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Patients with metabolic syndrome (MetS) are at high risk of developing cardiovascular disease (CVD) and lipoprotein(a) (Lp(a)) is an independent risk factor for CVD. This study aimed to determine the effect of vertical sleeve gastrectomy (VSG)–induced weight loss on Lp(a) levels in obese individuals. Patients submitted to VSG from January 2011 to July 2015 were included. Anthropometric and metabolic parameters were recorded before and 12 months after surgery. Univariate analysis identified associations between Lp(a) and anthropometry and metabolic parameters, and the logistic regression predictors of Lp(a) decrease after VSG. MetS was present in 47% of the 330 patients involved. Patients with MetS had higher body mass index (BMI) and triglyceride levels and were more insulin-resistant. No differences were found between groups respecting Lp(a) levels prior to surgery (15.2 mg/dL vs. 15.0 mg/dL, p = 0.795). After surgery, patients without MetS had a decrease in Lp(a) levels (14.7 mg/dL vs. 12.3 mg/dL, p = 0.006), while MetS patients showed no differences (13.9 mg/dL vs. 14.6 mg/dL, p = 0.302). The regression model evidenced that older age and Δ HDL-c were predictors of Lp(a) decrease, whereas the greater the number of MetS components and lower estimated BF% loss, the lesser odds of decreasing Lp(a) after surgery. Despite a global improvement of conventional CVD risk factors, only individuals without MetS showed a decrease of Lp(a) levels after VSG. Further studies should explore not only the pathophysiological mechanisms underlying the absence of decrease of Lp(a) levels in MetS patients, but also its impact on the metabolic beneficial changes usually observed after VSG.

Purpose To compare choroidal thickness (CT) between patients with systemic lupus erythematosus (SLE) without ophthalmologic manifestations and a control group. To study the effects in CT of disease duration, activity index, medication and systemic comorbidities. Methods Cross-sectional study where spectral-domain optical coherence tomography with enhanced depth imaging was used to measure CT in 13 locations, subfoveally and at 500-µm intervals along a horizontal and a vertical section from the fovea. Linear regression models were used. Results Sixty-eight SLE patients and fifty healthy controls were enrolled. CT multivariable analysis revealed lower values in SLE patients (12.93-26.73 µm thinner) in all locations, except the inferior quadrants (6.48-10.44 µm thicker); however, none of these results reached statistical significance. Contrary to the control group, the normal topographic variation in CT between macular quadrants and from the center to the periphery was not observed in the SLE group. Multivariable analysis in the SLE group alone revealed a significant negative association with anticoagulants (50.10-56.09 µm thinner) and lupus nephritis (40.79-58.63 µm thinner). Contrary to controls, the CT of SLE patients did not respond to changes in mean arterial pressure. Conclusion CT in SLE appears to be thinner, particularly in the subset of patients with nephritis and taking anticoagulants, suggesting more advanced systemic vascular disease. Choroidal responses to hemodynamic changes may also be altered in SLE.

O trabalho tem por objetivo analisar as políticas públicas educacionais para os negros, pardos e indígenas na Universidade, apontando os avanços e retrocessos que a legislação brasileira tem presentado ao longo da história. Para isso, por meio de uma pesquisa bibliográfica e documental, analisamos inicialmente o histórico da cotas raciais no Brasil, apontando seus pressupostos e características. Na sequência realiza-se uma análise da legislação, que trata das questões das cotas que permeiam as políticas públicas educacionais. Concluímos que as políticas públicas educacionais de cotas raciais são relevantes, pois integram jovens que tem uma desvantagem social na Universidade.

During the last decade, many cartilage tissue engineering strategies have been developed, being the stem cell-based approach one of the most promising. Transforming Growth Factor-β3 (TGF-β3) and Insulin-like Growth Factor-I (IGF-I) are key proteins involved in the regulation of chondrogenic differentiation. Therefore, these two growth factors (GFs) were immobilized at the surface of a single electrospun nanofibrous mesh (NFM) aiming to differentiate human Bone Marrow-derived Mesenchymal Stem Cells (hBM-MSCs). The immobilization of defined antibodies (i.e. anti-TGF-β3 and anti-IGF-I) allows the selective retrieval of the abovementioned GFs from human platelet lysates (PL). Biochemical assays, involving hBM-MSCs cultured on biofunctional nanofibrous substrates under basal culture medium during 28⠯days, confirm the biological activity of bound TGF-β3 and IGF-I. Specifically, the typical spherical morphology of chondrocytes and the immunolocalization of collagen type II confirmed the formation of a cartilaginous ECM. Therefore, the proposed biofunctional nanofibrous substrate is able to promote chondrogenesis., The authors would like to acknowledge the Portuguese Foundation for Science and Technology (FCT) for the PhD grant of MRC (PD/BD/113797/2015) financed by the FCT Doctoral Program on Advanced Therapies for Health (PATH) (FSE/POCH/PD/169/2013), the Post-doc fellowships of MAS and ARP (SFRH/BPD/73322/2010 and SFRH/BPD/90332/2012), the IF grant of AM (IF/00376/2014), and the projects SPARTAN (PTDC/CTM-BIO/4388/2014) and FRONthera (NORTE-01-0145-FEDER-0000232)., info:eu-repo/semantics/publishedVersion

Background Computed tomography (CT) perfusion has been studied as a tool to predict delayed cerebral ischemia (DCI) and clinical outcome in spontaneous subarachnoid hemorrhage (SAH). The purpose of the study was to determine whether quantitative CT perfusion performed within 72 hours after admission can predict the occurrence of DCI and clinical outcome as measured with a modified Rankin scale (mRS) at 3 months after ictus. Methods Cerebral perfusion was assessed in a prospective cohort of patients with acute SAH. CT perfusion parameters at Results A total of 66 patients underwent CT perfusion at 3 for each one second increase in TTP at admission (OR = 1.08; 95% CI: 1.00, 1.17; p = 0.061). Conclusions We identified an association of early TTP changes with DCI and poor clinical outcome. However, there were no associations with cerebral blood flow or mean transit time and DCI/clinical outcome. CT perfusion still remains to be validated as a tool in predicting outcome in SAH.

Purpose A comprehensive protocol to evaluate voice quality can support a full characterisation of voice disorders and be used to plan voice interventions. The purpose of this study was to develop and validate a standardised protocol for voice assessment, contributing with a comprehensive and valuable tool for clinician practice and research. Method The initial structure and content of the protocol was based on an extensive literature review of existing voice assessment tools. The content validity was then assessed by a panel of voice specialist, using a modified Bland and Altman graphical method and the intraclass correlation coefficient (ICC). A group of participants with vocal pathology was finally assessed by two voice specialists on the same day (inter-rater reliability), and, on a second day, by a single evaluator (intra-rater reliability). Inter and intra-reliability were evaluated through Cohen's kappa (k) for nominal variables, and Spearman's Correlation Coefficient (ρ) for quantitative and ordinal variables. Results The Bland and Altman analysis, revealed a reasonable agreement between the experts and the ICC values were lower than expected, but the confidence intervals were very wide. The intra-rater reliability of the protocol's nominal variables was almost perfect, with a mean k of 0.977; inter-rater reliability of nominal variables was also almost perfect, with a mean k of 0.893. The ordinal and quantitative variables revealed a very good to excellent relationship, with a mean ρ of 0.912. Conclusions Evidence of content validity, high intra and inter-rater reliability of a standardised protocol for voice assessment, have been shown. This protocol can be used to assess and collect data from patients, to train voice specialists and to develop reference voice databases. It has been designed to serve voice experts with diverse backgrounds and assessment needs.

Patients' previous disability (PD) is a key factor when considering acute stroke therapy. PD's exact impact on functional prognosis of patients with acute ischemic stroke remains not entirely clarified. We aimed to analyze PD's influence on functional outcome three months after ischemic stroke.Retrospective analysis of prospectively collected data concerning patients with acute ischemic stroke admitted to Stroke Unit of a tertiary center who underwent acute phase therapy between 2017 and 2019. Modified Rankin Scale (mRS) was used to define PD (with previous mRS≥3). Patients with PD were selected for treatment based on similar baseline characteristics to patients without PD. Patients were classified into two groups according to previous mRS: mRS3 and mRS≥3. We defined bad outcome at three months after stroke as mRS≥3 for patients with previous mRS3, and as a higher score than baseline mRS for patients with previous mRS≥3.We identified 1169 eligible patients - 1016 patients with previous mRS3 and 153 patients with previous mRS≥3. Most baseline characteristics did not differ significantly between them. For patients ≤75 years old, PD was associated with worse outcome (odds ratio estimate [OR] 4.50, p 0.001). For patients75 years old, PD was protective against worse outcome (OR 0.42, p 0.001). In patients with previous mRS≥3 and75 years old, there was a higher proportion of women (p = 0.005).PD might not be a relevant factor when considering acute stroke therapy in selected patients75 years old, especially women. Further studies are needed to clarify these findings.

A rinite ocupacional é uma patologia inflamatória da mucosa nasal caracterizada por sintomas nasais intermitentes ou persistentes e/ou limitação variável do fluxo aéreo nasal e/ou hipersecreção nasal devido a causas atribuíveis a um ambiente de trabalho específico. Pode ser classificada em alérgica (IgE-mediada ou não IgE-mediada) ou não alérgica. A rinite ocupacional alérgica é habitualmente a expressão clínica inaugural da sensibilização das vias aéreas a um alergénio presente no ambiente laboral e pode preceder o aparecimento da asma ocupacional. Embora o diagnóstico seja essencialmente clínico, pelos aspetos médico-legais envolvidos, torna-se importante identificar os agentes etiológicos, sendo a prova de provocação nasal o gold-standard diagnóstico; no entanto, quando não está disponível, poderá ser feita uma avaliação no local de trabalho. A opção terapêutica mais eficaz consiste na evicção da exposição. Neste artigo reunimos a evidência científica atual relativa à rinite ocupacional, partindo de um caso clínico para contextualização do problema.

UIDB/04077/2020 PTDC/BTM‐SAL/29335/2017 UIDB/04138/2020 UIDP/04138/2020 grant (2020.04441.BD) of C.R. This work aimed to produce bionanocomposites of chitosan incorporated with zinc oxide nanoparticles (ZnO NPs) synthesized using food industry by-products and to characterize them. Such nanoparticles are highlighted due to their low cost, antimicrobial activity, accessibility, and sustainability synthesis. Four different levels of ZnO NPs (0, 0.5, 1.0, and 2.0% w/w of chitosan) were tested, and the bionanocomposites were characterized in terms of their hydrophobicity, mechanical, optical, and barrier properties. Overall, the incorporation of ZnO NPs changed the composites from brittle to ductile, with enhanced elongation at break and reduced Young Modulus and tensile strength. Thus, ZnO NPs acted as plasticizer, turning the films more flexible, due to the presence of organic compounds on the NPs. This also favored permeability of oxygen and of water vapor, but the good barrier properties were maintained. Optical properties did not change statistically with the ZnO NPs incorporation. Thus, the characterization presented in this paper may contribute to support a decision on the choice of the material’s final application. publishersversion published

Objetivo: explorar as evidências dos últimos nove anos à cerca das escolhas de manejo terapêutico e profilático em grávidas com anemia falciforme. Métodos: é um estudo descritivo realizado na base de dados da Biblioteca Virtual da Saúde, Medline e Lilacs no período de 2010 a 2019, com uso dos descritores Anemia e Falciforme e Gravidez. Discussão: a anemia falciforme é uma doença genética e hereditária que altera a estrutura físico-química da hemoglobina, gerando complicações que podem afetar a vida dos portadores, inclusive a gravidez, a qual se torna de alto risco. É necessária a interação de uma equipe multiprofissional qualificada para acompanhar a gestante com anemia falciforme durante o pré-natal e o puerpério, a fim de evitar riscos maternos e fetais,orientar, realizar diagnósticos precoces e fornecer uma assistência integral ao binônimo mãe-filho. Conclusão: 13 apesar de todas as intercorrências causadas na gestação com anemia falciforme, o direito reprodutivo deve ser assegurado e, para isso, o planejamento gestacional deve ser realizado, a fim de fornecer suporte necessário e integral para a mãe e o feto.

OBJECTIVE The study aimed to assess the association between intrauterine growth of preterm infants and energy and macronutrient contents in their mothers' milk. STUDY DESIGN A historical cohort of mothers of preterm infants was assessed according to offspring's intrauterine growth. Fetal growth restriction (FGR) was defined as small-for-gestational age or appropriate for gestational age with fetal growth deceleration. During the first 4 weeks after delivery, the composition of daily pool samples of mothers' milk was measured by using a mid-infrared human milk analyzer. Explanatory models for milk energy, true protein, total carbohydrate, and fat contents were obtained by generalized additive mixed effects regression models. RESULTS In total, 127 milk samples were analyzed from 73 mothers who delivered 92 neonates. Energy content was significantly higher in mothers with chronic hypertension (average: +6.28 kcal/dL; 95% confidence interval [CI]: 0.54-12.01; p = 0.034) and for extremely preterm compared with very preterm infants (average: +5.95 kcal/dL; 95% CI: 2.16-9.73; p = 0.003), and weakly associated with single pregnancies (average: +3.38 kcal/dL; 95% CI: 0.07-6.83; p = 0.057). True protein content was significantly higher in mothers with chronic hypertension (average: +0.91 g/dL; 95% CI: 0.63-1.19; p

Affection promotes transformations in education, allowing to stimulate pleasure during learning, favoring the child to better adapt to the environment, and its insertion as a pedagogical practice becomes necessary. The aim of this study was to investigate the importance of affectivity in early childhood education. This is a narrative, descriptive and exploratory bibliographic review. Based on the theme "Affectivity as a methodological practice in early childhood education: a narrative review", he formulated the following guiding question: What is the importance of affectivity as a methodological practice in teaching children? And online research databases such as ScieLO, ERIC, Google Scholar were consulted. In all, nineteen articles (19) were selected, according to the inclusion and exclusion criteria. The studies addressed the concepts of affectivity and its relationship with teaching, affectivity in the family context, the role of the teacher in the use of affectivity in the classroom, and the importance of affectivity in the teaching of early childhood education for the development and learning of children. kids. Affection must be seen as a practical approach in teaching children as a positive strategy in the learning process, strategies that can be developed by the teacher in the school environment, and also in the family context, as the bond between the student and his family provides benefits as for sociability and learning. El afecto promueve transformaciones en la educación, permitiendo estimular el placer durante el aprendizaje, favoreciendo que el niño se adapte mejor al entorno, y se hace necesaria su inserción como práctica pedagógica. El objetivo de este estudio fue investigar la importancia de la afectividad en la educación infantil. Es una revisión bibliográfica narrativa, descriptiva y exploratoria. A partir del tema "La afectividad como práctica metodológica en la educación infantil: una revisión narrativa", formuló la siguiente pregunta orientadora: ¿Cuál es la importancia de la afectividad como práctica metodológica en la enseñanza a los niños? Y se consultaron bases de datos de investigación en línea como ScieLO, ERIC, Google Scholar. En total, se seleccionaron diecinueve artículos (19), de acuerdo con los criterios de inclusión y exclusión. Los estudios abordaron los conceptos de afectividad y su relación con la docencia, la afectividad en el contexto familiar, el papel del docente en el uso de la afectividad en el aula y la importancia de la afectividad en la enseñanza de la educación infantil para el desarrollo y el aprendizaje. de los niños. El afecto debe ser visto como un enfoque práctico en la enseñanza de los niños como una estrategia positiva en el proceso de aprendizaje, estrategias que pueden ser desarrolladas por el docente en el ámbito escolar, y también en el contexto familiar, ya que el vínculo entre el alumno y su familia proporciona beneficios en cuanto a sociabilidad y aprendizaje. A afetividade promove transformações na educação, permitindo estimular o prazer durante o aprendizado, favorecendo a criança a uma melhor adaptação ao meio, e torna-se necessário sua inserção como prática pedagógica. O objetivo desse estudo foi investigar a importância da afetividade na educação infantil. Trata-se de uma revisão bibliográfica de cunho narrativa, descritiva e exploratória. A partir da temática “A afetividade como prática metodológica na educação infantil: uma revisão narrativa”, formulou a seguinte questão norteadora: Qual a importância da afetividade como prática metodológica no ensino de crianças? E foram consultados bases dados online de pesquisa tais como ScieLO, ERIC, Google Acadêmico. Ao todo dezenove artigos (19) foram selecionados, conforme os critérios de inclusão e exclusão. Os estudos abordavam sobre os conceitos de afetividade e sua relação com o ensino, a afetividade no contexto familiar, o papel do docente na utilização da afetividade em sala de aula, e a importância da afetividade no ensino da educação infantil para o desenvolvimento e aprendizado das crianças. A afetividade deve ser vista como uma abordagem prática no ensino das crianças como estratégia positiva no processo de aprendizagem, estratégias estas que podem ser desenvolvidas pelo professor no ambiente escolar, e também no âmbito familiar, pois o vínculo entre o aluno e sua família propiciam benefícios quanto a sociabilidade e aprendizagem.

Introduction: Combined intravenous therapy (IVT) and mechanical thrombectomy (MT) is the standard treatment for acute ischemic stroke (AIS) with large vessel occlusion (LVO). However, the use of IVT before MT is recently being questioned. Objectives: To compare patients treated with IVT before MT with those treated with MT alone, in a real-world scenario. Methods: Retrospective analysis of AIS patients with LVO of the anterior circulation who underwent MT, with or without previous IVT, between 2016 and 2018. Results: A total of 524 patients were included (347 submitted to IVT+MT; 177 to MT alone). No differences between groups were found except for a higher time from stroke onset to CT and to groin puncture in the MT group (297.5 min vs 115.0 min and 394.0 min vs 250.0 min respectively, p < 0.001). Multivariable analysis showed that age

Copyright © 2021 the Author(s). Published by PNAS. This open access article is distributed under Creative Commons Attribution-NonCommercial-NoDerivatives License 4.0 (CC BY-NC-ND)., Sprouting angiogenesis is fundamental for development and contributes to cancer, diabetic retinopathy, and cardiovascular diseases. Sprouting angiogenesis depends on the invasive properties of endothelial tip cells. However, there is very limited knowledge on how tip cells invade into tissues. Here, we show that endothelial tip cells use dactylopodia as the main cellular protrusion for invasion into nonvascular extracellular matrix. We show that dactylopodia and filopodia protrusions are balanced by myosin IIA (NMIIA) and actin-related protein 2/3 (Arp2/3) activity. Endothelial cell-autonomous ablation of NMIIA promotes excessive dactylopodia formation in detriment of filopodia. Conversely, endothelial cell-autonomous ablation of Arp2/3 prevents dactylopodia development and leads to excessive filopodia formation. We further show that NMIIA inhibits Rac1-dependent activation of Arp2/3 by regulating the maturation state of focal adhesions. Our discoveries establish a comprehensive model of how endothelial tip cells regulate its protrusive activity and will pave the way toward strategies to block invasive tip cells during sprouting angiogenesis., C.A.F. was supported by a European Research Council starting grant (679368), the European Union H2020-TWINN-2015—Twinning (692322), the Fundação para a Ciência e a Tecnologia funding (grants IF/00412/2012, EXPL/BEX-BCM/2258/2013, PTDC/MED-PAT/31639/2017, and PTDC/BIA-CEL/32180/2017 and fellowships CEECIND/04251/2017 and CEECIND/02589/2018), and a grant from the Fondation Leducq (17CVD03).

Simple Summary The main problem encountered in the management of prostate cancer (PCa) is the inability to distinguish slow-growing indolent tumors from aggressive tumors. It is therefore important to explore non-invasive assays for the early detection of this aggressive subtype, when it can still be treated effectively. The presence of the TWEAK cytokine in biofluids of the PCa microenvironment might drive the secretion of extracellular vesicles (EVs) containing exo-oncomicroRNAs capable of modifying the tumor microenvironment. These exo-oncomicroRNAs are potentially useful as PCa biomarkers. We identified 2 exo-oncomiRNAs isolated from semen EVs by the action of TWEAK in the tumor microenvironment and, we determined their usefulness as biomarkers of PCa prognostic. We also established, for the first time, that TWEAK modulates potential exo-oncomiRNA targets, both tightly linked to cancer progression. In conclusion, our study shows that semen detection of TWEAK-regulated exo-oncomiRNAs can improve PCa prognosis, opening new avenues for diagnosis and treatment. Abstract Liquid biopsy-based biomarkers, including microRNAs packaged within extracellular vesicles, are promising tools for patient management. The cytokine tumor necrosis factor-like weak inducer of apoptosis (TWEAK) is related to PCa progression and is found in the semen of patients with PCa. TWEAK can induce the transfer of exo-oncomiRNAs from tumor cells to body fluids, and this process might have utility in non-invasive PCa prognosis. We investigated TWEAK-regulated exo-microRNAs in semen and in post-digital rectal examination urine from patients with different degrees of PCa aggressiveness. We first identified 14 exo-oncomiRNAs regulated by TWEAK in PCa cells in vitro, and subsequently validated those using liquid biopsies from 97 patients with PCa. Exo-oncomiR-221-3p, -222-3p and -31-5p were significantly higher in the semen of high-risk patients than in low-risk peers, whereas exo-oncomiR-193-3p and -423-5p were significantly lower in paired samples of post-digital rectal examination urine. A panel of semen biomarkers comprising exo-oncomiR-221-3p, -222-3p and TWEAK was designed that could correctly classify 87.5% of patients with aggressive PCa, with 85.7% specificity and 76.9% sensitivity with an area under the curve of 0.857. We additionally found that TWEAK modulated two exo-oncomiR-221-3p targets, TCF12 and NLK. Overall, we show that liquid biopsy detection of TWEAK-regulated exo-oncomiRNAs can improve PCa prognosis prediction.

Background: Data on risk factors for uncontrolled asthma in preschool children are controversial. Objective: This study aims to explore the association between clinical and functional parameters and the lack of asthma control in preschool children. Methods: Children aged 3-5 years with asthma and healthy controls were recruited. A questionnaire was used to identify potential risk factors for uncontrolled asthma, as defined by the Global INitiative for Asthma criteria. Lung function and bronchial reversibility were evaluated through impulse oscillometry and spirometry. Adjusted odds ratios were estimated based on multivariable generalized additive regression models. The discriminative ability of the models was measured by the area under the receiver operating characteristic curve (AUC). Results: The study population comprised 121 children (107 with asthma and 14 healthy controls). Fifty-three patients (50%) had uncontrolled asthma. After adjustment, the variables associated with an increased risk of lack of control were as follows: “More than 3 flare-ups in the last 12 months”, “Moderate to severe rhinitis”, and “Relative variation in postbronchodilator FVC and FEV1”. The AUC of the final models that included variation in FVC or FEV1 were 0.82 and 0.81, respectively. The R5-20, R5-20%, and AX z-score values of the healthy group were lower than those of children with asthma. Conclusion: In preschool children, clinical and functional parameters are associated with uncontrolled asthma. More studies are needed to confirm the usefulness of impulse oscillometry. Key words: Asthma. Asthma control. Lung function tests. Preschool asthma. Risk factors.

Purpose: This study assesses the estimation of the risk for falls among community-dwelling stroke survivors referred for ambulatory physiotherapy and explores factors that affect the risk. Methods: Observational, cross-sectional with nested case-control study, of individuals, referred to physiotherapy less than 12 months after stroke and able to walk independently. Berg Balance Scale, Timed Up and Go Test, and the Motor Assessment Scale were applied. Berg Balance Scale ≤45 or Timed Up and Go Test > 14 were used to estimate the risk for falls. The discrimination ability of the estimation was assessed. Alternative models were explored by logistic regression analysis. Results: One hundred sixty-seven patients fulfilled the inclusion criteria. Patients were 21 to 87years old (median 66), 98 men (58.7%), and in 133 (79.6%) the stroke occurred in the last 6 months. Falls were reported by 78 (46.7%) of the patients but 139 (83.2% [95%CI 76.84–88.14]) were estimated as having risk for falls. The discrimination ability of the estimation of the actual occurrence of falls by Berg Balance Scale ≤45 or Timed Up and Go Test >14 was 55% (95%CI 47.5–62.4). The actual occurrence of falls was associated only with Motor Assessment Scale, as a protective factor. The discrimination ability of the estimation of the actual occurrence of falls by Motor Assessment Scale alone was area under the curve 0.69 (95%CI 0.60–0.77). Conclusions: Different tools with better performance are needed to identify the risk for falls after stroke. info:eu-repo/semantics/publishedVersion

This work was funded by ERDF (European Regional Development Fund) through the operations: POCI- -01-0145-FEDER-029130 (“mINSPIRERS—mHealth to measure and improve adherence to medication in chronic obstructive respiratory diseases - generalisation and evaluation of gamification, peer support and advanced image processing technologies”) co-funded by the COMPETE2020 (Programa Operacional Competitividade e Internacionalização), Portugal 2020 and by Portuguese Funds through FCT (Fundação para a Ciência e a Tecnologia). © 2020, Sociedade Portuguesa de Alergologia e Imunologia Clinica. All rights reserved. Aims: To identify distinct asthma control clusters based on Control of Allergic Rhinitis and Asthma Test (CARAT) and to compare patients’ characteristics among these clusters. Methods: Adults and adolescents (≥13 years) with persistent asthma were recruited at 29 Portuguese hospital outpatient clinics, in the context of two observational studies of the INSPIRERS project. Demographic and clinical characteristics, adherence to inhaled medication, beliefs about inhaled medication, anxiety and depression, quality of life, and asthma control (CARAT, >24 good control) were collected. Hierarchical cluster analysis was performed using CARAT total score (CARAT-T). Results: 410 patients (68% adults), with a median (percentile 25–percentile 75) age of 28 (16-46) years, were analysed. Three clusters were identified [mean CARAT-T (min-max)]: cluster 1 [27(24-30)], cluster 2 [19(14-23)] and cluster 3 [10(2-13)]. Patients in cluster 1 (34%) were characterised by better asthma control, better quality of life, higher inhaler adherence and use of a single inhaler. Patients in clusters 2 (50%) and 3 (16%) had uncontrolled asthma, lower inhaler adherence, more symptoms of anxiety and depression and more than half had at least one exacerbation in the previous year. Further-more, patients in cluster 3 were predominantly female, had more unscheduled medical visits and more anxiety symp-toms, perceived a higher necessity of their prescribed inhalers but also higher levels of concern about taking these inhalers. There were no differences in age, body mass index, lung function, smoking status, hospital admissions or specialist physician follow-up time among the three clusters. Conclusion: An unsupervised method based on CARAT--T, identified 3 clusters of patients with distinct, clinically meaningful characteristics. The cluster with better asthma control had a cut-off similar to the established in the validation study of CARAT and an additional cut-off seems to distinguish more severe disease. Further research is necessary to validate the asthma control clusters identified. publishersversion published

BACKGROUND/OBJECTIVES: To prospectively evaluate changes in peripapillary retinal nerve fibre layer (pRNFL), in all macular layers and in choroidal thickness (CT) in a cohort of systemic lupus erythematosus (SLE) patients without ophthalmologic manifestations. To associate those changes with ophthalmic characteristics, disease activity state, medication and systemic comorbidities. SUBJECTS/METHODS: Prospective cohort study of 68 previously diagnosed SLE patients. In two study visits (V1 and V2) at least 12 months apart, patients underwent a complete ophthalmologic examination including spectral domain-optical coherence tomography (SD-OCT) and an autoimmune disease specialist assessment. Automatic retinal segmentation was performed. pRNFL was determined globally and in the six peripapillary sectors and each macular layer thickness was determined in the nine early treatment diabetic retinopathy study (ETDRS) subfields. CT was manually measured at 13 locations in the posterior pole. Only one eye per patient was randomly selected for inclusion. Generalised linear mixed effects models were employed. RESULTS: Sixty-five patients completed the study. The median follow-up time was twelve months. At V2, pRNFL was significantly thinner globally (p = 0.006) and in the temporal inferior sector (p = 0.017). Patients under chronic medication with anticoagulants or antihypertensives had significantly thinner pRNFL in some locations. No significant changes were observed in macular layers or choroidal thickness between study visits. CONCLUSIONS: SLE patients presented early SD-OCT signs of neurodegeneration, evidenced by a progressive reduction in pRNFL thickness. Regardless of study visit, baseline chronic medication with anticoagulants or antihypertensives was associated with lower pRNFL thickness, accounting for a deleterious effect of cardiovascular risk factors.

Introduction. The Test for Respiratory and Asthma Control in Kids (TRACK) is a tool to assess asthma control in preschool children. This study aims to validate the Portuguese from Portugal version of the TRACK questionnaire. Methods. A prospective cohort study was carried out to assess their psychometric characteristics. Caregivers of 141 children under age 5 with asthma symptoms were enrolled. Results. Internal reliability was close to 0.70 (Cronbach's α). The test-retest reliability was 0.87. TRACK scores were different between well, partially, and non-controlled asthma groups (p less than 0.001). Patients rated as having better control showed an increase in TRACK scores. Conclusions. The Portuguese version of the TRACK questionnaire is accurate and reliable for monitoring asthma control. Its use may help to overcome challenges with the management of this age group. info:eu-repo/semantics/publishedVersion

Resumen Objetivo Comparar la actividad del Servicio de Urologia de un Hospital Universitario Portugues durante el estado de alarma y el periodo equivalente del ano anterior. Comparamos el numero de consultas electivas y pruebas diagnosticas urologicas, el numero y el tipo de cirugias electivas, asi como las caracteristicas demograficas de los pacientes y las principales causas de ingreso al Servicio de Urgencias (SU) de Urologia durante los dos periodos mencionados. Materiales y metodos Los datos de 691 pacientes que acudieron a urgencias desde el 18 de marzo de 2020 hasta el 2 de mayo de 2020 -y del mismo periodo del ano anterior- se recogieron del software medico institucional. Los datos recopilados fueron edad, sexo, fecha de visita al servicio de urgencias, derivacion desde otros hospitales, color del triaje, causa del ingreso, diagnostico al alta y la necesidad de cirugia de urgencia u hospitalizacion. Con la intencion de identificar las asociaciones entre las variables demograficas y clinicas con el hecho de haber sido sometido a una cirugia de urgencia (variable), se aplicaron modelos de regresion logistica. Resultados El analisis multivariante mostro asociacion entre el sexo del paciente con el hecho de ser sometido a una cirugia, con una disminucion del 65,6% en las probabilidades para el genero masculino. El periodo (COVID versus sin-COVID) no mostro una asociacion significativa con la cirugia. Conclusion Nuestro departamento experimento una reduccion importante en la actividad. Tambien observamos una reduccion de las causas urgentes para acudir a los servicios de urgencias considerados menos graves. El porcentaje de casos que requirieron cirugia de urgencia y hospitalizacion fue mayor durante el periodo COVID.

This cohort study describes the evolution of resting energy expenditure (REE), respiratory quotient (RQ), and adiposity in infants recovering from corrective surgery of major congenital gastrointestinal tract anomalies. Energy and macronutrient intakes were assessed. The REE and RQ were assessed by indirect calorimetry, and fat mass index (FMI) was assessed by air displacement plethysmography. Longitudinal variations over time are described. Explanatory models for REE, RQ, and adiposity were obtained by multiple linear regression analysis. Twenty-nine infants were included, 15 born preterm and 14 at term, with median gestational age of 35.3 and 38.1 weeks and birth weight of 2304 g and 2935 g, respectively. In preterm infants, median REE varied between 55.7 and 67.4 Kcal/kg/d and median RQ increased from 0.70 to 0.86&ndash, 0.92. In term infants, median REE varied between 57.3 and 67.9 Kcal/kg/d and median RQ increased from 0.63 to 0.84&ndash, 0.88. Weight gain velocity was slower in term than preterm infants. FMI, assessed in a subset of 15 infants, varied between a median of 1.7 and 1.8 kg/m2 at term age. This low adiposity may be related to poor energy balance, low fat intakes, and low RQ&cedil, that were frequently recorded in several follow-up periods.

Introduction: Following the 2014 International Society of Urological Pathology meeting, a rapidly growing body of evidence by several researchers has been demonstrating a poor prognosis in association with cribriform morphology. The aim of our study was to describe the presence of cribriform foci in specimens of radical prostatectomies and to evaluate whether demographic and clinical characteristics are associated with the presence of cribriform pattern. Materials and methods: This cohort study was based on 70 radical retropubic prostatectomies specimens collected between 2012 and 2016 and evaluated for the association of the cribriform pattern with age, prostate-specific antigen at surgery day, Gleason on biopsy, Gleason after radical prostatectomy, extracapsular extension, vesicles invasion, margins, multiparametric magnetic resonance imaging, and post-operative radiotherapy. Results; From the univariable analysis, biochemical prostatespecific antigen recurrence (p = 0.001), extracapsular extension (p = 0.003), pre-operative prostate-specific antigen (p = 0.017), vesicles invasion, (p = 0.038) and post-operative radiotherapy (p < 0.001) showed an association with the presence of cribriform pattern. There was also a significant difference of cribriform pattern and Gleason 7 in needle biopsy (p = 0.020) and cribriform pattern and Gleason 8 or 9 in radical prostatectomy specimen (p = 0.036). Conclusions: In our study, the increase in preoperative prostate-specific antigen had a high association with cribriform pattern. Further evidence is needed to discriminate preoperative prostate specific antigen values that might potentially be associated with the presence of cribriform pattern. Raising our knowledge about the cribriform pattern can be an excellent opportunity to correctly identify and treat patients who will eventually die from prostate cancer, sparing treatment in those who will not.

Background The COVID-19 pandemic has led to high levels of physical, psychological, and social stress among health care professionals, including postgraduate students in medical and multidisciplinary residencies. This stress is associated with the intense fear of occupational exposure to SARS-CoV-2, the virus known to cause COVID-19. These professionals are at risk of developing physical and mental illnesses not only due to the infection but also due to prolonged exposure to multidimensional stress and continued work overload. Objective This study aims to evaluate the prevalence of symptoms suggestive of mental disorders and burnout syndrome and determine the risk factors for burnout among postgraduate students in medical and multidisciplinary residencies in Brazil during the COVID-19 pandemic. Methods For this prospective cohort study with parallel groups, participants were recruited between July and September 2020 to achieve a sample size of at least 1144 participants. Research instruments such as Depression, Anxiety, and Stress Scale; Patient Health Questionnaire; Brief Resilient Coping Scale; and Oldenburg Burnout Inventory will be used to collect data. Data will be collected in 2 waves: the first wave will include data related to sample characterization and psychosocial evaluation, and the second wave will be launched 12 weeks later and will include an evaluation of the incidence of burnout as well as correlations with the potential predictive factors collected in the first wave. Additionally, we will collect data regarding participants’ withdrawal from work. Results The recruitment took place from July 29 to September 5, 2020. Data analyses for this phase is already in progress. The second phase of the study is also in progress. The final data collection began on December 1, 2020, and it will be completed by December 31, 2020. Conclusions We believe the findings of this study will help evaluate the impact of the COVID-19 pandemic on the mental health conditions of health professionals in Brazil as well as contribute to the planning and implementation of appropriate measures that can alleviate these mental health challenges. International Registered Report Identifier (IRRID) DERR1-10.2196/24298

Objetivo: explorar as evidencias dos ultimos nove anos a cerca das escolhas de manejo terapeutico e profilatico em gravidas com anemia falciforme. Metodos: e um estudo descritivo realizado na base de dados da Biblioteca Virtual da Saude, Medline e Lilacs no periodo de 2010 a 2019, com uso dos descritores Anemia e Falciforme e Gravidez. Discussao: a anemia falciforme e uma doenca genetica e hereditaria que altera a estrutura fisico-quimica da hemoglobina, gerando complicacoes que podem afetar a vida dos portadores, inclusive a gravidez, a qual se torna de alto risco. E necessaria a interacao de uma equipe multiprofissional qualificada para acompanhar a gestante com anemia falciforme durante o pre-natal e o puerperio, a fim de evitar riscos maternos e fetais, orientar, realizar diagnosticos precoces e fornecer uma assistencia integral ao binonimo mae-filho. Conclusao: apesar de todas as intercorrencias causadas na gestacao com anemia falciforme, o direito reprodutivo deve ser assegurado e, para isso, o planejamento gestacional deve ser realizado, a fim de fornecer suporte necessario e integral para a mae e o feto.

This article reports comparison results from studying the alignment of selected metadata models, used to manage E‑Learning Materials (ELM) in the medicine and healthcare education, against the accreditation standards of the European Accreditation Council for Continuing Medical Education (EACCME). The study aims to (1) illustrate the variety of application profiles developed as metadata models in that field, (2) identify the alignment of the metadata models with the criteria set by the EACCME. This study com¬pared several application profiles, developed based on established metadata standards, using an evaluation matrix created using the accreditation criteria set by the EACCME. Further technical criteria were added to compare between the metadata models and their alignment with the new techniques used for publishing data online. Such techniques aid in the searchabililty and discovery of online content via the internet. Therefore, the use of XML and RDF technologies combined with the use of ontologies and controlled vocabulary was emphasized in the implementation of many metadata models. One limitation faced during conducting this research was the poor documentation of the methodology for designing the metadata models. Despite this, it is apparent that the EACCME criteria can work as best practices guidelines for describing the content of digital libraries with medical and healthcare content in order to be accredited later on. The study showed that the medicine and healthcare educational content requires specialized metadata models that consider having specific properties such as clinical history and expiry time of its material shown in some of the application profiles. Further research should be conducted to evaluate the completeness and conformity of applying the application profiles in digital libraries and online repositories to the standards’ guidelines.

INTRODUCTION: Freshwater ecosystems provide propitious conditions for the acquisition and spread of antibiotic resistance genes (ARGs), and integrons play an important role in this process. MATERIAL AND METHODS: In the present study, the diversity of putative environmental integron-cassettes, as well as their potential bacterial hosts in the Velhas River (Brazil), was explored through intI-attC and 16S rRNA amplicons deep sequencing. RESULTS AND DISCUSSION: ORFs related to different biological processes were observed, from DNA integration to oxidation-reduction. ARGs-cassettes were mainly associated with class 1 mobile integrons carried by pathogenic Gammaproteobacteria, and possibly sedentary chromosomal integrons hosted by Proteobacteria and Actinobacteria. Two putative novel ARG-cassettes homologs to fosB3 and novA were detected. Regarding 16SrRNA gene analysis, taxonomic and functional profiles unveiled Proteobacteria, Bacteroidetes, Firmicutes, and Actinobacteria as dominant phyla. Betaproteobacteria, Alphaproteobacteria, and Actinobacteria classes were the main contributors for KEGG orthologs associated with resistance. CONCLUSIONS: Overall, these results provide new information about environmental integrons as a source of resistance determinants outside clinical settings and the bacterial community in the Velhas River. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s42770-020-00409-8.

A beata de cigarro é um resíduo que, apesar de ser tóxico, é omnipresente. Existem dificuldades em controlar a sua dispersão no ambiente e em fazer a sua recolha e tratamento. No entanto, existem estudos e iniciativas para a sua valorização. O filtro que as compõe é de plástico e está abrangido pela Diretiva (UE) 2019/904 do Parlamento Europeu e do Conselho, relativa aos plásticos de uso único. Em Portugal foi publicada recentemente a Lei nº 88/2019, de 3 de Setembro, que tem como objetivo reduzir o seu impacte no ambiente. A Faculdade de Ciências e Tecnologias da Universidade Nova de Lisboa (FCT NOVA) tem a obrigação legal de disponibilizar cinzeiros e de assegurar a limpeza da área circundante. Esta é uma boa oportunidade para se implementar um sistema de recolha seletiva de beatas neste campus universitário que permita a sua valorização. Contudo, para que tal funcione de forma apropriada é essencial que os fumadores alterem o seu comportamento de descarte das beatas para o chão e passem a colocar as beatas nos locais apropriados. Com o intuito de se fazer uma intervenção neste sentido, foi feito um diagnóstico à situação atual relativamente a este resíduo, que consistiu no levantamento do número e localização de cinzeiros, na observação e registo de áreas com maior presença de beatas no chão e na elaboração de um questionário para avaliar os comportamentos, as opiniões e as atitudes dos utentes da FCT NOVA. Os resultados dos questionários indicam que as normas sociais dos fumadores são diferentes das dos não fumadores. Observou-se que o descarte correto de beatas é feito com maior frequência que o esperado, apesar de estar longe do desejado. Constatou-se uma grande carência de cinzeiros no campus, assim como a existência de várias áreas onde as beatas se acumulam no chão, especialmente em zonas de relvado e à entrada dos edifícios. A concentração mais elevada contabilizada verificou-se à entrada do Edifício X, com 129 beatas/m2. Tendo por base este diagnóstico, sugere-se o desenvolvimento de um plano de intervenção, medidas para a alteração de comportamentos e redução das beatas no chão, nomeadamente a realização de campanhas de sensibilização e mobilização dirigidas aos utentes da FCT NOVA e a aquisição e localização estratégica de cinzeiros nos locais com maior concentração de beatas. Espera-se que os resultados deste estudo possam contribuir para o desenvolvimento de um plano de gestão para este resíduo.

Background Systemic lupus erythematosus (SLE) is a chronic, autoimmune and multisystemic disease. Recent studies with functional and structural magnetic resonance imaging and cognitive tests report an unexpectedly high frequency of central nervous system involvement, even in patients with asymptomatic SLE. The purpose of this study was to identify early signs of retinal neurodegeneration by comparing the thickness of the peripapillary retinal nerve fiber layer (pRNFL) and all macular layers between patients with SLE without ophthalmologic manifestations and healthy controls. The effect of disease duration and systemic comorbidities was also studied. Methods Cross-sectional study, in which all participants underwent a complete ophthalmologic evaluation including retinal segmentation analysis with spectral domain-optical coherence tomography. Patients with SLE also received a detailed autoimmune disease specialist evaluation to assess the disease activity state and systemic involvement. For pRNFL thickness, the global and six peripapillary sectors were determined. Each macular layer thickness was determined in the nine Early Treatment Diabetic Retinopathy Study (ETDRS) subfields. A multiple linear regression analysis was performed to control for the effect of potential demographic, ophthalmic and systemic confounders. A second multivariable analysis, including patients with SLE only, was performed to assess the effect of disease-specific variables on the outcome measures. Results Sixty-eight eyes of 68 patients with SLE and 50 eyes of 50 healthy controls were considered. The pRNFL was significantly thinner in the SLE group globally (p = 0.026) and in the temporal superior (p = 0.007) and temporal (p = 0.037) sectors. In patients with SLE, chronic medication for hypercholesterolemia, hypertension and anticoagulants were associated with a significant thinning of the pRNFL. Patients with SLE presented significant thinning in the photoreceptor layer in five ETDRS areas (p Conclusion Patients with SLE present early signs of retinal neurodegeneration, as evidenced by a reduction in the photoreceptor layer and pRNFL. These signs are more pronounced in patients with higher cardiovascular risk burden or neuropsychiatric involvement.

The aim of this study was to compare all retinal layers' thickness in full-term and preterm children without retinopathy of prematurity (ROP).Cross-sectional study including two groups of patients: group 1 children with history of preterm gestation without ROP (gestational age 37 weeks) and group 2 healthy children with history of full-term gestation. All subjects underwent an ophthalmic examination including spectral domain-optical coherence tomography. After automatic retinal segmentation, each retinal layer thickness (eight separate layers and overall thickness) was calculated in all nine Early Treatment Diabetic Retinopathy Study areas. Demographic, systemic, gestational, and birth data were collected. Generalized additive regression models were used to analyze the data.Fifty-one children (51 eyes) were recruited, 19 full-term and 32 preterm children, mean age at ophthalmic examination of 10.58 (4.21) and 14.13 (3.16), respectively. In multivariable analysis, the preterm group's retinal thickness was significantly decreased in total retina nasal outer sector, ganglion cell layer (GCL), and inner plexiform layer (IPL), specifically GCL temporal outer (p = 0.010), GCL superior outer (p = 0.009), IPL temporal outer (p = 0.022), and IPL superior outer (p = 0.004), when compared with full-term group. From the variables compared only with birth head circumference that influenced the models, a non-linear association was identified and consequently modeled with splines through a generalized additive model.This study suggests that preterm children without ROP have structural retinal alterations, mostly in GCL and IPL in outer areas of the macula. Therefore, it is crucial to question gestational history since these retinal changes may be found later in life leading to useless investigation.

Mangroves are dynamic ecosystems, which provide important ecological services to coastal areas due to the high rates of primary production and harbor several marine organisms . They are composed by a salinity tolerant vegetation that thrives in tropical and subtropical regions of the world under tidal influence. Plants broadly influence the ambient by means of photosynthesis and their leaves are responsible for a great part of the energy and organic matter input into planet Earth. Healthy plants in nature live in association and actively interact with a multitude of microorganisms belonging to several microbial types, collectively called the plant microbiota. Tropical ecosystems harbor a great epiphytic bacteria diversity with the potential to house new bacteria species, but most of the epiphytic microorganisms are uncultivated under commonly laboratory conditions when compared to other environments and little is known about the epiphytic bacterial diversity on mangrove habitats. Bacterial community structure of Laguncularia racemosa phylloplane, a well-adapted mangrove species with salt exudation at foliar levels, was accessed through 16S rRNA amplicon sequencing. Sampling was performed in three different sites across a transect from upland to the seashore in a preserved mangrove forest located in the city of Cananéia, São Paulo state, Brazil. Higher bacteria diversity was observed in intermediary locations between the upland to the seashore, showing that exists significant intraspecific spatial variation in bacteria communities between a single host species with the selection of specific population between an environmental transect. Bacteria reside in complex interactive communities in close association with competitors and partners. Microbial communities are dynamic and their structuration are determined by the pairwise interactions that occur between different species. Therefore, microbial cells exhibit intercellular communication and are aware of other cells in their vicinity, producing coordinated responses. In this work we also evaluated the multispecies interactions among ten strains isolated from Laguncularia racemosa phylloplane. All the strains had their growth diameter measured when growing in monocultures compared against their own growth in the pairwise interactions and in the consortium of three bacteria. In the total, fifteen consortia showed significant differences in the growth diameter of the bacteria in at least one combination. However, twenty-one consortia combinations did not show significant differences in the bacteria growth while interacting. In conclusion this work has showed that bacteria from L. racemosa phylloplane can sense other strains nearby and alter their rates of growth in response to the co-cultures. Os manguezais são ecossistemas dinâmicos, que prestam importantes serviços ecológicos às áreas costeiras devido às altas taxas de produção primária e por abrigarem vários organismos marinhos. Eles são compostos por vegetação tolerante à salinidade que prosperam nas regiões tropicais e subtropicais do mundo sob influência das marés. As plantas influenciam amplamente o ambiente por meio da fotossíntese e suas folhas são responsáveis por grande parte da energia e da matéria orgânica inserida no planeta Terra. Plantas saudáveis, na natureza, vivem em associação e interagem ativamente com uma infinidade de microorganismos pertencentes a vários tipos microbianos, coletivamente denominados como microbiota. Os ecossistemas tropicais abrigam uma grande diversidade de bactérias epifíticas com potencial para abrigarem novas espécies, mas a maioria dos microrganismos epifíticos não é cultivada sob condições comuns de laboratório quando comparada a outros ambientes, e pouco se sabe sobre a diversidade bacteriana epifítica em habitats de manguezais. A estrutura da comunidade bacteriana do filoplano de Laguncularia racemosa, uma espécie de mangue bem adaptada e com exsudação de sal em níveis foliares, foi acessada por meio do sequenciamento do amplicon 16S rRNA. A amostragem foi realizada em três locais diferentes, através de um transecto do continente até a beira-mar, em uma floresta de mangue preservada, localizada na cidade de Cananéia, Estado de São Paulo, Brasil. Observou-se maior diversidade bacteriana em locais intermediários entre o continente e a beira-mar, mostrando que existe uma variação espacial intraespecífica significativa nas comunidades bacterianas entre uma única espécie de planta, com a seleção de população específica entre um transecto ambiental. As bactérias residem em comunidades interativas complexas em estreita associação com possíveis espécies competidoras e parceiras. As comunidades microbianas são dinâmicas e sua estruturação é determinada pelas interações em pares que ocorrem entre diferentes espécies. Portanto, as células microbianas exibem comunicação intercelular e estão cientes de outras células próximas, produzindo respostas coordenadas. Neste trabalho, também avaliou-se as interações multiespécies entre dez linhagens isoladas do filoplano de Laguncularia racemosa. Todas as linhagens tiveram seu diâmetro de crescimento medido ao crescer em monoculturas, comparado com o seu próprio crescimento nas interações em pares e no consórcio de três bactérias. No total, quinze consórcios mostraram diferenças significativas no diâmetro de crescimento das bactérias em pelo menos uma combinação. No entanto, vinte combinações de consórcios não mostraram diferenças significativas no crescimento de bactérias durante as interações. Em conclusão, este trabalho mostrou que as bactérias do filoplano de L. racemosa podem detectar outras cepas próximas e alterar suas taxas de crescimento em resposta às co-culturas.

Apreviously healthy 53-year-old woman presented with new onset arterial hypertension diagnosed during workup for daily pulsatile bilateral frontal headaches and paroxysmal episodes of fatigue, palpitations and sweating. High urinary metanephrines were detected and an abdominal magnetic resonance image evidenced two nodular bilateral adrenal lesions and a left iliac focal lesion. (18)F-FDG-PET/CT (fluorodeoxyglucose-positron emission tomography/computed tomography) scanning revealed mild-to-moderate uptake in both adrenal lesions and mild uptake in the iliac bone, whereas (123)I-metaiodobenzylguanide scintigraphy revealed uptake only in the right adrenal. CT-scan confirmed the heterogeneous nodular lesion on the right adrenal gland as suspicious for pheochromocytoma and a non-specific sclerotic lesion in the iliac. A right adrenalectomy was performed with posterior resolution of symptoms and normalisation of urinary metanephrines. Histology confirmed a pheochromocytoma and later a mutation of the TMEM127 gene was detected. The present case highlights the importance of genetic testing for pheochromocytoma in order to better guide the management of these patients.

Background and objectives: Randomized trials for mechanical thrombectomy (MT) excluded patients with ischemic strokes due to isolated posterior cerebral artery occlusion (IPCAO), and there is no evidence for best acute treatment strategy in these patients. We aimed to assess the effectiveness and safety of MT in acute IPCAO. Methods: We retrospectively analyzed consecutive patients with acute stroke due to IPCAO submitted to MT and/or intravenous thrombolysis (IVT), between 2015-2019. Effectiveness outcomes (recanalization rate, first-pass effect, NIHSS 24h improvement and 3-month Modified Ranking Scale - mRS) and safety outcomes (complications, symptomatic intracranial hemorrhage (SICH) and 3-month mortality) were described and compared between groups. Results: A total of 38 patients were included, 25 underwent MT and 13 had IVT alone. Successful and complete recanalization were achieved in 68% and 52% of MT patients, respectively. NIHSS improvement at 24h was found in 56% of MT patients versus 30.8% of patients submitted to IVT alone (OR [95% CI]=2.86 [0.69-11.82]) and excellent functional outcome at 3 months (mRS≤1) was achieved in 54.2% of MT patients versus 38.5% in the IVT group (OR [95% CI]=1.60 [0.41-6.32]). Complications occurred in 3 (12%) procedures and there were no SICH. Mortality at 3 months was 20% in the MT group and 15.4% in patients submitted to IVT alone. Conclusions: Our results reflect a real-world scenario in a single center and seem to support the recently growing literature showing that MT is a feasible and safe treatment in IPCAO, with favorable effectiveness. info:eu-repo/semantics/publishedVersion

Introdução: Garantir o ensino de primeiros socorros assegura uma melhor assistência em situações de emergência. Para isso, a população de ambiente escolar é uma parcela importante para propagar esse conhecimento, já que a mesma se encontra em um ambiente propenso a acidentes. Objetivo: Descrever a experiência do processo de ensino-aprendizagem, em primeiros socorros para crianças, adolescentes e professores de uma instituição de ensino, assim como a importância da educação em saúde no ambiente escolar. Métodos: Estudo descritivo, do tipo de relato de experiência, realizado no primeiro semestre de 2017, com público alvo de crianças, adolescentes, professores e responsáveis, proveniente de um projeto de extensão vinculado a Universidade Federal do Rio Grande do Norte. Resultados: Foram realizados seis encontros com assuntos pertinentes aos primeiros socorros, com 21 crianças e 12 responsáveis. Foi utilizada a metodologia de aulas expositivas acerca de situações de primeiros socorros e simulação da prática de imobilização da ví­tima em acidentes e de reanimação cardiopulmonar. Conclusão: As abordagens metodológicas foram consideradas com êxito pelos organizadores, atingindo o objetivo de educar as crianças, adolescentes e responsáveis acerca dos cuidados de primeiros socorros. É necessário articulação para implementação de educação em saúde nas escolas.Palavras-chave: primeiros socorros, educação em saúde, aprendizagem.