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Erythema elevatum diutinum is a rare neutrophilic dermatosis with vasculitis, which presents as persistent, symmetrical, purple or brownish papules and nodules, mainly in the extensor surface of the limbs. We describe a case of erythema elevatum diutinum and polyarthritis as initial manifestations of Crohn's disea se associated spondyloarthritis. A 51-year-old man, from São Tomé e Príncipe, with previous history of treated tuberculosis and chronic hepatitis B infection, was admitted due to 4 months history of polyarthritis, hyperpigmented papules on the extensor surfaces, occasional episodes of bloody mucous diarrhea and significant weight loss. Histology of the skin showed myeloperoxidase positive neutrophilic granulocytes with moderate karyorrhexis, consistent with erythema elevatum diutinum. Colonoscopy showed erosions in sigmoid and rectum. Diagnosis of erythema elevatum diutinum secondary to Crohn's disease with associated peripheral spondyloarthritis was assumed. The patient was treated with prednisolone, sulphasalazine, metronidazole, azathioprine and tenofovir with good clinical response. As erythema elevatum diutinum can be secondary to multiple systemic diseases, including rheumatic diseases and inflammatory bowel disease, being aware and re - cognizing this entity can be of great importance for rheumatologists. publishersversion published

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Objective: To update the recommendations for the treatment of rheumatoid arthritis (RA) with biological therapies, endorsed by the Portuguese Society of Rheu -matology (SPR). Methods: These treatment recommendations were formulated by Portuguese rheumatologists based on litera -ture evidence and consensus opinion. At a national meeting the 11 recommendations were discussed and updated. The document resulting from this meeting circulated to all Portuguese rheumatologists, who anonymously voted online on the level of agreement with the recommendations. Results: These recommendations cover general aspects as shared decision, prospective registry in Reuma.pt, asses sment of activity and RA impact and treatment objec tive. Consensus was also achieved regarding specific aspects as initiation of biologic therapy, assessment of res pon se, switching and definition of persistent remission. Conclusion: These recommendations may be used for guidance of treatment with biological therapies in patients with RA. As more evidence becomes available and more therapies are licensed, these recommendations will be updated. publishersversion published

Pistacia terebinthus L. is used as an edible food plant and in folk medicine due to its medicinal properties. Its fruits contain an oil with important therapeutic and interesting nutritional properties due to the high content in oleic and linoleic acids.

Background: Methotrexate (MTX) is the first-line drug in the treatment of rheumatoid arthritis (RA) and the most commonly prescribed disease modifying antirheumatic drug. Moreover, it is also used as an adjuvant drug in patients under biologic therapies, enhancing the efficacy of biologic agents. Objectives: To review the literature and update the Portuguese recommendations for the use of MTX in rheumatic diseases first published in 2009. Methods: The first Portuguese guidelines for the use of MTX in rheumatic diseases were published in 2009 and were integrated in the multinational 3E Initiative (Evi - dence Expertise Exchange) project. The Portuguese rheumatologists based on literature evidence and consensus opinion formulated 13 recommendations. At a national meeting, the recommendations included in this document were further discussed and updated. The document resulting from this meeting circulated to all Portuguese rheumatologists, who anonymously voted online on the level of agreement with the updated recommendations. Results: Results presented in this article are mainly in accordance with previous guidelines, with some new information regarding hepatitis B infection during MTX treatment, pulmonary toxicity monitoring, hepatotoxi - city management, association with hematologic neoplasms, combination therapy and tuberculosis scree - ning during treatment. Conclusion: The present recommendations combine scientific evidence with expert opinion and attained desirable agreement among Portuguese rheumatologists. The regular update of these recommendations is essen - tial in order to keep them a valid and useful tool in daily practice. publishersversion published

Background: Serious infections are a major cause of morbidity and mortality in systemic inflammatory rheumatic disease (SIRD) patients. Although vaccination may prevent numerous infections, vaccination uptake rates are low in this group of patients. Objectives: To develop evidence-based recommendations for vaccination in SIRD patients. Methods: We searched MEDLINE (until 31 October 2014) and EMBASE (until 14 December 2014) databases, as well as the ACR and EULAR congress abstracts (2011-2014). Patients with any systemic inflammatory rheumatic disease were included and all vaccines were considered. Any safety and efficacy outcomes were admitted. Search results were submitted to title and abstract selection, followed by detailed review of suitable studies. Data were subsequently pooled according to the type of vaccine and the SIRD considered. Results were presented and discussed by a multidisciplinary panel and systematic literature review (SLR)-derived recommendations were voted according to the Delphi method. The level of agreement among rheumatologists was assessed using an online survey. Results: Eight general and seven vaccine-specific recommendations were formulated. Briefly, immunization status should routinely be assessed in all SIRD patients. The National Vaccination Program should be followed and some additional vaccines are recommended. To maximize the efficacy of vaccination, vaccines should preferably be administered 4 weeks before starting immunosuppression or, if possible when disease activity is controlled. Non-live vaccines are safe in SIRD, including immunosuppressed patients. The safety of live attenuated vaccines in immunosuppressed patients deserves further ascertainment, but might be considered in particular situations. Discussion: The present recommendations combine scientific evidence with the multidisciplinary expertise of our taskforce panel and attained desirable agreement among Portuguese rheumatologists. Vaccination recommendations need to be updated on a regular basis, as more scientific data regarding vaccination efficacy and safety, emergent infectious threats, new vaccines as well as new immunomodulatory therapies become available.

OBJECTIVE: To provide evidence-based guidance for the rational and safe prescription of biological therapies in children and adolescents with juvenile idiopathic arthritis (JIAs) considering the latest available evidence and the new licensed biologics. METHODS: Rheumatologists and Pediatricians with expertise in Pediatric Rheumatology updated the recommendations endorsed by the Portuguese Society of Rheumatology and the Portuguese Society of Pediatrics based on published evidence and expert opinion. The level of agreement with final propositions was voted using an online survey. RESULTS: In total, 20 recommendations to guide the use of biological therapy in children and adolescents with JIAs are issued, comprising 4 general principles and 16 specific recommendations. A consensus was achieved regarding the eligibility and response criteria, maintenance of biological therapy, and procedures in case of non-response, for each JIA category. Specific recommendations concerning safety procedures were also updated. CONCLUSIONS: These recommendations take into account the specificities of each JIA category and are intended to continuously improve the management of JIA patients. publishersversion publishersversion published

International audience

The composition of supercritical CO 2 extracts and essential oils obtained by hydrodistillation of Bupleurum fruticosum L., growing spontaneously in Italy and Portugal, and its antifungal activity is reported. The collected extracts were analyzed by GC-FID and GC-MS methods. The minimal inhibitory concentration (MIC) and the minimal lethal concentration (MLC) were used to evaluate the antifungal activity of the oils against Candida albicans, C. tropicalis, C. krusei, C. guillermondii, C. parapsilosis, Cryptococcus neoformans, Trichophyton rubrum, T. mentagrophytes, Microsporum canis, M. gypseum, Epidermophyton floccosum, Aspergillus niger, A. fumigatus and A. flavus.

This research work was carried out in the areas of Higher Education, Teaching Technology and Web Information Management with the aim of developing a model for identifying and classifying competences and learning outcomes (MICRA) and an ontology of the information management model (SICRA). The MICRA model was applied in a case study, whereas the verification and validation of its previously defined functionalities led to ontology validation. MICRA shows to be an innovative model, based on a thorough, organized and systematic analysis of the educational context. In addition, SICRA goes beyond other ontologies as it not only defines reusable competences, classified according to Bloom's taxonomy, but also defines and establishes a correspondence among Computer Science Knowledge Areas. We have thus contributed to making learning institutions' training curricula widely available, allowing for their contrastive analysis in order to promote student and teacher mobility within the European Higher Education Area and in other countries.

Nos últimos anos tem-se observado um rápido desenvolvimento da inovação tecnológica. A Transformação Digital aumenta a competitividade das empresas, melhora o posicionamento económico das organizações e é responsável pela globalização dos negócios. A importância da Indústria 4.0 não é exceção, para o desenvolvimento da contabilidade e da gestão. Por outro lado, exige novos procedimentos de trabalho, formação e novas competências digitais. Com o crescimento da inovação, a exigência de formação diferenciada e altamente qualificada com conhecimentos tecnológicos, tem vindo a crescer entre Instituições e Países, para responderem às necessidades das empresas e dos mercados de trabalho. A evolução da sociedade e o papel do Ensino Superior na transformação digital, motivaram a realização deste trabalho, que tem como objetivo compreender a importância da Transformação Digital e da Indústria 4.0 na sociedade. Assim como, identificar as estratégias desenvolvidas pelas Instituições de Ensino Superior (IES), para acompanharem e contribuírem para o desenvolvimento económico e social das regiões. Com base neste pressuposto, foram formuladas um conjunto de questões de investigação, para responder à questão principal deste estudo, que pretende identificar a influência que as IES desempenham no desenvolvimento digital das regiões, especialmente os Institutos Politécnicos Públicos da Área Metropolitana do Porto. A metodologia adotada para responder aos objetivos deste estudo e questões de investigação formuladas, foi um estudo exploratório, com recurso a entrevistas semiestruturadas e questionários. Foram realizadas 10 entrevistas e recolhidas 37 respostas aos questionários. A análise das entrevistas e os resultados obtidos nos questionários, permitiram verificar a influência positiva das IES no desenvolvimento digital da região Norte. Permitiram também, identificar as motivações das empresas para adotarem a transformação digital, as competências necessárias para responder às novas exigências do mercado de trabalho e a estratégia adotada pelas IES para acompanhar a evolução digital da sociedade.