Post-Tracheal Extubation Negative Pressure Pulmonary Edema

O edema pulmonar de pressão negativa (EPPN) também descrito na literatura como edema agudo do pulmão pós-obstrutivo ou pós-extubação traqueal, é uma entidade rara, com uma incidência de aproximadamente 0.1 % em doentes anestesiados. Os autores descrevem o caso, ocorrido após extubação traqueal, de um doente submetido a orquidectomia por via laparoscópica sob anestesia geral balanceada. Relatam a fisiopatologia, o padrão radiológico e broncoscópico e as medidas terapêuticas instituídas

Selective pressure acting on influenza virus neuraminidase protein and relation with development of resistance to antiviral drugs

Neuraminidase (NA) protein of influenza viruses has the particularity of being under antibody and antiviral drug selective pressure, as it is one of the main surface antigens and the target of neuraminidase inhibitors(NAIs). The aim of this study is to investigate the selective pressure(SP) acting on the NA of seasonal and pandemic influenza viruses. It comprises two objectives: (a)to evaluate the contribution of positive SP for the emergence of NAIs resistant viruses; and (b)to determine the impact of NAIs introduction into clinic and its wide use during pandemic on the SP acting on NA. For the 1st objective it will be analysed the SP acting on the sites associated with NAIs resistance or reduction in susceptibility. The 2nd objective implies a differential evolutionary pressure analysis according to time, with 3 sub-datasets of NA sequences being considered: (1)before worldwide introduction of NAIs into clinic(1999); (2)before wide use of oseltamivir during A(H1N1)2009 pandemic(2009); and (3)from 2009 to date. A large dataset of full-length NA coding sequences will be used for each (sub)type/variant, comprising sequences obtained at national level(since 2000/2001) and sequences available at GISAID and NCBI. A(H1N1)seasonal dataset was already created, including a total of 1523 sequences, from which 94 belong to 1st sub-dataset, 1094 to 2nd and 335 to 3rd. All SP analysis will be performed using the expertise acquired with this workshop. This study may contribute for understanding the role of antiviral drug selective pressure in NAIs resistance, patterns of emergency of resistant viruses and NA evoluti

Evaluation and Characterization of Influenza Antiviral Drug Resistance in Portugal: Major Results and Achievements of a 5-Year Study

In 2007 started to be carried out for the first time in Portugal a study focused on influenza antiviral drug resistance. Three main objectives were established:(1)to determine the antiviral profile of influenza viruses to oseltamivir, zanamivir and amantadine;(2)to determine and monitor the baseline level of susceptibility along winter seasons and for each influenza sub(type);(3)to analyse and characterize the whole genome of viruses that showed phenotypic levels of inhibition to neuraminidase inhibitors(NAIs). NAIs profile was determined phenotypically, using a fluorescence MUNUNA assay, and genotypically by NA and HA sequencing. A total of 340 seasonal viruses(117 A(H3N2),93 A(H1N1),130 B) were tested for oseltamivir and of 297(112 A(H3N2),68 A(H1N1),117 B) for zanamivir. Additionally, 142 A(H1N1)pdm09 viruses were evaluated for both NAIs. Whole genome sequencing was performed in 27 of the A(H1N1)pdm09 viruses. Amantadine profile was determined through M2 pyrosequencing or conventional sequencing in a total of 205 seasonal A viruses(138 A(H3N2),84 A(H1N1)) and of 117 A(H1N1)pdm09 viruses. Main results are: -Resistance to oseltamivir in 27 A(H1N1) seasonal viruses(29%,N=93) from 2007/2008 and 2008/2009 and in one A(H1N1)pdm09 virus(0.7%,N=142) from 2010/2011. These viruses exhibited a highly reduced level of inhibition to oseltamivir by phenotypic analysis (170-650 IC50 fold-change) and NA H275Y mutation; -One suspected case of clinical resistance to oseltamivir with a mixed population of H275Y viruses(73,8%H275,26.2%Y275); -No resistance to zanamivir; -Dual reduced susceptibility to oseltamivir and zanamivir in one B virus(0,85%,N=117) and in two A(H1N1)pdm09 viruses(1,41%,N=142). These viruses exhibited a 2-4 IC50 fold-change level of inhibition to both NAIs. A mixed population of D197N viruses was found in the B virus(56%D197,44%N197) and the two A(H1N1)pdm09 viruses shared NA I223V and PB2 V480I mutations; -Resistance to amantadine in 49 A(H3N2) viruses(35,5%,N=138) from 2005/2006 to 2008/2009(46 S31N,3 S31N+V27A), and in all A(H1N1)pdm09 viruses(S31N). This 5-year study allowed to establish a technical platform for influenza antiviral drug resistance evaluation, to timely detect the emergence of resistant viruses, to acquire know-how on the natural variation of virus susceptibility, and to contribute for the management of cases suspected of clinical resistance. Additionally, it allowed the gathering of a large amount of data that will be used in more advanced studies, focused on evolutionary analysis and on detailed characterization of specific mutations

Influence of oxygen content on the antibacterial effect of Ag-O coatings deposited by magnetron sputtering

Ag and AgOx thin films were deposited by pulsed DC magnetron sputtering, for medical devices, in order to provide antibacterial properties. During the deposition process, oxygen flow, and, consequently, oxygen fraction, was varied (0â15 sccm) to understand the influence of oxygen species in the physical, chemical and structural properties of thin films. Coatings morphology was observed by scanning electron microscopy (SEM) and their nanostructure and composition were assessed by X-ray diffraction (XRD) and X-ray photoelectron spectroscopy (XPS) and energy dispersive spectroscopy (EDS), respectively. XRD and XPS analyses revealed that Ag thin films are composed by metallic Ag, which crystallizes in fcc-Ag phase; whereas AgOx showed a mixture of Ag2O and AgO phases for low oxygen fraction that became single AgO with the increase of oxygen fraction in the discharge. Surface wettability and surface tension of the coatings were also determined showing hydrophobic character. Halo inhibition zone tests were performed against Staphylococcus epidermidis, in order to evaluate the antibacterial behavior of coatings, and silver ion release was measured. Only AgOx presented antibacterial behavior, showing that the presence of silver oxide are the main reasons for the antibacterial effect, probably due to the increased production of ROS (Reactive Oxygen Species),making these coatings promising for medical applications.The authors acknowledgments the financial support of FCTFundação para a Ciência e Tecnologia through grant SFRH/BD/90321/2012. Also thank support by FEDER through the COMPETE Program and by the Portuguese Foundation for Science and Technology (FCT) in the framework of the Strategic Funding UID/FIS/04650/2013, and projects ERA-SIINN/0004/2013 through the “Fundo Europeu de Desenvolvimento Regional” (FEDER)

Hábitos de aconselhamento de medicamentos por fisioterapeutas

O fisioterapeuta, enquanto profissional de saúde envolvido na promoção e educação para a saúde, e apresentando funções de aconselhamento, poderá, no exercício da sua prática clínica, aconselhar medicamentos aos seus utentes, para além da eventual administração dos mesmos. No entanto, e apesar dessas práticas, o fisioterapeuta tem na maior parte dos casos pouca formação na área da farmacologia. O aconselhamento de medicamentos deverá ter em consideração de que modo os efeitos da sua utilização irão influenciar o tratamento de fisioterapia e vice-versa. É, por isso, fundamental que estes profissionais sejam detentores de formação na área da farmacologia de modo a potenciar os benefícios e minimizar os riscos destas interacções. Objectivos do estudo - Geral: caracterizar os hábitos de aconselhamento de medicamentos por fisioterapeutas em Portugal. Específicos: identificar os grupos farmacoterapêuticos mais aconselhados; determinar as situações e razões referidas para o aconselhamento de medicamentos; determinar a informação prestada pelos fisioterapeutas sobre os medicamentos aconselhados

Influenza A(H1N1)pdm09 Resistance and Cross-Decreased Susceptibility to Oseltamivir and Zanamivir Antiviral Drugs

Neuraminidase inhibitors (NAIs) oseltamivir and zanamivir are currently the only effective antiviral drugs available worldwide for the management of influenza. The potential development of resistance is continually threatening their use, rationalizing and highlighting the need for a close and sustained evaluation of virus susceptibility. This study aimed to analyze and characterize the phenotypic and genotypic NAIs susceptibility profiles of A(H1N1)pdm09 viruses circulating in Portugal from 2009 to 2010/2011. A total of 144 cases of A(H1N1)pdm09 virus infection from community and hospitalized patients were studied, including three suspected cases of clinical resistance to oseltamivir. Oseltamivir resistance was confirmed for two of the suspected cases. Neuraminidase (NA) H275Y resistant marker was found in viruses from both cases but for one it was only present in 26.2% of virus population, raising questions about the minimal percentage of resistant virus that should be considered relevant. Cross-decreased susceptibility to oseltamivir and zanamivir (2-4 IC50 fold-change) was detected on viruses from two potentially linked community patients from 2009. Both viruses harbored the NA I223V mutation. NA Y155H mutation was found in 18 statistical non-outlier viruses from 2009, having no impact on virus susceptibility. The mutations at NA N369K and V241I may have contributed to the significantly higher baseline IC50 value obtained to oseltamivir for 2010/2011 viruses, compared to viruses from the pandemic period. These results may contribute to a better understanding of the relationship between phenotype and genotype, which is currently challenging, and to the global assessment of A(H1N1)pdm09 virus susceptibility profile and baseline level to NAIs

Chemoinformatic Approaches To Predict the Viscosities of Ionic Liquids and Ionic Liquid-Containing Systems

UID/QUI/50006/2019.Modelling, predicting, and understanding the factors influencing the viscosities of ionic liquids and related mixtures are sequentially checked in this work. The molecular maps of atom-level properties (MOLMAP codification system) is adapted for a straightforward inclusion of ionic liquids and mixtures containing ionic liquids. Random Forest models have been tested in this context and an optimal model was selected. The interpretability of the selected Random Forest model is highlighted with selected structural features that might contribute to identify low viscosities. The constructed model is able to recognize the influence of different structural variables, temperature, and pressure for a correct classification of the different systems. The codification and interpretation systems are highlighted in this work.authorsversionpublishe

Comparing Handcrafted Features and Deep Neural Representations for Domain Generalization in Human Activity Recognition

Human Activity Recognition (HAR) has been studied extensively, yet current approaches are not capable of generalizing across different domains (i.e., subjects, devices, or datasets) with acceptable performance. This lack of generalization hinders the applicability of these models in real-world environments. As deep neural networks are becoming increasingly popular in recent work, there is a need for an explicit comparison between handcrafted and deep representations in Out-of-Distribution (OOD) settings. This paper compares both approaches in multiple domains using homogenized public datasets. First, we compare several metrics to validate three different OOD settings. In our main experiments, we then verify that even though deep learning initially outperforms models with handcrafted features, the situation is reversed as the distance from the training distribution increases. These findings support the hypothesis that handcrafted features may generalize better across specific domains.publishe