Novas Fronteiras no Prognóstico

A pancreatite aguda é um processo inflamatório do pâncreas com variável envolvimento dos tecidos pancreático, peripancreáticos e órgãos à distância. Em 80% dos casos a pancreatite aguda é leve, com edema intersticial e com recuperação, geralmente dentro da primeira semana. A pancreatite necrotizante, que pode ocorrer entre 15 a 20% dos doentes, é caracterizada por necrose, envolvendo o pâncreas e os tecidos peripancreáticos. Quando complicada por infeção está associada a uma alta morbimortalidade e a elevados encargos económicos. Foi demonstrado, em vários estudos, o papel do stresse oxidativo na fisiopatologia da pancreatite aguda, particularmente na patogénese e na progressão deste processo inflamatório. No entanto, não está claro se as espécies reativas de oxigénio atuam como mediadores ou se iniciam a complexa cascata de eventos que leva à pancreatite aguda. O papel exato do stresse oxidativo no desenvolvimento desta condição patológica permanece assim por esclarecer. A identificação precoce de doentes que irão desenvolver pancreatite aguda grave é de extrema importância, uma vez que vai permitir uma monitorização mais apertada, uma terapia de suporte individualizada e a prevenção das complicações associadas. O objetivo desta dissertação foi aprofundar o conhecimento da fisiopatologia da pancreatite aguda no contexto de doentes com etiologia litiásica, nomeadamente na sua patogénese e na progressão do processo inflamatório, através da avaliação do stresse oxidativo e na identificação de novos biomarcadores de prognóstico, recorrendo-se ao estudo do perfil metabolómico. Neste sentido, foi realizado um estudo em modelo animal e um estudo clínico numa amostra de doentes, de modo a identificar possíveis biomarcadores de prognóstico da pancreatite aguda de etiologia litiásica. O estudo experimental realizado no rato, como modelo animal, consistiu na indução da pancreatite aguda em modelos cirúrgicos, que mimetizam a etiologia litiásica e num modelo não cirúrgico, modelo da hiperestimulação com análogo da colecistoquinina, a ceruleína. Foi proposto um score de gravidade da pancreatite aguda com recurso a parâmetros histológicos: edema, necrose, infiltrado inflamatório, hemorragia e vacuolização e que permitiu a classificação da pancreatite aguda em ausente, ligeira, moderada e grave. Quando se correlacionou este score com a procalcitonina, verificou-se uma correlação muito forte, indicando que a gravidade do score reflete o processo inflamatório pancreático. Verificou-se que o stresse oxidativo assumiu um papel na fase precoce do processo inflamatório pancreático, com a elevação dos níveis das espécies reativas de oxigénio, uma diminuição das defesas antioxidantes e disfunção mitocondrial nos animais com pancreatite aguda e nas suas formas mais graves. No estudo clínico constatou-se que, na amostra constituída por doentes com pancreatite aguda litiásica, na admissão, o azoto ureico, os neutrófilos e os leucócitos foram os melhores marcadores de gravidade, às 48 horas, a hepcidina, a razão neutrófilos/linfócitos e o índex de resposta inflamatória sistémica foram os melhores biomarcadores de prognóstico. Quando se avaliou o stresse oxidativo, na admissão dos doentes, observou-se uma elevação dos níveis das espécies reativas de oxigénio, uma diminuição das defesas antioxidantes e disfunção mitocondrial, principalmente naqueles com pancreatite aguda grave. Estes achados evidenciam o papel do stresse oxidativo como mediador, desde a fase inicial da pancreatite aguda litiásica, e como eventual marcador de prognóstico. Foi, também na admissão dos doentes, estudado o perfil metabolómico que permitiu identificar, como eventuais biomarcadores de prognóstico da pancreatite aguda litiásica grave, a treonina, a fenilalanina e os lípidos. Este estudo translacional permitiu identificar novos biomarcadores de prognóstico e contribuir para uma melhor compreensão do processo fisiopatológico da pancreatite aguda litiásica.Acute pancreatitis is an inflammatory process of the pancreas with variable involvement of the pancreatic, peripancreatic tissues and distant organs. In 80% of cases, acute pancreatitis is mild, with interstitial oedema and recovery, usually within the first week. Necrotising pancreatitis, which may occur in 15-20% of patients, is characterised by necrosis involving the pancreas and peripancreatic tissues. When complicated by infection, it is associated with high morbidity and mortality and a high economic burden. The role of oxidative stress in the pathophysiology of acute pancreatitis has been demonstrated in several studies, particularly in the pathogenesis and progression of this inflammatory process. However, it is unclear whether reactive oxygen species act as mediators or initiate the complex cascade of events leading to acute pancreatitis. The exact role of oxidative stress in the development of this pathological condition thus remains unclear. Early identification of patients who will develop severe acute pancreatitis is of utmost importance, as it will allow closer monitoring, individualised supportive therapy and the prevention of associated complications. This dissertation aims to deepen the knowledge of the pathophysiology of acute pancreatitis in patients with biliary etiology, particularly in its pathogenesis and in the progression of the inflammatory process, through the assessment of oxidative stress and in the identification of new prognostic biomarkers, using the study of the metabolomic profile. In this sense, a study in an animal model and a clinical study in a sample of patients was performed to identify possible prognostic biomarkers of biliary acute pancreatitis. The experimental in the rat, as an animal model, consisted in induction of acute pancreatitis in surgical models, mimicking the lithiasis aetiology and in a non-surgical model, hyperstimulation model with cholecystokinin analogue, cerulein. A score of severity of acute pancreatitis was proposed using histological parameters: oedema, necrosis, inflammatory infiltrate, haemorrhage and vacuolization, which allowed the classification of acute pancreatitis into absent, mild, moderate and severe. When this score was correlated with procalcitonin, a very strong correlation was found, indicating that the severity of the score reflects the pancreatic inflammatory process. Oxidative stress was found to play a role in the early stage of the pancreatic inflammatory process, with increased levels of reactive species, decreased antioxidant defences and mitochondrial dysfunction in animals with acute pancreatitis and in its more severe forms. In the clinical study, we found that in the sample of patients with biliary acute pancreatitis, on admission, blood urea nitrogen, neutrophils and leucocytes were the best markers of severity. At 48 hours hepcidin, neutrophil-lymphocyte ratio and systemic inflammatory response index were the best biomarkers of prognosis. When oxidative stress was assessed at patient admission, an elevation in reactive oxygen species levels, decreased antioxidant defences, and mitochondrial dysfunction was observed, mainly in those with severe acute pancreatitis. These findings highlight the role of oxidative stress as a mediator, from the initial phase of biliary acute pancreatitis and as a possible prognostic marker. The metabolomic profile of patients was also studied at admission, allowing the identification of threonine, phenylalanine and lipids as possible prognostic biomarkers of severe biliary acute pancreatitis. This translational study allowed us to identify new prognostic biomarkers and better understand the pathophysiological process of biliary acute pancreatitis

The Role of networked robotic systems to survey coastal phenomena: the Douro river plume case study

Propagation of river plumes along the coast strongly depends on several physical processes, which determine the plume fate over the shelf. The Douro is one of the largest rivers of the Iberian Peninsula, representing the most important freshwater input into the Atlantic Ocean on the northwestern Portuguese coast. Traditional methods of in situ measurements are often complicated and expensive due to the high spatial and temporal variability of its dominant drivers. By now, the general dispersion patterns of the Douro River Plume was mostly studied by numerical models and remote sensing imagery, considering the main drivers involved: river discharge, wind, and tide. From those results, the Douro River plume is classified as large-scale and surface-advected, presenting characteristics of a prototypical plume. The wind was found to play an essential role in the plume dispersion and fate. For example, southerly winds increase the velocity of the northward current, frequently merging the Douro plume with the northerly generated Minho plume. Both riverine water masses can propagate to the Rias Baixas (Spain), dramatically changing their normal circulation. By these reasons, the development of accurate and reliable plume monitoring systems is an important and challenging task. This work reports the recent use of robotic systems (AUVs and UAVs) to detect, track and survey the Douro Plume front autonomously. These systems can survey this highly dynamic environment and characterize the frontal regions of the plume regarding salinity, water temperature, turbidity, and chlorophyll concentrations under summer conditions when the plume area is small and mainly tidally driven. Results from several frontal crossings, coincident with satellite imagery acquisitions (some of which were obtained in near real-time by the new Sentinel-2 mission), demonstrated the AUVs capability to fairly detect the front structure. Cross-frontal exchanges observed in the water column by AUVs along the front emphasize the importance of new technologies use on the monitoring and detection of high spatial and temporal dynamical phenomena such as river plumes.Peer Reviewe

The use of the code of document classification of archive of the National Council of Archives

Estudo sobre o uso do Código de Classificação de Documentos de Arquivo elaborado pelo Conselho Nacional de Arquivos (Conarq) para ser aplicado nos arquivos dos órgãos públicos da Administração Federal. Procurou-se conhecer a real utilização do Código de Classificação do Conarq nos Ministérios instalados em Brasília, tanto do ponto de vista quantitativo quanto qualitativo. Buscou-se, nos órgãos que utilizam o instrumento, saber as principais dificuldades encontradas em sua aplicação, a existência de treinamento e o nível de assistência oferecida pelo Arquivo Nacional. ___________________________________________________________________________________ ABSTRACTStudy on the use of the Code of Document Classification of Archive elaborated for the National Council of Archives (Conarq) to be applied in the archives of the public agencies of the Federal Administration. It was looked to know the real use of the Code of Classification of the Conarq in the Ministries installed in Brasilia, as much of how much qualitative the quantitative point of view. One searched, in the agencies that use the instrument, to know the main difficulties found in its application, the existence of training and the level of assistance offered for the National Archive

Síndrome hemorrágica pulmonar em cão associada à leptospirose

Background: Leptospirosis is probably the most widespread and prevalent zoonosis in the world, being classified as an emerging infectious disease for humans and dogs. Sporadically, dogs may present with cough and dyspnea, indicative of pulmonary involvement, associated with interstitial pneumonia and pulmonary hemorrhage with alveolar consolidation. Such changes stem from pulmonary haemorrhagic syndrome, which has emerged as a fatal complication, being documented in some areas in Europe and little described in North America. In this sense, the present study aims to report pulmonary hemorrhagic syndrome in a dog with leptospirosis.Case: A dog with no defined breed, aged 45 days, weighing 2.2 kg, with a history of apathy, anorexia, jaundice, hematochezia and vocalisation with a two day evolution was seen. Physical examination revealed a rectal temperature of 37.2°C, icteric mucosa, capillary filling time of two seconds, respiratory rate of 80 movements per minute and heart rate of 140 beats per minute, dehydration rate estimated at 8%, prostration, adequate body score, normal cardiac sounds and clean lung fields, in addition to petechiae in the abdominal region, whose palpation evidenced the presence of fluid in intestinal loops. The blood sample sent to the macroscopic serum agglutination was reagent for the serovar Icterohaemorragiae, titration of 200. Blood count revealed leukocytosis due to neutrophilia, with left-sided deviation, eosinopenia, presence of rare hypersegmentated neutrophils, rare toxic neutrophils, mild cytoplasmic basophilia and rare reactive lymphocytes. Platelet estimation demonstrated thrombocytopenia. No haemoparasites were seen. Regarding the biochemical evaluation, there were changes in liver enzymes and markers of renal failure. Fluid therapy was used with 0.9% NaCl solution, 5 mg/ kg doxycycline intravenously every 12 h and nasogastric probe for administration of nutritional support. One day after the initial evaluation, hemoptysis and diffuse crackling occurred in pulmonary lobes on auscultation. In the radiograph of the chest, pulmonary fields were characterized by a diffuse interstitial bronchial pattern and a focal area, located in the left caudal lobe, with opacification tending to the alveolar pattern. Due to pulmonary alterations, the animal presented respiratory arrest and evolved to death. During necropsy, the macroscopic evaluation revealed a pinkish coloration pattern, with multifocal reddish areas with coalescent interspersed in the parenchyma and hypocrepitation. Regarding the morphology, multifocal hemorrhagic pneumonia was observed, focally extensive, moderate to severe.Discussion: Recently, pulmonary haemorrhagic syndrome has emerged as a severe form of leptospirosis in many species, including humans and dogs. Patients may develop fulminant pulmonary haemorrhage and result in a high mortality rate. Physiopathogenesis is poorly understood, however, it is believed that there is a multifactorial pathogenesis involving factors related to both pathogen and host, such as immunological mechanisms and coagulopathies. Studies in humans have shown a better evolution after the use of cyclophosphamide, but the benefits of this therapy have not yet been determined in dogs. Therefore, pulmonary haemorrhagic syndrome should be considered in patients with leptospirosis who show respiratory changes, due to the severity of the clinical signs and the high lethality associated with this clinical condition

Comunicação de notícias difíceis: percepção de médicos que atuam em oncologia

Objetivo: conhecer a prática de médicos que atuam em oncologia na comunicação de notícias difíceis, identificando estratégias e dificuldades em realizá-la. Método: qualitativo descritivo, realizada com quinze médicos que atuam em oncologia. Os dados foram coletados por meio de entrevista com roteiro semiestruturado elaborado pelos autores. Resultados: notou-se que, paradoxalmente ao contexto da humanização na atenção à saúde, o processo de ensino e aprendizagem tem desprezado pilares da atenção humanizada. Notou-se a insipiência do conhecimento sobre comunicação de notícias difíceis juntamente com a carência de disciplinas que abordam o tema durante a graduação médica. Conclusão: para o enfrentamento de situações adversas como a comunicação de notícias difíceis não existe uma capacitação apta a resolver totalmente os sentimentos negativos envolvidos nesse processo. Reafirma-se a necessidade da implantação de estratégias educacionais que caminhem em direção a uma formação médica sincronizada com o processo de humanização da assistência à saúde e com os fatores psicossociais que envolvem o tema da mort

Comunicação de notícias difíceis: percepção de médicos que atuam em oncologia

Objetivo: conhecer a prática de médicos que atuam em oncologia na comunicação de notícias difíceis, identificando estratégias e dificuldades em realizá-la. Método: qualitativo descritivo, realizada com quinze médicos que atuam em oncologia. Os dados foram coletados por meio de entrevista com roteiro semiestruturado elaborado pelos autores. Resultados: notou-se que, paradoxalmente ao contexto da humanização na atenção à saúde, o processo de ensino e aprendizagem tem desprezado pilares da atenção humanizada. Notou-se a insipiência do conhecimento sobre comunicação de notícias difíceis juntamente com a carência de disciplinas que abordam o tema durante a graduação médica. Conclusão: para o enfrentamento de situações adversas como a comunicação de notícias difíceis não existe uma capacitação apta a resolver totalmente os sentimentos negativos envolvidos nesse processo. Reafirma-se a necessidade da implantação de estratégias educacionais que caminhem em direção a uma formação médica sincronizada com o processo de humanização da assistência à saúde e com os fatores psicossociais que envolvem o tema da mort

PRIMARY RENAL LYMPHOMA IN TWO CATS: CASE REPORT

Lymphoma is a hematopoietic neoplasia which occurs due to the proliferation of malignant lymphocytes. It can be present in different forms, including alimentary, mediastinal, multicentric and extranodal.   In both cases described in this report, signs consistent with chronic kidney disease were present. An ultrasound-guided fine-needle aspiration was performed and suggested a lymphocyte neoplastic process. Both cats received prednisolone and life support treatment, with mild improvement. One cat was euthanatized and the other died spontaneously, five and seven days after onset of treatment, respectively. The kidneys were enlarged, whitish, irregular, with a firm mass in the cortex. Histopathology confirmed that the lymphoma was restricted to the kidneys

VINHOS QUE PENSAM - parte II/III UTILIZAÇÃO DA CONDUTIVIDADE ELÉTRICA APARENTE DO SOLO NA INSTALAÇÃO E GESTÃO DAS CULTURAS: EXEMPLIFICAÇÃO NA VINHA

o principal objetivo deste trabalho passou por verificar: • a relação entre a CEa do solo e os indicadores de textura; • se a CEa do solo poderá ser um parâmetro importante na instalação e gestão de parcelas de vinha ou outro tipo de culturas

Effect of different solutions in reversing the damage caused by radiotherapy in dentin structure

Previous studies have shown that radiotherapy of the head and neck region can cause direct changes in dental structure. This study evaluated the effect of different solutions on the dentin chemical composition and collagen structure of irradiated dentin. Sixty maxillary canines were distributed in 2 groups (n=30): non-irradiated and irradiated (radiotherapy: X-rays of 6 MV in 30 cycles of 2 Gy to 60 Gy). The teeth were sectioned, sanded, and polished to obtain 3x3x2 mm fragments, which were redistributed in 3 subgroups (n=10) according to the treatment employed: chlorhexidine 2% (CL), chitosan 0.2% (QT), and 0.5 M carbodiimide (EDC). The samples were analyzed in FTIR at time zero (T0-control) and after 1 (T1), 3 (T3), and 5 (T5) minutes of immersion in the tested solutions. The data for the areas of the carbonate (C), amide I (AI) bands, and the ratio between the areas of the amide III/proline and hydroxyproline (AIII/PH) bands were analyzed using ANOVA and Tukey test (?=5%). QT showed lower C values at T1, T3, and T5 (P0.05). Radiotherapy changes the secondary structure of collagen, and EDC was able to restore collagen integrity after 1 minute of immersion, without changing dentin inorganic composition