Experiência profissionalizante na vertente de farmácia comunitária, hospitalar e investigação

O presente trabalho encontra-se dividido em três capítulos. O primeiro capítulo diz respeito à investigação realizada no âmbito da avaliação de procedimentos e normas de preparação e administração de citotóxicos injetáveis, nomeadamente na área da extravasão. O cancro é uma das principais causas de morte em Portugal e uma das situações com maior impacto ao nível da prestação de cuidados hospitalares, sendo que para o seu tratamento é necessário recorrer, muitas vezes, à quimioterapia injetável. Os citotóxicos intravenosos são fármacos muito tóxicos e sem seletividade pelas células tumorais, tendo sido descritos pela literatura vários casos de toxicidade em profissionais de saúde por exposição ocupacional a estes fármacos. Também os doentes podem sofrer com esta toxicidade, nomeadamente se, por qualquer fator, ocorrer uma extravasão. Desta forma, o estudo realizado tem por objetivo avaliar procedimentos de atuação na preparação e administração de citotóxicos injetáveis mas também analisar a necessidade de proceder ao desenvolvimento de um manual de atuação em caso de extravasão. O estudo permitiu-nos verificar que, nos hospitais incluídos no estudo, a preparação de citotóxicos injetáveis é realizada com intervenção farmacêutica (64,1%) e sem intervenção farmacêutica e que a preparação decorre tanto nos serviços farmacêuticos (53,8%) como em hospital de dia, sendo que o local de preparação influencia a classe de profissionais de saúde que prepara os citotóxicos (Fisher’s Exact Test, p<0,001). Também as condições em que decorrem as preparações foram avaliadas e foi possível observar que todos os hospitais inquiridos preparam os antineoplásicos intravenosos em CFLV, não obstante, somente 28 hospitais dos 39 incluídos no estudo (71,8%) possuem estas CFLV inseridas num sistema modular de salas limpas. No que diz respeito à extravasão de citotóxicos injetáveis, verificou-se que 32 dos 39 hospitais inquiridos (82,1%) possuem manual de atuação em caso de extravasão mas somente 10 dos 39 hospitais (25,6%) possuem kit de extravasão, realçando-se o facto de que os que não possuem manual de atuação afirmam ser importante o desenvolvimento de um. Também os procedimentos de documentação das extravasões foram inquiridos e verificou-se que 31 dos 39 hospitais (79,5%) procedem ao registo dos incidentes ocorridos. Através do registo do número de extravasões ocorridas no ano de 2011 por parte dos hospitais e da média de preparações efetuadas diariamente calculámos também a média de extravasões nesse mesmo ano, sendo esta de 0,048% (IC95%: 0,019% - 0,076%), o que vai ao encontro dos valores descritos na literatura. Em suma, perante a verificação de que alguns procedimentos são alvo de lacunas foi desenvolvido um manual de atuação em caso de extravasão com a finalidade de padronizar a atuação dos profissionais de saúde de acordo com guidelines atualizadas. O segundo capítulo relata as atividades que desenvolvi e acompanhei ao longo do meu estágio em farmácia hospitalar. O período de estágio permitiu-me aperceber da importância do farmacêutico hospitalar no domínio dos cuidados de saúde e do medicamento e ainda seguir as atividades realizadas na farmacotecnia, na distribuição em dose unitária, no ambulatório e na logística e armazenamento. Por fim, o terceiro capítulo espelha o meu estágio em farmácia comunitária. O farmacêutico comunitário encontra-se à cabeceira do doente e estabelece uma relevante ligação entre o este e o medicamento, sendo que o estágio me permitiu sentir a importância da farmácia comunitária no acesso aos cuidados básicos de saúde.This thesis is divided into three chapters. The first chapter concerns research carried out to assess procedures and guidelines for the preparation and administration of injectable chemotherapy, particularly in the area of extravasation. Cancer is an important cause of death in Portugal and one of the situations with the greatest impact at the level of hospital care, and its treatment often requires the administration of injectable chemotherapy. The intravenous cytotoxic drugs are very toxic medicines and lack selectivity for tumor cells. Several cases of toxicity in healthcare workers by occupational exposure to these drugs have been described in the literature. Furthermore, patients can also suffer from this toxicity, in particular if, by any factor, extravasation occurs. Thus, the present study aims at evaluating the established procedures to prepare and administer injectable cytotoxics and assessing the need for an operation manual to manage chemotherapy extravasation. The study showed that in the surveyed hospitals the preparation of injectable cytotoxics is performed both with pharmaceutical intervention (64,1%) and without pharmaceutical intervention and that preparation takes place both in pharmaceutical services (53,8%) and in the hospital oncology day unit. The location in the hospital for chemotherapy preparation influences the class of healthcare professionals involved in the preparation (Fisher's Exact Test, p<0,001). Conditions in which preparations are elaborated were also analysed and it was observed that all hospitals surveyed prepare intravenous antineoplastics in biological safety cabinets (BSC). Nevertheless, only 28 (71,8%) out of 39 hospitals included in the study have these BSC inserted in clean-rooms. With respect to cytotoxic extravasation, it was found that 32 hospitals (82,1%) have chemotherapy extravasation guidelines, but only 10 hospitals (25,6%) have an extravasation kit. Healthcare professionals from hospitals that lack chemotherapy extravasation guidelines recognized the importance of developing it. Furthermore, procedures for documentation of extravasations were inquired and it was found that 31 hospitals (79,5%) record the incidents. By recording the number of extravasations that occurred in 2011 and the mean of daily preparations made, it was also possible to calculate the mean of extravasations that occurred in that same year, which amounted to 0,048% (IC95%: 0,019% -0 ,076%), well within the values described in the literature. In sum, given the finding that some procedures have flaws, a manual was developed for chemotherapy extravasation management, with a view to standardizing procedures of healthcare professionals in accordance with current guidelines. The second chapter describes the activities developed and followed through the hospital pharmacy internship. The training period allowed for recognition of the importance of the hospital pharmacist in the field of healthcare services and medicines circuit. It also allowed for following activities at pharmacy compounding, unit dose distribution, ambulatory service, logistics and storage. Finally, the third chapter describes the community pharmacy internship. The community pharmacist is at the bedside of the patient and establishes an important link between him/her and the drug. This training period proved the importance of community pharmacy to access basic healthcare services

A decade of post-graduated university teaching in advanced wound intervention: e-health and databases research - new borders for knowledge development

Evidence-based practice and the database research are fundamental in order to provide high standards of wound care. We aim to evaluate the use of e-health resources, mainly electronic databases in order to identify the major categories of study interest in post-graduate students in this area

Avaliação da disponibilidade de alimentos para pessoas com restrições alimentares em lanchonetes do hipercentro de Belo Horizonte/MG / Evaluation of food availability for people with food restrictions in the snack bars of hypercenter of Belo Horizonte/MG

Apesar dos avanços nas pesquisas e políticas de Alimentação e Nutrição tem sido percebido, em algumas áreas dos centros urbanos, a dificuldade para encontrar alimentos in natura, frescos e adequados aos portadores de doenças crônicas não transmissíveis e de intolerâncias alimentares. Considerando o exposto, este estudo objetivou analisar a disponibilidade de alimentos para pessoas com restrições alimentares e a frequência de alimentos in natura e processados ofertados nas lanchonetes do hipercentro de Belo Horizonte. O estudo foi realizado em 72 lanchonetes através da análise dos alimentos expostos nas vitrines e nos cardápios. Foi utilizado um formulário para registro da especificação, quantidade e preço de venda de produtos com teor reduzido de açúcar; teor reduzido de sódio; sem lactose; sem glúten; salgados; sanduíches; saladas e bebidas. Os resultados foram apresentados como média dos alimentos especiais encontrados e frequência de disponibilidade para cada categoria de alimentos vendidos. Os resultados mostraram a baixa disponibilidade de alimentos que atendam a necessidades especiais, chegando a representar, em média, menos de um produto por estabelecimento. A maior prevalência de alimentos comercializados é nas categorias de salgadinhos fritos e assados. Os preços médios per capita dos alimentos encontrados nas lanchonetes variaram de R$3,82 a R$ 10,94. Mensalmente, excluindo os domingos, os lanches podem totalizar de R$111,02 a R$ 384,54 o que corresponde a 11,63% a 40,30% do salário mínimo vigente nacional. Os resultados encontrados demonstram a dificuldade de acesso aos alimentos in natura e adequados a situações especiais. Para ampliar a disponibilidade a estes produtos faz-se necessária a criação e implementação de medidas governamentais e políticas públicas que incentivem a inclusão de alimentos in natura e a diversificação dos cardápios destes estabelecimentos. 

A Gene Expression Signature to Select Hepatocellular Carcinoma Patients for Liver Transplantation

Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc.OBJECTIVE: To propose a new decision algorithm combining biomarkers measured in a tumor biopsy with clinical variables, to predict recurrence after liver transplantation (LT). SUMMARY BACKGROUND DATA: Liver cancer is one of the most frequent causes of cancer-related mortality. LT is the best treatment for hepatocellular carcinoma (HCC) patients but the scarcity of organs makes patient selection a critical step. Additionally, clinical criteria widely applied in patient eligibility decisions miss potentially curable patients while selecting patients that relapse after transplantation. METHODS: A literature systematic review singled out candidate biomarkers whose RNA levels were assessed by quantitative PCR in tumor tissue from 138 HCC patients submitted to LT (>5 y follow up, 32% beyond Milan criteria). The resulting four gene signature was combined with clinical variables to develop a decision algorithm using machine learning approaches. The method was named HepatoPredict. RESULTS: HepatoPredict identifies 99% disease-free patients (>5 y) from a retrospective cohort, including many outside clinical criteria (16%-24%), thus reducing the false negative rate. This increased sensitivity is accompanied by an increased positive predictive value (88,5%-94,4%) without any loss of long-term overall survival or recurrence rates for patients deemed eligible by HepatoPredict; those deemed ineligible display marked reduction of survival and increased recurrence in the short and long term. CONCLUSIONS: HepatoPredict outperforms conventional clinical-pathologic selection criteria, (Milan, UCSF) providing superior prognostic information. Accurately identifying which patients most likely benefit from LT enables an objective stratification of waiting lists and information-based allocation of optimal versus suboptimal organs.publishersversionepub_ahead_of_prin

AVALIAÇÃO DA ATIVIDADE ANTIBACTERIANA DO VENENO BRUTO DE Crotalus durissus terrificus

Os venenos de serpentes são reconhecidos como uma fonte promissora de substâncias farmacologicamente ativas e potencialmente úteis para o desenvolvimento de novas drogas antimicrobianas. Esse trabalho teve como objetivo investigar a atividade antimicrobiana do veneno de Crotalus durissus terrificus contra várias bactérias. A determinação da atividade antibacteriana foi realizada pelo método de microdiluição em placas e a ação na estrutura do envelope bacteriano pelo ensaio violeta de cristal. As proteínas do extrato bruto foram separadas por eletroforese e caracterizadas quanto à sua atividade proteolítica. O veneno de C. d. terrificus apresentou ação antimicrobiana frente bactérias gram-positivas e gram-negativas. Os valores de MIC foram definidos para Pseudomonas aeruginosa ATCC 27853 (62.5 μg/ mL), Staphylococcus aureus ATCC 25923 (125 μg/mL) e Micrococcus luteus ATCC 9341 (≤ 500 μg/mL). Para Salmonella enterica serovar typhimurium ATCC 14028 e Corynebacterium glutamicum ATCC 13032, o decréscimo no crescimento bacteriano não foi detectado visualmente, mas foi estatisticamente significante. O teste do cristal violeta demonstrou que o veneno bruto aumentou a permeabilidade das células bacterianas e o perfil de proteína secretada está em consonância com relatos anteriores. Os resultados sugerem que as proteínas com atividade lítica contra bactérias no veneno de C. d. terrificus merecem atenção para uma melhor caracterização, uma vez que podem trazer reforços para o escasso arsenal terapêutico empregado para combater a multirresistência microbiana.Palavras-chave: veneno de cascavel, ação antimicrobiana, envelope celular, atividade proteolítica

Nutritive Value and Bioactivities of a Halophyte Edible Plant: Crithmum maritimum L. (Sea Fennel)

Research funded by FEDER/COMPETE and Fundação para a Ciência e Tecnologia (FCT) via grants UIDB/00313/2020 and UIDP/00313/2020 to CQC, LA/P/0045/2020 to ALiCE, UIDB/50020/2020 and UIDP/50020/2020 to LSRE-LCM, and UIDB/MAR/04292/2020 to MARE, and to the Integrated Programme of SR&TD “Smart Valorization of Endogenous Marine Biological Resources Under a Changing Climate” (Centro-01-0145-FEDER-000018) and to Rede Nacional de Ressonância Magnética Nuclear (RNRMN, UC-NMR).Crithmum maritimum L. (sea fennel), an edible xerophyte of coastal habitats, is considered an emerging cash crop for biosaline agriculture due to its salt-tolerance ability and potential applications in the agri-food sector. Here, the nutritional value and bioactive properties of sea fennel are described. Sea fennel leaves, flowers, and schizocarps are composed of carbohydrates (>65%) followed by ash, proteins, and lipids. Sea fennel’s salty, succulent leaves are a source of omega-6 and omega-3 polyunsaturated fatty acids, especially linoleic acid. Extracts obtained from flowers and fruits/schizocarps are rich in antioxidants and polyphenols and show antimicrobial activity against Staphylococcus aureus, Staphylococcus epidermis, Candida albicans, and Candida parapsilosis. Plant material is particularly rich in sodium (Na) but also in other nutritionally relevant minerals, such as calcium (Ca), chlorine (Cl), potassium (K), phosphorus (P), and sulfur (S), beyond presenting a potential prebiotic effect on Lactobacillus bulgaricus and being nontoxic to human intestinal epithelial Caco-2 model cells, up to 1.0% (w/v). Hence, the rational use of sea fennel can bring nutrients, aroma, and flavor to culinary dishes while balancing microbiomes and contributing to expanding the shelf life of food products.info:eu-repo/semantics/publishedVersio

Crithmum maritimum L. (Sea Fennel)

Funding Information: Research funded by FEDER/COMPETE and Fundação para a Ciência e Tecnologia (FCT) via grants UIDB/00313/2020 and UIDP/00313/2020 to CQC, LA/P/0045/2020 to ALiCE, UIDB/50020/2020 and UIDP/50020/2020 to LSRE-LCM, and UIDB/MAR/04292/2020 to MARE, and to the Integrated Programme of SR&TD “Smart Valorization of Endogenous Marine Biological Resources Under a Changing Climate” (Centro-01-0145-FEDER-000018) and to Rede Nacional de Ressonância Magnética Nuclear (RNRMN, UC-NMR). Publisher Copyright: © 2024 by the authors.Crithmum maritimum L. (sea fennel), an edible xerophyte of coastal habitats, is considered an emerging cash crop for biosaline agriculture due to its salt-tolerance ability and potential applications in the agri-food sector. Here, the nutritional value and bioactive properties of sea fennel are described. Sea fennel leaves, flowers, and schizocarps are composed of carbohydrates (>65%) followed by ash, proteins, and lipids. Sea fennel’s salty, succulent leaves are a source of omega-6 and omega-3 polyunsaturated fatty acids, especially linoleic acid. Extracts obtained from flowers and fruits/schizocarps are rich in antioxidants and polyphenols and show antimicrobial activity against Staphylococcus aureus, Staphylococcus epidermis, Candida albicans, and Candida parapsilosis. Plant material is particularly rich in sodium (Na) but also in other nutritionally relevant minerals, such as calcium (Ca), chlorine (Cl), potassium (K), phosphorus (P), and sulfur (S), beyond presenting a potential prebiotic effect on Lactobacillus bulgaricus and being nontoxic to human intestinal epithelial Caco-2 model cells, up to 1.0% (w/v). Hence, the rational use of sea fennel can bring nutrients, aroma, and flavor to culinary dishes while balancing microbiomes and contributing to expanding the shelf life of food products.publishersversionpublishe

Plasma β-III tubulin, neurofilament light chain and glial fibrillary acidic protein are associated with neurodegeneration and progression in schizophrenia

Schizophrenia is a progressive disorder characterized by multiple psychotic relapses. After every relapse, patients may not fully recover, and this may lead to a progressive loss of functionality. Pharmacological treatment represents a key factor to minimize the biological, psychological and psychosocial impact of the disorder. The number of relapses and the duration of psychotic episodes induce a potential neuronal damage and subsequently, neurodegenerative processes. Thus, a comparative study was performed, including forty healthy controls and forty-two SZ patients divided into first-episode psychosis (FEP) and chronic SZ (CSZ) subgroups, where the CSZ sub group was subdivided by antipsychotic treatment. In order to measure the potential neuronal damage, plasma levels of β-III tubulin, neurofilament light chain (Nf-L), and glial fibrillary acidic protein (GFAP) were performed. The results revealed that the levels of these proteins were increased in the SZ group compared to the control group (P < 0.05). Moreover, multiple comparison analysis showed highly significant levels of β-III tubulin (P = 0.0002), Nf-L (P = 0.0403) and GFAP (P < 0.015) in the subgroup of CSZ clozapine-treated. In conclusion, β-III tubulin, Nf-L and GFAP proteins may be potential biomarkers of neurodegeneration and progression in SZFundação para a Ciência e a Tecnologia | Ref. SFRH/BD/135623/20Instituto de Salud Carlos III | Ref. P16/00405Ministerio de Sanidad, Igualdad y Política Social | Ref. 2017I054Agencia del Conocimiento en Salud | Ref. PRIS2-17Xunta de Galicia | Ref. IN607C-2017/02Xunta de Galicia | Ref. IN607B 2018/1

A neurophysiological signature of dynamic emotion recognition associated with social communication skills and cortical gamma-aminobutyric acid levels in children

IntroductionEmotion recognition is a core feature of social perception. In particular, perception of dynamic facial emotional expressions is a major feature of the third visual pathway. However, the classical N170 visual evoked signal does not provide a pure correlate of such processing. Indeed, independent component analysis has demonstrated that the N170 component is already active at the time of the P100, and is therefore distorted by early components. Here we implemented, a dynamic face emotional paradigm to isolate a more pure face expression selective N170. We searched for a neural correlate of perception of dynamic facial emotional expressions, by starting with a face baseline from which a facial expression evolved. This allowed for a specific facial expression contrast signal which we aimed to relate with social communication abilities and cortical gamma-aminobutyric acid (GABA) levels.MethodsWe recorded event-related potentials (ERPs) and Magnetic Resonance (MRS) measures in 35 typically developing (TD) children, (10–16 years) sex-matched, during emotion recognition of an avatar morphing/unmorphing from neutral to happy/sad expressions. This task allowed for the elimination of the contribution low-level visual components, in particular the P100, by morphing baseline isoluminant neutral faces into specific expressions, isolating dynamic emotion recognition. Therefore, it was possible to isolate a dynamic face sensitive N170 devoid of interactions with earlier components.ResultsWe found delayed N170 and P300, with a hysteresis type of dependence on stimulus trajectory (morphing/unmorphing), with hemispheric lateralization. The delayed N170 is generated by an extrastriate source, which can be related to the third visual pathway specialized in biological motion processing. GABA levels in visual cortex were related with N170 amplitude and latency and predictive of worse social communication performance (SCQ scores). N170 latencies reflected delayed processing speed of emotional expressions and related to worse social communication scores.DiscussionIn sum, we found a specific N170 electrophysiological signature of dynamic face processing related to social communication abilities and cortical GABA levels. These findings have potential clinical significance supporting the hypothesis of a spectrum of social communication abilities and the identification of a specific face-expression sensitive N170 which can potentially be used in the development of diagnostic and intervention tools