Analgesia e Anestesia Obstétricas na Maternidade do Hospital D. Estefânia: Estudo Retrospectivo

Resumo: Por intermédio deste estudo, pretendeu-se verificar qual a realidade em termos de analgesia e anestesia obstétricas na Maternidade do Hospital D. Estefânia, ao longo de 4 anos. Para isso, foi realizado um estudo retrospectivo no período entre Janeiro de 2005 e Dezembro de 2008. Foram avaliados a classificação ASA das parturientes, o número total de partos, o número de parturientes submetidas a técnicas locorregionais e suas complicações, número de cesarianas e a necessidade de conversão de técnica regional para anestesia geral. No período do estudo, houve um total de 8291 partos, maioritariamente em mulheres ASA I, dos quais 2643 foram cesarianas. A maioria das parturientes (77%) foi submetida a uma técnica locorregional, para analgesia de trabalho de parto ou anestesia para cesariana, com baixa taxa de complicações (2,9%) e com rara necessidade de conversão para anestesia geral (3,5%). As autoras concluiram que, na Maternidade do Hospital D. Estefânia, a epidural continua a ser a técnica gold standard para analgesia do trabalho de parto, com raras complicações e permitindo a fácil conversão para anestesia para cesariana

Mercapturate Pathway in the Tubulocentric Perspective of Diabetic Kidney Disease

BACKGROUND: The recent growing evidence that the proximal tubule underlies the early pathogenesis of diabetic kidney disease (DKD) is unveiling novel and promising perspectives. This pathophysiological concept links tubulointerstitial oxidative stress, inflammation, hypoxia, and fibrosis with the progression of DKD. In this new angle for DKD, the prevailing molecular mechanisms on proximal tubular cells emerge as an innovative opportunity for prevention and management of DKD as well as to improve diabetic dysmetabolism. SUMMARY: The mercapturate pathway (MAP) is a classical metabolic detoxification route for xenobiotics that is emerging as an integrative circuitry detrimental to resolve tubular inflammation caused by endogenous electrophilic species. Herein we review why and how it might underlie DKD. Key Messages: MAP is a hallmark of proximal tubular cell function, and cysteine-S-conjugates might represent targets for early intervention in DKD. Moreover, the biomonitoring of urinary mercapturates from metabolic inflammation products might be relevant for the implementation of preventive/management strategies in DKD.info:eu-repo/semantics/publishedVersio

A regulation-based classification system for marine protected areas: A response to Dudley et al. [9]

Dudley et al. [9] commented on our paper [11], arguing that the current IUCN objective-based categorization of protected areas, which is also used in marine protected areas (MPAs), should not be abandoned and replaced by the new regulation-based classification system [11]. Here we clarify that we do not advocate replacing the current IUCN categories, but highlight the benefits of using both the objective-based IUCN categories and the new regulation-based classification when applied to MPAs. With an increasing number of MPA types being implemented, most of them multiple-use areas zoned for various purposes, assessing ecological and socio-economic benefits is key for advancing conservation targets and policy objectives. Although the IUCN categories can be used both in terrestrial and marine systems, they were not designed to follow a gradient of impacts and there is often a mismatch between stated objectives and implemented regulations. The new regulation-based classification system addresses these problems by linking impacts of activities in marine systems with MPA and zone classes in a simple and globally applicable way. Applying both the IUCN categories and the regulation based classes will increase transparency when assessing marine conservation goals.ERA-Net BiodivERsA project "BUFFER Partially protected areas as buffers to increase the linked social ecological resilience"; national funders ANR (France); FCT (Portugal); FOR-MAS (Sweden); SEPA (Sweden); RCN (Norway); project BUFFER; Fernand Braudel IFER fellowship (Fondation Maison des Sciences de l'Homme); Fundacao para a Ciencia e a Tecnologia (FCT) [UID/MAR/04292/2013

The Importance of the Differential Diagnosis of Autoimmune Limbic Encephalitis in Patients with Neuropsychiatric Symptoms

Introdução: A encefalite límbica autoimune revela-se muitas vezes uma síndrome paraneoplásica que pode afetar o sistema nervoso central. Manifesta-se com alterações das fun- ções psicológicas e pode surgir apenas com sintomas psiquiátricos isolados. Frequentemente, o contacto inicial com estes doentes é realizado pelo psiquiatra. Deste modo, é essencial a consideração desta patologia como diagnóstico diferencial, visto a sua deteção e tratamento precoces melhorarem consideravelmente o prognóstico de vários tipos de neoplasias. Objetivo: O objetivo deste trabalho foi abordar a encefalite límbica autoimune como diagnóstico diferencial em doentes com sintomas neuropsiquiátricos. Métodos: Foi realizada uma pesquisa bibliográfica na base de dados PubMed com as seguintes palavras: limbic encephalitis, psychiatric. Resultados e Conclusão: A associação entre os diversos tipos de anticorpos e os diferentes quadros psiquiátricos é de destacar, revelando que os distúrbios paraneoplásicos fornecem, assim, exemplos específicos de como autoanticorpos podem afetar a função neuronal. A deteção e tratamento precoces desta patologia são essenciais. É ainda necessário realçar o papel das doenças autoimunes no conhecimento das doenças psiquiátricas em geral.info:eu-repo/semantics/publishedVersio

Somatic mosaicism and common genetic variation contribute to the risk of very-early-onset inflammatory bowel disease

Very-early-onset inflammatory bowel disease (VEO-IBD) is a heterogeneous phenotype associated with a spectrum of rare Mendelian disorders. Here, we perform whole-exome-sequencing and genome-wide genotyping in 145 patients (median age-at-diagnosis of 3.5 years), in whom no Mendelian disorders were clinically suspected. In five patients we detect a primary immunodeficiency or enteropathy, with clinical consequences (XIAP, CYBA, SH2D1A, PCSK1). We also present a case study of a VEO-IBD patient with a mosaic de novo, pathogenic allele in CYBB. The mutation is present in ~70% of phagocytes and sufficient to result in defective bacterial handling but not life-threatening infections. Finally, we show that VEO-IBD patients have, on average, higher IBD polygenic risk scores than population controls (99 patients and 18,780 controls; P < 4 × 10$^{-10}$), and replicate this finding in an independent cohort of VEO-IBD cases and controls (117 patients and 2,603 controls; P < 5 × 10$^{-10}$). This discovery indicates that a polygenic component operates in VEO-IBD pathogenesis

Cyto-Histological Profile of MicroRNAs as Diagnostic Biomarkers in Differentiated Thyroid Carcinomas

Introduction: The repertoire of microRNAs (miRNAs) in thyroid carcinomas starts to be elucidated. Among differentiated thyroid carcinomas (DTCs), papillary thyroid carcinoma (PTC) is the most frequent. The assessment of miRNAs expression may contribute to refine the pre-surgical diagnosis in order to obtain a personalized and more effective treatment for patients. Aims: This study aims to evaluate (1) the miRNAs in a series of DTCs, and their association with the presence of selected genetic mutations in order to improve diagnosis and predict the biologic behavior of DTC/PTC. (2) The reliability of molecular tests in Ultrasound-guided Fine Needle Aspiration Cytology (US-FNAC) for a more precise preoperative diagnosis. Material and methods: This series includes 176 samples (98 cytology and 78 histology samples) obtained from 106 patients submitted to surgery, including 13 benign lesions (controls) and 93 DTCs (cases). The microRNA expression was assessed for miR-146b, miR-221, miR-222, and miR-15a through quantitative reverse transcriptase-polymerase chain reaction (qRT-PCR). The results were analyzed by the 2-ΔΔCT method, using miR16 as an endogenous control. Regarding PTC diagnosis, the discriminative ability of miRNAs expression was assessed by the area under the Receiver Operating Characteristic Curve (AUC). In PTCs, the association of miRNAs expression, clinicopathological features, and genetic mutations (BRAF, RAS, and TERTp) was evaluated. Results/discussion: All the analyzed miRNAs presented a tendency to be overexpressed in DTCs/PTCs when compared with benign lesions, both in cytology and histology samples. In cytology, miRNAs expression levels were higher in malignant tumors than in benign tumors. In histology, the discriminative abilities regarding PTC diagnosis were as follows: miR-146b (AUC 0.94, 95% CI 0.87-1), miR-221 (AUC 0.79, 95% CI 0.68-0.9), miR-222 (AUC 0.76, 95% CI 0.63-0.89), and miR-15a (AUC 0.85, 95% CI 0.74-0.97). miR-146b showed 89% sensitivity (se) and 87% specificity (sp); miR-221 se = 68.4, sp = 90; miR-222 se = 73, sp = 70; and mi-R15a se = 72, sp = 80. MicroRNAs were associated with worst-prognosis clinicopathological characteristics in PTCs (p < 0.05), particularly for miR-222. Our data reveal a significant association between higher expression levels of miR-146b, miR-221, and miR-222 in the presence of the BRAF mutation (p < 0.001) and miR-146b (p = 0.016) and miR-221 (p = 0.010) with the RAS mutation, suggesting an interplay of these mutations with miRNAs expression. Despite this study having a relatively small sample size, overexpression of miRNAs in cytology may contribute to a more precise preoperative diagnosis. The miRNAs presented a good discriminative ability in PTC diagnosis. The association between the miRNAs expression profile and genetic alterations can be advantageous for an accurate diagnosis of DTCs/PTCs in FNAC.info:eu-repo/semantics/publishedVersio

Bursty egocentric network evolution in Skype

In this study we analyze the dynamics of the contact list evolution of millions of users of the Skype communication network. We find that egocentric networks evolve heterogeneously in time as events of edge additions and deletions of individuals are grouped in long bursty clusters, which are separated by long inactive periods. We classify users by their link creation dynamics and show that bursty peaks of contact additions are likely to appear shortly after user account creation. We also study possible relations between bursty contact addition activity and other user-initiated actions like free and paid service adoption events. We show that bursts of contact additions are associated with increases in activity and adoption - an observation that can inform the design of targeted marketing tactics.Comment: 7 pages, 6 figures. Social Network Analysis and Mining (2013

Population homogeneity for the antibody response to COVID-19 BNT162b2/Comirnaty vaccine is only reached after the second dose across all adult age ranges

ABSTRACT: While mRNA vaccines are administrated worldwide in an effort to contain the COVID-19 pandemic, the heterogeneity of the humoral immune response they induce at the population scale remains unclear. Here, in a prospective, longitudinal, cohort-study, including 1245 hospital care workers and 146 nursing home residents scheduled for BNT162b2 vaccination, together covering adult ages from 19 to 99 years, we analyse seroconversion to SARS-CoV-2 spike protein and amount of spike-specific IgG, IgM and IgA before vaccination, and 3-5 weeks after each dose. We show that immunogenicity after a single vaccine dose is biased to IgG, heterogeneous and reduced with increasing age. The second vaccine dose normalizes IgG seroconversion in all age strata. These findings indicate two dose mRNA vaccines is required to reach population scale humoral immunity. The results advocate for the interval between the two doses not to be extended, and for serological monitoring of elderly and immunosuppressed vaccinees.info:eu-repo/semantics/publishedVersio