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Abstract The aim of this study was to evaluate the antimicrobial susceptibility profile of Aeromonas sp., and Escherichia coli isolated from samples of yellow hake (Cynoscion acoupa). We analyzed 53 Aeromonas spp. and four E. coli isolates. We observed increased resistance of E. coli to levofloxacin and sulfa-trimethoprim as well as resistance of Aeromonas spp. to ampicillin, amoxicillin-clavulanate, cefuroxime, and cefotaxime. The multiple antimicrobial resistance(MAR) index indicated multidrug resistance in 90.54% (n=48) of Aeromonas spp. isolates and in 50% (n=2) of E. coli isolates. One strain of Aeromonas spp. was resistant to all 11tested antimicrobials (MAR index = 1.00). In vitro,piperacillin + tazobactam was the most effective antimicrobial for E. coli,and cefepime and levofloxacin were the most effective antimicrobials for Aeromonas spp. Therefore, in case of illnesses caused by these microorganisms, these antimicrobials should be used. The multidrug resistance of Aeromonas spp. and E. coli in this study is elevated. This is worrisome considering the increase in bacteria resistant to multiple drugs, reducing the options for successful clinical antimicrobial use.

Familial hypercholesterolemia (FH) is a common genetic disorder of lipid metabolism caused by pathogenic/likely pathogenic variants in LDLR, APOB, and PCSK9 genes. Variants in FH-phenocopy genes (LDLRAP1, APOE, LIPA, ABCG5, and ABCG8), polygenic hypercholesterolemia, and hyperlipoprotein (a) [Lp(a)] can also mimic a clinical FH phenotype. We aim to present a new diagnostic tool to unravel the genetic background of clinical FH phenotype. Biochemical and genetic study was performed in 1,005 individuals with clinical diagnosis of FH, referred to the Portuguese FH Study. A next-generation sequencing panel, covering eight genes and eight SNPs to determine LDL-C polygenic risk score and LPA genetic score, was validated, and used in this study. FH was genetically confirmed in 417 index cases: 408 heterozygotes and 9 homozygotes. Cascade screening increased the identification to 1,000 FH individuals, including 11 homozygotes. FH-negative individuals (phenotype positive and genotype negative) have Lp(a) >50 mg/dl (30%), high polygenic risk score (16%), other monogenic lipid metabolism disorders (1%), and heterozygous pathogenic variants in FH-phenocopy genes (2%). Heterozygous variants of uncertain significance were identified in primary genes (12%) and phenocopy genes (7%). Overall, 42% of our cohort was genetically confirmed with FH. In the remaining individuals, other causes for high LDL-C were identified in 68%. Hyper-Lp(a) or polygenic hypercholesterolemia may be the cause of the clinical FH phenotype in almost half of FH-negative individuals. A small part has pathogenic variants in ABCG5/ABCG8 in heterozygosity that can cause hypercholesterolemia and should be further investigated. This extended next-generation sequencing panel identifies individuals with FH and FH-phenocopies, allowing to personalize each person’s treatment according to the affected pathway.

Objectives: Therapeutic options for pancreatic neuroendocrine neoplasia (Pan-NEN) have increased over the last decade. We aim to understand the evolution of the prognosis of patients with diagnosis of Pan-NEN within a 12-year period, considering the implementation of new treatments. Methods: This study is a retrospective cohort study of patients diagnosed with Pan-NENs between 2006 and 2017. Survival outcome estimates were calculated by Kaplan–Meier method. The impact of baseline clinicopathological characteristics on survival was explored with the use of Cox proportional hazard model. Results: Of the 97 patients, 77 (79.9%) had well-differentiated neuroendocrine tumor (NET) according to WHO 2010 classification, and 52 (53.6%) had l ocalized or locoregional disease. There were no differences between clinicopathological characteristics and survival outcomes when comparing patients diagnosed between 2006–2011 and 2012–2017. Neuroendocrine carcinoma – HR 2.76, 95% CI 1.17–6.55 – and stages III and IV at diagnosis were independent poor prognostic factors – HR 6.02, 95% CI 2.22–16.33 and HR 6.93, 95% CI 2.94–16.32, respectively. Conclusions: The new therapeutic approaches did not induce better survival outcomes on Pan-NEN in recent years. This is possibly due to the indolent nature of NET grades 1 and 2, even metastatic, allowing patients to be submitted to new target therapies along their disease course.

Introduction: With the increase of esophageal and gastric cancer, surgery will be more often performed. Anastomotic leakage (AL) is one of the most feared postoperative complications of gastroesophageal surgery. It can be managed by conservative, endoscopic (such as endoscopic vacuum therapy and stenting), or surgical methods, but optimal treatment remains controversial. The aim of our meta-analysis was to compare (a) endoscopic and surgical interventions and (b) different endoscopic treatments for AL following gastroesophageal cancer surgery. Methods: Systematic review and meta-analysis, with search in three online databases for studies evaluating surgical and endoscopic treatments for AL following gastroesophageal cancer surgery. Results: A total of 32 studies comprising 1,080 patients were included. Compared with surgical intervention, endoscopic treatment presented similar clinical success, hospital length of stay, and intensive care unit length of stay, but lower in-hospital mortality (6.4% [95% CI: 3.8–9.6%] vs. 35.8% [95% CI: 23.9–48.5%]. Endoscopic vacuum therapy was associated with a lower rate of complications (OR 0.348 [95% CI: 0.127–0.954]), shorter ICU length of stay (mean difference −14.77 days [95% CI: −26.57 to −2.98]), and time until AL resolution (17.6 days [95% CI: 14.1–21.2] vs. 39.4 days [95% CI: 27.0–51.8]) when compared with stenting, but there were no significant differences in terms of clinical success, mortality, reinterventions, or hospital length of stay. Conclusions: Endoscopic treatment, in particular endoscopic vacuum therapy, seems safer and more effective when compared with surgery. However, more robust comparative studies are needed, especially for clarifying which is the best treatment in specific situations (according to patient and leak characteristics).

Energy poverty vulnerability constitutes a significant concern in Portugal, with 17.5% of the population being unable to keep their home adequately warm. Furthermore, there is evidence that a substantial number of children live in unhealthy homes. This study aims to comprehensively characterise a sample of 101 Portuguese families with children and their homes in order to identify opportunities for actions for promoting long-lasting energy efficiency and environment health-promoting behavioural changes. To accomplish this aim, two tools—a building survey checklist and a questionnaire to participants—were developed and implemented to collect harmonised data on building-specific characteristics and on participants’ socioeconomic status and behaviour. The home visits for recruitment and data collection were conducted from July 2021 to April 2022. The results suggest that, for the population under study, the main opportunities for improvement include: (i) replacing low energy-efficient technologies, with high emission rates, namely those used for heating purposes, with cleaner and more efficient alternatives; (ii) providing citizens with detailed information about their home’s energy use and indoor air quality and (iii) educating the population on the best-practices for reducing indoor air stuffiness, mitigating the risk of hazardous exposures, improving thermal comfort and saving energy.

The decarbonisation of the building sector is crucial for Portugal’s goal of achieving economy-wide carbon neutrality by 2050. To mobilize communities towards energy efficiency measures, it is important to understand the primary drivers and barriers that must be overcome through policymaking. This paper aims to review existing Energy Policies and Actions (EPA) in Portugal and assess their effectiveness in improving Energy Efficiency (EE) and reducing CO2 emissions in the building sector. The Local Energy Planning Assistant (LEPA) tool was used to model, test, validate and compare the implementation of current and alternative EPAs in the North of Portugal, including the national EE plan. The results indicate that electrification of heating and cooling, EE measures, and the proliferation of Renewable Energy Sources (RES) are crucial for achieving climate neutrality. The study found that the modelling of alternative EPAs can be improved to reduce investment costs and increase Greenhouse Gas (GHG) emissions reduction. Among the alternatives assessed, the proposed one (Alternative 4) presents the best returns on investment in terms of cost savings and emissions reduction. It allows for 52% investment cost savings in the residential sector and 13% in the service sector when compared to the current national roadmap to carbon neutrality (Alternative 2). The estimated emission reduction in 2050 for Alternative 4 is 0.64% for the residential sector and 3.2% for the service sector when compared to Alternative 2.

A identificação das condições higiênico-sanitárias do pescado é de suma importância para a promoção da saúde e a qualidade de vida da população. Dessa forma, o presente trabalho teve como objetivo avaliar a qualidade microbiológica e verificar o perfil de susceptibilidade a antimicrobianos das cepas isoladas de amostras de tambaqui (C. macropomum) comercializadas na cidade de São Luís, Maranhão. As 60 amostras de tambaqui, obtidas de supermercados e feiras livres, foram analisadas quanto à determinação do Número Mais Provável (NMP) de coliformes totais e termotolerantes; pesquisa de Escherichia coli; pesquisa de Aeromonas spp., e perfil de resistência antimicrobiana. Foi detectada uma elevada contagem de coliformes totais e termotolerantes, além de bactérias patogênicas, tais como: Aeromonas spp. em 56 (93,3%) e E. coli, em 13 (43,3%) das amostras analisadas. Em relação ao perfil de resistência antimicrobiana, os isolados de E. coli demonstraram baixos percentuais de resistência e as cepas de Aeromonasapresentaram elevados níveis de resistência aos antimicrobianos testados. Pode-se concluir que o tambaqui comercializado em São Luís − MA apresenta condições higiênico-sanitárias inadequadas para o consumo. Palavras-chave: microbiologia, pescado, saúde pública, antibiograma

Resumo O estudo das condições higiênico sanitárias de alimentos cárneos consumidos crus, como o sashimi, é necessário para definir sua qualidade e possíveis consequências para a saúde humana. Foram coletadas 60 amostras de sashimi de salmão (Salmo salar), de dez restaurantes na cidade de São Luís, Maranhão - Brasil, sendo seis de cada local. As amostras foram analisadas para contagem de coliformes a 35 °C, coliformes a 45 °C e Staphylococcus coagulase positiva e negativa, identificação da presença de Escherichia coli, Salmonella sp., Vibrio parahaemolyticus e Aeromonas spp, teste de suscetibilidade a antimicrobianos dos isolados e quantificação de histamina nas amostras. Os resultados mostraram elevadas contagens de coliformes a 35 °C e 12 amostras com >102 NMP/g de coliformes a 45 °C, presença de E. coli e de Salmonella sp. em 3 amostras cada, ausência de V. parahaemolyticus e Staphylococcus coagulase positiva e contagem de Staphylococcus coagulase negativa entre

Artigo publicado com erros: https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/7306 Na página 732, Tabela 5, onde se lê: Lanreótido Deverá ler-se: Octreótido

This paper proposes the use of decomposition analysis to assess the effect of local energy-related actions towards climate change mitigation, and thus improve policy evaluation and planning at the local level. The assessment of the impact of local actions has been a challenge, even from a strictly technical perspective. This happens because the total change observed is the result of multiple factors influencing local energy-related greenhouse gas (GHG) emissions, many of them not even influenced by local authorities. A methodology was developed, based on a recently developed decomposition model, that disaggregates the total observed changes in the local energy system into multiple causes/effects (including local socio-economic evolution, technology evolution, higher-level governance frame and local actions). The proposed methodology, including the quantification of the specific effect associated with local actions, is demonstrated with the case study of the municipality of Malmö (Sweden) in the timeframe between 1990 and 2015.

This paper identifies and characterizes the technical measures and policy instruments that can be used to promote energy efficiency and the use of renewable sources for domestic hot water (DHW). DHW presents a considerable potential for abatement of greenhouse gas emissions around the world. Measures were characterized in terms of level of transformation, impact and scope, among others. Policy instruments were characterized in terms of target groups, competences required for implementation, major challenges and nature of the instruments. A matrix showing the applicability of policy instruments per technical measure was derived, enabling policy makersto better choose articulated measures and policy instruments for their policy packs.

The changes observed in a municipal or local energy system over a period of time is due a number of concurrent dynamics such as the local social and economic trends, higher-level policies (e.g., national), and the local policies. Thus, a thorough identification and characterization of the many factors of change is key for an adequate assessment of the effectiveness of policies adopted at the local level, as well as for future planning. Such thorough identification and characterization of the factors that are determinant for the evolution of the local energy system is the content of this paper. The identification is performed through a systematic literature review, followed by a synthesis process. The factors identified are grouped into the categories of local context, local socio-economic and cultural evolution, higher-level governance framework, and local climate change mitigation actions. They are represented through a set of measurable variables. The factors and respective variables can be used to improve the disaggregation of changes in the local energy system into individual causes, leading to a better assessment of the evolution over time.

Introdução: O objetivo deste artigo é rever a experiência do Instituto Português de Oncologia do Porto na terapêutica de tumores neuroendócrinos gastroenteropancreáticos com 177Lu-DOTA-TATE, tendo como principais pontos de análise a segurança e eficácia terapêutica. Material e Métodos: Foi realizada uma análise retrospetiva dos processos clínicos de doentes com tumores neuroendócrinos gastroenteropancreáticos, submetidos a terapêutica com 177Lu-DOTA-TATE entre abril de 2011 e novembro de 2013. Resultados: Dos 36 casos revistos, 30 completaram os três ciclos de 177Lu-DOTA-TATE (83,3%). Nesses doentes foram registados: efeitos colaterais agudos em 8,9% dos ciclos; toxicidade hepática grau 3 CTCAE em 13,3% dos doentes (todos com alterações prévias da função hepática); ausência de toxicidade renal ou hematológica significativa; melhoria sintomática em 71,4% dos doentes; tempo mediano global desde o início da terapêutica até progressão de doença de 25,6 meses; tempo mediano global de sobrevivência desde o diagnóstico de 121,7 meses. Verificou-se um maior tempo livre de progressão de doença e de sobrevivência nos doentes com expressão elevada de recetores da somatostatina (p < 0,05). Discussão: A peptide receptor radionuclide therapy com 177Lu-DOTA-TATE apresenta respostas clínicas favoráveis com segurança e boa tolerabilidade terapêutica, conforme evidenciado no nosso estudo pelos seguintes achados: melhoria dos sintomas na maioria dos doentes e aumento significativo do tempo livre de progressão de doença e da sobrevivência (sobretudo nos doentes com expressão elevada de sstr), com efeitos colaterais agudos e subagudos/crónicos significativos numa minoria de doentes. Conclusão: A peptide receptor radionuclide therapy com 177Lu-DOTA-TATE é uma terapêutica promissora, com benefícios reais em termos de eficácia e segurança nos doentes com tumores neuroendócrinos gastroenteropancreáticos.

Têm sido publicados vários estudos acerca da infecção por Epstein-Barr vírus (EBV) e o desenvolvimento de carcinoma da nasofaringe (NPC). As prevalências dos tipos histológicos e a presença de infecção latente pelo EBV são diferentes em regiões endémicas e não endémicas. OBJETIVO: O objectivo deste estudo consistiu na detecção de EBV em tecido tumoral da nasofaringe e sangue periférico de doentes com NPC e em indivíduos saudáveis, provenientes duma área não-endémica, de baixo risco. MÉTODOS: Detecção de EBV em amostras de doentes com carcinoma da nasofaringe e indivíduos saudáveis. Neste estudo de série foram avaliadas as implicações clínicas da presença de EBV circulante no sangue periférico de doentes com carcinoma da nasofaringe. RESULTADOS: Este estudo indica que a frequência de casos EBV positivos detectados no sangue periférico é superior em tumores de estádio mais avançado. CONCLUSÕES: Estes resultados indicam que se observam diferenças na pesquisa do vírus Epstein-Barr no grupo de doentes com NPC e no grupo controlo, sem tumor. Este estudo pode ajudar na compreensão dos mecanismos biológicos do cancro da nasofaringe e da correlação destes tumores com a infecção por EBV numa área não-endémica, de baixo risco.Several studies have been published concerning Epstein-barr virus (EBV) infection and nasopharyngeal cancer (NPC) development. The incidences of histological types are different according to endemic or non-endemic regions. Latent EBV infection is found in almost all cases of NPC in endemic regions, but normally absent in type I carcinomas, more common in non-endemic regions. AIM: The purpose of this hospital-based study was to analyze the presence of EBV in nasopharyngeal tumor tissues and in peripheral blood of nasopharyngeal cancer patients and healthy individuals, in a low risk, non-endemic area. METHODS: EBV detection in samples of nasopharyngeal cancer patients and healthy individuals. RESULTS: This study indicates that the frequency of EBV positive cases in peripheral blood is higher in advanced tumor stages. CONCLUSIONS: The incidence rates of NPC have a distinct distribution. Since the prevalence of this disease is low in occidental countries, little is known about the biology of these tumors in non-endemic areas. We observed statistically significant differences in EBV detection between the NPC patient group and the control group. This study may help to understand the biological mechanisms of NPC and the correlation of EBV infection with this disease, in a low risk, non-endemic region.

Introdução: Os tumores epiteliais tímicos (TET), a maioria timomas, são neoplasias desenvolvidas a partir das células epiteliais do timo e constituem cerca de 30% das massas do mediastino anterior em adultos. Os timomas são constituídos por células sem características citológicas de malignidade, sendo o comportamento maligno determinado pela invasão da cápsula e estruturas adjacentes. Estes tumores apresentam um amplo espectro de características clínicas e morfológicas, e as pequenas séries de doentes conhecidas tornam difícil o estabelecimento de um tratamento standard. Material e métodos: Efectuou-se um estudo retrospectivo dos doentes admitidos com diagnóstico de timoma no Instituto Português de Oncologia - Centro do Porto (IPO-Porto), de 1983 a 2004. Foram analisadas as suas características clínicas, classificação histológica segundo a OMS, o estadiamento de Masaoka, e a sua relação com as modalidades de tratamento. Procedeu-se à revisão dos registos clínicos destes doentes e revisão do material histológico para a classificação segundo critérios da OMS de 1999. Resultados: No IPO-Porto, entre 1983 e 2004, foram tratados 28 doentes com TET. Destes, 21 eram timomas invasivos, sendo estes o objecto deste estudo. Dos dados demográficos salienta-se que eram 11 homens, 10 mulheres, com uma idade mediana de 55 anos (24-79 anos). A classificação histológica da OMS foi a seguinte: 2 doentes (9,5%) Tipo A, 6 (28,6%) tipo AB, 4 (19%) tipo B1, 2 (9,5%) tipo B2, 7 (33,4%) tipo B3. O estadiamento segundo Masaoka foi 9 doentes (42,8%) com estádio II, 6 (28,6%) com estádio III e 6 (28,6%) com estádio IVa. A maioria dos doentes apresentava sintomas locais à apresentação, com apenas 1 doente com diagnóstico de aplasia eritrocitária e 5 com Mastenia gravis (MG). Os 6 doentes submetidos apenas a ressecção cirúrgica completa não tiveram evidência de recorrência da doença (2 tipo A-II, 2 tipo AB-II, 1 tipo B1-II, 1 tipo B2-IVa), com follow-up variando entre 8 e 144 meses. 10 doentes com ressecção completa receberam tratamento adjuvante, 6 radioterapia (4 doentes B3-II, 2 doentes B3-III), 2 quimioterapia (AB-IVa) e 2 radioterapia e quimioterapia (B1-IVa, B2-III). Apenas os 2 doentes que efectuaram quimioterapia adjuvante recidivaram, aos 168 e 46 meses, e morreram aos 168 e 49 meses. Os restantes doentes que efectuaram tratamento adjuvante encontram-se sem evidência de doença. Dos 5 doentes com ressecção incompleta seguido de tratamento complementar (2 doentes AB-III, 2 B1-IVa, 1 B3-III), 3 morreram aos 11 meses (B3-III), aos 12 meses (B1-IVa) e aos 241 meses (AB-III), este último por MG. Conclusões: Apesar de se tratar de uma pequena série, os factores preditivos de mau prognóstico foram a ressecção incompleta, estádio avançado e o subtipo histológico B3. É necessário investigar o papel do tratamento adjuvante e neoadjuvante no grupo de doentes com doença avançada e subtipo histológico B3.Introduction: Epithelial thymic tumours (ETT), which comprise the majority of thymomas, are neoplasias developed from the epithelial cells of the thymus and constitute around 30% of anterior mediastinal masses in adults. Thymomas consist of cells with no cytological characteristics of malignity; malignant behaviour is determined by invasion of the capsule and adjacent structures. These tumours present a broad spectrum of clinical and morphological characteristics and the small series of known patients makes establishing a standard treatment difficult. Material and methods: A retrospective study was made into thymoma diagnosed patients admitted to the Portuguese Oncology Institute in Porto (IPOPorto) from 1983 to 2004. Clinical characteristics were analysed and a histological classification made in accordance with World Health Organization criteria, Masaoka staging, and their relation to treatment methods. A review of the clinical records of these patients was then made, as well as a review of histological material for classification in line with 1999 WHO criteria. Results: Twenty-eight ETT patients were treated at the IPO-Porto between 1983 and 2004. Of these, 21 had invasive thymomas and these are the subject of this study. Eleven subjects were male and 10 female, with a median age of 55 years (24-79 years). The WHO histological classification was as follows: 2 patients (9.5%) type A, 6 (28.6%) type AB, 4 (19%) type B1, 2 (9.5%) type B2, 7 (33.4%) type B3. Masaoka staging was 9 patients (42.8%) with stage II, 6 (28.6%) with stage III and 6 (28.6%) with stage IVa. The majority of patients had local symptoms, with only one subject diagnosed with erythrocyte aplasia and five with Myasthenia Gravis (MG). The 6 patients who were given complete surgical resection only showed no evidence of disease recurrence (2 type A-II, 2 type AB-II, 1 type B1-II, 1 type B2- IVa), with follow-up from 8-144 months. Ten patients with complete resection received adjuvant treatment; 6 radiotherapy (4 B3-II patients, 2 B3-III patients), 2 chemotherapy (AB-IVa) and 2 chemo and radiotherapy (B1-IVa, B2-III). Only the 2 patients who underwent adjuvant chemotherapy relapsed, at 168 and 46 months, dying at 168 and 49 months, respectively. The remaining patients who were given adjuvant treatment did not present signs of disease. Of the 5 subjects having incomplete resection followed by complementary treatment (2 AB-III patients, 2 B1-IVa patients, 1 B3-III patient), 3 died, at 11 months (B3-III), 12 months (B1-IVa) and 241 months (AB-III), the latter with MG. Conclusions: Predictive factors of bad prognosis here were incomplete resection, advanced staging and B3 histological subtype, the smallness of this series notwithstanding. It is necessary to investigate the role of adjuvant and neoadjuvant treatment in a group of subjects with advanced disease of the B3 histological subtype.

Resumo: Introdução: Os tumores epiteliais tímicos (TET), a maioria timomas, são neoplasias desenvolvidas a partir das células epiteliais do timo e constituem cerca de 30% das massas do mediastino anterior em adultos. Os timomas são constituídos por células sem características citológicas de malignidade, sendo o comportamento maligno determinado pela invasão da cápsula e estru-turas adjacentes. Estes tumores apresentam um amplo espectro de características clínicas e morfológicas, e as pequenas séries de doentes conhecidas tornam difícil o estabelecimento de um tratamento standard.Material e métodos: Efectuouse um estudo retrospectivo dos doentes admitidos com diagnóstico de ti moma no Instituto Português de Oncologia - Centro do Porto (IPO-Porto), de 1983 a 2004. Foram anali-sadas as suas características clínicas, classificação histológica segundo a OMS, o estadiamento de Masaoka, e a sua relação com as modalidades de tratamento. Procedeu-se à revisão dos registos clínicos destes doentes e revisão do material histológico para a classificação segundo critérios da OMS de 1999.Resultados: No IPO-Porto, entre 1983 e 2004, fo-ram tratados 28 doentes com TET. Destes, 21 eram timomas invasivos, sendo estes o objecto deste estudo. Dos dados demográficos salienta-se que eram 11 homens, 10 mulheres, com uma idade mediana de 55 anos (24-79 anos). A classificação histológica da OMS foi a seguinte: 2 doentes (9,5%) Tipo A, 6 (28,6%) tipo AB, 4 (19%) tipo B1, 2 (9,5%) tipo B2, 7 (33,4%) tipo B3. O estadiamento segundo Masaoka foi 9 doentes (42,8%) com estádio II, 6 (28,6%) com estádio III e 6 (28,6%) com estádio IVa. A maioria dos doentes apresentava sintomas locais à apresen-tação, com apenas 1 doente com diagnóstico de aplasia eritrocitária e 5 com Mastenia gravis (MG).Os 6 doentes submetidos apenas a ressecção cirúrgica completa não tiveram evidência de recorrência da doença (2 tipo A-II, 2 tipo AB-II, 1 tipo B1-II, 1 tipo B2-IVa), com follow-up variando entre 8 e 144 meses. 10 doentes com ressecção completa receberam tratamento adjuvante, 6 radioterapia (4 doentes B3-II, 2 doentes B3-III), 2 quimioterapia (AB-IVa) e 2 radioterapia e quimioterapia (B1-IVa, B2-III). Apenas os 2 doentes que efectuaram quimioterapia adjuvante reci-divaram, aos 168 e 46 meses, e morreram aos 168 e 49 meses. Os restantes doentes que efectuaram tratamento adjuvante encontram-se sem evidência de doença. Dos 5 doentes com ressecção incompleta seguido de tratamento complementar (2 doentes AB-III, 2 B1-IVa, 1 B3-III), 3 morreram aos 11 meses (B3-III), aos 12 meses (B1-IVa) e aos 241 meses (AB-III), este últi-mo por MG.Conclusões: Apesar de se tratar de uma pequena série, os factores preditivos de mau prognóstico foram a ressecção incompleta, estádio avançado e o subtipo histológico B3. à necessário investigar o papel do tratamento adjuvante e neoadjuvante no grupo de doentes com doença avançada e subtipo histológico B3.Rev Port Pneumol 2007; XIII (4): 553-585 Abstract: Introduction: Epithelial thymic tumours (ETT), which comprise the majority of thymomas, are neoplasias developed from the epithelial cells of the thymus and constitute around 30% of anterior mediastinal masses in adults. Thymomas consist of cells with no cytological characteristics of malignity; malignant behaviour is determined by invasion of the capsule and adjacent structures. These tumours present a broad spectrum of clinical and morphological characteristics and the small series of known patients makes establishing a standard treatment difficult.Material and methods: A retrospective study was made into thymoma diagnosed patients admitted to the Portuguese Oncology Institute in Porto (IPO-Porto) from 1983 to 2004. Clinical characteristics were analysed and a histological classification made in accordance with World Health Organization criteria, Masaoka staging, and their relation to treatment methods. A review of the clinical records of these patients was then made, as well as a review of histological material for classification in line with 1999 WHO criteria.Results: Twenty-eight ETT patients were treated at the IPO-Porto between 1983 and 2004. Of these, 21 had invasive thymomas and these are the subject of this study. Eleven subjects were male and 10 female, with a median age of 55 years (24-79 years). The WHO histological classification was as follows: 2 patients (9.5%) type A, 6 (28.6%) type AB, 4 (19%) type B1, 2 (9.5%) type B2, 7 (33.4%) type B3. Masaoka staging was 9 patients (42.8%) with stage II, 6 (28.6%) with stage III and 6 (28.6%) with stage IVa. The majority of patients had local symptoms, with only one subject diagnosed with erythrocyte aplasia and five with Myasthenia Gravis (MG).The 6 patients who were given complete surgical resection only showed no evidence of disease recurrence (2 type A-II, 2 type AB-II, 1 type B1-II, 1 type B2-IVa), with follow-up from 8-144 months. Ten patients with complete resection received adjuvant treatment; 6 radiotherapy (4 B3-II patients, 2 B3-III patients), 2 chemotherapy (AB-IVa) and 2 chemo and radiotherapy (B1-IVa, B2-III). Only the 2 patients who under-went adjuvant chemotherapy relapsed, at 168 and 46 months, dying at 168 and 49 months, respectively. The remaining patients who were given adjuvant treatment did not present signs of disease. Of the 5 subjects having incomplete resection followed by complementary treatment (2 AB-III patients, 2 B1-IVa patients, 1 B3-III patient), 3 died, at 11 months (B3-III), 12 months (B1-IVa) and 241 months (AB-III), the latter with MG.Conclusions: Predictive factors of bad prognosis here were incomplete resection, advanced staging and B3 histological subtype, the smallness of this series not-withstanding. It is necessary to investigate the role of adjuvant and neoadjuvant treatment in a group of subjects with advanced disease of the B3 histological subtype.Rev Port Pneumol 2007; XIII (4): 553-585 Palavras-chave: Tumores epiteliais tímicos, timomas, Miastenia gravis, quimioterapia, radioterapia, Key-words: Epithelial thymic tumours, thymomas, Myasthenia gravis, chemotherapy, radiotherapy

The Metabolic Syndrome increases the risk for atherosclerotic cardiovascular disease and type 2 Diabetes Mellitus. Increased fructose consumption and/or mineral deficiency have been associated with Metabolic Syndrome development. This study aimed to investigate the effects of 8 weeks consumption of a hypersaline sodium-rich naturally sparkling mineral water on 10% fructose-fed Sprague-Dawley rats (Metabolic Syndrome animal model). The ingestion of the mineral water (rich in sodium bicarbonate and with higher potassium, calcium, and magnesium content than the tap water used as control) reduced/prevented not only the fructose-induced increase of heart rate, plasma triacylglycerols, insulin and leptin levels, hepatic catalase activity, and organ weight to body weight ratios (for liver and both kidneys) but also the decrease of hepatic glutathione peroxidase activity and oxidized glutathione content. This mineral-rich water seems to have potential to prevent Metabolic Syndrome induction by fructose. We hypothesize that its regular intake in the context of modern diets, which have a general acidic character interfering with mineral homeostasis and are poor in micronutrients, namely potassium, calcium, and magnesium, could add surplus value and attenuate imbalances, thus contributing to metabolic and redox health and, consequently, decreasing the risk for atherosclerotic cardiovascular disease.

A obesidade, particularmente a obesidade visceral, dá origem a um estado de inflamação sistémica de baixo grau através de vários mecanismos. A sobrecarga metabólica desencadeia reacções de stresse oxidativo e stresse dos organelos, com inflamação. A hipertrofia dos adipócitos facilita o seu rebentamento, o que desencadeia uma resposta inflamatória. No tecido adiposo de indivíduos obesos há um grande aumento de macrófagos, que se localizam em redor de adipócitos mortos. Todas estas células, adipócitos sob stresse, macrófagos e linfócitos, também presentes no tecido adiposo do obeso, segregam citocinas inflamatórias. Para além disso, os dados recentemente adquiridos sobre o microbiota intestinal e a sua interacção com a gordura alimentar e com a obesidade trouxeram novas hipóteses para a relação da dieta gorda/obesidade com a inflamação. Há, ainda, a considerar outros fenómenos, como o stresse psicológico e a disrupção dos ritmos circadianos, como contribuintes para o estado de inflamação. Por sua vez, a inflamação é em grande parte responsável pela relação entre a obesidade e as morbilidades que lhe estão associadas, como a aterosclerose, diabetes, doenças cardiovasculares e cancro.

A prevalência crescente da obesidade sugere que há outros factores a considerar para além do binómio nutrição/exercício físico. Entre aqueles, os factores sociais parecem ter um papel da maior relevância. A aceleração do tempo subjectivo, desalinhamento circadiano, diminuição do tempo de sono, indisciplina alimentar, perda do valor afectivo‑social dos alimentos e perda do controlo social das refeições comunitárias/familiares podem estar todos a contribuir para a crescente obesidade. Outro factor de grande peso é o stresse crónico da sociedade actual. A avalanche informacional, a competição, e os esforços das pessoas para se manterem na corrente solicitam reacções de stresse, o que favorece o desenvolvimento da obesidade. Uma das respostas mais desfavoráveis é a derrota/perda do controlo, muito facilitada pelo contraste entre a atitude passiva e expectativas altas criadas na população pelo sistema de política /marketing, e as más notícias divulgadas continuamente, ou as dificuldades reais das pessoas. Só uma abordagem filosófica geral poderá fazer retroceder a presente epidemia de obesidade.

Obesity prevalence is increasing all over the world. Most affected are people changing from a traditional lifestyle to an environment with both availability of high energy diet and less physical activity. Glycemic index (GI) is a measure of dietary glycemic carbohydrates, representing their ability to raise blood glucose concentrations. It refers to the postprandial blood glucose response expressed as a percentage of the response to a reference food (glucose or white bread) containing the same carbohydrate content. Given the present high consumption of sugary drinks, the putative contribution of these products to obesity deserves investigation. The aim of this study was to determine the GI of some drinks from the Portuguese market. Postprandial glycemia after ingestion of apple Frutis, peach Frutis, Green tea Frutea, green tea, black tea, lupin infusion, rooibos infusion, raftilose solution or bran solution has been determined for two hours in a caucasian population of young adults of any sex, 17 to 24 years of age. Apple Frutis GI was found to be 54.3, i.e., a low GI; Frutea Green tea had a GI of 64.7, considered as a moderate GI; peach Frutis showed a high GI, 86.6. Green and Black teas as well as rooibos and lupin infusions, all with added glucose (25 g), did not change glycemic response in comparison with the reference solution (water with 25 g glucose). No differences were seen after raftilose and bran solutions by comparison with the reference solution. GI information may help the choice of carbohydrates to include in a healthy diet. Formerly considered as a parameter of interest to diabetic patients, it may actually interest anybody concerned with a healthy diet. This study has been performed by medical and nutritional science students, who observed glycemic excursions in themselves, after drink ingestion. This experiment allowed them to see the impressive rise of glycemia after ingestion of a sugary drink, by comparison with basal levels which would not rise if plain water or other nonsugary drink had been ingested.

The increasing incidence of obesity and the metabolic syndrome is disturbing. The activation of inflammatory pathways, used normally as host defence, reminds the seriousness of this condition. There is probably more than one cause for activation of inflammation. Apparently, metabolic overload evokes stress reactions, such as oxidative, inflammatory, organelle and cell hypertrophy, generating vicious cycles. Adipocyte hypertrophy, through physical reasons, facilitates cell rupture, what will evoke an inflammatory reaction. Inability of adipose tissue development to engulf incoming fat leads to deposition in other organs, mainly in the liver, with consequences on insulin resistance. The oxidative stress which accompanies feeding, particularly when there is excessive ingestion of fat and/or other macronutrients without concomitant ingestion of antioxidant-rich foods/beverages, may contribute to inflammation attributed to obesity. Moreover, data on the interaction of microbiota with food and obesity brought new hypothesis for the obesity/fat diet relationship with inflammation. Beyond these, other phenomena, for instance psychological and/or circadian rhythm disturbances, may likewise contribute to oxidative/inflammatory status. The difficulty in the management of obesity/metabolic syndrome is linked to their multifactorial nature where environmental, genetic and psychosocial factors interact through complex networks.

Resumo: A via de sinalização intracelular do receptor do factor de crescimento epidérmico (EGFR) é hoje um alvo importante na terapêutica do cancro do pulmão de não pequenas células (CPNPC). Após a divulgação dos resultados do estudo BR.21, que além da sua eficácia mostrou também que era bem tolerado por doentes de idade avançada, o erlotinib, inibidor específico do domínio tirosina-cínase do EGFR, foi aprovado para tratamento do CPNPC após falência de pelo menos uma linha de quimioterapia (QT).Os autores apresentam um caso clínico de uma doente do sexo feminino, de 63 anos, com uma história clínica de angina de peito, à qual foi diagnosticado um adenocarcinoma do pulmão. Por má tolerância do tratamento com QT, usouse o erlotinib em segunda linha de tratamento. Obteve-se uma boa resposta da doença, com melhoria sintomática, e os efeitos adversos, em grau ligeiro a moderado, foram bem tole-rados sem necessidade de ajuste posológico.Rev Port Pneumol 2008; XIV (Supl 3): S17-S22 Abstract: the epidermal growth-factor receptor (EGFR) and its signaling pathway have become a major target for therapy of non-small cell lung cancer (NSCLC). After the BR.21 study showed its effectiveness and its tolerability in older patients, erlotinib, a specific EGFR tyrosine-kinase inhibitor, has been approved for NSCLC therapy after failure of treatment with at least one line of chemotherapy (CT).The authors present the case of a 63 years-old female patient, with a history of angina pectoris, who was diagnosed with a lung adenocarcinoma. Because of poor tolerance to first-line CT, she had second-line treatment with erlotinib. There was a good response to therapy, along with symptomatic improvement. Adverse effects were light to moderate, well tolerated, and required no dose reduction.Rev Port Pneumol 2008; XIV (Supl 3): S17-S22 Palavras-chave: Carcinoma do pulmão de não pequenas células, adenocarcinoma do pulmão, erlotinib, tratamento de segunda linha, Key-words: Non-small cell lung cancer, lung adenocarcinoma, erlotinib, second-line therapy

Obesity is increasing all over the world, its morbidity justifying a serious effort to improve the situation. Diet and physical exercise constitute major measures to fight obesity. We aimed to investigate the effect of acute exercise intensity over plasma insulin, growth hormone and somatostatin responses. Plasma levels of insulin, growth hormone, somatostatin and glucose were measured at baseline, after 15 minutes of moderate intensity exercise and after 15 minutes of high intensity exercise in a group of young healthy volunteers. Insulin, growth hormone and somatostatin were measured by immunoradioassay and glucose by a glucose oxidase method. After moderate intensity exercise plasma insulin levels tended to decrease, growth hormone tended to increase and somatostatin did not change. A similar period of high intensity exercise led to a similar decrease of plasma insulin, a much higher increase of growth hormone plasma level and no change of somatostatin. Glycemia suffered no significant change throughout the experiment. We conclude that hormonal changes induced by physical exercise depend on the intensity of exercise. When comparing moderate with high intensity exercise, a similar response of plasma insulin and a lower growth hormone/somatostatin ratio may support a healthier cardiovascular effect for moderate intensity exercise.

CONTEXT AND OBJECTIVE: Mycobacterium avium subsp. paratuberculosis (MAP) has attracted the interest of researchers because of similarities between paratuberculosis and Crohn's disease (CD). The aim of this study was to evaluate the frequency of MAP through cultures, histology and polymerase chain reaction (PCR) on intestinal biopsies from Brazilian CD patients. Quantitative real time PCR (qRT-PCR) was performed on positive samples. DESIGN AND SETTING: Analytical cross-sectional study with control group at two federal universities. METHODS: Fresh samples were collected from 25 patients; five with CD, eight with ulcerative colitis (UC) and 12 controls with non-inflammatory bowel disease (nIBD). Formalin-fixed paraffin-embedded (FFPE) samples from 143 patients were also collected: 44 CD, 49 UC and 56 nIBD. RESULTS: None of the fresh samples was positive for MAP. Five FFPE samples (one CD, two UC and two nIBD) and three fresh samples (one in each group) were positive through IS900-PCR. qRT-PCR was performed on these eight samples. Among the FFPE samples, there were 192.12 copies/μl in the CD group, 72.28 copies/μl in UC and 81.43 copies/μl in nIBD. Among the fresh samples, there were 432.99 copies/μl, 167.92 copies/μl and 249.73 copies/μl in the CD, UC and nIBD groups, respectively. The highest bacterial load was in the CD group. CONCLUSION: This study does not provide evidence for a role of MAP in the etiology of CD, although MAP DNA was detected in all three patient groups. This is the first report of MAP presence in human intestinal biopsies in Brazil.

Simple Summary: This study implemented a 12-week exercise program for 13 female breast cancer survivors, aged 35–53, focusing on quality of life, self-esteem, and depression. Participants engaged in twice-weekly sessions of aerobic and resistance training exercises. Results showed significant improvements in quality of life, particularly in future health prospects and arm symptoms, and in self-esteem. Although depressive symptoms decreased, the change was not statistically significant. The study underscores the importance of physical exercise as a supportive method for managing breast cancer therapy and its side effects. It highlights the need to demystify exercise post-cancer diagnosis, especially among less active groups, promoting healthier lifestyles. Community-based programs and educational initiatives are recommended to enhance the adoption of physical activity, optimizing recovery and improving overall well-being for breast cancer survivors. Controlled study designs usually report that physical exercise improves the health of women living with breast cancer. However, many of these women are not sufficiently active to experience the benefits of exercise. The main objective was to analyze the effect of a physical exercise program on quality of life, self-esteem, and depression in breast cancer survivors. Thirteen participants (46.54 ± 6.31 years old) completed the exercise intervention. Three patient-reported questionnaires were used: Supplementary Questionnaire Breast Cancer Module (QLQ-BR23), Beck Depression Inventory (BDI), and Rosenberg Self-Esteem Scale (RSES). All participants had significantly improved self-esteem (p = 0.004). Although there were no statistically significant changes in depression, there was a notable decrease in scores (6.39 ± 4.75 vs. 5.00 ± 4.75; p = 0.080). Regarding quality of life, significant improvements were observed in "future perspectives" (p = 0.047) and "arm symptoms" (p = 0.015). No significant changes were noted in the other variables. Our results suggest that physical exercise is an effective strategy that positively affects breast cancer survivors' quality of life and self-esteem. The results reinforce the need for community-based exercise programs for breast cancer survivors. Healthcare professionals should promote physical exercise to improve health outcomes before, during, and after treatment. [ABSTRACT FROM AUTHOR]

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