Mutação rara em homozigotia no gene do recetor da hormona libertadora das gonadotrofinas (GNRHR) em doente com hipogonadismo hipogonadotrófico isolado congénito

Trabalho apresentado como poster e depois seleccionado para comunicação oral.INTRODUÇÃO: O hipogonadismo hipogonadotrófico isolado congénito (HHI) caracteriza-se pela falência parcial ou completa do desenvolvimento pubertário na maioria dos casos devido à falta de estímulo das gonadotrofinas induzido pela GnRH. Face à presença ou ausência de olfato o HHI divide-se em dois síndromes: HHI com hiposmia/anosmia ou Síndrome de Kallmann (SK) e HHI com olfacto normal (HHIn). HHIn representa cerca de 40% dos casos de HHI. O HHI pode ser devido a diferentes mutações identificadas em mais de quinze genes. Em cerca de 40%-50% do HHIn familiar e em ~17% dos doentes com a forma esporádica da doença, têm sido identificadas mutações no gene GNRHR. Neste trabalho descreve-se um caso esporádico de HHIn associado a uma mutação rara em homozigotia do gene GNRHR. CASO CLÍNICO: Doente sexo masculino, 37 anos, caucasiano, recorre à consulta para reavaliação hormonal. Refere cirurgia aos 6 anos por criptorquidia bilateral. Nascido de gravidez normal, sem história de consanguinidade dos pais; sem história familiar conhecida de atraso pubertário. Ao longo de anos fez terapêutica hormonal injectável (cuja designação desconhece) de forma irregular, que abandonou aos 27 anos por “não ver resultados”. Obesidade grave desde a adolescência. Peso máximo 150 Kg aos 34 anos. Perda de 56 Kg nos últimos 18 meses (dieta+exercício). Exame físico: ausência de pêlos na face; Alt. 192cm; Enverg. 197cm; Peso 96,3kg; IMC 26; ginecomastia bilateral; testículos atróficos (< 4mL) e micropénis. Sem alterações olfactivas, auditivas ou outras. Avaliação bioquímica: Testosterona total (TT) 71.5 ng/dL (VR 241-827); FSH 0.62 mUI/mL (VR 1.4-18.1); LH <0.07 mUI/mL (VR 1.5-9.3). Doseamentos das restantes hormonas hipofisárias normais; beta-gonadotrofina coriónica normal. A RM hipotálamo-hipofisária não revelou alterações e a densitometria óssea foi compatível com osteopénia do colo do fémur (Tscore:-1.3) e trabecular (Tscore:-1.8). Cariotipo 46,XY. Iniciou testosterona transdérmica 50 mg/dia. TT um mês após início da terapêutica: 737 ng/dL. ESTUDO MOLECULAR: Extração de DNA genómico de sangue periférico, amplificação enzimática dos 3 exões do gene GNRHR e sequenciação cíclica pelo método de Sanger. A análise molecular revelou a presença da alteração c.924_926delCTT (p.Phe309del), em homozigotia, no exão 3 do gene GNRHR. O estudo complementar dos progenitores revelou, em ambos, a presença em heterozigotia da referida mutação. DISCUSSÃO: Evidencia-se que no presente doente a alteração c.924_926delCTT foi detectada em homozigotia tendo-se comprovado o genótipo do mesmo através do estudo dos seus progenitores. Esta alteração já foi descrita em heterozigotia composta (associada a outra mutação diferente no mesmo gene) em dois doentes com HHI (não familiares)1,2 e em heterozigotia em dois familiares (pai e filha, ambos com atraso pubertário)2, sendo esta a primeira vez que é descrita em homozigotia. Trata-se de uma alteração extremamente rara em que o estudo molecular permite inferir que houve falência na ativação do eixo gonadotrófico desde a vida intrauterina. O defeito molecular identificado, poderá ter condicionado a integração/posicionamento do GNRHR na membrana celular, o que terá bloqueado o estímulo da GnRH que induz à síntese de FSH e de LH, permitindo explicar o HHI congénito do doente em causa

Adherence to treatment in allergic rhinitis using mobile technology. The MASK Study

Background: Mobile technology may help to better understand the adherence to treatment. MASK-rhinitis (Mobile Airways Sentinel NetworK for allergic rhinitis) is a patient-centred ICT system. A mobile phone app (the Allergy Diary) central to MASK is available in 22 countries. Objectives: To assess the adherence to treatment in allergic rhinitis patients using the Allergy Diary App. Methods: An observational cross-sectional study was carried out on all users who filled in the Allergy Diary from 1 January 2016 to 1 August 2017. Secondary adherence was assessed by using the modified Medication Possession Ratio (MPR) and the Proportion of days covered (PDC) approach. Results: A total of 12143 users were registered. A total of 6949 users reported at least one VAS data recording. Among them, 1887 users reported >= 7 VAS data. About 1195 subjects were included in the analysis of adherence. One hundred and thirty-six (11.28%) users were adherent (MPR >= 70% and PDC = 70% and PDC = 1.50) and 176 (14.60%) were switchers. On the other hand, 832 (69.05%) users were non-adherent to medications (MPR Conclusion and clinical relevance: Adherence to treatment is low. The relative efficacy of continuous vs on-demand treatment for allergic rhinitis symptoms is still a matter of debate. This study shows an approach for measuring retrospective adherence based on a mobile app. This also represents a novel approach for analysing medication-taking behaviour in a real-world setting.Peer reviewe

Allergic Rhinitis and its Impact on Asthma (ARIA) Phase 4 (2018) : Change management in allergic rhinitis and asthma multimorbidity using mobile technology

Allergic Rhinitis and its Impact on Asthma (ARIA) has evolved from a guideline by using the best approach to integrated care pathways using mobile technology in patients with allergic rhinitis (AR) and asthma multimorbidity. The proposed next phase of ARIA is change management, with the aim of providing an active and healthy life to patients with rhinitis and to those with asthma multimorbidity across the lifecycle irrespective of their sex or socioeconomic status to reduce health and social inequities incurred by the disease. ARIA has followed the 8-step model of Kotter to assess and implement the effect of rhinitis on asthma multimorbidity and to propose multimorbid guidelines. A second change management strategy is proposed by ARIA Phase 4 to increase self-medication and shared decision making in rhinitis and asthma multimorbidity. An innovation of ARIA has been the development and validation of information technology evidence-based tools (Mobile Airways Sentinel Network [MASK]) that can inform patient decisions on the basis of a self-care plan proposed by the health care professional.Peer reviewe

Correlation between work impairment, scores of rhinitis severity and asthma using the MASK-air (R) App

Background In allergic rhinitis, a relevant outcome providing information on the effectiveness of interventions is needed. In MASK-air (Mobile Airways Sentinel Network), a visual analogue scale (VAS) for work is used as a relevant outcome. This study aimed to assess the performance of the work VAS work by comparing VAS work with other VAS measurements and symptom-medication scores obtained concurrently. Methods All consecutive MASK-air users in 23 countries from 1 June 2016 to 31 October 2018 were included (14 189 users; 205 904 days). Geolocalized users self-assessed daily symptom control using the touchscreen functionality on their smart phone to click on VAS scores (ranging from 0 to 100) for overall symptoms (global), nose, eyes, asthma and work. Two symptom-medication scores were used: the modified EAACI CSMS score and the MASK control score for rhinitis. To assess data quality, the intra-individual response variability (IRV) index was calculated. Results A strong correlation was observed between VAS work and other VAS. The highest levels for correlation with VAS work and variance explained in VAS work were found with VAS global, followed by VAS nose, eye and asthma. In comparison with VAS global, the mCSMS and MASK control score showed a lower correlation with VAS work. Results are unlikely to be explained by a low quality of data arising from repeated VAS measures. Conclusions VAS work correlates with other outcomes (VAS global, nose, eye and asthma) but less well with a symptom-medication score. VAS work should be considered as a potentially useful AR outcome in intervention studies.Peer reviewe

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio

ARIA digital anamorphosis : Digital transformation of health and care in airway diseases from research to practice

Digital anamorphosis is used to define a distorted image of health and care that may be viewed correctly using digital tools and strategies. MASK digital anamorphosis represents the process used by MASK to develop the digital transformation of health and care in rhinitis. It strengthens the ARIA change management strategy in the prevention and management of airway disease. The MASK strategy is based on validated digital tools. Using the MASK digital tool and the CARAT online enhanced clinical framework, solutions for practical steps of digital enhancement of care are proposed.Peer reviewe

A Gaseous Argon-Based Near Detector to Enhance the Physics Capabilities of DUNE

This document presents the concept and physics case for a magnetized gaseous argon-based detector system (ND-GAr) for the Deep Underground Neutrino Experiment (DUNE) Near Detector. This detector system is required in order for DUNE to reach its full physics potential in the measurement of CP violation and in delivering precision measurements of oscillation parameters. In addition to its critical role in the long-baseline oscillation program, ND-GAr will extend the overall physics program of DUNE. The LBNF high-intensity proton beam will provide a large flux of neutrinos that is sampled by ND-GAr, enabling DUNE to discover new particles and search for new interactions and symmetries beyond those predicted in the Standard Model

Snowmass Neutrino Frontier: DUNE Physics Summary

The Deep Underground Neutrino Experiment (DUNE) is a next-generation long-baseline neutrino oscillation experiment with a primary physics goal of observing neutrino and antineutrino oscillation patterns to precisely measure the parameters governing long-baseline neutrino oscillation in a single experiment, and to test the three-flavor paradigm. DUNE's design has been developed by a large, international collaboration of scientists and engineers to have unique capability to measure neutrino oscillation as a function of energy in a broadband beam, to resolve degeneracy among oscillation parameters, and to control systematic uncertainty using the exquisite imaging capability of massive LArTPC far detector modules and an argon-based near detector. DUNE's neutrino oscillation measurements will unambiguously resolve the neutrino mass ordering and provide the sensitivity to discover CP violation in neutrinos for a wide range of possible values of δCP. DUNE is also uniquely sensitive to electron neutrinos from a galactic supernova burst, and to a broad range of physics beyond the Standard Model (BSM), including nucleon decays. DUNE is anticipated to begin collecting physics data with Phase I, an initial experiment configuration consisting of two far detector modules and a minimal suite of near detector components, with a 1.2 MW proton beam. To realize its extensive, world-leading physics potential requires the full scope of DUNE be completed in Phase II. The three Phase II upgrades are all necessary to achieve DUNE's physics goals: (1) addition of far detector modules three and four for a total FD fiducial mass of at least 40 kt, (2) upgrade of the proton beam power from 1.2 MW to 2.4 MW, and (3) replacement of the near detector's temporary muon spectrometer with a magnetized, high-pressure gaseous argon TPC and calorimeter