A review on recent advances in implanted medical devices security

The Implanted Medical Devices (IMD) industry has grown over the past few decades and is expected to grow in the coming ones. Being an asset for the health and quality of life of a patient, the availability of IMD-related products, their increasing complexity and advances in communication capabilities do not seem to have been seamlessly accompanied by cybersecurity concerns. Recent IMD can be integrated in the concept of IoT (Internet of Things) and thus, they are also exposed to attacks impacting on privacy and, above all, on the health and even the life of the device users. While in an early stage of the IMD development, the security procedures were based on the existing classic protocols and models and their functional capabilities were the focus of development, recent efforts have been made to address security from the start. In this paper we review the most recent contributions on the cybersecurity of IMD products and we highlight innovative ideas that represent new design and development paradigms of these devices next generations. In this review it is reinforced that the technological evolution and the progressive access of attackers to resources capable of exploiting multiple vulnerabilities can have a crucial impact in the IMD already implanted in the patient's body, designed to remain in operation for many years. Also, it brings the need to develop novel and robust protocols to guarantee security compatible with constrained computing resources and extremely low energy requirements to be feasible. Finally, the security and privacy concerns regarding this kind of devices should be addressed in the design phase and policies must move from damage mitigation to threat prevention.5311-8814-F0ED | Sara Maria da Cruz Maia de Oliveira PaivaN/

Polimedicação em idosos institucionalizados em lares do norte de Portugal

A polimedicação é uma problemática em crescimento, sobretudo na população idosa, fruto das doenças crónicas que obrigam ao uso simultâneo de vários medicamentos. Esta problemática tem vindo a agravar-se dado que a população mundial tende a envelhecer drasticamente nos próximos anos. Em 2050 prevê-se que o número de idosos represente 32% da população portuguesa. Caracterizar a terapêutica medicamentosa, a polimedicação e eventuais interações em idosos institucionalizados, bem como fatores associados à polimedicação. Métodos: Trata-se de um estudo transversal de base populacional, descritivo-correlacional. A amostra foi constituída por 155 idosos (≥65 anos) polimedicados (≥3 medicamentos) e institucionalizados em lares localizados no norte de Portugal (distritos do Porto, Vila Real e Viseu). Os dados foram obtidos por consulta dos ficheiros clínicos. Na análise da terapêutica recorreu-se à lista de Beers e à classificação de Delafuente para avaliar eventuais interações. O tratamento de dados foi realizado no programa SPSS (v. 21.0), tendo sido aplicada estatística descritiva e os testes de Kolmogorov-Smirnov e ANOVA, com nível de significância de 5%. Resultados: A amostra constituída maioritariamente por idosos do sexo feminino (69% vs. 31%), com idades compreendidas entre os 65 e 99 anos (média de 83,73), sendo que 34,2% tinham entre 85-89 anos. Em média, são administrados por dia 6,85 medicamentos diferentes, sendo os anti-hipertensores os mais prescritos (71,0%), seguidos das benzodiazepinas (57,4%), dos antiácidos/antiulcerosos (51,6%) e dos antidislipidémicos (47,7%). Segundo a lista de Beers, 0,6% dos idosos toma fármacos a ser sempre evitados e 10,3% toma fármacos raramente apropriados. Segundo Delafuente, encontraram-se 13 possíveis interações medicamentosas. Apenas a idade parece estar associada ao número de medicamentos administrados diariamente (p=0,017), sendo os idosos entre 80-84 anos os que consomem mais medicamentos (média 7,85). Conclusão: Verificou-se a existência do fenómeno da polimedicação registando-se uma média de quase 7 medicamentos diferentes por dia, sendo os anti-hipertensores os mais prescritos. Identificaram-se 13 possíveis interações medicamentosas e 10,3% dos idosos tomavam fármacos raramente apropriados. A idade parece estar associada à polimedicação

Polypharmacy in institutionalized elderly in nursing homes of Northern Portugal

The polypharmacy is a growing problem, especially in the elderly population due to chronic diseases requiring the simultaneous use of drugs. This issue has become worse due to the increasing aging of the world population. Objectives: To characterize drug therapy, polypharmacy and possible interactions in institutionalized elderly, as well as polypharmacy associated factors. Methods: This cross-sectional and correlational study, had a sample of 155 elderly (≥65 years) polymedicated (≥3 drugs) and institutionalized in nursing homes in northern Portugal districts (Porto, Vila Real and Viseu). Data were obtained by consulting the clinical files. Beers list and the Delafuente classification were used to evaluate the therapeutic and possible interactions. It was used descriptive statistics, the Kolmogorov-Smirnov and ANOVA tests, with a significance level of 5%. Results: The sample consisted mainly of females elderly (69% vs. 31%), aged between 65 and 99 years (mean 83.73), while 34.2% was between 85-89 years old. On average, 6.85 different drugs are administered per day, and antihypertensives are the most prescribed (71.0%). According to the list of Beers, 0.6% of seniors take drugs that should be avoided wherever possible and 10.3% takes drugs rarely appropriate. According Delafuente, we find 13 possible drug interactions. Only age seems to be associated with the number of drugs administered daily (p=0.017), older between 80-84 years are those who consume more. Conclusions: Regarding polypharmacy there was an average of about 7 different drugs per day, antihypertensives the most prescribed. We identified 13 possible drug interactions and about 10% of elderly taking drugs rarely appropriate. Age seems to be associated with polypharmacy.info:eu-repo/semantics/publishedVersio

A novel strategy of acrylamide mitigation in fried potatoes using asparaginase and high pressure technology

The potentiality of high pressure processing (HPP) to possibly enhance diffusion of asparaginase into raw potato sticks, and consequently on reduction of acrylamide levels in fried potatoes was evaluated. Raw potato sticks were immersed in asparaginase (10,000 ASNU/L) and immediately subjected to 0.1, 100, 200 and 400 MPa for 5 min, with total enzymatic reaction times of 5, 10 and 20 min and room temperature. Pressurized raw potato sticks became softer, more flexible, and required lower energy for cutting (up to 47% less); the roughness of potato surface and moisture content were slightly reduced; and the concentration of soluble solids in the exterior solutions increased, indicative of a leaching effect. Due to changes induced by asparaginase and/or HPP on raw potatoes, fried potatoes exhibited higher weight loss after frying, and higher hardness (crispness). The combined treatment with asparaginase and HPP showed to reduce acrylamide levels by 26 -47%, while with asparaginase or HPP alone there was no significant reduction.publishe

Nanotechnology applied to drug delivery – formulation, development and characterization studies

Azelaic acid shows bacteriostatical activity against many microorganism species and is commonly used in the treatment of acne. However, some technical issues and a reduced patient compliance have been associated with its topical application forms. Thus, nanotechnology may represent an innovative strategy that might help to overcome these problems. The objective of this study was to develop and to characterize PLGA nanoparticles containing azelaic acid. Nanoparticles were produced by a modified spontaneous emulsification/solvent diffusion method and then included into a gel of Carbopol 940. Several parameters were characterized such as zeta potential, particle size and encapsulation efficiency. Particle mean size was 378.63 nm (with PI around 0.09) and zeta potential was -7.82 mV. The encapsulation efficiency of azelaic acid was 76 ± 3.81%. Consequently, these PLGA nanoparticles can be considered a useful tool for azelaic acid delivery

Three dimensional printing : A new approach for the manufacture of individualized medicines

Poster presented at the FIP Virtual Event, 4-25 September 2020N/

Dysmetabolism and Sleep Fragmentation in Obstructive Sleep Apnea Patients Run Independently of High Caffeine Consumption

Funding Information: This research was funded by the Portuguese Science and Technology Foundation (FCT) with the grant number CEECIND/04266/2017. Acknowledgments: The authors would like to thank Eunice Silva for technical support. Funding Information: Funding: This research was funded by the Portuguese Science and Technology Foundation (FCT) with the grant number CEECIND/04266/2017.Daytime hypersomnolence, the prime feature of obstructive sleep apnea (OSA), frequently leads to high coffee consumption. Nevertheless, some clinicians ask for patients’ caffeine avoidance. Caffeinated drinks are sometimes associated with more severe OSA. However, these effects are not consensual. Here we investigated the effect of caffeine consumption on sleep architecture and apnea/hypopnea index in OSA. Also, the impact of caffeine on variables related with dysmetabolism, dyslipidemia, and sympathetic nervous system (SNS) dysfunction were investigated. A total of 65 patients diagnosed with OSA and 32 without OSA were included after given written informed consent. Polysomnographic studies were performed. Blood was collected to quantify caffeine and its metabolites in plasma and biochemical parameters. 24 h urine samples were collected for catecholamines measurement. Statistical analyses were performed by SPSS: (1) non-parametric Mann-Whitney test to compare variables between controls and OSA; (2) multivariate logistic regression testing the effect of caffeine on sets of variables in the 2 groups; and (3) Spearmans’ correlation between caffeine levels and comorbidities in patients with OSA. As expected OSA development is associated with dyslipidemia, dysmetabolism, SNS dysfunction, and sleep fragmentation. There was also a significant increase in plasma caffeine levels in the OSA group. However, the higher consumption of caffeine by OSA patients do not alter any of these associations. These results showed that there is no apparent rationale for caffeine avoidance in chronic consumers with OSA.publishersversionpublishe

Finite element analysis of pectus carinatum surgical correction via a minimally invasive approach

Pectus carinatum (PC) is a chest deformity caused by a disproportionate growth of the costal cartilages compared to the bony thoracic skeleton, pulling the sternum towards, which leads to its protrusion. There has been a growing interest on using the 'reversed Nuss' technique as a minimally invasive procedure for PC surgical correction. A corrective bar is introduced between the skin and the thoracic cage and positioned on top of the sternum highest protrusion area for continuous pressure. Then, it is fixed to the ribs and kept implanted for about 2-3 years. The purpose of this work was to (a) assess the stresses distribution on the thoracic cage that arise from the procedure, and (b) investigate the impact of different positioning of the corrective bar along the sternum. The higher stresses were generated on the 4th, 5th and 6th ribs backend, supporting the hypothesis of pectus deformities correction-induced scoliosis. The different bar positioning originated different stresses on the ribs' backend. The bar position that led to lower stresses generated on the ribs backend was the one that also led to the smallest sternum displacement. However, this may be preferred, as the risk of induced scoliosis is lowered.This work was financially supported by the Potuguese Foundation for Science and Techrnology (FCT) under the R&D project PTDC/SAU-BEB/103368/2008 and the fellowship SFRH/BPD/46851/2008