High-sensitivity cardiac troponin I as a reliable prognosis biomarker in patients with hypertrophic cardiomyopathy

BACKGROUND: Hypertrophic cardiomyopathy (HCM) is the most common inherited cardiac disease and is associated with increased risk of cardiovascular events. For risk assessment, guidelines recommend carrying out different tests during follow-up. However, the role of plasma biomarkers such as serum high-sensitivity cardiac troponin- I (hs-cTnI) has not yet been well established. To get more data, we analyzed the relationships between this biomarker and clinical and imaging parameters. METHODS: We performed a retrospective study based on the review of data of HCM patients with at least one hs-cTnI measurement in our center and compared the clinical profiles of patients with and without hs-cTnI elevation. In case of several measurements, the highest hs-cTnI value was considered. RESULTS: Out of 98 patients, 52% presented elevated hs-cTnI. Median level of ambulatory measurements was 17 ng/mL. Maximum left-ventricle (LV) hypertrophy was mainly basal-septal or septal, with a mean value of 18 mm. Late gadolinium enhancement was mainly intramyocardial. During follow-up, 37 patients developed at least one cardiovascular complication. 75 patients had at least one ambulatory hs-cTnI measurement, out of which 15 had more than one measurement. Significant differences between measurements occurred in 5 (33%) out of these 15 patients. The presence of elevated ambulatory hs-cTnI levels was significantly associated with a reduced LV ejection fraction (LVEF) (p=0,006) and an increased maximum LV wall thickness (p=0,044). CONCLUSIONS: In our study, elevated ambulatory hs-cTnI was associated with both reduced LVEF and increased maximum LV wall thickness. The availability of baseline hs-cTnI levels may help in stratifying the risk of HCM patients

Radiology Case

Lactente do sexo masculino com seis meses. Antecedentes pessoais: gestação de termo, vigiada e sem intercorrências, somatometria ao nascimento adequada, índice de Apgar 10/10 no 1º e 5º minuto e período neonatal sem intercorrências.

Enfermagem de Reabilitação na prevenção de quedas em idosos no domicílio

Objective: Identify intrinsic and extrinsic factors associated with the risk of fall in the elderly at home; Analyse the result of rehabilitation nursing care on decreasing the risk of fall in the elderly at home. Methodology: Descriptive case study with three participants who are patients that are integrated into long-term care team unit integrated in the community care, with neurological and balance changes, targets of rehabilitation nursing care with potential for recovery. Results: During eight weeks of implementation of the rehabilitation nursing care program, there was a decrease in intrinsic risk factors for falls, related to balance, transfers and mobility. When evaluating the results obtained it is possible to observe that all the participants obtained gains. In all cases there were gains in the ability of the participants to perform your daily living activities the in 45 points and an increase in the Equilibrium of 42 points. The evolution in the degree of dependence occurred only in one case, and in the other two cases, severe dependence was maintained. Conclusion: The rehabilitation nursing care produce gains in balance and decreased dependency which consequently reduces the risk of fall in the elderly at home. The rehabilitation nursing at home in subacute phases of neurological disease can enhance these results.Objetivo: Identificar factores intrínsecos y extrínsecos asociados a riesgos de caídas en ancianos en el hogar; Analizar el resultado de cuidados de enfermería de rehabilitación en la disminución de los riesgos de caídas de los ancianos en el hogar. Métodos: Estudio de caso descriptivo con tres participantes que son pacientes que están integrados en el equipo de Cuidados Continuados Integrados de la Unidad de Cuidados de la Comunidad, con alteraciones de origen neurológicos y con alteración del equilibrio, objetivo de cuidados de la enfermería de rehabilitación con potencial de recuperación. Resultados: Durante ocho semanas de implementación del programa de cuidados de enfermería de rehabilitación se verificó la disminución de factores de riesgos intrínsecos para la caída, relacionados con el equilibrio, las transferencias y la movilidad. Al evaluar los resultados obtenidos es posible observar que todos los participantes obtuvieron ganancias. En general, en todos los casos hubo ganancias en la capacidad de los participantes para ejecutar sus actividades de vida diarias en 45 puntos y un aumento del Equilibrio de 42 puntos. La evolución en el grado de dependencia ocurrió sólo en un caso, siendo que en los restantes dos se mantuvo la dependencia grave. Conclusión: Los cuidados de enfermería de rehabilitación producen ganancias en el equilibrio y en la disminución de la dependencia, lo que disminuye el riesgo de caída en ancianos en el domicilio. La enfermería de rehabilitación en el domicilio en las fases subagudas de la enfermedad neurológica puede potenciar estos resultados.Objetivo: Identificar fatores intrínsecos e extrínsecos associados ao risco de queda em idosos no domicílio; Analisar o resultado de cuidados de Enfermagem de Reabilitação na diminuição do risco de queda em idosos no domicílio. Métodos: Estudo de caso descritivo com três participantes que são utentes integrados na Equipa de Cuidados Continuados Integrados de uma Unidade de Cuidados na Comunidade, com alterações do foro neurológico e com alteração do equilíbrio, alvos de cuidados de enfermagem de reabilitação, e com potencial de recuperação. Resultados: Durante oito semanas de implementação do programa de cuidados de enfermagem de reabilitação verificou-se a diminuição de fatores de risco intrínsecos para queda, relacionados com o equilíbrio, com as transferências e com a mobilidade. Ao avaliar os resultados obtidos é possível observar que todos os participantes obtiveram ganhos. De uma forma geral, em todos os casos houve ganhos na capacidade dos participantes executarem as AVD’s (IB) em 45 pontos e um aumento do Equilíbrio (EEB) de 42 pontos. A evolução no grau de dependência ocorreu apenas em um caso, sendo que nos restantes dois manteve-se a dependência grave. Conclusão: Os cuidados de enfermagem de reabilitação indiciam produzir ganhos no equilíbrio e na capacidade de execução dos autocuidados, o que consequentemente diminui o risco de queda em idosos no domicílio. A enfermagem de reabilitação no domicílio nas fases subagudas da doença neurológica pode potencializar estes resultados

Antioxidant activity of thyme waste extract in O/W emulsions

Thymus vulgaris (thyme) is an aromatic plant and its essential oil has been applied as antimicrobial and antioxidant due to the presence of phenolic compounds. However, after steam distillation, the deodorized plant material is rejected, despite the possible presence of bioactive compounds. Ethanolic thyme waste extract revealed the presence of benzoic acid, 4-hydroxybenzoic acid, ferulic acid, caffeic acid, and sinapic acid. This waste thyme extract had the capacity for preventing the formation of primary and secondary lipid oxidation products in emulsions O/W (oil in water), constituted by diverse proportions of wheat and almond oils, without interfering with the viscosity parameters, for 10 weeks, at 37 °C. The increasing proportion of almond oil (≥50%) in the emulsion increases its resistance to oxidation, which is improved with the presence of an optimal concentration of tested thyme waste extract (0.02% and 0.04%). The waste thyme extract can, therefore, be used as an antioxidant either in food or pharmaceutical emulsions O/W, replacing the synthetic antioxidants.Agência financiadora Fundacao para a Ciencia e Tecnologia-FCT; Portugal UID/BIA/04325/2013-MEDTBIO UID/MAR/00350/2013info:eu-repo/semantics/publishedVersio

Vinculação, alterações fisiológicas e relações de cariz íntimo na idade adulta

As relações íntimas na idade adulta, aos olhos da Teoria da Vinculação, têm vindo a ser alvo de diversos estudos e de crescentes desenvolvimentos, à luz daqueles que são os pressupostos metodológicos e conceptuais. A TV proposta por Bowlby (1973), alicerçada no construto de modelos internos dinâmicos (MID), parece ser um bom ponto de partida para a exploração da relação entre a vinculação na infância e relações íntimas na idade adulta. Tendo como objetivo geral a compreensão da relação entre a organização da vinculação, a representação da relação íntima e a resposta fisiológica individual num momento de interação diádica, este estudo apresenta um carácter inovador, na medida em que permite associar a variação da resposta cardíaca ao momento de interação diádica, aquando a administração da Couple Interaction Task (CIT). Os participantes deste estudo foram um casal heterossexual, com 25 e 31 anos de idade, ao qual foram administrados, individualmente, e gravados em registo áudio, as entrevistas Adult Attachment Interview (AAI) e Intimate Relationship Interview (IRI), seguidos da CIT, realizada em casal, simultaneamente à medição da frequência cardíaca através do Biopac BioNomadix. Os resultados obtidos vão de encontro aos encontrados na literatura, evidenciando que a organização da vinculação se associa à representação da relação íntima – onde é visível a continuidade do padrão de vinculação –, assim como a qualidade da interação diádica. Relativamente à frequência cardíaca verificou-se que o elemento seguro apresenta um padrão de maior variância cardíaca e maior responsividade, ao contrário do elemento caracterizado como desligado, que apresenta um padrão de responsividade cardíaca neutro.Intimate relationships in adulthood, in the eyes of the attachment theory, have been the target of several studies and growing developments, in the light of those that are the methodological and conceptual assumptions. Attachment theory proposed by Bowlby (1973), based on the construct of dynamic internal models (MID), seems to be a good starting point for exploring the relationship between childhood’s attachment and intimate relationships in adulthood. With the general objective of understanding the relationship between the organization of attachment, the representation of the intimate relationship and the individual physiological response at a time of dyadic interaction, this study presents an innovative character, as it allows associate the variation of the cardiac response to the moment of dyadic interaction when administering the Couple Interaction Task (CIT). The participants of this study were a heterosexual couple, with 25 and 31 years old, who were individually administered and recorded in audio recording, the instruments Adult Attachment Interview (AAI) and Intimate Relationship Interview (IRI), followed by CIT, administered as a couple, simultaneously to the measurement of heart rate through the Bionomadix Biopac. The results obtained go against those found in the literature, evidencing that the attachment organization influences the representation of the intimate relationship – where the continuity of the attachment pattern is visible – as well as the quality of the dyadic interaction. Regarding the heart rate, it was found that the secure element presents a pattern of higher cardiac variance and greater responsiveness, as opposed to the element characterized as dismissing, which presents a pattern of neutral cardiac responsiveness

Conhecimentos e atitudes dos médicos dentistas na prevenção e diagnóstico precoce do cancro oral

Introdução: O cancro oral define-se como um grupo de neoplasias malignas que engloba a região da cabeça e pescoço. Recentes estatísticas globais reportaram 377,713 novos casos e 177,757 mortes por cancro oral, em 2020, em todo o mundo. Os médicos dentistas devem estar atentos a todos os sinais e sintomas para fazer um correto diagnóstico e evitar que os pacientes sejam diagnosticados já numa fase avançada da doença. Para além de atuarem na deteção da doença, os médicos dentistas têm também um papel importante na reabilitação, aliviando os efeitos colaterais da terapia oncológica. Objetivos: Determinar os conhecimentos dos médicos dentistas no que diz respeito ao diagnóstico precoce de lesões potencialmente malignas e de cancro oral, bem como analisar as suas atitudes e práticas para a prevenção desta patologia. Materiais e métodos: A amostra foi constituída pelos médicos dentistas que responderam a um questionário online divulgado através de email ou de outras plataformas digitais entre os meses de dezembro de 2022 e fevereiro de 2023.O instrumento de recolha de dados, adaptado dos questionários de Dib (2003) e Horowitz (2000), foi dividido em 4 grupos: I- Caracterização pessoal do profissional de saúde oral; II- Cancro oral e lesões potencialmente malignas; III- Prática clínica de diagnóstico de cancro oral; IV- Opinião pessoal. Após a recolha dos dados, fez-se a codificação e inserção no SPSS, onde se realizou todo o tratamento estatístico descritivo e inferencial. Resultados: Participaram no estudo 102 médicos dentistas. Apesar de a maioria dos profissionais de saúde reconhecer corretamente o género mais afetado pela patologia, bem como o tipo de cancro oral mais comum, apenas 22,5% sabe identificar os locais com maior potencial de malignização. A maioria dos médicos dentistas faz a avaliação das mucosas, língua, palato, pavimento da boca e região retromolar no exame intra-oral. Contudo, destes, nem todos fazem a palpação dos gânglios linfáticos da região da cabeça e pescoço. Menos de metade dos clínicos realizaram uma biópsia durante a sua atividade profissional, por este motivo a maioria dos inquiridos não se sente confortável na realização desta tarefa. Apenas 4,9% dos médicos dentistas considera ter uma capacidade muito boa no diagnóstico de lesões com potencial de malignização ou cancro oral. Ainda não é unânime, entre os inquiridos, que esta profissão seja preponderante na prevenção e deteção do cancro oral. Conclusão: Embora os resultados obtidos neste estudo não tenham sido totalmente decepcionantes, encontrámos algumas lacunas que podem ser melhoradas, nomeadamente no que diz respeito ao conhecimento dos clínicos sobre lesões com potencial maligno. Assim, é fundamental investir na educação e formação nesta área, de forma a consciencializar e travar a evolução desta patologia.Introduction: Oral cancer is defined as a group of malignant neoplasms that encompass the head and neck region. Recent global statistics reported 377,713 new cases and 177,757 deaths from oral cancer in 2020 worldwide. Dentists must be alert to all signs and symptoms in order to make a correct diagnosis and prevent patients from being diagnosed at an advanced stage of the disease. In addition to detecting the disease, dentists also play an important role in rehabilitation, alleviating the side effects of cancer therapy. Objectives: To determine the knowledge of dentists regarding the early diagnosis of potentially malignant lesions and oral cancer, as well as to analyze their attitudes and practices for the prevention of this pathology. Materials and methods: The sample consisted of dentists who answered an online questionnaire distributed by email or other digital platforms between December 2022 and February 2023. The data collection instrument, adapted from the questionnaires of Dib (2003) and Horowitz (2000), was divided into 4 groups: I- Personal characterization of the oral health professional; II- Oral cancer and potentially malignant lesions; III- Clinical practice of oral cancer diagnosis; IV- Personal opinion. After data collection, data were coded and entered into SPSS where all descriptive and inferential statistical treatment was performed. Results: 102 dentists participated in the study. Although most health professionals correctly recognized the gender most affected by the pathology as well as the most common oral cancer, only 22.5% could identify the sites with greater potential for malignancy. Most dentists evaluate the mucous membranes, tongue, palate, mouth floor and retromolar region in the intraoral examination. However, of these, not all perform palpation of the lymph nodes of the head and neck region. Less than half of the clinicians have ever performed a biopsy during their professional activity, for this reason most of the respondents do not feel comfortable in performing this task. Only 4.9% of the dentists consider that they have very good skills in diagnosing lesions with malignant potential or oral cancer. It is still not unanimous that this profession is preponderant in the prevention and detection of oral cancer. Conclusion: Although the results obtained in this study were not completely disappointing, we found some gaps that can be improved, particularly regarding the clinicians' knowledge about lesions with malignant potential. Thus, it is crucial to invest in education and training in this area in order to raise awareness and halt the evolution of this pathology

Digital Innovation and Transformation: a Quasi-Systematic Literature Review

Nowadays there are several examples of successful companies that run innovative digital business models. Studies indicate that companies that do not follow the technological tendencies will possibly cease to exist in the next years. Besides, Digital Transformation has a direct impact on relations and forms of consumption. However, although much have been said about this topic, the literature has not established yet a common ground about the meaning of Digital Innovation and Digital Transformation. The purpose of this paper is to identify, analyze and synthesize the various aspects of the main concepts related to Digital Innovation and Transformation (DI&T). We have done a quasi-systematic review of the literature, generating as a primary outcome a list of the main constructs related to DI&T, as well as their definitions. Our main contribution is a map that conceptualizes and relates DI and DT that could be used as a base for future researchers

Visualization of Digital Transformation Initiatives Elements through ArchiMate Viewpoints

Digital transformation stems from a mix of personal and corporate IT environments and involves integrating digital technologies and business processes in a digital economy. As such, organizations expect that digital transformation improves performance, increases their reach, and ensures better business results. However, there is still a lack of (i) conceptual models to provide an accurate representation of the digital transformation elements; and (ii) standard visualizations of such elements to specific stakeholders. In a previous work, a reference model to support digital transformation initiatives using ArchiMate was proposed. In this paper, we address the second part of this problem regarding the need for specific visualizations. We followed the Design Science Research approach to learn how to identify the needs of the stakeholders, extending and improving the reference model through the design of a set of architectural viewpoints. We used the well-known ArchiSurance case to demonstrate the application of the viewpoints and semi-structured interviews to evaluate the proposal, providing insights to the discussion of the results obtained.</p