Peritubular Capillaries C4d Deposits in Renal Allograft Biopsies and Anti HLA I/II Alloantibodies Screening. Incidence and Clinical Importance

Aim: To characterise clinically the patients with C4d in peritubular capillaries deposits (C4dPTCD) and/or circulating anti-HLA class I/II alloantibodies. To determine the correlation between positive C4dPTCD and circulating anti-HLA class I/II alloantibodies during episodes of graft dysfunction. Subjects and Methods: C4d staining was performed in biopsies with available frozen tissue obtained between January 2004 and December 2006. The study was prospective from March 2005, when a serum sample was obtained at the time of biopsy to detect circulating anti-HLA class I/II alloantibodies. Results: We studied 109 biopsies in 86 cadaver renal transplant patients. Sixteen of these (14.7%) presented diffuse positive C4dPTCD. There was a 13.5% rate of +C4dPTCD incidence within the first six months of transplantation and 16% after six months (p>0.05). Half of the +C4dPTCD in the first six months was associated with acute humoral rejection. After six months, the majority of +C4dPTCD (n=7/8) was present in biopsies with evidence of interstitial fibrosis/tubular atrophy and/or transplant glomerulopathy. The C4dPTCD was more frequent in patients with positive anti-HCV antibodies(p<0.0001), a previous renal transplant (p=0.007), and with a panel reactivity antibody (PRA) ≥ 50%(p=0.0098). The anti-HCV+ patients had longer time on dialysis (p=0.0019) and higher PRA(p=0.005). Circulating anti-HLA I/II alloantibodies were screened in 46 serum samples. They were positive in 10.9% of samples, all obtained after six months post transplant. Circulating alloantibodies were absent in 92.5% of the C4d negative biopsies. Conclusion: We found an association between the presence of C4dPTCD and 2nd transplant recipients,higher PRA and the presence of anti-HCV antibodies. The presence of HCV antibodies is not a risk factor for C4dPTCD per se, but appears to reflect longer time on dialysis and presensitisation. In renal dysfunction a negative alloantibody screening is associated with a reduced risk of C4dPTCD (<10%)

Transient Symptomatic Zinc Deficiency in an Exclusively Breastfed Infant

A 3-month-old, full term female infant, adequate for gestational age, and exclusively breastfed, was admitted with a 10 day history of generalised scaling erythematous dermatitis, affecting the face (perinasal, nasolabial folds and periauricular), acral and intertriginous areas, with irritability and failure to thrive. Her mother had been treated with isoniazid since the third trimester because of family contact with tuberculosis. Based on a diagnosis of suspected impetiginised eczema, the infant was treated with flucloxacillin and prednisolone, and maternal isoniazid was suspended, with no improvement. Investigations found low serum zinc levels in the infant (33 μg/dL; normal range (NR) >60 μg/dL), normal plasma zinc levels in the mother (111.3 μg/dL; NR 68-120 μg/dL) and lower than the normal range of zinc levels in breast milk (270μg/L; NR 1000-2500 μg/L), suggesting acrodermatitis caused by zinc deficiency. Oral zinc supplementation (3 mg/kg/day) was started with a marked improvement in skin lesions, as well as good weight gain. At the age of 6 months, after food diversification, supplementation was suspended, without any recurrence of symptoms.info:eu-repo/semantics/publishedVersio

Pulmonary artery sling: a rare cause of stridor and respiratory distress

info:eu-repo/semantics/publishedVersio

Experience and Learning from the COVID-19 Pandemic in Portugal: Perceptions of Community Pharmacy Professionals

Background: During the COVID-19 pandemic, community pharmacy (CP) professionals were among those who experienced the greatest risk of contracting SARS-CoV-2, which forced major adaptations. Objectives: The objectives of the study were to describe the changes implemented in CP professionals during the pandemic, understand the perception of professionals about their experience, and explore changes to remain. Methods: An observational and cross-sectional study was conducted via an online questionnaire (June-September 2020). The target population was CP professionals working in Portugal for >2 years and serving the public during the pandemic. Results: Of a total of 353 participants, 84% were female (mean age of 37.6 years), and 81% were pharmacists (mean professional experience of 12.9 years). In the management and organizational dimensions, the most mentioned changes were adaptation to legislative changes (90%), fluctuations in the treasury (82%), and reduction of working hours (46%). Only 2% resorted to simplified layoff. In the back office, there was a need to adapt stock management (93%) and purchase personal protective equipment (99%). In the front office, there was a change in service policies - wicket or conditional opening (92%), routes of the arrival of user requests (91%), and home delivery (82%). Physical changes occurred in 100% of pharmacies. The most frequently implemented procedures were the use of protection systems and PPE, articulation with hospital pharmacies for dispensing in proximity (75%), and training in this area (55%). Regarding interpersonal climate, improvements in the connection between team members are evident: increase in mutual help (57%), solidarity (54%), and group cohesion (50%); in the relationship with clients, the majority indicated the replacement of the usual user by third parties (71%), and changes in communication channels (increase in use of technological means 68%). Conclusions: Results illustrate the profound impact of the pandemic on CP professionals, both professionally and personally. It also highlights the importance of their roles in proximity and community support. © 2023 S. Karger AG. All rights reserved.This work was funded by 4IE project (0499_4IE_PLUS_4_E) funded by the Interreg V-A España-Portugal (POCTEP) 2017/2022 ( https://4ie.eu/ )

Social, Behavioural and Biological Risk Factors for Pregnancy in Adolescence: A Case-Control Study

Introdução: O melhor conhecimento dos factores de risco da gravidez na adolescência, especialmente a não desejada, pode ser uma forma de contribuir para a sua prevenção. Objectivo: Determinar possíveis factores de risco sociais, comportamentais e biológicos de gravidez na adolescência. Métodos: Estudo de caso-controlo comparando adolescentes grávidas (casos) com adolescentes que nunca estiveram grávidas (controlos). Foram analisados factores de risco (a) social: índice de Graffar, tipo de família, rendimento escolar e abandono escolar; (b) comportamental: hábitos de dependência, coitarca, contracepção e número de parceiros sexuais; e (c) biológico: idade, menarca, regularidade dos ciclos menstruais, índice de massa corporal e perturbações da saúde mental. Resultados: Foram incluídas 50 jovens em cada grupo, emparelhadas por idade. Os factores de risco de gravidez encontrados com significado estatístico foram (a) sociais: índice de Graffar ≥4 (OR: 4,96; IC 95%: 1,96-12,74), família não nuclear (OR: 4,64; IC 95%: 1,83-11,98), reprovações prévias (OR: 8,84; IC 95%: 3,20-25,16) e abandono escolar (OR: 9,01; IC 95%: 3,34-24,96); (b) comportamentais: hábitos de dependência (OR: 8,43; IC 95%: 1,65-57,87) e não utilização de contracepção (OR: 44,33; IC 95%: 5,05-100,92); e (c) biológicos: idade de menarca <12 anos (OR: 5,25; IC 95%: 1,89-15,02), irregularidade dos ciclos menstruais (OR: 4,51; IC 95%: 1,74-11,91) e índice de massa corporal >percentil 85 (OR: 2,95; IC 95%: 1,04-8,55). Não se revelaram factores de risco de gravidez a existência de mais de um parceiro sexual (OR: 4,42; IC: 0,5-99,31), idade de coitarca <15 anos (OR: 5,11; IC 95%: 0,93-36,71) e as perturbações da saúde mental (OR=1; IC 95%=0,15-6,63). Conclusão: Na promoção da saúde sexual e reprodutiva sugere-se que se dê atenção privilegiada às jovens de meio desfavorecido, de famílias não nucleares, com insucesso escolar, hábitos de dependência, idade menor de menarca, ausência de contracepção, irregularidade menstrual e excesso de peso

The Effects of Concurrent Resistance and Endurance Training Follow a Specific Detraining Cycle in Young School Girls

The purpose of this study was to compare the effects of an 8-week training period of strength training alone (GR), or combined strength and endurance training (GCOM), followed by 12-weeks of de-training (DT) on body composition, power strength and VO2max adaptations in a schooled group of adolescent girls. Sixty-seven healthy girls recruited from a Portuguese public high school (age: 13.5+1.03 years, from 7(th) and 9th grade) were divided into three experimental groups to train twice a week for 8 wks: GR (n=21), GCOM (n=25) and a control group (GC: n=21; no training program). Anthropometric parameters variables as well as performance variables (strength and aerobic fitness) were assessed. No significant training-induced differences were observed in 1kg and 3kg medicine ball throw gains (2.7 to 10.8%) between GR and GCOM groups, whereas no significant changes were observed after a DT period in any of the experimental groups. Significant training-induced gains in CMVJ (8 to 12%) and CMSLJ (0.8 to 5.4%) were observed in the experimental groups. Time of 20m significantly decreased (GR: -11.5% and GCOM: -10%) after both treatment periods, whereas only the GR group kept the running speed after a DT period of 12 weeks. After training VO2max increased only slightly for GCOM (4.0%). No significant changes were observed after the DT period in all groups, except to GCOM in CMVJ and CMSLJ. Performing simultaneous strength and endurance training in the same workout does not appear to negatively influence power strength and aerobic fitness development in adolescent girls. Indeed, concurrent strength and endurance training seems to be an effective, well-rounded exercise program that can be prescribed as a means to improve initial or general strength in healthy school girls. De-training period was not sufficient to reduce the overall training effects.info:eu-repo/semantics/publishedVersio

Falências de Orgão em Pediatria

Objectivos: 1) Caracterizar as falências mono (OF) e multiorgão (MOF) numa Unidade de Cuidados Intensivos Pediátricos em relação a; altura do internamento em que ocorrem; associação de orgãos em falência e evolução dos doentes com falência mono e multiorgão. 2) Avaliar a performance de um índice de gravidade, o Pediatric Risk of Mortality (PRISM), para a população total da Unidade e para o grupo das falências multiorgão. 3) Identificar marcadores de risco de mortalidade nos doentes com MOF. Métodos: Revisão de uma base de dados e análise retrospectiva de todos os doentes internados em relação aos critérios de OF e MOF, sugeridos por Wilkinson et al. População: Total de doentes internados na Unidade de Cuidados Intensivos Pediátricos (UCIP) de um Hospital Terciário, durante um período de dois anos (Abril de 1991 a Março de 1993). Resultados Principais / Conclusões: Foram avaliados 1120 doentes, com uma média de idades de 45.9 ± 51.1 meses, sendo 961 (85.8%) médicos e 159 (14.2%) cirúrgicos. Eram previamente saudáveis 695 (62.1%), sendo os restantes 424 (37.9%) portadores de doença crónica. A mortalidade global foi de 5% (56/1120 doentes). Cento e oitenta e sete doentes (16.7%) preencheram critérios de falência mono-orgão (OF), destes, 180 (96.3%) estavam em OF já à entrada e 7 (3.7%) tiveram falência não simultânea de mais de um orgão. A mortalidade dos doentes com falência mono-orgão foi de 3.7% (7 doentes). Cento e um doentes (9.02%) tiveram falência multiorgão (MOF), definida como falência simultânea de dois ou mais orgãos, em qualquer altura do internamento. Existia MOF já à entrada em 90 doentes (89.1%). Houve 47 doentes com falência máxima de 2 orgãos (46.6%), 42 (41.6%) com falência de 3 orgãos. 10 (9.9%) com falência de 4 orgãos e 2 (1.98%) com falência de 5 orgãos. A mortalidade por número de orgãos em falência foi respectivamente de 23.4%; 66.7%; 80% e 100%. A mortalidade global dos doentes com falência multiorgão foi de 48.5% (49/101 doentes). O PRISM revelou um bom valor predictivo quando aplicado na totalidade dos doentes: discriminação (W) (avaliada pela área sob curvas ROC) W = 0.959 SE = 0.00085 e calibração (H) (avaliada pelo Hosmer-Lemesshow goodness-of-fit test) H = 13.217 p = 0.104. Estes valores permitem considerar este índice de gravidade como estando bem aferido para a população da Unidade. Quando aplicado ao grupo das MOF a discriminação foi aceitável (W = 0.732 SE = 0.036) mas a calibração foi má (H = 29.780 p = 0.00026). A análise multivariada mostrou que um score de PRISM % 15 e um número de orgãos em falência % 3, tanto na admissão como em qualquer altura do internamento, têm uma importância significativa na probabilidade de morte

The effects of concurrent resistance and endurance training follow a detraining period in elementary school students

The purpose of this study was to compare the effects of an 8-week training period of resistance training alone (GR), or combined resistance and endurance training (GCOM), followed by 12 weeks of detraining (DT) on body composition, explosive strength, and ·VO₂max adaptations in a large sample of adolescent school boys. Forty-two healthy boys recruited from a Portuguese public high school (age: 13.3 ± 1.04 years) were assigned to 2 experimental groups to train twice a week for 8 weeks: GR (n = 15), GCOM (n = 15), and a control group (GC: n = 12; no training program). Significant training-induced differences were observed in 1- and 3-kg medicine ball throw gains (GR: +10.3 and +9.8%, respectively; GCOM: +14.4 and +7%, respectively), whereas no significant changes were observed after a DT period in both the experimental groups. Significant training-induced gains in the height and length of the countermovement (vertical-and-horizontal) jumps were observed in both the experimental groups. No differences were perceived after a DT period in lower limb power. Time at 20 m decreased significantly for both intervention programs (GR: -11.5% and GCOM: -12.4%, <0.00), but either GR or GCOM groups kept the running speed after a DT period of 12 weeks. After training, the ·VO₂max increased only significantly for GCOM (4.6%, p = 0.01). A significant loss was observed after a DT period in GR but not in GCOM. Performing resistance and endurance training in the same workout does not impair strength development in young school boys. As expected, strength training by itself does not improve aerobic capacity. Our results also suggest that training program effects even persist at the end of the DT period.info:eu-repo/semantics/publishedVersio

Mosaic of microbiological colonization of canine wounds

Objetivo: Averiguar a eficácia antimicrobiana do hidrogel de quitosano com sais de prata in vivo comparativamente a um antimicrobiano disponível no mercado. Materiais e métodos: Realiza-se uma colheita a amostras clínicas das feridas dos cães com zaragatoas esterilizadas, que serão transportadas em meio de transporte para o laboratório. Estas amostras serão inoculadas em meios de cultura, agar MacConkey, agar Sangue e caldo nutritivo e incubadas a 37ºC durante 24h ou 48h. As culturas são observadas e após isolamento das bactérias presentes, realiza-se a identificação bacteriana através de provas bioquímicas com o equipamento VITEK 2 COMPAK. Será realizado o teste de suscetibilidade a antimicrobianos (TSA), também no equipamento VITEK, ou pelo o método de difusão em disco, no caso de microorganismos de crescimento lento. Para o ensaio in vivo, os cães são divididos em dois grupos, um grupo controlo que será tratado com uma substância antimicrobiana que existe no mercado e um grupo teste em que se aplicará o hidrogel em estudo. Caso seja possível, no mesmo cão, serão utilizados os dois produtos em feridas diferentes. Uma semana após o tratamento, realiza-se novamente uma colheita para perceber se os microorganismos foram inibidos com o hidrogel em estudo, comparativamente ao de mercado