Doença de Alzheimer: perspetivas de tratamento

A Doença de Alzheimer foi descrita pela primeira vez por Alois Alzheimer há mais de cem anos [1]. É a demência mais comum e afeta cerca de 75% das mais de 35 milhões de pessoas no mundo com demência [2]. É uma doença neurodegenerativa progressiva que apresenta duas lesões cardinais características: placas senis e emaranhados neurofibrilares. Estas alterações neuropatológicas podem ser provocadas por alterações genéticas e ambientais [3]. Durante a década passada, muitas hipóteses foram propostas para a patogénese da Doença de Alzheimer. Aquelas que foram globalmente aceites foram a teoria da cascata de β-amilóide e a teoria da hiperfosforilação da proteína tau [4]. Clinicamente, a Doença de Alzheimer é caracterizada por perda progressiva de memória e orientação e outros défices cognitivos que incluem afetação do julgamento e da tomada de decisões, apraxia e perturbações da linguagem [5]. Durante anos, foram realizados vários ensaios clínicos com o objetivo de curar a doença e diminuir a sua progressão; contudo, ainda não existem terapias efetivas. Como tal, os objetivos deste trabalho consistem em rever a Doença de Alzheimer, abordando a sua epidemiologia, etiologia, fisiopatologia, manifestações clínicas e diagnóstico, bem como, ao acompanhar os estudos clínicos mais recentes, sistematizar as possibilidades de tratamento que estão atualmente em investigação. A pesquisa bibliográfica foi obtida através das bases de dados Medline/PubMed, Medscape e e-medicine. Foram também consultados alguns livros de referência. A pesquisa foi realizada em Inglês. Após investigação extensa e detalhada, foi possível concluir que há diversos tratamentos em estudo com o objetivo de curar a doença e desacelerar a sua progressão; no entanto, nenhum se revelou eficaz. Entre aqueles é de salientar os compostos que têm como alvo as vias de amilóide e tau, a neuroinflamação e o dano oxidativo. O fármaco que apresentou melhores resultados clínicos (melhoria na função cognitiva de pacientes com Doença de Alzheimer moderada a severa) foi o Etanarcept, um inibidor do fator de necrose tumoral. Num futuro próximo esperam-se os resultados dos ensaios clínicos que ainda estão a decorrer.Alzheimer’s Disease was first described by Alois Alzheimer more than 100 years ago [1]. It is the most common dementia and it is responsible for 75% of the more than 35 million people suffering from dementia worldwide [2]. It is a progressive neurodegenerative disease and its hallmarks consist in senile plaques and neurofibrillary tangles. These neuropathological processes may be dued to genetic and environmental abnormalities [3]. In the past decade, several Alzheimer’s Disease pathogenesis hypotheses were proposed. The ones globally accepted were the β-amyloid cascade and tau protein hyper-phosphorylation mechanisms [4]. Alzheimer’s Disease is clinically characterized by progressive memory and orientation loss and other cognitive deficits including impaired judgment and decision making, apraxia and language disturbances [5]. With the purpose of cure the disease and stop its progression, several clinical trials have been developed in the last years, however there are no effective therapies yet available. As so, the objectives of this work consist of reviewing Alzheimer’s Disease focusing on epidemiology, etiology, physiopathology, clinical features and diagnosis and summarize the treatment options under investigation by following the latest clinical trials. The literature research was made not only using Medline/Pubmed, Medscape and e-medicine databases but also consulting some reference books. This research was made in English. After an extensive and detailed investigation it was clear that there are innumerous drugs in study aiming the cure of the disease and the stop of its progression, but none of them has proven to be sufficiently effective. Among them the most relevant are the ones targetting amyloid and tau pathways, neuroinflammation and oxidative stress. The best clinical results were obtained with Etanarcept, a tumor necrosis factor, which revealed improvement in moderate to severe Alzheimer’s Disease patients’ cognitive function. The field is awaiting the results of several clinical trials under development

Competencias Relacionales de Ayuda en los enfermeros: validación de un instrumento de medida

Considerando a importância da avaliação das competências relacionais de ajuda nos enfermeiros, torna-se necessário utilizar instrumentos fiáveis e adaptados aos contextos. Assim, o objectivo deste estudo foi avaliar as propriedades psicométricas do Inventário de Competências Relacionais de Ajuda (ICRA), através da realização de estudos de fiabilidade e validade, no sentido de aumentar o grau de confiança ou de exatidão que podemos ter na informação obtida por meio da utilização deste instrumento. O estudo quantitativo foi realizado numa amostra de 690 enfermeiros, que exerciam funções em seis hospitais e oito centros de saúde em Portugal. Os resultados obtidos indicam a existência de uma estrutura multidimensional das competências relacionais de ajuda diferenciando-se em quatro dimensões (competências genéricas, empáticas, de comunicação e de contacto), com correlações positivas entre si. O valor de Alpha Cronbach obtido por dimensão foi superior a .79, revelador de uma boa consistência interna dos itens por fator.Considering the importance of assessing nurses' helping relationship skills, it was necessary to use reliable and context-adapted instruments. Thus, the objective of this study was to assess the psychometric properties of the Helping Relationship Skills Inventory (Inventário de Competências Relacionais de Ajuda, ICRA), by conducting reliability and validity studies to increase the level of confidence or accuracy of the data obtained using this instrument. This quantitative study was conducted on a sample of 690 nurses who worked in six hospitals and eight health centres in Portugal. The results indicate a multidimensional structure of helping relationship skills, divided into four different dimensions (generic, empathetic, communication and contact skills) with a positive correlation between them. Cronbach's alpha for each dimension was higher than .79, showing a good internal consistency of the items within each factor.Considerando la importancia de la evaluación de las competencias relacionales de ayuda en los enfermeros, se hace necesario utilizar instrumentos fiables y adaptados a los contextos. Este estudio objetivó evaluar las propiedades psicométricas del Inventario de Competencias Relacionales de Ayuda (ICRA), mediante realización de estudios de fiabilidad y validez en sentido de aumentar el grado de confianza o exactitud de la información obtenida a través del uso del instrumento. El estudio cualitativo se realizó con muestra de 690 enfermeros con funciones en 6 Hospitales y 8 Centros de Salud en Portugal. Los resultados obtenidos indican existencia de una estructura multidimensional de competencias relacionales de ayuda, diferenciándose en cuatro dimensiones (competencias genéricas, empáticas, de comunicación, de contacto), con correlaciones positivas entre sí. El valor de Alpha de Cronbach obtenido por dimensión fue superior a .79, lo que revela buena consistencia interna de los ítems por factor

Response of patients with acute respiratory failure caused by COVID-19 to awake-prone position outside the intensive care unit based on pulmonary involvement

OBJECTIVES: Since there are difficulties in establishing effective treatments for COVID-19, a vital way to reduce mortality is an early intervention to prevent disease progression. This study aimed to evaluate the performance of patients with COVID-19 with acute hypoxic respiratory failure according to pulmonary impairment in the awake-prone position, outside of the intensive care unit (ICU). METHODS: A prospective observational cohort study was conducted on COVID-19 patients under noninvasive respiratory support. Clinical and laboratory data were obtained for each patient before the treatment and after they were placed in the awake-prone position. To identify responders and non-responders after the first prone maneuver, receiver operating characteristic curves with sensitivity and specificity of the PaO2/FiO2 and SpO2/FiO2 indices were analyzed. The maneuver was considered positive if the patient did not require endotracheal intubation for ventilatory assistance. RESULTS: Forty-eight patients were included, and 64.6% were categorized as responders. The SpO2/FiO2 index was effective for predicting endotracheal intubation in COVID-19 patients regardless of lung parenchymal damage (area under the curve 0.84, cutoff point 165, sensitivity 85%, specificity 75%). Responders had better outcomes with lower hospital mortality (hazard ratio [HR]=0.107, 95% confidence interval [CI]: 0.012-0.93) and a shorter length of stay (median difference 6 days, HR=0.30, 95% CI: 0.13-0.66) after adjusting for age, body mass index, sex, and comorbidities. CONCLUSIONS: The awake-prone position for COVID-19 patients outside the ICU can improve oxygenation and clinical outcomes regardless of the extent of pulmonary impairment. Furthermore, the SpO2/FiO2 index discriminates responders from non-responders to the prone maneuver predicting endotracheal intubation with a cutoff under or below 165. &nbsp

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio

Identification of heavy-flavour jets with the CMS detector in pp collisions at 13 TeV

Many measurements and searches for physics beyond the standard model at the LHC rely on the efficient identification of heavy-flavour jets, i.e. jets originating from bottom or charm quarks. In this paper, the discriminating variables and the algorithms used for heavy-flavour jet identification during the first years of operation of the CMS experiment in proton-proton collisions at a centre-of-mass energy of 13 TeV, are presented. Heavy-flavour jet identification algorithms have been improved compared to those used previously at centre-of-mass energies of 7 and 8 TeV. For jets with transverse momenta in the range expected in simulated $\mathrm{t}\overline{\mathrm{t}}$ events, these new developments result in an efficiency of 68% for the correct identification of a b jet for a probability of 1% of misidentifying a light-flavour jet. The improvement in relative efficiency at this misidentification probability is about 15%, compared to previous CMS algorithms. In addition, for the first time algorithms have been developed to identify jets containing two b hadrons in Lorentz-boosted event topologies, as well as to tag c jets. The large data sample recorded in 2016 at a centre-of-mass energy of 13 TeV has also allowed the development of new methods to measure the efficiency and misidentification probability of heavy-flavour jet identification algorithms. The heavy-flavour jet identification efficiency is measured with a precision of a few per cent at moderate jet transverse momenta (between 30 and 300 GeV) and about 5% at the highest jet transverse momenta (between 500 and 1000 GeV)

Evidence for the Higgs boson decay to a bottom quark–antiquark pair

info:eu-repo/semantics/publishe

Search for heavy resonances decaying to a top quark and a bottom quark in the lepton+jets final state in proton–proton collisions at 13 TeV

info:eu-repo/semantics/publishe