Coordenação de estudos clínicos no centro hospitalar lisboa ocidental, E.P.E.

In the scope of the Master’s Degree in Clinical Research Management, and with the main goal of allowing students to have a direct contact with real work environment, a curricular internship was performed during both semesters of 2021/2022.This internship was done at Centro Hospitalar de Lisboa Ocidental, E.P.E. (CHLO), specifically at Hospital de São Francisco Xavier (HSFX), under the existing collaboration with NOVA Clinical Research Unit (NOVA CRU) and having Doctor Sara Maia as the advisor. This report is organized in the following chapters: I. Contextualization of the Master’s Degree curricular internship at CHLO, presentation of the host institutions as well as the learning goals proposed for the internship. II. Study Coordination activities performed at CHLO during the internship and their presentation and quantification. III. Bibliographic Review regarding “The impact of health literacy in clinical research”. It is important to highlight that, for this report, only the internship hours performed between 20th September 2021 and 31st March 2022 were considered, adding up to 798 hours. However, a 6-month Research Initiation Scholarship that began in 26th April 2021 allowed a previous start of Study Coordination activities at CHLO, namely at Hospital de Egas Moniz (HEM) and at Hospital de Santa Cruz (HSC). This scholarship allowed the student to gain competences related to the coordination of clinical studies in a hospital setting, previously the beginning of the internship, and therefore allowed her to perform several tasks in an independent manner.The curricular internship, as well as its report, allowed the consolidation of all knowledge and competences acquired in the area of Clinical Research Management

Infratentorial Multiple Sclerosis Relapse Presenting as Continuous Hemifacial Myokymia

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Proteomics to Identify New Blood Biomarkers for Diagnosing Patients With Acute Stroke

Funding Information: UCIBIO-UID/Multi/04378/2019 also supported by FCT (CEEC Funding Information: This work was financed by Fundação para a Ciência e a Tecnologia (FCT) with PTDC/MEC-NEU/28750/2017 grant, LA/P/0140/2020 funding,iNOVA4Health—UIDB/04462/2020, and UCIBIO-UID/Multi/04378/2019 units. A.S.C. is supported by FCT. R.M. is also supported by FCT (CEEC position, 2019–2025 investigator). Funding Information: This work was financed by Fundação para a Ciência e a Tecnologia (FCT) with PTDC/MEC-NEU/28750/2017 grant, LA/P/0140/2020 funding, Publisher Copyright: © 2023 The Authors.BACKGROUND: Blood biomarkers are a potential tool for early stroke diagnosis. We aimed to perform a pilot and exploratory study on untargeted blood biomarkers in patients with suspected stroke by using mass spectrometry analysis. METHODS AND RESULTS: This was a prospective observational study of consecutive patients with suspected stroke admitted within 6 hours of last being seen well. Blood samples were collected at admission. Patients were divided into 3 groups: ischemic stroke (IS), intracerebral hemorrhage (ICH), and stroke mimics. Quantitative analysis from mass spectrometry data was performed using a supervised approach. Biomarker-based prediction models were developed to differentiate IS from ICH and ICH+stroke mimics. Models were built aiming to minimize misidentification of patients with ICH as having IS. We included 90 patients, one-third within each subgroup. The median age was 71 years (interquartile range, 57–81 years), and 49 participants (54.4%) were women. In quantitative analysis, C3 (complement component 3), ICAM-2 (intercellular adhesion molecule 2), PLGLA (plasminogen like A), STXBP5 (syntaxin-binding protein 5), and IGHV3-64 (immunoglobulin heavy variable 3-64) were the 5 most significantly dysregulated proteins for both comparisons. Biomarker-based models showed 88% sensitivity and 89% negative predictive value for differentiating IS from ICH, and 75% sensitivity and 95% negative predictive value for differentiating IS from ICH+stroke mimics. ICAM-2, STXBP5, PLGLA, C3, and IGHV3-64 displayed the highest importance score in our models, being the most informative for identifying patients with stroke. CONCLUSIONS: In this proof-of-concept and exploratory study, our biomarker-based prediction models, including ICAM-2, STXBP5, PLGLA, C3, and IGHV3-64, showed 75% to 88% sensitivity for identifying patients with IS, while aiming to minimize misclassification of ICH. Although our methodology provided an internal validation, these results still need validation in other cohorts and with different measurement techniques.publishersversionpublishe

Impacto social da esclerose múltipla: empregabilidade e estado civil

Trabalho final do 6º ano médico com vista à atribuição do grau de mestre (área científica de neurologia) no âmbito do ciclo de estudos de Mestrado Integrado em Medicina.Introdução: A esclerose múltipla (EM) afeta pessoas no começo da vida profissional ativa, quando a família e a carreira estão em pleno desenvolvimento, tendo consequências disruptivas na vida familiar, relações inter-pessoais e no estado de empregabilidade. Pretendeu-se caracterizar o impacto social da EM atendendo à empregabilidade e ao estado civil. Métodos: Estudo transversal numa população de 362 doentes com EM seguidos em consulta de doenças desmielinizantes no Centro Hospitalar e Universitário de Coimbra. Através da plataforma iMed® recolheram-se as características demográficas, clínicas e o estado de empregabilidade. Resultados: A taxa de desemprego na população ativa foi de 12%. No entanto, a percentagem de doentes profissionalmente inativos (desempregados e reformados) foi 19,2% entre os 25-54 anos e 51,1% entre os 55-64 anos. Nesta amostra estão aposentados 64 doentes com idade média de 57,5(± 11,3) anos e 71,9% abandonaram o emprego antes dos 65 anos. A maior taxa de empregabilidade identificou-se entre os doentes com EDSS - Expanded Disability Status Scale - [0-3] (75,2%), forma clínica surto-remissão (EMSR) (70,3%), doença com [0-10] anos de evolução (69,5%) e que têm ensino superior (77,5%). A percentagem de divorciados foi de 7,7% e as maiores taxas de divórcio encontraram-se entre os doentes com EDSS intermédia ]3-6[ (13,6%), forma clínica secundária progressiva (EMSP) (10,3%) e >20 anos de duração da doença (10,6%). Discussão: A capacidade de ter uma vida profissional ativa é suportada por níveis leves de incapacidade física, por formas clínicas sem agravamento progressivo, por menos anos de evolução da doença e maior nível de educação. A taxa de desemprego entre os doentes estudados aproximou-se da taxa de desemprego nacional (12,4%). No entanto, a grande maioria dos doentes reformou-se antecipadamente e, em média, aposentaram-se pelo menos mais de 4,5 anos antes da população geral. A análise do estado civil revelou maior percentagem de indivíduos divorciados na amostra estudada, face à população portuguesa, diferindo em 2,1%. Conclusão: A EM tem um impacto transversal na vida dos doentes, particularmente a nível da dimensão laboral. Devem promover-se estratégias flexíveis que permitam a vida profissional ativa e, assim, melhorar a qualidade de vida destes doentes. Relativamente ao estado civil, os resultados sugerem maiores percentagens de divórcio do que na população geral podendo equacionar-se que possam existir fatores subjacentes relacionados com a EM. Background: Multiple sclerosis (MS) usually affects people in the prime of professional life, when family and career are developing themselves, leading to disruptions in employment, relationships and family life. This study aims to characterize the social impact of MS taking into account employment and marital status. Methods: A cross-sectional study was made in a population of 362 patients followed in demyelinating diseases department of the Centro Hospitalar e Universitário de Coimbra. Demographic and clinical characteristics and the employment status were collected through iMed® software. Results: The unemployment rate in the labor force was 12%. However, the percentage of professionally inactive patients (unemployed and retired) was 19,2% between 25-54 years and 51,1% between 55-64 years. In this sample are 64 retired patients with a mean age of 57,5(± 11,3) years and 71,9% of them left the job before age 65. The highest employment rate was seen between patients with EDSS - Expanded Disability Status Scale - [0-3] (75,2%), relapsing-remitting multiple sclerosis (RRMS) (70,3%), [0-10] years of disease duration (69,5%) and with higher education level (77,5%). The percentage of divorced patients was 7,7% and the highest divorce rates were found among patients with intermediate EDSS ]3-6[ (13,6%), secondary-progressive multiple sclerosis (SPMS) (10,3%) and >20 years of disease duration (10,6%). Discussion: Significant factors in the ability to have a working life were lower physical disability, disease course without progressive worsening, shorter disease duration and higher education level. The unemployment rate among patients studied approaches the national unemployment rate (12,4%). However, the majority of patients have retired early and, on average, are retired at least more than 4,5 years before the general population. Analysis of marital status showed an overage of divorced patients in our sample, compared to the portuguese population, differing by 2,1%. Conclusion: MS has a strong impact in patients’ life, particularly at the level of the labor dimension. Some strategies should be promoted to allow the active working life and, thus, improve the quality of life of these patients. Regarding marital status, the results suggest higher divorce percentages than the general population, suggesting that there may be underlying factors related to MS

Bismuth encephalopathy- a rare complication of long-standing use of bismuth subsalicylate

Background: Drugs containing bismuth, although usually safe, may rarely cause neurotoxicity. Case presentation: We describe the case of a 44-year-old woman treated with bismuth subsalicylate for about 20 years, who developed abnormal behaviour and postural instability in two weeks. On examination, she had greyish discoloration of teeth, was confused and presented generalized myoclonic jerks. In the next days, her clinical condition deteriorated, with a reduction in alertness and more exuberant myoclonus. Brain MRI was unremarkable. CSF revealed mild elevation of protein content (47 mg/dL; reference range: 15-45 mg/dL) and elevation of white blood cell count (10/μL). Bismuth levels in urine (375 μg/L), serum (260 μg/L) and CSF (21.4 μg/L) samples were highly above the threshold for toxicity. Following supportive treatment and bismuth discontinuation, she made a full recovery within weeks. Conclusions: Although rare, bismuth encephalopathy should be considered in patients presenting with subacute encephalopathy and myoclonus. This encephalopathy can be subacute even after a chronic exposure. Cessation of bismuth can lead to a complete resolution in weeks.publishersversionpublishe

Nitrogen Acquisition and Transport in the Ectomycorrhizal Symbiosis—Insights from the Interaction between an Oak Tree and <i>Pisolithus tinctorius</i>

In temperate forests, the roots of various tree species are colonized by ectomycorrhizal fungi, which have a key role in the nitrogen nutrition of their hosts. However, not much is known about the molecular mechanisms related to nitrogen metabolism in ectomycorrhizal plants. This study aimed to evaluate the nitrogen metabolic response of oak plants when inoculated with the ectomycorrhizal fungus Pisolithus tinctorius. The expression of candidate genes encoding proteins involved in nitrogen uptake and assimilation was investigated in ectomycorrhizal roots. We found that three oak ammonium transporters were over-expressed in root tissues after inoculation, while the expression of amino acid transporters was not modified, suggesting that inorganic nitrogen is the main form of nitrogen transferred by the symbiotic fungus into the roots of the host plant. Analysis by heterologous complementation of a yeast mutant defective in ammonium uptake and GFP subcellular protein localization clearly confirmed that two of these genes encode functional ammonium transporters. Structural similarities between the proteins encoded by these ectomycorrhizal upregulated ammonium transporters, and a well-characterized ammonium transporter from E. coli, suggest a similar transport mechanism, involving deprotonation of NH4+, followed by diffusion of uncharged NH3 into the cytosol. This view is supported by the lack of induction of NH4+ detoxifying mechanisms, such as the GS/GOGAT pathway, in the oak mycorrhizal roots