Policy analysis: Does the WFD works with regard to CEC in aquatic environments? Case study: The Netherlands

The problematic of Contaminants of Emerging Concern (CEC) in the European Union (EU) surface water has been reported over the last decades as well as CEC’s potential impact on human health and the environment. The Water Framework Directive (2000/60/EC; WFD) is the main EU Directive for the protection of aquatic environments since it came in force. This Directive requires the monitoring of 45 priority substances regarding their environmental quality standards in order to achieve the good chemical status of water bodies until 2027. The last revision of the WFD in 2015 showed that Member States have not met the targets yet. The present dissertation aims to analyse whether WFD has been efficient enough to protect the aquatic ecosystems against CEC and evaluate if the environmental objectives will be complied until its last revision. The Netherlands was used as the case study. Interviews were carried out to 13 employees of the different layers in the Dutch water management system. Based on results obtained, it was concluded that the WFD has been the main European water legislation used to protect the aquatic environment from the occurrence of CEC in the last years. The Directive have created awareness and encourages Member States to take actions, however, some issues were identified. The conclusion is that WFD has not been efficient enough in the protection of aquatic environments against CEC. Although it is difficult to predict its success in 2027, two possible scenarios were identified. In the end, it was suggested a consistent assessment of CEC in aquatic environments, connection of WFD goals with EU’s chemicals regulations, collaboration between all interested parties and an integrated strategy to WFD implementation in the Member States

Anaplastic thyroid cancer: how far can we go?

Globally, thyroid cancer accounts for 2 % of all cancer diagnoses, and can be classified as well-differentiated or undifferentiated. Currently, differentiated thyroid carcinomas have good prognoses, and can be treated with a combination of therapies, including surgical thyroidectomy, radioactive iodine therapy and hormone-based therapy. On the other hand, anaplastic thyroid carcinoma, a subtype of undifferentiated thyroid carcinoma characterized by the loss of thyroid-like phenotype and function, does not respond to either radioactive iodine or hormone therapies. In most cases, anaplastic thyroid carcinomas are diagnosed in later stages of the disease, deeming them inoperable, and showing poor response rates to systemic chemotherapy. Recently, treatment courses using multiple-target agents are being explored and clinical trials have shown very promising results, such as overall survival rates, progression-free survival and tumor shrinkage. This review is focused on thyroid carcinomas, with particular focus on anaplastic thyroid carcinoma, exploring its undifferentiated nature. Special interest will be given to the treatment approaches currently available and respective obstacles or drawbacks. Our purpose is to contribute to understand why this malignancy presents low responsiveness to current treatments, while overviewing novel therapies and clinical trials.This research was funded by Fundação para a Ciência e a Tecnologia (FCT) through the Project Reference UID/DTP/04138/2019.info:eu-repo/semantics/publishedVersio

Effect of a sardine supplement on C-reactive protein in patients receiving hemodialysis

Objective - The study evaluated the effect of a canned sardine supplement in C-reactive protein (CRP) in patients on hemodialysis (HD) and the compliance and adherence to this supplement. Design - This was a quasi-experimental study: Participants with a serum CRP of 5 mg/dL or less volunteered to consume a sardine supplement or were maintained on the usual cheese/ham sandwich supplement. Setting - The study took place in two outpatient dialysis units in Lisbon, Portugal. Patients - The study comprised 63 patients receiving maintenance HD three times per week for at least 6 months and an initial CRP concentration of 5 mg/dL or less. Exclusion criteria included the presence of graft vascular access or history of cancer. Intervention - After a 4-week washout period, the nutritional intervention included a canned sardine sandwich for the case group (n = 31) and a cheese or ham sandwich for the control group (n = 32), to be ingested during each routine HD session, 3 times per week, for 8 weeks. Main outcome measure - Serum levels of high-sensitivity CRP were the outcome measure. Results - Only 65 patients from the invited 186 patients met the inclusion criteria and agreed to eat the sardine sandwich supplement three times per week and were involved in the study. A significant proportion of 48% (n = 31, case group) consumed the sardine sandwich supplement three times per week for 8 weeks, fulfilling the requirements and completing the study. The present investigation showed that a sardine sandwich supplement had no effect on CRP levels among patients on HD. However, when participants were stratified according to tertiles of CRP distribution values at baseline, a reduction in CRP levels was found for those in the higher tertile, being higher for the case group (P = .047). Although diabetic patients were excluded from the analysis (eight in the sardine supplementation group and seven in the control group) a significant CRP reduction was found (P = .034). Conclusion - Although a supplement of low-dose n-3 long-chain polyunsaturated fatty acids had no effect on the plasma high-sensitivity CRP of the supplemented group, a reduction in CRP levels was found when patients were stratified for tertiles of CRP (for the upper tertile) and diabetic status (for nondiabetic patients). These findings need to be further confirmed. This canned sardine supplement was accepted by an important proportion of patients, enhancing diet variety and contributing for a greater n-3 long-chain polyunsaturated fatty acids eicosapentaenoic acid and docosahexaenoic acid intake

miR-335 targets LRRK2 and mitigates inflammation in Parkinson’s disease

Copyright © 2021 Oliveira, Dionísio, Gaspar, Correia Guedes, Coelho, Rosa, Ferreira, Amaral and Rodrigues. 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.Parkinson's disease (PD) is mainly driven by dopaminergic neuronal degeneration in the substantia nigra pars compacta accompanied by chronic neuroinflammation. Despite being mainly sporadic, approximately 10% of all cases are defined as heritable forms of PD, with mutations in the leucine-rich repeat kinase (LRRK2) gene being the most frequent known cause of familial PD. MicroRNAs (miRNAs or miRs), including miR-335, are frequently deregulated in neurodegenerative diseases, such as PD. Here, we aimed to dissect the protective role of miR-335 during inflammation and/or neurodegenerative events in experimental models of PD. Our results showed that miR-335 is significantly downregulated in different PD-mimicking conditions, including BV2 microglia cells stimulated with lipopolysaccharide (LPS) and/or overexpressing wild-type LRRK2. Importantly, these results were confirmed in serum of mice injected with 1-methyl-1-4-phenyl-1,2,3,6-tetrahydripyridine hydrochloride (MPTP), and further validated in patients with idiopathic PD (iPD) and those harboring mutations in LRRK2 (LRRK2-PD), thus corroborating potential clinical relevance. Mechanistically, miR-335 directly targeted LRRK2 mRNA. In the BV2 and N9 microglia cell lines, miR-335 strongly counteracted LPS-induced proinflammatory gene expression, and downregulated receptor interacting protein 1 (RIP1) and RIP3, two important players of necroptotic and inflammatory signaling pathways. Further, miR-335 inhibited LPS-mediated ERK1/2 activation. LRRK2-Wt-induced proinflammatory gene expression was also significantly reduced by miR-335 overexpression. Finally, in SH-SY5Y neuroblastoma cells, miR-335 decreased the expression of pro-inflammatory genes triggered by α-synuclein. In conclusion, we revealed novel roles for miR-335 in both microglia and neuronal cells that strongly halt the effects of classical inflammatory stimuli or LRRK2-Wt overexpression, thus attenuating chronic neuroinflammation.This research was funded in part by UIDB/04138/2020 from Fundação para a Ciência e Tecnologia (FCT), Portugal. SO received a Ph.D. fellowship (PD/BD/128332/2017) from FCT.info:eu-repo/semantics/publishedVersio

Environmental control of biological rhythms: effects on development, fertility and metabolism

Internal temporal organisation properly synchronised to the environment is crucial for health maintenance. This organisation is provided at the cellular level by the molecular clock, a macromolecular transcription-based oscillator formed by the clock and the clock-controlled genes that is present in both central and peripheral tissues. In mammals, melanopsin in light-sensitive retinal ganglion cells plays a considerable role in the synchronisation of the circadian timing system to the daily light/dark cycle. Melatonin, a hormone synthesised in the pineal gland exclusively at night and an output of the central clock, has a fundamental role in regulating/timing several physiological functions, including glucose homeostasis, insulin secretion and energy metabolism. As such, metabolism is severely impaired after a reduction in melatonin production. Furthermore, light pollution during the night and shift work schedules can abrogate melatonin synthesis and impair homeostasis. Chronodisruption during pregnancy has deleterious effects on the health of progeny, including metabolic, cardiovascular and cognitive dysfunction. Developmental programming by steroids or steroid-mimetic compounds also produces internal circadian disorganisation that may be a significant factor in the aetiology of fertility disorders such as polycystic ovary syndrome. Thus, both early and late in life, pernicious alterations of the endogenous temporal order by environmental factors can disrupt the homeostatic function of the circadian timing system, leading to pathophysiology and/or disease.This work was supported by grants 1110220 from FONDECYT and ACT1116 from CONICYT, Chile (to HGR); Fundação de Amparo a Pesquisa do Estado de São Paulo (FAPESP) and Conselho Nacional de Desenvolvimento Tecnológico e Científico (CNPq; Brazil, to AMC, FGA and JCN); Pro-Reitoria de Pesquisa Universidade Federal de Minas Gerais, Brazil (to MOP); fellowship 21120472 from CONICYT (Chile) to (NM) and an NIEHS sponsored Pilot Grant from the Department of Environmental Medicine at the University of Rochester School of Medicine to MTS

Spectrum of molecular alterations detected in the CYP21A2 gene associated with 21-hydroxylase deficiency

A maioria dos doentes com hiperplasia suprarrenal congénita (HSC) apresenta alterações moleculares no gene CYP21A2, o qual codifica a enzima 21-hidroxilase (21-OH). Os doentes com a forma clássica de deficiência em 21-OH (21-OHD) apresentam a síntese de cortisol diminuída no córtex adrenal e, os casos mais graves, também apresentam deficiência de aldosterona. As mulheres com 21-OHD grave apresentam excesso de andrógenos desde a sua vida fetal conduzindo à virilização dos órgãos genitais externos. Tanto homens como mulheres com 21-OHD completa não sintetizam a aldosterona e, consequentemente, logo após o nascimento, podem desenvolver crises de perda de sal se não forem corretamente diagnosticados e tratados. A 21- OHD não clássica é devida à deficiência parcial em 21-OH, os fenótipos clínicos são menos graves, as mulheres não apresentam virilização dos genitais externos ao nascimento, e geralmente os sinais relativos a excesso de androgénios podem surgir durante a infância ou até mais tarde (durante ou após a puberdade). Neste trabalho descrevem-se as alterações e os genótipos mais frequentes encontrados em doentes portugueses não adultos com 21-OHD. As alterações mais frequentes encontradas na forma clássica da HSC são c.293-13C> G, diferentes deleções/quimeras/conversões génicas do gene CYP21A2 e c.518T> A, enquanto na 21-OHD não-clássica a variante c.844G> T é a mais frequente. Estes resultados contribuem para um diagnóstico correto e uma melhor gestão clínica dos doentes, para o seu aconselhamento genético e para oferecer o diagnóstico pré-natal a casais com risco de ter filhos afetados com a forma clássica de 21-OHD.Most of the patients with congenital adrenal hyperplasia (CAH) have molecular alterations in the CYP21A2 gene, which encodes the enzyme 21-hydroxylase (21-OH). Patients with the classic form of 21-OH deficiency (21-OHD) have the synthesis of cor tisol impaired in the adrenal cor tex and, the most severe cases also have aldosterone deficiency. Females with severe 21-OHD, star ting their fetal life have excess of androgens leading to external genitalia virilization at bir th. Both males and females with complete 21-OHD are not able to synthesize aldosterone, consequently soon af ter bir th may develop salt wasting crises if not correctly diagnosed and treated. Non-classic 21-OHD is due to par tial deficiency of 21-OH, the clinical phenotypes are less severe, females don’t present ambiguity of the external genitalia at bir th, usually signs of androgen excess may be present during childhood or even later in life (during or af ter puber ty). We present here the most frequent alterations and genotypes found in non adult Por tuguese patients with 21-OHD. The most frequent alterations found in the classic form of CAH are c.293-13C>G, dif ferent CYP21A2 deletions/quimeras/gene conversions and c.518T>A, while in non-classic 21-OHD the variant c.844G>T is the most frequent. These results contribute to a correct patient diagnosis, to a better clinical care, genetic counseling and to of fer pre-natal diagnosis to couples at risk of having af fected babies with the classic form of 21-OHD.info:eu-repo/semantics/publishedVersio

Capacidade de gestão pública e desenvolvimento municipal na região norte do Brasil: uma análise multivariada e espacial de indicadores

A investigação possui o objetivo de analisar as relações entre a capacidade de gestão pública e o desenvolvimento nos municípios da Região Norte do Brasil. O ambiente do planejamento e do controle na gestão pública estão inseridos em um amplo e relevante debate no Brasil para a construção de mecanismos capazes de aperfeiçoar regionalmente a capacidade de gestão municipal em favor da promoção do bem-estar das populações.Todavia, é imprescindível a compreensão das dinâmicas que envolvem as relações entre a gestão pública e o processo de desenvolvimento em cada região brasileira. Nesta perspectiva, por meio de um banco de dados que envolveu os 450 municípios da Região Norte do Brasil, a investigação questiona em que medida a capacidade de gestão municipal está relacionada ao desenvolvimento nos municípios da região Norte do Brasil. Na análise espacial do Índice de desenvolvimento Municipal (IDM), realizada por meio do Box Map, o estudo destacou indicativos de um perfil de cluster de elevado IDM nos Estados do Amazonas e do Pará. No tocante ao Índice de Capacidade de Gestão Municipal (ICGM), a investigação apontou a dimensão terceirização e informação como aquela que apresentou melhor nível de desempenho. O estudo mensurou para a Região Norte do Brasil um IDM de 0,166, classificado como crítico, e um ICGM de 0,358, classificado como em nível de Ale

Doença de Kawasaki - aspectos epidemiológicos, fisiopatológicos, manejo terapêutico e correlação a COVID-19

A Doença de Kawasaki (DK) é uma vasculite que afeta predominantemente os vasos sanguíneos de médio porte, especialmente as artérias coronárias do coração. Nos últimos anos, tornou-se uma crescente preocupação de saúde pública, devido ao aumento notável de casos, tornando-se a causa mais comum de doença cardíaca pediátrica adquirida em países desenvolvidos, como Japão, Coréia e Estados Unidos da América (EUA). A causa exata da DK ainda é incerta, mas suspeita-se de uma combinação de fatores genéticos e infecciosos. Estudos sugerem que agentes virais podem desempenhar um papel desencadeante, pois a frequência da doença mostra correlação com a sazonalidade de infecções respiratórias comuns. Os sintomas característicos da DK incluem febre persistente, congestão ocular bilateral não exsudativa, eritema e edema de língua, lábios e mucosa oral, além de alterações nas extremidades e linfadenomegalia cervical. Embora não existam testes específicos para diagnóstico, a ecocardiografia do coração e dos grandes vasos sanguíneos é um exame importante para avaliar o envolvimento coronariano. Ademais, o tratamento padrão para DK envolve o uso precoce de imunoglobulina intravenosa e ácido acetilsalicílico (AAS), o que reduz significativamente o risco de desenvolvimento de aneurismas coronarianos, uma complicação grave da doença. Outrossim, o diagnóstico diferencial é crucial devido à semelhança de sintomas com outras infecções virais comuns em crianças pequenas. Além disso, a infecção por COVID-19 em crianças pode se manifestar de forma assintomática ou leve, mas casos graves podem levar à síndrome inflamatória multissistêmica (MIS-C), que compartilha características clínicas e patológicas com a DK. Portanto, a possibilidade de MIS-C deve ser considerada em crianças com sintomas sugestivos e histórico de exposição ao SARS-CoV-2

Identification of clusters of asthma control: A preliminary analysis of the inspirers studies

This work was funded by ERDF (European Regional Development Fund) through the operations: POCI- -01-0145-FEDER-029130 (“mINSPIRERS—mHealth to measure and improve adherence to medication in chronic obstructive respiratory diseases - generalisation and evaluation of gamification, peer support and advanced image processing technologies”) co-funded by the COMPETE2020 (Programa Operacional Competitividade e Internacionalização), Portugal 2020 and by Portuguese Funds through FCT (Fundação para a Ciência e a Tecnologia).© 2020, Sociedade Portuguesa de Alergologia e Imunologia Clinica. All rights reserved. Aims: To identify distinct asthma control clusters based on Control of Allergic Rhinitis and Asthma Test (CARAT) and to compare patients’ characteristics among these clusters. Methods: Adults and adolescents (≥13 years) with persistent asthma were recruited at 29 Portuguese hospital outpatient clinics, in the context of two observational studies of the INSPIRERS project. Demographic and clinical characteristics, adherence to inhaled medication, beliefs about inhaled medication, anxiety and depression, quality of life, and asthma control (CARAT, >24 good control) were collected. Hierarchical cluster analysis was performed using CARAT total score (CARAT-T). Results: 410 patients (68% adults), with a median (percentile 25–percentile 75) age of 28 (16-46) years, were analysed. Three clusters were identified [mean CARAT-T (min-max)]: cluster 1 [27(24-30)], cluster 2 [19(14-23)] and cluster 3 [10(2-13)]. Patients in cluster 1 (34%) were characterised by better asthma control, better quality of life, higher inhaler adherence and use of a single inhaler. Patients in clusters 2 (50%) and 3 (16%) had uncontrolled asthma, lower inhaler adherence, more symptoms of anxiety and depression and more than half had at least one exacerbation in the previous year. Further-more, patients in cluster 3 were predominantly female, had more unscheduled medical visits and more anxiety symp-toms, perceived a higher necessity of their prescribed inhalers but also higher levels of concern about taking these inhalers. There were no differences in age, body mass index, lung function, smoking status, hospital admissions or specialist physician follow-up time among the three clusters. Conclusion: An unsupervised method based on CARAT--T, identified 3 clusters of patients with distinct, clinically meaningful characteristics. The cluster with better asthma control had a cut-off similar to the established in the validation study of CARAT and an additional cut-off seems to distinguish more severe disease. Further research is necessary to validate the asthma control clusters identified.publishersversionpublishe