Educação pós-graduada em cuidados paliativos pediátricos – experiência de uma instituição de ensino superior

Introdução: O desenvolvimento de serviços de Cuidados Paliativos Pediátricos (CPP) é uma prioridade atual dos sistemas de saúde desenvolvidos. Em Portugal o seu reconhecimento tem crescido desde 2013, quando foram constituídos grupos de trabalho na pediatria e nos cuidados paliativos. Nesse mesmo ano, antecipando as necessidades formativas, uma instituição de ensino superior decidiu criar um curso de pós-graduação (PG) em CPP. Objetivos: Avaliar, desde o 1º ano letivo (2013/14 –2018/19), a diversidade dos formandos e a adequação da sua distribuição por área geográfica nacional e respetiva estimativa de crianças com necessidades paliativas (CcNP). Métodos: Revimos a base de dados das inscrições dos alunos, excluindo aqueles que não concluíram a PG; para as omissões contactámos os alunos por email. Consultámos a base de dados do INE para obter a população pediátrica (0-17 anos) no último ano disponível(2017). Para calcular as CcNP utilizámosos dados publicados no relatório do ObservatórioPortuguês de CP sobre a estimativa decrianças com doença crónica complexa.Resultados: Desde a sua criação esta PG contacom 130 alunos –N=121;93% do génerofeminino; idade mediana 37 anos (22-61). Amediana anual é de 20 alunos (entre 14 em2013 e 42 em 2016, anoem que uma organizaçãoatribuiu 20 bolsas). A maioria cuida decrianças (96;74%). A área mais representadaé a enfermagem (54;42%), seguida da medicina(51;39%), da psicologia (12;9%) e doserviço social (6;5%); outros alunos vieram daeducação (3), voluntariado (2), terapia musical(1) e fisioterapia (1). A região com mais alunosé a ARS LVT (83;64%), seguida da ARS Norte(25;19%), Centro (11;8%), Alentejo (5;4%) eAlgarve (1). Dos Açores vieram 2 alunos e daMadeira 1; no corrente ano temos 1 aluno doBrasil e 1 de Angola (este online). Utilizando aestimativa do OPCP (45:10000 crianças residentes),verificámos que em 2017 o númerode CcNP variou entre 360 (Algarve) e 2639(Norte), resultando num rácio profissionais formados:CcNP entre 1:29 (área metropolitanade Lisboa) e 1:360 (Algarve).Conclusão: Nestes 6 anos letivos, a PG emCPP educou profissionais da saúde (sobretudoda Pediatria, Enfermagem e Medicina) e áreasafins, indo ao encontro das necessidades formativasnacionais. Predominam os formandosda ARS LVT, onde é lecionada a PG. Face aocrescente reconhecimento das necessidadesem CPP, é premente estimular a formação deprofissionais das outras zonas do país.info:eu-repo/semantics/publishedVersio

Sun-dried pears: Phenolic compounds and antioxidant activity.

Two different regional varieties of pears, S. Bartolomeu and Amêndoa, were analyzed fresh and after sun-drying. The total phenolic composition and antioxidant capacity of these pears were determined. The total antioxidant capacity was compared using two different methods: DMPD (N,N-dimethyl-p-phenylenediamine) and the method of ABTS (2,2’-azinobis(3-ethylbenzothiazoline-6-sulfonic acid)) radical scavenging. The ABTS method, when compared with the DMPD method, showed a better correlation between the content of phenolic compounds of the pears and their antioxidant activity. The fresh pear possessed higher amounts of phenolic compounds and higher antioxidant capacity when compared to sun-dried pear. The antioxidant efficiency was expressed as Trolox equivalent and as ascorbic acid equivalent. For both methods, the Trolox equivalent was higher than the ascorbic acid equivalent

Tracing magnetism and pairing in FeTe-based systems

In order to examine the interplay between magnetism and superconductivity, we monitor the non- superconducting chalcogenide FeTe and follow its transitions under insertion of oxygen, doping with Se and vacancies of Fe using spin-polarized band structure methods (LSDA with GGA) starting from the collinear and bicollinear magnetic arrangements. We use a supercell of Fe8Te8 as our starting point so that it can capture local changes in magnetic moments. The calculated values of magnetic moments agree well with available experimental data while oxygen insertions lead to significant changes in the bicollinear or collinear magnetic moments. The total energies of these systems indicate that the collinear-derived structure is the more favorable one prior to a possible superconducting transition. Using a 8-site Betts-cluster-based lattice and the Hubbard model, we show why this structure favors electron or hole pairing and provides clues to a common understanding of charge and spin pairing in the cuprates, pnictides and chalcogenides

a pilot study in mice

Pneumocystis pneumonia (PcP) is a major cause of mortality and morbidity in immunocompromised patients. There are limited alternative therapeutic choices to trimethoprim-sulfamethoxazole (TMP-SMX) which is the standard first line therapy/prophylaxis for PcP. The efficacy of low doses of caspofungin and caspofungin in association with TMP-SMX standard-prophylactic dose was evaluated in an experimental model of Pneumocystis. Susceptibility of Pneumocystis spp. to low doses of caspofungin and caspofungin/TMP-SMX was evaluated in Balb/c immunosuppressed mice, infected intranasally with P. murina. Caspofungin was administered once daily at 0.1 mg/kg, 0.05 mg/kg, and 0.001 mg/kg and TMP-SMX was administered by oral gavage (12.25 mg/62.5 mg/day), for 21 days. Efficacy was calculated based on the reduction in organism burden determined through quantitative fluorescent-based real-time PCR (qPCR). Serum β-1,3-D-glucan was measured as an additional marker of infection. The present data showed that caspofungin demonstrated anti-Pneumomocystis effect. However, the doses administrated were too low to achieve Pneumocystis eradication, which suggests that echinocandin treatment should not be administrated as mono-therapy. After 21 days of treatment, P. murina was not detected in the lungs of mice with either TMP-SMX or caspofungin/TMP-SMX. The results showed that, even at the lowest concentrations tested, the efficacy of caspofungin in association with TMP-SMX was higher than the efficacy of either drug used alone. The administration of caspofungin/TMP-SMX was at least 1.4 times more effective against P. murina infection than TMP-SMX used alone. The most promising result was achieved with the combination of caspofungin 0.05 mg/kg/day with TMP-SMX 12.5 mg–62.5 mg/day, which reduced the parasite burden to undetectable levels immediately at the 14th day of treatment, showing a highly marked anti-Pneumomocystis effect. These data suggest that the administration of low doses of caspofungin in combination with low doses of TMP-SMX may provide an improved treatment protocol for Pneumocystis infection clearance.publishersversionpublishe

The Second Transmembrane Domain of P2X7 Contributes to Dilated Pore Formation

Activation of the purinergic receptor P2X7 leads to the cellular permeability of low molecular weight cations. To determine which domains of P2X7 are necessary for this permeability, we exchanged either the C-terminus or portions of the second transmembrane domain (TM2) with those in P2X1 or P2X4. Replacement of the C-terminus of P2X7 with either P2X1 or P2X4 prevented surface expression of the chimeric receptor. Similarly, chimeric P2X7 containing TM2 from P2X1 or P2X4 had reduced surface expression and no permeability to cationic dyes. Exchanging the N-terminal 10 residues or C-terminal 14 residues of the P2X7 TM2 with the corresponding region of P2X1 TM2 partially restored surface expression and limited pore permeability. To further probe TM2 structure, we replaced single residues in P2X7 TM2 with those in P2X1 or P2X4. We identified multiple substitutions that drastically changed pore permeability without altering surface expression. Three substitutions (Q332P, Y336T, and Y343L) individually reduced pore formation as indicated by decreased dye uptake and also reduced membrane blebbing in response to ATP exposure. Three others substitutions, V335T, S342G, and S342A each enhanced dye uptake, membrane blebbing and cell death. Our results demonstrate a critical role for the TM2 domain of P2X7 in receptor function, and provide a structural basis for differences between purinergic receptors. © 2013 Sun et al

Accuracy of the new rapid test for monitoring adalimumab levels

The loss of response to adalimumab (ADL) has been related to low serum concentrations at trough. Currently, most methods commercially available for the quantification of ADL are enzyme-linked immunosorbent assay (ELISA) based, with a turnaround time of approximately 8 h, delaying the target dosage adjustment to the subsequent infusion. In this study, we aimed to evaluate the performance of the newly available rapid-test ADL quantification assay by comparing it with three established ELISA methods, using spiked samples and a set of clinical samples.info:eu-repo/semantics/publishedVersio

Fungal microbiota from rain water and pathogenicity of Fusarium species isolated from atmospheric dust and rainfall dust

In order to determine the presence of Fusarium spp. in atmospheric dust and rainfall dust, samples were collected during September 2007, and July, August, and October 2008. The results reveal the prevalence of airborne Fusarium species coming from the atmosphere of the South East coast of Spain. Five different Fusarium species were isolated from the settling dust: Fusarium oxysporum, F. solani, F. equiseti, F. dimerum, and F. proliferatum. Moreover, rainwater samples were obtained during significant rainfall events in January and February 2009. Using the dilution-plate method, 12 fungal genera were identified from these rainwater samples. Specific analyses of the rainwater revealed the presence of three species of Fusarium: F. oxysporum, F. proliferatum and F. equiseti. A total of 57 isolates of Fusarium spp. obtained from both rainwater and atmospheric rainfall dust sampling were inoculated onto melon (Cucumis melo L.) cv. Piñonet and tomato (Lycopersicon esculentum Mill.) cv. San Pedro. These species were chosen because they are the main herbaceous crops in Almeria province. The results presented in this work indicate strongly that spores or propagules of Fusarium are able to cross the continental barrier carried by winds from the Sahara (Africa) to crop or coastal lands in Europe. Results show differences in the pathogenicity of the isolates tested. Both hosts showed root rot when inoculated with different species of Fusarium, although fresh weight measurements did not bring any information about the pathogenicity. The findings presented above are strong indications that long-distance transmission of Fusarium propagules may occur. Diseases caused by species of Fusarium are common in these areas. They were in the past, and are still today, a problem for greenhouses crops in Almería, and many species have been listed as pathogens on agricultural crops in this region. Saharan air masses dominate the Mediterranean regions. The evidence of long distance dispersal of Fusarium spp. by atmospheric dust and rainwater together with their proved pathogenicity must be taken into account in epidemiological studies

Feasibility, drug safety, and effectiveness of etiological treatment programs for Chagas disease in Honduras, Guatemala, and Bolivia: 10-year experience of Médecins Sans Frontières

BACKGROUND: Chagas disease (American trypanosomiasis) is a zoonotic or anthropozoonotic disease caused by the parasite Trypanosoma cruzi. Predominantly affecting populations in poor areas of Latin America, medical care for this neglected disease is often lacking. Médecins Sans Frontières/Doctors Without Borders (MSF) has provided diagnostic and treatment services for Chagas disease since 1999. This report describes 10 years of field experience in four MSF programs in Honduras, Guatemala, and Bolivia, focusing on feasibility protocols, safety of drug therapy, and treatment effectiveness. METHODOLOGY: From 1999 to 2008, MSF provided free diagnosis, etiological treatment, and follow-up care for patients <18 years of age seropositive for T. cruzi in Yoro, Honduras (1999-2002); Olopa, Guatemala (2003-2006); Entre Ríos, Bolivia (2002-2006); and Sucre, Bolivia (2005-2008). Essential program components guaranteeing feasibility of implementation were information, education, and communication (IEC) at the community and family level; vector control; health staff training; screening and diagnosis; treatment and compliance, including family-based strategies for early detection of adverse events; and logistics. Chagas disease diagnosis was confirmed by testing blood samples using two different diagnostic tests. T. cruzi-positive patients were treated with benznidazole as first-line treatment, with appropriate counseling, consent, and active participation from parents or guardians for daily administration of the drug, early detection of adverse events, and treatment withdrawal, when necessary. Weekly follow-up was conducted, with adverse events recorded to assess drug safety. Evaluations of serological conversion were carried out to measure treatment effectiveness. Vector control, entomological surveillance, and health education activities were carried out in all projects with close interaction with national and regional programs. RESULTS: Total numbers of children and adolescents tested for T. cruzi in Yoro, Olopa, Entre Ríos, and Sucre were 24,471, 8,927, 7,613, and 19,400, respectively. Of these, 232 (0.9%), 124 (1.4%), 1,475 (19.4%), and 1,145 (5.9%) patients, respectively, were diagnosed as seropositive. Patients were treated with benznidazole, and early findings of seroconversion varied widely between the Central and South American programs: 87.1% and 58.1% at 18 months post-treatment in Yoro and Olopa, respectively; 5.4% by up to 60 months in Entre Ríos; and 0% at an average of 18 months in Sucre. Benznidazole-related adverse events were observed in 50.2% and 50.8% of all patients treated in Yoro and Olopa, respectively, and 25.6% and 37.9% of patients in Entre Ríos and Sucre, respectively. Most adverse events were mild and manageable. No deaths occurred in the treatment population. CONCLUSIONS: These results demonstrate the feasibility of implementing Chagas disease diagnosis and treatment programs in resource-limited settings, including remote rural areas, while addressing the limitations associated with drug-related adverse events. The variability in apparent treatment effectiveness may reflect differences in patient and parasite populations, and illustrates the limitations of current treatments and measures of efficacy. New treatments with improved safety profiles, pediatric formulations of existing and new drugs, and a faster, reliable test of cure are all urgently needed

The costs of preventing and treating chagas disease in Colombia

Background: The objective of this study is to report the costs of Chagas disease in Colombia, in terms of vector disease control programmes and the costs of providing care to chronic Chagas disease patients with cardiomyopathy. Methods: Data were collected from Colombia in 2004. A retrospective review of costs for vector control programmes carried out in rural areas included 3,084 houses surveyed for infestation with triatomine bugs and 3,305 houses sprayed with insecticide. A total of 63 patient records from 3 different hospitals were selected for a retrospective review of resource use. Consensus methodology with local experts was used to estimate care seeking behaviour and to complement observed data on utilisation. Findings: The mean cost per house per entomological survey was $4.4 (in US$ of 2004), whereas the mean cost of spraying a house with insecticide was $27. The main cost driver of spraying was the price of the insecticide, which varied greatly. Treatment of a chronic Chagas disease patient costs between$46.4 and $7,981 per year in Colombia, depending on severity and the level of care used. Combining cost and utilisation estimates the expected cost of treatment per patient-year is$1,028, whereas lifetime costs averaged $11,619 per patient. Chronic Chagas disease patients have limited access to healthcare, with an estimated 22% of patients never seeking care. Conclusion: Chagas disease is a preventable condition that affects mostly poor populations living in rural areas. The mean costs of surveying houses for infestation and spraying infested houses were low in comparison to other studies and in line with treatment costs. Care seeking behaviour and the type of insurance affiliation seem to play a role in the facilities and type of care that patients use, thus raising concerns about equitable access to care. Preventing Chagas disease in Colombia would be cost-effective and could contribute to prevent inequalities in health and healthcare.Wellcome Trus