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A investigação de recursos renováveis tem sido progressiva principalmente em relação aos recursos marinhos. As algas são das biomassas marinhas mais estudadas pela sua capacidade de fixar os gases do efeito de estufa, de converter a energia solar em energia química, serem das maiores fontes de sais minerais e de compostos de elevado interesse comercial. Os amino-ácidos do tipo micosporinas (MAAs) são neste contexto um bom exemplo. Estas podem ser utilizadas em inúmeras áreas industriais sendo mais comummente consideradas de interesse na cosmética. Com o intuito de separar as MAAs para possível aplicação cosmética, neste trabalho foi proposto desenvolver um processo de extração e purificação, pela combinação de uma extração sólido-líquido, ultrafiltração (100 kDa) e precipitação com mudança de pH. Todo o processo foi otimizado, nomeadamente no que diz respeito à avaliação do melhor solvente (PBS (pH 7,4)), o tempo de extração e a razão sólido-líquido. Após desenvolvido e otimizado o processo de extração e purificação, foi possível separar três frações de compostos de alto valor acrescentado, uma rica em ficoeritrina, uma rica em proteínas e uma rica em MAAs (cerca de 50 % do total de MAAs extraído da biomassa). Research into renewable resources has been progressive, especially the one related with marine resources. Seaweeds are one of the most studied biomass matrices in this context because of their capacity to fix greenhouse gases, convert solar energy into chemical energy, while being a major source of mineral salts and compounds of high interest for research in numerous areas. One compound with a high level of interest present in macroalgae are the mycosporine-like amino acids (MAAs). These compounds can be used in numerous industrial areas being the most common in cosmetics. To separate the MAAs from the other compounds present in the macroalgae Gracilaria gracilis, this work applied the solid-liquid extraction method and purification by ultrafiltration (100 kDa) followed by precipitation with pH change to 12. The best solvent by was choose as being PBS (1X, pH 7.4) and then the remaining process conditions were optimized, namely the extraction time and the solid-liquid ratio. After the process optimization, three fractions of high value-added compounds were separated, a first one rich in phycoerythrin, a second one rich in proteins and a third one rich in MAAs (about 50 % of the total of MAAs present in the biomass were recovery). Mestrado em Engenharia Química

Subvalvular aortic stenosis manifesting as a subaortic membrane predisposes to bacterial endocarditis, which typically affects the aortic valve or, less frequently, the left ventricular outflow tract. We present the case of a 60-year-old woman expressing an odd form of a subvalvular aortic membrane in conjunction with a left Valsalva sinus pseudoaneurysm as a result of an endocarditis complication.

Whipple’s disease is a rare and systemic infectious disease that classically presents with gastrointestinal symptoms. The epidemiology of cardiac involvement is unknown. However, with the advent of improved molecular techniques, it is increasingly recognized as a cause of culture-negative endocarditis. Monotherapy treatment with trimethoprim-sulfamethoxazole is associated with relapses, sometimes in organs different than those previously affected. We present the case of a man diagnosed with classic Whipple disease, initially treated with trimethoprim-sulfamethoxazole. Twenty-two years later, he is diagnosed with endocarditis by the same agent. Whipple’s disease, particularly Whipple’s endocarditis is an extremely difficult entity to diagnose and to treat. Indications for treatment remain controversial and are still based on clinical experience and case series. This particular patient, with a recurrence two decades after the initial episode, highlights the ineffectiveness of trimethoprim/sulfametoxazole for the treatment of Tropheryma whipplei infection, even when used for long periods. Furthermore, this case illustrates the diagnostic difficulty so often associated with endocarditis and the importance of interdisciplinarity when addressing this infection.

BACKGROUND Pre-infarction angina (PIA) is associated with improved prognosis in patients with ST-elevation myocardial infarction (STEMI). Some studies suggest that diabetes may blunt the effect of ischaemic preconditioning. We sought to study the impact of PIA in diabetic patients with STEMI. METHODS Consecutive patients with STEMI who underwent primary angioplasty were included. PIA was defined as ≥1 episode of chest pain during the week preceding STEMI diagnosis. Incident major adverse cardiovascular events (MACE) were defined as the first occurrence of all-cause death, stroke or acute myocardial infarction. RESULTS Of the 1143 included patients, 25% were diabetic and 32% had a history of PIA. Diabetic patients with PIA had smaller infarct sizes as estimated by peak creatine kinase (CK) [1144 (500-2212) vs. 1715 (908-3309) U/L, P = 0.003] and peak troponin [3.30 (1.90-6.58) vs. 4.88 (2.50-9.58) ng/ml, P = 0.002], compared to diabetics without PIA. They also had a lower likelihood of evolving with moderate to severe reduced left ventricle ejection fraction (LVEF) (25.6%, n = 22 vs. 46.6%, n = 82, P = 0.001). In non-diabetic patients, PIA was associated with reduced peak CK [1549 (909-2909) vs. 1793 (996-3078), P = 0.0497], but not troponin (3.74 [2.23-7.11] vs. 4.56 [2.44-7.77] ng/ml, P = 0.19), and was not associated with reduced LVEF (32.0%, n = 85 vs. 37.4%, n = 207, P = 0.13). Both diabetic and non-diabetic patients with PIA had a lower likelihood of evolving with a Killip class III/VI (non-diabetic patients: 5.6% vs. 14.1%, P = 0.002; diabetic patients: 12.8% vs. 24.6%, P = 0.049). Over a median follow-up of 18.0 (12.1-25.5) months, PIA was associated with a significant reduction in the incidence of MACE [hazard ratio 0.52, 95% confidence interval (CI) 0.37-0.74, P < 0.001], irrespective of diabetes status. CONCLUSION PIA is an independent predictor of favourable outcomes in the setting of STEMI for both diabetic and non-diabetic patients.

BACKGROUND There were gaps between guidelines and practice when surgery was the only treatment for aortic stenosis (AS). OBJECTIVES This study analyzed the decision to intervene in patients with severe AS in the EORP VHD (EURObservational Research Programme Valvular Heart Disease) II survey. METHODS Among 2,152 patients with severe AS, 1,271 patients with high-gradient AS who were symptomatic fulfilled a Class I recommendation for intervention according to the 2012 European Society of Cardiology guidelines; the primary end point was the decision for intervention. RESULTS A decision not to intervene was taken in 262 patients (20.6%). In multivariate analysis, the decision not to intervene was associated with older age (odds ratio [OR]: 1.34 per 10-year increase; 95% CI: 1.11 to 1.61; P = 0.002), New York Heart Association functional classes I and II versus III (OR: 1.63; 95% CI: 1.16 to 2.30; P = 0.005), higher age adjusted Charlson comorbidity index (OR: 1.09 per 1-point increase; 95% CI: 1.01 to 1.17; P = 0.03), and a lower transaortic mean gradient (OR: 0.81 per 10-mm Hg decrease; 95% CI: 0.71 to 0.92; P < 0.001). During the study period, 346 patients (40.2%, median age 84 years, median EuroSCORE II [European System for Cardiac Operative Risk Evaluation II] 3.1%) underwent transcatheter intervention and 515 (59.8%, median age 69 years, median EuroSCORE II 1.5%) underwent surgery. A decision not to intervene versus intervention was associated with lower 6-month survival (87.4%; 95% CI: 82.0 to 91.3 vs 94.6%; 95% CI: 92.8 to 95.9; P < 0.001). CONCLUSIONS A decision not to intervene was taken in 1 in 5 patients with severe symptomatic AS despite a Class I recommendation for intervention and the decision was particularly associated with older age and combined comorbidities. Transcatheter intervention was extensively used in octogenarians. (J Am Coll Cardiol 2021;78:2131-2143) (c) 2021 by the American College of Cardiology Foundation.

Mestrado Bolonha em Marketing Esta investigação tem como objetivos (1) investigar que fatores levam ao desenvolvimento de uma utilização viciante da rede social TikTok, considerando características individuais do utilizador, gratificações obtidas durante o uso da rede social, o estado de flow e o sentimento de pertença; (2) examinar se o estado de flow induzido durante a utilização da TikTok varia com as características individuais do utilizador, com as gratificações anteriormente identificadas e com o sentimento de pertença, e por fim, (3) investigar se o sentimento de pertença varia com as gratificações obtidas durante o uso da rede social. O estudo usa uma metodologia quantitativa, com recurso a questionário online. Foram obtidas 650 respostas válidas através de uma amostra por conveniência, e usada a técnica de análise de regressões lineares múltiplas. Esta pesquisa traz novos insights para a literatura sobre o vício em redes sociais, identificando alguns dos antecedentes do vício na TikTok. Mais especificamente, os dados permitem especular que o Sentimento de Pertença pode representar um novo mecanismo pelas quais as motivações Evasão e Autoexpressão influenciam a adição à TikTok. Este estudo fornece evidências da relação positiva entre as gratificações nas redes sociais e a sua influência no flow e no sentimento de pertença, levando ao uso problemático de uma rede social. Este conhecimento pode ajudar a informar os provedores de redes sociais sobre os triggers do envolvimento dos utilizadores. Pode ainda ajudar a informar as autoridades de saúde pública sobre como ajudar os utilizadores a superar comportamentos de dependência nas redes sociais. This research aims to (1) investigate which factors lead to the development of addictive use of the social network TikTok, considering individual user characteristics, gratifications obtained during the use of the social network, the state of flow and the sense of belonging; (2) examine whether the state of flow induced during the use of TikTok varies with the individual user characteristics, with the previously identified gratifications and with the sense of belonging, and finally, (3) investigate whether the sense of belonging varies with the gratifications obtained during the use of the social network. The study uses a quantitative methodology, using an online questionnaire. 650 valid responses were obtained through a convenience sample, and the multiple linear regression analysis technique was used. This research brings new insights to the literature on social media addiction by identifying some of the antecedents of addiction on TikTok. More specifically, the data allow us to speculate that Sense of Belonging may represent a novel mechanism by which Escapism and Self-expression motivations influence TikTok addition. This study provides evidence of the positive relationship between social network gratifications and their influence on flow and sense of belonging, leading to problematic social network use. This knowledge can help inform social network providers about the triggers of user engagement. It can also help inform public health authorities on how to help users overcome addictive behaviour on social networks. info:eu-repo/semantics/publishedVersion

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Funding Acknowledgements Type of funding sources: None. Introduction Although the perceived prognosis of patients with precapillary pulmonary hypertension (PH) is poor, the natural history of this condition is very heterogeneous. In this study we sought to identify predictors of poor outcomes which could help refine prognosis. Methods We studied consecutive patients referred to our centre from 12/2016 to 11/2018 with confirmed precapillary PH. A range of clinical, laboratory, echocardiographic and right heart catheterization (RHC) data variables were collected to assess predictors of survival. Outcome was defined as mortality from any cause. Results Of the 80 included patients, 51 (64%) were female and mean age was 60.5 ± 16.0 years. The majority of patients (45%) had pulmonary arterial hypertension (group 1) and 41% were chronic thromboembolic pulmonary hypertensive disease patients (group 4). During a median follow-up of 18.7 [IQR 12.3 – 26.7] months, 10 patients (12.5%) died. New York Heart Association (NYHA) functional class (HR 19.4 [95% CI 2.56 - 147.5], p = 0.004) was the strongest predictor of mortality, whereas higher haemoglobin (HR 0.70 [0.49 - 0.99], p= 0.047) and 6-minute walking distance (6MWD) expressed as percentage of predicted (HR 0.96 [0.93 - 0.99], p = 0.004) were associated with better survival overall. Echocardiographic parameters such as eccentricity index (HR 3.35 (95% CI 1.11 - 10.0), p = 0.031), short pulmonary acceleration time (HR 0.98 [95% CI 0.96 - 0.99], p = 0.008), the presence of moderate to severe tricuspid regurgitation (HR 6.46 [95% CI 1.67 - 25.0], p = 0.007) and pericardial effusion (HR 3.86 [95% CI 1.12 - 13.4], p = 0.033) were also associated with death. Traditional right ventricular function parameters such as fractional area change, tricuspid annular plane systolic excursion (TAPSE) and S velocity of the lateral annular tricuspid annulus did not predict mortality in these patients. Invasive pressures and pulmonary vascular resistance measured by RHC were also not associated with mortality. In multivariable analysis, NYHA functional class was the only independent predictor of mortality in patients with precapillary PH (HR 14.5 [95% CI 2.3 - 146.8], p = 0.006). Conclusion Eccentricity index, short pulmonary acceleration time, moderate to severe tricuspid regurgitation and pericardial effusion were associated with poor survival. Functional class was the strongest independent predictor of mortality in precapillary PH patients. These parameters may help stratify the risk of death in this heterogenous population.

Submitted by Maria Helena Ribeiro (helena.ribeiro@lisboa.ucp.pt) on 2021-09-17T12:55:55Z No. of bitstreams: 1 152119191_ Sofia Cruz _ DPDFA.pdf: 2129290 bytes, checksum: 6e9d5102db97eb1070e657e226bf2623 (MD5) Made available in DSpace on 2021-09-17T12:55:55Z (GMT). No. of bitstreams: 1 152119191_ Sofia Cruz _ DPDFA.pdf: 2129290 bytes, checksum: 6e9d5102db97eb1070e657e226bf2623 (MD5) Previous issue date: 2021-01-27

Funding Acknowledgements Type of funding sources: None. Background Right heart catheterization (RHC) is the gold-standard method to confirm the diagnosis of Pulmonary Hypertension (PH) and to differentiate between pre- and post-capillary PH. However, RHC is an invasive and sometimes low-available procedure, which cannot be performed in all the patients with suspected PH. Clinical and echocardiographic scores have been developed to predict pre-capillary PH. We aimed to compare the performance of four of these scores in a population with suspected PH. Methods We retrospectively included consecutive patients who underwent RHC for suspected PH. If the non-invasive evaluation was clearly suggestive of left heart disease, RHC was dispensed being considered not clinically relevant. We also excluded patients with congenital heart disease. We compared the performance of four scores to predict pre-capillary PH: Score 1 (Opotowsky et al.), score 2 (Richter et al.), score 3 (Berthelot et al.) and score 4 (D’Alto et al.. Results Of the 142 included patients, 76 patients had pre-capillary PH, 42 had post-capillary PH and 24 patients did not meet invasive criteria for PH. We were able to perform the aforementioned scores in the majority of our patients (82% for score 1, 100% for score 2, 98% for score 3 and 83% for score 4). The AUC to predict pre-capillary PH using these scores were 0.74 for score 1, 0.77 for score 2, 0.82 for score 3 and 0.70 for score 4 (p = 0.37). Using the best cut-off points for each score, the score 3 correctly classified the highest percentage of patients (75.5%), with a sensitivity of 92% and a specificity of 60% to predict pre-capillary PH. Conclusion Combined clinical and echocardiographic characteristics can be used to predict pre-capillary PH with a fairly good performance. Score 3 (Berthelot et al.) was the score with the highest discrimination power. Validation of these scores in larger cohorts of patients with suspected PH are needed. Clinical and echocardiographic characteristics Interpretation Opotowsky et al. LA diameter (24 mm: -1), mid-systolic notch or acceleration time 10 (-1) Score ≥ 0 has a sens. 100% and a spec. 62% for pre-capillary PH Richter et al. Age > 68 years (+1), BMI > 30 kg/m2 (+1), absence of RV enlargement (+1), LA enlargement (+1) Score >4 predicted post-capillary PH (AUC 0.78) Berthelot et al. Atrial fibrillation (+2), diabetes mellitus (+1), LA enlargement (15 ≤ LAA < 19: +1, 19 ≤ LAA < 24: +2, ≥ 19 cm2: +3), RV end-diastolic area ( 1 (+1), RV forming the heart apex (+1) Score ≥ 2 has a sens. 99% and a spec. 54% for pre-capillary PH (AUC 0.85) Table 1. The clinical and echocardiographic scores evaluated in this study. AUC: area under the curve, EI: eccentricity index, IVC: inferior vena cava, LA: left atrial, LAA: left atrial area, LV: left ventricle, LVMI: left ventricle mass index, PH: pulmonary hypertension, Sens.: sensibility, Spec.: specificity, RV: right ventricle Abstract Figure.

Dissertação de Mestrado em Direito apresentada à Faculdade de Direito O presente trabalho traduz uma reflexão sobre o sentido e alcance da problemática dos sistemas de vigilância à distância no contexto das relações laborais e, em face do exposto, estamos em condições de concluir que se trata de uma problemática, manifestamente, complexa.Compreenda-se que, de facto, está é uma matéria bastante sensível e que exige uma compatibilização dos direitos em causa, por um lado o direito do trabalhador à reserva da intimidade da vida privada e à privacidade e, por outro lado, os direitos do empregador, desde logo, o direito de livre iniciativa económica e a desenvolver a sua atividade nos exatos termos em que se obrigou no pacto social. Neste sentido, encontramos de ambos os lados direitos fundamentais, com a categoria de direitos, liberdades e garantias, com consagração constitucional e que, nesse sentido, gozam da tutela prevista no art. 18.º da CRP. A compatibilização de que se fala não é de fácil concretização, pois exige uma ponderação de direitos, exige que no caso concreto se afira quais os direitos a proteger e quais os direitos a sacrificar.A grande questão passa por perceber até onde se devem proteger os bens e direitos referenciados, que são património de todos nós. E, mais especificamente no meio laboral, há que encontrar mecanismos de proteção da parte mais vulnerável, o trabalhador.O principal desafio é perceber como estes mecanismos podem, efetivamente, entrar em rota de colisão com os direitos de personalidade do trabalhador e como a sua posição, manifestamente débil, em relação à posição que ocupa do seu empregador o pode colocar numa posição desvantajosa, porquanto o empregador poderá fazer uso desses mecanismos de vigilância à revelia das normas legais. The present work reflects a reflection on the meaning and scope of the problem of remote surveillance systems in the context of industrial relations and, in view of the above, we are in a position to conclude that this is a clearly complex problem.It should be understood that, in fact, this is a very sensitive matter and that demands a compatibility of the rights in question, on the one hand, the right of the worker to reserve the privacy of privacy and privacy and, on the other hand, the rights of the employee. employer, from the outset, the right of free economic initiative and to develop its activity in the exact terms in which it was obliged in the social pact. In this sense, we find fundamental rights on both sides, with the category of rights, freedoms and guarantees, with constitutional consecration and which, in this sense, enjoy the protection provided for in art. 18 of the CRP. The compatibility that we are talking about is not easy to achieve, since it requires a weighing of rights, it requires that in the specific case it is clear which rights are to be protected and which are the rights to sacrifice.The big question is to understand how far the referenced goods and rights should be protected, which are the heritage of all of us. And, more specifically in the workplace, mechanisms must be found to protect the most vulnerable part, the worker.The main challenge is to understand how these mechanisms can effectively collide with the worker's personality rights and how his position, manifestly weak, in relation to the position he occupies with his employer can put him in a disadvantageous position, since the employer will be able to make use of these surveillance mechanisms in spite of legal norms.

Background Pre-infarct angina (PIA) has been shown to reduce reperfusion injury and infarct size in patients with ST-elevation myocardial infarction (STEMI) and currently represents the most efficient form of myocardial conditioning yet discovered. The role of diabetes on ischemic preconditioning remains controversial – while some pre-clinical studies suggest that diabetes blunts ischemic conditioning, clinical studies are lacking. Methods We retrospectively evaluated consecutive patients with STEMI admitted in our hospital from January 2008 to August 2018 who underwent primary angioplasty (PCI). PIA was defined as chest, arm or jaw pain during the preceding 48h before STEMI diagnosis. Peak creatine kinase and peak Troponin T levels were used as a surrogate of infarct size. Ischemic time (IT) was defined as the time between the onset of symptoms to the restoration of flow after either guidewire passage, thrombus aspiration or first balloon inflation. Results Of the 1143 included patients, 74% (n=845) were male and mean age was 62.6±13.1 years. A quarter of STEMI-patients had diabetes (25%, n=285). Almost a third of the patients (32%, n=359) had a history of angina in the preceding 48h before STEMI (PIA). The proportion of PIA was similar between diabetic and non-diabetic patients. In patients with diabetes, PIA was associated with lower creatine kinase (CK) (1144 [500–2212] vs 1715 [908–3309] U/L, p=0.0029) and Troponin T (TnT 3.30 [1.90–6.58] vs 4.88 [2.50–9.58] ng/mL, p=0.0022) despite similar IT as compared to those without PIA (328 [200–554] vs. 258 [180–530] minutes, p=0.1365). In non-diabetic patients, PIA was not significantly associated with infarct size (TnT 3.74 [2.23–7.11] vs 4.56 [2.44–7.77] ng/mL, p=0.1945; CK 1549 [910 - 2909] vs 1793 [996 - 3078] U/L, p=0.0653) even after adjustment for the increased ischemic time (240 [150–550] vs. 210 [140–405] minutes, p=0.0128) (β=−0.12, p=0.085 for CK and β=−0.11, p=0.183 for TnT). A significant interaction was observed between the existence of PIA and diabetes on peak TnT (p=0.026 for interaction) and CK (p=0.047 for interaction), which was independent of the culprit vessel and IT. During a median follow-up period of 18.0 [12.1–25.5] months, 268 (24.0%) MACE events have occurred (165 deaths, 27 strokes, 46 myocardial infarctions and 26 target vessel revascularization). PIA was associated with a significant reduction in the incidence of MACE (HR 0.66 (95% CI: 0.48–0.89)) driven by a reduction on mortality (HR 0.44 (95% CI: 0.28–0.70)). Diabetes was associated with an increased incidence of MACE (HR 1.42 (95% CI: 1.07–1.89)). No interaction was found between diabetes and PIA on their effect on MACCE events. Conclusion PIA is a strong predictor of favourable outcomes in the setting of STEMI. The effect of PIA on myocardial protection in patients with STEMI undergoing primary PCI seems to be modulated by the presence of diabetes. Distribution of Peak CK and Peak TnT Funding Acknowledgement Type of funding source: None

Background The benefits of exercise-based cardiac rehabilitation (EBCR) programs in post-acute myocardial infarction (AMI) patients have been demonstrated. Our aim was to assess the impact of EBCR in ≥ 70-years-old vs. younger post-AMI patients. Methods We retrospectively evaluated patients who underwent a supervised EBCR protocol, twice a week during 6-12 weeks. We evaluated changes in several outcomes based on pre- and post-CRP assessments. Results Of a total of 1607 patients, 333 (21%) were ≥ 70-years-old. After the EBCR, an overall improvement on functional capacity, daily physical activity, lipid profile, body mass index, glycated hemoglobin (HbA1c), N-terminal pro-brain natriuretic peptide (NT-pro-BNP) and C-reactive protein was observed in both younger and older patients (P < 0.05). Older patients showed a smaller benefit on the increment of daily physical activity and lipid profile improvement, but a larger reduction in NT-pro-BNP. In the multivariate analysis, only improvements on daily physical activity and HbA1c were dependent on age. Conclusion As their younger counterparts, older patients, significantly improved functional capacity, metabolic parameters and level of daily physical activity after EBCR.

International audience; Patients with rheumatoid arthritis (RA) are at higher risk for having underdiagnosed heart failure, however there are no recommendations regarding echocardiographic screening. We aimed to determine the prevalence of subclinical ventricular dysfunction in RA applying current echocardiographic guidelines, its association with patients' characteristics, biomarkers and prognostic parameters and compare the 2016 guidelines to the recommendations from 2009. Prospective study of RA patients without known heart disease, categorized as preserved ventricular function (PVF), systolic dysfunction (SD), isolated diastolic dysfunction (DD) or indeterminate diastolic function (IDF) as per the 2016 echocardiography guidelines-or any ventricular dysfunction (AVD) comprehending the last 3. The median age was 58 years and 78% were females. The majority had PVF (73%), followed by DD (13%), IDF (11%) and SD (4%). Concordance with the 2009 echocardiographic guidelines was low. Compared with PVF, AVD patients were older (65 vs 55 years, p 57 years) was the only independent predictor of AVD or DD. AVD was significantly associated with higher NT-proBNP and lower distance in 6-min walk test. There were no significant independent associations between characteristics of RA disease and ventricular function. A total of 17% of RA patients without known cardiovascular disease presented subclinical systolic or diastolic dysfunction, which was associated with older age. The echocardiographic screening may have clinical value in identifying subclinical ventricular dysfunction, especially in older RA patients.

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Introduction Noninvasive echocardiography evaluation of the right ventricle (RV) has been shown to have prognostic value in patients with pulmonary hypertension (PH). Different etiology groups might have different echocardiographic phenotypes. In this study, we aimed to study echocardiographic characterization of the different PH groups and its ability to predict pulmonary vascular disease severity. Methods We collected echocardiographic and right heart catheterization (RHC) data from 97 (75% female, age 65 ± 15 years) consecutive patients referred to an expert tertiary care referral PH centre from 12/2016 to 11/2018. Echocardiographic analysis was performed using Echo-Pac software from GE Healthcare®. Group 3 and 5 were not included in the group comparison analysis due to few patients included. Results Group 2 PH was the most frequent etiology of PH (35), followed by group 1 (26), group 4 (18), group 5 (3) and group 3 (2). The echocardiographic evaluation of this population as a whole showed borderline parameters of RV dysfunction (tricuspid annular plane systolic excursion (TAPSE) 18 ± 4 mm, fractional area change (FAC) 33 ± 10% and S’ tricuspid wave 10 ± 3 cm/sec). Mean RV global strain was -15 ± 5 and RV free wall strain was -17 ± 7. PH group 1 had a significantly lower FAC (26 ± 4%, p = 0.0025), higher eccentricity index (IE) (1.5 ± 0.1, p = 0.01), and more frequently RV outflow tract (RVOT) notching than other groups (62%, p = 0.012). Group 4 presented an intermedium echocardiographic phenotype between group 1 and 2, and showed more abnormal strain values than the other groups. Group 2 had fewer patients in sinus rhythm (atrial fibrillation in 34% of patients, p = 0.02), presented a thicker interventricular septum (11.3 ± 1.8, p = 0.014), a higher FAC (35 ± 3%, p = 0.0025), higher E mitral wave velocity (72 ± 6 cm/s, p PH groups 1 and 4 had higher Pulmonary Vascular Resistance (PVR) and Pulmonary Mean Arterial Pressure (PMAP) values than group 2, which significantly correlated with echocardiographic RV function parameters as TAPSE, FAC, RV global strain and IE. In PH group 2, eccentricity index was the only predictor of PVR (β=4.1, p = 0.018). In this population, a left atria volume < 32.7 cm3/m2 (OR 4.25, CI 1.71 - 10.55) and a E/e’ ratio < 12 (OR 4.72, CI 2.05 - 10.87) predicted PECP < 15 mmHg. RV global strain > -17.1 predicted PVR > 3 wood (OR 3.46, CI 1.50 - 8.02) and PMAP > 20 mmHg (OR 4.92, CI 1.67 - 14.51). TAPSE < 18 mm predicted PVR > 3 wood (OR 7.41, CI 2.99 - 18.36, AUC 0.72). Conclusion Different PH groups present mild echocardiographic differences between them. PH group 1 presented with more echocardiographic signs of RV disfunction, and PH group 2 had higher FAC, E/E’ and larger right and left atria. RV function parameters predicted PVR in PH groups 1 and 4, and EI was the only predictor of PVR in PH group 2. Abstract P1505 Figure.

Background Pulmonary arterial capacitance (PAC) has emerged as one of the strongest hemodynamic predictors of adverse outcomes in a wide spectrum of cardiovascular diseases, including pulmonary hypertension in heart failure with preserved ejection fraction (HFpEF-PH). We aimed to study non-invasive surrogates for PAC using transthoracic echocardiography in this population. Methods We retrospectively evaluated consecutive patients referred to an expert tertiary care referral centre from December 2016 to November 2018. Transthoracic echocardiography (TTE) was performed within 1 year of right heart catheterization (RHC). Echo-Pac software from GE Healthcare® was used to perform echocardiographic analysis. PAC was calculated dividing right ventricular stroke volume by pulmonary arterial pulse (systolic – diastolic) pressure, measured by RHC. Results Of the 105 enrolled patients, 43 were had HFpEF-PH. Among these, 72% were female and mean age was 68.9 ± 11.2 years. Median time between TTE and RHC was 68 (IQR 34 – 191) days. Most patients were in NYHA class II (60.5%) and class III (34.9%). Fifty eight percent of the patients had history of paroxysmal or permanent atrial fibrillation. This population presented borderline parameters of right ventricle (RV) systolic dysfunction: fractional area change (FAC) 35.3 ± 9.2%, tricuspid annular plane systolic excursion (TAPSE) 18.3 ± 5.1 mm, tricuspid S’ wave 10.4 ± 2.9 and RV global longitudinal strain -15.5 ± 4.0. Regarding invasive assessment, this population presented mean pulmonary artery pressures of 38.8 ± 13.9 mmHg, pulmonary artery wedge pressure of 21.6 ± 6.4 mmHg, pulmonary vascular resistance of 3.9 ± 2.7 Wood and median PAC of 0.13 (IQR 0.09 – 0.19) ml/mmHg. The TAPSE / Pulmonary arterial systolic pressure (PASP) ratio and the Right ventricular outflow track velocity time integral (RVOT VTI) / PASP ratio were the parameters that best correlated with PAC (r = 0.69, p = 0.002 for both parameters) (table 1). These parameters were obtainable in the majority of patients (31/43). Blant-Altman analysis revealed good agreement between these measures and PAC with a mean difference of - 0.17 (CI -0.21 - -0.13) for RVOT VTI / PASP ratio and -0.23 (CI -0.28 - -0.18) for TAPSE /PASP ratio. Conclusion In a HFpEF – PH population, TAPSE / PASP and RVOT VTI / PASP are easily obtainable in most patients and significantly correlate with PAC. Abstract P1289 Figure.

Introduction Noninvasive echocardiography evaluation of the right ventricle (RV) has been shown to have prognostic value in patients with pulmonary hypertension (PH). Recently, speckle-tracking echocardiography has emerged as a new tool in the RV assessment. In this study, we aimed to study the value of global longitudinal strain in the RV evaluation of these patients. Methods We collected clinical, laboratory, echocardiographic and right heart catheterization (RHC) data from consecutive patients referred to an expert tertiary care referral centre from 12/2016 to 11/2018. Global RV systolic peak longitudinal strain (RVS) and RV free wall peak longitudinal strain (RVFWS) (mean of the basal, mid- and apical-segments) were measured by speckle-tracking technique with Echo-Pac software from GE Healthcare®. Results Of the 97 included patients, 76% were female. The mean age was 65 ± 15 years. Most patients were in NYHA class II. Median time between TTE and RHC was 70 days [IQR 34 - 184]. Group 2 PH was the most frequent aetiology of PH (35), followed by group 1 (26), group 4 (18), group 5 (3) and group 3 (2). The echocardiographic evaluation of this population showed borderline parameters of RV dysfunction (tricuspid annular plane systolic excursion (TAPSE) 18 ± 4 mm, fractional area change (FAC) 33 ± 10% and S’ tricuspid wave 10 ± 3 cm/sec). Mean RV global strain was -15 ± 5 and RV free wall strain was -17 ± 7. Both strain parameters significantly correlated with other echocardiographic parameters such as TAPSE, FAC, Tricuspid S wave, RV diastolic diameter, eccentricity index (EI), systolic pulmonary artery pressure (SPAP), pulmonary acceleration time and presence of RV outflow tract notching. Strain parameters were also associated with pulmonary artery pressures and pulmonary vascular resistance (PVR) measured by RHC. Strain parameters did not correlate with PECP (p > 0.05). In multivariate analysis, RV global longitudinal strain predicted invasive mean pulmonary artery pressure and PVR independently of TAPSE and FAC (β=1.38, p -17.1 predicted PVR > 3 wood (OR 3.46, CI 1.50 - 8.02, AUC 0.72) and PMAP > 20 mmHg (OR 4.92, CI 1.67 - 14.51, AUC 0.78). TAPSE < 18 mm predicted PVR > 3 wood (OR 7.41, CI 2.99 - 18.36, AUC 0.72). Conclusion RV global and free wall longitudinal strain significantly correlate with other echocardiographic parameters of RV structure and function and with invasive pulmonary artery pressures and PVR. Abstract 555 Figure.

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Introduction Mechanical complications after myocardial infarction (MI) have become uncommon since the introduction of primary angioplasty. They can lead to a rapid clinical deterioration and a fatal outcome, with patient’s survival being depen­dent on their prompt recognition and intervention. We describe a case of two rare mechanical complications: a partial papillary muscle rupture after MI, followed by an early severe obstructive thrombosis of the implanted bioprosthetic valve. […] Partial Papillary Muscle Rupture after Myocardial Infarction and Early Severe Obstructive Bioprosthetic [...]

Relatório da Prática de Ensino Supervisionada apresentada no ISPA – Instituto Universitário / ESEI Maria Ulrich para obtenção de grau de Mestre em Educação Pré-Escolar O presente Relatório Final da Prática de Ensino Supervisionada tem como objetivo analisar e compreender os contributos da prática profissional para o desenvolvimento da autonomia e da independência de um grupo de crianças em idade pré-escolar, mais concretamente com 5 anos. A problemática emerge da observação da dependência das crianças sobre os adultos, ou seja, muito frequentemente perguntavam o que iriam fazer de seguida, se poderiam realizar as tarefas que os interessava ou as necessárias à rotina diária. Esta dependência nos cuidados, na tomada de decisões sobre o espaço e sobre o uso a dar aos materiais disponíveis, assim como a falta de participação ativa sobre as regras da sala, constituíram o ponto de partida da pesquisa. Neste sentido, para analisar e compreender que estratégias poderiam contribuir para o desenvolvimento da independência e da autonomia das crianças, implementei um plano de ação que procurei que assentasse na organização social do grupo, na participação ativa e coletiva das crianças sobre as regras da sala, com vista a promover, progressivamente, a tomada de iniciativa e a responsabilização sobre o espaço, materiais e sobre a rotina. Após a intervenção e a respetiva implementação das estratégias, constatei algumas melhorias, concretamente no que se relaciona com independência e autonomia das crianças na realização das tarefas. Estas melhorias relacionam-se com a compreensão que as crianças foram fazendo das regras da sala, bem como da apropriação que foram, gradualmente tomando do espaço e dos materiais. Apesar desta melhoria, considero que seria necessário mais tempo e mais oportunidades, sobretudo contínuas, para que as crianças progredissem ainda mais na sua autonomia ao nível da organização participada do grupo. The present final report of supervised teaching practice , aims to analyze and understand what are the benefits of the practice for the development of autonomy and independence of a group of pre-school children, more concretely with 5 years old. The problem emerges from the observation of children, more specifically of the dependence of the children on adults, that is, they often asked what they would do next, or if they could perform some tasks of their interest or necessary for the usually routine. This dependency on care , decision-making on space and on the use of materials available, as the lack of active participation of the classroom rules, constituted the starting point of the research. In this sense, to analyze and comprehend what strategies could contribute for the development of independence and autonomy of the children, I've implemented a plan of action/intervention that I tried to settle in the social organization of the group, in the active and collective participation of children about rules of the classroom, with a view to promoting, progressively, the taking of initiative and accountability of the space, materials and routine. After this intervention and implementation of strategys, I notice some improvements, particularly as regards of the constant requests of autorizacion to perform tasks.These improvements are related to the compreension that children were making of the classroom rules, as the appropiation that they, gradually were taking from space and materials. Regardless this improvement, i consider that will be necessery more time and more opurtunities, specially continued, for children could progress even more in their autonomy of group organization.

Resumo: A ecocardiografia é o método de imagem mais usado na prática clínica diária da cardiologia moderna, dada a sua disponibilidade, portabilidade, ausência de efeitos biológicos deletérios relevantes e menor custo quando comparada com a maioria das outras modalidades de imagem. A evolução tecnológica das últimas décadas, com a introdução de novos e cada vez mais complexos métodos de avaliação ecocardiográfica, alargou ainda mais as indicações para a realização de um ecocardiograma; no entanto, conduziu igualmente ao aumento da informação produzida pelo exame e à maior complexidade da sua interpretação com potencial geração de erros de avaliação por operadores com menor experiência. De modo a assegurar a qualidade e a segurança dos exames minimizando os riscos para os pacientes e a necessidade de duplicação de exames, é necessário uniformizar a prática da ecocardiografia em Portugal. O presente documento pretende contribuir para este esforço, enumerando‐se competências a adquirir e procedimentos a adotar de modo a garantir operadores e laboratórios qualificados. Abstract: Echocardiography is the most widely used imaging technique in modern cardiological clinical practice, since it is readily available, portable and safe, and provides a comprehensive morphological and functional assessment at low cost compared to other imaging modalities. Recent technological advances have introduced new echocardiographic techniques and widened the clinical applications of echocardiography. However, these developments have also led to an increase in information, rendering interpretation of the data provided by the exam more complex; this may result in assessment errors by less experienced operators. Standardization of procedures and training in echocardiography is therefore essential to ensure quality and safety for patients. The present document aims to contribute to this end, recommending quality requirements for operators and echocardiography laboratories in Portugal. Palavras‐chave: Ecocardiografia, Laboratório de Ecocardiografia, Treino, Competência, Relatório, Qualidade, Keywords: Echocardiography, Echocardiography laboratory, Training, Competence, Report, Quality

Echocardiography is the most widely used imaging technique in modern cardiological clinical practice, since it is readily available, portable and safe, and provides a comprehensive morphological and functional assessment at low cost compared to other imaging modalities. Recent technological advances have introduced new echocardiographic techniques and widened the clinical applications of echocardiography. However, these developments have also led to an increase in information, rendering interpretation of the data provided by the exam more complex; this may result in assessment errors by less experienced operators. Standardization of procedures and training in echocardiography is therefore essential to ensure quality and safety for patients. The present document aims to contribute to this end, recommending quality requirements for operators and echocardiography laboratories in Portugal. Resumo: A ecocardiografia é o método de imagem mais usado na prática clínica diária da cardiologia moderna, dada a sua disponibilidade, portabilidade, ausência de efeitos biológicos deletérios relevantes e menor custo quando comparada com a maioria das outras modalidades de imagem. A evolução tecnológica das últimas décadas, com a introdução de novos e cada vez mais complexos métodos de avaliação ecocardiográfica, alargou ainda mais as indicações para a realização de um ecocardiograma; no entanto, conduziu igualmente ao aumento da informação produzida pelo exame e à maior complexidade da sua interpretação com potencial geração de erros de avaliação por operadores com menor experiência. De modo a assegurar a qualidade e a segurança dos exames minimizando os riscos para os pacientes e a necessidade de duplicação de exames, é necessário uniformizar a prática da ecocardiografia em Portugal. O presente documento pretende contribuir para este esforço, enumerando-se competências a adquirir e procedimentos a adotar de modo a garantir operadores e laboratórios qualificados. Keywords: Echocardiography, Echocardiography laboratory, Training, Competence, Report, Quality, Palavras-chave: Ecocardiografia, Laboratório de Ecocardiografia, Treino, Competência, Relatório, Qualidade