The platelet-to-lymphocyte ratio (PLR) and the clinical impact on the outcome of stroke patients under previous aspirin therapy

Introdução: Plaquetas e linfócitos desempenham um papel crítico nas vias fisiopatológicas dos estadios iniciais do AVC isquémico agudo (AIS). O rácio plaquetas-linfócitos (PLR) é um parâmetro acessível para avaliar a resposta inflamatória, pois pode ser calculada a partir de um hemograma regular. A aspirina/ácido acetilsalicílico (AAS) desempenha um papel central na prevenção secundária de doenças cardiovasculares, no entanto, o seu impacto no PLR e consequente prognóstico não são completamente compreendidos. Objetivos: Explorar a relação entre aspirina e PLR e os consequentes efeitos na mortalidade e recorrência de AVC em pacientes com AVC isquémico. Métodos: 424 pacientes foram incluídos neste estudo observacional. Os valores do PLR foram calculados a partir da primeira amostra de sangue na admissão. O efeito do PLR na mortalidade e recorrência de AVC foi avaliado usando a metodologia de Kaplan-Meier, teste de log-rank, modelos de risco proporcional de Cox e Análise Bootstrap. Resultados: Os nossos resultados indicam uma associação do PLR alto (>170) com má sobrevida global em pacientes com AVC (HR 1,880, IC 95% 1,176 - 3,005, p = 0,008), principalmente naqueles sem registo de terapia com aspirina (p = 0,018). A modelação do risco de um segundo evento (recorrência) no período de 36 meses demonstrou capacidade preditiva do PLR (p=0,004) confirmada pela análise Bootstrap (p = 0,001; 1000 repetições). A inclusão do PLR nas equações dos modelos de simulação proporciona um ganho de quase 20% na capacidade preditiva (índice C 0,779 aumenta para 0,946). Conclusões: O rácio plaquetas-linfócitos (PLR) está ligado a um impacto clínico com piores desfechos para pacientes com AVC e isso é demonstrado pela primeira vez em relação à terapia prévia com aspirina.Background: Platelets and lymphocytes play a critical role in the pathophysiological pathways of the early stages of acute ischemic stroke (AIS). Platelet-to-lymphocyte ratio (PLR) is an accessible parameter to evaluate inflammatory response as it can be calculated from a regular hemogram. Aspirin/acetylsalicylic acid (ASA) plays a central role in the secondary prevention of cardiovascular disease, however, its impact on PLR levels and consequent prognostics are not completely understood. Aims: Explore the relationship between aspirin and PLR and the consequent effects on mortality and stroke recurrence in patients with AIS. Methods: 424 patients were included in this observational study. PLR values were calculated from the first blood sample at admission. The effect of PLR on mortality and stroke recurrence was evaluated using Kaplan-Meier methodology, log-rank test, Cox proportional hazard models, and Bootstrap Analysis. Results: Our results indicate an association of high PLR (>170) with a poor overall survival on stroke patients (HR 1.880, 95%CI 1.176 - 3.005, p = 0.008), particularly in those with no record of aspirin therapy (p = 0.018). Modeling the risk of a second event (recurrence) in the timeframe of 36 months demonstrated a predictive capacity for PLR (p=0.004) confirmed by Bootstrap analysis (p = 0.001; 1000 replications). The inclusion of PLR in simulating models' equations provides a gain of nearly 20% in the predictive ability (C-index 0.779 increases to 0.946). Conclusions: The platelet-to-lymphocyte ratio (PLR) has a link to clinical impact with worse outcomes for stroke patients and this is firstly demonstrated related to previous aspirin therapy

The effect of a design label on product choice in FMCG

The concept of User Innovation is not very familiar to consumers, but a growing number of companies are starting to invest on users to assist their R&D process. Thompson and Malaviya’s Skepticism-Identification model explain why companies should encourage but at the same be careful when communicating that a product was designed by users. This experimental study aims to understand the influence of the level of user input in product design on product choice. The design continuum: (1) firm-designed; (2) user-designed and (3) co-creation (the collaboration between the two) is applied to the FMCG industry and tested whether product nature (hedonic and utilitarian) influences consumers’ responses. Firstly, the results indicated that co-creation is the preferred design label, regardless of the product nature. A co-created label enhances perceptions of product quality and for this reason, managers should use this increase in product value to create a competitive advantage in the marketplace. Secondly, the results indicated that utilitarian products draw the most benefits from a user design label. When looking at communicating the product design mode, companies should first look at the nature of their products.Os consumidores não se encontram muito familiarizados com o conceito de “inovação do consumidor”. Contudo, um número crescente de empresas começa a investir cada vez mais no seu contributo para o processo de I&D. O modelo “Ceticismo-Identificação” de Thompson e Malaviya explica as razões que incentivam e alertam sobre os cuidados da comunicação de que um produto foi concebido pelos consumidores. O presente estudo experimental tem como objectivo perceber a influência do grau de contribuição dos consumidores (na fase de concepção) na escolha do mesmo. O contínuo (1) concebido por profissionais (2) por consumidores e (3) cocriação (colaboração entre as duas partes) é aplicado em Bens de Consumo e é testado perante naturezas de produto distintas (hedónica e utilitária). Os resultados indicam que, em primeiro lugar, a cocriação é a opção mais preferida dos consumidores, independentemente da natureza do produto. Os consumidores percepcionam uma qualidade superior nestes produtos, sendo que as empresas podem ganhar uma vantagem competitiva no mercado. Em segundo lugar, os resultados indicam que os produtos utilitários vão beneficiar fortemente da comunicação de que um produto foi concebido por utilizadores, o que sugere que as empresas devem analisar a natureza do produto antes de investirem neste tipo de estratégias

Os impactos dos efeitos imunomodulatórios das beta-glucanas fúngicas na saúde humana

A modulação cuidadosa do sistema imunológico é essencial para garantir uma resposta imunológica eficaz, equilibrada e adaptativa, promovendo a saúde geral do organismo. Esta revisão tem por objetivo discutir as funções imunomodulatórias das beta-glucanas fúngicas. As beta-glucanas podem interagir com diversos receptores presentes na superfície das células imunológicas, o que resulta na ativação ou na inibição de células tanto da imunidade inata quanto adaptativa. As consequências afetam processos inflamatórios, hipersensibilidades e autoimunidades. Diversos são os fatores que podem interferir e determinar se a interferência das beta-glucanas no sistema imunológico será positiva ou negativa. Dentre estes fatores, podemos citar o peso molecular, as ramificações estruturais e a solubilidade das beta-glucanas. Ensaios clínicos têm reunido evidências dos efeitos benéficos das beta-glucanas na saúde humana, fortalecendo o sistema imunológico e reduzindo infecções. Os desafios encontrados para que as beta-glucanas tenham seu uso clínico aprovado e incentivado incluem a heterogeneidade das estruturas moleculares das beta-glucanas e a variação na resposta entre indivíduos. Por outro lado, o aprofundamento no estudo destas moléculas poderá ultrapassar tais barreiras e colaborar para o desenvolvimento de estratégias que melhorem sua biodisponibilidade e eficácia

A snapshot of the quality of therapy in nursing homes

Poster presented at the 1st International Congress of CiiEM: From Basic Sciences to Clinical Research, 27-28 November 2015, Egas Moniz, Caparica, Portugal

Drug-related problems identified in a sample of Portuguese institutionalised elderly patients and pharmacists’ interventions to improve safety and effectiveness of medicines

This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/), which permits any noncommercial use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made."Background Currently, people live longer but often with poor quality of life. The decrease in healthy life-years is partly attributable to the institution of polypharmacy to treat various comorbidities. Objectives The objectives of the study were to determine the prevalence and nature of drug-related problems (DRPs) in polypharmacy elderly patients residing in nursing homes and to test the acceptability of a pharmacist’s intervention. Methods An exposure cohort was constituted in three Portuguese nursing homes, where all polypharmacy (five or more medicines) elderly patients (≥65 years of age) were analysed and then a random stratified sample was extracted to be subject to an intervention. Clinical and therapeutic data were collected and analysed for DRPs and classified according to the II Granada Consensus, by a pharmacist-led team. The intervention was the formulation of a pharmacist’s recommendations to prescribers addressing clinically relevant DRPs, along with suggestions for therapy changes. Results The initial sample included 126 elderly patients taking 1332 medicines, where 2109 DRPs were identified. The exposure cohort included 63 patients, with comparable baseline data (p > 0.005). Manifest DRPs occurred in 31.7 % of the intervention group (mainly quantitative ineffectiveness–DRP 4), whereas potential DRPs were identified in 100 % of patients (mainly non-quantitative unsafe–DRP 5). Amongst the DRPs identified, 584 (56.7 %) were reported to prescribers (all types of DRPs) and 113 (11 %) to nurses (only non-quantitative ineffectiveness–DRP 3). A total of 539 pharmacist recommendations were presented to physicians, corresponding to 62 letters sent by mail, each including an average of 8.7 recommendations to solve DRPs present in intervention group (IG) patients. There was a high non-response rate (n = 34 letters; 54.8 %; containing 367 pharmacist recommendations; 68.1 %) and amongst recommendations receiving feedback, only 8.7 % of pharmacist recommendations made were accepted (n = 15). Positive responses were significantly associated with a lower number of recommendations made, whereas a higher number of recommendations increased the odds of no response (p < 0.001). Conclusion A pharmacist-led medication review proved useful in identifying DRPs in elderly polypharmacy nursing home residents. Stronger bonds must be developed between healthcare professionals to increase patient safety in the vulnerable institutionalised elderly population.

Results from a population-based cohort study

Funding Information: We have read the journal's policy and the authors of this manuscript have the following competing interests: ARF reports travel grants from Roche and advisory board fees from Daiichi Sankyo, Gilead, Merck Sharp & Dohme, Novartis and Roche, outside the submitted work. DMB reports travel grants from LEO Farmacêuticos, Merck Sharp & Dohme, Ipsen, Janssen, Roche, and Novartis, advisory board fees from Janssen, Pfizer, Merck Sharp & Dohme, Angelini, AstraZeneca, and Novartis, and institutional grants from F. Hoffmann-La Roche, outside the submitted work. The other authors have declared that no competing interests exist. Funding Information: The authors acknowledge the RON network that cooperated in providing up-to-date information on cases diagnosed and treated with the drug of interest (participating institutions: Centro Hospitalar Universit?rio de S?o Jo?o, Centro Hospitalar Universit?rio Lisboa Norte, Centro Hospitalar Universit?rio do Algarve, Hospital de Braga, Centro Hospitalar e Universit?rio de Coimbra, Centro Hospitalar de Tr?s-os-Montes e Alto Douro, Hospital Central do Funchal, Centro Hospitalar de Vila Nova de Gaia/Espinho, Centro Hospitalar Lisboa Ocidental, Hospital Garcia de Orta, Centro Hospitalar Universit?rio Lisboa Central, Hospital Distrital de Santar?m, Centro Hospitalar de Entre o Douro e Vouga, Hospital da Senhora da Oliveira Guimar?es, Centro Hospitalar de Set?bal, Centro Hospitalar e Universit?rio do Porto, Centro Hospitalar Tondela Viseu, Hospital do Esp?rito Santo de ?vora, Centro Hospitalar Barreiro Montijo, Hospital Beatriz ?ngelo, Hospital do Santo Esp?rito da Ilha Terceira, Hospital do Divino Esp?rito Santo de Ponta Delgada, Hospital Pedro Hispano ? ULS Matosinhos, Hospital do Litoral Alentejano ? Santiago do Cac?m ? ULS Litoral Alentejano, Centro Hospitalar do Oeste, Centro Hospitalar M?dio Tejo, Hospital Jos? Joaquim Fernandes ? Beja ? ULS Baixo Alentejo, Centro Hospitalar Universit?rio da Cova da Beira, Centro Cl?nico Champalimaud, Hospitais CUF, Hospitais da Luz, Hospitais dos Lus?adas, Hospital Particular do Algarve). Publisher Copyright: © 2022 The AuthorsBackground: Real-world (RW) data may provide valuable information on the effectiveness and safety of medicines, which is particularly relevant for clinicians, patients and third-party payers. Evidence on the effectiveness of palbociclib plus fulvestrant is scarce, which highlights the need of additional studies. The aim of this study was to evaluate the effectiveness of palbociclib plus fulvestrant in advanced breast cancer (ABC). Materials and methods: We conducted a population-based retrospective cohort study and cases of interest were identified through the Portuguese National Cancer Registry database and additional data sources. Patients aged≥18 years, diagnosed with ABC and exposed to palbociclib plus fulvestrant between May 31, 2017 and March 31, 2019 were included. Patients were followed-up until death or cut-off date (February 28, 2021). Primary outcome was rw-progression-free survival (rwPFS). Secondary outcomes were rw-overall survival (rwOS), rw-time to palbociclib failure (rwTPF) and rw-time to next treatment (rwTTNT). Results: A total of 210 patients were included. Median age was 58 years (range 29–83) and 99.05% were female. Median follow-up time was 23.22 months and, at cut-off date, treatment had been discontinued in 189 patients, mainly due to disease progression (n = 152). Median rwPFS was 7.43 months (95% confidence interval [CI] 6.28–9.05) and 2-year rwPFS was 16.65% (95%CI 11.97–22.00). Median rwOS was 24.70 months (95%CI 21.58–29.27), median rwTPF was 7.5 months (95%CI 6.51–9.08) and median rwTTNT was 11.74 months (95%CI 10.33–14.08). Conclusion: Palbociclib plus fulvestrant seems an effective treatment for ABC in real-world context. Compared to registrations studies, rwPFS and rwOS were shorter in real-life setting.publishersversionpublishe

Exploiting the antiparasitic activity of naphthalimides derivatives

A set of 1,8-naphtalimides derivatives were synthesized and tested against three protozoans that cause important human diseases: Leishmaniainfantum, Trypanosomabrucei and Trypanosomacruzi. Additionally, toxicity was determined by growth inhibition of THP-1 derived macrophages. The results suggest that chemical modifications in the carbon chain linking the naphthalimide and the substituting groups have different effects in the parasites. This work should provide new insights new insights for the design and optimization of more potent and directed naphthalimide derivatives against these organisms.The research leading to these results has received funding from the European Community’s Seventh Framework Programme under grant agreements No.602773 (Project KINDRED). L.G. was supported by the Fundaçãopara a Ciência e Tecnologia through grant SFRH/BD/81604/2011.The research leading to these results has received funding from the European Community’s Seventh Framework Programme under grant agreements No.602773 (Project KINDRED). Thanks are due also to the NMR Portuguese network (PTNMR, BrukerAvance III 400Univ. Minho), and FCT and FEDER for financial support to CQ/UM.info:eu-repo/semantics/publishedVersio

Developing a subpopulation-based model for the olive fruit fly Bactrocera oleae (Diptera: Tephritidae): conceptual model out-line

Bactrocera oleae Rossi (olive fruit fly) is a dipteran of the family Tephritidae, considered the key pest of olives in Mediterranean countries, where it causes losses of great economic impact. Nat ural pest control is an important alternative or complement to the use of plant protection products against B. oleae. This is an ecosystem service that can be enhanced if we are able to predict its behav ior, which can be done through computer models simulating interactions between animals, agricul tural management and climate. In this paper we present the conceptual model of a spatially explicit subpopulation-based model being developed for B. oleae in olive groves. In this modelling tech nique, the simulated dynamic landscape is segmented into non-overlapping cells, where the sub populations of B. oleae are represented as separate but interacting entities. Our model is based on the Animal Landscape Man Simulation System (ALMaSS), which comprises a highly detailed and realistic landscape representation, incorporating data on different aspects of farm management, crop development, and climate, and where simulated entities operate. We present the general out line of B. oleae’s life cycle, as well as succinct information on how these organisms interact with their environment. This is a step for the development of the final model and its implementation in AL MaSS.info:eu-repo/semantics/publishedVersio