Modelos de cura: aplicação ao cancro da mama feminino

A Análise de Sobrevivência tem como objetivo o estudo do tempo desde um instante inicial bem definido até ao acontecimento de determinado evento. Por exemplo, poderá ser o tempo de vida de um indivíduo desde o momento em que lhe é diagnosticada uma doença até a sua morte ou cura. Com a evolução da medicina, começou a se verificar a existência de indivíduos para os quais nunca se observava o acontecimento de interesse e designaram-se esses indivíduos por curados, imunes, ou não suscetíveis. Assim, da Análise de Sobrevivência clássica surgem os modelos de cura. Neste trabalho, aplicaram-se estes conceitos a uma base de dados referentes a 833 mulheres diagnosticadas com cancro da mama, entre 1998 e 2005. Verificou-se a existência de um risco de morte maior em mulheres na faixa etária dos 50 a 59 anos. Comprovou-se que o estadiamento tem um papel preponderante em relação ao prognóstico, sendo que, quanto mais avançado o estadio pior o prognóstico. Dos tratamentos a que os doentes foram submetidos, a realização de cirurgia é indicativa de um melhor prognóstico, assim como a realização de hormonoterapia e de radioterapia. No entanto, este último tratamento não se revelou estatisticamente significativo para o modelo de regressão de Cox. A realização de quimioterapia apenas reflete um melhor prognóstico nos primeiros dois anos, o que já não acontece a partir dai. Esta caraterística inesperada ficou-se a dever à esperança de vida que o tratamento oferece aos doentes no estadio IV e da associação entre a existência de gânglios metastizados e o agravamento do prognóstico, no caso do estadio II. O modelo de cura foi aplicado apenas ao grupo de mulheres no estadio IV, pois só neste caso se admitiu que o tempo de follow-up era suficiente, obtendo-se uma taxa de cura de 7;4%.Universidade da Madeir

perceptions and choices among rheumatology outpatients

OBJECTIVE: Biobanks for research (BBR) have enormous value for research, including those specifically oriented to chronic diseases. Knowing public attitudes and perceptions is key to design and implement patient-centered BBR. We assessed patient awareness, perception and choices among rheumatology outpatients regarding aging biobanking activities. METHODS: We conducted a cross-sectional survey of patients, aged 50 or older, attending an outpatient rheumatology tertiary department. Demographic data and perceptions about biobanking were collected and statistical analysis was performed. RESULTS: 132 valid questionnaires were obtained (mean age: 63,4; 68,2% female; mean education years: 8,35). 61,7% of respondents did not know the specific term "biobank", 57,7% knew they could donate biological material for BBR, 89,9% agreed with these infrastructures and 88,3% would consider participation Those participants with more years of education were more knowledgeable and prone to biobank participation. Willingness to participate in BBR was mainly related (86,4%) to the advancement of scientific knowledge and not individual gain. Scientific research institutes were indicated as the most adequate institutions to manage BBR. Informed consent, anonymity and confidentiality ranked as top requisites for biobank participation. 61,3% of respondents expressed their agreement with aging biobanks, considering these as a sign of respect for specific problems of people of older ages such as higher disease burdens. CONCLUSION: Knowledge of biobanks was found to be limited. Participants were positive toward the setting up of biobanks in general and patient-centered aging biobanks in particular. Knowledge about biobanks and acceptance were higher among participants with higher education years.publishersversionpublishe

Pseudocercospora cruenta NA CULTIVAR DE FEIJÃO-CAUPI BRS NOVAERA NO ESTADO DO PARÁ

Cowpea is a very consumed legume in Brazil, mainly in the regions North and Northeast of Brazil, where it is considered as a source of basic protein for the local population. The average yield of the crop is 484 kg/ha, but it may be reduced by phytosanitary problems. The Embrapa Cowpea Breeding Program released a cultivar called BRS Novaera, aiming to improve productivity and resistance to plant pathogens. It is considered as highly resistant to the diseased known as coffee stain, moderately resistant to golden mosaic and susceptible to thread blight, powdery mildew and other viruses, with no references to the disease cercospora spot. In the monitoring carried out at the Demonstration Unit for the Production of Bean Seeds of Embrapa Amazônia Oriental, in Belém, PA, plants with symptoms of leaf spots similar to the cercospora spot were detected, which were analyzed in the Laboratory of Plant Pathology at Embrapa Amazônia Oriental. The causal agent of the leaf spots was the fungus Pseudocercospora cruenta.Keywords: leaf spot; Vigna unguiculata.O feijão-caupi é uma leguminosa muito consumida no Brasil, principalmente nas regiões Norte/Nordeste, onde é tido como fonte de proteína básica para a população local, podendo, no entanto, ter sua produção ser reduzida por problemas fitossanitários. O Programa de Melhoramento de Feijão-caupi da Embrapa lançou a cultivar BRS Novaera, com o objetivo de melhorar a produtividade e resistência a fitopatógenos, sendo considerada como altamente resistente à mancha-café, moderadamente resistente ao mosaico dourado e suscetível à mela, oídio e demais viroses, sem referências à mancha de cercospora. Em monitoramento realizado na Unidade Demonstrativa de Produção de Sementes de Feijão-caupi da Embrapa Amazônia Oriental, em Belém, PA, foram detectadas plantas com sintomas de manchas foliares semelhantes à mancha de cercospora, as quais foram analisadas no Laboratório de Fitopatologia da Embrapa Amazônia Oriental, sendo constatado como agente causal o fungo Pseudocercospora cruenta.Palavras-chaves: mancha foliar, Vigna unguiculata

Uso do Arco de Maguerez na concepção de uma educação em saúde sobre práticas integrativas e complementares

Este estudo objetiva relatar a experiência do uso da Metodologia da Problematização com apoio do Arco de Maguerez no curso de graduação em Enfermagem, bem como os resultados alcançados. A experiência se deu com 5 alunos de uma instituição de ensino superior pública, localizada em Uberlândia, Minas Gerais, Brasil. Foram realizadas as cinco etapas do Arco de Maguerez: 1. Observação da realidade; 2. Pontos-chave; 3. Teorização; 4. Hipóteses de solução; 5. Aplicação à realidade. A vivência resultou na aplicação de uma ação educativa e em uma educação continuada. Tal ação educativa focou na integralidade da assistência, à medida que cooperou para um cuidado holístico, e agregou a todos os envolvidos conhecimentos de métodos alternativos para a promoção e para a prevenção de agravos da saúde mental e física por meio das práticas integrativas e complementares

“FATORES PREDITORES DE SUCESSO NA EXTUBAÇÃO OROTRAQUEAL DE INDIVÍDUOS INTERNADOS EM UTI PEDIÁTRICA COM ÊNFASE EM CARDIOLOGIA"

 To highlight, from the literature, the repercussions of early extubation performed on children after cardiac surgery. Methods: This is an integrative review. To develop the guiding question, the PICo strategy was applied: P - Child; I - Repercussions of cardiac surgery; Co - Early extubation. Furthermore, the following databases were used: Embase, Medical Literature Analysis and Retrieval System Online, SCOPUS, Web of Science, and the virtual library Scientific Electronic Library Online and timeless search. N = 6,836 studies were found, and n = 4 articles were selected to compose this review. For orotracheal extubation in pediatric patients, it is strongly recommended to assess their readiness. However, the use of a device or practice that was superior to clinical judgment has not yet been accurately determined. Results: Early extubation after cardiac surgical procedures has gained prominence in recent years, becoming a perioperative care practice capable of reducing the demand for analgesic and sedative medications, given that endotracheal intubation can be considered a harmful stimulant. Final considerations: Therefore, it was possible to understand the repercussions of early extubation after pediatric cardiac surgery, in addition to understanding the concerns related to the safety of this practice, due to the limited evidence of its use in children. Furthermore, there was a lack of studies related to the topic, highlighting the need for new research that addresses the effects of early extubation and its repercussions for pediatric patients.Evidenciar, a partir da literatura, quais as repercussões da extubação precoce realizada na criança após cirurgia cardíaca. Métodos: Trata-se de uma revisão integrativa. Para elaborar a questão norteadora, aplicou-se a estratégia PICo: P - Criança; I - Repercussões de cirurgia cardíaca; Co - Extubação precoce. Ainda, utilizou-se as seguintes bases de dados: Embase, Medical Literature Analysis and Retrieval System Online, SCOPUS, Web of Science, e a biblioteca virtual Scientific Electronic Library Online e busca atemporal. Foram encontrados n = 6.836 estudos, sendo selecionado n = 4 artigos para compor esta revisão.Para a extubação orotraqueal em pacientes pediátricos, é fortemente recomendada a avaliação de sua prontidão. No entanto, a utilização de um dispositivo ou prática que fosse superior ao julgamento clínico ainda não foi determinada com exatidão. Resultados: A realização da extubação precoce após o procedimento cirúrgico cardíaco ganhou destaque nos últimos anos, tornando-se uma prática dos cuidados perioperatórios, capaz de reduzir a demanda por medicamentos analgésicos e sedativos, visto que a intubação endotraqueal pode ser considerada um estimulante nocivo. Considerações finais: Logo, foi possível compreender as repercussões da extubação precoce após a cirurgia cardíaca pediátrica, além de entender as preocupações relacionadas à segurança desta prática, devido às evidências limitadas do seu uso para as crianças. Ainda, percebeu-se a escassez de estudos relacionados à temática, ressaltando a necessidade de novas pesquisas que abordem os efeitos da extubação precoce e suas repercussões para o paciente pediátrico

SARS-CoV-2 introductions and early dynamics of the epidemic in Portugal

Genomic surveillance of SARS-CoV-2 in Portugal was rapidly implemented by the National Institute of Health in the early stages of the COVID-19 epidemic, in collaboration with more than 50 laboratories distributed nationwide. Methods By applying recent phylodynamic models that allow integration of individual-based travel history, we reconstructed and characterized the spatio-temporal dynamics of SARSCoV-2 introductions and early dissemination in Portugal. Results We detected at least 277 independent SARS-CoV-2 introductions, mostly from European countries (namely the United Kingdom, Spain, France, Italy, and Switzerland), which were consistent with the countries with the highest connectivity with Portugal. Although most introductions were estimated to have occurred during early March 2020, it is likely that SARS-CoV-2 was silently circulating in Portugal throughout February, before the first cases were confirmed. Conclusions Here we conclude that the earlier implementation of measures could have minimized the number of introductions and subsequent virus expansion in Portugal. This study lays the foundation for genomic epidemiology of SARS-CoV-2 in Portugal, and highlights the need for systematic and geographically-representative genomic surveillance.We gratefully acknowledge to Sara Hill and Nuno Faria (University of Oxford) and Joshua Quick and Nick Loman (University of Birmingham) for kindly providing us with the initial sets of Artic Network primers for NGS; Rafael Mamede (MRamirez team, IMM, Lisbon) for developing and sharing a bioinformatics script for sequence curation (https://github.com/rfm-targa/BioinfUtils); Philippe Lemey (KU Leuven) for providing guidance on the implementation of the phylodynamic models; Joshua L. Cherry (National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health) for providing guidance with the subsampling strategies; and all authors, originating and submitting laboratories who have contributed genome data on GISAID (https://www.gisaid.org/) on which part of this research is based. The opinions expressed in this article are those of the authors and do not reflect the view of the National Institutes of Health, the Department of Health and Human Services, or the United States government. This study is co-funded by Fundação para a Ciência e Tecnologia and Agência de Investigação Clínica e Inovação Biomédica (234_596874175) on behalf of the Research 4 COVID-19 call. Some infrastructural resources used in this study come from the GenomePT project (POCI-01-0145-FEDER-022184), supported by COMPETE 2020 - Operational Programme for Competitiveness and Internationalisation (POCI), Lisboa Portugal Regional Operational Programme (Lisboa2020), Algarve Portugal Regional Operational Programme (CRESC Algarve2020), under the PORTUGAL 2020 Partnership Agreement, through the European Regional Development Fund (ERDF), and by Fundação para a Ciência e a Tecnologia (FCT).info:eu-repo/semantics/publishedVersio

MAMMALS IN PORTUGAL : A data set of terrestrial, volant, and marine mammal occurrences in P ortugal

Mammals are threatened worldwide, with 26% of all species being includedin the IUCN threatened categories. This overall pattern is primarily associatedwith habitat loss or degradation, and human persecution for terrestrial mam-mals, and pollution, open net fishing, climate change, and prey depletion formarine mammals. Mammals play a key role in maintaining ecosystems func-tionality and resilience, and therefore information on their distribution is cru-cial to delineate and support conservation actions. MAMMALS INPORTUGAL is a publicly available data set compiling unpublishedgeoreferenced occurrence records of 92 terrestrial, volant, and marine mam-mals in mainland Portugal and archipelagos of the Azores and Madeira thatincludes 105,026 data entries between 1873 and 2021 (72% of the data occur-ring in 2000 and 2021). The methods used to collect the data were: live obser-vations/captures (43%), sign surveys (35%), camera trapping (16%),bioacoustics surveys (4%) and radiotracking, and inquiries that represent lessthan 1% of the records. The data set includes 13 types of records: (1) burrowsjsoil moundsjtunnel, (2) capture, (3) colony, (4) dead animaljhairjskullsjjaws, (5) genetic confirmation, (6) inquiries, (7) observation of live animal (8),observation in shelters, (9) photo trappingjvideo, (10) predators dietjpelletsjpine cones/nuts, (11) scatjtrackjditch, (12) telemetry and (13) vocalizationjecholocation. The spatial uncertainty of most records ranges between 0 and100 m (76%). Rodentia (n=31,573) has the highest number of records followedby Chiroptera (n=18,857), Carnivora (n=18,594), Lagomorpha (n=17,496),Cetartiodactyla (n=11,568) and Eulipotyphla (n=7008). The data setincludes records of species classified by the IUCN as threatened(e.g.,Oryctolagus cuniculus[n=12,159],Monachus monachus[n=1,512],andLynx pardinus[n=197]). We believe that this data set may stimulate thepublication of other European countries data sets that would certainly contrib-ute to ecology and conservation-related research, and therefore assisting onthe development of more accurate and tailored conservation managementstrategies for each species. There are no copyright restrictions; please cite thisdata paper when the data are used in publications.info:eu-repo/semantics/publishedVersio

Mammals in Portugal: a data set of terrestrial, volant, and marine mammal occurrences in Portugal

Mammals are threatened worldwide, with ~26% of all species being included in the IUCN threatened categories. This overall pattern is primarily associated with habitat loss or degradation, and human persecution for terrestrial mammals, and pollution, open net fishing, climate change, and prey depletion for marine mammals. Mammals play a key role in maintaining ecosystems functionality and resilience, and therefore information on their distribution is crucial to delineate and support conservation actions. MAMMALS IN PORTUGAL is a publicly available data set compiling unpublished georeferenced occurrence records of 92 terrestrial, volant, and marine mammals in mainland Portugal and archipelagos of the Azores and Madeira that includes 105,026 data entries between 1873 and 2021 (72% of the data occurring in 2000 and 2021). The methods used to collect the data were: live observations/captures (43%), sign surveys (35%), camera trapping (16%), bioacoustics surveys (4%) and radiotracking, and inquiries that represent less than 1% of the records. The data set includes 13 types of records: (1) burrows | soil mounds | tunnel, (2) capture, (3) colony, (4) dead animal | hair | skulls | jaws, (5) genetic confirmation, (6) inquiries, (7) observation of live animal (8), observation in shelters, (9) photo trapping | video, (10) predators diet | pellets | pine cones/nuts, (11) scat | track | ditch, (12) telemetry and (13) vocalization | echolocation. The spatial uncertainty of most records ranges between 0 and 100 m (76%). Rodentia (n =31,573) has the highest number of records followed by Chiroptera (n = 18,857), Carnivora (n = 18,594), Lagomorpha (n = 17,496), Cetartiodactyla (n = 11,568) and Eulipotyphla (n = 7008). The data set includes records of species classified by the IUCN as threatened (e.g., Oryctolagus cuniculus [n = 12,159], Monachus monachus [n = 1,512], and Lynx pardinus [n = 197]). We believe that this data set may stimulate the publication of other European countries data sets that would certainly contribute to ecology and conservation-related research, and therefore assisting on the development of more accurate and tailored conservation management strategies for each species. There are no copyright restrictions; please cite this data paper when the data are used in publications

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Strain-related pathogenicity in Diplodia corticola

Diplodia corticola is one of the most aggressive fungal pathogens of Quercus species and is involved in the decline of Mediterranean cork oak forests and Californian oaks. Information regarding variation in virulence between strains is scarce. We hypothesize that D. corticola strains differ in virulence and consequently induce different symptoms in infected plants. To test this, infection assays were carried out on Quercus suber half-sib seedlings with seven strains of D. corticola. Visual symptoms of infection (external lesions, leaf wilting, exudation and others) were recorded in parallel with physiological and biochemical parameters. All strains were able to cause lesions but at differing levels of aggressiveness. We show that internal lesion length did not correlate directly with strain aggressiveness and this agrees with physiological parameters that should be taken into account to infer about strain pathogenicity. Infection by all strains induced an overall negative impact on the net photosynthetic rate and an increase in the oxidative stress status of plants; however, significant differences were found when the effects of different strains were compared. Results also suggest that being under optimum growth conditions, prior to and during infection, allowed plants to respond to the pathogen. At the end of the experiment, some strains of D. corticola established a latent pathogen-like relationship with cork oak. This is the first study to show that D. corticola virulence is strain-dependent