Portugal at the cross road of international chronic respiratory programmes

July 1-4, 2015 two meetings will be held with the Directorate General of Health in Lisbon, Portugal to discuss chronic respiratory programmes of the WHO Global Alliance against Chronic Respiratory Diseases (GARD)1,2 and European Innovation Partnership on Active and Healthy Ageing (EIP on AHA)3 (AIRWAYS ICPs: Integrated Care Pathways for airway diseases).4 The goals of these meetings will be to make an update of these two international actions and to strengthen the WHO noncommunicable disease (NCD) action plan (2013---2020)

Urban core as a centrality that expresses urban functions: Comparative study of the cities of Chapecó and Videira/SC

According to Gordon Cullen (1988), cities can generate well-being and provide life facilities such as job offers, access to services and social interaction. They are attractive territories that intrinsically create fields of interactions and relationships in different scopes, intensities, ranges and complexities, which makes the understanding of the urban fact increasingly complex (THEMATICS). The west of Santa Catarina, as an object, consist of small and medium-sized urban structures poorly understood in their complexities (PROBLEM). Thus, the objective was to express and reveal the essence and importance of these in the urban network that they form, enabling the understanding of the urbanization process from the study of the central urban centers of the cities of Chapecó and Videira (OBJECTIVE). RENNER (2018) when studying the growth of cities, evidenced elements that explain the anatomy, identity, as well as the importance and relationships of each city, both in its own structure and in the network. The Urban Nucleus reveals, through its typology, circulation channels and vegetated spaces, the “heart” of these urban structures, as well as the elements that give meaning to their centrality (METHODOLOGY). The comparative study carried out between the cities of western Santa Catarina showed how the Urban Center reveals the structures of these networks and express their strength in the urban network that they form, helping in the macro understanding of the dynamics of the territory both by the urban inequalities that compose and by the socio-spatial segregation that ranks and differentiates them in terms of attractiveness and opportunities (RESULTS). Keywords: urban nucleus, urban form, Chapecó, Videira.Segundo Gordon Cullen (1988), as cidades podem gerar bem-estar e proporcionar facilidades de vida como oferta de emprego, acesso a serviços e convívio social. São territórios atratores que intrinsecamente criam campos de interações e relações em diferentes abrangências, intensidades, alcances e complexidades, o que torna cada vez mais complexa a compreensão do fato urbano (TEMÁTICA). O oeste catarinense, enquanto objeto, se constitui de pequenas e médias estruturas urbanas pouco compreendidas em suas complexidades (PROBLEMA). Assim objetivou-se expressar e revelar a essência e importância destas na rede urbana que conformam, possibilitando a compreensão do processo de urbanização a partir do estudo dos núcleos urbanos centrais das cidades de Chapecó e Videira (OBJETIVO). RENNER (2018) ao estudar o crescimento das cidades, evidenciou elementos que explicitam a anatomia, a identidade, bem como a importância e as relações de cada cidade, tanto na sua própria estrutura quanto na rede. O Urban Nucleus (Núcleo Urbano) revela, por meio de sua tipologia, dos canais de circulação e dos espaços vegetados o “coração” destas estruturas urbanas, bem como os elementos que dão significado à sua centralidade (METODOLOGIA). O estudo comparativo realizado entre as cidades do oeste catarinense mostrou o quanto o Núcleo Urbano revela as estruturas dessas malhas e expressam a sua força na rede urbana que conformam, auxiliando na macro compreensão das dinâmicas do território tanto pelas desigualdades urbanas que compõem quanto pela segregação socioespacial que as hierarquiza e diferencia enquanto atratividade e oportunidades (RESULTADOS). Palavras-chave: núcleo urbano, forma urbana, Chapecó, Videira.Peer Reviewe

Protein promiscuity in H2O2 signaling

Significance: Decrypting the cellular response to oxidative stress relies on a comprehensive understanding of the redox signaling pathways stimulated under oxidizing conditions. Redox signaling events can be divided into upstream sensing of oxidants, midstream redox signaling of protein function, and downstream transcriptional redox regulation. Recent Advances: A more and more accepted theory of hydrogen peroxide (H2O2) signaling is that of a thiol peroxidase redox relay, whereby protein thiols with low reactivity toward H2O2 are instead oxidized through an oxidative relay with thiol peroxidases. Critical Issues: These ultrareactive thiol peroxidases are the upstream redox sensors, which form the first cellular port of call for H2O2. Not all redox-regulated interactions between thiol peroxidases and cellular proteins involve a transfer of oxidative equivalents, and the nature of redox signaling is further complicated through promiscuous functions of redox-regulated "moonlighting" proteins, of which the precise cellular role under oxidative stress can frequently be obscured by "polygamous" interactions. An ultimate goal of redox signaling is to initiate a rapid response, and in contrast to prokaryotic oxidant-responsive transcription factors, mammalian systems have developed redox signaling pathways, which intersect both with kinase-dependent activation of transcription factors, as well as direct oxidative regulation of transcription factors through peroxiredoxin (Prx) redox relays. Future Directions: We highlight that both transcriptional regulation and cell fate can be modulated either through oxidative regulation of kinase pathways, or through distinct redox-dependent associations involving either Prxs or redox-responsive moonlighting proteins with functional promiscuity. These protein associations form systems of crossregulatory networks with multiple nodes of potential oxidative regulation for H2O2-mediated signaling

Skin Lesion Analyser: An Efficient Seven-Way Multi-Class Skin Cancer Classification Using MobileNet

Skin cancer, a major form of cancer, is a critical public health problem with 123,000 newly diagnosed melanoma cases and between 2 and 3 million non-melanoma cases worldwide each year. The leading cause of skin cancer is high exposure of skin cells to UV radiation, which can damage the DNA inside skin cells leading to uncontrolled growth of skin cells. Skin cancer is primarily diagnosed visually employing clinical screening, a biopsy, dermoscopic analysis, and histopathological examination. It has been demonstrated that the dermoscopic analysis in the hands of inexperienced dermatologists may cause a reduction in diagnostic accuracy. Early detection and screening of skin cancer have the potential to reduce mortality and morbidity. Previous studies have shown Deep Learning ability to perform better than human experts in several visual recognition tasks. In this paper, we propose an efficient seven-way automated multi-class skin cancer classification system having performance comparable with expert dermatologists. We used a pretrained MobileNet model to train over HAM10000 dataset using transfer learning. The model classifies skin lesion image with a categorical accuracy of 83.1 percent, top2 accuracy of 91.36 percent and top3 accuracy of 95.34 percent. The weighted average of precision, recall, and f1-score were found to be 0.89, 0.83, and 0.83 respectively. The model has been deployed as a web application for public use at (https://saketchaturvedi.github.io). This fast, expansible method holds the potential for substantial clinical impact, including broadening the scope of primary care practice and augmenting clinical decision-making for dermatology specialists.Comment: This is a pre-copyedited version of a contribution published in Advances in Intelligent Systems and Computing, Hassanien A., Bhatnagar R., Darwish A. (eds) published by Chaturvedi S.S., Gupta K., Prasad P.S. The definitive authentication version is available online via https://doi.org/10.1007/978-981-15-3383-9_1

Pneumothorax secondary to a Pulmonary Bullae in a dog

Background: Pulmonary bullae are thin-walled cavitary lesions within the subpleural parenchyma. They are a result of the destruction, dilatation and coalescence of bordering alveoli and their rupture is the most common cause of pneumothorax in dogs. Radiographic and CT imaging are excellent tools for identifying and quantifying pneumothorax. Surgical treatment is considered standard for treatment of pneumothorax consequential to pulmonary bullae. The aim of this report was to describe a case of pneumothorax secondary to pulmonary bullae in a dog.Case: A 5-year-old male crossbreed dog, weighing 11.5 kg, was presented to the Uberaba’s Veterinary Hospital due to becoming easily tired in the previous 3 weeks, and its worsening in the last 2 days by presenting panting. The dog’s guardian did not witness any traumas, but informed that the animal resided with other 14 dogs and also that it frequently collided the thorax against the door when it came down from the bed. Physical examination showed diaphragmatic breathing, inspiratory dyspnea and stridor lung sound. Thoracocentesis revealed presence of air in the pleural cavity and pneumothorax. Radiographic images confirmed this condition. The dog stayed in the hospital and chest drains were placed. Since the amount of sucked air did not reduce with time and due to the emergence of subcutaneous emphysema, the dog went through exploratory thoracotomy that revealed impairment of the right caudal lung lobe, proceeding to lobectomy. The dog stayed in the hospital with chest drains until the contents of the suctions reduced significantly. With the removal of the drains, the dog was sent home and had a full recovery. Histopathology of the impaired lung revealed pulmonary bullae.Discussion: The dog from this report presented clinical signs consistent with pneumothorax, such as dyspnea, diaphragmatic breathing and exercise intolerance. Radiography of the chest region revealed images consistent with this condition, as it is an excellent tool for identifying it. This dog’s guardian was unable to confirm if there was occurrence of trauma due to the large number of cohabitants. In dogs, spontaneous pneumothorax commonly results from the rupture of pulmonary bullae, and these bullae may result from trauma, infectious diseases, thrombosis, obstructive, neoplastic, congenital or idiopathic conditions. Except from trauma, there were no evidence to support any of the other causes of pulmonary bullae in this case.  Traumatic injuries are very common in veterinary medicine, and blunt thoracic traumas with consequential pneumothorax are especially common. The emerging of subcutaneous emphysema, as happened with this dog, is frequently associated with pneumomediastine, and rarely has pathophysiologic impairments. The patient stayed in the hospital for support therapy and thoracocentesis, corroborating with literature; but since there was no improvement, it went through exploratory lobectomy, which revealed impairment of the right caudal lung lobe, proceeding to its exeresis. Surgical intervention is standard procedure in these cases. Histopathology of the impaired lung suggested the presence of pulmonary bullae. In literature, histopathological definitions for this condition are inconsistent, but usually locate the bullae within the pulmonary parenchyma, having walls less than 1 mm thick. Through radiology, unlike with cysts, identifying pulmonary bullae is challenging. In conclusion, this report showed that pulmonary bullae should be considered as a differential diagnose in patients showing pneumothorax considering it is hard to identify through imaging, and that it is important to adopt early therapy and surgical intervention for better outcomes.Keywords: dyspnea, panting, pulmonary lobectomy, thoracotomy, chest drain.Titulo:  Pneumotórax secundário a bolha pulmonar em cão.Descritores: dispneia, ofegante, lobectomia pulmonar, toracotomia, dreno torácico

Entrevista da família para doação de órgãos na perspectiva dos profissionais: revisão integrativa/ Family interview for organ donation in the professionals perspective: integrative review

Identificar os estudos qualitativos publicados sobre abordagem familiar no processo de doação de órgãos. Revisão integrativa da literatura com busca dos artigos publicados entre 1997 a 2017, indexados nas bases de dados SciELO, Bireme, Pubmed, Sage Journal, Lilacs, MEDLINE, Google Acadêmico, e CAPES. Os estudos foram analisados mediante estatística descritiva e análise de conteúdo. Foram encontrados 19 estudos; sendo estes, predominantemente desenvolvidos no Brasil. Quanto a área, a enfermagem foi a mais frequente; sendo a fenomenologia o referencial teórico mais utilizado. Para a síntese do conhecimento, foram construídas as seguintes categorias: Aspectos bioéticos no processo de doação de órgãos; Percepção dos profissionais de saúde ao processo de doação de órgãos; Assistência à família do paciente potencial doador; e Educação profissional para a entrevista familiar. Os estudos qualitativos, em se tratando da abordagem familiar, ainda são insuficientes para compreender os entraves e apontar estratégias para melhorar a abordagem familiar

PREVALÊNCIA DE QUEDAS ENTRE IDOSOS DE UMA INSTITUIÇÃO DE LONGA PERMANÊNCIA

O risco de queda em idosos é de grande relevância, considerando que é um evento natural e próprio do envelhecimento e está diretamente relacionado à qualidade de vida e dependência. O objetivo deste estudo foi descrever a prevalência de quedas entre idosos de uma Instituição de Longa Permanência para Idosos do Centro-Oeste Mineiro. Trata-se de um estudo de caso realizado com 12 idosos de uma Instituição de Longa Permanência para Idosos do Centro-Oeste Mineiro, cuja coleta de dados foi realizada no mês de abril. Para avaliar as quedas e fatores associados, foram aplicados três instrumentos: miniexame do estado mental, timed up and go test e instrumento que contempla dados sobre quedas e fatores associados entre idosos institucionalizados. Os resultados apontam que 75,0% dos idosos sofreram o evento queda no último ano, parte do corpo mais atingida pela queda foram os membros inferiores 44,4%, 66,7% dos idosos estão classificados com importante déficit de mobilidade física. Dentre os fatores associados, destacamos a idade, a polifarmácia, às comorbidades, o nível escolar e ao funcionamento cognitivo destes idosos. Concluímos que a prevalência de quedas no idoso é alta (75%) e as consequências decorrentes das mesmas são preocupantes. Faz-se necessário a avaliação integral dos idosos, com o intuito de minimizar e prevenir os riscos de quedas, bem como as possíveis complicações do estado de saúde do idoso institucionalizado.Palavras-Chave: Acidentes por Quedas. Idoso. Instituição de Longa Permanência para Idosos

Novas abordagens médicas a mulher vítima de violência doméstica na atenção primária por meio da telemedicina durante a pandemia

INTRODUÇÃO: As normas e leis da sociedade, até recentemente, permitiam ou não puniam a violência de gênero, como nos casos de assassinatos de mulheres em que se alegava a defesa da honra. Assim, nos últimos anos, várias medidas foram tomadas com o intuito de prevenir e combater o problema. OBJETIVO: Descrever as novas abordagens médicas as mulheres vítimas de violência doméstica na atenção primária. MÉTODO: A coleta dos dados se deu por meio de um questionário confeccionado por estudantes de medicina, após a consulta pela telemedicina, quando foram identificadas as mulheres em situação de vulnerabilidade. A seguir, foi feita a montagem do plano terapêutico objetivando sua melhora e futura análise dos dados e foi anexado ao prontuário das pacientes. RESULTADOS: Durante atendimento através da telemedicina houve dez pacientes que foram orientadas sobre o que poderiam fazer durante seu dia a dia para melhorar a qualidade de vida no período da pandemia. Entretanto, apenas seis pacientes retornaram à ligação após as orientações e, dentre estas, quatro tiveram resultados de violência confirmados. CONCLUSÃO:  Com o advento da pandemia do COVID 19, as mulheres ficaram mais expostas a violência doméstica e ao desenvolvimento de transtornos psicológicos associados com esse trauma. A telemedicina pode ser uma ferramenta de apoio importante nestas situações

Motor phenotype of LRRK2 G2019S carriers in early-onset Parkinson disease

Objective: To determine the motor phenotype of LRRK2 G2019S mutation carriers. LRRK2 mutation carriers were previously reported to manifest the tremor dominant motor phenotype, which has been associated with slower motor progression and less cognitive impairment compared with the postural instability and gait difficulty (PIGD) phenotype. Design: Cross-sectional observational study. Setting: Thirteen movement disorders centers. Participants: Nine hundred twenty-five early-onset Parkinson disease cases defined as age at onset younger than 51 years. Main Outcome Measures: LRRK2 mutation status and Parkinson disease motor phenotype: tremor dominant or PIGD. Demographic information, family history of Parkinson disease, and the Unified Parkinson's Disease Rating Scale score were collected on all participants. DNA samples were genotyped for LRRK2 mutations (G2019S, I2020T, R1441C, and Y1699C). Logistic regression was used to examine associations of G2019S mutation status with motor phenotype adjusting for disease duration, Ashkenazi Jewish ancestry, levodopa dose, and family history of Parkinson disease. Results: Thirty-four cases (3.7%) (14 previously reported) were G2019S carriers. No other mutations were found. Carriers were more likely to be Ashkenazi Jewish (55.9% vs 11.9%; P < .001) but did not significantly differ in any other demographic or disease characteristics. Carriers had a lower tremor score (P = .03) and were more likely to have a PIGD phenotype (92.3% vs 58.9%; P = .003). The association of the G2019S mutation with PIGD phenotype remained after controlling for disease duration and Ashkenazi Jewish ancestry (odds ratio, 17.7; P < .001). Conclusion: Early-onset Parkinson disease G2019S LRRK2 carriers are more likely to manifest the PIGD phenotype, which may have implications for disease course