Estudo da variação da espessura e densidade ótica corneal em pacientes com Diabetes Mellitus tipo 2

A Diabetes Mellitus (DM) é uma doença crónica e um importante problema de saúde pública, uma das quatro doenças não-transmissíveis prioritárias (DNT’s) mencionadas pela Organização Mundial de Saúde, e cuja sua prevalência tem aumentado drasticamente ao longo do tempo. A hiperglicemia, um efeito comum da diabetes não controlada, pode, ao longo do tempo, levar a importantes complicações. Estas podem ser caracterizadas por problemas cardiovasculares, nefropatias, neuropatias e problemas oculares. Como consequência, veio o interesse de estudar a influência da diabetes numa das estruturas do olho, a córnea, na qual foi observada a presença de sinais e características significantes relacionadas com a diabetes. O objetivo deste estudo consistiu em analisar alterações na espessura e densidade ótica corneal em pacientes com Diabetes Mellitus tipo 2. Paralelamente, foi realizada uma análise da relação destas duas variáveis com fatores de risco tais como, o sexo, tempo de diagnóstico da DM, Hemoglobina Glicada A1c (HbA1c), Índice de massa corporal (IMC) e o colesterol total. Não foram encontradas diferenças estatisticamente significativas na espessura da córnea de pacientes diabéticos e não-diabéticos. No entanto, foi verificado que a espessura da membrana de Bowman é significativamente mais baixa em pacientes com diabetes. O mesmo acontece para os valores de densidade, em que não foram encontradas diferenças estatisticamente significativas, no que se refere à densidade por camada. Contrariamente ao que verifica quando é analisada a densidade radial, em que são encontrados resultados significativos em todas as camadas, excetuando na camada posterior. Em suma, foram encontradas algumas alterações associadas à presença da Diabetes Mellitus nas variáveis estudadas.Diabetes Mellitus (DM) is a chronic disease and an important public health problem, one of the four priority noncommunicable diseases (NCDs) mentioned by the World Health Organization, whose prevalence has increased dramatically over time. Hyperglycemia, a common effect of uncontrolled diabetes, can, over time, lead to important complications. These can be characterized by cardiovascular problems, nephropathies, neuropathies and eye problems. Consequently, the interest came to study the influence of diabetes in one of the structures of the eye, the cornea, in which significant signs and characteristics related to diabetes were observed. The objective of this study was to analyze changes in thickness and corneal density in patients with type 2 diabetes mellitus. In parallel, an analysis was made of the relationship between these two variables with risk factors such as gender, time of diagnosis of DM, glycated hemoglobin A1c (HbA1c), body mass index (BMI), and total cholesterol. No statistically significant differences were found in the thickness of diabetic and non-diabetic patients. However, it has been found that Bowman's membrane thickness is significantly lower in patients with diabetes. The same is true for density values, where no statistically significant differences were found for density per layer. Contrary to what is verified when the radial density is analyzed, in which significant results are found in all the layers, except in the posterior layer. In summary, we found some changes associated with the presence of Diabetes Mellitus in the studied variables

Liderança feminina nas escolas de Macau: uma abordagem exploratória

ln this piece of research the authors analyse the underrepresentation of women in management and leadership roles in Macau's schools. The authors identify two kinds of factors they believe are crucial in the study of the above mentioned phenomenon: the societal culture and the intra-organizational cultures that prevail locally in the field of education. Derogatory images of the feminine, which are rooted in the Chinese history and culture, as well as authoritarian and manly styles of educational leadership, are combined to deter the access of women to top places in schools. The authors also believe that the difficulties that the women who aspire to leadership positions in school organizations face can be increased in contexts in which the education is submitted to the market principies and mechanisms.Neste artigo analisam-se as razões da sub-representação das mulheres em posições de gestão e liderança nas escolas de Macau. Os autores identificam dois tipos de factores que consideram fundamentais no estudo do referido fenómeno: a cultura societal e as culturas intraorganizacionais que predominam localmente no domínio da educação. Imagens penalizadoras do feminino, enraizadas na história e na cultura chinesas, bem como estilos autoritários e masculinistas de liderança educacional, conjugam-se para dificultar o acesso das mulheres aos lugares de topo nas escolas. Os autores defendem igualmente que as dificuldades enfrentadas pelas aspirantes a posições de liderança nas organizações escolares podem acentuar-se em contextos em que a educação está sujeita aos princípios e mecanismos de mercado

0125: Observational study on Takotsubo cardiomyopathy

IntroductionTakotsubo cardiomyopathy (TC) is a still rarely diagnosed clinical syndrome, which is characterized by transient cardiac dysfunction with reversible wall motion abnormalities.AimDetermine the demographic characteristics, clinical presentation and prognosis of patients with TC.MethodsRetrospective study of 39 patients admitted for TC in a cardiology center during a period of 3 years.ResultsIn the population studied, the mean age was 67.15±12.01 years and women were predominant.The most frequent comorbidities were hypertension (76.9%), dyslipidemia (51.3%), psychiatric illness (23.1%) and diabetes mellitus (12.8%). The emotional stress was the most common triggering event (n=10), however, in 17 patients we were not able to identify any precipitating factor. Cardinal symptoms which led to admission, were acute chest pain (n=28) and dyspnoea (n=15).The most common ECG findings were ST segment elevation (n=21), inversion of the T wave (n=21) and QTc prolongation (n=22).All patients had typical wall motion abnormalities in the echocardiography and/or ventriculography. The mean ejection fraction was 35.59±5.54%.The most common in-hospital complication was acute heart failure (n=16, 41%), whereas 3 patients developed cardiogenic shock. The presence of moderate to severe LVS dysfunction (p=0.048) and higher levels of C reactive protein (p=0.02) and pBNP (p=0.042) were associated with the development of acute heart failure. Rhythm disturbances occurred in 3 patients and there was only one non-cardiovascular death.At follow-up at 6 months all patients showed recovery of LVS function; there was one recurrence and 3 deaths from non-cardiovascular causes.ConclusionAccording to the literature, our review shows higher prevalence of TC in women and a clinical and electrocardiographic presentation similar to the picture of an acute coronary syndrome. In the acute phase, the TC is not necessarily a benign entity, because we observed a high prevalence of acute heart failure

Successful Management of Prosthetic Valve Brucella Endocarditis with Antibiotherapy Alone

Objectives: To report a case of mechanical aortic prosthesis Brucella endocarditis successfully treated with antibiotics alone. Materials and methods: We describe a clinical case and present a review of the literature. Results: A 60-year-old female farmer with a mechanical aortic prosthetic valve presented with low back pain and fever. She was diagnosed with prosthetic valve Brucella mellitensis endocarditis and was cured with antibiotic therapy alone. Few cases of successfully treated prosthetic valve Brucella endocarditis without surgery have been reported. Conclusion: Prosthetic valve Brucella endocarditis usually requires surgical valve replacement. However, selected patients may be successfully treated with antibiotic therapy alone

Cystic adenomatoid malformations are induced by localized FGF10 overexpression in fetal rat lung

Fibroblast growth factor-10 (FGF10) is a mesenchymal growth factor, involved in epithelial and mesenchymal interactions during lung branching morphogenesis. In the present work, FGF10 overexpression was transiently induced in a temporally and spatially restricted manner, during the pseudoglandular or canalicular stages of rat lung development, by trans-uterine ultrasound-guided intraparenchymal microinjections of adenoviral vector encoding the rfgf10 transgene. The morphologic and histologic classification of the resulting malformations were dependent upon developmental stage and location. Overexpression of FGF10 restricted to the proximal tracheobronchial tree during the pseudoglandular phase resulted in large cysts lined by tall columnar epithelium composed primarily of Clara cells with a paucity of Type II pneumocytes, resembling bronchiolar type epithelium. In contrast, FGF10 overexpression in the distal lung parenchyma during the canalicular phase resulted in small cysts lined by cuboidal epithelial cells composed of primarily Type II pneumocytes resembling acinar epithelial differentiation. The cystic malformations induced by FGF10 overexpression appear to closely recapitulate the morphology and histology of the spectrum of human congenital cystic adenomatoid malformation (CCAM). These findings support a role for FGF10 in the induction of human CCAM and provide further mechanistic insight into the role of FGF10 in normal and abnormal lung development.This project was in part funded by proceeds from the Ruth and Tristram C. Colket Jr. Chair in Pediatric Surgery (A.W.F.), and the Fundação para a Ciência e Tecnologia (POCI/SAUOBS/56428/2004). S.G. was supported by FCT grant ref. SFRH/BD/15260/2004

Monitoring of vegetation cover through biophysical indices and management of protected areas

The maintenance of vegetation diversity established in caatinga areas is at great risk, and the creation of protected areas is a vital strategy for their preservation. The use of remote sensing and the application of vegetation indices will contribute to greater efficiency in its monitoring, which is not a common practice in Brazil. The objective of this study was to identify the condition of the vegetation cover of a nature conservation unit, through the application of biophysical indexes: NDVI, LAI, SAVI, EVI and NDWI, generated from the analysis of orbital images for the years 2007, 2013 and 2016. It was verified that the vegetation cover of this protected area is relatively preserved, with the detection of exposed areas and under water stress, indispensable information for the management of legally protected spaces

332 Predictors and prognostic value of contrast-induced nephropathy in patients undergoing primary angioplasty

PurposeContrast-induced nephropathy (CIN) after coronariography has been associated to increased morbidity and mortality. Patients submitted to primary angioplasty seem to be at higher risk for CIN development, owing in part to hemodynamic status. We sought to determine the prevalence, predictors and prognostic value of CIN occurrence after primary angioplasty.MethodsA total of 141 patients consecutively submitted to primary angioplasty and admitted to our coronary unit were reviewed. CIN was defined as impairment of renal function occurring within 48 hours after administration of contrast media and manifested by an absolute increase in the serum creatinine level of at least 0.5mg/dl or by a relative increase of at least 25% over the baseline value (in the absence of another cause). The primary end points were in-hospital and six-month mortality.ResultsCIN developed in 18.4% of the patients (n=26). Patients with CIN were older (68±13 vs 61±13 years; p<0.05) and more often had diabetes mellitus (38.5% vs 15.7%; p<0.05). Although statistical significance was not reached, there was a trend for higher prevalence of hypertension (61.5% vs 42.6%; p=0.09), female gender (30.8% vs 18.3%; p=0.18) and Killip class higher than one at admission (26.9% vs 16.3%; p=0.1) among patients with CIN. Patients with CIN had an higher mean time from symptoms to reperfusion (304±192 vs 397±206 minutes; p<0.04). By multivariate analysis, independent correlates of CIN were older age (OR=1.04; 95%CI=1.01 − 1.08) and diabetes mellitus (OR=2.99; 95%CI=1.08 − 8.3). Patients with CIN had higher in-hospital (19.2% vs 0.9%; p<0.05) and 6-month mortality (28.6% vs 4.9%; p<0.05).ConclusionsCIN was a frequent complication of primary angioplasty (18.4% of the patients). Independent predictors of CIN after primary angioplasty were older age and diabetes mellitus. Patients with CIN had a worse prognosis, both during in-hospital stay and at 6 months

Targeted gene transfer to fetal rat lung interstitium by ultrasound-guided intrapulmonary injection

In utero gene transfer to the developing lung may have clinical or research applications. In this study, we developed a new method for specifically targeting the fetal rat lung with adeno and lentiviral vectors encoding the enhanced green fluorescence protein (EGFP) marker gene at E15.5 using ultrasound biomicroscopy (UBM). Survival rate, morphometric parameters, viral biodistribution, and lung transduction efficiency were analyzed and compared to the intra-amniotic route of administration. Expression of EGFP started as early as 24 and 72 h after the injection of adenoviral and lentiviral vectors, respectively. Both vectors transduced lung parenchyma with gene expression limited to interstitial cells of the injected region, in contrast to intra-amniotic injection, which targeted the pulmonary epithelium. Expression of EGFP was most intense at E18.5 and E21.5 for adenoviral and lentiviral vectors, respectively. In contrast to lentivirus, adenoviral expression significantly declined until final analysis at 1 week of age. This study demonstrates the feasibility of targeting the fetal rat lung interstitium with viral vectors under UBM guidance during the pseudoglandular stage. This model system may facilitate in vivo studies of dynamic lung morphogenesis and could provide insight into the efficacy of prenatal gene transfer strategies for treatment of specific lung disorders.FCT Grant (SFRH/BD/15260/2004) on behalf of the FCT Grant POCI/SAU-OBS/56428/200