Critical raw materials deposits map of mainland Portugal: new mineral intelligence in cartographic form

ABSTRACT: Reliable and unhindered access to raw materials is a growing concern within the EU and across the globe and the demand for Critical Raw Materials (CRM) plays a crucial economic role in most developed countries around the world. These are of extreme importance for supply chains regarding new technologies, sustainability issues and carbon footprint reduction. The definition of a continuously updated list of CRM by the European Commission led to the first CRM Map of Europe in 2016. Following this, several countries have been surveying, preparing, and evaluating their mineral occurrences to create a resources/deposits database and, therefore, to create a CRM map of their own. With this purpose in mind, we present and explain the first Critical Raw Materials Deposits Map of mainland Portugal, at 1:700,000 scale. This paper describes the scientific, technical, and graphical methodologies involved in its design.info:eu-repo/semantics/publishedVersio

long-term follow-up (CIMbA-LT)

Funding Information: Collaborators of the CIMBA-LT study: Hospital Vila Franca de Xira: André Oliveira; João Gonçalves-Pereira; Joaquim Lima. Centro Hospitalar de Médio Tejo (Abrantes): Rui Assis; Joana Monteiro. Hospital Nélio Mendonça (Funchal): André Simões; Catarina Lume. Centro Hospitalar de Trás-os-Montes e Alto Douro (Vila Real): Maria João Pinto. Centro Hospitalar de Vila Nova de Gaia: Sara Pipa. Hospital de Braga: Laura Costa. Hospital de Bragança: Cristina Nunes. Hospital do Divino Espírito Santo (S. Miguel): Manuela Henriques; Luís Tavares. Hospital de Leiria: Filipa Sequeira. Centro Hospitalar Universitário de S.João (Porto): José-Artur Paiva; Tatiana Santos Vieira; Núria Jorge. Centro Hospital Universitário de Lisboa Norte (Lisboa): Ana Bento Rodrigues; Susana Fernandes; João Ribeiro. Hospital S.Francisco Xavier (Lisboa): Rui Morais; Pedro Póvoa; Luís Coelho. Centro Hospitalar Universitário de Coimbra: Ana Martinho; Iolanda Santos. Hospital Egas Moniz (Lisboa): Gabriela Almeida. Hospital de Beja: Alexandra Paula; Filipe Morais de Almeida. Centro Hospitalar Universitário do Algarve (Faro): Sofia Ribeiro. Publisher Copyright: © 2023, The Author(s).Background: The past years have witnessed dramatic changes in the population admitted to the intensive care unit (ICU). Older and sicker patients are now commonly treated in this setting due to the newly available sophisticated life support. However, the short- and long-term benefit of this strategy is scarcely studied. Methods: The Critically Ill patients’ mortality by age: Long-Term follow-up (CIMbA-LT) was a multicentric, nationwide, retrospective, observational study addressing short- and long-term prognosis of patients admitted to Portuguese multipurpose ICUs, during 4 years, according to their age and disease severity. Patients were followed for two years after ICU admission. The standardized hospital mortality ratio (SMR) was calculated according to the Simplified Acute Physiology Score (SAPS) II and the follow-up risk, for patients discharged alive from the hospital, according to official demographic national data for age and gender. Survival curves were plotted according to age group. Results: We included 37.118 patients, including 15.8% over 80 years old. The mean SAPS II score was 42.8 ± 19.4. The ICU all-cause mortality was 16.1% and 76% of all patients survive until hospital discharge. The SAPS II score overestimated hospital mortality [SMR at hospital discharge 0.7; 95% confidence interval (CI) 0.63–0.76] but accurately predicted one-year all-cause mortality [1-year SMR 1.01; (95% CI 0.98–1.08)]. Survival curves showed a peak in mortality, during the first 30 days, followed by a much slower survival decline thereafter. Older patients had higher short- and long-term mortality and their hospital SMR was also slightly higher (0.76 vs. 0.69). Patients discharged alive from the hospital had a 1-year relative mortality risk of 6.3; [95% CI 5.8–6.7]. This increased risk was higher for younger patients [21.1; (95% CI 15.1–39.6) vs. 2.4; (95% CI 2.2–2.7) for older patients]. Conclusions: Critically ill patients’ mortality peaked in the first 30 days after ICU admission. Older critically ill patients had higher all-cause mortality, including a higher hospital SMR. A long-term increased relative mortality risk was noted in patients discharged alive from the hospital, but this was more noticeable in younger patients.publishersversionpublishe

Adding 6 months of androgen deprivation therapy to postoperative radiotherapy for prostate cancer: a comparison of short-course versus no androgen deprivation therapy in the RADICALS-HD randomised controlled trial

Background Previous evidence indicates that adjuvant, short-course androgen deprivation therapy (ADT) improves metastasis-free survival when given with primary radiotherapy for intermediate-risk and high-risk localised prostate cancer. However, the value of ADT with postoperative radiotherapy after radical prostatectomy is unclear. Methods RADICALS-HD was an international randomised controlled trial to test the efficacy of ADT used in combination with postoperative radiotherapy for prostate cancer. Key eligibility criteria were indication for radiotherapy after radical prostatectomy for prostate cancer, prostate-specific antigen less than 5 ng/mL, absence of metastatic disease, and written consent. Participants were randomly assigned (1:1) to radiotherapy alone (no ADT) or radiotherapy with 6 months of ADT (short-course ADT), using monthly subcutaneous gonadotropin-releasing hormone analogue injections, daily oral bicalutamide monotherapy 150 mg, or monthly subcutaneous degarelix. Randomisation was done centrally through minimisation with a random element, stratified by Gleason score, positive margins, radiotherapy timing, planned radiotherapy schedule, and planned type of ADT, in a computerised system. The allocated treatment was not masked. The primary outcome measure was metastasis-free survival, defined as distant metastasis arising from prostate cancer or death from any cause. Standard survival analysis methods were used, accounting for randomisation stratification factors. The trial had 80% power with two-sided α of 5% to detect an absolute increase in 10-year metastasis-free survival from 80% to 86% (hazard ratio [HR] 0·67). Analyses followed the intention-to-treat principle. The trial is registered with the ISRCTN registry, ISRCTN40814031, and ClinicalTrials.gov, NCT00541047. Findings Between Nov 22, 2007, and June 29, 2015, 1480 patients (median age 66 years [IQR 61–69]) were randomly assigned to receive no ADT (n=737) or short-course ADT (n=743) in addition to postoperative radiotherapy at 121 centres in Canada, Denmark, Ireland, and the UK. With a median follow-up of 9·0 years (IQR 7·1–10·1), metastasis-free survival events were reported for 268 participants (142 in the no ADT group and 126 in the short-course ADT group; HR 0·886 [95% CI 0·688–1·140], p=0·35). 10-year metastasis-free survival was 79·2% (95% CI 75·4–82·5) in the no ADT group and 80·4% (76·6–83·6) in the short-course ADT group. Toxicity of grade 3 or higher was reported for 121 (17%) of 737 participants in the no ADT group and 100 (14%) of 743 in the short-course ADT group (p=0·15), with no treatment-related deaths. Interpretation Metastatic disease is uncommon following postoperative bed radiotherapy after radical prostatectomy. Adding 6 months of ADT to this radiotherapy did not improve metastasis-free survival compared with no ADT. These findings do not support the use of short-course ADT with postoperative radiotherapy in this patient population

Duration of androgen deprivation therapy with postoperative radiotherapy for prostate cancer: a comparison of long-course versus short-course androgen deprivation therapy in the RADICALS-HD randomised trial

Background Previous evidence supports androgen deprivation therapy (ADT) with primary radiotherapy as initial treatment for intermediate-risk and high-risk localised prostate cancer. However, the use and optimal duration of ADT with postoperative radiotherapy after radical prostatectomy remains uncertain. Methods RADICALS-HD was a randomised controlled trial of ADT duration within the RADICALS protocol. Here, we report on the comparison of short-course versus long-course ADT. Key eligibility criteria were indication for radiotherapy after previous radical prostatectomy for prostate cancer, prostate-specific antigen less than 5 ng/mL, absence of metastatic disease, and written consent. Participants were randomly assigned (1:1) to add 6 months of ADT (short-course ADT) or 24 months of ADT (long-course ADT) to radiotherapy, using subcutaneous gonadotrophin-releasing hormone analogue (monthly in the short-course ADT group and 3-monthly in the long-course ADT group), daily oral bicalutamide monotherapy 150 mg, or monthly subcutaneous degarelix. Randomisation was done centrally through minimisation with a random element, stratified by Gleason score, positive margins, radiotherapy timing, planned radiotherapy schedule, and planned type of ADT, in a computerised system. The allocated treatment was not masked. The primary outcome measure was metastasis-free survival, defined as metastasis arising from prostate cancer or death from any cause. The comparison had more than 80% power with two-sided α of 5% to detect an absolute increase in 10-year metastasis-free survival from 75% to 81% (hazard ratio [HR] 0·72). Standard time-to-event analyses were used. Analyses followed intention-to-treat principle. The trial is registered with the ISRCTN registry, ISRCTN40814031, and ClinicalTrials.gov , NCT00541047 . Findings Between Jan 30, 2008, and July 7, 2015, 1523 patients (median age 65 years, IQR 60–69) were randomly assigned to receive short-course ADT (n=761) or long-course ADT (n=762) in addition to postoperative radiotherapy at 138 centres in Canada, Denmark, Ireland, and the UK. With a median follow-up of 8·9 years (7·0–10·0), 313 metastasis-free survival events were reported overall (174 in the short-course ADT group and 139 in the long-course ADT group; HR 0·773 [95% CI 0·612–0·975]; p=0·029). 10-year metastasis-free survival was 71·9% (95% CI 67·6–75·7) in the short-course ADT group and 78·1% (74·2–81·5) in the long-course ADT group. Toxicity of grade 3 or higher was reported for 105 (14%) of 753 participants in the short-course ADT group and 142 (19%) of 757 participants in the long-course ADT group (p=0·025), with no treatment-related deaths. Interpretation Compared with adding 6 months of ADT, adding 24 months of ADT improved metastasis-free survival in people receiving postoperative radiotherapy. For individuals who can accept the additional duration of adverse effects, long-course ADT should be offered with postoperative radiotherapy. Funding Cancer Research UK, UK Research and Innovation (formerly Medical Research Council), and Canadian Cancer Society

Caracterização clínica e laboratorial das anemias microcíticas e hipocrómicas

Trabalho final de mestrado integrado em Medicina área científica de Hematologia, apresentado á Faculdade de Medicina da Universidade de CoimbraA anemia é uma alteração hematológica que surge com muita frequência na prática clínica. Segundo a Organização Mundial de Saúde é definida pela redução da concentração de hemoglobina no sangue periférico, abaixo dos valores normais para a idade e sexo. A Anemia Microcítica e Hipocrómica (AMH) é a mais prevalente e caracteriza-se por eritrócitos microcíticos e hipocrómicos, ou seja por diminuição do VGM (Volume Globular Médio inferior a 80fl), da HCM (Hemoglobina Corpuscular Média inferior a 27pg) e da CHMC (Concentração de Hemoglobina Corpuscular Média inferior a 30g/dL). A deficiência de ferro (Anemia ferropénica) constitui a causa mais comum de anemia em todo o mundo. Resulta, na maior parte dos casos, de perdas crónicas de sangue pelo tracto gastrointestinal e uterino. Outras causas de AMH são, necessidades aumentadas (prematuridade, crescimento e gravidez) e/ou a má absorção. A ingestão inadequada raramente se apresenta como causa isolada. Outro aspecto importante é a alteração no metabolismo do ferro, sendo de salientar a desregulação da hepcidina, a principal proteína reguladora da homeostasia deste ião, e as anomalias na síntese da globina ou do heme. O diagnóstico diferencial deve ser feito com as Talassémias, alguns casos de Anemia de Doença Crónica e de Anemia Sideroblástica e com a intoxicação por chumbo. A maior parte dos doentes com anemia são assintomáticos, sendo o diagnóstico feito em exames de rotina. Quando a anemia é mais grave, os sinais e sintomas traduzem a diminuição das funções dos tecidos e órgãos mais sensíveis à hipóxia. Assim, a abordagem dos doentes com anemia deve incluir a anamnese e exame físico minucioso, sendo importante a história nutricional, história familiar, etc. Para o diagnóstico e diagnóstico diferencial é fundamental, além do hemograma completo e contagem de reticulócitos, o estudo do metabolismo do ferro (concentração de ferro sérico, capacidade total de ligação do ferro (TIBC), ferritina sérica e o receptor de transferrina sérico). O tratamento da anemia passa pelo tratamento da doença de base, administração de suplementos de ferro (ferro por via oral ou parentérica), agentes indutores da eritropoiese e transfusão de concentrado de eritrócitos, dependendo do grau de anemia, da doença de base e do estado geral do doente. Este trabalho tem por objectivo fazer uma revisão teórica actualizada da literatura (recorrendo para isso a artigos científicos, livros e revistas da especialidade), sobre os mecanismos envolvidos na etiopatogenia da Anemia Microcítica Hipocrómica, a sua caracterização clínica e laboratorial, diagnóstico diferencial, e em que condições a terapêutica é necessária, e quais as opções existentes/disponíveis, as suas vantagens e desvantagensAnemia is a hematological change which frequently arises in clinical practice. According to the World Health Organization, it is defined by a reduction in hemoglobin concentration (which is below the normal values depending on age and sex), present in peripheral blood. The microcytic and hypochromic anemia (AMH) is the most common type of anemia and is characterized by microcytic and hypochromic erythrocytes, i.e. a decrease in MCV (mean corpuscular volume <80fl), MCH (mean corpuscular hemoglobin <27pg) and CHMC (mean corpuscular hemoglobin concentration <30g/dL). Iron deficiency (iron deficiency anemia) is the most common cause of anemia worldwide. In most cases, it is the result of chronic blood loss from the gastrointestinal tract and uterus. Increased needs for iron (as in prematurity, growth and pregnancy) and/or malabsorption are other causes of AMH. Inadequate intake is rarely presented as an isolated cause. Another important aspect is the change in iron metabolism and in particular the deregulation of hepcidin, which is the main regulatory protein of this ion homeostasis, as well as abnormalities in the synthesis of heme and globin. The differential diagnosis should be done with Thalassemia, some cases of Anemia of Chronic Disease and Sideroblastic Anemia, as well as lead poisoning. Most patients with anemia are asymptomatic, being diagnosed in routine examinations. When anemia is more severe, the signs and symptoms reflect the decrease of the functions of tissues and organs most sensitive to hypoxia. Thus, the medical examination of patients with anemia should include history and physical examination, with important nutritional history, family history, etc.. A complete blood count and a reticulocyte count are crucial for the diagnosis and the differential diagnosis, as well as the study of iron metabolism (serum iron concentration, total binding capacity of iron (TIBC), serum ferritin and serum transferrin receptor). The treatment of anemia involves the treatment of the underlying disease, as well as the administration of iron supplements (oral or parenteral route), agents that induce erythropoiesis and transfusion of packed red blood cells, depending on the degree of anemia, the underlying disease and the patient's general state. This paper is an updated review of the theoretical literature (using scientific articles, books and trade magazines) on the mechanisms involved in the pathogenesis of hypochromic microcytic anemia, its clinical and laboratory characteristics and the differential diagnosis. It also aims to evaluate the conditions under which therapy is needed, listing the options available and their advantages and disadvantages

A Rare and Potentially Catastrophic Infection: Primary Intestinal Aspergillosis—Case Report in an HIV Patient

Aspergillus species are ubiquitous in nature; however, infection is uncommon, except in immunocompromised or immunosuppressed hosts. We present the case of a 71-year-old woman with a history of human immunodeficiency virus infection who presented with fever, weight loss, and diarrhea, posteriorly diagnosed with intestinal aspergillosis after examination of a segmental enterectomy piece. The diagnosis was made postmortem once the patient died after fast and progressive deterioration in the postoperative period

Fecal microbiota transplantation as a potential way to eradicate multiresistant microorganisms

Multiresistant microorganism infection often can produce a life-threatening situation. We report two cases in which fecal microbiota transplantation used for the treatment of recurrent Clostridium difficile infection were effective in eradicating colonization by carbapenemase-producing Enterobacteriaceae. The presented cases illustrate the potential benefit of fecal microbiota transplantation in resolution of asymptomatic carrier states of multiresistant microorganisms, suggesting the need for further investigations with a view to their applicability in this area. Keywords: Multiresistant microorganisms, Carbapenemase-producing enterobacteriaceae, Fecal microbiota transplantatio

Hepatocellular carcinoma after direct-acting antiviral therapy for chronic HCV infection: Is it a real risk?

The newer oral treatments for chronic hepatitis C virus infection are one of the greatest revolutions in modern medicine. These drugs promise to eradicate the infection, showing high cure rates even in difficult to treat populations with very few side effects. Nevertheless, some cases of recurrence and de novo hepatocellular carcinoma after treatment with these drugs have been reported. We describe two cases of patients treated with direct-acting antiviral agents that developed hepatocarcinoma during follow-up post-treatment. Keywords: Hepatocellular carcinoma, HCV infection, Direct-acting antiviral therap

Prognostic models for intracerebral hemorrhage: systematic review and meta-analysis

Abstract Background Prognostic tools for intracerebral hemorrhage (ICH) patients are potentially useful for ascertaining prognosis and recommended in guidelines to facilitate streamline assessment and communication between providers. In this systematic review with meta-analysis we identified and characterized all existing prognostic tools for this population, performed a methodological evaluation of the conducting and reporting of such studies and compared different methods of prognostic tool derivation in terms of discrimination for mortality and functional outcome prediction. Methods PubMed, ISI, Scopus and CENTRAL were searched up to 15th September 2016, with additional studies identified using reference check. Two reviewers independently extracted data regarding the population studied, process of tool derivation, included predictors and discrimination (c statistic) using a predesignated spreadsheet based in the CHARMS checklist. Disagreements were solved by consensus. C statistics were pooled using robust variance estimation and meta-regression was applied for group comparisons using random effect models. Results Fifty nine studies were retrieved, including 48,133 patients and reporting on the derivation of 72 prognostic tools. Data on discrimination (c statistic) was available for 53 tools, 38 focusing on mortality and 15 focusing on functional outcome. Discrimination was high for both outcomes, with a pooled c statistic of 0.88 for mortality and 0.87 for functional outcome. Forty three tools were regression based and nine tools were derived using machine learning algorithms, with no differences found between the two methods in terms of discrimination (p = 0.490). Several methodological issues however were identified, relating to handling of missing data, low number of events per variable, insufficient length of follow-up, absence of blinding, infrequent use of internal validation, and underreporting of important model performance measures. Conclusions Prognostic tools for ICH discriminated well for mortality and functional outcome in derivation studies but methodological issues require confirmation of these findings in validation studies. Logistic regression based risk scores are particularly promising given their good performance and ease of application

Geological and mining heritage inventory of Aljustrel : A proposal for a geotouristic resource

Resumo alargadoSUMMARY: The Aljustrel mining district, in the SW Iberian Pyrite Belt, hosts the oldest mining activity known to date in the Iberian Peninsula. The unique geological record of the region with a good exposure of the host rocks and ores and the vast mining heritage makes this territory an outdoor laboratory for natural sciences learning, in particular for the ore generating processes. Inaugurated in 2018, the National Laboratory of Energy and Geology in Aljustrel has been developing, in collaboration with the Aljustrel Municipality, a set of activities for geological and mining heritage assessment.info:eu-repo/semantics/publishedVersio