ratio ajustado 3,1, IC 95% 1,4-6,9). Conclusões: Numa população de doentes com síndrome coronária aguda sem supradesnivelamento do segmento ST, o RDW esteve associado a uma maior mortalidade intra-hospitalar, tendo constituído um fator de risco independente para hemorragia major intra-hospitalar. Abstract: Introduction: Higher values of red blood cell distribution width (RDW) have recently been associated with worse outcome in patients with cardiovascular disease. However, its relation to bleeding events in patients with non-ST elevation acute coronary syndromes has not been established. Aim: To determine the prognostic value of RDW in patients with non-ST segment elevation acute coronary syndromes, particularly regarding the risk of major bleeding. Methods: We analyzed 513 consecutive patients admitted with non-ST elevation acute coronary syndromes. The population was divided into tertiles of baseline RDW and clinical, laboratory characteristics and adverse events were analyzed for each group. The primary outcome was defined as the occurrence of major bleeding (according to the Crusade bleeding score). The predictive value of RDW for risk of major bleeding was determined. Results: The mean RDW was 15.13%±1.62%. Patients in the third tertile were older and more frequently had renal dysfunction or previous coronary revascularization. Higher values of RDW were associated with greater risk of major bleeding and in-hospital death. RDW >15.7% was an independent predictor of bleeding events (odds ratio 3.1, 95% CI 1.4-6.9). Conclusions: In a population of patients with non-ST elevation acute coronary syndromes, RDW was associated with higher in-hospital mortality and was an independent predictor of in-hospital major bleeding. Palavras-chave: Síndrome Coronária aguda sem supradesnivelamento do segmento ST, Hemorragia, Índice de dispersão eritrocitária, Prognóstico, Keywords: Non-ST elevation acute coronary syndrome, Bleeding, Red blood cell distribution, Prognosis

Resumo: As reações de hipersensibilidade aos anti‐inflamatórios não‐esteroides são comuns na população em geral, estando definidos cinco tipos de reações. A prevalência desta reação adversa em doentes com enfarte agudo do miocárdio é incerta, constituindo a antiagregação plaquetária um desafio terapêutico nestes doentes. Atualmente existem vários protocolos de dessensibilização, contudo não existem orientações específicas para a sua utilização. Os autores apresentam o caso de um doente com síndrome coronária aguda e hipersensibilidade à aspirina, com necessidade de coronariografia urgente. A dessensibilização à aspirina é eficaz e segura na maioria dos doentes, contudo são necessários mais estudos aleatorizados em doentes com doença coronária para evidenciar os seus benefícios. Abstract: Hypersensitivity reactions to nonsteroidal anti‐inflammatory drugs are common and five types of reactions have been defined. The prevalence of such reactions in patients with myocardial infarction is unclear, and so antiplatelet therapy in this population is a challenge. Various desensitization protocols have been developed but there are no specific guidelines for their use. The authors present the case of a patient with acute coronary syndrome and aspirin hypersensitivity referred for urgent coronary angiography. Aspirin desensitization therapy is safe and successful in many patients, but more randomized trials are needed to confirm its benefits in coronary artery disease patients. Palavras‐chave: Síndrome coronária aguda, Hipersensibilidade aos anti‐inflamatórios não‐esteroides, Protocolos de dessensibilização, Keywords: Acute coronary syndrome, Hypersensitivity to nonsteroidal anti‐inflammatory drugs, Desensitization protocols

Ce travail montre certains des résultats du projet de recherche de l’initiation scientifique, financés par FAPEMIG/UFU, «L’emploi des cas latins dans le Somnium Scipionis de Cicéron». L’objectif de cette recherche a été d’approfondir l’étude de la syntaxe latine, pour la pleine compréhension du texte classique et, en particulier, cet article détache l´étude des emplois, c´est-à-dire, la syntaxe du cas Génitif. Le but est de montrer la diversité des utilisations du génitif dans l´oeuvre de Cicéron, dans le même temps j´ai essayé de comprendre la version de l´émérite Maria Helena Rocha Pereira, et ainsi comprendre l’emploi de chaque mot et «chaque cas». Nous avons constaté que l’emploi du génitif dans l´ouevre de Cicéron suit le modèle dit classique, parce qu’il est prosateur latin par excellence. Pratiquement tous les emplois du génitif furent trouvés dans le corpus: après la levée complète des occurrences, il a été très facile de sélectionner les plus expressives et de les examiner conformément à une séquence didactique.O presente trabalho mostra uma parte dos resultados do projeto de pesquisa de Iniciação Cientifica, financiado pela FAPEMIG/UFU, “O Emprego dos Casos Latinos no Somnium Scipionis de Cícero”. O objetivo da pesquisa foi o aprofundamento do estudo da morfossintaxe latina, para o pleno entendimento do texto clássico, e, especificamente, este artigo destaca o estudo dos empregos, isto é, da sintaxe do genitivo. O intuito é mostrar os variados usos do genitivo dentro da obra de Cícero, ao mesmo tempo em que se procurou entender a versão da emérita Maria Helena da Rocha Pereira e, assim, entender o emprego de cada palavra e de “cada caso”. Observamos que o emprego do genitivo na obra de Cícero segue o padrão dito clássico, até porque ele é o prosador latino por excelência. Praticamente todos os empregos do genitivo puderam ser encontrados no corpus: após o levantamento completo das ocorrências, foi muito fácil selecionar as mais expressivas e analisá-las de acordo com uma sequência didática.

Introdução: O carcinoma da mama é uma das principais causas de morte no nosso país. No Serviço de Radioterapia do Instituto Português de Oncologia de Coimbra de Coimbra utilizamos, desde há mais de 30 anos, um esquema de hipofraccionamento de radioterapia, denominado “Flash”, como opção terapêutica em doentes idosos ou com baixo Performance Status, portadores de carcinoma da mama localmente avançado ou com estádios IIb ou IV, com intenção neoadjuvante ou paliativa. Objectivos: Avaliar a resposta ao tratamento, nomeadamente sobrevivência global aos três anos, resposta local e toxicidades aguda e crónica, no grupo de doentes seleccionados submetidos a esquema de hipofraccionamento, em estudo retrospectivo. Metodologia: Entre Janeiro de 2006 e Dezembro de 2008, um total de 83 doentes com diagnóstico de Carcinoma da Mama Localmente Avançado ou com estádios IIb ou IV, foi submetido a “Flash” mamário. A dose de radioterapia prescrita foi de 13Gy / 2Fr / 3 dias (em 23 doentes - 27,7%) e 26Gy / 4Fr / 2,5 semanas (em 60 doentes - 72,3%), com fotões de 4 MV, sobre a mama afectada. Foi avaliada sobrevivência global segundo o método de Kaplan-Meier. A análise estatística foi efectuada através da aplicação SPSS, versão 17.0 e os testes estatísticos foram avaliados ao nível de significância de 5%. Resultados: 80 doentes (96,4%) que efectuaram “Flash” mamário eram do género feminino, com idades compreendidas entre os 59 e os 93 anos (idade média 80,72 + 5,87 anos) e Performance Status (Karnosfsky: 0 - 100) entre 90 e 50%. Em 72 doentes (86,7%) o diagnóstico histológico foi Carcinoma Ductal Invasivo. A cirurgia após a realização do “Flash” Mamário foi realizada em 44 doentes (53%) após evidência de resposta local à radioterapia, sendo a Mastectomia Radical Modificada a técnica cirúrgica mais frequente. Efectuou-se o diagnóstico de metastização óssea em 10 doentes (12%), sendo que a taxa de sobrevivência global foi de 68,7% (57 doentes), em quatro anos. Dez doentes (12%) morreram por progressão da doença ou persistência tumoral Em 42 doentes (50,6%) não se verificaram evidência ou progressão de doença e três doentes (3,6%) apresentaram melhoria clínica. Conclusões:O “Flash Mamário” é uma modalidade de tratamento segura, relativamente aos efeitos secundários, e opção terapêutica válida para doentes idosos ou com baixo Performance Status, com o diagnóstico de carcinoma localmente avançado ou estádio IIb ou IV, a título neoadjuvante ou paliativo. Há menor risco de recidiva/progressão, nos doentes com melhor estado geral, sendo a taxa de sobrevivência global maior

Introdução e Objectivos: A mastite é uma inflamação da mama, que pode ou não ser acompanhada de processo infeccioso, sendo o Staphylococcus aureus o gérmen mais frequentemente isolado. A grande maioria dos casos é unilateral e tem bom prognóstico. O objectivo deste estudo foi caracterizar as mastites neonatais infecciosas diagnosticadas e tratadas num hospital de nível 3. Métodos: Análise retrospectiva dos processos clínicos de lactentes com menos de dois meses com diagnóstico de mastite neonatal, observados entre Janeiro de 2000 e Dezembro de 2011. Foram avaliados aspectos clínicos, laboratoriais e microbiológicos bem como o tratamento instituído e evolução. Resultados: Foram incluídos 21 lactentes, 14 do sexo feminino. A mediana da idade de diagnóstico foi de 21 dias. A mastite foi unilateral em 19 casos. Os sinais clínicos mais frequentes foram tumefacção e eritema. Em três crianças foi documentada febre. O agente isolado no exsudato mamário foi Staphylococcus aureus, meticilina susceptível em seis casos e meticilina resistente em três. A terapêutica antibiótica mais utilizada foi a flucloxacilina, com duração mediana de dez dias. Registaram-se 11 casos de abcesso mamário, dez drenados cirurgicamente e um com drenagem espontânea. Em dois casos com identificação de Staphylococcus aureus meticilina resistente houve evolução favorável com drenagem cirúrgica, apesar de antibioticoterapia com β-lactâmico. Não ocorreu outro tipo de complicações. Conclusões: Tal como descrito na literatura, nesta série a mastite neonatal foi mais frequente no sexo feminino e unilateral. Em metade dos casos ocorreu formação de abcesso mamário. O único gérmen isolado foi Staphylococcus aureus (nove casos), sendo meticilina resistente em três, dois destes com evolução favorável com drenagem cirúrgica apesar de antibioticoterapia com β-lactâmico.

Carcinoid tumors are rare, most commonly originating from the neuroendocrine cells in the gastrointestinal tract. Carcinoid syndrome is characterized by flushing, diarrhea, and bronchospasm. Half of these patients have carcinoid heart disease, affecting the right side of the heart, causing tricuspid and pulmonary regurgitation and stenosis and subsequently right heart failure.73-year-old female was admitted with heart failure associated with episodes of diarrhea and flushing. The echocardiogram showed typical characteristics of carcinoid heart diasease. The CT scan of abdomen showed a small bowel mass. The 24-hour urine 5-hydroxyindoleacetic acid (5HIAA) and indium-111-pentetreotide scintigraphy confirmed the diagnosis. The patient was treated with furosemide, warfarine, digoxin and octreotide and there was clinical improvement.The echocardiogram was very useful, establishing the provisory diagnosis of a rare disease based on pathognomonic echocardiographic features.

Members of the TNF superfamily participate in kidney disease. Tumor necrosis factor (TNF) and Fas ligand regulate renal cell survival and inflammation, and therapeutic targeting improves the outcome of experimental renal injury. TNF-related apoptosis-inducing ligand (TRAIL and its potential decoy receptor osteoprotegerin are the two most upregulated death-related genes in human diabetic nephropathy. TRAIL activates NF-kappaB in tubular cells and promotes apoptosis in tubular cells and podocytes, especially in a high-glucose environment. By contrast, osteoprotegerin plays a protective role against TRAIL-induced apoptosis. Another family member, TNF-like weak inducer of apoptosis (TWEAK induces inflammation and tubular cell death or proliferation, depending on the microenvironment. While TNF only activates canonical NF-kappaB signaling, TWEAK promotes both canonical and noncanonical NF-kappaB activation in tubular cells, regulating different inflammatory responses. TWEAK promotes the secretion of MCP-1 and RANTES through NF-kappaB RelA-containing complexes and upregulates CCl21 and CCL19 expression through NF-kappaB inducing kinase (NIK-) dependent RelB/NF-kappaB2 complexes. In vivo TWEAK promotes postnephrectomy compensatory renal cell proliferation in a noninflammatory milieu. However, in the inflammatory milieu of acute kidney injury, TWEAK promotes tubular cell death and inflammation. Therapeutic targeting of TNF superfamily cytokines, including multipronged approaches targeting several cytokines should be further explored.