Sepsis needs follow-up studies in intensive care units : another avenue for translational research

© All rights are reserved by Carlota SaldanhaSepsis characteristics were highlight in this mini review in order to call attention for a complex, age- independent, acute disease faced suddenly by the human body under infection or traumatic stimuli. It may follow surgical intervention, traumatic accident or exposure to an infectious agent. Timely diagnosis and accurate stratification of the severity of sepsis are needed to understand the molecular mechanisms involved in this pathophysiology and reduce mortality. In order to obtain these achievements follow-up studies need to be conducted in intensive care units under translational research.info:eu-repo/semantics/publishedVersio

Spindle Coma in the Intensive Care Unit: Different Aetiologies – Different Outcomes

Spindle coma is an electroclinical entity that has been used to describe an EEG pattern of “sleep-like” activity in comatose patients. Although it has been associated with favourable prognosis, its aetiology is one of the key factors for patient outcome. The authors present three cases of spindle coma with different aetiologies (amitriptyline overdose, pontine myelinolysis and hypoxic-ischaemic encephalopathy) that culminated in different outcomes

Conhecimentos, atitudes e comportamentos dos estudantes do ensino superior quanto à sustentabilidade: a identificação de gaps

Introdução. Estudar o comportamento das pessoas em relação à sustentabilidade é fundamental para alcançar os objetivos do desenvolvimento sustentável (ODS). Para a implementação e realização dos ODS, o nível de conhecimento dos indivíduos é essencial. As atitudes das pessoas desempenham um papel importante na promoção e realização dos ODS (Guan et al., 2019). Vários estudos têm-se centrado especificamente nos estudantes do ensino superior, medindo os seus conhecimentos, atitudes e comportamentos em relação à sustentabilidade (e.g., Afroz & Ilham, 2020; Aleixo et al., 2021; Leiva-Brondo et al., 2022; Salas-Zapata & Cardona-Arias, 2021). Afroz e Ilham (2020) constataram que os inquiridos tinham um elevado conhecimento e atitudes positivas em relação aos ODS, mas correlações negativas entre o conhecimento e prática. Objetivos. Este trabalho está inserido no âmbito do projeto Erasmus+ Time2act@SD e visa identificar as lacunas existentes ao nível do conhecimento, atitudes e comportamentos dos estudantes do ensino superior (EES), no contexto europeu, no que diz respeito à sustentabilidade nas dimensões ambiental, social e económica. Metodologia. Seguiu-se um estudo de natureza descritivo e quantitativo. Aplicou-se o Sustainability Consciousness Questionnaire de Gericke et al. (2019) a uma amostra de 716 estudantes de instituições do ensino superior (IES) europeias. Dos participantes, 56,7% são do género feminino, 73,5% com idade igual ou inferior a 25 anos. A amostra inclui estudantes de todas as áreas disciplinares, mas as mais representadas são as ciências sociais. Há participantes de 15 países diferentes, mas a maioria das respostas provém de Portugal (35,2%), Turquia (19,6%), Chipre (15,1%) e Eslovénia (13,8%). Resultados. No domínio da sustentabilidade ambiental, as principais lacunas identificadas estão relacionadas com: (i) melhoria da qualidade da água através da redução da poluição; (ii) aumento da eficiência na utilização da água; (iii) promoção da saúde e do bem-estar através de uma maior utilização de transportes com energias limpas; (iv) utilização eficiente dos recursos naturais através da mudança de comportamentos individuais; (v) redução da produção de resíduos através da prevenção, redução, reciclagem e reutilização; (vi) melhoria da educação sobre as alterações climáticas. No domínio da sustentabilidade social, as principais lacunas identificadas dizem respeito a:(i) boa saúde e bem-estar; (ii) educação para a cidadania global; (iii) igualdade de género. No domínio da sustentabilidade económica, as principais lacunas identificadas dizem respeito a: (i) erradicação da pobreza; (ii) educação para a literacia financeira; (iii) trabalho digno para todos; (iv) redução das desigualdades; (v) garantia de um consumo sustentável. Conclusão. Este trabalho permitiu identificar as áreas onde emergem mais lacunas ao nível dos conhecimentos, atitudes e comportamentos dos EES na Europa. Os resultados podem ser utilizados para melhorar os processos de ensino aprendizagem das IES e delinear estratégias que melhorem a Educação para o Desenvolvimento Sustentável.info:eu-repo/semantics/publishedVersio

Hyperoxemia and excess oxygen use in early acute respiratory distress syndrome : Insights from the LUNG SAFE study

Publisher Copyright: © 2020 The Author(s). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Background: Concerns exist regarding the prevalence and impact of unnecessary oxygen use in patients with acute respiratory distress syndrome (ARDS). We examined this issue in patients with ARDS enrolled in the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study. Methods: In this secondary analysis of the LUNG SAFE study, we wished to determine the prevalence and the outcomes associated with hyperoxemia on day 1, sustained hyperoxemia, and excessive oxygen use in patients with early ARDS. Patients who fulfilled criteria of ARDS on day 1 and day 2 of acute hypoxemic respiratory failure were categorized based on the presence of hyperoxemia (PaO2 > 100 mmHg) on day 1, sustained (i.e., present on day 1 and day 2) hyperoxemia, or excessive oxygen use (FIO2 ≥ 0.60 during hyperoxemia). Results: Of 2005 patients that met the inclusion criteria, 131 (6.5%) were hypoxemic (PaO2 < 55 mmHg), 607 (30%) had hyperoxemia on day 1, and 250 (12%) had sustained hyperoxemia. Excess FIO2 use occurred in 400 (66%) out of 607 patients with hyperoxemia. Excess FIO2 use decreased from day 1 to day 2 of ARDS, with most hyperoxemic patients on day 2 receiving relatively low FIO2. Multivariate analyses found no independent relationship between day 1 hyperoxemia, sustained hyperoxemia, or excess FIO2 use and adverse clinical outcomes. Mortality was 42% in patients with excess FIO2 use, compared to 39% in a propensity-matched sample of normoxemic (PaO2 55-100 mmHg) patients (P = 0.47). Conclusions: Hyperoxemia and excess oxygen use are both prevalent in early ARDS but are most often non-sustained. No relationship was found between hyperoxemia or excessive oxygen use and patient outcome in this cohort. Trial registration: LUNG-SAFE is registered with ClinicalTrials.gov, NCT02010073publishersversionPeer reviewe

Precipito-diagnostico do môrmo

Dissertação inaugural. Escola de Medicina Veterinária. 1912N/

Eustachian Valve Endocarditis: Echocardiographic Diagnosis in a Critical Care Patient

Eustachian valve endocarditis is rare. A literature review revealed that only 29 cases have been reported and, among them, there is only one mention of an intensive care unit (ICU) admission. We present an 82-year-old man without previous medical records who presented with septic shock with multiple organ dysfunction. The patient was admitted to the ICU and deteriorated with combined shock (septic + cardiogenic). A second ultrasound screen detected a prominent Eustachian valve with mobile multilobulated vegetation attached. Transesophageal echocardiography confirmed a 12 mm oscillating mass attached to a visible Eustachian valve

Soluble CD40 ligand profiles in patients with septic shock

© 2016 – IOS Press and the authors. All rights reservedAIM: Soluble CD40 ligand (sCD40L) has been considered as a marker of thrombosis and inflammation in several diseases, including sepsis. Recent studies challenge this view and point to a role of sCD40L in vascular and endothelial function. An indication of that association in sepsis has not been obtained so far. Therefore, herein we evaluated association between sCD40L and markers of hemorheology and inflammation on context of septic shock. METHODS: Time-changes of sCD40L levels over 72 hours of Intensive Care Unit (ICU) internment were assessed in 22 patients with septic shock and compared with 36 healthy volunteers. Association of sCD40L levels with erythrocyte deformability and aggregation (as markers of hemorheology), plasma concentrations of haemoglobin (Hb, as markers of endothelial function) and white blood cells (WBC) count (as marker of low-grade inflammation) were assessed in patients with septic shock. RESULTS: At ICU admission, sCD40L concentrations in patients with septic shock were lower (p = 0.024) than levels of healthy volunteers. However, sCD40L did not change over 72 hours of internment (F = 2.1, p = 0.137). Soluble CD40L levels in patients with septic shock at ICU admission correlate with concentrations of Hb (r = 0.61, p = 0.00) and WBC count (r = 0.63, p = 0.00), but not to erythrocyte deformability (r≥0.157, p≤0.235) and aggregation (r≥–0.109, p≤0.192). CONCLUSIONS: These results seem to highlight a possible association of sCD40L to endothelial function and inflammation in septic shock context.Work was financially supported by Fundação para a Ciência e Tecnologia (SFRM/BPD/6308/2009)info:eu-repo/semantics/publishedVersio

Advanced System Architecture and Algorithms for Smart Distribution Grids: The Sustainable Approach

In order to allow large scale integration of Distributed Energy Resources in a secure and efficient way, the EU Project SuSTAINABLE designed a reference architecture for management and control of the distribution system as a whole. This novel architecture is based on the hierarchical architecture already deployed in the InovGrid test site in Évora, Portugal InovCity. This will require the development of specific algorithms and tools to support distribution system operation that are able to exploit distributed intelligence in several network components. These advanced control functionalities are summarily described and include: state estimation, loadand renewable energy forecasting and voltage control

Retinopathy Phenotypes in Type 2 Diabetes with Different Risks for Macular Edema and Proliferative Retinopathy

Our group reported that three diabetic retinopathy (DR) phenotypes: A, characterized by low microaneurysm turnover (MAT &lt; 6) and normal central retinal thickness (CRT); B, low MAT (&lt;6) and increased CRT, and C, high MAT (&ge;6), present different risks for development of macular edema (DME) and proliferative retinopathy (PDR). To test these findings, 212 persons with type 2 diabetes (T2D) and mild nonproliferative retinopathy (NPDR), one eye per person, were followed for five years with annual visits. Of these, 172 completed the follow-up or developed an outcome: PDR or DME (considering both clinically significant macular edema (CSME) and center-involved macular edema (CIME)). Twenty-seven eyes (16%) developed either CSME (14), CIME (10), or PDR (4), with one eye developing both CSME and PDR. Phenotype A showed no association with development of vision-threatening complications. Seven eyes with phenotype B and three with phenotype C developed CIME. Phenotype C showed higher risk for CSME development, with 17.41 odds ratio (p = 0.010), compared with phenotypes A + B. All eyes that developed PDR were classified as phenotype C. Levels of HbA1c and triglycerides were increased in phenotype C (p &lt; 0.001 and p = 0.018, respectively). In conclusion, phenotype C identifies eyes at higher risk for development of CSME and PDR, whereas phenotype A identifies eyes at very low risk for vision-threatening complications