Diagnóstico pouco usual de obstrução da traqueia

AbstractMale, 54 years old, with smoking habits. The patient complaints were cough, with bleeding secretions in the previous two months. Because of the persistence of the symptoms, a broncoscopy was proposed. This exam showed multiple lesions in the traquea, nearly 2cm above the vocal cords that compromised the airway and did not allow the progression of the bronchoscope. For this reason, it was decided to introduce a tracheal prosthesis. Because of instability, and the suspicion of malignancy we started thoracic irradiation. The histological specimen was compatible with anaplastic Lymphoma, CD 30+.Because of respiratory distress, with stridor, the prothesis was removed. The traquea was permeable after this.The patient was discharged and oriented to Clinical Haematology. He is clinically stable and under monitoring, having now completed a chemotherapy treatment with CHOP (Ciclophosphamide, Adriamycin or Hydroxydorubicin, Vincristine or Oncovin and Prednisone).The primary mediastinal Large Cells Lymphoma represents 11.5% of the Large Cells Lymphomas (2% of the non-Hodgkin’s Lymphomas). This neoplasm is in many studies considered incurable, but there are some positive results with the combination of radiotheraphy and chemotherapy. If there is any airway compromise, the tracheal prosthesis may be one option for the resolution of the respiratory insufficiency.Rev Port Pneumol 2006; XII (3): 303-30

A saúde nos Parâmetros Curriculares Nacionais: considerações a partir dos manuais de higiene

Este artigo tem o objetivo de expor algumas reflexões sobre os Parâmetros Curriculares Nacionais, especificamente o tema transversal relacionado à saúde partindo de um breve histórico acerca dos manuais de higiene. O Ministério da Saúde ressalta o período escolar como fundamental para a promoção da saúde, já que as crianças e jovens que se encontram nas escolas vivem a oportunidade de obter cada vez mais a adequação de hábitos e atitudes que vão sendo revistos, dependendo da idade. Delimitamos como objeto de estudo os Parâmetros Curriculares Nacionais, que é o instrumento utilizado hoje para nortear o trabalho dos professores em relação à educação e saúde e o Ministério não dispõe de programa específico para o escolar.Em termos de metas a serem atingidas, enquanto o movimento higienista buscava legitimar uma categoria, o PCN é um instrumento de uma política educacional que consagrou uma intervenção na organização e cultura escolar.Conclui-se que a educação em saúde no âmbito do escolar deveria ser um processo interdisciplinar envolvendo os setores de saúde e educação.This article has the objective of exposing some reflections on the National Curriculum Parameters, specifically the traverse them related to the health starting from a brief historic concerning hygiene manuals. The Ministry of Health highlight the school period as an important point for the promotion of health. Since children and young people who goes to schools, has the opportunity to acquire better habits and attitudes that have been reviewed, depending on the age. We defined as studying object the National Curriculum Parameters, wich is the instrument used today to lead the teachers’ work related to health education. The Ministry doesn’t has as specific school program. In terms of goals to be reached, while the hygienic movement search for to legitimate a category. NCP is an instrument of educational policies, wich has consecrated an intervention in the organization and school culture. It is concluded that health education in school context should be a process interdisciplinary involving the sections of health an education

Bronchiectasis: A retrospective study of clinical and aetiological investigation in a general respiratory department

AbstractBackgroundBronchiectasis can result from many diseases, which makes the aetiological investigation a complex process demanding special resources and experience. The aetiological diagnosis has been proven to be useful for the therapeutic approach.ObjectiveEvaluate how accurately and extensive the clinical and aetiological research was for adult bronchiectasis patients in pulmonology outpatient service which were not following a pre-existing protocol.MethodsWe retrospectively reviewed the records of 202 adult patients with bronchiectasis, including the examinations performed to explain the aetiology.ResultsThe mean age of the patients was 54±15 years, there was a predominance of female (63.9%) and non-smoker (70%) patients. Functional evaluation showed a mild airway obstruction.The sputum microbiological examination was available for 168 patients (43.1% had 3 or more sputum examinations during one year). Immunoglobulins and α1-antitrypsin were measured in around 50% of the patients. The sweat test and the CF genotyping test were performed in 18% and 17% of the patients, respectively.The most commonly identified cause was post-infectious (30.3%), mostly tuberculosis (27.2%). No definitive aetiological diagnosis was established in 57.4% of the patients. We achieved a lower aetiological diagnosis if we compare our series with studies in which a diagnostic algorithm was applied prospectively.ConclusionsThe general characteristics of our patients were similar with other series. Detailed investigation of bronchiectasis is not a standard practice in our outpatient service. These results suggest that the use of a predefined protocol, based on current guidelines, could improve the assessment of these patients and facilitate the achievement of a definitive aetiology

Green speciation of iron using aqueous two-phase system

Fe(II) and Fe(III) have distinct chemical and biological functions. Consequently, it is more important to determine the fraction of both oxidation state that knowing the total iron concentration in a sample. However, green methods for iron speciation are still limited. This work uses aqueous two-phase system, a safe alternative to liquid–liquid extraction, to perform the chemical speciation of iron. This method is based on the reaction of Fe(II) with 1,10-phenanthroline extractant, forming a complex of Fe(II)-phenanthroline that concentrates in the top phase of the system. The Fe(III) specie concentrated in the bottom phase of the system. Iron speciation was affected by the electrolyte nature, macromolecule type, quantity of phenanthroline added, and pH. The system formed by PEO1500 + Na3 C6 H5 O7 + H2 O at pH 6.00, containing 5.00 mmol kg–1 of phenanthroline, was successfully used to separate the iron species before determination by flame atomic absorption spectrometry. Under these optimal conditions, a separation factor of 233 was obtained between Fe(II) and Fe(III) with extraction percentages of (95.1 ± 1.0)% and (7.68 ± 0.50)%, respectively The proposed method was successfully applied for iron speciation in water samples, and provided recovery percentages ranging between 90 and 106%

Pre-training autoencoder for lung nodule malignancy assessment using CT images

Lung cancer late diagnosis has a large impact on the mortality rate numbers, leading to a very low five-year survival rate of 5%. This issue emphasises the importance of developing systems to support a diagnostic at earlier stages. Clinicians use Computed Tomography (CT) scans to assess the nodules and the likelihood of malignancy. Automatic solutions can help to make a faster and more accurate diagnosis, which is crucial for the early detection of lung cancer. Convolutional neural networks (CNN) based approaches have shown to provide a reliable feature extraction ability to detect the malignancy risk associated with pulmonary nodules. This type of approach requires a massive amount of data to model training, which usually represents a limitation in the biomedical field due to medical data privacy and security issues. Transfer learning (TL) methods have been widely explored in medical imaging applications, offering a solution to overcome problems related to the lack of training data publicly available. For the clinical annotations experts with a deep understanding of the complex physiological phenomena represented in the data are required, which represents a huge investment. In this direction, this work explored a TL method based on unsupervised learning achieved when training a Convolutional Autoencoder (CAE) using images in the same domain. For this, lung nodules from the Lung Image Database Consortium and Image Database Resource Initiative (LIDC-IDRI) were extracted and used to train a CAE. Then, the encoder part was transferred, and the malignancy risk was assessed in a binary classification—benign and malignant lung nodules, achieving an Area Under the Curve (AUC) value of 0.936. To evaluate the reliability of this TL approach, the same architecture was trained from scratch and achieved an AUC value of 0.928. The results reported in this comparison suggested that the feature learning achieved when reconstructing the input with an encoder-decoder based architecture can be considered an useful knowledge that might allow overcoming labelling constraints.This work is financed by National Funds through the Portuguese funding agency, FCT—Fundação para a Ciência e a Tecnologia within project UIDB/50014/2020

AS PARTICULARIDADES DO TRABALHO TEMPORÁRIO NO DISTRITO DE GUACHOS, MUNICÍPIO DE MARTINÓPOLIS - SP

Summary The presented work had as main approach to analyze the process of expropriation of the small agricultural producers and the intensification of the temporary work in the Region of Presidente Prudente, in the State of São Paulo. Such process if aggravated in virtue of the expansion of the culture of the sugar cane-of-sugar from years 1980, reducing the possibilities of access to the culture of the land for the small producers. In this context, the analysis was accomplished in the District of Guachos, city of Martinópolis, for reflecting of sharp form the characteristics of formation of the temporary work. In this direction, one became excellent to understand the process of constitution of a reserve of projecting man power in the District in I appraise, emphasizing the influence of the sugar cane-of-sugar plants on the local man power. Key words: Modernization; Agricultural Worker; Cattle; Sugar cane-of-sugar, Sazonalidade.O trabalho apresentado teve como enfoque principal analisar o processo de expropriação dos pequenos produtores rurais e a intensificação do trabalho temporário na Região de Presidente Prudente, no Estado de São Paulo. Tal processo se agravou em virtude da expansão da cultura da cana-de-açúcar a partir dos anos 1980, reduzindo as possibilidades de acesso ao cultivo da terra pelos pequenos produtores. Neste contexto, a análise efetivou-se no Distrito de Guachos, município de Martinópolis, por refletir de forma pronunciada as características de formação do trabalho temporário. Nesse sentido, tornou-se relevante compreender o processo de constituição de uma reserva de mão-de-obra volante no Distrito em apreço, enfatizando a influência das usinas de cana-de-açúcar sobre a mão-de-obra local. Palavras-chave: Modernização; Trabalhador Rural; Pecuária; Cana-de-açúcar, Sazonalidade

Management of Coronavirus Disease 2019 Patients With Lung Cancer: Experience From a Thoracic Oncology Center

Background: Cancer patients appear to be at a higher risk of complications from coronavirus disease 2019 (COVID-19). Specific data related to lung cancer (LC) patient management, active treatment, and/or recent diagnosis are still very limited. Here, we aimed to investigate the clinical presentation, baseline features, and clinical outcomes of LC patients with COVID-19. Methods: A retrospective case study was performed at Centro Hospitalar Universitário de São Joao, a tertiary hospital in the North of Portugal. Data from LC patients diagnosed with COVID-19 were collected during the first 10 months of the COVID-19 pandemic (March 2020–January 2021). Results: Twenty-eight patients with active LC were diagnosed with COVID-19, being adenocarcinoma the most common histological type present (n = 13, 46.4%). Sixteen patients had metastatic stage IV LC (61.5%). Twenty-five patients (89.3%) had relevant comorbidities including hypertension (39.3%) and chronic obstructive pulmonary disease (32.1%). For patients undergoing antineoplastic treatment, the median time from the last chemotherapy administration to COVID-19 diagnosis was of 16 days (interquartile range = 13–41 days). Half of patients were previously on corticosteroid therapy. Twenty patients (71.4%) needed hospitalization, 18 received oxygen therapy (64.3%), 3 (10.7%) of them received high-flow nasal cannula with good tolerability, and 1 (3.6%) needed non-invasive ventilation. Hydroxychloroquine and antibiotics were given to 4 (14.3%) and 12 (42.9%) patients, respectively. Seven patients (25%) died at a median time of 5 days following COVID-19 diagnosis. Conclusion: This is one of the first studies reporting the adverse outcomes associated with COVID-19 in LC patients at same time that adds evidence regarding the need to create protocols and guidelines to reduce the infection risk in such patients.NC-M acknowledges the Portuguese Foundation for Science and Technology under the Horizon 2020 Program (PTDC/PSI-GER/28076/2017)

The Role of Liquid Biopsy in Early Diagnosis of Lung Cancer

Liquid biopsy is an emerging technology with a potential role in the screening and early detection of lung cancer. Several liquid biopsy-derived biomarkers have been identified and are currently under ongoing investigation. In this article, we review the available data on the use of circulating biomarkers for the early detection of lung cancer, focusing on the circulating tumor cells, circulating cell-free DNA, circulating micro-RNAs, tumor-derived exosomes, and tumor-educated platelets, providing an overview of future potential applicability in the clinical practice. While several biomarkers have shown exciting results, diagnostic performance and clinical applicability is still limited. The combination of different biomarkers, as well as their combination with other diagnostic tools show great promise, although further research is still required to define and validate the role of liquid biopsies in clinical practice.This work is financed by the ERDF—European Regional Development Fund through the Operational Programme for Competitiveness and Internationalization—COMPETE 2020 Programme and by National Funds through the Portuguese funding agency, FCT—Fundação para a Ciência e a Tecnologia within project POCI-01-0145-FEDER-030263. Authors thank Abílio Cunha and Francisco Correia for the illustration work. NC-M acknowledges the Portuguese Foundation for Science and Technology under Horizon 2020 Program (PTDC/PSI-GER/28076/2017)

Impact of montelukast as add on treatment to the novel coronavirus pneumonia (COVID-19): protocol for an investigator-initiated open labeled randomized controlled pragmatic trial

Background: Montelukast, a safe drug widely use in asthmatic patients, may be an adjuvant in the treatment of Covid-19, either by improving lung injury and inflammation, or by acting as an anti-viral drug. We aim to assess the efficacy and safety of montelukast as add-on treatment in patients with Covid-19. Methods: We propose a randomized, controlled, parallel, open-label trial involving 160 hospitalized adult patients with confirmed Covid-19. Patients will be randomly assigned in a 1:1 ratio to receive either montelukast 10 mg, once a day for 14 days, in addition to standard of care (SoC), or SoC alone. SoC will follow the best practice for treating these patients, according to updated recommendations. The primary outcome is time to recovery. Participants will be assessed using diary cards to capture data on treatment-related improvements in an 8-point ordinal scale. Secondary endpoints will include changes in respiratory and inflammatory parameters, and adverse events. This phase IV clinical trial will take place at the University Hospital of São João, Porto. EudraCT number: 2020-001747-21. Results: This study intends to generate scientific evidence on efficacy and safety of montelukast as add-on treatment in Covid-19. The results will be essential to improve clinical outcomes which remains to be determined. Conclusion: Montelukast has been suggested as a potential drug with 2 main actions on Covid-19. The validation of montelukast as an adjuvant treatment may improve lung injury, inflammation, and symptoms leading to a better prognosis. The use of this drug may fulfil the existing gap on therapeutic options