Norma terapêutica da diabetes mellitus tipo 2 : metformina : uma perspectiva crítica

Clinical guidelines have the potential to increase health gains, but also to cause harm. In this opinion article we state some misgivings about the application of the Portuguese National Health Directorate’s guideline type 2 diabetes therapy: metformin in primary care. We seek to highlight guideline wording that may allow for multiple interpretations(alternatives to monotherapy with metformin, hierarchy of drugs to be associated with metformin, and metformin contraindications). Furthermore, we argue that it seems that choosing a glycemic target of 6.5% in a normative document to be applied in the general population may have unforeseen consequences

Implementação de OSCEs como Metodologia de Ensino e Avaliação na NOVA Medical School (NMS) | Relato de um Teste Piloto

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Extraction of triterpenoids and phenolic compounds from: Ganoderma lucidum: optimization study using the response surface methodology

Chitosan is widely used in the preparation of organic-inorganic composite materials, such as n-HAp/CS composites, which find application for bone regeneration. The methods for their preparation are various, and usually based on the preparation of intermediate n-HAp/CS dispersions, which can greatly influence the final properties of the resulting composites since it is expected that homogenous and stable dispersions lead to composite materials with improved final properties. This work hypothesizes that, additionally to process parameters such as pH, n-HAp/CS weight ratio, mixing conditions and the presence of salts, chitosan itself has a high impact on dispersions stability. Thus, the importance of properly control the preparation of the n-HAp/CS intermediate dispersions is highlighted by doing a systematic study where relevant processing parameters were studied at lab scale using ultrasonication, alone or in the presence of chitosan, namely on particle size and zeta potential. Furthermore, and based on the best laboratorial conditions, the production of n-HAp/CS nanocomposite dispersions in continuous mode was attempted through NETmix® technology, an innovative static mixer and reactor developed at the Associate Laboratory LSRE-LCM of the Faculty of Engineering of the University of Porto (FEUP).Financial support for this work was provided in part by project Project POCI-01-0145-FEDER-006984 – Associate Laboratory LSRE-LCM funded by FEDER through COMPETE2020 - Programa Operacional Competitividade e Internacionalização (POCI) – and by national funds through FCT - Fundação para a Ciência e a Tecnologia , and by “ AIProcMat@N2020 - Advanced Industrial Processes and Materials for a Sustainable Northern Region of Portugal 2020 ”, with reference NORTE-01-0145-FEDER-000006, supported by NORTE 2020 under the Portugal 2020 Partnership Agreement, through the European Regional Development Fund (ERDF) . FCT and FEDER under Programme PT2020 for financial support to CIMO (UID/AGR/00690/2013). G. Ruphuy thanks Universidad de Costa Rica (UCR) and Ministerio de Ciencia, Tecnología y Telecomunicaciones de Costa Rica (MICITT) for her scholarship. Authors thank Fluidinova S.A. for providing the HAp samples.info:eu-repo/semantics/publishedVersio

Optimization of the extraction of phenolic compounds from Ganoderma lucidum

Ganoderma lucidum (Curtis) P. Karst, a rich source of several bioactive compounds, has been utilized for its medicinal and nutraceutical purposes since earliest history. Among its bioactive constituents, the phenolic content has been widely reported to be responsible for some its bioactive properties. Recent trends in bioactive compounds’ recovery have been focused on finding the best techniques that maximally extract valuable compounds from natural matrices. This study is aimed at optimizing the extraction of phenolic compounds (Ph) from G. lucidum using conventional techniques such as Soxhlet extraction (SE), heat assisted extraction (HAE) and comparing with ultrasound assisted extraction (UAE), considered a more sustainable method. The SE technique was optimized by applying 7 cycles while to effectively carry out the optimization of HAE and UAE, response surface methodology (RSM) was applied using a circumscribed central composite design with three independent variables (time, ethanol content, temperature or ultrasonic power). The extraction yield and total Ph were maximized and the optimal conditions were determined. For the SE technique, a positive linear dependency was achieved for the extraction yield, while for the Ph content expressed in terms of mg equiv. gallic acid (EGA) per g dw (dry weight), a significantly increase was observed up to the 5th cycle before a gradual decrease. The conditions that maximize the responses (extraction yield and total phenolics) were: 78.9 min, 90.0 °C and 62.5 % ethanol and 40 min, 100.0 W and 89.5% ethanol for HAE and UAE, respectively. The latter was the most effective, capable of achieving 4.9 ± 0.6 % extraction yield and 106.6 ± 16.2 mg EGA/g dw. The extraction process optimization proved to be a viable option for obtaining phenolic rich extracts from G. lucidum that can be used as bio-based ingredients.info:eu-repo/semantics/publishedVersio

Depresión en los cuidadores familiares de enfermos crónicos

Chronic illness affects the individual who suffers as all those who maintain relationships with patients, and especially to his family and caregivers. Over 50% of caregivers show high levels of depression and anxiety, which vary depending on the duration and intensity of the clinical condition of the person cared for. Material and Methods We used a non-probability sampling technique of incidental type, selecting a total of 300 people who were divided into three subsamples of 100 subjects each; Relatives caring for people who are totally dependent; Relatives caring for children and youth totally dependent and finally family caregivers of people with diseases of mild dependence, evaluated with the Beck Depression Inventory. We created a questionnaire that included questions on personal characteristics, social and labor, both of the dependent person and the family caregiver. Results and conclusions We could observe that most families do not have levels of depression or this is of a mild level unlike other studies reviewed.La enfermedad crónica afecta tanto al sujeto que la padece como a todas aquellas personas que mantienen relación con el enfermo, y muy especialmente a su familia y a sus cuidadores. Más del 50% de los cuidadores muestran altos niveles de depresión y ansiedad, variando estas en función de la duración e intensidad de la situación clínica de la persona cuidada. Material y métodos Se utilizó una técnica de muestreo no probabilístico de tipo incidental y se seleccionó un total de 300 personas, las que se dividieron en tres submuestras de 100 sujetos cada una: familiares que cuidaban a personas totalmente dependientes, familiares que cuidaban a niños y jóvenes totalmente dependientes, y familiares cuidadores de personas con enfermedades de dependencia leve. Estas fueron evaluadas con el Inventario de Depresión de Beck. Se creó un cuestionario en el que se incluyeron preguntas sobre las características personales, sociales y laborales tanto de la persona dependiente como del familiar cuidador. Resultados y conclusiones Se puede observar que la mayoría de los familiares no presenta niveles de depresión o esta es de carácter leve a diferencia de otros estudios revisados

Design science approach

Funding Information: This project (PrimaryCare@COVID-19: Digital Platform for Supporting Chronic Patients and COVID-19 consultations and Monitoring in Primary Care) was funded by the Funda??o para a Ci?ncia e Tecnologia (Ministry of Science of Technology, Portugal) under the Research4COVID-19 program. Funding Information: This project (PrimaryCare@COVID-19: Digital Platform for Supporting Chronic Patients and COVID-19 consultations and Monitoring in Primary Care) was funded by the Fundação para a Ciência e Tecnologia (Ministry of Science of Technology, Portugal) under the Research4COVID-19 program. Publisher Copyright: © 2021 Luís Velez Lapão, Mariana Peyroteo, Melanie Maia, Jorge Seixas, João Gregório, Miguel Mira da Silva, Bruno Heleno, Jorge César Correia.Background: The COVID-19 pandemic is straining health systems and disrupting the delivery of health care services, in particular, for older adults and people with chronic conditions, who are particularly vulnerable to COVID-19 infection. Objective: The aim of this project was to support primary health care provision with a digital health platform that will allow primary care physicians and nurses to remotely manage the care of patients with chronic diseases or COVID-19 infections. Methods: For the rapid design and implementation of a digital platform to support primary health care services, we followed the Design Science implementation framework: (1) problem identification and motivation, (2) definition of the objectives aligned with goal-oriented care, (3) artefact design and development based on Scrum, (4) solution demonstration, (5) evaluation, and (6) communication. Results: The digital platform was developed for the specific objectives of the project and successfully piloted in 3 primary health care centers in the Lisbon Health Region. Health professionals (n=53) were able to remotely manage their first patients safely and thoroughly, with high degrees of satisfaction. Conclusions: Although still in the first steps of implementation, its positive uptake, by both health care providers and patients, is a promising result. There were several limitations including the low number of participating health care units. Further research is planned to deploy the platform to many more primary health care centers and evaluate the impact on patient's health related outcomes.publishersversionpublishe