Auto-imagem dos doentes em cuidados paliativos

Relatório de prática clínica apresentado à Escola Superior de Saúde Dr. Lopes Dias do Instituto Politécnico de Castelo Branco para cumprimento dos requisitos necessários à obtenção do grau de mestre em Cuidados Paliativos.O Mestrado em Cuidados Paliativos pretende instruir e desenvolver competências a Profissionais de Saúde, para o exercício autónomo de cuidados especializados prestados a pessoas com problemas de saúde crónicos e com prognóstico limitado, sem esquecer a sua família. No presente relatório reuni de forma clara e sintetizada as etapas de crescimento pessoal e profissional pelas quais passei durante a realização da Prática Clínica do curso, os objectivos inicialmente propostos e os concretizados, bem como as actividades realizadas para os alcançar. Apresento este trabalho sob uma metodologia substancialmente descritiva. Tendo como objecto de estudo em particular o tema Auto-Imagem dos doentes em Cuidados Paliativos, pretendi abordar a temática de forma a justificar as actividades realizadas, gerais e específicas, para cumprir os objectivos iniciais. Para isso, recorri a autores e artigos científicos relativos maioritariamente à área de Cuidados Paliativos e Psicologia clínica. Ao longo do trabalho apresento os objectivos delineados, as actividades desenvolvidas na Prática Clínica, bem como a descrição do local onde a desenvolvi e as dificuldades sentidas. O Objectivo primordial da Prática Clínica era a aquisição de competências nos pilares de Cuidados Paliativos: Trabalho em Equipa, Controlo de Sintomas, Apoio à Família e Comunicação.ABSTRACT: The Master degree in Palliative Care pretend to teach and develop competences in Health Care Professionals to the autonome practice of specialized care to a particular group of patients with chronic disease and limited prognosis, without forgetting the family. This Relatory pretends to reunite in a clear and sintetizes way the professional and personal stages that I lived during the practical part of the Master, the inicially goals and achieved, well as the activities that I realizes to achieved them. I present this document by a descriptive method. Having as main goal of this study in particular the theme of self-image in Palliative Care, I pretend to approach the theme in a way to justified the activities that I realized to fulfill the initial main goals. To do so, I resort to authors and cientific articles related mainly to the area of Palliative Care and Clinic Psychology. In the curse of this document I presente the objectives outlined, the activities developed in clinical practice, as well as the description of the local that I developed them and the difficulties that I felt. The main objective in the practice was to gain competences in palliative care pillars: team work, symptomatic control, family support and communication

Implantes imediatos no sector anterior: uma revisão sistemática

Tese de mestrado, Medicina Dentária, Universidade de Lisboa, Faculdade de Medicina Dentária, 2016Introdução: Implantes imediatos são colocados após a extracção dentária. As vantagens são a possível diminuição do tempo de tratamento, do número de cirurgias e da reabsorção óssea que, possivelmente, melhora a estética final. As desvantagens poderão ser a dificuldade em atingir a estabilidade primária e o risco aumentado de infeções e complicações. Objetivos: Responder à questão PICO: “Em pacientes que precisem de reabilitação implantar na zona anterior de canino a canino com recurso à técnica imediata, apresentará esta uma taxa de sucesso superior à técnica convencional?” Materiais e Métodos: Foi realizada uma pesquisa nas bases de dados MEDLINE e Cochrane Database of Systematic Reviews no mês de Dezembro de 2015. As palavras chave foram: immediate implant anterior OR immediate implant placement anterior OR immediate implant anterior AND extraction socket OR immediate implant anterior installation OR immediate implant esthetic. Encontraram-se 992 artigos e aplicaram-se critérios de inclusão e exclusão. Foram seleccionados 161 após a leitura do título e abstract. No final, incluiram-se 15 artigos: 5 estudos retrospetivos e 10 prospetivos. Resultados: Foram avaliados 15 estudos, 461 pacientes, 557 implantes com um follow-up médio de 29 meses, apresentando uma taxa de sucesso/sobrevivência médias de 99,5% 99,4%, respectivamente. Avaliou-se ainda as complicações, a existência de carga imediata não funcional, a colocação de membrana, a perda óssea e a estética final. Os resultados dos parâmetros avaliados são semelhantes aos obtidos pela técnica convencional. Conclusão: A colocação de implantes imediatos na zona anterior, de canino a canino, parece ser uma técnica fiável e previsível, no entanto, a análise de viés dos artigos revelou que estes ainda não possuem evidência científica necessária para se recomendar a colocação de implantes imediatos na zona anterior de canino a canino como prática clínica usual.Introduction: Immediate implants are placed in the same appointment as tooth extraction. The advantages may be treatment time, number of surgeries and dimineshed bone reabsortion, possibly improving esthetic results. The possible disadvantages may be difficulties in achieving primary stability and an increased risk of infection and complications. Objectives: Answser the PICO question: “In pacients who need implant treatment in anterior zone, from canine to canine, will immediate implants present a sucess rate superior to convenional techique?” Materials and Methods: Extensive literature review of the Cochrane Database of Systematic Reviews and MEDLINE electronic databases up to December 2015 identified eligible studies. The key words were immediate implant anterior OR immediate implant placement anterior OR immediate implant anterior AND extraction socket OR immediate implant anterior installation OR immediate implant esthetic, it wasn’t apply any filters for not loose any result of interest. It was found 992 articles, and it was applied inclusion and exclusion criteria. It was selected 161 after reading title and abstract. In the end, this systematic review included 15 articles: 5 and 10 was retrospective and prospective studies, respectively. Results: It was evaluated 15 studies, 461 pacients, 557 implants with a mean follow-up of 29 months, presenting a sucess/survival rate of 99,5% and 99,4%, respectively. Complications, immediate non function loading, grafting materials, bone loss and final esthetic were also evaluated. The results show that all the availed parameters are similar to the results of convencional technique. Conclusion: Immediate implants in anterior zone seems to be a fiable and predictable technique. The risk of bias is very high, so there is no cientific evidence to recommend the use of immediate implants in the anterior zone as an usual clinical pratice

“I pass… ” : promote healthy lifestyle habits

Revista de Psicologia da Criança e do Adolescente. - ISSN 1647-4120. - v. 6, n. 2 (Julho-Dezembro 2015). - p. 93-103.O “EU PASSO…” é um programa de promoção de hábito de vida saudável em jovens com idades entre os 11 e os 15 anos. O programa “EU PASSO…” tem a sua implementação durante dois anos, ao longo dos quais são trabalhados cinco componentes da saúde (Social, Alimentação, Estudo, Desporto e Higiene), bem como a promoção de competências psicossociais como a Tomada de Decisão, Resistência à Pressão dos Pares, Educação Sexual e a Prevenção dos Consumos de Álcool e Tabaco. O presente estudo apresenta os resultados conseguidos com a implementação do programa nos concelhos de Cascais, Lisboa-Benfica e Oeiras, nos anos letivos de 2011/2012 e 2012/2013, resultados muito favoráveis, através dos quais se verificou uma diminuição dos fatores de risco e um aumento dos fatores de proteção, tanto na perceção dos professores como dos próprios alunos. Revelou ainda um grande impacto social nos alunos, nos professores e ainda nas famílias dos alunos, com resultados muito positivos.The “I PASS...” is a Program which aims to Promote Healthy Lifestyle Habits and Psychosocial Skills in young people from ages 11 to 15, which includes in its design a gradual process of intervention over two years of implementation. The Program is based on a HEALTH concept which requires the balance of 5 components (Social, Food, Study, Sports, Hygiene) and promoting essential skills for healthy youth development: Emotional Management, Decision Making, Resistance to Peer Pressure, Sexual Education, and Tobacco and Alcohol Use Prevention. The present sturdy presents the results of the implementation of “I PASS…” in Cascais, Lisboa-Benfica and Oeiras councils, in Portugal, between 2011 and 2013. In general the evaluation of the results was very positive and it coincides with the process evaluation (qualitative) developed throughout the program and the Social Impact Assessment (external evaluation) performed by the Consultant Stone-Soup

Enhancing the topical delivery of N-acetyl-D-glucosamine: screening emulsifying systems

N-acetyl-D-glucosamine (GlcNAc) is a hydrophilic compound (log P = –2.1) and a versatile topical active. A monomer of hyaluronan (HA), it shares many of its physiological effects: it improves skin hydration, promotes the production of collagen and HA by fibroblasts and, as a tyrosinase inhibitor, also reduces hyperpigmentation [1–3]. However, contrary to HA, GlcNAc has a low molecular weight (221.21 g.mol-1), which makes it a suitable compound to permeate the skin. Amphiphilic emulsifiers are used to stabilise emulsions, yet there is limited information about their influence on skin delivery [4]. This study explored the influence of different emulsifiers in optimising the topical delivery of GlcNAc

Enhancing the topical delivery of N-acetyl-D-glucosamine: screening emulsifying systems

N-acetyl-D-glucosamine (GlcNAc) is a hydrophilic compound (log P = –2.1) and a versatile topical active. A monomer of hyaluronan (HA), it shares many of its physiological effects: it improves skin hydration, promotes the production of collagen and HA by fibroblasts and, as a tyrosinase inhibitor, also reduces hyperpigmentation [1–3]. However, contrary to HA, GlcNAc has a low molecular weight (221.21 g.mol-1), which makes it a suitable compound to permeate the skin. Amphiphilic emulsifiers are used to stabilise emulsions, yet there is limited information about their influence on skin delivery [4]. This study explored the influence of different emulsifiers in optimising the topical delivery of GlcNAc

Enhanced Immunogenicity of Mitochondrial-Localized Proteins in Cancer Cells.

Epitopes derived from mutated cancer proteins elicit strong antitumor T-cell responses that correlate with clinical efficacy in a proportion of patients. However, it remains unclear whether the subcellular localization of mutated proteins influences the efficiency of T-cell priming. To address this question, we compared the immunogenicity of NY-ESO-1 and OVA localized either in the cytosol or in mitochondria. We showed that tumors expressing mitochondrial-localized NY-ESO-1 and OVA proteins elicit significantdly higher frequencies of antigen-specific CD8+ T cells in vivo. We also demonstrated that this stronger immune response is dependent on the mitochondrial location of the antigenic proteins, which contributes to their higher steady-state amount, compared with cytosolic localized proteins. Consistent with these findings, we showed that injection of mitochondria purified from B16 melanoma cells can protect mice from a challenge with B16 cells, but not with irrelevant tumors. Finally, we extended these findings to cancer patients by demonstrating the presence of T-cell responses specific for mutated mitochondrial-localized proteins. These findings highlight the utility of prioritizing epitopes derived from mitochondrial-localized mutated proteins as targets for cancer vaccination strategies.S

HLA-E-restricted, Gag-specific CD8+ T cells can suppress HIV-1 infection, offering vaccine opportunities

Human leukocyte antigen-E (HLA-E) normally presents an HLA class Ia signal peptide to the NKG2A/C-CD94 regulatory receptors on natural killer (NK) cells and T cell subsets. Rhesus macaques immunized with a cytomegalovirus-vectored simian immunodeficiency virus (SIV) vaccine generated Mamu-E (HLA-E homolog)-restricted T cell responses that mediated post-challenge SIV replication arrest in >50% of animals. However, HIV-1-specific, HLA-E-restricted T cells have not been observed in HIV-1-infected individuals. Here, HLA-E-restricted, HIV-1-specific CD8 + T cells were primed in vitro. These T cell clones and allogeneic CD8 + T cells transduced with their T cell receptors suppressed HIV-1 replication in CD4 + T cells in vitro. Vaccine induction of efficacious HLA-E-restricted HIV-1-specific T cells should therefore be possible

HLA-E-restricted SARS-CoV-2-specific T cells from convalescent COVID-19 patients suppress virus replication despite HLA class Ia down-regulation

Pathogen-specific CD8+ T cell responses restricted by the nonpolymorphic nonclassical class Ib molecule human leukocyte antigen E (HLA-E) are rarely reported in viral infections. The natural HLA-E ligand is a signal peptide derived from classical class Ia HLA molecules that interact with the NKG2/CD94 receptors to regulate natural killer cell functions, but pathogen-derived peptides can also be presented by HLA-E. Here, we describe five peptides from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that elicited HLA-E–restricted CD8+ T cell responses in convalescent patients with coronavirus disease 2019. These T cell responses were identified in the blood at frequencies similar to those reported for classical HLA-Ia–restricted anti–SARS-CoV-2 CD8+ T cells. HLA-E peptide–specific CD8+ T cell clones, which expressed diverse T cell receptors, suppressed SARS-CoV-2 replication in Calu-3 human lung epithelial cells. SARS-CoV-2 infection markedly down-regulated classical HLA class I expression in Calu-3 cells and primary reconstituted human airway epithelial cells, whereas HLA-E expression was not affected, enabling T cell recognition. Thus, HLA-E–restricted T cells could contribute to the control of SARS-CoV-2 infection alongside classical T cells

MAIT cell clonal expansion and TCR repertoire shaping in human volunteers challenged with Salmonella Paratyphi A

Mucosal-associated invariant T (MAIT) cells are innate-like T cells that can detect bacteria-derived metabolites presented on MR1. Here we show, using a controlled infection of humans with live Salmonella enterica serovar Paratyphi A, that MAIT cells are activated during infection, an effect maintained even after antibiotic treatment. At the peak of infection MAIT cell T-cell receptor (TCR)β clonotypes that are over-represented prior to infection transiently contract. Select MAIT cell TCRβ clonotypes that expand after infection have stronger TCR-dependent activation than do contracted clonotypes. Our results demonstrate that host exposure to antigen may drive clonal expansion of MAIT cells with increased functional avidity, suggesting a role for specific vaccination strategies to increase the frequency and potency of MAIT cells to optimize effector function