Requisitos técnicos de um sistema de informação de determinação de parâmetros de exposição radiológicos : para radiografias do tórax e da coluna lombar

A evolução tecnológica dos sistemas de radiologia digital possibilita a diminuição da exposição dos pacientes à radiação. No entanto, se as potencialidades dos mesmos não forem usadas de forma adequada, podem originar exposições elevadas, desnecessárias nos pacientes. De modo a diminuir o erro humano do Técnico de Radiologia na seleção de parâmetros de exposição e a adequar a exposição radiológica do paciente criou-se um Sistema de Informação (SI) que realiza uma estimativa da dose de radiação, na realização de radiografias da coluna lombar, nas incidências de frente e de perfil, e de radiografias do tórax, na incidência postero-anterior (PA), realizadas seguindo as recomendações. A metodologia adotada para a realização deste trabalho teve como base as quatro primeiras fases do Modelo em Cascata. Inicialmente, foi necessário efetuar uma recolha de informação relativa aos parâmetros de exposição utilizados na realização de radiografias da coluna lombar e do tórax, face à antropometria de cada paciente. Esta recolha possibilitou estimar valores de referência de dose de radiação, que serviram de base para a definição dos requisitos técnicos e desenho do SI a desenvolver. De modo a testar o desenho do sistema foi efetuada uma avaliação do mesmo com base num questionário efetuado a sete Técnicos de Radiologia com cerca de 10 anos de experiência profissional e com Mestrado. Os resultados obtidos nesta avaliação permitem considerar que o desenho do SI cumpre os requisitos pré-definidos, estando reunidas todas as condições necessárias do mesmo para a passagem, num trabalho futuro, às restantes fases do Modelo em Cascata de forma a tornar o SI operacional

Phantom comparison for MRI quality control tests according to manufacturers and national standards

Quality control tests are mandatory and essential to monitor Magnetic Resonance Imaging equipment. These assist in determining improper functioning or parameters below established reference levels. The objective of this study was to perform quality control tests in magnetic resonance imaging equipment and to compare their methodology with both FLUKE and KONEX phantoms. Different protocols were used for their evaluation, including the American Association of Physics in Medicine, the American College of Radiologists, and the Brazilian National Health Surveillance Agency. In this study, we demonstrated the results for the most critical tests: slice thickness accuracy, slice position accuracy, high-contrast spatial resolution, low-contrast resolution, magnetic field, and slice thickness uniformity. The results are that, although both phantom objects are efficient for carrying out the tests required in Brazilian regulations, the KONEX phantom consumes less time, as it requires less to image all its structures. The FLUKE phantoms need a longer acquisition time to obtain all test structures and object images. Nevertheless, the results obtained in both are within limits required by Brazilian regulations and limits suggested by the manufacturers' manuals. This work is expected to be a basis for other physicians and services using similar phantoms

Transcriptional and metabolic changes associated with internode development and reduced cinnamyl alcohol dehydrogenase activity in sorghum

27 páginas.- 7 figuras.- 2 tablas.- 157 referencias.- Supplementary data The following supplementary data are available at JXB online.Phenolic metabolism is rewired during internode development and in response to cinnamyl alcohol dehydrogenase perturbation in sorghum, with different sets of genes and accumulating compounds. The molecular mechanisms associated with secondary cell wall (SCW) deposition in sorghum remain largely uncharacterized. Here, we employed untargeted metabolomics and large-scale transcriptomics to correlate changes in SCW deposition with variation in global gene expression profiles and metabolite abundance along an elongating internode of sorghum, with a major focus on lignin and phenolic metabolism. To gain deeper insight into the metabolic and transcriptional changes associated with pathway perturbations, a bmr6 mutant [with reduced cinnamyl alcohol dehydrogenase (CAD) activity] was analyzed. In the wild type, internode development was accompanied by an increase in the content of oligolignols, p-hydroxybenzaldehyde, hydroxycinnamate esters, and flavonoid glucosides, including tricin derivatives. We further identified modules of genes whose expression pattern correlated with SCW deposition and the accumulation of these target metabolites. Reduced CAD activity resulted in the accumulation of hexosylated forms of hydroxycinnamates (and their derivatives), hydroxycinnamaldehydes, and benzenoids. The expression of genes belonging to one specific module in our co-expression analysis correlated with the differential accumulation of these compounds and contributed to explaining this metabolic phenotype. Metabolomics and transcriptomics data further suggested that CAD perturbation activates distinct detoxification routes in sorghum internodes. Our systems biology approach provides a landscape of the metabolic and transcriptional changes associated with internode development and with reduced CAD activity in sorghum.This work was supported by Fundacao de Amparo a Pesquisa do Estado de Sao Paulo (FAPESP) via the BIOEN Young Investigators Awards research grant (FAPESP no. 2015/02527-1). This study was financed in part by the Coordenacao de Aperfeicoamento de Pessoal de Nivel Superior-Brasil (CAPES) -Finance Code 001, by FEDER/Agencia Estatal de Investigacion with the Spanish Projects AGL2017-83036-R and PID2020-118968RB-I00, and by Junta de Andalucia (Consejeria de Transformacion Economica, Industria, Conocimiento y Universidades, project P20_00017). IC is indebted to Conselho Nacional de Desenvolvimento Cientifico e Tecnologico (CNPq) for the research fellowship 302927/2018-2. SSF was funded for a post-doctoral fellowship (FAPESP n0. 2016/06917-1). MSS was funded for a master's fellowship (FAPESP no. 2015/18361-5). AVAP was funded for a scientific initiation fellowship (FAPESP no. 2016/06714-3). LGAL was funded for a scientific initiation fellowship (FAPESP no. 2019/14604-1).Peer reviewe

Identification of clusters of asthma control: A preliminary analysis of the inspirers studies

This work was funded by ERDF (European Regional Development Fund) through the operations: POCI- -01-0145-FEDER-029130 (“mINSPIRERS—mHealth to measure and improve adherence to medication in chronic obstructive respiratory diseases - generalisation and evaluation of gamification, peer support and advanced image processing technologies”) co-funded by the COMPETE2020 (Programa Operacional Competitividade e Internacionalização), Portugal 2020 and by Portuguese Funds through FCT (Fundação para a Ciência e a Tecnologia).© 2020, Sociedade Portuguesa de Alergologia e Imunologia Clinica. All rights reserved. Aims: To identify distinct asthma control clusters based on Control of Allergic Rhinitis and Asthma Test (CARAT) and to compare patients’ characteristics among these clusters. Methods: Adults and adolescents (≥13 years) with persistent asthma were recruited at 29 Portuguese hospital outpatient clinics, in the context of two observational studies of the INSPIRERS project. Demographic and clinical characteristics, adherence to inhaled medication, beliefs about inhaled medication, anxiety and depression, quality of life, and asthma control (CARAT, >24 good control) were collected. Hierarchical cluster analysis was performed using CARAT total score (CARAT-T). Results: 410 patients (68% adults), with a median (percentile 25–percentile 75) age of 28 (16-46) years, were analysed. Three clusters were identified [mean CARAT-T (min-max)]: cluster 1 [27(24-30)], cluster 2 [19(14-23)] and cluster 3 [10(2-13)]. Patients in cluster 1 (34%) were characterised by better asthma control, better quality of life, higher inhaler adherence and use of a single inhaler. Patients in clusters 2 (50%) and 3 (16%) had uncontrolled asthma, lower inhaler adherence, more symptoms of anxiety and depression and more than half had at least one exacerbation in the previous year. Further-more, patients in cluster 3 were predominantly female, had more unscheduled medical visits and more anxiety symp-toms, perceived a higher necessity of their prescribed inhalers but also higher levels of concern about taking these inhalers. There were no differences in age, body mass index, lung function, smoking status, hospital admissions or specialist physician follow-up time among the three clusters. Conclusion: An unsupervised method based on CARAT--T, identified 3 clusters of patients with distinct, clinically meaningful characteristics. The cluster with better asthma control had a cut-off similar to the established in the validation study of CARAT and an additional cut-off seems to distinguish more severe disease. Further research is necessary to validate the asthma control clusters identified.publishersversionpublishe

Both “illness and temptation of the enemy”: melancholy, the medieval patient and the writings of King Duarte of Portugal (r. 1433–38)

Recent historians have rehabilitated King Duarte of Portugal, previously maligned and neglected, as an astute ruler and philosopher. There is still a tendency, however, to view Duarte as a depressive or a hypochondriac, due to his own description of his melancholy in his advice book, the Loyal Counselor. This paper reassesses Duarte's writings, drawing on key approaches in the history of medicine, such as narrative medicine and the history of the patient. It is important to take Duarte's views on his condition seriously, placing them in the medical and theological contexts of his time and avoiding modern retrospective diagnosis. Duarte's writings can be used to explore the impact of plague, doubt and death on the life of a well-educated and conscientious late-medieval ruler

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Projeto Pontes Atlânticas: uma ponte entre os estudantes de Fisioterapia da Lusofonia

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