Multiple imputation methods for bivariate outcomes in cluster randomised trials.

Missing observations are common in cluster randomised trials. The problem is exacerbated when modelling bivariate outcomes jointly, as the proportion of complete cases is often considerably smaller than the proportion having either of the outcomes fully observed. Approaches taken to handling such missing data include the following: complete case analysis, single-level multiple imputation that ignores the clustering, multiple imputation with a fixed effect for each cluster and multilevel multiple imputation. We contrasted the alternative approaches to handling missing data in a cost-effectiveness analysis that uses data from a cluster randomised trial to evaluate an exercise intervention for care home residents. We then conducted a simulation study to assess the performance of these approaches on bivariate continuous outcomes, in terms of confidence interval coverage and empirical bias in the estimated treatment effects. Missing-at-random clustered data scenarios were simulated following a full-factorial design. Across all the missing data mechanisms considered, the multiple imputation methods provided estimators with negligible bias, while complete case analysis resulted in biased treatment effect estimates in scenarios where the randomised treatment arm was associated with missingness. Confidence interval coverage was generally in excess of nominal levels (up to 99.8%) following fixed-effects multiple imputation and too low following single-level multiple imputation. Multilevel multiple imputation led to coverage levels of approximately 95% throughout. © 2016 The Authors. Statistics in Medicine Published by John Wiley & Sons Ltd

Síndrome HELLP sobreposta a síndrome hemolítica-urêmica

A pregnancy complicated by typical hemolytic uremic syndrome (HUS) and hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome is reported. At 20 weeks of gestation, a case of HUS was diagnosed, with Shiga toxin-producing Escherichia coli identified. Plasmapheresis allowed continuation of the pregnancy for 5 weeks. Superimposed preeclampsia and HELLP syndrome were diagnosed after the establishment of nephrotic range proteinuria, hypertension and recurrence of hemolysis. This is a singular case, as it demonstrates that HELLP syndrome can superimpose upon HUS, a fact that can impact future research on reproductive immunology. It also reminds clinicians that the overlapping of clinical and laboratory findings in HELLP syndrome makes the diagnosis of other thrombotic microangiopathies during pregnancy a clinical challenge.info:eu-repo/semantics/publishedVersio

Hemossiderose Pulmonar: Revisão Casuística da Consulta de Hematologia Pediátrica do Hospital de Dona Estefânia Durante o Período 1976-1994

Os autores fazem uma análise retrospectiva dos processos de crianças com hemossiderose pulmonar (HP) inscritas na Consulta de Hematologia Pediátrica do Hospital de Dona Estefânia no período de 1976 a 1994. Foram caracterizados o sexo e a raça dos doentes, a idade de aparecimento da sintomatologia inicial, o período que decorreu entre esta e a confirmação do diagnóstico e os aspectos clínicos, laboratoriais e radiológicos respeitantes ao diagnóstico, terapêutica e evolução clínica. A propósito desta entidade nosológica, é feita uma revisão bibliográfica. Confirma-se que a HP é uma doença rara, que inicialmente se apresenta com um quadro de anemia ferropénica arrastada com ou sem sintomatologia respiratória. O diagnóstico faz-se pelo achado de hemossiderófagos no lavado gástrico ou bronco-alvéolar. A etiopatogenia mantém-se desconhecida e a corticoterapia continua a ser a terapêutica mais eficaz no controlo da hemorragia pulmonar. A doença tem uma evolução inconstante, persistente ou intermitente, com um prognóstico variável, geralmente grave

O Valor dos Indices Plaquetários na Púrpura Trombocitopénica Imune e Leucémia Linfo e Mieloblástica Aguda. Bases Clínico-Laboratoriais no Contributo para o Diagnóstico Diferencial Entre Estas Duas Patologias

Os autores apresentam um trabalho onde se pretende avaliar a utilidade dos índices plaquetários — volume plaquetário médio (VPM) e o coeficiente de variação do diâmetro plaquetário (CVDP ou PDW = Platelet Distribution Width) — e do número de plaquetas (PLAQ) no diagnóstico diferencial da trombocitopénia na púrpura trombocitopénica aguda (PTI) e na leucémia linfoblástica ou mieloblástica aguda (LLAULMA). Do mesmo modo, estudam comparativamente os dados clínicos e laboratoriais nestes dois grupos de doentes. Caracterizam 59 casos de doentes em idade pediátrica com PTI e 19 casos com LLA/LMA, seguidos na Unidade de Hematologia Infantil do Hospital de Dona Estefânia. Concluem não existir diferenças significativas entre as variáveis VPM e PDW entre os dois grupos de doentes. Com base nas três variáveis (VPM, PDW, PLAQ) foi construída uma regra de discriminação que fornece uma boa separação entre os grupos. Da caracterização clínico-laboratorial ressaltaram diferenças significativas entre as duas entidades nosológicas, o que permitiria prescindir a realização do mielograma para exclusão do diagnóstico de LLA/LMA numa criança com trombocitopénia significativa isolada

H-Ferritin Is Essential for Macrophages' Capacity to Store or Detoxify Exogenously Added Iron

Macrophages are central cells both in the immune response and in iron homeostasis. Iron is both essential and potentially toxic. Therefore, iron acquisition, transport, storage, and release are tightly regulated, by several important proteins. Cytosolic ferritin is an iron storage protein composed of 24 subunits of either the L- or the H-type chains. H-ferritin differs from L-ferritin in the capacity to oxidize Fe2+ to Fe3+. In this work, we investigated the role played by H-ferritin in the macrophages' ability to respond to immune stimuli and to deal with exogenously added iron. We used mice with a conditional deletion of the H-ferritin gene in the myeloid lineage to obtain bone marrow-derived macrophages. These macrophages had normal viability and gene expression under basal culture conditions. However, when treated with interferon-gamma and lipopolysaccharide they had a lower activation of Nitric Oxide Synthase 2. Furthermore, H-ferritin-deficient macrophages had a higher sensitivity to iron-induced toxicity. This sensitivity was associated with a lower intracellular iron accumulation but a higher production of reactive oxygen species. These data indicate that H-ferritin modulates macrophage response to immune stimuli and that it plays an essential role in protection against iron-induced oxidative stress and cell death.Tis work was fnanced by FEDER - Fundo Europeu de Desenvolvimento Regional funds through the COMPETE2020 - Operacional Programme for Competitiveness and Internationalization (POCI), Portugal 2020, and by Portuguese funds through FCT - Fundação para a Ciência e a Tecnologia/Ministério da Ciência, Tecnologia e Ensino Superior in the framework of the project PTDC/IMI-MIC/1683/2014 (POCI-01-0145-FEDER-016590). PFO and MGA acknowledge FCT for the Investigador FCT 2015. We thank the valuable collaboration of the following i3S Scientifc Platforms: Cell Culture and Genotyping Core Facility (CCGen), [Histology and Electron Microscopy Service (HEMS), and BioSciences Screening], member of the PPBI (PPBI-POCI-01-0145-FEDER-022122)], Animal Facility, and Flow Cytometry Unit (TraCy). We acknowledge Lukas Kuhn (Swiss Institute for Experimental Cancer Research, Lausanne, Switzerland) for kindly providing the frst breeding pairs of Fth1−/− mice. Te authors also acknowledge Marisa Castro, from Departamento de Biologia Molecular from ICBAS, Clara Bento, from i3S, and Edgar Pinto from LAQV – REQUIMTE for technical assistance at diferent stages of the project

Alienation and health in adolescents : an original evaluation tool

Copyright © 2018 by authors and Open Access Library Inc. This work is licensed under the Creative Commons Attribution International License (CC BY 4.0).The present work aims to construct and validate a tool enabling to evaluate alienation in Portuguese adolescents. Participants were a group of adolescents that participated in the Portuguese survey of the European study Health Behaviour in School-aged Children (HBSC). For this study, only adolescents from the 8th and 10th grades were included in the sample, comprising 3869 students. The results show a good adequacy of the confirmatory factorial analysis (CFA) model. This model revealed 3 subscales proposals—Demotivation, Isolation and Instability, and a full scale—Total Alienation. When analyzed in relation to other variables (gender, grade, wellbeing indicator and risk indicator), the alienation subscales showed an association between alienation and risk. These results are consistent with other studies about alienation which emphasizes that having good social relationships is associated with higher levels of wellbeing and quality of life and less involvement in risk behaviours by young peopleinfo:eu-repo/semantics/publishedVersio

“A Gente Quer Inteiro e não pela Metade” – A Importância da Função Social dos Contratos e para uma Sobrevivência Digna.

O contrato tradicional, antes visto como simples negócio jurídico bilateral, circulador de bens e serviços entre particulares, passa a ter papel relevante no cenário de modelo social estabelecido pela Constituição. Deve harmonizar a liberdade das partes com a dignidade humana, garantindo não apenas uma contratação livre e com força obrigatória, mas um contrato que permita sobrevivência social. “A gente não quer só comida, quer comida, diversão e arte”. Interlocução entre o jagunço Riobaldo – Grande Sertão: Veredas - e os Titãs. PALAVRAS-CHAVE: função social dos contratos. sobrevivência social. direito civil e constituição federal. dignidade da pessoa humana. ABSTRACT The traditional contract, before seen as a simple legal and bilateral deal, circulator of goods and services between parts, shall have a relevant role in the social scenario established by the Constitution. It must harmonize the freedom of the parts with human dignity, guaranteeing not only a clear hiring with obligatory force, but a contract that allows. "We don’t want just food. We want food, entertainment and art". Dialogue between gunman Riobaldo – Grande Sertão: Veredas – and the Titãs. KEYWORDS: the social function of the contract. social survival. federal constitucion. human dignity. Data da Submissão:25/11/2013 Data da Aceitação: 30/04/201

Um Caso Clínico de Ependimoma do Filum Terminal

Os ependimomas são tumores sólidos com origem nas células que delimitam o sistema ventricular e o canal ependimário. A sua localização habitual varia com a idade e, nos ependimomas espinhais, a sintomatologia é inespecífica o que motiva diagnósticos tardios. Os autores descrevem o caso clínico de uma criança de 9 anos de idade, com dor lombosagrada, alteração da marcha, postura anti-álgica e inversão da lordose lombar. A ressonância magnética nuclear (RMN) revelou um -tumor da cauda equina (filum terminal). Procedeu-se à excisão completa do tumor; o exame histológico permitiu diagnosticar um ependimoma mixo-papilar do filum terminal. No pós-operatório verificou-se retenção urinária transitória que resolveu gradualmente. Dois anos após a cirurgia o doente encontra-se assintomático persistindo apenas ausência dos reflexos aquilianos. Faz-se uma pequena abordagem das manifestações clínicas, diagnóstico e terapêutica dos ependimomas espinhais

Mental health promotion in school context : validation of the ES’COOL scale for teachers

Copyright: © Tomé G (2018). This Article is distributed under the terms of Creative Commons Attribution 4.0 International License.Introduction: In general, a large proportion of young people report themselves as healthy, happy and satisfied with their circumstances. However, it was estimated that about 20%of youths experience significant stress at times, which raised concerns about the long-term impact of this distress on future adjustment. However, there is evidence that only a small proportion of young people with disorders receive treatment, and that their personal distress is steadily linked to negative outcomes at school and to overall maladjustment ...info:eu-repo/semantics/publishedVersio

A multiply substituted G-H loop from foot-and-mouth disease virus in complex with a neutralizing antibody: A role for water molecules

The crystal structure of a 15 amino acid synthetic peptide, corresponding to the sequence of the major antigenic site A (G-H loop of VP1) from a multiple variant of foot-and-mouth disease virus (FMDV), has been determined at 2·3 resolution. The variant peptide includes four amino acid substitutions in the loop relative to the previously studied peptide representing FMDV C-S8c1 and corresponds to the loop of a natural FMDV isolate of subtype C1. The peptide was complexed with the Fab fragment of the neutralizing monoclonal antibody 4C4. The peptide adopts a compact fold with a nearly cyclic conformation and a disposition of the receptor-recognition motif Arg-Gly-Asp that is closely related to the previously determined structure for the viral loop, as part of the virion, and for unsubstituted synthetic peptide antigen bound to neutralizing antibodies. New structural findings include the observation that well-defined solvent molecules appear to play a major role in stabilizing the conformation of the peptide and its interactions with the antibody. Structural results are supported by molecular-dynamic simulations. The multiply substituted peptide developed compensatory mechanisms to bind the antibody with a conformation very similar to that of its unsubstituted counterpart. One water molecule, which for steric reasons could not occupy the same position in the unsubstituted antigen, establishes hydrogen bonds with three peptide amino acids. The constancy of the structure of an antigenic domain despite multiple amino acid substitutions has implications for vaccine design