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

FUNGAL AND MICOTOXIN CONTAMINATION IN MIXED FEEDS: EVALUATING RISK IN CATTLE INTENSIVE REARING OPERATIONS (FEEDLOTS)

Argentina is the fourth global beef producer. Exposure to mycotoxins through contaminated feed is a major hazard for ruminants. In the present study we assess mycobiota, aflatoxin B1 (AFB1), fumonisin B1 (FB1), deoxynivalenol (DON) and zearalenone (ZEA) levels in total mixed rations (TMRs) during two consecutive years. Total fungal counts were evaluated and fungal species were identified. Also, ability of A. flavus isolates to produce AFB1 in vitro was tested. Natural contamination with AFB1 and FB1 was quantified by HPLC. Deoxynivalenol and zearalenone were analysed by immunochromatography and thinlayer chromatogra- phy (TLC), respectively. Fungal counts varied from not detectable (ND) to 2.10 x 108 CFU g-1. The prevalent genera were Aspergillus spp (60 %) and Fusarium spp (66.7 %), respectively The prevalent species was Aspergillus fumigatus. 50 % of A. flavus strains produced 75 to 112.5 μg g-1 AFB1. 46 % of 2007 samples were contaminated with 4 to 10 μg kg-1 AFB1. Deoxynivalenol was detected in 33.3 % of the samples (≥ 1. 25 μg g-1). Fumonisin B1 and ZEA were not detected. This study can be useful to estimate the mycotoxicological risk of cattle TMRs in this region and to compare results with studies from other beef-producing countries

Analysis of gut microbiota in rheumatoid arthritis patients. Disease-related dysbiosis and modifications induced by etanercept

A certain number of studies were carried out to address the question of how dysbiosis could affect the onset and development of rheumatoid arthritis (RA), but little is known about the reciprocal influence between microbiota composition and immunosuppressive drugs, and how this interaction may have an impact on the clinical outcome. The aim of this study was to characterize the intestinal microbiota in a groups of RA patients treatment-naïve, under methotrexate, and/or etanercept (ETN). Correlations between the gut microbiota composition and validated immunological and clinical parameters of disease activity were also evaluated. In the current study, a 16S analysis was employed to explore the gut microbiota of 42 patients affected by RA and 10 healthy controls. Disease activity score on 28 joints (DAS-28), erythrocyte sedimentation rate, C-reactive protein, rheumatoid factor, anti-cyclic citrullinated peptides, and dietary and smoking habits were assessed. The composition of the gut microbiota in RA patients free of therapy is characterized by several abnormalities compared to healthy controls. Gut dysbiosis in RA patients is associated with different serological and clinical parameters; in particular, the phylum of Euryarchaeota was directly correlated to DAS and emerged as an independent risk factor. Patients under treatment with ETN present a partial restoration of a beneficial microbiota. The results of our study confirm that gut dysbiosis is a hallmark of the disease, and shows, for the first time, that the anti-tumor necrosis factor alpha (TNF-α) ETN is able to modify microbial communities, at least partially restoring a beneficial microbiota

A Self-Reference False Memory Effect in the DRM Paradigm: Evidence from Eastern and Western Samples

It is well established that processing information in relation to oneself (i.e., selfreferencing) leads to better memory for that information than processing that same information in relation to others (i.e., other-referencing). However, it is unknown whether self-referencing also leads to more false memories than other-referencing. In the current two experiments with European and East Asian samples, we presented participants the Deese-Roediger/McDermott (DRM) lists together with their own name or other people’s name (i.e., “Trump” in Experiment 1 and “Li Ming” in Experiment 2). We found consistent results across the two experiments; that is, in the self-reference condition, participants had higher true and false memory rates compared to those in the other-reference condition. Moreover, we found that selfreferencing did not exhibit superior mnemonic advantage in terms of net accuracy compared to other-referencing and neutral conditions. These findings are discussed in terms of theoretical frameworks such as spreading activation theories and the fuzzytrace theory. We propose that our results reflect the adaptive nature of memory in the sense that cognitive processes that increase mnemonic efficiency may also increase susceptibility to associative false memories

A Method to Improve the Early Stages of the Robotic Process Automation Lifecycle

The robotic automation of processes is of much interest to organizations. A common use case is to automate the repetitive manual tasks (or processes) that are currently done by back-office staff through some information system (IS). The lifecycle of any Robotic Process Automation (RPA) project starts with the analysis of the process to automate. This is a very time-consuming phase, which in practical settings often relies on the study of process documentation. Such documentation is typically incomplete or inaccurate, e.g., some documented cases never occur, occurring cases are not documented, or documented cases differ from reality. To deploy robots in a production environment that are designed on such a shaky basis entails a high risk. This paper describes and evaluates a new proposal for the early stages of an RPA project: the analysis of a process and its subsequent design. The idea is to leverage the knowledge of back-office staff, which starts by monitoring them in a non-invasive manner. This is done through a screen-mousekey- logger, i.e., a sequence of images, mouse actions, and key actions are stored along with their timestamps. The log which is obtained in this way is transformed into a UI log through image-analysis techniques (e.g., fingerprinting or OCR) and then transformed into a process model by the use of process discovery algorithms. We evaluated this method for two real-life, industrial cases. The evaluation shows clear and substantial benefits in terms of accuracy and speed. This paper presents the method, along with a number of limitations that need to be addressed such that it can be applied in wider contexts.Ministerio de Economía y Competitividad TIN2016-76956-C3-2-

Qual o Papel dos Bloqueadores-Beta numa Coorte de Tratamento Contemporânea de Doentes com Síndrome Coronária Aguda? Análise de Emparelhamento de Score de Propensão

INTRODUCTION: The evidence for beta-blocker use in patients after acute coronary syndrome (ACS), particularly in those with left ventricular (LV) dysfunction, dates from the late 1990s. We aimed to assess the role of beta-blockers in a contemporary population of patients with ACS. METHODS: Propensity-score matching (1:2) was performed for the use of beta-blockers in a population of consecutive patients admitted to our department with ACS. After matching, 1520 patients were analyzed. Cox regression analysis was used to assess the impact of beta-blocker use on the primary outcome (one-year all-cause mortality). RESULTS: Patients who did not receive beta-blockers were less aggressively treated with other pharmacological and invasive interventions and had higher one-year mortality (20.3% vs. 7.5%). Beta-blocker use was an independent predictor of mortality, with a significant relative risk reduction of 56%. The other independent predictors were age, diabetes, LV dysfunction, heart rate, systolic blood pressure and creatinine on admission. The impact of beta-blockers was significant for all classes of LV function, including patients with normal or mildly reduced ejection fraction. CONCLUSIONS: In a contemporary ACS population, we confirmed the benefits of beta-blocker use after ACS, including in patients with normal or mildly to moderately impaired LV function.info:eu-repo/semantics/publishedVersio

Intravitreal ranibizumab for myopic choroidal neovascularization: 12-month results

PURPOSE: The purpose of this study was to evaluate the safety and efficacy of intravitreal ranibizumab after 12 months in the treatment of choroidal neovascularization secondary to pathologic myopia. METHODS: This was a prospective, multicenter, consecutive, nonrandomized, interventional case series. The study included 34 eyes of 32 patients with choroidal neovascularization secondary to pathologic myopia; 13 eyes had previous photodynamic therapy, and 21 eyes had no previous treatment. The patients were followed for > or = 12 months. Best-corrected visual acuity, optical coherence tomography, and the presence of metamorphopsia were assessed monthly. RESULTS: Mean visual acuity improved 8 letters from baseline to 12-month follow-up, and the difference was statistically significant (P or = 3 lines, 44% improved > or = 2 lines, 65% improved > or = 1 line, and 79% improved > or = 0 lines. Central retinal thickness decreased significantly from baseline to the 12-month follow-up (P < 0.01). A mean of 3.6 treatments were performed during the 12-month follow-up, and no systemic or ocular side effects were registered during that time. CONCLUSION: One-year results of intravitreal ranibizumab for myopic choroidal neovascularization are very promising. Additional prospective studies are necessary to better determine long-term efficacy and safety

Cohexisting Medullary and Papillary Thyroid Cancer

Purpose: Papillary thyroid carcinomas (PTCs) and medullary thyroid carcinomas (MTCs) have always been considered different in terms of their incidence rates, cell origins, and histopathological features. Simultaneous occurrence of both disease entities is very rare. Methods: We describe a series of cases with simultaneous MTC and PTC occurrences in the thyroid gland. Results: From 2,897 patients (mean age, 49.2±12.5; 81% women) who underwent thyroidectomy for cancer between 2000 and 2015, we reviewed 11 cases of simultaneous occurrence of MTCs and PTCs. Multifocal PTC with simultaneous MTC was detected in 5 of the 11 cases (45%). Of these PTC patients, 2 had 2 foci, 2 had 3 foci, and 1 had 4 foci. There was 1 case of multifocal MTC with solitary PTC. One patient presented with “composite thyroid carcinoma” with mixed features of MTCs and PTCs. Eight patients (72%) presented an association with diffuse lymphocytic thyroiditis. The sizes of the tumors were 1.95±0.23 cm vs. 1.20±0.20 cm for PTCs and MTCs, respectively (P=0.531). The prevalence of extrathyroidal extension was 33.1% vs. 30.2% for PTCs and MTCs, respectively (P=0.282). All patients underwent total thyroidectomy and central neck node dissection. Radio iodine was delivered to 44% of patients. Follow-up review revealed 9 disease-free patients and 1 with local neck recurrence, while 1 patient died due to non-thyroid reasons. Conclusion: There are only 30 reports describing a total of 50 cases in the English literature regarding concurrent PTC and MTC in the same gland. This study represents one of the largest case series. Whether the incidence of another cancer in these patients is coincidental, or due to the possible activation of a common tumorigenic pathway for both follicular and parafollicular thyroid cells, remains to be elucidated

Fishers' knowledge and seahorse conservation in Brazil

From a conservationist perspective, seahorses are threatened fishes. Concomitantly, from a socioeconomic perspective, they represent a source of income to many fishing communities in developing countries. An integration between these two views requires, among other things, the recognition that seahorse fishers have knowledge and abilities that can assist the implementation of conservation strategies and of management plans for seahorses and their habitats. This paper documents the knowledge held by Brazilian fishers on the biology and ecology of the longsnout seahorse Hippocampus reidi. Its aims were to explore collaborative approaches to seahorse conservation and management in Brazil; to assess fishers' perception of seahorse biology and ecology, in the context evaluating potential management options; to increase fishers' involvement with seahorse conservation in Brazil. Data were obtained through questionnaires and interviews made during field surveys conducted in fishing villages located in the States of Piauí, Ceará, Paraíba, Maranhão, Pernambuco and Pará. We consider the following aspects as positive for the conservation of seahorses and their habitats in Brazil: fishers were willing to dialogue with researchers; although captures and/or trade of brooding seahorses occurred, most interviewees recognized the importance of reproduction to the maintenance of seahorses in the wild (and therefore of their source of income), and expressed concern over population declines; fishers associated the presence of a ventral pouch with reproduction in seahorses (regardless of them knowing which sex bears the pouch), and this may facilitate the construction of collaborative management options designed to eliminate captures of brooding specimens; fishers recognized microhabitats of importance to the maintenance of seahorse wild populations; fishers who kept seahorses in captivity tended to recognize the condtions as poor, and as being a cause of seahorse mortality

Parenteral Nutrition-Associated Cholestasis and Triglyceridemia in Surgical Term and Near-Term Neonates: A Pilot Randomized Controlled Trial of Two Mixed Intravenous Lipid Emulsions

BACKGROUND: Cholestasis is a common complication in infants receiving prolonged parenteral nutrition (PN). We studied the effects of two intravenous lipid emulsions composed with either 30% soybean oil, 30% medium-chain triglycerides (MCT), 25% olive oil, and 15% fish oil (SMOF) or with 50% MCT and 50% soybean oil n-6 (MCT/SOY) on the incidence of cholestasis in surgical term and near-term neonates. METHODS: A single-center, double-blinded, randomized controlled trial compared the incidence of cholestasis using either SMOF or MCT/SOY in neonates born at gestational age ≥34 weeks undergoing major surgery. The primary outcome was the incidence of conjugated serum bilirubin >1 mg/dL. Other liver enzymes were assessed as secondary outcomes. A post-hoc analysis assessed serum triglycerides levels. Odds ratios were estimated by mixed-effects regression models. RESULTS: Enrollment was prematurely interrupted because the MCT/SOY became unavailable, thus 49 infants (SMOF 22, MCT/SOY 27) completed the study. The exposure (time on PN, cumulative dose of lipids) was similar in both groups. Similar cumulative incidence rates were found for elevated conjugated bilirubinemia and other liver enzymes. Hypertriglyceridemia >250 mg/dL (12/49) was more frequent in MCT/SOY (37.0%, 95% CI 21.53-55.77) than in SMOF (9.1%, 95% CI 2.53-27.81, p = 0.024). Triglyceridemia at the first assessment (median 8 postnatal days) was significantly higher with MCT/SOY than with SMOF (181 vs. 134 mg/dL, p = 0.006). Over the whole study period, mean triglyceride concentration was 36.5 mg/dL higher with MCT/SOY compared with SMOF (p = 0.013). CONCLUSION: Both emulsions had similar effects on the incidence of cholestasis and markers of liver integrity, but MCT/SOY induced higher serum triglyceride concentrations.info:eu-repo/semantics/publishedVersio