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© International League of Associations for Rheumatology (ILAR) 2021, Evidence for the role of sex in the clinical manifestations of systemic sclerosis (SSc) patients is emerging. Some multicenter cohorts have shown that male SSc patients have more severe disease and worse survival. To assess the differences in clinical manifestations and survival in Portuguese SSc patients according to gender. Data from male and female adult SSc patients included in the Rheumatic Diseases Portuguese Register (Reuma.pt) were analysed and compared. Survival was calculated for patients included in Reuma.pt. within the first two years of diagnosis (inception cohort). In total, 1054 adult patients with SSc were included, 12.5% males. No differences in demographic features and comorbidities were found between the sexes, except for a higher rate of cigarette smokers among men. Diffuse cutaneous SSc and anti-topoisomerase antibodies were more prevalent in males than females. Additionally, male patients presented significantly more myositis, interstitial lung disease and gastric involvement. There were no differences in the patterns of drug use between the sexes. During follow-up, more deaths were reported in men than women (12.1% vs 7.3%, p = 0.04). The overall 1-, 3-, and 5-year survivals from diagnosis of the inception cohort (N = 469) for men vs women were 96.4% vs 98.2%, 93% vs 95.9%, and 75.8% vs 93.2%, respectively, with statistically significant differences (p < 0.01). This study confirms the existence of gender differences in clinical and immunological SSc features. Although SSc is less common in men than women, men have a more severe expression of skin and internal organ involvement and worse survival. Key Points • There are differences in SSc disease manifestations between sexes. • Males more commonly have diffuse cutaneous SSc, anti-topoisomerase antibodies, pulmonary and musculoskeletal involvement. • In the inception cohort, men had worse survival rates than women.

Introdução: O acidente vascular cerebral (AVC) tem um impacto enorme na vida das pessoas e famílias. Frequentemente, a pessoa em situação de AVC apresenta alterações motoras que carecem da intervenção fulcral do enfermeiro especialista em Enfermagem de Reabilitação (EEER) na implementação de um programa de reabilitação, integrado na equipa interdisciplinar, para garantir uma transição segura para o domicílio. Objetivo: Identificar as intervenções do EEER que capacitam a pessoa e família/cuidador, em situação de AVC com alteração motora na preparação do regresso casa. Método: Revisão sistemática da literatura nas bases de dados Pub Med, EBSCO e ProQuest, com aplicação de critérios de inclusão e exclusão, num horizonte temporal de 5 anos (2014-2019). Resultados: Foram incluídos 3 artigos que reforçam a necessidade da aplicação de programas de reabilitação que integrem as dimensões física, psicológica e cognitiva da pessoa, bem como o papel fundamental dos cuidadores familiares na gestão da dependência e das atividades de vida diárias (AVD) da pessoa com AVC. Conclusão: A intervenção do EEER deve estar integrada num programa de reabilitação motora, com recurso a estratégias: educação para a saúde; identificação e capacitação do cuidador; ensino e treino de AVD e referenciação para os recursos da comunidade, com o objetivo de promover o treino e supervisão, dando continuidade ao processo de reabilitação. Palavras-chave: AVC; enfermagem; movimento; reabilitação

© Springer Nature Switzerland AG 2020, Background and objective: The number of older patients with rheumatoid arthritis is increasing, but data on drug effectiveness and safety in these patients are scarce. This study assessed the effectiveness and safety of biologic disease-modifying antirheumatic drugs in older patients with rheumatoid arthritis. Methods: This prospective cohort study was based on data recorded in the Rheumatic Diseases Portuguese Register (Reuma.pt). Treatment persistence, European League Against Rheumatism response at 6 and 12 months, and adverse events were compared between adult (age < 65 years), old (age 65-74 years), and very old (age ≥ 75 years) patients. Results: In total, 2401 patients were included, of which 379 were old and 83 were very old. Older patients had higher disease activity at baseline (Disease Activity Score 28: 5.5 in adults, 5.7 in old patients, and 6 in very old patients; p = 0.02) and more comorbidities, with patients aged 65-74 years beginning biologic disease-modifying antirheumatic drugs later in the course of rheumatoid arthritis. Treatment persistence was similar in the three patient groups (p = 0.07). The European League Against Rheumatism response rates were comparable in the three groups at 6 months (81.6% of adults, 75.2% of old patients, and 81.8% of very old patients; p = 0.19), and inferior in old patients at 12 months. The proportion of patients who experienced adverse events was also similar in the three groups (21% of adults, 22.5% of old patients, and 22.9% of very old patients; p = 0.76), but the rate of serious adverse events was higher in old patients (1.94/100 patient-years) and very old patients (4.29/100 patient-years) compared with 1.03/100 patient-years in adult patients with rheumatoid arthritis (p < 0.05). Conclusions: Adults, old patients, and very old patients with rheumatoid arthritis benefit similarly from biologic disease-modifying antirheumatic drug treatments, although older patients have more active disease at baseline and more comorbidities. However, it is necessary to consider the risk of serious adverse events in older patients when prescribing a biologic.

Background:Systemic sclerosis (SSc) may present distinctive manifestations and survival in different ethnic and geographic groups.Objectives:To describe the clinical features, treatments, and survival of adult SSc patients registered in Reuma.pt/SSc.Methods:Demographic features, SSc subsets, fulfilment of classification criteria, clinical and immunologic characteristics, comorbidities, medication and deaths were reviewed. Survival was calculated for patients included in the registry within the first 2 years of diagnosis.Results:In total, 1054 patients were included, 87.5% female, mean age at diagnosis 52.7 ± 14.8 years. The most common subset was limited cutaneous (lc)SSc (56.3%), followed by diffuse cutaneous (dc)SSc (17.5%), preclinical SSc (13%), overlap syndrome (9.8%) and SSc sine scleroderma (3.3%). Raynaud’s phenomenon (93.4%) and skin thickening (76.9%) were the most observed manifestations. Gastrointestinal (62.8% vs 47.8%), pulmonary (59.5% vs 23%) and cardiac (12.8% vs 6.9%) involvement were significantly more prevalent in dcSSc compared to lcSSc (Table 1). 52.5% of patients were ACA positive and 21% anti-topoisomerase positive, with significant differences between lcSSc and dcSSc. One third of patients was treated with immunomodulators, 53.6% with vasodilators, 23% received glucocorticoids and 2.3% biologics.During the median follow-up 12.4 years, 83 deaths (7.9%) were verified. The overall 1, 2 and 5 years survival was 98.0%, 96.8% and 92.6% respectively, without significant differences between lcSSc and dcSSc (Figure 1).Conclusion:Reuma.pt/SSc register is useful in routine patient monitoring and contributes to improve knowledge about this rare and complex disease. Clinical features of Portuguese SSc patients are similar to what has been described in other populations although the overall 5-year survival in recently diagnosed patients appears to be higher than previously reported.Table 1.Cumulative clinical and immunologic characteristics of Portuguese SSc patientsClinical and immunologic featuresTotalN=1054Limited cutaneous SScN= 576 (56.3%)Diffuse cutaneous SScN=180 (17.5%)P valueSkin involvement – N(%) N=987688 (90.6)525 (90.7)180 (100)Skin thickening * – N (%) N= 962680 (76.9)512 (88.9)180 (100)Digital ulcers – N (%) N=970325(33.5)186 (34.7)4 (51.5)Raynaud’s Phenomenon – N (%) N=1010943 (93.4)539 (95.7)157 (92.4)0.06Musculoskeletal involvement – N(%) N=972346 (45.6)247 (42.7)99 (55)Cardiac involvement –N(%) – N=92471 (7.7)36 (6.9)19 (12.8)0.02Renal involvement –N(%) – N= 91717 (1.9)8!1.5)6 (4.1)0.07Gastrointestinal involvement - N(%) N=933508 (48.2)277 (47.8)113 (62.8)Pulmonary involvement – N(%) N=915261 (28.5)119 (23)88 (59.5)PAH – N(%) N= 87114 (1.6)10 (2)1 (0.7)0.23Intersticial lung disease – N(%) N=765218 (28.5)100 (22.7)75 (57.7)Antinuclear antibodies - N(%) N=1040934 (89.8)522 (90.2)154 (88.5)0.57Anti-centromere – N(%) N= 1027540 (52.6)383 (67.1)16 (9.5)Anti-Scl70 – N(%) N=1020214 (21)12 (3.3)104 (60.1)Anti-RNA polymerase III – N(%) N=71025 (3.5)12 (3.3)7 (5.6)0.38ComorbiditiesHypertension – N(%) N=431117 (27.1)76 (29.7)67 (20.7)0.1Hyperlipidemia – N(%) N=43171 (13.4)72 (12.2)24 (15.9)0.08Neoplasia – N(%) N=105429 (2.8)12 (2.1)7 (3.9)0.14PDE-5 (phosdiasterase-5); PPIs (proton pump inhibitors); PAH-Pulmonary arterial hypertension confirmed by right heart catheterization. Immunomodulators includes Metothrexate, Leflunomide, Hydroxycloroquine; Azathioprine, Mycophenolate Mofetil and Cyclophosphamide; * Does not include sclerodactyly.Figure 1.Panel A - Survival in years from diagnosis of patients with SSc included in Reuma.pt in the first 2 years of disease (N=472). Panel B - survival according to SSc subset (lcSSc and dcSSC).Disclosure of Interests:None declared

The passive transfer of viral antibodies from Intravenous human immunoglobulin (IVIg) has been previously reported, but still with limited awareness. We report a case of a patient with granulomatosis with polyangiitis with passive transfer of hepatitis B virus surface and core antibodies following IVIg infusions. We highlight this possible consequence of IVIg administration, that does not confer an infectious risk and will help prevent unnecessary administration of anti-viral treatment, unwarranted referrals to gastroenterology services and withholding of essential immunosuppressive agents in rheumatology patients.

N/A.

Objective.Unconfirmed reports describe association of ankylosing spondylitis (AS) with several candidate genes includingANKH. Cellular export of inorganic pyrophosphate is regulated by the ANK protein, and mutant mice (ank/ank), which have a premature stop codon in the 3’ end of theankgene, develop severe ankylosis. We tested the association between single-nucleotide polymorphisms (SNP) in these genes and susceptibility to AS in a population of patients with AS. We investigated the role of these genes in terms of functional (BASFI) and metrological (BASMI) measures, and the association with radiological severity (mSASSS).Methods.Our study was conducted on 355 patients with AS and 95 ethnically matched healthy controls. AS was defined according to the modified New York criteria. Four SNP inANKH(rs27356, rs26307, rs25957, and rs28006) were genotyped. Association analysis was performed using Cochrane-Armitage and linear regression tests for dichotomous and quantitative variables. Analyses of Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), BASFI, and mSASSS were controlled for sex and disease duration.Results.None of the 4 markers showed significant single-locus disease associations (p > 0.05), suggesting thatANKHwas not a major determinant of AS susceptibility in our population. No association was observed between these SNP and age at symptom onset, BASDAI, BASFI, BASMI, or mSASSS.Conclusion.These results confirm data in white Europeans thatANKHis probably not a major determinant of susceptibility to AS.ANKHpolymorphisms do not markedly influence AS disease severity, as measured by BASMI and mSASSS.

Este relato de experiência surge como resultado da nova metodologia adotada no Curso de Enfermagem da Pontifícia Universidade Católica de São Paulo no ano de 2007. A atividade foi desenvolvida em uma escola no Bairro Aparecidinha, em Sorocaba/SP. Na entrevista com os professores, estes demonstraram preocupação em relação ao comportamento dos alunos e com o baixo rendimento escolar. Os relatos indicaram também que no bairro faltam espaços de lazer para esses jovens. Esta intervenção, que é a 2ª edição de “Somar esforços para transformar”, foi chamada de “Cinema, pipoca e conversa”. Constitui um projeto piloto e pretende se estender às outras séries da escola. Teve como objetivos: promover uma maior integração entre os jovens do bairro, estimulá-los à reflexão a respeito da realidade na qual estão inseridos e facilitar a criação de espaços de convivência e lazer. Participaram do encontro 29 jovens, da 7ª série A, com média de idade de 14 anos, sendo 18 meninas. Utilizamos os filmes “Quem mexeu no meu queijo” e “O poder da visão” como evento de aproximação e ponto de partida para a discussão. Foi realizada, também, uma dinâmica de socialização onde todos os elementos/significados foram explorados. Ao final da atividade, foi solicitado que cada aluno fizesse por escrito um relato do significado daquela reunião. Na análise dos discursos ficou claro que essa atividade os fez perceber que mesmo as situações mais adversas podem ser mudadas. Falaram da conquista da cidadania e da necessidade do estudo como uma das formas para criar possibilidades. Para os alunos da graduação, mais uma vez ganhou visibilidade a prática voltada à comunidade, que atua especialmente na inclusão social, na convivência e na comunicação, possibilitando aumentar o compromisso e fortalecer o vínculo entre os estudantes e os jovens da comunidade.

To develop recommendations for the treatment of axial spondyloarthritis with biological therapies, endorsed by the Portuguese Society of Rheumatology.These treatment recommendations were formulated by Portuguese rheumatologists based on literature evidence and consensus opinion. A draft of the recommendations and supporting evidence was first circulated to all Portuguese rheumatologists and their suggestions were incorporated in the draft. Secondly, at a national meeting the recommendations were presented, discussed and revised. Finally, the document resulting from this meeting was again circulated to all Portuguese rheumatologists, who anonymously voted online on the level of agreement with the recommendations.A consensus was achieved regarding the initiation, assessment of response and switching biological therapies in patients with axial spondyloarthritis.These recommendations may be used for guidance in deciding which patients with axial spondyloarthritis should be treated with biological therapies. They cover a rapidly evolving area of therapeutic intervention. As more evidence becomes available and more biological therapies are licensed, these recommendations will have to be updated.

The authors present the revised version of the Portuguese Society of Rheumatology (SPR) guidelines for the treatment of Rheumatoid Arthritis (RA) with biological therapies. In these guidelines the criteria for introduction and maintenance of biological agents are discussed as well as the contraindications and procedures in the case of nonresponders. Biological treatment (with a tumour necrosis factor antagonist, abatacept or tocilizumab) should be considered in RA patients with a disease activity score 28 (DAS 28) equal to or greater than 3.2 despite treatment with at least 20mg-weekly-dose of methotrexate (MTX) for at least 3 months or, if such treatment is not possible, after 3 months of other conventional disease modifying drug or combination therapy. A DAS 28 score between 2.6 and 3.2 with a significant functional or radiological deterioration under treatment with conventional regimens could also constitute an indication for biological treatment. The treatment goal should be remission or, if that is not achievable, at least a low disease activity, defined by a DAS28 lower than 3.2, without significative functional or radiological worsening. The response criteria, at the end of the first 3 months of treatment, are a decrease of at least 0.6 in the DAS28 score. After 6 months of treatment res­ponse criteria is defined as a decrease greater than 1.2 in the DAS28 score. Non-responders, in accordance to the Rheumatologist’s clinical opinion, should try a switch to another biological agent (tumour necrosis factor antagonist, abatacept, rituximab or tocilizumab).

The availability of population-specific normative data regarding disease severity measures is essential for patient assessment. The goals of the current study were to characterize the pattern of ankylosing spondylitis (AS) in Portuguese patients and to develop reference centile charts for BASDAI, BASFI, BASMI and mSASSS, the most widely used assessment tools in AS. AS cases were recruited from hospital outpatient clinics, with AS defined according to the modified New York criteria. Demographic and clinical data were recorded. All radiographs were evaluated by two independent experienced readers. Centile charts for BASDAI, BASFI, BASMI and mSASSS were constructed for both genders, using generalized linear models and regression models with duration of disease as independent variable. A total of 369 patients (62.3% male, mean ± (SD) age 45.4 ± 13.2 years, mean ± (SD) disease duration 11.4 ± 10.5 years, 70.7% B27-positive) were included. Family history of AS in a first-degree relative was reported in 17.6% of the cases. Regarding clinical disease pattern, at the time of assessment 42.3% had axial disease, 2.4% peripheral disease, 40.9% mixed disease and 7.1% isolated enthesopatic disease. Anterior uveitis (33.6%) was the most common extra-articular manifestation. The centile charts suggest that females reported greater disease activity and more functional impairment than males but had lower BASMI and mSASSS scores. Data collected through this study provided a demographic and clinical profile of patients with AS in Portugal. The development of centile charts constitutes a useful tool to assess the change of disease pattern over time and in response to therapeutic interventions.

Made available in DSpace on 2014-06-11T19:26:00Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-11-29Bitstream added on 2014-06-13T18:29:18Z : No. of bitstreams: 1 patricio_mfgmk_me_prud.pdf: 642086 bytes, checksum: 9a3face8bed26cec66b023faa2f068f3 (MD5) Este trabalho apresenta uma pesquisa de mestrado, desenvolvida junto à linha de pesquisa “Práticas e Processos Formativos em Educação”, do Programa de Pós-graduação em Educação – Mestrado Interinstitucional entre a Faculdade de Ciências e Tecnologia da Universidade Estadual Paulista, campus de Presidente Prudente e a Universidade Federal de Juiz de Fora. Trata-se de uma pesquisa qualitativa, de natureza analítico-descritiva, cujo objetivo é investigar e analisar as percepções dos tutores – professores formadores – sobre o Programa Pró-Letramento em Matemática, desenvolvido na rede municipal de ensino de Juiz de Fora. O interesse por esta pesquisa surgiu de nossa preocupação com a formação continuada dos professores que ensinam Matemática nos anos iniciais do Ensino Fundamental, segmento em que atuamos como professora no Colégio de Aplicação João XXIII/UFJF. A coleta de dados se deu por meio de entrevista com a Coordenadora do Programa da rede municipal de ensino, abordando a implantação deste projeto, da aplicação de questionário e de entrevistas com três tutores, a fim de identificar seus perfis, bem como as suas percepções sobre o Programa. Um dos tutores é licenciado em Matemática e preocupa-se de forma mais expressiva com o ensino do conteúdo da Matemática. Os dois outros tutores são formados em Pedagogia e dão maior relevância à formação integral do aluno. Acreditamos que esta diferença de “olhar” para o ensino e aprendizagem da Matemática possa estar associada à formação da graduação. Os três possuem Pós-graduação e mais de dez anos de experiência no exercício do magistério. De acordo com o Guia do Curso de Matemática, a formação continuada deve desenvolver... This study introduces a research for a Master‟s Degree, developed together with the “Practices and Formative Processes in Education” line of study, from the Post-Graduation in Education Program – from the Universidade Federal de Juiz de Fora (UFJF, acronym in Portuguese) together with the Universidade Estadual Paulista (UNESP – University from the State of São Paulo, acronym in Portuguese). It is a qualitative research, of a analytical-descriptive nature, whose goal is to investigate and analyze the perceptions from the tutors – Teacher Trainers – about the Pro-Literacy Program in Mathematics developed by the public schools from the city of Juiz de Fora. The interest in this research was brought about our concern with the continuous improvement of Mathematics teachers in the first years of Elementary School, segment in which we work as teachers, at the Colégio de Aplicação João XXIII, which belongs to the Federal University of Juiz de Fora (UFJF). The gathering of data was carried out through interview with the coordinator of the Program of the city, approaching the implementation of the project; through questionnaires and interviews with three tutors so as to identify their profiles, as well as their perceptions of the Program. 0ne tutor is licensed to teach Mathematics and is more concerned with teaching mathematic contents. Two tutors are graduated in Education and focus on the development of the student as a whole. All of the tutors are post-graduated, and have been teaching for over ten years. According to the official guide of Mathematics, the development of the student has to entice an investigative and reflexive attitude, bearing in mind that the professional activity is a field of production of knowledge, involving learning processes that go beyond the mere use of what has been learned. However... (Complete abstract click electronic access below)

Introduction A number of genetic-association studies have identified genes contributing to ankylosing spondylitis (AS) susceptibility but such approaches provide little information as to the gene activity changes occurring during the disease process. Transcriptional profiling generates a 'snapshot' of the sampled cells' activity and thus can provide insights into the molecular processes driving the disease process. We undertook a whole-genome microarray approach to identify candidate genes associated with AS and validated these gene-expression changes in a larger sample cohort. Methods A total of 18 active AS patients, classified according to the New York criteria, and 18 gender- and age-matched controls were profiled using Illumina HT-12 whole-genome expression BeadChips which carry cDNAs for 48,000 genes and transcripts. Class comparison analysis identified a number of differentially expressed candidate genes. These candidate genes were then validated in a larger cohort using qPCR-based TaqMan low density arrays (TLDAs). Results A total of 239 probes corresponding to 221 genes were identified as being significantly different between patients and controls with a P-value SPOCK2 (osteonectin) and EP300, which modulate cartilage and bone metabolism. Conclusions We have validated a gene expression signature for AS from whole blood and identified strong candidate genes that may play roles in both the inflammatory and joint destruction aspects of the disease.

In Portugal, 13 cases of tuberculosis (TB) were reported, in the period between 1999 and 2005, in 960 patients exposed to anti-TNFalpha treatment (1.35%), 8 females and 5 males. Mean age was 46.7 +/- 13.8 years. 9 patients had rheumatoid arthritis (RA), in 639 exposed patients (1.4%), 3 had ankylosing spondylitis (AS), in 200 exposed patients (1.5%) and 1 had psoriatic arthritis (PA), in 101 exposed patients (1%). The anti-TNFa used was in 8 cases infliximab (in 456 patients exposed, 1.5%), in 4 adalimumab (in 171 patients exposed, 2.3%) and in 1 etanercept (in 333 exposed, 0.3%). Treatment with a biological agent was started 11.1 +/- 8.7 months (min 3 and max 50) before TB onset. Tuberculin skin test (TST) was performed in 9 out of the 13 patients (the other 4 had started biological therapy before 2002). In 3 cases the TST response was 0 mm, in 3 less than 10 mm, in one was 14 mm and in two 20 mm. In the 3 cases with a TST response superior to 10 mm, isoniazid treatment 300 mg/d was prescribed, during 9 months. The time between first symptoms and TB diagnosis was 2.6 +/- 2.9 months. TB involvement was pulmonary in 6 patients, lymph node disease in 2, peritoneal and pulmonary in 2, osteoarticular in one case, lymph node disease and splenic in another and miliar TB in the last case. One death was reported; all of the other cases had a good outcome after anti-TB treatment. In two cases (one treated with adalimumab and the other with infliximab), paradoxical response to treatment occurred. None of the patients has restarted biological therapy after TB treatment.

Background Reuma.pt, the Rheumatic Diseases Register from the Portuguese Society of Rheumatology has recently expanded its coverage to Systemic Lupus Erythematous (SLE) patients, the Reuma.pt/LES. Reuma.pt/LES is a web-based platform launched in September 2012 that simultaneously serves as a nationwide registry and as an electronic medical record. Its aim is to register all patients with SLE and follow them up in a standard manner in order to improve the monitoring and clinical care for patients with SLE while simultaneously increase the knowledge of this disease. Methods The authors present the structure and the functioning of this national project, giving as an example the subpopulation of patients with SLE from two centres in Lisbon (Hospital Santa Maria and Hospital Garcia de Orta) included in Reuma.pt/LES. Results 878 patients from all the country with the clinical diagnosis of SLE were registered in the database Reuma.pt/LES until January 2013. Recorded information includes demographics, work status, life-styles, ACR and SLICC 2012 classification criteria, thrombotic and obstetric manifestations, SLE disease activity at each visit, fatigue scale, health related quality of life measures (SF-36 and EQD5), irreversible damage, comorbid conditions, medication and adverse events. Hospital Santa Maria (Lisbon) and the Hospital Garcia de Orta (Almada) contributed to Reuma.pt/LES with 305 patients, 95,1% females, 80% Caucasians with a mean age of 45.5 ±14.9y. The mean age at diagnosis was 35.9 ±14.9y and the mean disease duration was 10.3 ± 7.3y. SLE Disease Activity Index (SLEDAI) at the first evaluation was 3,4 ± 3,8 and current accrual damage assessed by the Systemic Lupus International Collaborating Clinics (SLICC) was 0,7 ± 1,1. Hypertension was reported in 24% of the patients, diabetes in 8.8% and cardiovascular diseases in 11%. The vast majority of patients was treated with hydroxychloroquine (93.9%) and corticosteroids (prednisolone 44.6%, prednisone 12.4%, deflazacort 18.%). Immunosuppressive drugs were used in about half of the cases (azathioprine in 27%, methotrexate in 15.5%, cyclophosphamide in 7.4%, micophenolate in 5%) and to a lesser extent biological therapies (rituximab in 5.9% and belimumab in 0.98% of the patients). Conclusions Reuma.pt, is a very useful tool, that allows a more efficient patient follow-up, and standardized data collection, storage and analysis, with the ultimate objective of improving patient care and simultaneously scientific research in the field of SLE. Disclosure of Interest None Declared

Thirty-seven evaluable patients with progressive disseminated breast carcinoma were treated with a combination of mitoxantrone 14 mg/m2 i.v. every 3 weeks plus prednisone 20 mg/m2 p.o. daily with a reducing dose over several weeks. Thirteen of 37 patients (35%) achieved an objective response with two complete regressions. The median duration of response was 7 months and the median duration of survival 14 months. The cardiac function of all patients was monitored by serial left ventricular ejection fraction, at rest and after stress, and 3-monthly thereafter. Ten patients showed a deterioration in the ejection fraction after a minimum cumulative dose of 86 mg/m2 (six cycles), but only four developed clinical cardiac failure which was easily reversible after stopping mitoxantrone. Leucopenia was the dose-limiting toxicity. Nausea and/or vomiting were generally mild and transient. Alopecia was minimal. These results confirmed that this combination is effective and well tolerated in the treatment of disseminated breast carcinoma, and cardiotoxicity can be avoided with adequate monitoring of the left ventricular ejection fraction after six cycles of therapy (86 mg/m2).

Forty-eight patients with advanced breast carcinoma who had not received prior chemotherapy (minimum follow up 21 months) were randomised to receive either adriamycin 70 mg m-2 i.v. 3-weekly for 8 cycles (Regimen A) or adriamycin 35 mg m-2 i.v. 3-weekly for 16 courses (Regimen B). Objective responses were seen in 14/24 (58%) patients with regimen A (4 complete) and 6/24 (25%) with regimen B (1 complete) (P less than 0.02). The median duration of response was 14 months with regimen A and 6.5 months with regimen B. The median duration of survival was 20 months and 8 months respectively (P less than 0.01). The toxicity was similar with each regimen. There was no evidence of deterioration in left ventricular ejection fraction nor congestive heart failure in any patient. It is concluded that when given at 3-weekly intervals adriamycin is a more effective treatment for advanced breast cancer at higher rather than lower dosage.

O presente trabalho tem por objetivo a análise dos programas de reabilitação do património industrial, e a inventariação do Património industrial de Sines, particularmente as industrias corticeira e conserveira, do período de 1850 a 1974, coligindo o trabalho iniciado por Sandra Patrício do Arquivo de Sines. Pretende-se também refletir sobre a tendência corrente de reabilitação para fins museológicos. O primeiro capítulo analisa a situação internacional e nacional do património industrial, tendo por base a pesquisa bibliográfica. Reflete ainda sobre o programa adequado para reabilitação do património fabril. O segundo capítulo analisa a reabilitação do património industrial na sua vertente económica de turismo industrial. Estuda o tema e apresenta projetos bem-sucedidos, que fizeram face ao problema de sazonalidade e da rentabilidade, características do turismo. O terceiro e último capítulo é dedicado inteiramente a Sines. Numa ordem cronológica é apresentada a evolução da industria na cidade de Sines, desde as fábricas da salga romanas ao aparecimento do Complexo Industrial, assim como os projetos previstos para a industria de Sines. Apresenta-se um inventário e mapeamento das fábricas de cortiça e conservas, possíveis localizar, que permitem conhecer um importante período industrial de Sines, património praticamente inexistente atualmente. The present work has, as purpose, the analysis and inventory of the industrial patrimony of Sines, particularly the cork and canning industry, from the 1850’s to 1974, compiling the work started by Sandra Patrício at the Sines Archive. It will also ponder on the current tendency of rehabilitation with museum purposes. The first chapter analyses what is the international and national situation of the industrial patrimony, through the reflection and study of the bibliographical documents. It is also contemplated the adequate programme for industrial patrimony restoration. The second chapter analyses the restauration of the industrial patrimony in its economic component of industrial tourism. It study’s the theme and presents successful projects that have solved the seasonality and profitability issues associated to tourism. The third chapter is dedicated entirely to Sines. The town’s industry is presented in chronological order throughout history, since salting roman factories through the Industrial Complex and future related projects.