Análise do perfil clínico de crianças e adolescentes com marcapasso cardíaco: experiência de um serviço de estimulaçao cardíaca artificial

OBJETIVO: Descrever a experiência de um Laboratório de Marca-passo com a estimulaçao cardíaca no paciente pediátrico. MÉTODOS: Estudo transversal observacional, com coleta retrospectiva de dados de 47 pacientes, registrados no período de 1988 a 2010, envolvendo caracterizaçao da amostra, dados clínicos, tipo de marca-passo, técnica de implante, limiar de estimulaçao, complicaçoes e associaçao de distúrbios de conduçao atrioventricular com cardiopatias congênitas. RESULTADOS: Nos 47 pacientes, a média de idade ao implante foi de 75,7 +/- 72,1 meses (mediana 60 meses). O implante foi mais precoce nos paciente com BAVT (bloqueio atrioventricular total) congênito quando comparado aos implantes realizados por outras causas, com diferença estatisticamente significante. As principais indicaçoes de implante foram BAVT congênito (44,7%) e BAV no pós-operatório de cirurgias cardíacas (27,7%). Com relaçao ao posicionamento dos eletrodos, em 21,2% (10/47) o eletrodo foi posicionado no epicárdio, em 27,7% (13/47) no endocárdio e em 51,1% (24/47), um eletrodo epicárdico implantado inicialmente foi substituído por eletrodo endocárdico. Cardiopatia congênita associada ocorreu em 42,5% dos pacientes. A frequência de complicaçoes foi de 14,9% (7/47) sendo que, em 71,4% (5/7), houve complicaçoes relacionadas aos eletrodos. Os limiares de estimulaçao mantiveram estabilidade, exceto quando houve fratura ou deslocamento dos eletrodos. CONCLUSAO: É importante considerar as diferenças anatômicas e fisiológicas das crianças ao escolher o sistema de estimulaçao cardíaca, a técnica de implante, o modo de programaçao e a forma adequada para controle do marca-passo e acompanhamento desses pacientes

Análise do perfil clínico de crianças e adolescentes com marcapasso cardíaco: experiência de um serviço de estimulaçao cardíaca artificial

OBJETIVO: Descrever a experiência de um Laboratório de Marca-passo com a estimulaçao cardíaca no paciente pediátrico. MÉTODOS: Estudo transversal observacional, com coleta retrospectiva de dados de 47 pacientes, registrados no período de 1988 a 2010, envolvendo caracterizaçao da amostra, dados clínicos, tipo de marca-passo, técnica de implante, limiar de estimulaçao, complicaçoes e associaçao de distúrbios de conduçao atrioventricular com cardiopatias congênitas. RESULTADOS: Nos 47 pacientes, a média de idade ao implante foi de 75,7 +/- 72,1 meses (mediana 60 meses). O implante foi mais precoce nos paciente com BAVT (bloqueio atrioventricular total) congênito quando comparado aos implantes realizados por outras causas, com diferença estatisticamente significante. As principais indicaçoes de implante foram BAVT congênito (44,7%) e BAV no pós-operatório de cirurgias cardíacas (27,7%). Com relaçao ao posicionamento dos eletrodos, em 21,2% (10/47) o eletrodo foi posicionado no epicárdio, em 27,7% (13/47) no endocárdio e em 51,1% (24/47), um eletrodo epicárdico implantado inicialmente foi substituído por eletrodo endocárdico. Cardiopatia congênita associada ocorreu em 42,5% dos pacientes. A frequência de complicaçoes foi de 14,9% (7/47) sendo que, em 71,4% (5/7), houve complicaçoes relacionadas aos eletrodos. Os limiares de estimulaçao mantiveram estabilidade, exceto quando houve fratura ou deslocamento dos eletrodos. CONCLUSAO: É importante considerar as diferenças anatômicas e fisiológicas das crianças ao escolher o sistema de estimulaçao cardíaca, a técnica de implante, o modo de programaçao e a forma adequada para controle do marca-passo e acompanhamento desses pacientes

Portuguese recommendations for the treatment of atopic dermatitis with biologic therapy and JAK inhibitors in adult patients

Funding Information: Disclosure and potential conflicts of interest: TT has received research grants and/or consulting fees from AbbVie, Almirall, Amgen, Arena Pharmaceuticals, Biocad, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, LEO Pharma, MSD, Novartis, Pfizer, Samsung-Bioepis, Sandoz and Sanofi. MG has received research grants and/or consulting fees from Abbvie, Leo, Lilly, Novartis, Pfizer, Sanofi and Takeda. MJPL has received research grants and/or consulting fees from AbbVie, Almirall, Janssen, Leo-Pharma, Lilly, Novartis, Pfizer, Sanofi and Viatris. CC has received research grants and/or consulting fees from Janssen, Sanofi-Genzyme, Procter&Gamble, Astellas, Galderma, Leo-Pharma and Mylan. MS has received research grants and/or consulting fees from Janssen, Novartis and Pfizer. PMB has received research grants and/ or consulting fees from AbbVie, Pfizer, Janssen, LEO Pharma, Novartis, Sanofi, Teva, Bayer and L’Oreal. LR, JR, RC, AM and PF have no conflicts of interest to declare. The International Committee of Medical Journal Editors (ICMJE) Potential Conflicts of Interests form for the authors is available for download at: https://www.drugsincontext.com/wp-content/uploads/2021/11/dic.2021-9-5-COI.pdf Publisher Copyright: Copyright: Copyright © 2021 Torres T, Gonçalo M, Paiva Lopes MJ, Claro C, Ramos L, Selores M, Mendes Bastos P, Rocha J, Carvalho R, Mota A, Filipe P on Behalf of the Atopic Dermatitis Group of the Portuguese Society of Dermatology and Venereology. Published by Drugs in Context under Creative Commons License Deed CC BY NC ND 4.0 which allows anyone to copy, distribute and transmit the article provided it is properly attributed in the manner specified below. No commercial use without permission.Atopic dermatitis is a highly prevalent chronic, immune-mediated inflammatory skin disease with a significant burden on patients, families and healthcare systems. This article presents recommendations developed by the Atopic Dermatitis Group of the Portuguese Society of Dermatology and Venereology addressing several clinical questions that arise in the management and care of moderate-to-severe atopic dermatitis with biologic agents and Janus kinase (JAK) inhibitors based on the available evidence. The recommendations were generated after a thorough evaluation of existing guidelines on the treatment of atopic dermatitis, publications concerning new biologics and JAK inhibitors not yet incorporated into existing guidelines, and expert-based recommendations. It also includes considerations on atopic dermatitis severity, indications for initiating biologic agents and JAK inhibitors, parameters to be considered in the treatment choice, in particular treatment goals, and recommendations for the use, screening and monitoring of these therapies.publishersversionpublishe

Bronchoalveolar Lavage Proteomics in Patients with Suspected Lung Cancer

All experiments including MS analysis were supported by Fundacao para a Ciencia e Tecnologia project EXPL/DTP-PIC/0616/2013. RM is supported by FCT investigator program 2012 (IF/01002/2012). ASC is supported by grant SFRH/BPD/85569/2012 funded by Fundacao para a Ciencia e Tecnologia.Lung cancer configures as one of the deadliest types of cancer. The future implementation of early screening methods such as exhaled breath condensate analysis and low dose computed tomography (CT) as an alternative to current chest imaging based screening will lead to an increased burden on bronchoscopy units. New approaches for improvement of diagnosis in bronchoscopy units, regarding patient management, are likely to have clinical impact in the future. Diagnostic approaches to address mortality of lung cancer include improved early detection and stratification of the cancers according to its prognosis and further response to drug treatment. In this study, we performed a detailed mass spectrometry based proteome analysis of acellular bronchoalveolar lavage (BAL) fluid samples on an observational prospective cohort consisting of 90 suspected lung cancer cases which were followed during two years. The thirteen new lung cancer cases diagnosed during the follow up time period clustered, based on liquid chromatography-mass spectrometry (LC-MS) data, with lung cancer cases at the time of BAL collection. Hundred and thirty-tree potential biomarkers were identified showing significantly differential expression when comparing lung cancer versus non-lung cancer. The regulated biomarkers showed a large overlap with biomarkers detected in tissue samples.publishersversionpublishe

Is the proteome of bronchoalveolar lavage extracellular vesicles a marker of advanced lung cancer?

Funding: R.M. is supported by Fundação para a Ciência e a Tecnologia (CEEC position, 2019–2025 investigator). This article is a result of the projects (iNOVA4Health—UID/Multi/04462/2013), supported by Lisboa Portugal Regional Operational Programme (Lisboa2020), under the PORTUGAL 2020 Partnership Agreement, through the European Regional Development Fund (ERDF). This work is also funded by FEDER funds through the COMPETE 2020 Programme and National Funds through FCT—Portuguese Foundation for Science and Technology under the projects number PTDC/BTM-TEC/30087/2017 and PTDC/BTM-TEC/30088/2017. This work was supported by the Wellcome Trust/DBT India Alliance Margdarshi Fellowship (grant number IA/M/15/1/502023) awarded to A.P. B.C.-S., M.C.S.C. and C.B. are supported by the Champalimaud Foundation and the EMBO Installation Grant 3921.Acellular bronchoalveolar lavage (BAL) proteomics can partially separate lung cancer from non-lung cancer patients based on principal component analysis and multivariate analysis. Furthermore, the variance in the proteomics data sets is correlated mainly with lung cancer status and, to a lesser extent, smoking status and gender. Despite these advances BAL small and large extracellular vehicles (EVs) proteomes reveal aberrant protein expression in paracrine signaling mechanisms in cancer initiation and progression. We consequently present a case-control study of 24 bronchoalveolar lavage extracellular vesicle samples which were analyzed by state-of-the-art liquid chromatography-mass spectrometry (LC-MS). We obtained evidence that BAL EVs proteome complexity correlated with lung cancer stage 4 and mortality within two years´ follow-up (p value = 0.006). The potential therapeutic target DNMT3B complex is significantly up-regulated in tumor tissue and BAL EVs. The computational analysis of the immune and fibroblast cell markers in EVs suggests that patients who deceased within the follow-up period display higher marker expression indicative of innate immune and fibroblast cells (four out of five cases). This study provides insights into the proteome content of BAL EVs and their correlation to clinical outcomes.publishersversionpublishe

Large-scale screening of unknown varieties in a grapevine intra-varietal variability collection

Since the last decade of the last century, it is known that many old grapevine varieties are descendants of other varieties through natural crossing. Portugal has an important program for the conservation of representative samples of intra-varietal variability of all autochthonous varieties, managed by the Portuguese Association for Grapevine Diversity (PORVID), which makes looking for genotypes with dubious identification an important activity from a perspective of its valorisation. This communication presents the results of the molecular analysis of 5,000 samples (accessions) from the PORVID’s collection, using nine microsatellite loci currently recommended by the International Organization of Vine and Wine (OIV) for genetic grapevine identification. The results obtained confirmed the molecular identity of 4,220 samples corresponding to 214 varieties present in the official list of Portuguese varieties. In 780 samples, 95 profiles with a plural number of accessions revealed not to be listed in the Vitis International Variety Catalogue (VIVC) database, corresponding to possible varieties either descendent from natural crossing from at least one known parental variety, or from undetermined origin. Furthermore, the need for a comprehensive strategy aimed at uncovering other hidden varieties is discussed to prevent their imminent loss, deepen understanding of their origin, and add economic value and sustainability to the vine and wine sector

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

A gestão de estratégias de trade marketing no retalho : o caso da Wells

Mestrado Bolonha em Ciências EmpresariaisO presente trabalho final de Mestrado, desenvolvido como relatório de estágio, ocorreu no grupo empresarial Sonae, mais especificamente na insígnia Wells, e tem como objetivo apresentar o projeto desempenhado durante os meses de estágio na área de Trade Marketing (TM). O projeto em questão, desenvolvido no âmbito dos estágios curriculares da SONAE, foi um desafio criado para a melhoria do processo de gestão dos espaços promocionais. Assim, o relatório de estágio pretende avaliar as estratégias de trade marketing da empresa em questão, compreendendo a sua importância e relevância para o negócio. Relativamente à metodologia, este trabalho possui uma natureza descritiva pois durante os meses de estágio foram desenvolvidas atividades na área de trade marketing, com ênfase na promoção de vendas e merchandising. Sendo assim, para a elaboração do relatório de estágio, foi fundamental a realização de uma análise através de estudos de caso assim como a realização de entrevistas semi-estruturadas e recolha de informação relevante. O trade marketing da Wells caracteriza-se pela contínua gestão das relações com os fornecedores e da gestão dos produtos no ponto de venda, a nível da organização dos produtos, da sua exposição ou da promoção no preço. Em referência à exposição do produto, o merchandising é uma das estratégias de trade marketing trabalhadas nas lojas Wells dando destaque aos produtos ou à imagem de uma marca. É através destes espaços e da promoção de vendas que o negócio influencia o comportamento de compra do consumidor, quer seja na frequência da compra ou no valor da mesma.This final Master's work, developed as an internship report, took place in the Sonae business group, more specifically in the Wells brand, and aims to present the project carried out during the months of my internship in the trade marketing area (TM). The project in question, developed within the scope of SONAE's curricular internships, was a challenge created to improve the process of managing promotional spaces. The internship report therefore aims to evaluate the company's trade marketing strategies, understanding their importance and relevance to the business. In terms of methodology, this work is descriptive in nature because during the months of my internship I carried out activities in the area of Trade Marketing, with an emphasis on sales promotion and merchandising. Therefore, in order to prepare the internship report, it was essential to carry out an analysis through case studies as well as semi-structured interviews and the collection of relevant information. Wells' trade marketing is characterised by the ongoing management of relations with suppliers and the management of products at the point of sale, in terms of product organisation, display and price promotion. In terms of product display, merchandising is one of the trade marketing strategies used in Wells shops, highlighting products or a brand's image. It's through these spaces and sales promotion that the business influences consumer buying behaviour, whether it's the frequency of purchase or the value of the purchase.info:eu-repo/semantics/publishedVersio

Enhancing longevity of pacemakers through reprogramming. Underutilization and cost-effectiveness

OBJECTIVE: This study was performed to observe the number of pacemakers that had never been reprogrammed after implantation, and the effect of optimised output programming on estimated longevity of pulse generators in patients with pacemaker METHODS: Sixty patients with Teletronics Reflex pacemakers were evaluated in a pacemaker clinic, from the time of the beginning of its activities, in June 1998, until March 1999. Telemetry was performed during the first clinic visit, and we observed how many pulse generators retained nominal output settings of the manufactures indicating the absence of reprogramming until that date. After evaluation of the capture threshold, reprogramming of pacemakers was performed with a safety margin of 2 to 2.5:1, and we compared the estimated longevity based on battery current at the manufacturer's settings with that based on settings achieved after reprogramming. RESULTS: In 95% of the cases, the original programmed setting was never reprogrammed before the patients attended the pacemaker clinic. Reprogramming the pacemaker prolonged estimated pulse generator life by 19.7±15.6 months (35.5%). CONCLUSION: The majority of the pacemakers evaluated had never been reprogrammed. Estimated pulse generator longevity can be prolonged significantly, using this simple, safe, efficacious, and cost-effective procedure