Cuidados paliativos em doentes com cancro

Projeto de Pós-Graduação/Dissertação apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Mestre em Ciências FarmacêuticasNos últimos anos as doenças oncológicas têm vindo a sofrer um grande aumento, passando por muitos a ser vistas como uma nova epidemia. A busca incessante da cura para estas doenças promove a constante negação da morte, deixando para segundo plano as intervenções na saúde dos doentes terminais. As intervenções que têm como objetivo proporcionar ao doente um fim de vida digno e com o mínimo de sofrimento, bem como paz e estabilidade à família que o acompanha em doenças carregadas de sofrimento não só físico como psicológico denominam-se cuidados paliativos. Neste âmbito surge esta dissertação de mestrado, introduzindo os cuidados paliativos com o devido enquadramento teórico. Relata-se a sua história, desde o aparecimento deste tipo de cuidados. É feita uma abordagem aos cuidados paliativos onde se descreve os seus princípios e filosofias, as unidades onde se efetuam e prestam este tipo de cuidados bem como o funcionamento das suas equipas e quais os seus modelos de atuação. Procura-se através da análise de casos de doentes com cancro avaliar a evolução de sintomas associados a este tipo de doenças. Por fim enfatiza-se o funcionamento e desenvolvimentos dos Cuidados Paliativos em Portugal nos últimos anos, presta-se ainda uma cuidada atenção aos cuidados paliativos pediátricos relatando o seu desenvolvimento e as suas diferenças em relação aos mesmos quando prestados em adultos. In the last years the incidence of oncological diseases has increased being seen by many as a new epidemic. The relentless pursuit of a cure promotes a constant denial of death, leaving aside active and effective interventions on the healthcare of these terminal patients that would dignify his life. These interventions are named as hospice care. Those cares provide the patient a worthy end of life with a minimal suffering, as well peace and stability to the family with all the physical and psychological suffering. In this context this dissertation arises, introducing palliative care with proper theoretical framework. Relates the history of hospice cares as since its foundation, describing its principles and philosophies as units in which they take place this type of care as well as the functioning of their work teams and their role models. Through the analysis of cancer patients, to evaluate the evolution of the symptoms associated to such diseases. Finally describe the operation and development of hospice care in Portugal in recent years and take a careful attention to paediatrics hospice care and his development and which differences they have relative to the cares of the adults

Abordagem clínica da leucoplasia verrucosa proliferativa

O cancro oral é um dos 10 cancros mais comuns no mundo, apresentando taxas de mortalidade elevadas. É na maioria das vezes diagnosticado tardiamente. Contudo sabe-se que existe um grupo de lesões, designadas, de potencialmente malignas, que têm capacidade de evoluir e progredir até cancro oral. Entre este encontra-se a leucoplasia oral, caracterizada como uma mancha ou placa branca que não pode ser identificada clínica ou patologicamente como nenhuma outra lesão branca e sem etiologia conhecida para além do tabaco (OMS, 1978). Existem vários tipos de leucoplasias, contudo há uma rara, sem etiologia conhecida e com caracter bastante agressivo, designada, leucoplasia verrucosa proliferativa. É caracterizada como uma leucoplasia de progressão lenta, com características multifocais, que se apresenta clinicamente com aspeto verrucoso e com prolongamentos exofíticos e proliferativos. Apresenta elevadas taxas de transformação maligna e de recidiva após tratamento, não havendo ainda um tratamento totalmente eficaz. Devido a sua elevada taxa de transformação maligna e a evolução para carcinoma verrucoso e carcinoma de células escamosas, é importante que seja feito um diagnóstico precoce, para que se tente travar a sua evolução, o que melhora o prognóstico e a morbilidade associada à lesão. Diminuindo, assim, também, a incidência de cancro oral, ou pelo menos a incidência de cancro oral extensivo.Oral Cancer is one of the 10 most common cancers in the world, with high mortality rates. Is most often diagnosed late. However, it is known that there is a group of potentially malignant lesions that have the ability to evolve into oral cancer. Spot or white plaque that can not be identified clinically or pathologically as no other white lesion and no known etiology other than tobacco (WHO, 1978). There are several types of leukoplakias, however there is a leukoplakia without kown etiology, rare and with a very aggressive character, called proliferative verrucous leukoplakia. Is characterized as a slow progression leukoplakia, with multifocal features, that presents clinically verrucous appearance and with exophytic and proliferative projections. Presents with high rates of malignant transformation and relapse after treatment, with no totally effective treatment. Because of its high rate of malignant transformation and evolution in to verrucous carcinoma and squamous cell carcinoma, it is important that exists early diagnosis to try to halt its evolution and reducing the incidence of oral cancer or extensive oral cancer

Rare autosomal dominant hereditary hemochromatosis associated with SLC40A1 gene: ferroportin disease or type 4 hereditary hemochromatosis?

Ferroportin (FPN1), encoded by the SLC40A1 gene, is the unique cellular iron exporter identified in mammals. FPN1 transfers iron from the intestine and macrophages into the bloodstream. This function is negatively regulated by hepcidin. Mutations in SLC40A1 may affect FPN1 function, originating distinct autosomal dominant diseases: (i) the Ferroportin Disease (FD), due to loss-of-function mutations, is characterized by decreased iron export from enterocytes and severely affected iron transfer in macrophages, giving rise to a marked iron accumulation in spleen and liver; and (ii) the Type 4 Hereditary Hemochromatosis (HH), resulting from gain-of-function mutations conferring resistance to hepcidin-mediated FPN1 degradation and consequently high cellular iron export. In this study, 335 individuals suspected of having non-classic HH were enrolled. Six genes related with iron metabolism were analysed by SSCP, dHPLC or NGS. The latter used TruSeq or Nextera XT libraries and a MiSeq platform (Illumina). Genetic variants found were validated by Sanger sequencing. Predictive consequences at protein level were evaluated using Polyphen-2 and SIFT softwares. From all patients analysed, three SLC40A1 pathogenic variants were detected in heterozygosity in three women: two missense, c.238G>A, p.Gly80Ser and c.610G>A, p.Gly204Ser; and one deletion, c.485_487delTTG; p.Val162del. These variants had been reported in public databases, but they were not known to be present in the Portuguese population. The p.Gly80Ser and the p.Val162del are FPN1 loss-of-function mutations and were found associated with hyperferritinemia and low transferrin saturation (FD). In contrast, the p.Gly204Ser induced a gain of FPN1 function with a full iron export capacity giving the patient a type 4-HH phenotype, which includes iron overload, hyperferritinemia and high transferrin saturation. Detailed clinical evaluation of the suspected patients are useful to unravel the effect of different mutations in FPN1 function, expression and regulation.This work was partially supported by INSA_2013DGH910 and GenomePT (POCI-01-0145-FEDER-022184).info:eu-repo/semantics/publishedVersio

Caracterização da estrutura populacional de isolados de Escherichia coli provenientes de suiniculturas de produção intensiva e extensiva de Portugal

Projeto de Pós-Graduação/Dissertação apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Mestre em Ciências FarmacêuticasEscherichia coli é uma bactéria pertencente à numerosa família Enterobacteriaceae. Está normalmente associada a infeções do trato urinário, meningites do recém-nascido, infeções intestinais e septicemia. E. coli constitui também uma das bactérias mais prevalentes na flora intestinal dos animais e do Homem, sendo por isso frequentemente usada como indicador da pressão seletiva causada pelo uso de antibióticos no Homem e nos animais, com especial ênfase em animais para consumo humano. Dados recolhidos na Europa demonstram que há uma elevada ocorrência de estirpes de E.coli consideradas comensais provenientes tanto do Homem como de animais resistentes a vários antibióticos. Os isolados de E.coli pertencentes aos grupos filogenéticos A e B1 são tradicionalmente considerados comensais. Contudo, cada vez mais têm sido associados a infeções extraintestinais tal como acontece nos grupos de maior virulência B2 e D. O presente trabalho tem como objetivo principal caracterizar a estrutura populacional de isolados de E.coli provenientes de suiniculturas portuguesas, avaliar a sua resistência a antibióticos frequentemente usados clinicamente e relacionar essas resistências com a virulência tipicamente associada aos grupos filogenéticos, pois ainda são escassos os estudos neste nicho. É também objetivo deste estudo contribuir para a melhoria de estratégias de prevenção e controlo da transmissão da resistência aos antibióticos ao Homem, quer pela cadeia alimentar, quer através do ambiente, diminuindo desta forma os riscos para a Saúde Pública. Para isso, foram analisados 155 isolados bacterianos, provenientes de amostras de animais e do ambiente (águas, ar, rações, entre outras) de uma suinicultura Portuguesa de produção intensiva, e outra de produção extensiva. Depois de realizada a extração do DNA bacteriano nos isolados analisados, identificou-se a presença de E. coli por PCR. Para os isolados identificados E. coli, procedeu-se a um PCR multiplex para determinação do grupo filogenético, tendo os produtos de PCR sido analisados por electroforese em gel de agarose. Efetuou-se ainda a análise da suscetibilidade aos antibióticos dos isolados de E. coli através do método de difusão por discos, tendo sido testados antibióticos pertencentes a diferentes classes. Dos 155 isolados bacterianos analisados foram identificados como sendo E. coli 103 isolados (66%). Foi ainda observado que os isolados provenientes das duas suiniculturas estudadas foram mais frequentemente resistentes aos antibióticos espectinomicina (100%), neomicina (95%) e estreptomicina (85%). De uma forma geral, foram registadas maiores percentagens de resistência na suinicultura de produção intensiva. O grupo filogenético A é predominante no total de isolados considerados resistentes. Embora em menos quantidade, o filogrupo D aparece associado a isolados de E. coli resistentes a quase todos os antibióticos analisados. As suiniculturas portuguesas parecem assim ser potenciais reservatórios de bactérias virulentas e com resistências a antibióticos de uso clinico Humano e possivelmente de genes de resistência a antibióticos com elevada capacidade de dispersão. O tema da resistência aos antimicrobianos é um assunto de elevada importância, contudo é uma área que ainda tem uma grande lacuna, sobretudo no papel dos animais na epidemiologia da resistência a antibióticos, sendo necessário realizar mais estudos para que seja possível implementar medidas eficazes no controlo de resistências a antibióticos. Escherichia coli is a bacteria part of the numerous family known as Enterobacteriaceae. It is normally associated with urinary tract infections, newborn meningitis intestinal infections and septicemia. E. coli is also one of the most prolific bacteria both in men’s and animal’s intestinal flora, which is why it is frequently used as an indicator of the selective pressure caused by the use of antibiotics in men and animals, especially when it comes to the production of animals for human consume. Data gathered around Europe shows a high occurrence of E.coli commensal strains present in men and animals which are resistant to various antibiotics. E.coli isolated belonging to phylogenetic groups A and B1 are traditionally considered to be commensal. Nevertheless, they have increasingly been associated with extra-intestinal infections, something common among the more virulent groups B2 and D. The main objective of this study is to characterize the population structure of E.coli isolated obtained from Portuguese pig farms, evaluate their resistance to some of the most clinically used antibiotics and to relate those resistances with the virulence showed by the phylogenic groups, as there are very few studies on the matter. This study also intends to define strategies or enhance those already in place in order to help prevent the transmission of resistances to men, may it be through the food chain or the environment, ultimately decreasing public health’s risks. With that aim in mind, 155 bacteria isolated were analyzed using samples of animals and the environment (water, air, rations, among others) belonging to an intensive production Portuguese pig farm and another one of extensive production. After extracting bacterial DNA from the isolated, it was possible to identify the presence of E. coli by PCR. For the identified E. coli isolated it was done a PCR multiplex to determine the phylogenic group, including the analysis of every single PCR product by the way of agar gel electrophoresis. It was also conducted the susceptibility analysis of the E. coli isolated through the disc diffusion method (Kirby – Bauer method), with different classes antibiotics being tested. Of the 155 bacterial isolated analyzed, 103 isolated (66%) were identified as being E. coli. Additionally, it was also observed that the isolated originating from the two studied pig farms were frequently more resistant to the spectinomycin antibiotic (100%), neomycin (95%) and streptomycin (85%). In general, higher percentages of resistance were recorded in the intensive production pig farm. The phylogenetic group A is predominant in the total number of isolated considered to be resistant. Although in a lesser quantity, phylogenetic group B appears associated to E. coli. isolated resistant to almost all antibiotics tested. Portuguese pig farms seem to be potential virulent bacteria repositories with resistance to human clinic antibiotics and possibly also repositories of antibiotic resistant genes with high capacity of dispersion. The theme of antimicrobial resistance is a matter of huge importance but still an area with a lot to discover, mainly in the role played by animals in the epidemiology of antibiotic resistance. It is necessary to conduct more studies in order to make it possible to implement efficient measures in the control of antibiotic resistances

Ovarian Response, Follicular Function and Oocyte Developmental Competence in Gonadotropin Treated Prepubertal Calves

Sexual immaturity during the prepubertal period in cattle is characterized by low pulse frequency of LH, anovulatory waves of follicle development, absence of corpora lutea (i.e., progesterone) and oocytes of reduced developmental capacity in vitro when compared to oocytes of sexually mature animals. However, calf ovaries are responsive to exogenous gonadotropin treatment early in life, and the use of prepubertal animals as a source of oocytes for in vitro embryo production may have significant potential to decrease generation interval and accelerate the rate of genetic gain. The overall objective of this thesis was to investigate the effect of exogenous FSH treatment on the ovarian response, hormonal profiles, ovulation and oocyte developmental competence in prepubertal calves. In the first study (Chapter 3) the effect of cumulative dose (200 mg vs. 350 mg) and duration (4 vs. 7 days) of FSH treatment on the ovarian response and the number of spontaneous and induced ovulations in 5-month-old calves were compared. Calves (n=24) were selected for gonadotropin treatment from a group of spring-born calves (n=51) based on the antral follicle counts (AFC) at the time of wave emergence. Calves were classified in low, medium and high AFC, and the ones in the medium classification (250.8, range of 20 to 32 follicles) were used in this study. At the end of the FSH treatment and 24 hours after treatment with pLH, the number of follicles 9 mm was greater in the 7-day than in the 4-day treatment group and in calves given a cumulative dose of 350 mg of FSH compared to those given 200 mg. Spontaneous ovulations were observed in 14 calves between Day 4 of FSH treatment and 12-hours post-LH treatment. The number of total and spontaneous ovulations was higher in the 7-day treatment groups than in the 4-day groups, and the number of spontaneous ovulations was higher in calves given a cumulative dose of 200 mg FSH than 350 mg. Numbers of ovulations in response to exogenous LH did not differ among groups. In the second study (Chapter 4), data showed in prepubertal calves (n=46) that the number of follicles at the beginning of a wave was predictive of the number recruited into subsequent waves and that after FSH treatment, the number of medium and large sized follicles available for follicular aspiration was positively associated with the number of follicles 1 mm at the time of wave emergence. In calves with low (n=12) and high (n=10) AFC at wave emergence, 7 days of FSH treatment resulted in a higher number of large than small size follicles than the 4 days of FSH treatment. High AFC at wave emergence resulted in a greater number of follicles 6 mm available for aspiration and a greater number of cumulus oocyte complexes (COC) collected than low AFC. The third study (Chapter 5) was designed to investigate the relationship between the antral follicular counts and plasma concentrations of AMH and FSH at the time of wave emergence in prepubertal calves and to compare the effects of age and duration of gonadotropin treatment on ovarian response of prepubertal and pubertal cattle. The AFC and the plasma concentrations of AMH at the time of wave emergence were positively correlated and both were positively correlated with the number of follicles 6 mm at the time of oocyte collection. Ovarian response was greater in calves at 4 months of age than at 7 months and was characterized by a higher number of medium to large (i.e., 6mm) sized follicles and higher number of recovered oocytes following transvaginal ultrasound-guided aspiration. Prolonged follicular growth by the 7-day treatment resulted in a greater number of large follicles at the end of the treatment and a greater degree of follicular maturation, characterized by lower intrafollicular E2:P4 ratio and higher proportion of fully expanded COC after LH treatment. In the fourth study (Chapter 6), different methods to control endogenous LH release and prevent ovulations during 7 days of exogenous FSH treatment were investigated. A long-acting progesterone (Long-acting P4) treatment at the time of follicular ablation and the GnRH antagonist Cetrorelix given at 48 hours intervals during FSH treatment were effective in preventing endogenous LH release and spontaneous ovulations during 7 days of exogenous FSH treatment. Ovulations were observed after FSH treatment in the Long-acting P4 treatment groups, while ovulations were prevented in calves of the Cetrorelix group. Luteal structures formed due to spontaneous ovulations were functional and a positive correlation was observed between the number of structures and the plasma concentrations of progesterone. In Chapter 7, oocyte developmental competence following in vitro vs. in vivo maturation of oocytes from prepubertal calves and in vivo maturation of oocytes from calves and pubertal heifers given 4 or 7 days of exogenous FSH treatment were evaluated in Study I. Spontaneous ovulations before oocyte collection were observed in calves and prevented meaningful comparisons among groups, resulting in lower rates of cleavage and blastocyst in the 7-day in vivo group. Blastocyst rates did not differ between 4-day in vivo vs. 4- and 7-day in vitro. In Study II, 4, 6 and 7 days of exogenous FSH treatment under controlled endogenous LH release were compared and six days of exogenous FSH support was associated with the greatest developmental competence of oocytes collected from 5-month-old calves

Healthcare Signage Design: A review on recommendations for effective signing systems

This article provides a set of recommendations, selected from the systematic literature review carried out, regarding signage systems for healthcare institutions that can be used for designing or redesigning more competent signage systems. The signage systems in healthcare settings are usually poorly designed due to the expansion of the original facilities, a lack of awareness of existing guidelines by the developers, and a lack of agreement between the existing recommendations. There are several guidelines and recommendations available in the literature; however, each work was developed for specific cultural contexts, so there is a lack of uniformity among them. Hence, there is a need to uniformize the guidelines for signage design in healthcare, in order to provide supportive information for developers to build and implement effective and efficient signage systems. This study examined the available literature on the subject and established a set of guidelines organized in categories to help the design process. A literature review was conducted, and 34 selected publications were analyzed from which recommendations were created. A best practices manual was also studied and used as the analytical framework to establish the design categories of the developed recommendations. This review resulted in guidelines divided into nine design categories that should be considered in the design and implementation process of signage systems in healthcare facilities

Studying strategies for air distribution inside a refrigeration chamber.

info:eu-repo/semantics/publishedVersio

Enhancing Bioenergy Recovery from Agro-food Biowastes as a Strategy to Promote Circular Bioeconomy

Agro-food industries produce large amounts of wastes challenging innovative and efficient valorisation strategies promoting the circular bioeconomy concept. Anaerobic digestion technology is an interesting route for bioenergy recovery in the agro-food chain sector. In this work, a simple approach is proposed for assessing energy performance of livestock manure and mixed sewage sludge, as substrate by coupling the potential addition of several agro-food biowastes (co-substrate: fruit and vegetable biowastes, fish canning industry, other manures, coffee wastes, and non-edible crops). The results obtained showed an increase of energy performance indicator ranging from 30 to 250% and 62 to 539%, for livestock manure and mixed sewage sludge, respectively. This conceptual approach for feedstocks promotes the circular bioeconomy as it encourages the stakeholders to a smart use of anaerobic biotechnology at rural-level or urban-levelinfo:eu-repo/semantics/submittedVersio

Studying street geometry influence in PM10 concentration

info:eu-repo/semantics/publishedVersio