Training medical students to improve the management of people with epilepsy

Purpose: To evaluate the knowledge, attitude and perception of medical students prior to and after a training course about epilepsy. Methods: We used a KAP questionnaire with sixty-one questions which assesses knowledge, attitude and practice of epilepsy. Questionnaires were completed by 185 medical students, before and after epilepsy training. We compared the answers to see whether the lecture had changed the knowledge, attitude and practice in epilepsy. Results: One hundred and six students completed the questionnaire before an eight hour course on epilepsy and 79 students completed the questionnaire one year after the course. Comparison of the knowledge scores prior to (mean=53.9, standard deviation=11.4) and after the course (mean=63.8, standard deviation=11.9) showed that students had improved knowledge after the course (t-test=5.6, p < 0.001). Discussion: Training course on epilepsy for medical students can promote improvement in the knowledge, attitudes and perception regarding epilepsy, which is maintained one year later. These results highlight the importance of continuous educational programs within the Medical Curriculum

“A Good Death” - Palliative Surgery in Trisomy 18

A trissomia 18 caracteriza-se por múltiplas anomalias, incluindo doença cardíaca em 60 a 90% dos casos e elevada mortalidade. O mau prognóstico global, conduz habitualmente a uma politica de “cuidados mínimos” mas, paliar, é também nestas situações, um imperativo ético. Descreve-se o caso de uma recém-nascida sem diagnóstico pré natal, mas com confirmação por cariotipo, com cardiopatia, que condicionou insuficiência cardíaca congestiva e angústia respiratória crescente, inviabilizando alta hospitalar, como era desejo da família. Após consenso entre os pais e o corpo clínico responsável, foi decidida intervenção cirúrgica cardíaca paliativa, que possibilitou melhoria clínica e alta para o domicílio. Os autores defendem que a cirurgia cardíaca pode ser uma atitude a considerar em casos de trissomia 18, pois pode aliviar o sofrimento

Major CD4 T-Cell Depletion and Immune Senescence in a Patient with Chronic Granulomatous Disease

Chronic granulomatous disease (CGD) results from primary defects in phagocytic reactive oxygen species (ROS) production. T-cell evaluation is usually neglected during patients’ follow-up, although T-cell depletion has been reported in CGD through unknown mechanisms. We describe here a 36-year-old patient with X-linked CGD with severe CD4 T-cell depletion <200 CD4 T-cells/μl, providing insights into the mechanisms that underlie T-cell loss in the context of oxidative burst defects. In addition to the typical infections, the patient featured a progressive T-cell loss associated with persistent lymphocyte activation, expansion of interleukin (IL)-17-producing CD4 T-cells, and impaired thymic activity, leading to a reduced replenishment of the T-cell pool. A relative CD4 depletion was also found at the gut mucosal level, although no bias to IL-17-production was documented. This immunological pattern of exhaustion of immune resources favors prompt, potentially curative, therapeutic interventions in CGD patients, namely, stem-cell transplantation or gene therapy. Moreover, this clinical case raises new research questions on the interplay of ROS production and T-cell homeostasis and immune senescence

In vitro binding and survival assays of Leishmania parasites to peripherical blood monocytes and monocyte-derived macrophages isolated from dogs naturally and experimentally infected with Leishmania (Leishmania) chagasi

<p>Abstract</p> <p>Background</p> <p>There are a few works considering the characterization of canine monocyte-derived macrophages as well as a standardized procedure for isolation, culture, and infection of these cells with <it>Leishmania</it>. We have performed several modifications in order to improve the canine monocyte-derived macrophage cultures. In addition, we have done a comparative study between monocytes and monocyte-derived macrophages from dogs naturally and experimentally infected with <it>L. chagasi</it>.</p> <p>Results</p> <p>In the presence of exogenous serum, opsonized <it>Leishmania </it>promastigotes binds better to monocytes/macrophages than without serum. Otherwise, this binding occurs due to the strict correlation between the opsonized biologic particles with the third receptor of the complement (CR3-CD11b/CD18). In fact, our assays with CD11b confirmed the importance of this receptor for canine cells and the <it>L. chagasi </it>experimental system. Moreover, monocytes obtained from naturally infected dogs have shown a higher number of monocytes bounded to promastigotes. The experimental results regarding survival have shown that promastigote forms of opsonized <it>L. chagasi </it>were more infective, because we found higher numbers of promastigotes bound to the different cells. As a consequence, after forty-eight hours of binding, higher numbers of amastigotes appeared inside monocyte-macrophages.</p> <p>Conclusion</p> <p>These studies have given support to continue comparative studies involving canine monocytes, monocyte-derived macrophages and peritoneal macrophages. Since we have standardized the canine cell culture, we are looking forward to determining the phenotypic properties of these cells before and after <it>L. chagasi </it>infection using flow cytometry.</p

The pregnant woman with heart disease: management of pregnancy and delivery

Women with heart disease are at risk of cardiac complications during pregnancy and delivery. Risk assessment should be performed in these women, and the management of pregnancy and delivery should be planned accordingly. Depending on the risk, women should be cared for in specialised centres, regional centres or a combination of both. Multidisciplinary teams must be involved in the care of these women. Adequate organisation of care and communication between the team members is important to prevent complications

Determinants for the success of software startups: Insights from a regional cluster

In recent years, we have seen a growing interest in technology-based companies and intensive knowledge. Several regional clusters have appeared supported in dynamic entrepreneurial ecosystems which, alongside intrinsic aspects of the business, are important determinants of the success of new companies. However, most startups created in these innovation-oriented spaces do not survive the first years of life, due to the high competitiveness of the technological market, due to deficiencies in the business model, due to the support conditions provided by the surrounding ecosystem, and finally due to a weak adjustment between all these dimensions. Among several models available, the Early-Life Decision Model (ELDM) presents itself as an interesting framework for studying the development and success conditions of software companies. This article discusses the application of the ELDM based on a series of interviews conducted to 15 Portuguese software startups installed in a technological cluster located in the northeast of Portugal. Based on the results obtained, it was appropriate to add a new dimension to the ELDM model (learning) and complementing it with the perspectives of the business type and internal versus external determinants.This work was supported by COMPETE: POCI-01-0145-FEDER-007043 and FCT (Fundação para a Ciência e a Tecnologia) within the Project Scope: UID/CEC/00319/2013

Urinary incontinence related to perineal muscle strength in the first trimester of pregnancy: cross-sectional study

Objective To analyze pelvic floor muscle strength (PFMS), urinary continence and quality of life related to urinary incontinence (UI) of women in the first trimester of pregnancy. Method Cross-sectional study with a sample of 500 women who started prenatal care in a complementary healthcare facility in Guarulhos, state of São Paulo, from 2012 and 2013. Pelvic floor muscle strength was evaluated through perineometry. The pregnant women who presented UI answered the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF). Results It was found that maternal age (OR=1.06; CI95% 1.02-1.11) and prior UI (OR=15.12; 95%CI 8.19-27.92) are the variables that, in tandem, best explain the occurrence of UI at the beginning of pregnancy. The mean score on the ICIQ-SF was 8.2 (SD=3.9), considered a moderate impact on quality of life. Conclusion Older pregnant women with prior UI are more likely to have UI in the first trimester of pregnancy.
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Women’s pelvic floor muscle strength and urinary and anal incontinence after childbirth: a cross-sectional study

Abstract OBJECTIVE To analyse pelvic floor muscle strength (PFMS) and urinary and anal incontinence (UI and AI) in the postpartum period. METHOD Cross-sectional study carried out with women in their first seven months after child birth. Data were collected through interviews, perineometry (Peritron™), and the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF). RESULTS 128 women participated in the study. The PFMS mean was 33.1 (SD=16.0) cmH2O and the prevalence of UI and AI was 7.8% and 5.5%, respectively. In the multiple analyses, the variables associated with PFMS were type of birth and cohabitation with a partner. Newborn’s weight, previous pregnancy, UI during pregnancy, and sexual activity showed an association with UI after child birth. Only AI prior to pregnancy was associated with AI after childbirth. CONCLUSION Vaginal birth predisposes to the reduction of PFMS, and caesarean section had a protective effect to its reduction. The occurrence of UI during pregnancy is a predictor of UI after childbirth, and women with previous pregnancies and newborns with higher weights are more likely to have UI after childbirth.AI prior to pregnancy is the only risk factor for its occurrence after childbirth. Associations between PFMS and cohabitation with a partner, and between UI and sexual activity do not make possible to conclude that these variables are directly associated