O gânglio sentinela : passado, presente e futuro : artigo de revisão

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2018Historicamente, a descoberta da biópsia do gânglio sentinela (GS) é atribuída a Morton e Cochran. No entanto, sabe-se que o percurso desta técnica começou muito antes, com inúmeros contributos que permitiram que o desenvolvimento da biópsia do GS seja considerado actualmente como um dos mais importantes feitos em Medicina. O procedimento baseia-se no facto de existir um primeiro gânglio linfático filtrador de células tumorais, cuja remoção permite actuar directamente na história natural do cancro, evitando a formação de metástases, melhorando assim o prognóstico dos doentes. Vários estudos ao longo dos anos puseram em evidência o papel da biópsia do GS no que concerne ao estadiamento, tratamento e prognóstico da doença oncológica, dos quais importa destacar o estudo ACSOG-Z0011, revolucionário ao demonstrar que biópsias positivas nem sempre implicavam a necessidade de realização esvaziamento axilar, com benefícios claros na morbilidade e sem prejuízo da sobrevivência a longo prazo. Não só a biópsia do GS tornou obsoleta a realização de esvaziamento ganglionar em alguns pacientes oncológicos, como permitiu estadiar de forma mais precisa, o que tornou a abordagem mais individualizada a cada doente. Nesta revisão refere-se a evolução histórica da biópsia do GS, quais as considerações actuais sobre a técnica e faz-se algumas reflexões sobre qual será o futuro da técnica, tendo em conta algumas alternativas que começam hoje a surgir.Historically, the discovery of the sentinel node biopsy (SNB) is atributed to Morton and Cochran. However, it is known that this technique’s path began many years before. Several past contributions allowed the development of the SNB to be considered nowadays as one of the most important breakthroughs in modern medicine. The procedure is based on the existence of one first lymph node that filtrates the tumour cells. If one removes this node, one prevents the formation of metastasis. This way it is possible to act directly on the natural history of the disease, improving patient’s prognosis. Numerous studies throughout the years showed the importance of the SNB concerning cancer staging, treatment and prognosis. Of these, it is important to mention the ACSOG-Z0011, a revolutionary study that revealed that not every positive biopsy meant that an axillary lymphatic node dissection was needed. This has clear benefits in morbidity, without prejudice in terms of long-term survival. Not only the SNB turned the axillary lymphatic node dissection in some patients obsolete, but also allowed a more precise disease staging, which made each patient’s approach more individualised. In this review it is referred the historical evolution of the SNB, the current considerations of the technique and some reflections are made about what the future holds for SNB, considering some new approaches to the technique that are arisin

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Patients and health professional's perspective of functional mobility in Parkinson's Disease

Copyright © 2020 Bouça-Machado, Gonçalves, Lousada, Patriarca, Costa, Nunes, Dias, Caldas, Valadas, Lobo, Guedes, Rosa, Coelho and Ferreira. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.Background: Functional mobility (FM) is the person's ability to move to accomplish daily living tasks and activities. FM limitations are common in Parkinson's disease, increase with disease progression, and can be highly disabling. Although several studies in Parkinson's disease (PD) field use this concept, only recently, a formal definition has been proposed. Objective: We aimed to explore patient's and health professional's perspectives of FM in PD. Methods: A focus group methodology has been used. Four focus groups, with a total of 10 patients and 10 health professionals, were performed. Six patients were early stage and four advanced stage. The health professional's group was composed of five neurologists and five physiotherapists. The suitability of the new concept, the impact of FM limitations in PD patient's daily routine, and the potential benefit of walking aids have been discussed. Results: All participants were able to provide a spontaneous definition of FM, matching with the proposed concept. All agreed that PD affects patient's FM, increasing the limitations with disease progression, and with the existence of a serious prejudice with walking aids that hinders its use. Early-stage patient's perspective seems to be more in line with neurologist's perspective, while the views of advanced-stage patients were closer to physiotherapist's views. Conclusion: FM concept was considered as intuitive and useful. FM limitations have an important physical and social impact in the advanced stage of the disease. Although patients and health professionals acknowledge walking aid's benefit improving patient's FM, the prejudice associated with this type of tools limits its recommendation and use.The authors would like to thank to the Fundação para a Ciência e a Tecnologia (FCT) (SFRH/BD/120773/2016 to RB-M).info:eu-repo/semantics/publishedVersio

A distinct neuromelanin magnetic resonance imaging pattern in parkinsonian multiple system atrophy

© The Author(s) 2020. Open Access. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.Background: Parkinsonian variant of multiple system atrophy is a neurodegenerative disorder frequently misdiagnosed as Parkinson's disease. No early imaging biomarkers currently differentiate these disorders. Methods: Simple visual imaging analysis of the substantia nigra and locus coeruleus in neuromelanin-sensitive magnetic resonance imaging and nigrosome 1 in susceptibility-weighted sequences was performed in thirty patients with parkinsonian variant of multiple system atrophy fulfilling possible/probable second consensus diagnostic criteria. The neuromelanin visual pattern was compared to patients with Parkinson's disease with the same disease duration (n = 10) and healthy controls (n = 10). Substantia nigra semi-automated neuromelanin area/signal intensity was compared to the visual data. Results: Groups were similar in age, sex, disease duration, and levodopa equivalent dose. Hoehn & Yahr stage was higher in parkinsonian multiple system atrophy patients, 69% of whom had normal neuromelanin size/signal, significantly different from Parkinson's disease patients, and similar to controls. Nigrosome 1 signal was lost in 74% of parkinsonian multiple system atrophy patients. Semi-automated neuromelanin substantia nigra signal, but not area, measurements were able to differentiate groups. Conclusions: In patients with parkinsonism, simple visual magnetic resonance imaging analysis showing normal neuromelanin substantia nigra and locus coeruleus, combined with nigrosome 1 loss, allowed the distinction of the parkinsonian variant of multiple system atrophy from Parkinson's disease and healthy controls. This easy and widely available method was superior to semi-automated measurements in identifying specific imaging changes in substantia nigra and locus coeruleus.info:eu-repo/semantics/publishedVersio

Comparative Effectiveness of COVID-19 Vaccines in Preventing Infections and Disease Progression from SARS-CoV-2 Omicron BA.5 and BA.2, Portugal

We estimated comparative primary and booster vaccine effectiveness (VE) of SARS-CoV-2 Omicron BA.5 and BA.2 lineages against infection and disease progression. During April-June 2022, we implemented a case-case and cohort study and classified lineages using whole-genome sequencing or spike gene target failure. For the case-case study, we estimated the adjusted odds ratios (aORs) of vaccination using a logistic regression. For the cohort study, we estimated VE against disease progression using a penalized logistic regression. We observed no reduced VE for primary (aOR 1.07 [95% CI 0.93-1.23]) or booster (aOR 0.96 [95% CI 0.84-1.09]) vaccination against BA.5 infection. Among BA.5 case-patients, booster VE against progression to hospitalization was lower than that among BA.2 case-patients (VE 77% [95% CI 49%-90%] vs. VE 93% [95% CI 86%-97%]). Although booster vaccination is less effective against BA.5 than against BA.2, it offers substantial protection against progression from BA.5 infection to severe disease.The acquisition of sequencing equipment and reagents used in this study by the Instituto Nacional de Saúde Doutor Ricardo Jorge was partially funded by the HERA project (grant no. 2021/PHF/23776) supported by the European Commission through the European Centre for Disease Control, and also partially funded by the GenomePT project (grant no. POCI-01-0145-FEDER-022184), supported by COMPETE 2020–Operational Programme for Competitiveness and Internationalisation, Lisboa Portugal Regional Operational Programme, Algarve Portugal Regional Operational, under the Portugal 2020 Partnership Agreement, through the European Regional Development Fund, and by the Portuguese Science and Technology Foundation. Algarve Biomedical Center Laboratory received public funding through the Project ALG-D2-2021-06 Variants Screen in Southern Portugal– Monitoring Variants of Concern in Southern Portugal and the Portuguese Science and Technology Foundation national support through the Comprehensive Health Research Center (grant no. UIDP/04923/2020)info:eu-repo/semantics/publishedVersio

Assessment of the Implementation of the International Health Regulations during the COVID-19 Pandemic: Portugal as a Case Study

Introduction: The International Health Regulations (IHR) were developed to prepare countries to deal with public health emergencies. The spread of SARS-CoV-2 underlined the need for international coordination, although few attempts were made to evaluate the integrated implementation of the IHR’s core capacities in response to the COVID-19 pandemic. The aim of this study was to evaluate whether IHR shortcomings stem from non-compliance or regulatory issues, using Portugal as a European case study due to its size, organization, and previous discrepancies between self-reporting and peer assessment of the IHR’s core capacities. Methods: Fifteen public health medical residents involved in contact tracing in mainland Portugal interpreted the effectiveness of the IHR’s core capabilities by reviewing the publicly available evidence and reflecting on their own field experience, then grading each core capability according to the IHR Monitoring Framework. The assessment of IHR enforcement considered efforts made before and after the onset of the pandemic, covering the period up to July 2021. Results: Four out of nine core IHR capacities (surveillance; response; risk communication; and human resource capacity) were classified as level 1, the lowest. Only two were graded level 3 (preparedness; and laboratory), the highest. The remaining three) (national legislation, policy & financing; coordination and national focal point communication; and points of entry) were classified as level 2. Conclusion: Portugal exemplifies the extent to which implementation of the IHR was not fully achieved, which has resulted in the underperformance of several core capacities. There is a need to improve preparedness and international cooperation in order to harmonize and strengthen the global response to public health emergencies, with better political, institutional, and financial support

MAMMALS IN PORTUGAL : A data set of terrestrial, volant, and marine mammal occurrences in P ortugal

Mammals are threatened worldwide, with 26% of all species being includedin the IUCN threatened categories. This overall pattern is primarily associatedwith habitat loss or degradation, and human persecution for terrestrial mam-mals, and pollution, open net fishing, climate change, and prey depletion formarine mammals. Mammals play a key role in maintaining ecosystems func-tionality and resilience, and therefore information on their distribution is cru-cial to delineate and support conservation actions. MAMMALS INPORTUGAL is a publicly available data set compiling unpublishedgeoreferenced occurrence records of 92 terrestrial, volant, and marine mam-mals in mainland Portugal and archipelagos of the Azores and Madeira thatincludes 105,026 data entries between 1873 and 2021 (72% of the data occur-ring in 2000 and 2021). The methods used to collect the data were: live obser-vations/captures (43%), sign surveys (35%), camera trapping (16%),bioacoustics surveys (4%) and radiotracking, and inquiries that represent lessthan 1% of the records. The data set includes 13 types of records: (1) burrowsjsoil moundsjtunnel, (2) capture, (3) colony, (4) dead animaljhairjskullsjjaws, (5) genetic confirmation, (6) inquiries, (7) observation of live animal (8),observation in shelters, (9) photo trappingjvideo, (10) predators dietjpelletsjpine cones/nuts, (11) scatjtrackjditch, (12) telemetry and (13) vocalizationjecholocation. The spatial uncertainty of most records ranges between 0 and100 m (76%). Rodentia (n=31,573) has the highest number of records followedby Chiroptera (n=18,857), Carnivora (n=18,594), Lagomorpha (n=17,496),Cetartiodactyla (n=11,568) and Eulipotyphla (n=7008). The data setincludes records of species classified by the IUCN as threatened(e.g.,Oryctolagus cuniculus[n=12,159],Monachus monachus[n=1,512],andLynx pardinus[n=197]). We believe that this data set may stimulate thepublication of other European countries data sets that would certainly contrib-ute to ecology and conservation-related research, and therefore assisting onthe development of more accurate and tailored conservation managementstrategies for each species. There are no copyright restrictions; please cite thisdata paper when the data are used in publications.info:eu-repo/semantics/publishedVersio

Plantar povoações no território: (re)construindo a urbanização da capitania do Piauí, 1697-1761

The Piauí province´s urbanization has kept up with since late 17th century a complex process dealt among Portuguese Crown, the regal representatives, the network woven by the Casa da Torre and by the resident population in its countryside. What it was content of Rodelas countryside has begun to build with territorial identity since the foundation of first parish in 1697. Structuring itself discontinuously in time and space, the Piauí had reformed in 1758, year of creation of its autonomous government. And had became urban in 1761 when the king D. José I and marquis of Pombal had framed by the royal letter written in June 19 a territory formed by six towns and one city. Thus, this paper purposes to reconstructing the Piauí province according to agents involved in the urbanization processes. It proposes to deconstructing Crown´s polices by means towns strategically placed in territory aiming at control and "remedy" of routine injustices practiced in Piauí´s hinterlands. The method of presenting this reconstruction draws on interconnection between text (manuscript documents) and image (maps and photography) which in their discourses have represented a Piauí as space of experiences apprehended as much in official dimension as inhabitant´s everyday life.A urbanização da capitania do Piauí acompanhou, desde finais do século XVII, um complexo processo negociado entre a Coroa portuguesa, os representantes régios, a rede clientelar urdida pela Casa da Torre e a população residente em seus sertões. O que antes era conteúdo dos sertões de Rodelas passou a construir-se como identidade territorial a partir da fundação da primeira freguesia, em 1697, dedicada a Nossa Senhora da Vitória. Estruturando-se descontinuamente no tempo e no espaço, o Piauí reforma-se em 1758, ano da autonomização do seu governo. E fez-se urbano em 1761, quando D. José I e o marquês de Pombal equacionaram, por meio da carta régia de 19 de junho, um território formado por seis vilas e uma cidade. Nessa direção, o objetivo deste artigo consiste em reconstruir o processo de formação da capitania do Piauí segundo os agentes envolvidos na urbanização do território. Propõe-se descortinar as políticas da Coroa por meio da oficialização de povoações estrategicamente locadas no território visando o controle e o "remédio" das injustiças rotineiras do Piauí. O método de apresentar essa reconstrução vale-se da interconexão entre texto (documentação manuscrita) e imagem (mapas e fotografias), que em suas entrelinhas representam um Piauí como espaço de experiências sentidas tanto na dimensão oficial quanto no cotidiano dos seus moradores

Mammals in Portugal: a data set of terrestrial, volant, and marine mammal occurrences in Portugal

Mammals are threatened worldwide, with ~26% of all species being included in the IUCN threatened categories. This overall pattern is primarily associated with habitat loss or degradation, and human persecution for terrestrial mammals, and pollution, open net fishing, climate change, and prey depletion for marine mammals. Mammals play a key role in maintaining ecosystems functionality and resilience, and therefore information on their distribution is crucial to delineate and support conservation actions. MAMMALS IN PORTUGAL is a publicly available data set compiling unpublished georeferenced occurrence records of 92 terrestrial, volant, and marine mammals in mainland Portugal and archipelagos of the Azores and Madeira that includes 105,026 data entries between 1873 and 2021 (72% of the data occurring in 2000 and 2021). The methods used to collect the data were: live observations/captures (43%), sign surveys (35%), camera trapping (16%), bioacoustics surveys (4%) and radiotracking, and inquiries that represent less than 1% of the records. The data set includes 13 types of records: (1) burrows | soil mounds | tunnel, (2) capture, (3) colony, (4) dead animal | hair | skulls | jaws, (5) genetic confirmation, (6) inquiries, (7) observation of live animal (8), observation in shelters, (9) photo trapping | video, (10) predators diet | pellets | pine cones/nuts, (11) scat | track | ditch, (12) telemetry and (13) vocalization | echolocation. The spatial uncertainty of most records ranges between 0 and 100 m (76%). Rodentia (n =31,573) has the highest number of records followed by Chiroptera (n = 18,857), Carnivora (n = 18,594), Lagomorpha (n = 17,496), Cetartiodactyla (n = 11,568) and Eulipotyphla (n = 7008). The data set includes records of species classified by the IUCN as threatened (e.g., Oryctolagus cuniculus [n = 12,159], Monachus monachus [n = 1,512], and Lynx pardinus [n = 197]). We believe that this data set may stimulate the publication of other European countries data sets that would certainly contribute to ecology and conservation-related research, and therefore assisting on the development of more accurate and tailored conservation management strategies for each species. There are no copyright restrictions; please cite this data paper when the data are used in publications