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/

Wealth and Disability in Later Life: The English Longitudinal Study of Ageing (ELSA)

We examined wealth inequalities in disability, taking into account the effect of both depression and social support among older English adults using data from 5,506 community-dwelling people aged 50 years and over from the English Longitudinal Study of Ageing (ELSA). Disability was measured as self-reported limitations in the Basic Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL). Depressive symptomatology was measured using the 8-item Center for Epidemiological Studies-Depression (CES-D) scale. Social support was assessed by marital status and frequency of contact with friends, relatives or children. Multinomial logistic regression models were used to assess the role of social support and depressive symptoms on disability by total household wealth, which is a measure of accumulated assets over the course of life. Our findings showed that the poorest men with disability were more likely to live without a partner and have no weekly contact with children, family or friends compared to the wealthiest. Among women with disability, the poorest were more likely to report loneliness and have no partner while the wealthiest and the intermediate groups were more likely to be living with a partner. There was a strong inverse dose-response association between wealth and depressive symptoms among all participants with disability. This study shows a clear wealth gradient in disability among older English adults, especially for those with elevated depressive symptoms

Difficulty in performing activities of daily living and the need for help in older adults: evidence on social distancing models from the ELSI-COVID-19 initiative

To analyze whether the older adults with difficulty or need of help to perform basic or instrumentals activities of daily living are more socially distanced in times of COVID-19. A total of 4,035 older adults participated in the telephone interviews from the second wave of the Brazilian Longitudinal Study of Aging (ELSI-Brazil). Difficulty, need and receiving help were classified into: (1) independents; (2) had difficulty without need for care; (3) had difficulty, needed and have received care from someone within their household; (4) had difficulty, needed and have received care from someone outside their household; and (5) had difficulty and needed care but did not receive it. Social distancing was categorized as follows: did not leave their houses in the last 7 days, left their houses for essential activities and went out for non-essential activities. Multinomial regression model adjusted for age, sex, schooling and great geographical region was performed. Older adults who had difficulty, needed and have received help from within their homes (odds ratio - OR = 2.34 95%CI: 1.25-4.39) or from outside their homes (OR = 3.94; 95%CI: 2.24-6.92) were more socially distanced. Age increased the odds of not going out (OR = 1.06; 95%CI: 1.03-1.09) while be men reduced it (OR = 0.48; 95%CI: 0.33-0.70). Living in the South of Brazil has increased the odds of the respondents going out for essential activities (OR = 1.77; 95%CI: 1.01-3.10). Older adults who had difficulty, needed and have received help from within or outside their homes did not leave their homes in the last 7 days. Even with social distancing, these older adults can not have their exposure to COVID-19 reduced, weakening the theory of selective social distancing

Poor sleep quality and oral health among older Brazilian adults

Objectives: This study evaluates the association between normative and subjective oral health measures and poor self‐reported sleep quality among community‐dwelling older adults in Brazil. / Methods: This was a cross‐sectional study with data from the Brazilian Longitudinal Study of Aging. The dependent variable was the poor sleep quality. Independent variables of interest included number of teeth and self‐reported impact of oral health on eating/chewing and on maintaining emotional stability. / Results: Poor sleep quality was reported by 17.8 (95% CI 16.6; 19.2) of the participants, 29% of the participants were edentulous, and 30% had 20 or more teeth. Impacts of oral health on eating and maintaining emotional stability was found among 33.3% and 20% of the older adults, respectively. After adjusting for all oral health measures and covariates, the magnitude of the associations between the number of teeth and sleep quality was attenuated. Sleep quality was related to oral health impacts on eating (OR 1.19 [95% CI 1.00; 1.41]) and on emotional stability (OR 1.51 [95% CI 1.21; 1.87]). / Conclusions: This study found an association between oral health and sleep quality emphasizing the importance of oral health to general health

Femtosecond laser and microkeratome-assisted Descemet stripping endothelial keratoplasty: first clinical results

Purpose: To evaluate the use of a femtosecond laser combined with a microkeratome in the preparation of posterior corneal disks for Descemet stripping automated endothelial keratoplasty (DSAEK).
Methods: This experimental study involved ultrathin DSAEK tissue preparation of 22 donor corneas unsuitable for transplantation. The first cut was performed with an Intralase® FS60 laser and the second cut with a Moria CBm 300-µm microkeratome. The thickness of the first cut was modified for each cornea to obtain a final graft thickness of less than 110 µm. Precut and postcut central pachymetry were performed with an ultrasonic pachymeter. Central endothelial cell density (ECD) was calculated before and 24 hours after tissue preparation. 
Results: Final graft thickness was 105.0 ± 26.1 (SD) µm (range 65-117). The mean microkeratome head cut thickness was 324.5 ± 10.9 µm (range 310-345). Precut and postcut ECDs averaged 2250 ± 222 and 2093 ± 286 cells/mm2, respectively, representing 6.9% of cell loss. No corneas were perforated.
Conclusion: Femtosecond FS60 lasers and Moria CBm 300-µm microkeratomes can be used sequentially to prepare consistently thin DSAEK grafts with no irregular cuts or cornea perforations

Use of Moisturizers and Lubricants for Vulvovaginal Atrophy

The estrogen decrease in postmenopausal women results in functional and anatomical changes in the genitourinary tract. The most prevalent and bothersome symptoms are vaginal dryness, dyspareunia, and reduced lubrication, which can significantly affect the quality of life of these women, principally those who are sexually active. Hormonal therapy with local estrogens is generally considered the "gold standard." However, there are cases in which there are clinical concerns about its use or women opt for non-hormonal options. Thus, safe and effective non-hormonal options are needed to improve symptoms in these women. Moisturizers and lubricants are first-line therapy for breast cancer survivors.info:eu-repo/semantics/publishedVersio

Does undiagnosed diabetes mitigate the association between diabetes and cognitive impairment? Findings from the ELSI‐Brazil study

Background: Type 2 diabetes mellitus (T2DM) is associated with cognitive impairment. However, most of the evidence has been based on self‐reported T2DM, and undiagnosed diabetes has not been considered as a separate category. We aimed to examine the extent to which undiagnosed diabetes modifies the association between diabetes and cognitive impairment in a representative sample of Brazilian adults aged 50 years and older. / Methods: We analyzed baseline data from 1944 participants of the Brazilian Longitudinal Study of Aging (ELSI‐Brazil) conducted from 2015 to 2016. Diabetes was evaluated based on self‐reported doctor diagnosis and glycosylated hemoglobin levels. Participants were classified as diabetics (D), undiagnosed diabetics (UDD), or nondiabetics (ND). Cognitive function was assessed by word list learning and verbal fluency tests. Three multiple logistic regression models were used to evaluate the changes in the strength of the associations. / Results: Participants with diabetes had 49% greater odds of exhibiting impaired memory than nondiabetics (odds ratio [OR] = 1.49; 95% CI: 1.01‐2.20). By combining UDD and ND, the association between diabetes and impaired memory was attenuated by 2.0%, losing its statistical significance (OR = 1.46; 95% CI: 0.98‐2.17). By combining UDD and D, the association was attenuated by 7.4% (OR = 1.38; 95% CI: 1.01‐1.90). No significant association was found between T2DM and impaired verbal fluency. / Conclusion: This study found an association between T2DM and impaired memory but not with impaired verbal fluency. When UDD individuals are considered diabetics, this association is attenuated; when UDD individuals are considered as ND, this association is attenuated to the extent that it loses its statistical significance, affecting thus the clinical interpretation

Effect of immunocastration and caponization on fatty acid composition of male chicken meat

Research Areas: AgricultureAiticle in International JournalABSTRACT - Recently, immunocastration with Improvac (ImmC). has been tested in broilers and a considerable reduction in serum testosterone concentration (reduced by 79% compared to roosters) was observed. The aim of this study was to evaluate the effect of immunocastration on meat fatty acid (FA) composition and its comparison with caponized and intact males (roosters). The study was conducted with 3 experimental groups: control group (roosters), the group of birds submitted to surgical caponization (SurgC), and the group of birds submitted to immunocastration with Improvac. The comparison of breast meat partial FA sums of castrated (SurgC and ImmC) with control birds (roosters) revealed that castrated birds showed significantly higher content of n-3 polyunsaturated fatty acids (n-3 PUFA) than control birds (1.76 vs. 1.46 g/100 g of total FA; superiority of 20.2%), which has contributed to the occurrence of significant differences on both the n-6/n-3 ratio and the atherogenicity index (AI). In contrast, on leg meat portion, castrated birds displayed higher contents of both total saturated and monounsaturated fatty acids (SFA and MUFA, with 2.2 and 4.1% more, respectively) and lower total n-6 PUFA content (8.3% less) than was observed in control birds, which contributed to significant differences in the AI index. On the other hand, the comparison of breast meat portion from SurgC with ImmC showed that immunocastration contributed to lower total SFA and higher total n-6 PUFA, which have contributed to significant differences on both Polyunsaturated/Saturated (P/S) and n-6/n-3 ratios. Whereas, on leg meat portion no significant differences were observed on partial sums and a single difference was observed on the thrombogenicity index. Immunocastration of broilers has contributed to minor changes in the FA profile, but has improved the overall lipid quality indexes in both breast and leg meat portions. Therefore, immunocastration could be applied as an alternative method to caponization without negative consequences in meat FA profile.info:eu-repo/semantics/publishedVersio

Photon-number-resolving segmented avalanche-photodiode detectors

We investigate the feasibility and performance of photon-number-resolved photodetection employing avalanche photodiodes (APDs) with low dark counts. The main idea is to split n photons over m modes such that every mode has no more than one photon, which is detected alongside propagation by an APD. We characterize performance by evaluating the purities of positive-operator-valued measurements (POVMs), in terms of APD number and photon loss.Comment: 5 pages, 7 figures, submitted for publicatio