Plano de negócios da Associação dos Produtores Rurais em Manejo Florestal e Agricultura: Apruma.

projeto; Plano de marketing; Plano operacional; Plano ambiental e social; Estudos econômicos e financeiros; Anexosbitstream/CPAF-AC/15623/1/doc102.pd

Effectiveness of repetitive influenza vaccination against SARS-CoV-2 infection among a cohort of health care workers in Portugal

Vaccination for influenza has been essential over the years to protect the most vulnerable populations. Moreover, it was recently suggested that influenza vaccination might confer some nonspecific immunity to other viruses and be associated with a lower risk for coronavirus disease 2019 (COVID-19) morbidity and mortality. Therefore, we aimed to assess the effectiveness of repetitive influenza vaccination against SARS-CoV-2 infection in a cohort of health care workers (HCWs). This study was conducted among HCWs at São João University Hospital Center (CHUSJ), Porto, Portugal, a tertiary reference hospital for diagnosis and therapy, one of the largest hospitals in the country with approximately 6000 HCWs. We analyzed databases for influenza vaccination conducted between 2012 and 2019 and COVID-19 laboratory testing retrieved from the first and last registered positive COVID test date before HCW's COVID-19 vaccination started. The study outcome was the incidence of the first SARS-CoV-2 infection, as determined by reverse transcription polymerase chain reaction (RT-PCR). Age and sex were considered potential confounders. We used multivariable Cox regression to estimate odds ratios. Neither the absolute number nor the proportion of influenza shots influenced the risk of getting infected by SARS-CoV-2 (adjusted odds ratio 1.02, 95% CI: 0.9–1.06 and 1.17 95% CI: 0.86–1.58, respectively). Similar findings were observed in most cases when the analysis was restricted by year. The findings from our retrospective observational analysis of a HCWs cohort failed to support any protective effect between repetitive influenza vaccination and SARS-CoV-2 infection

Aneurysmal Degeneration of the Brachial Artery after Vascular Access Creation: Surgical Treatment Results

True peripheral artery aneurysms proximal to a longstanding arteriovenous fistula is a well-recognized complication. Late aneurysmal degeneration is rare. This study analyzed the characteristics, therapeutic options, and outcomes of true donor brachial artery aneurysms (DBAA) after arteriovenous fistula (AVF) for hemodialysis. We retrospectively collected the data of patients with DBAA after AVF creation, surgically repaired between January 2001 and September 2015. We excluded patients with pseudoaneurysms, anastomotic aneurysms, and infected aneurysms. We recorded patient's demographics, type of access, aneurysm characteristics, symptoms, treatment, and follow-up. Ten patients were treated for aneurysmal degeneration of the brachial artery. Average aneurysm diameter was 37.5 mm. All cases had, at least, one previous distal AVF, ligated or thrombosed, at the time of diagnosis. The first access was created in mean 137 months before the diagnosis of DBAA. Nine patients had previous medical history of renal transplant and were under immunosuppressive therapy. All patients were symptomatic at the time of diagnosis. In all cases, the treatment was aneurysmectomy followed by interposition bypass. One patient developed a postoperative hematoma with the need of surgical drainage. At 50 months of follow-up, one patient was submitted to percutaneous angioplasty due to an anastomotic stenosis. No other complications occurred during the entire follow-up period (mean: 69 months). The pathogenesis underlying DBAA remains unclear. Increased blood flow after AVF creation, immunosuppressive therapy, and ligation/thrombosis of the AVF may contribute to aneurysm formation. Surgical treatment by aneurysmectomy and bypass, with autogenous conducts, is a safe and effective option.info:eu-repo/semantics/publishedVersio

Increased lung inflammation with oxygen supplementation in tracheotomized spontaneously breathing rabbits: an experimental prospective randomized study

BACKGROUND: Mechanical ventilation is a well-known trigger for lung inflammation. Research focuses on tidal volume reduction to prevent ventilator-induced lung injury. Mechanical ventilation is usually applied with higher than physiological oxygen fractions. The purpose of this study was to investigate the after effect of oxygen supplementation during a spontaneous ventilation set up, in order to avoid the inflammatory response linked to mechanical ventilation. METHODS: A prospective randomised study using New Zealand rabbits in a university research laboratory was carried out. Rabbits (n = 20) were randomly assigned to 4 groups (n = 5 each group). Groups 1 and 2 were submitted to 0.5 L/min oxygen supplementation, for 20 or 75 minutes, respectively; groups 3 and 4 were left at room air for 20 or 75 minutes. Ketamine/xylazine was administered for induction and maintenance of anaesthesia. Lungs were obtained for histological examination in light microscopy. RESULTS: All animals survived the complete experiment. Procedure duration did not influence the degree of inflammatory response. The hyperoxic environment was confirmed by blood gas analyses in animals that were subjected to oxygen supplementation, and was accompanied with lower mean respiratory rates. The non-oxygen supplemented group had lower mean oxygen arterial partial pressures and higher mean respiratory rates during the procedure. All animals showed some inflammatory lung response. However, rabbits submitted to oxygen supplementation showed significant more lung inflammation (Odds ratio = 16), characterized by more infiltrates and with higher cell counts; the acute inflammatory response cells was mainly constituted by eosinophils and neutrophils, with a relative proportion of 80 to 20% respectively. This cellular observation in lung tissue did not correlate with a similar increase in peripheral blood analysis. CONCLUSIONS: Oxygen supplementation in spontaneous breathing is associated with an increased inflammatory response when compared to breathing normal room air. This inflammatory response was mainly constituted with polymorphonuclear cells (eosinophils and neutrophils). As confirmed in all animals by peripheral blood analyses, the eosinophilic inflammatory response was a local organ event.The authors would like to thank Centro Hospitalar do Porto for funding regarding the purchase of animals, animal food, and other husbandry expenses. No funding was used to reimburse any of the authors, nor any of the persons who helped and are herein thanked. Funding for open access publication was supported by the Anesthesia Department at Centro Hospitalar do Port

Consensus Recommendations of the Multiple Sclerosis Study Group and Portuguese Neuroradiological Society for the Use of the Magnetic Resonance Imaging in Multiple Sclerosis in Clinical Practice: Part 1

INTRODUCTION: Magnetic resonance imaging is established as a recognizable tool in the diagnosis and monitoring of multiple sclerosis patients. In the present, among multiple sclerosis centers, there are different magnetic resonance imaging sequences and protocols used to study multiple sclerosis that may hamper the optimal use of magnetic resonance imaging in multiple sclerosis. In this context, the Group of Studies of Multiple Sclerosis and the Portuguese Society of Neuroradiology, after a joint discussion, appointed a committee of experts to create recommendations adapted to the national reality on the use of magnetic resonance imaging in multiple sclerosis. The purpose of this document is to publish the first Portuguese consensus recommendations on the use of magnetic resonance imaging in multiple sclerosis in clinical practice. MATERIAL AND METHODS: The Group of Studies of Multiple Sclerosis and the Portuguese Society of Neuroradiology, after discussion of the topic in national meetings and after a working group meeting held in Figueira da Foz on May 2017, have appointed a committee of experts that have developed by consensus several standard protocols on the use of magnetic resonance imaging in the diagnosis and follow-up of multiple sclerosis. The document obtained was based on the best scientific evidence and expert opinion. Subsequently, the majority of Portuguese multiple sclerosis consultants and departments of neuroradiology scrutinized and reviewed the consensus paper; comments and suggestions were considered. Technical magnetic resonance imaging protocols regarding diagnostic, monitoring and the recommended information to be included in the magnetic resonance imaging report will be published in a separate paper. RESULTS: We provide some practical guidelines to promote standardized strategies to be applied in the clinical practice setting of Portuguese healthcare professionals regarding the use of magnetic resonance imaging in multiple sclerosis. CONCLUSION: We hope that these first Portuguese magnetic resonance imaging guidelines, based in the best available clinical evidence and practices, will serve to optimize multiple sclerosis management and improve multiple sclerosis patient care across Portugal.info:eu-repo/semantics/publishedVersio

Acetonitrile adducts of tranexamic acid as sensitive ions for quantification at residue levels in human plasma by UHPLC-MS/MS

The quantitative analysis of pharmaceuticals in biomatrices by liquid chromatography coupled with electrospray ionization tandem mass spectrometry (LC-ESI-MS/MS) is often hampered by adduct formation. The use of the molecular ion resulting from solvent adducts for quantification is uncommon, even if formed in high abundance. In this work, we propose the use of a protonated acetonitrile adduct for the quantitative analysis of tranexamic acid (TXA) by LC-MS/MS. The high abundance of the protonated acetonitrile adduct [M + ACN + H]+ was found to be independent of source-dependent parameters and mobile phase composition. The results obtained for TXA analysis in clinical samples were comparable for both [M + ACN + H]+ and [M + H]+ , and no statistically significant differences were observed. The relative stability and structure of the [M + ACN + H]+ ions were also studied by analyzing probable structures from an energetic point of view and by quantum chemical calculations. These findings, and the studied fragmentation pathways, allowed the definition of an acetimidium structure as the best ion to describe the observed acetonitrile protonated adduct of TXA.info:eu-repo/semantics/publishedVersio

Evolution of University Medical Education in the Republic of Guinea-Bissau 1985-2020

Introdução A República da Guiné-Bissau (RGB) apresenta um cenário de escassez e mal-distribuição dos recursos humanos da saúde (RHS). O ensino médico surge na RGB na década de 1980, destacando-se a Faculdade de Medicina Raúl Díaz-Argüelles García (FM), tutelada pela cooperação cubana. O presente trabalho teve por objetivo contribuir para uma proposta de oferta formativa mais adequada às necessidades deste Estado, partindo da análise do que se tem feito e dos resultados da implementação de iniciativas formativas, enquadrando-a nas tensões entre a colonialidade das parcerias internacionais e o realismo africano. Materiais e métodos Seguiu-se um modelo lógico construído para o efeito, recorrendo a uma abordagem de métodos mistos. Os dados foram recolhidos com recurso a um questionário misto aplicado a alunos do curso de medicina; a entrevistas semiestruturadas a atores chave em matéria de formação de RHS; a um grupo focal com personalidades ligadas ao ensino e gestão de RHS; a revisão narrativa da literatura publicada sobre a matéria; e a análise de documentos oficiais relacionados com o tema. Procedeu-se a análise de conteúdo dos dados qualitativos obtidos. Foram definidas seis categorias de análise de acordo com o modelo lógico do estudo. Procedeu-se a análise estatística descritiva dos dados quantitativos obtidos nos questionários. A apresentação de resultados e consequente discussão foram orientadas pelo modelo lógico do estudo. Resultados e discussão A RGB vive a realidade descrita para grande parte dos estados africanos que passa pela colonialidade do saber e dos mercados; limitada capacidade de formação de recursos humanos da saúde; falta de políticas adequadas para profissionais de saúde; e ausência de planos de formação em recursos humanos da saúde. Verifica-se um desfasamento entre produção e necessidades destes recursos, bem como entre qualidade e quantidade de quadros formados, realidades que espelham falhas de planeamento. Na sequência do contexto complexo observado, e associado à intervenção de atores dominante e relações de poder entre estes, a evolução do ensino médico na RGB resulta de uma convergência de planeamento estratégico deliberado e do reconhecimento de estratégias emergentes. A estratégia deliberada reflete-se de duas formas: num contexto de colonialidade, na tentativa deliberada de entrada de atores internacionais – concretamente a cooperação cubana; ou, numa perspetiva pan-africana de harmonização regional da formação. São conhecidas as limitações associadas à falta de um planeamento estratégico deliberado por parte da RGB. Apesar da proposta da CEDEAO para uma convergência regional em matéria de formação de RHS, na RGB sobressai a posição de colonialidade do ensino médico a par com um currículo académico não adaptado à realidade guineense. Conclusão A urgência da necessidade de a RGB desenvolver uma estratégia e um compromisso público com o ensino universitário, permitindo uma maior integração regional e uma oferta mais sustentável da formação médica, torna-se a grande conclusão deste trabalho. As soluções encontradas terão de ter em conta um contexto particularmente complexo e de grande fragilidade das instituições deste Estado, numa aposta de desconstrução da colonialidade do conhecimento, assumindo o realismo africano.publishersversionpublishe

Poloxamer 407 based-nanoparticles for controlled release of methotrexate

Poloxamer 407 (P407)-based nanoparticles were produced by the high pressure homogenization method for the encapsulation and delivery of methotrexate (MTX), aiming intravenous therapeutic applications. The surface of these nanoparticles was functionalized by conjugation of P407 with folic acid (FA) or with MTX, which served as targeting ligand agents. MTX-P407 conjugate was also developed to increase the final drug cargo. Two hydrophobic derivatives of MTX, MTX di-ethylated ester (MTX-OEt) and the ionic complex MTX-dimethyldioctadecylammonium bromide (MTX-DODAB) were produced and entrapped onto P407-based nanoparticles. All formulations developed revealed a monodisperse character comprising small and narrow nanoparticles (<100 nm). P407 nanoparticles (functionalized with FA) and MTX-P407 nanoparticles, both loaded with MTX-OEt, demonstrated a slow drug release profile. The effect of lipase from Aspergillus oryzae on the hydrolysis of the linkage between the P407 and MTX, and consequent MTX release profile, was also evaluated. We observed a controlled and slow release of MTX (<50% of release after 11 days) in the presence of enzyme. These MTX-P407 nanoparticles loaded with MTX-OEt induced a great effect against Caco-2 cancer cells (40% of cell death after 72 h of incubation), demonstrating higher efficiency than the free MTX at the same concentration.This study was supported by the Portuguese Foundation for Science and Technology (FCT) under the scope of the strategic funding of UID/BIO/04469/2019 unit and BioTecNorte operation (NORTE-01-0145-FEDER-000004) funded by the European Regional Development Fund under the scope of Norte2020 - Programa Operacional Regional do Norte. The authors also thanks to FCT for funding their scholarship: Jennifer Noro (SFRH/BD/121673/2016) and Carla Silva (SFRH/IF/00186/2015). This work has also received funding from the European Union Horizon 2020 research and innovation program under grant agreement NMP-06-2015-683356 FOLSMART.info:eu-repo/semantics/publishedVersio