Gestão farmacoterapêutica no doente idoso

Dissertação para obtenção do grau de Mestre no Instituto Superior de Ciências da Saúde Egas MonizA população idosa tem vindo a crescer ao longo dos anos em consequência da diminuição da fecundidade, por emancipação da mulher, do aumento da esperança média de vida, por diminuição da mortalidade à nascença, e da emigração da sociedade portuguesa. O envelhecimento leva a modificações fisiológicas que conduzem ao desenvolvimento de diversas doenças e síndromes geriátricas, e que condicionam alterações farmacocinéticas e farmacodinâmicas, que tornam o comportamento dos fármacos difícil de prever. O idoso está, assim, associado ao aumento da prevalência de morbilidades e, consequentemente, ao elevado consumo de medicamentos, a denominada polimedicação. A polimedicação condiciona maior carga de iatrogenia, como o aumento da probabilidade de reacções adversas, de interações medicamentosas e das síndromes geriátricas. A polimedicação também promove a diminuição da adesão à terapêutica. Face ao exposto, torna-se obrigatório otimizar a gestão farmacoterapêutica no doente idoso, com a colaboração do farmacêutico. Neste processo, o farmacêutico, inserido numa equipa multidisciplinar, tem como objetivo analisar e assegurar uma terapêutica medicamentosa individualizada e apropriada para os doentes deste grupo etário. Entre outras atividades, o farmacêutico deve promover a formação do doente e do seu cuidador, auxiliando-os na melhoria da compreensão sobre a medicação e seus benefícios, por forma a melhorar a sua adesão à terapêutica. O farmacêutico tem como compromisso promover a monitorização terapêutica, avaliando a resposta do doente idoso à mesma, em relação à segurança e eficácia, Para a realização destas atividades, o farmacêutico tem que conhecer as especificidades fisiológicas que afetam a resposta farmacológica no idoso e quais as ferramentas, que foram desenvolvidas e se encontram validadas, que o ajudaram na persecução deste objetivo: procurando maximizar a qualidade de vida do doente idoso por via da utilização adequada dos medicamentos

Prevalence of adult overweight and obesity in 20 European countries, 2014

Background: Monitoring obesity and overweight prevalence is important for assessing interventions aimed at preventing or reducing the burden of obesity. This study aimed to provide current data regarding the prevalence of overweight and obesity of adults, from 20 European countries. Methods: Participants were 34 814 (16 482 men) adults with mean age 50.8 ± 17.7. Data from European Social Survey round 7, 2014, were analysed. Body mass index (BMI) was calculated from self-reported height and weight. Results: The proportion of underweight was only 2%, and 44.9% for normal weight. Overweight and obese accounted for 53.1%. More men than women were overweight (44.7% vs. 30.5%). Older adults were significantly more overweight (42.4%) and obese (20.9%) than middle age and younger adults. Retired people account for a greater proportion of overweight (42.0%) and obese (21.5%), when compared with employed, unemployed and students. People from rural areas were significantly more overweight (39.1 vs. 36.1%) and obese (17.0 vs. 15.3%) than those who lived in urban areas. The estimates indicate that the highest prevalence of overweight was in Czech Republic (45.2%), Hungary (43.7%) and Lithuania (41.7%). For obesity, Slovenia (20.8%), Estonia (19.7%) and the United Kingdom (19.2%) were the countries with the highest prevalence. Conclusion: Even though data was self-reported, and individuals tend to overestimate their height and underestimate their weight, the prevalence of overweight and obesity is considered high. More than half of the European population is overweight and obese. This study strengthens and updates the claims of an excessive weight epidemic in Europe.publishersversionpublishe

StAN: exploiting shared interests without disclosing them in gossip-based publish/subscribe

Publish/subscribe mechanisms for scalable event dissemination are a core component of many distributed systems ranging from EAI middleware to news dissemination in the Internet. Hence, a lot of research has been done on overlay networks for efficient decentralized topic-based routing. Specifically, in gossip-based dissemination, approximating nodes with shared interests in the overlay makes dissemination more efficient. Unfortunately, this usually requires fully disclosing interests to nearby nodes and impacts reliability due to clustering. In this paper we address this by starting with multiple overlays, one for each topic subscribed, that then separately self-organize to share a large number of physical connections, thereby leading to reduced message traffic and maintenance overhead. This is achieved without a node ever disclosing an interest to another node that doesn’t share it and without impacting the robustness of the overlay. Besides presenting the overlay maintenance protocol, we evaluate it using simulation in order to validate our results

In search for the role of thermospermine synthase gene in poplar vascular development

This work is supported by the FCT project PTDC/AGR-GPL/098369/2008 and FCT PhD grant SFRH/BD/30074/2006 (A.M.).Peer Reviewe

Neonatal alloimmune thrombocytopenia: two different neonatal manifestations of the same disease

Fetal and neonatal alloimmune thrombocytopenia is a rare disorder in which maternal alloantibodies cross the placenta and cause fetal thrombocytopenia. Most cases are mild but can be potentially fatal if there is an intracranial haemorrhage. Usually, the mother is asymptomatic during pregnancy and no screening is routinely recommended unless there is obstetric or family history. After birth, prompt identification is crucial so that the newborn is closely monitored and treatment is given, if needed, to prevent serious complications. In this article we present two clinical cases of fetal and neonatal alloimmune thrombocytopenia in first-born children, after uneventful pregnancies, with different outcomes and discuss the obstetric management and follow-up in future pregnancies

Combining central pattern generators with the electromagnetism-like algorithm for head motion stabilization during quadruped robot locomotion

Visually-guided locomotion is important for autonomous robotics. However, there are several difficulties, for instance, the head shaking that results from the robot locomotion itself that constraints stable image acquisition and the possibility to rely on that information to act accordingly. In this article, we propose a controller architecture that is able to generate locomotion for a quadruped robot and to generate head motion able to minimize the head motion induced by locomotion itself. The movement controllers are biologically inspired in the concept of Central Pattern Generators (CPGs). CPGs are modelled based on nonlinear dynamical systems, coupled Hopf oscillators. This approach allows to explicitly specify parameters such as amplitude, offset and frequency of movement and to smoothly modulate the generated oscillations according to changes in these parameters. We take advantage of this particularity and propose a combined approach to generate head movement stabilization on a quadruped robot, using CPGs and a global optimization algorithm. The best set of parameters that generates the head movement are computed by the electromagnetism-like algorithm in order to reduce the head shaking caused by locomotion. Experimental results on a simulated AIBO robot demonstrate that the proposed approach generates head movement that does not eliminate but reduces the one induced by locomotion

A UTILIZAÇÃO DE INSTRUMENTOS DE REFLEXÃO NO CURSO DE FORMAÇÃO INICIAL DE PROFESSORES NO INSTITUTO SUPERIOR DE CIÊNCIAS DA EDUCAÇÃO-HUAMBO E ISUPE EKUIKUI II NA PROVÍNCIA DO HUAMBO

The use of reflection tools in initial teacher training has been discussedaround the world. Despite the international debate, there is no almostliterature on the subject in Angola. This is why, we proposed to analyze theexistence of knowledge/perception about reflective tools and their respectiveuse in initial teacher training courses at ISCED-Huambo and ISUPE EKUIKUIII in the Huambo Province. For such, we used a quantitative methodologyusing statistical analysis that involved descriptive and inferential statisticalmeasures performed through SPSS, and the Chi-square test was used tocompare the results. It was found that teachers have greaterknowledge/perception of reflection tools than students; as for the use oftheir respective reflection tools, the percentage is higher in teachers 19.6%vs 12.1% although the difference is not statistically significant χ2 (2) =2,338, p = .311; Despite this difference, we concluded that there is no use ofreflection tools, because, whenever the participants were asked tojustify/specify which instruments they used, they presented qualitativecategories that do not respond to the frequencies found. The contribution ofthis research aims to encourage ISCED-Huambo and ISUPE-EKUIKUI II touse reflections tools as elements of an active methodology in the classes, inthe pedagogical practices or curricular internships of the initial teachertraining courses.O debate sobre instrumentos de reflexão na Formação Inicial de Professores (FIP) tem-se desenvolvido na arena internacional. Apesar disso, em Angola quase não existe literatura sobre o tema. Por esta razão, propusemo-nos analisar a existência de conhecimento ou perceção de Instrumentos de Reflexão (IR) e a sua respetiva utilização na FIP no ISCED-Huambo e ISUPE EKUIKUI II na província do Huambo. Para tal, utilizámos uma metodologia quantitativa com recurso a análise estatística que envolveu medidas de estatística descritiva e inferencial, efetuadas através de SPSS. Para comparar os resultados utilizou-se o teste do Qui-quadrado. Constatou-se que os professores têm maior conhecimento/perceção do que os estudantes; quanto à utilização dos respetivos IR, a percentagem é mais elevada nos professores 19.6% vs 12.1% mas a diferença não é estatisticamente significativa χ 2(2)= 2.338, p =.311; porém, apesar da diferença conclui-se que não existe utilização de IR nos cursos FIP, porque, sempre que os participantes foram inquiridos a justificar/especificar que instrumentos utilizavam, apresentaram categorias qualitativas que não respondem às frequências encontradas. O contributo desta pesquisa assenta em encorajar o ISCED-Huambo e o ISUPEEKUIKUI II a utilizar os IR como elementos de metodologia ativa nas aulas, nas práticas pedagógicas ou estágios dos cursos de FIP

Development of a Gold Nanoparticle-Based Lateral-Flow Immunoassay for Pneumocystis Pneumonia Serological Diagnosis at Point-of-Care

UID/Multi/04378/2019. POCI-01-0145-FEDER-007728. UID/QUI/50006/2019. POCI-01-0145-FEDER-007265. SFRH/BD/108433/2015. GG/001/2014.Pneumocystis jirovecii pneumonia (PcP) is a major human immunodeficiency virus (HIV)-related illness, rising among immunocompromised non-HIV patients and in developing countries. Presently, the diagnosis requires respiratory specimens obtained through invasive and costly techniques that are difficult to perform in all patients or implement in all economic settings. Therefore, the development of a faster, cost-effective, non-invasive and field-friendly test to diagnose PcP would be a significant advance. In this study, recombinant synthetic antigens (RSA) of P. jirovecii’s major surface glycoprotein (Msg) and kexin-like serine protease (Kex1) were produced and purified. These RSA were applied as antigenic tools in immunoenzymatic assays for detection of specific anti-P. jirovecii antibodies (IgG and IgM) in sera of patients with (n = 48) and without (n = 28) PcP. Results showed that only IgM anti-P. jirovecii levels were significantly increased in patients with PcP compared with patients without P. jirovecii infection (p ≤ 0.001 with both RSA). Thus, two strip lateral flow immunoassays (LFIA), based on the detection of specific IgM anti-P. jirovecii antibodies in human sera samples, were developed using the innovative association of P. jirovecii’s RSA with spherical gold nanoparticles (AuNPs). For that, alkanethiol-functionalized spherical AuNPs with ca. ~40 nm in diameter were synthetized and conjugated with the two RSA (Msg or Kex1) produced. These AuNP-RSA conjugates were characterized by agarose gel electrophoresis (AGE) and optimized to improve their ability to interact specifically with serum IgM anti-P. jirovecii antibodies. Finally, two LFIA prototypes were developed and tested with pools of sera from patients with (positive sample) and without (negative sample) PcP. Both LFIA had the expected performance, namely, the presence of a test and control red colored lines with the positive sample, and only a control red colored line with the negative sample. These results provide valuable insights into the possibility of PcP serodiagnosis at point-of-care. The optimization, validation and implementation of this strip-based approach may help to reduce the high cost of medical diagnosis and subsequent treatment of PcP both in industrialized and low-income regions, helping to manage the disease all around the world.publishersversionpublishe