Multimodal neuromonitoring in children with severe traumatic brain injury

Traumatic brain injury (TBI) is a main cause of child morbidity and mortality worldwide. Survivors with severe neurological impairment represent an important burden to families and society. Modern neurocritical care management focuses on minimizing secondary brain injury and the use of management strategies based on multimodal brain monitoring has a potential to improve patient outcome. Cerebral autoregulation is an important mechanism allowing cerebral blood flow to stay constant despite fluctuations of cerebral perfusion pressure. It has been shown to be impaired in children with TBI and loss of autoregulation is associated with a poor outcome. There are several techniques that allow continuous calculation of autoregulation indices (and its surrogate - cerebrovascular reactivity) using intracranial pressure, blood flow velocity or cerebral oxygenation and its correlation to arterial blood pressure or cerebral perfusion pressure (CPP). The aim of this thesis was to study the accuracy of different methods of neuromonitoring, ranging from non-invasive and invasive acquisition of signals involved in cerebral haemodynamics to the study of cerebral autoregulation in children with TBI. The secondary objective was to study the association of autoregulation impairment with clinical outcome. In the introduction, traumatic brain injury in children and the theoretical principles of neuromonitoring are presented in detail with focus on the parameters used in the studies performed throughout the thesis. The cerebral autoregulation principles are also reviewed. The main body of the thesis is divided in four sections: In the first section, I review the role of neurovascular sonography in paediatric traumatic brain injury. Namely, the role of TCD in estimating intracranial pressure and cerebral perfusion pressure; evaluating cerebral autoregulation and continuous monitoring; detecting regional variations on cerebral haemodynamics and in the diagnosis of brain death. In the second section, I document through several clinical cases the usefulness of TCD for bedside decisions in the paediatric emergency department and in the paediatric intensive care unit. Five patients with different types of acute brain injury are presented. TCD was useful in the identification of intracranial hypertension in traumatic brain injury, hydrocephalus and central nervous system infection; identification of decreased cerebral perfusion pressure in hypovolemic shock and the diagnosis of impending cerebral circulatory arrest in a child with meningococcal septicaemia. I discuss the importance of TCD in each scenario through a revision of relevant literature and with my own experience. In the third section, I assess TCD as a non-invasive method to estimate cerebral perfusion pressure in children with severe traumatic brain injury. In order to accomplish this objective the feasibility of a novel non-invasive method of cerebral perfusion pressure estimation (nCPP) using a TCD-spectral accounting method in children with severe TBI was tested. There was a good correlation between invasive cerebral perfusion pressure and nCPP and nCPP monitoring with TCD appears to be a feasible method for cerebral perfusion pressure assessment in paediatric TBI. The novel spectral nCPP tested in this study has a decent correlation with invasive CPP and can predict low CPP with excellent accuracy at the 70-mmHg threshold. In the fourth and final section of this thesis, I present the results of a prospective cohort study performed throughout the four years of the thesis development. All children admitted to our paediatric intensive care unit with severe TBI were included to study three different methods of monitoring autoregulation: pressure-reactivity index (PRx), transcranial Doppler derived mean flow velocity index (Mx) and near-infrared spectroscopy derived cerebral oximetry index (COx). This is the first study to compare these three different methods of monitoring cerebral autoregulation in a group of children. PRx seems to be the most robust index to access cerebrovascular reactivity in children with TBI. It allows calculation of optimal CPP for the individual patient and has promising prognostic value. The main conclusions of this thesis are: • Transcranial Doppler is a useful technique to assist the clinical decisions at the bedside in children with acute brain injury; • Multimodal neuromonitoring is feasible in paediatric patients with TBI; • PRx seems to be the most sensitive index for cerebral autoregulation monitoring in children and has prognostic value; • Non-invasive continuous neuromonitoring is promising but it is still not accurate enough to replace invasive monitoring

Editorial

Dá-se início neste número da Acta Radiológica Portuguesa a uma fase renovada na vida da nossa revista coincidindo com a entrada plena em funções do seu novo Editor, Prof. Doutor Filipe Caseiro Alves.A renovação não passa apenas pela capa concebida em linhas modernas, mas mantendo a sobriedade gráfica.Decorre substancialmente dos moldes de constituição do Conselho Editorial e da programação de novas rubricas.À semelhança do que se passa com revistas congéneres internacionais, constituiu-se o Conselho Editorial à luz da evolução ocorrida na Ciência da Imagem, pelo progressivo desenvolvimento de áreas de subespecialização. Daí que se tenham criado diferentes secções e nelas se tenham incorporado profissionais de qualidade, quer na sua actividade privada, quer hospitalar e que às matérias a que ficam adstritos têm dedicado muito do seu esforço e saber.É natural que com o tempo se façam os reajustamentos necessários para a manutenção em permanência de um Conselho coeso e homogéneo.Em meu entender estes colegas não terão apenas a missão de rever, com a autoridade que lhe é reconhecida, os artigos enviados para publicação, mas cabe-lhes também a obrigação de terem um papel activo na publicação de artigos de sua autoria

Liderança e storytelling : o poder das histórias no contexto da liderança organizacional

No contexto da dinâmica de mercado em que vivemos, tão competitivo e inacessível, com a crise a provocar uma taxa de desemprego elevada e constantes mudanças nas organizações, a necessidade de desenvolver novas ferramentas de liderança torna-se um desafio importante. A liderança é um tema com largos anos de investigação e constantes mudanças. Esta dissertação, intitulada Liderança e Storytelling: O poder das histórias no contexto da liderança organizacional, visa compreender de que forma o storytelling pode ter influência quando utilizado na comunicação de um líder numa organização, essencialmente, no relacionamento com os seus colaboradores. A investigação que levamos a cabo abordará diversos temas, que direta ou indiretamente se relacionam com o nosso tema central: liderança e storytelling. Assim exploraremos as temáticas da comunicação, da liderança e a sua evolução ao longo do tempo, como as suas teorias, das mais antigas às contemporâneas, focando em especial a inteligência emocional e a relação entre líder e liderado. Através de uma metodologia qualitativa, assente em entrevistas semidiretivas a líderes empresariais, trabalhamos de um ponto de vista empírico o tema em estudo, procurando clarificar, interpretar teoricamente, práticas e narrativas de liderança e storytelling. Como resultado principal, esta investigação sugere que o storytelling é uma prática constante na comunicação do líder, consciente ou inconscientemente, e que tem importância nas organizações. Por outro lado, no entanto, não se trata ainda de uma técnica utilizada deliberadamente e com intenção estratégica.In the context of market dynamics in which we live, so competitive and inaccessible, with the crisis leading to a high unemployment rate and constant changes in organizations, the need to develop new leadership tools becomes a major challenge. Leadership is a topic with many years of research and constant change. This thesis, entitled Liderança e Storytelling: O poder das histórias no contexto da liderança organizacional, aims to understand how storytelling can have an effect when used in the communication of a leader in an organization, essentially in the relationship with your employees. The research that we conduct will address various topics that directly or indirectly relate to our central theme: leadership and storytelling. So we explore the themes of communication, leadership and its evolution over time, as their theories, from the most ancient to contemporary, focusing in particular on emotional intelligence and the relationship between leader and follower. Through a qualitative methodology, based on semi directive interviews with business leaders, we work from an empirical point of view the subject being studied, seeking to clarify, interpret theory, practice and leadership narratives and storytelling. As a main result, this research suggests that storytelling is a constant practice in communication leader, consciously or unconsciously, and that is important in organizations. On the other hand, however, it is not yet a technical and strategic used deliberately intended

Analysis of odd-mass technetium isotopes with the Alaga model

The structure of the odd-mass technetium isotopes is analyzed with the Alaga model which involves the coupling of a three-particle valence-shell cluster to the quadrupole vibrational field. The calculated energy-level sequence and decay properties are consistent with the general trend of the available experimental information although no attempt of the best fit to individual properties was pursued.Facultad de Ciencias Exacta

Septic Pulmonary Embolism Case Report: Optimal Outcome after Insertion of an Inferior Vena Cava Filter in a Patient with Staphylococcus aureus Bacteraemia

A 14-year-old patient presented with bilateral pneumonia and pleural effusions, septic arthritis of the hip, deep venous thrombosis, and pulmonary thromboembolism. Methicillin-sensitive Staphylococcus aureus (S. aureus) containing the Panton Valentine Leukocidin (PVL) genes was isolated. Contraindication to anticoagulation prompted inferior vena cava filter placement. He completed 4 weeks of treatment with flucloxacillin, with good clinical outcome. S. aureus containing PVL genes should be sought in cases of necrotizing pneumonia as it seems to increase the risk of severe multifocal infection and thrombotic complications. There are few reports of placement of filters during S. aureus sepsis and bacteraemia. This case highlights that when anticoagulation is not feasible, an inferior vena cava filter can be inserted safely, even in patients with active sepsis and high risk for seeding of the filter. Long-term follow-up confirmed a successful outcome with sterilization of the septic thrombosis with no further pulmonary embolism or additional sepsis episodes

ETN Valued Species and Sites Report

Provide operations and maintenance support to scientific teams initiating studies of valued species, such as Bluefin tuna, European eel, sea bass, sea trout. To achieve this deliverable a workshop will be hold focussing on launching and networking activities

Large-Scale Evaluation of Candidate Genes Identifies Associations between VEGF Polymorphisms and Bladder Cancer Risk

Common genetic variation could alter the risk for developing bladder cancer. We conducted a large-scale evaluation of single nucleotide polymorphisms (SNPs) in candidate genes for cancer to identify common variants that influence bladder cancer risk. An Illumina GoldenGate assay was used to genotype 1,433 SNPs within or near 386 genes in 1,086 cases and 1,033 controls in Spain. The most significant finding was in the 5′ UTR of VEGF (rs25648, p for likelihood ratio test, 2 degrees of freedom = 1 × 10(−5)). To further investigate the region, we analyzed 29 additional SNPs in VEGF, selected to saturate the promoter and 5′ UTR and to tag common genetic variation in this gene. Three additional SNPs in the promoter region (rs833052, rs1109324, and rs1547651) were associated with increased risk for bladder cancer: odds ratio (95% confidence interval): 2.52 (1.06–5.97), 2.74 (1.26–5.98), and 3.02 (1.36–6.63), respectively; and a polymorphism in intron 2 (rs3024994) was associated with reduced risk: 0.65 (0.46–0.91). Two of the promoter SNPs and the intron 2 SNP showed linkage disequilibrium with rs25648. Haplotype analyses revealed three blocks of linkage disequilibrium with significant associations for two blocks including the promoter and 5′ UTR (global p = 0.02 and 0.009, respectively). These findings are biologically plausible since VEGF is critical in angiogenesis, which is important for tumor growth, its elevated expression in bladder tumors correlates with tumor progression, and specific 5′ UTR haplotypes have been shown to influence promoter activity. Associations between bladder cancer risk and other genes in this report were not robust based on false discovery rate calculations. In conclusion, this large-scale evaluation of candidate cancer genes has identified common genetic variants in the regulatory regions of VEGF that could be associated with bladder cancer risk

HIV-1 diversity and pre-treatment drug resistance in the era of integrase inhibitor among newly diagnosed ART-naïve adult patients in Luanda, Angola

This research was funded by the Fundação Calouste Gulbenkian (FCG), under the ENVOLVE Ciência PALOP program that funded the HITOLA project (Number 250466), AREF (AREF-312-CRUZ-F-C0931), Science and Technology Development Project (PDCT) within the scope of the MUTHIVAO project (Number 36 MESCTI/PDCT/2022), FCT MARVEL (PTDC/SAU-PUB/4018/2021), FCT GHTM-UID/04413/2020 and LA-REAL-LA/P/0117/2020.The surveillance of drug resistance in the HIV-1 naïve population remains critical to optimizing the effectiveness of antiretroviral therapy (ART), mainly in the era of integrase strand transfer inhibitor (INSTI) regimens. Currently, there is no data regarding resistance to INSTI in Angola since Dolutegravir-DTG was included in the first-line ART regimen. Herein, we investigated the HIV-1 genetic diversity and pretreatment drug resistance (PDR) profile against nucleoside/tide reverse transcriptase inhibitors (NRTIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs), protease inhibitors (PIs), and INSTIs, using a next-generation sequencing (NGS) approach with MinION, established to track and survey DRMs in Angola. This was a cross-sectional study comprising 48 newly HIV-diagnosed patients from Luanda, Angola, screened between March 2022 and May 2023. PR, RT, and IN fragments were sequenced for drug resistance and molecular transmission cluster analysis. A total of 45 out of the 48 plasma samples were successfully sequenced. Of these, 10/45 (22.2%) presented PDR to PIs/NRTIs/NNRTIs. Major mutations for NRTIs (2.2%), NNRTIs (20%), PIs (2.2%), and accessory mutations against INSTIs (13.3%) were detected. No major mutations against INSTIs were detected. M41L (2%) and I85V (2%) mutations were detected for NRTI and PI, respectively. K103N (7%), Y181C (7%), and K101E (7%) mutations were frequently observed in NNRTI. The L74M (9%) accessory mutation was frequently observed in the INSTI class. HIV-1 pure subtypes C (33%), F1 (17%), G (15%), A1 (10%), H (6%), and D (4%), CRF01_AG (4%) were observed, while about 10% were recombinant strains. About 31% of detected HIV-1C sequences were in clusters, suggesting small-scale local transmission chains. No major mutations against integrase inhibitors were detected, supporting the continued use of INSTI in the country. Further studies assessing the HIV-1 epidemiology in the era of INSTI-based ART regimens are needed in Angola.info:eu-repo/semantics/publishedVersio

Serological screening in a large-scale municipal survey in Cascais, Portugal, during the first waves of the COVID-19 pandemic: lessons for future pandemic preparedness efforts

BackgroundSerological surveys for SARS-CoV-2 were used early in the COVID-19 pandemic to assess epidemiological scenarios. In the municipality of Cascais (Portugal), serological testing combined with a comprehensive socio-demographic, clinical and behavioral questionnaire was offered to residents between May 2020 and beginning of 2021. In this study, we analyze the factors associated with adherence to this municipal initiative, as well as the sociodemographic profile and chronic diseases clinical correlates associated to seropositivity. We aim to contribute with relevant information for future pandemic preparedness efforts.MethodsThis was a cross-sectional study with non-probabilistic sampling. Citizens residing in Cascais Municipality went voluntarily to blood collection centers to participate in the serological survey. The proportion of participants, stratified by socio-demographic variables, was compared to the census proportions to identify the groups with lower levels of adherence to the survey. Univariate and multivariate logistic regression were used to identify socio-demographic, clinical and behavioral factors associated with seropositivity.ResultsFrom May 2020 to February 2021, 19,608 participants (9.2% of the residents of Cascais) were included in the study. Based on the comparison to census data, groups with lower adherence to this survey were men, the youngest and the oldest age groups, individuals with lower levels of education and unemployed/inactive. Significant predictors of a reactive (positive) serological test were younger age, being employed or a student, and living in larger households. Individuals with chronic diseases generally showed lower seroprevalence.ConclusionThe groups with low adherence to this voluntary study, as well as the socio-economic contexts identified as more at risk of viral transmission, may be targeted in future pandemic situations. We also found that the individuals with chronic diseases, perceiving higher risk of serious illness, adopted protective behaviors that limited infection rates, revealing that health education on preventive measures was effective for these patients