Caracterização da Utilização de Sugamadex no Centro Hospitalar de Lisboa Central - Hospital de S. José

Introdução O sugamadex é uma gama ciclodextrina modificada que forma um complexo com os bloqueadores neuromusculares rocurónio e vecurónio, revertendo o bloqueio neuromuscular (BNM) induzido por estes fármacos1,2,3,4. O sugamadex apresentou valor terapêutico acrescentado em relação aos anticolinesterásicos, nomeadamente à neostigmina, para a reversão do BNM causado pelo rocurónio e vecurónio1,3. No Hospital de São José (HSJ) este medicamento foi introduzido em Outubro de 2010 para a reversão do BNM profundo e nas situações de risco de vida imediato associadas a via aérea difícil com impossibilidade de ventilar e de entubar. A dispensa do sugamadex é efectuada por reposição de stock mediante envio de justificação clínica aos Serviços Farmacêuticos (SF). Objetivo Caracterizar a utilização de sugamadex no HSJ: evolução do consumo, serviços clínicos utilizadores e adequação da utilização clínica face às indicações aprovadas pela Comissão de Farmácia e Terapêutica (CFT). Métodos Pesquisa e análise bibliográfica. Recolha, através da do sistema de gestão integrada do circuito do medicamento, dos dados de consumo desde Outubro de 2010 até Junho de 2015, por semestre e por serviço clínico. Recolha das indicações terapêuticas em que o sugamadex foi administrado, no período acima referido, através da consulta das justificações clínicas. Análise retrospectiva dos dados recolhidos. Resultados Apresentação gráfica dos consumos de sugamadex nos serviços utilizadores no período em estudo. Apresentação gráfica das indicações terapêuticas em que foi administrado, por serviço e no período em estudo. Conclusões O consumo de sugamadex tem um evidente crescimento desde o seu início de utilização. A justificação dominante para a utilização do sugamadex é a curarização residual. Verifica-se um alargamento do âmbito de utilização, face às indicações aprovadas pela CFT. Decorridos cinco anos de utilização, justifica-se uma reavaliação das indicações de utilização no HSJ pela CFT. Bibliografia 1. Chambers D, Paulden M, Paton F, Heirs M, Duffy S, Craig D, et al. Sugammadex for the reversal of muscle relaxation in general anaesthesia: a systematic review and economic assessment. Health Technol Assess 2010;14(39). 2. De Boer HD, Van Egmond J, Driessen JJ, Booij LH. Update on the management of neuromuscular block: Focus on sugammadex. Neuropsychiatr Dis Treat 2007;3:539-44. 3. Relatório avaliação prévia de medicamento para uso humano em meio hospitalar – DCI – Sugamadex (06-05-2010) – Infarmed - acedido a 27/08/2015 www.infarmed.pt. 4. Resumo das Características do Medicamento Bridion® 100 mg/ml solução injectável - acedido a 27/08/2015 www.ema.europa.eu/

Migration Routes of New World Sanderlings (Calidris alba)

We color-marked Sanderlings (Calidris alba Pallas) at 19 locations in 6 countries in the New World and coordinated a network of volunteers to locate banded individuals in migration over a five-year period. The observers reported 252 independent sightings of birds in countries different from the country of banding. Sanderlings that migrate north to the Arctic from Chile and Peru travel principally through the central corridor (Texas and northward) of the United States and Canada; smaller numbers follow the Pacific coast. A few migrate north from the Pacific coast of South America along the Atlantic coast of the United States. Southbound from the Arctic to coastal Chile and Peru, many individuals switch eastward to stopovers on the Atlantic coast, including birds that migrated north along the U.S. Pacific coast. Sanderlings banded in Brazil during the nonbreeding period appear only on the U.S. Atlantic coast in migration. Our results emphasize the individual nature of migration. We found considerable heterogeneity in migratory behavior among individuals that spend the nonbreeding season together on the same beaches. Individuals from widely separated nonbreeding sites often shared similar pathways. In this species and perhaps in others, no simple single migratory route connects breeding with nonbreeding regions

CONSERVATION OF THE ORINOCO GOOSE (NEOCHEN JUBATA) IN THE MIDDLE ARAGUAIA RIVER, TOCANTINS, BRAZIL.

The Orinoco goose, (Neochen jubata) is a grazing herbivore of open habitats that was once widely distributed in tropical South America. Centuries of overhunting and habitat loss have reduced it to widely scattered remnant populations; it is categorized as Near Threatened globally. Within the Cerrado biome, the Middle Araguaia River houses the largest remnant population. In August 2017, a study was started to assess the situation of the Orinoco Goose in the regions of Araguaia National Park, Cantão State Park, and adjacent rice fields. We conducted counts from an aerial census (a 700 km transect), monthly boat censuses (40 km) and land censuses in rice plantations. The aircraft census counted 367 individuals in August 2017, while monthly monitoring of a stretch of the lower Javaés River over more than two years showed a seasonal population variation associated with the flood regime, with the species virtually disappearing during the flood period between January and April when river beaches are submerged. During this period, large flocks of about 1,000 Orinoco Geese were discovered not far away, concentrated in small stretches of rice plantation agro-systems in the region.  This behavioral seasonal concentration makes the species susceptible to poisoning and epizootic diseases. The findings suggest the need to re-categorize the Orinoco Goose population of the Middle Araguaia River as “Threatened” for the State of Tocantins due to the decline observed in the last 10 years, the maximum estimated population size, and the significant seasonal concentrations in a restricted area. At the same time, it is necessary to develop an action plan for its conservation in the surroundings of Ilha do Bananal, and throughout Brazil, where its threat status must be reviewed

Formation of Lipofuscin-Like Autofluorescent Granules in the Retinal Pigment Epithelium Requires Lysosome Dysfunction

PURPOSE: We aim to characterize the pathways required for autofluorescent granule (AFG) formation by RPE cells using cultured monolayers. METHODS: We fed RPE monolayers in culture with a single pulse of photoreceptor outer segments (POS). After 24 hours the cells started accumulating AFGs that were comparable to lipofuscin in vivo. Using this model, we used a variety of light and electron microscopical techniques, flow cytometry and Western blot to analyze the formation of AFGs. We also generated a mutant RPE line lacking cathepsin D by gene editing. RESULTS: AFGs seem to derive from incompletely digested POS-containing phagosomes and after 3 days are surrounded by a single membrane positive for lysosome markers. We show by various methods that lysosome-phagosome fusion is required for AFG formation, and that impairment of lysosomal pH or catalytic activity, particularly cathepsin D activity, enhances AF accumulation. CONCLUSIONS: We conclude that lysosomal dysfunction results in incomplete POS degradation and enhanced AFG accumulation

Potential of novel Mycobacterium tuberculosis infection phase-dependent antigens in the diagnosis of TB disease in a high burden setting

<p>Abstract</p> <p>Background</p> <p>Confirming tuberculosis (TB) disease in suspects in resource limited settings is challenging and calls for the development of more suitable diagnostic tools. Different <it>Mycobacterium tuberculosis (M.tb) </it>infection phase-dependent antigens may be differentially recognized in infected and diseased individuals and therefore useful as diagnostic tools for differentiating between <it>M.tb </it>infection states. In this study, we assessed the diagnostic potential of 118 different <it>M.tb </it>infection phase-dependent antigens in TB patients and household contacts (HHCs) in a high-burden setting.</p> <p>Methods</p> <p>Antigens were evaluated using the 7-day whole blood culture technique in 23 pulmonary TB patients and in 19 to 21 HHCs (total n = 101), who were recruited from a high-TB incidence community in Cape Town, South Africa. Interferon-gamma (IFN-γ) levels in culture supernatants were determined by ELISA.</p> <p>Results</p> <p>Eight classical TB vaccine candidate antigens, 51 DosR regulon encoded antigens, 23 TB reactivation antigens, 5 TB resuscitation promoting factors (rpfs), 6 starvation and 24 other stress response-associated TB antigens were evaluated in the study. The most promising antigens for ascertaining active TB were the rpfs (Rv0867c, Rv2389c, Rv2450c, Rv1009 and Rv1884c), with Areas under the receiver operating characteristics curves (AUCs) between 0.72 and 0.80. A combination of <it>M.tb </it>specific ESAT-6/CFP-10 fusion protein, Rv2624c and Rv0867c accurately predicted 73% of the TB patients and 80% of the non-TB cases after cross validation.</p> <p>Conclusions</p> <p>IFN-γ responses to TB rpfs show promise as TB diagnostic candidates and should be evaluated further for discrimination between <it>M.tb </it>infection states.</p