Monitorización periódica de la carga viral del virus de Epstein-Barr en sangre como marcador del grado de inmunosupresión y del riesgo de infección en portadores de trasplante de pulmón

Estudios recientes sugieren que la viremia del Virus Epstein-Barr (VEBd) puede actuar como un marcador de grado de inmunosupresión en portadores de trasplante de órgano sólido. Esta hipótesis no ha sido probada hasta ahora en el trasplante de pulmón (TP). Objetivos: Estudiar la historia natural de VEB en el TP y valorar la relación entre la detección de VEB en sangre periférica y el desarrollo de infecciones, rechazo agudo y rechazo crónico. Pacientes y Métodos: Se incluyeron a 63 pacientes sometidos a TP en el Hospital Universitario 12 de Octubre entre Octubre de 2008 y Mayo de 2013. La VEBd se evaluó por RT-PCR de manera trimestral. La aparición de complicaciones tardías (disfunción crónica del injerto pulmonar [DCIP], cualquier infección o infección oportunista [IO]) se analizó en función de la detección de la VEBd dentro de los primeros seis meses tras el trasplante. Resultados: Se detectó VEBd en 30 pacientes (47,6%). El pico VEBd fue mayor en pacientes con cualquier tipo de infección tardía (2,23 vs 1,73 log10 copias/mL; P = 0,026) e IO tardía (2,39 vs 1,74 log10 copias/mL; P = 0,004). La presencia de VEBd ≥2 log10 copias/mL en los primeros seis meses después del trasplante se asoció con un mayor riesgo de IO tardía (Hazard ratio ajustado [aHR]: 7,92; intervalo de confianza [IC] del 95%: 2,10-29,85; P = 0,002). Los receptores con VEBd detectable durante los primeros 6 meses tras el trasplante también tuvieron un menor periodo libre de DCIP (P = 0,035), aunque esta asociación no se mantuvo estadísticamente significativo en el análisis multivariante (aHR: 1,26; IC 95%: 0,87-5,29; P = 0,099). Conclusiones: La detección de VEBd dentro de los primeros 6 meses después del TP es frecuente. Nuestros resultados sugieren que este fenómeno se correlaciona con la aparición de complicaciones tardías en el post-trasplante

A cooperação na distribuição de Vinho do Porto

Pretendeu-se com este estudo investigar a cooperação na distribuição do vinho do Porto, procurando que o seu contributo prático seja significativo para o conhecimento de marketing, ao nível dos canais de distribuição, nomeadamente, que concorra para o conhecimento do processo de cooperação entre empresas produtoras/engarrafadoras de vinho do Porto e empresas de distribuição num ambiente de múltiplos canais. Efectuou-se um estudo de casos de uma empresa de vinho do Porto, estudando o perfil de distribuição e maiores evoluções ocorridas nos principais mercados: Inglaterra, França e Holanda. Do estudo resultou a formulação de doze hipóteses que foram investigadas quantitativamente, tendo sido enviado um inquérito a cento e uma empresas produtoras/engarrafadoras de vinho do Porto e de distribuição alimentar. Os dados recolhidos foram sujeitos a tratamento estatístico através do modelo Probit. A investigação teve como alicerce a teoria dos custos de transacção, teoria da dependência de recursos, teoria das redes e teoria dos jogos. Os resultados do estudo demonstraram que a opção pelos múltiplos canais constitui uma decisão estratégica para a distribuição de vinho do Porto; que as práticas de conflito, quando intensas e persistentes, impedem o desenvolvimento de relações de cooperação; que uma empresa confiável facilita a resolução de conflitos e que o aumento da confiança e a maior capacidade de adaptação incrementam a tendência para cooperar. Observou-se também que a cooperação não é afectada por factores culturais como a existência de um comercial estrangeiro e que a cooperação com os parceiros de distribuição constitui uma vantagem competitiva para as empresas de vinho do Porto.The main purpose of this study is to research cooperation in Port wine distribution. We aimed to develop a practical and significant contribution towards marketing knowledge on distribution channels, namely to learn cooperation between Port wine companies and distribution firms on a multiple channels set. Based on a case study from the Port wine industry, twelve research hypotheses were raised. The case study was carried out with a Port Wine Company, taking into consideration its distribution profile in the three main markets: France, Great Britain, and the Netherlands. We then conducted a quantitative research based on a questionnaire sent to 101 Port wine producers and distribution companies. A binary probit model was developed to analyze the data. The conceptual framework was based on Transaction Cost Theory, Resource Based Theory, Network Theory and Game Theory. The results of the study show that the multiple channels option represents a strategic choice for Port wine distribution; that conflict, when permanent and intense, avoids development of cooperative relationships; a trustworthy company has more probability to solve conflicts; when trust and adaptation capabilities increase so does cooperation potential. Results also show that the existence of a foreign Sales rep amongst the team does not negatively influence cooperation. Finally, results show that cooperation with distribution partners constitutes a competitive advantage for Port wine companies

Primary Diffuse Large B Cell Lymphoma in Kidney with Involvement of Central Nervous System and Heart in a Siamese Cat

Background: Lymphoma is the most common neoplasia in cats and usually happens in middle-aged males of European breeds, FeLV-positive test is also observed in 25% to 50% of these cases. The diagnostic of renal lymphoma is based on clinical signs, the diagnosis is based on clinical signs associated with additional tests. Histological an immunohistochemical evaluations allows the classifcation which can provide prognostic information. Central nervous system metastasis is frequently reported, but lingual and lung lobe extension were also reported. Here, we report a case of renal lymphoma with systemic involvement of heart and CNS in a cat. Case: A 3-year-old male Siamese cat presented with weight loss, emesis, anorexia, polydipsia and polyuria for at least 3 weeks. The clinical parameters were stable, but presenting pale mucosal membrane and also severe dehydration. Complete blood count and chemistry profle revealed anemia and severe azotemia. On abdominal palpation, bilateral renomegaly and irregular contours of both kidneys were also detected. The kidneys were enlarged and had irregular contours on palpation, confrmed by abdominal ultrasonography, that revealed kidneys with markedly irregular contours, and the presence of fluid with high cellularity between cortical and renal capsule (capsular fluid). An aspiration citology by fne-needle from the capsular fluid guided by ultrasound was collected and sent to cytological analysis, which suggested lymphoma. The aspirate was moderately cellular and consisted of large round cells with distinct, scant, basophilic cytoplasm, round nuclei with dense chromatin, inconspicuous nucleoli, and large amount of naked cells. On the second day of treatment the cat presented a cardiopulmonary arrest not responsive to cardiopulmonary cerebral resuscitation, died, and the owner authorized the necropsy, allowing the renal biopsy showing that the same neoplastic cells presented in kidneys were also seen in heart and central nervous system, suggesting the occurrence of primary renal lymphoma with involvement of to these tissues, and the diagnosis was high grade diffuse large cell lymphoma. And also histopathological exam diagnosed high grade diffuse large cell lymphoma. Discussion: The patient died, and the post-mortem histological analysis confrmed the diagnosis of primary diffuse large B cell lymphoma in kidney with systemic involvement of heart and central nervous system (CNS). Lymphoma is the most common renal tumor in cats, however primary feline renal tumors are rare and few reports are available at this time. Here we report the occurrence of primary renal lymphoma in a Siamese cat, and there´s no previous report of this type of lymphoma especially in this breed. More investigation is needed to evaluate the susceptibility of Siamese cat breed to the development of primary renal lymphoma. It is diffcult to determine whether the renal involvement is primary or it is a consequence of the multicenter type. In the present report the same neoplasic infltration observed in kidney was also found in central nervous system and heart. The cytology is a quickly, non-invasive, and sensitivity method for the diagnostic of lymphoma. However, the cytology do not provides the immune diagnosis of diffuse large B cell, and although it is useful for staging lymphoma, histopathology and immunohistochemistry is always necessary for classifcation and grading. Since the diagnosis, the cat of this report survived only 2 days, which reinforces the bad prognosis of renal lymphoma. The renal lymphoma should be considered as a potential cause of severe azotemia, and should be taken as the mainly differential diagnosis among neoplasias of kidneys in cats.Keywords: oncology, feline, extranodal, lymph nodes, cance

Morphometric and Vascular Analyses and MMP-2 Expression in Bladders of Animals with Bovine Enzootic Haematuria

Background: Bovine enzootic haematuria is a chronic, non-infectious disease caused by the ingestion of bracken Pteridium aquilinum that contain ptaquiloside, substance responsible for the development of neoplasms in combination with bovine papillomavirus infection. Studies examining metalloproteinases have shown that these enzymes may be useful as prognostic markers and many studies have correlated the intratumoural microvessel density and incidence of metastasis in a variety of cancers, including bladder cancer. This study aimed to evaluate the urothelial morphology and vasculature and quantify the expression of the enzyme metalloproteinase-2 in the bladder lesions of bovine with enzootic haematuria.Materials, Methods & Results: Forty bladders with macroscopic lesions were subjected to routine histological processing. The material was stained using the Hematoxylin-Eosin (HE) and Weigert's resorcin-fuchsin staining methods. The morphometric analysis included the measurement of the total thickness of the urothelium. Microscopically, the lesions were differentiated as neoplastic or non-neoplastic, and the vascular changes were characterised as vascular proliferation, ectasia, dilation and thickening and the material stained using the Weigert's resorcin-fuchsin method was used to evaluate sclerosis and the vascular fibroelastosis. The metalloproteinase expression was evaluated using an anti-metalloproteinase-2 antibody. The main non-neoplastic lesions found in the urothelium included clear cell metaplasia, dysplasia, hyperplasia, haemorrhage, cystitis cystica and Brunn's nests and the neoplastic lesions were haemangioma, myxoma, transitional cell carcinoma, adenocarcinoma, in situ carcinoma and haemangiosarcoma. The urothelium measurements revealed differences between the epithelial thicknesses of bladders with and without neoplasms. The bladder vasculature evaluation revealed the frequent occurrence of different pathological aspects, such as vascular proliferation, dilation, expansion, ectasia and thickening; more severe vascular proliferation, thickening and fibroelastosis were observed in bladders with neoplasms. Metalloproteinase-2 expression was observed in the epithelial cells, fibroblasts, endothelial cells and smooth muscle cells present in the tumour tissue and was a significant increase in the expression of MMP-2 in the neoplasms of mesenchymal origin compared to the neoplasms of epithelial origin.Discussion: The presence of a large variety of non-neoplastic lesions indicates the possibility that there are other factors concomitant to BEH involved. Epithelial hyperplasia and metaplasia, for example, could be the result of damage caused by bovine papillomavirus type 2 or even an altered urine pH. Furthermore, it is believed that the bladder has the capacity to generate various types of neoplasms due to the different histological components of the bladder, thus enabling it to generate both mesenchymal and epithelial lesions. The thickness of the urothelium was greater in all the quadrants with neoplasms compared to the quadrants without neoplasms. These data revealed that it is possible to use less invasive diagnostic imaging methods to characterise bovine enzootic haematuria and to measure tumour progression based on the severity of vascular changes. The vascular proliferation and thickening were significant in bladders with neoplasms, which may be explained by the fact that tumours require an extensive vascular supply. In addition, many tumours release vascular growth factors and promote neovascularisation. The intensity of the immunostaining of metalloproteinase-2 differed among the different types of neoplasms. However, due to the diversity of the tumours, it was not possible to establish a relationship between metalloproteinase-2 expression and tumour progression

SARS-CoV-2 in Brazil and Psychosocial Repercussions on Men’s Health: Health Literacy Is Important

This study aimed at analyzing the psychosocial repercussions of the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) pandemic on the health of men living in Brazil. For this, we carried out a socio-historical and qualitative study, with the participation of 200 men who answered an online questionnaire. The data collected were processed in the NVIVO12® software, structured by the Collective Subject Discourse method, and analyzed from the epidemic disease theoretical framework proposed by Charles Rosenberg. Our results showed that the SARS-CoV-2 pandemic brought about repercussions of different dimensions that compromised the health of men living in Brazil. The repercussions evidenced were behavioral changes and emergence of new habits due to the pandemic; uncomfortable family situations; impaired affective and sexual relationships; harms in marital relationships; and insecurity and psychological distress. It is important to implement strategies that maximize men’s health literacy, promoting better communication in terms of health, and search for help and suitable information about health/mental health.info:eu-repo/semantics/publishedVersio

Home intravenous infusion: educational technologies for the care of people with hemophilia

Objetivo: Elaborar e validar tecnologias educativas para o cuidado domiciliar de pessoas com hemofilia em infusão endovenosa do fator de coagulação. Método: Estudo metodológico, desenvolvido em três etapas: elaboração de tecnologias educativas, avaliação de conteúdo e aparência por juízes e apreciação por pessoas com hemofilia. As tecnologias educativas − cartilha e infográfico − foram elaboradas mediante revisão de literatura. Na etapa de avaliação com juízes, foi utilizada a técnica Delphi em duas rodadas, por meio do Índice de Validade de Conteúdo, concordância superior a 0,80 em relação a clareza de linguagem, pertinência prática e relevância teórica. Na avaliação com o público-alvo, foi considerado o nível de concordância de respostas positivas maior ou igual a 80% nos itens de organização, o estilo de escrita, a aparência e a motivação para a leitura. Resultados: A cartilha apresentou índice de validade de conteúdo global de 0,88 na primeira rodada e 0,98 na segunda; e o infográfico, 0,88 na primeira rodada e 0,97 na segunda. Na apreciação das tecnologias educativas pelo público-alvo, o nível de concordância das respostas positivas foi superior a 80%. Conclusão: Este estudo elaborou tecnologias educativas, cartilha e infográfico, que poderão contribuir com a adesão ao tratamento e promoção do cuidado, por meio de padronização das orientações às pessoas com hemofilia em infusão endovenosa domiciliar.Objective: To develop and validate educational technologies for home care of people with hemophilia on intravenous infusion of clotting factor. Method: This is a methodological study, developed in three stages: development of educational technologies, content and appearance assessment by judges, and appraisal by people with hemophilia. The educational technologies – a booklet and an infographic - were developed through a literature review. In the assessment stage with judges, the Delphi technique was used in two rounds, through Content Validity Index, agreement greater than 0.80 in regarding clarity of language, practical relevance, and theoretical relevance. In the assessment with the target audience, the level of agreement of positive responses greater than or equal to 80% in the items of organization, writing style, appearance and motivation for reading was considered. Results: The booklet presented a global content validity index of 0.88 in the first round and 0.98 in the second; and the infographic, 0.88 in the first round and 0.97 in the second. In the assessment of educational technologies by the target audience, the level of agreement of positive responses was higher than 80%. Conclusion: This study developed educational technologies, a booklet and an infographic, which could contribute to adherence to treatment and promotion of care, by standardizing the guidelines for people with hemophilia in intravenous infusion at homeinfo:eu-repo/semantics/publishedVersio

Neurological, Psychiatric, and Biochemical Aspects of Thiamine Deficiency in Children and Adults.

Thiamine (vitamin B1) is an essential nutrient that serves as a cofactor for a number of enzymes, mostly with mitochondrial localization. Some thiamine-dependent enzymes are involved in energy metabolism and biosynthesis of nucleic acids whereas others are part of the antioxidant machinery. The brain is highly vulnerable to thiamine deficiency due to its heavy reliance on mitochondrial ATP production. This is more evident during rapid growth (i.e., perinatal periods and children) in which thiamine deficiency is commonly associated with either malnutrition or genetic defects. Thiamine deficiency contributes to a number of conditions spanning from mild neurological and psychiatric symptoms (confusion, reduced memory, and sleep disturbances) to severe encephalopathy, ataxia, congestive heart failure, muscle atrophy, and even death. This review discusses the current knowledge on thiamine deficiency and associated morbidity of neurological and psychiatric disorders, with special emphasis on the pediatric population, as well as the putative beneficial effect of thiamine supplementation in autism spectrum disorder (ASD) and other neurological conditions

SARS-CoV-2 introductions and early dynamics of the epidemic in Portugal

Genomic surveillance of SARS-CoV-2 in Portugal was rapidly implemented by the National Institute of Health in the early stages of the COVID-19 epidemic, in collaboration with more than 50 laboratories distributed nationwide. Methods By applying recent phylodynamic models that allow integration of individual-based travel history, we reconstructed and characterized the spatio-temporal dynamics of SARSCoV-2 introductions and early dissemination in Portugal. Results We detected at least 277 independent SARS-CoV-2 introductions, mostly from European countries (namely the United Kingdom, Spain, France, Italy, and Switzerland), which were consistent with the countries with the highest connectivity with Portugal. Although most introductions were estimated to have occurred during early March 2020, it is likely that SARS-CoV-2 was silently circulating in Portugal throughout February, before the first cases were confirmed. Conclusions Here we conclude that the earlier implementation of measures could have minimized the number of introductions and subsequent virus expansion in Portugal. This study lays the foundation for genomic epidemiology of SARS-CoV-2 in Portugal, and highlights the need for systematic and geographically-representative genomic surveillance.We gratefully acknowledge to Sara Hill and Nuno Faria (University of Oxford) and Joshua Quick and Nick Loman (University of Birmingham) for kindly providing us with the initial sets of Artic Network primers for NGS; Rafael Mamede (MRamirez team, IMM, Lisbon) for developing and sharing a bioinformatics script for sequence curation (https://github.com/rfm-targa/BioinfUtils); Philippe Lemey (KU Leuven) for providing guidance on the implementation of the phylodynamic models; Joshua L. Cherry (National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health) for providing guidance with the subsampling strategies; and all authors, originating and submitting laboratories who have contributed genome data on GISAID (https://www.gisaid.org/) on which part of this research is based. The opinions expressed in this article are those of the authors and do not reflect the view of the National Institutes of Health, the Department of Health and Human Services, or the United States government. This study is co-funded by Fundação para a Ciência e Tecnologia and Agência de Investigação Clínica e Inovação Biomédica (234_596874175) on behalf of the Research 4 COVID-19 call. Some infrastructural resources used in this study come from the GenomePT project (POCI-01-0145-FEDER-022184), supported by COMPETE 2020 - Operational Programme for Competitiveness and Internationalisation (POCI), Lisboa Portugal Regional Operational Programme (Lisboa2020), Algarve Portugal Regional Operational Programme (CRESC Algarve2020), under the PORTUGAL 2020 Partnership Agreement, through the European Regional Development Fund (ERDF), and by Fundação para a Ciência e a Tecnologia (FCT).info:eu-repo/semantics/publishedVersio