Real-world data from the Portuguese Nivolumab Expanded Access Program (EAP) in previously treated Non Small Cell Lung Cancer (NSCLC).

OBJECTIVE: The main aim of the study was to evaluate the efficacy and safety profile of Nivolumab, an immune-checkpoint-inhibitor antibody, in advanced, previously treated, Non-Small Cell Lung Cancer (NSCLC) patients, in a real world setting. METHODS: We performed a retrospective, multicentre data analysis of patients who were included in the Portuguese Nivolumab Expanded Access Program (EAP). Eligibility criteria included histologically or citologically confirmed NSCLC, stage IIIB and IV, evaluable disease, sufficient organ function and at least one prior line of chemotherapy. The endpoints included Overall Response Rate (ORR), Disease Control Rate (DCR), Progression Free Survival (PFS) and Overall Survival (OS). Safety analysis was performed with the National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE), version 4.0, and immune-related Adverse Events (irAEs) were treated according to protocol treatment guidelines. Tumour response was assessed using the Response Evaluation Criteria in Solid Tumours (RECIST) version 1.1. Data was analysed using SPSS, version 21.0 (IBM Statistics). RESULTS: From June 2015 to December 2016, a total of 229 patients with advanced NSCLC were enrolled at 30 Portuguese centres. Clinical data were collected up to the end of July 2018. The baseline median age was 64 years (range 37-83) and the majority of patients were males (70.3%) and former/current smokers (69.4%). Patients with non-squamous histology predominated (88.1%), and 67.6% of the patients had received 2 or more prior lines of chemotherapy. Out of 229 patients, data was available for 219 patients (3 patients did not start treatment, while data was unavailable in 7 patients); of the 219 patients, 15.5% were not evaluated for radiological tumour assessment, 1.4% had complete response (CR), 21% partial response (PR), 31% stable disease (SD) and 31.1% progressive disease (PD). Thus, the ORR was 22.4% and DCR was 53.4% in this population. At the time of survival analysis the median PFS was 4.91 months (95% CI, 3.89-6.11) and median OS was 13.21 months (95% CI, 9.89-16.53). The safety profile was in line with clinical trial data. CONCLUSIONS: Efficacy and safety results observed in this retrospective analysis were consistent with observations reported in clinical trials and from other centres.info:eu-repo/semantics/publishedVersio

The Portuguese Registry of Hypertrophic Cardiomyopathy: Overall results

INTRODUCTION: We report the results of the Portuguese Registry of Hypertrophic Cardiomyopathy, an initiative that reflects the current spectrum of cardiology centers throughout the territory of Portugal. METHODS: A direct invitation to participate was sent to cardiology departments. Baseline and outcome data were collected. RESULTS: A total of 29 centers participated and 1042 patients were recruited. Four centers recruited 49% of the patients, of whom 59% were male, and mean age at diagnosis was 53±16 years. Hypertrophic cardiomyopathy (HCM) was identified as familial in 33%. The major reason for diagnosis was symptoms (53%). HCM was obstructive in 35% of cases and genetic testing was performed in 51%. Invasive septal reduction therapy was offered to 8% (23% of obstructive patients). Most patients (84%) had an estimated five-year risk of sudden death of <6%. Thirteen percent received an implantable cardioverter-defibrillator. After a median follow-up of 3.3 years (interquartile range [P25-P75] 1.3-6.5 years), 31% were asymptomatic. All-cause mortality was 1.19%/year and cardiovascular mortality 0.65%/year. The incidence of heart failure-related death was 0.25%/year, of sudden cardiac death 0.22%/year and of stroke-related death 0.04%/year. Heart failure-related death plus heart transplantation occurred in 0.27%/year and sudden cardiac death plus equivalents occurred in 0.53%/year. CONCLUSIONS: Contemporary HCM in Portugal is characterized by relatively advanced age at diagnosis, and a high proportion of invasive treatment of obstructive forms. Long-term mortality is low; heart failure is the most common cause of death followed by sudden cardiac death. However, the burden of morbidity remains considerable, emphasizing the need for disease-specific treatments that impact the natural history of the disease.info:eu-repo/semantics/publishedVersio

SARS-CoV-2 seroprevalence in healthcare workers: The experience of a Portuguese COVID-19 front-line hospital during the 1st pandemic wave

Background: Healthcare workers (HCW) are at increased risk of SARS-CoV-2 infection. Here, we describe the SARS-CoV-2 seroprevalence in HCW who work daily at a COVID-19 front-line hospital in Portugal. Methods: To this end, the seroprevalence of 1027 HCW, assessed after the peak of the first pandemic wave, was determined using the following immunoassays: Euroimmun Anti-SARS-CoV-2 ELISA IgG (Euroimmun, Luebeck, Germany), Abbott SARS-CoV-2 IgG (Abbott Laboratories, Chicago), and Elecsys Anti-SARS-CoV–2 Total (Roche Diagnostics, Basel, Switzerland). Results: We found a 2.7% seroprevalence, very close to the one determined in the community (2.9%) for the same period. Conclusions: This low SARS-CoV–2 seroprevalence highlights the effectiveness of infection prevention and control measures implemented very early in the pandemic, namely the use of appropriate personal protective equipment.This research was supported by a grant from FCT Research4-COVID–19 (Project n° 186_596855206 – CertCOV)

An overview of the Portuguese electricity market

The electricity market in Portugal was recently opened to all consumers. However, it remains highly concentrated in terms of control of production and supply and the long-term power purchase arrangements still coexist with free market. This paper discusses the electricity market restructuring process in Portugal, presenting its main marks over the past years and the present situation. The evolution of the electricity prices in Portugal is analysed, and a comparison with EU-15 is presented. Special attention is given to Spain due to the possibility of cross-border competition in the future arising from the formation of the Iberian electricity market

Effect of air-abrasion regimens and fine diamond bur grinding on flexural strength, Weibull modulus and phase transformation of zirconium dioxide

PURPOSE This study evaluated the effect of air abrasion and polishing regimens on the flexural strength of yttrium stabilized polycrystalline tetragonal zirconia (Y-TZP). METHODS From Y-TZP blocks (InCeram 2000 YZ Cubes; Vita Zahnfabrik, Bad Säckingen, Germany) 120 bars (25 mm × 4 mm × 1.2 mm) were obtained according to ISO 6872:2008 and randomly divided into 4 groups: Group C: (control) without surface treatment (n = 30); Group APA: Air abrasion with aluminum oxide (44 µm) (n = 30); Group SC: Silica-coating (CoJet, 30 µm) (n = 30); Group FD: Fine diamond bur (n = 30). Subsequently, all specimens were subjected to 4-point bending test (in distilled water at 37°C) in a universal testing machine (EMIC DL 1000; São José dos Pinhais, Paraná, Brazil); cross-head speed: 0.5 mm/min). The characteristic strength (σ0) of each specimen was obtained from the flexural strength test and evaluated using Weibull analysis. X-ray diffraction analysis was utilized to quantity the monoclinic phase. The surface topography of specimens was analyzed using 3D optical profilometer and scanning electron microscopy (SEM) after surface conditioning methods. The flexural strength data (σ4p) were statistically analyzed by 1-way ANOVA, Tukey test (α = 0.05) and Weibull (m = modulus, σ0 = characteristic strength) were calculated. RESULTS The mean ± standard deviations (MPa) of the groups were as follows: C: 1196.2 ± 284.2a; APA: 1369.7 ± 272.3a; SC: 1207.1 ± 229.7a and FD: 874.4 ± 365.4b. The values (m) and (σ0) were as follows: C: 4.5 and 1308.12; APA: 5.9 and 1477.88; SC: 6.0 and 1300.28; and FD: 2.6 and 985.901, respectively. CONCLUSIONS Air particle abrasion with neither silica nor alumina showed significant difference compared to the control group but grinding with fine diamond bur impaired the flexural strength of the zirconia tested

Development and initial validation of the bronchiectasis exacerbation and symptom tool (BEST)

BACKGROUND: Recurrent bronchiectasis exacerbations are related to deterioration of lung function, progression of the disease, impairment of quality of life, and to an increased mortality. Improved detection of exacerbations has been accomplished in chronic obstructive pulmonary disease through the use of patient completed diaries. These tools may enhance exacerbation reporting and identification. The aim of this study was to develop a novel symptom diary for bronchiectasis symptom burden and detection of exacerbations, named the BEST diary. METHODS: Prospective observational study of patients with bronchiectasis conducted at Ninewells Hospital, Dundee. We included patients with confirmed bronchiectasis by computed tomography, who were symptomatic and had at least 1 documented exacerbation of bronchiectasis in the previous 12\u2009months to participate. Symptoms were recorded daily in a diary incorporating cough, sputum volume, sputum colour, dyspnoea, fatigue and systemic disturbance scored from 0 to 26. RESULTS: Twenty-one patients were included in the study. We identified 29 reported (treated exacerbations) and 23 unreported (untreated) exacerbations over 6-month follow-up. The BEST diary score showed a good correlation with the established and validated questionnaires and measures of health status (COPD Assessment Test, r =\u20090.61, p =\u20090.0037, Leicester Cough Questionnaire, r =\u2009-\u20090.52,p =\u20090.0015, St Georges Respiratory Questionnaire, r =\u20090.61,p &lt;\u20090.0001 and 6\u2009min walk test, r =\u2009-\u20090.46,p =\u20090.037). The mean BEST score at baseline was 7.1 points (SD 2.2). The peak symptom score during exacerbation was a mean of 16.4 (3.1), and the change from baseline to exacerbation was a mean of 9.1 points (SD 2.5). Mean duration of exacerbations based on time for a return to baseline symptoms was 15.3\u2009days (SD 5.7). A minimum clinically important difference of 4 points is proposed. CONCLUSIONS: The BEST symptom diary has shown concurrent validity with current health questionnaires and is responsive at onset and recovery from exacerbation. The BEST diary may be useful to detect and characterise exacerbations in bronchiectasis clinical trials

Food Allergy and Anaphylaxis in Infants and Preschool-Age Children

Food allergy (FA) prevalence data in infants and preschool-age children are sparse, and proposed risk factors lack confirmation. In this study, 19 children’s day care centers (DCC) from 2 main Portuguese cities were selected after stratification and cluster analysis. An ISAAC’s (International Study of Asthma and Allergies in Childhood) derived health questionnaire was applied to a sample of children attending DCCs. Outcomes were FA parental report and anaphylaxis. Logistic regression was used to explore potential risk factors for reported FA. From the 2228 distributed questionnaires, 1217 were included in the analysis (54.6%). Children’s median age was 3.5 years, and 10.8% were described as ever having had FA. Current FA was reported in 5.7%. Three (0.2%) reports compatible with anaphylaxis were identified. Reported parental history of FA, personal history of atopic dermatitis, and preterm birth increased the odds for reported current FA. A high prevalence of parental-perceived FA in preschool-age children was identified. Risk factor identification may enhance better prevention

Combined Effect of Air Pollution and House Dust Mite Exposure Over the airways

Introdução: A asma é uma doença respiratória crónica, cujo agravamento pode estar associado a factores ambientais, entre os quais os relacionados com a qualidade do ar. Objectivo: O presente trabalho pretendeu avaliar o efeito da exposição individual a poluentes atmosféricos em termos de função respiratória, num grupo de crianças com história de sibilância, entrando em consideração com o grau de infestação de ácaros do pó doméstico. Métodos: Um grupo de 51 crianças com história de sibilância, seleccionadas através do questionário do estudo ISAAC, foi acompanhado prospectivamente num estudo com medidas repetidas, que envolveu avaliações médicas padronizadas que incluíram a realização de espirometria, avaliação da exposição aos ácaros do pó e cálculo do valor de exposição individual a uma variedade de poluentes do ar: PM10, O3, NO2, benzeno, tolueno, xileno, etilbenzeno e formaldeído. Resultados: Observou -se uma elevada percentagem de colchões com um grau de infestação de ácaros médio ou elevado. Com excepção dos valores de PM10, os valores de exposição aos poluentes do ar não alcançaram valores elevados. Na análise multivariável, tanto os poluentes (designadamente PM10, NO2, benzeno, tolueno e etilbenzeno) como o grau de infestação de ácaros do pó associaram -se a deterioração da função pulmonar. Conclusão: O presente trabalho vem reforçar o interesse da exposição aos poluentes do ar em crianças com história de sibilância, que à semelhança do que acontece com os ácaros do pó influenciam as vias aéreas

Children's voices in Early Childhood Education and Care

Listening to and considering children’s voices shows respectful regard for children’s needs, interests and experiences, and helps discern what is meaningful for them in a particular subject or situation. Creating opportunities for the expression of children’s voices implies child-centred practice: recognising children as active agents, with evolving competences and capacity to understand, think and choose with some degree of autonomy, thus being able to influence decision-making. Therefore, the commitment to listen to children’s voices represents a fundamental step towards empowering children and supporting their participation rights. Importantly, children have the right to be heard and to have their voices considered from the earliest ages, in their significant relational contexts, such as early childhood education and care (ECEC). Listening to and valuing children’s multiple voices in ECEC can be done in many ways, ensuring the context, children’s background, characteristics and preferences are respected. In this chapter, we address the specificities of listening to children’s voices and taking them into account in ECEC. We discuss common challenges that may prevent the full expression and consideration of children’s voices, and ways to overcome them, to ensure children’s meaningful participation in what matters to them and support them in becoming active citizens in society.info:eu-repo/semantics/publishedVersio