Ulcerative colitis: let's talk about extent

Ulcerative colitis (UC) is a chronic inflammatory disease in which clinical course varies substantially between patients. The extent of the disease is usually pointed out as one of the factors responsible for this variation. With this study, we pretended to evaluate the differences in natural history and pharmacological therapy prescription between left-sided and extended UC

A comunicação online da Entidade Reguladora para a Comunicação Social: reflexões sobre performance comunicativa de instituições públicas

Dissertação de mestrado em Ciências de Comunicação (área de especialização em Publicidade e Relações Públicas)Compreender as instituições é pensá-las nos contextos em que se inserem. Mais do que índice, a comunicação torna-se a marca performativa dos conceitos basilares da instituição. Tendo surgido em fevereiro de 2006 (longe de consensos), a Entidade Reguladora para a Comunicação Social (ERC) é a instituição portuguesa cuja missão é implementar os princípios da regulação mediática. Contudo, num contexto em mutação, as noções de regulação e de governance mediáticas tomam contornos modeladores no que respeita aos organismos reguladores. Esta dissertação pretende, por isso, à luz da criação da sua dimensão organizacional, perceber a estratégia adotada para a comunicação externa da ERC, percebendo, desde logo, a concentração desta atividade num pólo digital: o site. Através da recolha de critérios performativos dos sistemas hipermédia, construindo uma grelha de análise de websites institucionais, foi possível estabelecer um conjunto de indicadores de análise, de maneira a perceber se a ERC está preparada para as necessidades inerentes a uma responsabilidade pública de comunicação externa, assim como se está apetrechada para fomentar a aproximação aos públicos, de modo a criar forças de legitimação da Entidade Reguladora no espaço público. Atendendo a valores tático-estratégicos, critérios de acessibilidade, navegabilidade, conteúdos ou usabilidade, na hora de ponderar os pontos fracos e fortes na balança, a performance da Entidade Reguladora parece afastar-se dos indicadores positivos que lhe permitiriam pôr em prática um sistema de regulação mediática apropriado às sociedades democráticas modernas, na partilha e intercâmbio com a sociedade civil.To understand the institutions in general we must think of them in their contexts. More than a manifestation, the communication becomes the performative mark of institution’s primary concepts. Born in Frebruary 2006 (and far from consensus) the Regulatory Entity for the Media (ERC) is the Portugueses institution on charge for the implementation of media regulation principles. However, in a changing context, the concepts os regulation and governance have been taking a modeling shape function when it concerns to regulatory bodies action. Understanding reality from an organization perspective, this dissertation aims to understand ERC’s strategy to communicate externally. The concentration of ERC’s communication activity on the digital world was, from the beginning, a research entry point. Through out the collect of hypermedia systems performative criteria and the creation of an analysis grid for institutional websites, it was possible to establish a set of indicators. These indicators helped to understand if ERC was prepared for the external communication public responsibility duties, as well as if the organization had the skills to provide a close relationship with the publics, promoting legitimation forces in the public sphere. Our study is based on tactical-strategic values, accessibility, navigability, contents and usability criteria. Taking the strenghs and the weaknesses, the Regulatory Entity for the Media seems to settle away from the positive indicators which were capable to provide a modern and democratic media regulatory systems, oriented to the sharing and the exchange of experiences with the civil society.Fundação para a Ciência e a Tecnologia (FCT) - Projeto PEst- OE/COM/UI0736/2011 - “A Regulação dos Media em Portugal: O Caso da ERC” (PTDC/CCI-COM/104634/2008

Risk factors for severity and recurrence of colonic diverticular bleeding

Background: Colonic diverticular bleeding is the most common cause of lower gastrointestinal bleeding. Risk factors related to severity and repeated bleeding episodes are not completely clearly defined. Objective: To characterize a Portuguese population hospitalized due to colonic diverticular bleeding and to identify the clinical predictors related to bleeding severity and rebleeding. Methods: Retrospective analysis of all hospitalized patients diagnosed with colonic diverticular bleeding from January 2008 to December 2013 at our institution. The main outcomes evaluated were bleeding severity, defined as any transfusion support requirements and/or signs of hemodynamic shock, and 1-year recurrence rate. Results: Seventy-four patients were included, with a mean age of 75.7 +/- 9.5 years; the majority were male (62.2%). Thirty-six patients (48.6%) met the criteria for severe bleeding; four independent risk factors for severe diverticular bleeding were identified: low hemoglobin level at admission (= 75 years; OR 4.7), bilateral diverticular location (OR 14.2) and chronic kidney disease (OR 5.6). The 1-year recurrence rate was 12.9%. We did not identify any independent risk factor for bleeding recurrence in this population. Conclusion: In this series, nearly half of the patients hospitalized with diverticular bleeding presented with severe bleeding. Patients with low hemoglobin levels, older age, bilateral diverticular location and chronic kidney disease had a significantly increased risk for severe diverticular bleeding. In addition, a small number of patients rebled within the first year after the index episode, although we could not identify independent risk factors associated with the recurrence of diverticular bleeding

Azatioprina na doença inflamatória intestinal: fatores preditivos da resposta sustentada a longo prazo

ResumoIntroduçãoA azatioprina (AZA) é uma opção terapêutica de manutenção na doença inflamatória intestinal (DII). Contudo, os fatores que influenciam ou predizem a sua resposta são pouco conhecidos.ObjetivoAvaliar os fatores preditivos de sucesso terapêutico da AZA a longo prazo.MétodosAnálise retrospetiva de todos os doentes com DII seguidos no nosso hospital medicados com AZA (2‐2,5mg/Kg/dia) por doença corticodependente ou corticorrefratária e, na doença de Crohn (DC), por comportamento fistulizante ou após cirurgia. Registámos o tipo de doença (DC/colite ulcerosa [CU]/DII indeterminada), parâmetros clínicos, parâmetros laboratoriais (PL) – leucócitos, PCR, hemoglobina, plaquetas e VGM – antes e aos 3 meses de tratamento, bem como terapêutica concomitante com 5‐ASA e corticoide. O tratamento foi considerado eficaz quando os doentes mantinham o controlo da doença por critérios clínicos/endoscópicos, com manutenção da AZA ou com cessação da mesma após 3 meses de tratamento, e sem necessidade de escalar a terapêutica. Excluímos os doentes com intolerância à AZA nos primeiros 3 meses e os tratados concomitantemente com agentes biológicos.ResultadosSetenta e dois doentes (37 mulheres e 35 homens); idade média de 38,0±13,8 anos; 35 doentes com DC, 34 com CU e 3 com DII indeterminada. Duração média de tratamento com AZA de 35,1±30,6 meses. A AZA foi eficaz em 48 doentes (66,7%). A idade no início da AZA prediz o sucesso terapêutico (R=0,303, p=0,019). O sexo, o tipo de doença e os PL antes do tratamento não tiveram relação com a eficácia. Aos 3 meses de tratamento, os PL mostraram relação com o sucesso terapêutico a longo prazo: leucócitos (r=–0,295, p=0,013), PCR (r=–0,332, p=0,005), hemoglobina (r=0,307, p=0,010), plaquetas (r=–0,360, p=0,003) e VGM (r=0,255, p=0,047); no seu conjunto os PL predizem a eficácia (R=0,517; p=0,005). Existe associação entre a localização da CU (r=–0,381; p=0,026), o tempo de tratamento concomitante com 5‐ASA (r=0,258, p=0,029) e a suspensão de corticoides (r=0,265, p=0,04) com a eficácia do tratamento.ConclusãoO tratamento com a AZA foi eficaz na maioria dos doentes com DII. A idade avançada no início da terapêutica e os PL aos 3 meses foram preditivos de resposta sustentada da AZA.AbstractIntroductionAzathioprine (AZA) is an option for maintenance therapy in Inflammatory Bowel Disease (IBD). However, the factors which influence or predict its response are poorly understood.AimEvaluate the predictive factors for a successful long‐term therapeutic response of AZA.MethodsRetrospective analysis of all patients with IBD followed up in our hospital treated with AZA (2‐2.5mg/Kg/day) due to steroid dependent or resistent disease or, in Crohn disease (CD), due to fistulizing behavior or post‐surgery. We recorded the type of disease (DC/ ulcerative colitis (UC), indeterminate IBD), clinical parameters, laboratory parameters (LP) – WBC, CRP, hemoglobin, platelets and MCV – before and after 3 months of treatment, as well as concomitant usage of 5‐ASA and steroids. The treatment was considered effective when patients maintained control of the disease by clinical/endoscopic criteria, with continued maintainance of AZA or cessation of therapy after 3 months of treatment, and without escalation of therapy. We excluded patients who show intolerance to AZA in the first 3 months and patients treated concomitantly with biological agents.Results72 patients (37 women and 35 men); mean age 38.0±13.8 years; 35 patients with CD, 34 with UC and 3 with indeterminate IBD. The average duration of treatment with AZA was 35.1±30.6 months. AZA was effective in 48 patients (66.7%). The age at onset of AZA predicts therapeutic sucess (R=0.303, p=0.019). The sex, type of disease and LP before treatment did not correlate with efficacy. The LP after 3 months of therapy correlated with therapeutic sucess in the long‐term: WBC (r=–0.295, p=0.013), CRP (r=–0.332, p=0.005), hemoglobin (r=0.307, p=0.010), platelets (r=–0.360, p=0.003) and MCV (r=0.255, p=0.047). In combination, LP predict the efficacy of treatment (R=0.517, p=0.005). There is also an association between the location of UC (r=–0.381, p=0.026), as well as the duration of concurrent treatment with 5‐ASA (r=0.258, p=0.029) and the suspension of steroids (r=0.265, p=0.04) with the efficacy of the treatment.ConclusionAZA proved to be an effective treatment in the majority of patients with IBD. The old age of onset of the therapy and LP at 3 months were predictive of a sustained response of AZA

Student assessment in Higher Education: a review of thesis carried out in Portuguese public universities

Student assessment has become, over the past years, an important and complex issue about higher education pedagogy. This paper aims to present a systematic review of empirical studies (Master and PhD thesis), carried out in Portuguese public universities, focused on the topic of student assessment in higher education, from the year 2010 to 2020. The research methodology followed a qualitative approach, using e PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) model to develop the systematic review. Findings show a trend of change in the assessment practices of students in higher education, whose direction points to an increase of formative assessment centered on students. A strong trend of innovation in assessment practices with the use of technologies also emerges from the studies

Prevention of risky drinking behavior at academic festivals: “tú decides” project

Objetivo: El consumo de alcohol en estudiantes universitarios ha alcanzado niveles preocupantes, siendo sus efectos sobre la conducción bastantes perjudiciales. Es importante desarrollar programas de prevención destinados a concienciarles sobre los efectos del consumo de alcohol en la conducción. La presente investigación ha evaluado la efectividad del programa de intervención “Tú Decides”, implementado en un festival académico, entre 2010-2014. Método: Se utilizó un diseño de investigación cuasiexperimental, en el que fueron incluidos 5.079 participantes con habilitación legal para conducir. Se les encuestó en dos momentos distintos, antes y después de la medición de la Tasa de Alcohol en Sangre (TAS) y la realización de una sesión informativa con recomendaciones técnicas para la prevención de la conducción bajo los efectos del alcohol. Se utilizó el test ANOVA de un factor para comparaciones de medias y el test chi-cuadrado para comparación de proporciones (p<0,05). Resultados: Se verificó que la intención de conducir disminuyó del primer (50,7%) al segundo momento (42,1%) (χ2=2078,71; p=0,000), dicha intención estaba influida por el nivel de alcoholemia (χ2=338,252; p=0,000), el género (χ2=35,718; p=0,000), la edad (χ2=62,805; p=0,000) y la situación profesional de los participantes (χ2=27,397; p=0,001). Conclusiones: Se puede afirmar que el principal objetivo de esta intervención fue alcanzado, en la medida en que los participantes siguieron las recomendaciones técnicas basadas en los resultados de la TAS.Objective: Alcohol consumption among university students has reached worrying levels, being its’ effects on driving highly prejudicial. This aspect emphasizes the necessity to develop prevention programs, intended to raise subjects’ awareness about the alcohol effects on driving. The present research tested the effectiveness of the intervention program “Tú Decides”, implemented during an Academic Week, between 2010-2014. Method: It was used a quasi-experimental design. A total of 5079 participants were inquired. They were asked, at two different moments, before and after the measurement of the Blood Alcohol Level (BAL) and giving an information session with technical recommendations to prevent driving under alcohol effects. A one factor ANOVA was used, in order to perform a mean comparison, as well as the Chi-square statistics, to perform a proportion comparison (p<0,05). Results: It was found that the intention to drive was lower at the second moment (42,1%) (χ2=2078.71; p=.000). This intention was influenced by BAC different levels (χ2=338.252; p=.000), gender (χ2=35.718; p=.000), age (χ2=62.805; p=.000) and professional situation of the participants (χ2=27.397; p=.001). Conclusions: We can affirm that the main objective of this intervention was achieved, since the participants followed the technical recommendations based on the BAC results

HIV infection and placental malaria reduce maternal transfer of multiple antimalarial antibodies in Mozambican women

Objectives: Maternal Plasmodium falciparum-specific antibodies may contribute to protect infants against severe malaria. Our main objective was to evaluate the impact of maternal HIV infection and placental malaria on the cord blood levels and efficiency of placental transfer of IgG and IgG subclasses. Methods: In a cohort of 341 delivering HIV-negative and HIV-positive mothers from southern Mozambique, we measured total IgG and IgG subclasses in maternal and cord blood pairs by quantitative suspension array technology against eight P. falciparum antigens: Duffy-binding like domains 3-4 of VAR2CSA from the erythrocyte membrane protein 1, erythrocyte-binding antigen 140, exported protein 1 (EXP1), merozoite surface proteins 1, 2 and 5, and reticulocyte-binding-homologue-4.2 (Rh4.2). We performed univariable and multivariable regression models to assess the association of maternal HIV infection, placental malaria, maternal variables and pregnancy outcomes on cord antibody levels and antibody transplacental transfer. Results: Maternal antibody levels were the main determinants of cord antibody levels. HIV infection and placental malaria reduced the transfer and cord levels of IgG and IgG1, and this was antigen-dependent. Low birth weight was associated with an increase of IgG2 in cord against EXP1 and Rh4.2. Conclusions: We found lower maternally transferred antibodies in HIV-exposed infants and those born from mothers with placental malaria, which may underlie increased susceptibility to malaria in these children. © 2021 The British Infection Associatio

HIV infection and placental malaria reduce maternal transfer of multiple antimalarial antibodies in Mozambican women

Objectives: Maternal Plasmodium falciparum-specific antibodies may contribute to protect infants against severe malaria. Our main objective was to evaluate the impact of maternal HIV infection and placental malaria on the cord blood levels and efficiency of placental transfer of IgG and IgG subclasses.Methods: In a cohort of 341 delivering HIV-negative and HIV-positive mothers from southern Mozambique, we measured total IgG and IgG subclasses in maternal and cord blood pairs by quantitative suspension array technology against eight P. falciparum antigens: Duffy-binding like domains 3-4 of VAR2CSA from the erythrocyte membrane protein 1, erythrocyte-binding antigen 140, exported protein 1 (EXP1), merozoite surface proteins 1, 2 and 5, and reticulocyte-binding-homologue-4.2 (Rh4.2). We performed univariable and multivariable regression models to assess the association of maternal HIV infection, placental malaria, maternal variables and pregnancy outcomes on cord antibody levels and antibody transplacental transfer.Results: Maternal antibody levels were the main determinants of cord antibody levels. HIV infection and placental malaria reduced the transfer and cord levels of IgG and IgG1, and this was antigen-dependent. Low birth weight was associated with an increase of IgG2 in cord against EXP1 and Rh4.2.Conclusions: We found lower maternally transferred antibodies in HIV-exposed infants and those born from mothers with placental malaria, which may underlie increased susceptibility to malaria in these children

Clinical management of canine leishmaniosis in Portugal : the veterinary community perspective

Dissertação de Mestrado Integrado em Medicina VeterináriaCanine leishmaniosis (CanL) is an endemic disease in more than 70 countries, including Portugal. Scientific research has allowed developments concerning the management of the disease, including the publication of international guidelines, such as those published by the LeishVet group. However, this management has shown to be variable among countries and there is scarce information concerning the treatment of the associated renal disease, which is often present in more advanced stages and is the main cause of death due to CanL. This study aimed to investigate the current paradigm of the clinical management of CanL in Portugal, including the treatment of renal disease in these patients. An online questionnaire was developed, including 24 to 64 questions, depending on the answering pathway of each respondent. The content was divided in three parts: general characteristics, medical approach (diagnosis, treatment and prevention) in face of different hypothetical scenarios of CanL and other questions. This last part focused on the knowledge regarding the existing guidelines, the diagnostic tools routinely applied and the use of immunosuppressants for treatment of glomerulonephritis secondary to CanL. After internal validation, the questionnaire was uploaded using an electronic platform and diffused online, over 2 months, via Portuguese social network veterinary groups. The survey included 86 answers and revealed that most measures applied by the enquired veterinary clinicians are in accordance with the international recommendations. Furthermore, the treatment with miltefosine and allopurinol was prioritized to that of meglumine antimoniate (MA) with allopurinol (selected by 48.8% and 23.3%, respectively) in stage IV of CanL, probably due to the nephrotoxicity associated with MA, according to some studies. Furthermore, euthanasia was only considered for the stage IV scenario. The preferred protocol for treatment of proteinuria in dogs with leishmaniosis consisted in the use of angiotensin converting enzyme inhibitors (ACEI). The use of immunosuppressants was considered by 44.2% of the veterinary surgeons, showing an evident preference for prednisolone (94.7%) and, in a much lesser proportion, for mycophenolate mofetil (5.3%). These findings contributed to emphasise the lack of evidence regarding the use of specific immunosuppressive drugs for the treatment of immune-mediated glomerular disease, especially when associated with an infectious cause, and the preference given to miltefosine rather than MA in the most advanced stage of disease.RESUMO - ABORDAGEM CLÍNICA DA LEISHMANIOSE CANINA EM PORTUGAL: A PERSPETIVA DA COMUNIDADE MÉDICO-VETERINÁRIA - A Leishmaniose canina (LCan) é uma doença endémica em mais de 70 países, incluindo Portugal. A investigação científica tem permitido desenvolvimentos relativamente à abordagem da doença, incluindo a publicação de linhas orientadoras internacionais, como as do grupo LeishVet. Apesar disso, esta abordagem tem-se revelado variável entre países e há escassa informação sobre o tratamento da doença renal associada, frequentemente presente em estádios mais avançados e considerada a principal causa de morte devido a LCan. Este estudo teve por objetivo investigar o paradigma atual da abordagem clínica da LCan em Portugal, incluindo o tratamento da doença renal nestes pacientes. Foi desenvolvido um questionário, incluindo 24 a 64 questões, dependendo do encadeamento de respostas de cada inquirido. O conteúdo dividiu-se em três partes: características gerais, abordagem médica (diagnóstico, tratamento e prevenção) perante diferentes cenários hipotéticos de LCan e outras questões. Esta última parte focou-se no conhecimento das linhas orientadoras existentes, nas ferramentas de diagnóstico habitualmente aplicadas e no uso de imunossupressores no tratamento de glomerulonefrite secundária a LCan. Após validação interna, o questionário foi disponibilizado online, através de uma plataforma eletrónica, e divulgado através das redes sociais, durante 2 meses, em grupos destinados à comunidade médico-veterinária. O estudo incluiu 86 respostas e revelou que a maior parte das medidas aplicadas pelos médicos veterinários são concordantes com as recomendações internacionais. Mais ainda, o tratamento com miltefosina e alopurinol foi priorizado em relação ao uso de antimoniato de meglumina (AM) com alopurinol (selecionados por 48,8% e 23,3%, respetivamente) no estádio IV da doença, provavelmente devido à nefrotoxicidade associada ao AM, segundo alguns estudos. Para além disso, a eutanásia foi apenas considerada para o cenário do estádio IV. O protocolo preferido para o tratamento de proteinúria em cães com leishmaniose consistiu no uso de inibidores da enzima de conversão da angiotensina (IECA). O uso de imunossupressores foi considerado por 44,2% dos veterinários, com uma preferência evidente por prednisolona (94,7%) e, numa proporção muito menor, por micofenolato de mofetil (5,3%). Estes resultados contribuíram para salientar a escassez de dados sobre o uso de imunossupressores específicos para o tratamento de cães com doença glomerular imunomediada, especialmente quando associada a uma causa infeciosa, e a preferência dada à miltefosina, em relação ao AM, no estádio mais avançado da doença.N/