Repositório RCAAP

Dietary studies can reveal valuable information on how species exploit their habitats and are of particular importance for insular endemics conservation as these species present higher risk of extinction. Reptiles are often neglected in island systems, principally the ones inhabiting remote areas, therefore little is known on their ecological networks. The Selvagens gecko Tarentola (boettgeri) bischoffi, endemic to the remote and integral reserve of Selvagens Archipelago, is classified as Vulnerable by the Portuguese Red Data Book. Little is known about this gecko’s ecology and dietary habits, but it is assumed to be exclusively insectivorous. The diet of the continental Tarentola species was already studied using classical methods. Only two studies have used next-generation sequencing (NGS) techniques for this genus thus far, and very few NGS studies have been employed for reptiles in general. Considering the lack of information on its diet and the conservation interest of the Selvagens gecko, we used morphological and DNA metabarcoding approaches to characterize its diet. The traditional method of morphological identification of prey remains in faecal pellets collected over a longer period was compared with metabarcoding of samples collected during rapid surveys. Molecular results revealed that this species is a generalist, feeding on invertebrate, plant and vertebrate items, whereas the morphological approaches were unable to detect the latter two. These results opened up new questions on the ecological role of the Selvagens gecko that deserves to be further explored, such as the possible predation on seabirds, plant services or trophic competition with the sympatric Madeira lizard Teira dugesii. Metabarcoding identified a greater diversity of dietary items at higher taxonomic resolution, but morphological identification enabled calculation of relative abundances and biomasses of ingested arthropods, and detected a dietary shift on invertebrate preys between seasons. Results of this study highlight the global applicability of rapid metabarcoding surveys for understudied taxa on remote islands that are difficult to access. We recommend using the metabarcoding approach, even if ‘speedy’ sampling only is possible, but we must highlight that disregarding long-term ecological data may lead to ‘hasty’ conclusion.

Tropical forests are experiencing increasing impacts from a multitude of anthropogenic activities, such as logging and conversion to agricultural use. These perturbations are expected to have strong impacts on ecological interactions and on the transmission dynamics of infection diseases. To date, no clear picture of the effects of deforestation on vector-borne disease transmission has emerged. This is associated with the challenge of studying complex systems where many vertebrate hosts and vectors co-exist. To overcome this problem, we focused on an innately-simplified system – a small oceanic island (São Tomé, Gulf of Guinea). We analyzed the impacts of human land-use on host-parasite interactions by sampling the bird community (1735 samples from 30 species) in natural and anthropogenic habitats at different elevations and screened individuals for haemosporidian parasites from three genera (Plasmodium, Haemoproteus, Leucocytozoon). Overall, Plasmodium had the highest richness but the lowest prevalence, while Leucocytozoon diversity was the lowest despite having the highest prevalence. Interestingly, co-infections (i.e. intra-host diversity) involved essentially Leucocytozoon lineages (69%). We also found marked differences between bird species and habitats. Some bird species showed low prevalence but harbored high diversity of parasites, while others showed high prevalence but were infected with fewer lineages. These infection dynamics are most likely driven by host specificity of parasites and intrinsic characteristics of hosts. In addition, Plasmodium was more abundant in disturbed habitats and at lower elevations, while Leucocytozoon was more prevalent in forest areas and at higher elevations. These results likely reflect the ecological requirements of their respective vectors: mosquitoes and black flies, respectively.

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O objectivo da Newsletter do Instituto de Saúde Baseado na Evidência (ISBE) é a disponibilização de informação sobre áreas relevantes para a prática clínica, baseada na melhor evidência científica. São localizados estudos relevantes e de alta qualidade, criticamente avaliados pela sua validade, importância dos resultados e aplicabilidade prática e resumidos numa óptica de suporte à decisão clínica. É dada prioridade aos estudos de causalidade – revisões sistemáticas, ensaios clínicos, estudos de coorte prospectivos/retrospectivos, estudos seccionais cruzados e caso‐controlo – incluindo‐se ainda, quando justificado, estudos qualitativos considerados de elevada qualidade metodológica e importância clínica.

Estudo sobre a leitura crítica desenvolvida por Autores dos séculos XVI-XIX (várias formações)sobre o processo de expansão e de decadência do Império Português Ultramarino. Completado com uma Cronologia da História da Expansão Portuguesa e do Império Ultramarino, de uma Antologia de textos e de Apontamentos biográficos dos respectivos Autores. Versão desenvolvida, completada e anotada do texto inicialmente publicado na "História de Portugal" direcção de João Medina (1ª ed. 1993). Divulga-se no RUL um excerto, com autorização da Autora e do Editor.

O objectivo da Newsletter do Instituto de Saúde Baseado na Evidência (ISBE) é a disponibilização de informação sobre áreas relevantes para a prática clínica, baseada na melhor evidência científica. São localizados estudos relevantes e de alta qualidade, criticamente avaliados pela sua validade, importância dos resultados e aplicabilidade prática e resumidos numa óptica de suporte à decisão clínica. É dada prioridade aos estudos de causalidade – revisões sistemáticas, ensaios clínicos, estudos de coorte prospectivos/retrospectivos, estudos seccionais cruzados e caso‐controlo – incluindo‐se ainda, quando justificado, estudos qualitativos considerados de elevada qualidade metodológica e importância clínica.

The One Health context considers health based on three pillars: humans, animals, and environment. This approach is a strong ally in the surveillance of infectious diseases and in the development of prevention strategies. Aspergillus spp. are fungi that fit substantially in this context, in view of their ubiquity, as well as their importance as plant pathogens, and potentially fatal pathogens for, particularly, humans and avian species. In addition, the emergence of azole resistance, mainly in Aspergillus fumigatus sensu stricto, and the proven role of fungicides widely used on crops, reinforces the need for a multidisciplinary approach to this problem. Avian species are involved in short and long distance travel between different types of landscapes, such as agricultural fields, natural environments and urban environments. Thus, birds can play an important role in the dispersion of Aspergillus, and of special concern, azole-resistant strains. In addition, some bird species are particularly susceptible to aspergillosis. Therefore, avian aspergillosis could be considered as an environmental health indicator. In this review, aspergillosis in humans and birds will be discussed, with focus on the presence of Aspergillus in the environment. We will relate these issues with the emergence of azole resistance on Aspergillus. These topics will be therefore considered and reviewed from the “One Health” perspective.

As the global COVID-19 pandemic advances, it increasingly impacts those vulnerable populations who already bear a heavy burden of neglected tropical disease. Chagas disease (CD), a neglected parasitic infection, is of particular concern because of its potential to cause cardiac, gastrointestinal, and other complications which could increase susceptibility to COVID-19. The over one million people worldwide with chronic Chagas cardiomyopathy require special consideration because of COVID-19's potential impact on the heart, yet the pandemic also affects treatment provision to people with acute or chronic indeterminate CD. In this document, a follow-up to the WHF-IASC Roadmap on CD, we assess the implications of coinfection with SARS-CoV-2 and Trypanosoma cruzi, the etiological agent of CD. Based on the limited evidence available, we provide preliminary guidance for testing, treatment, and management of patients affected by both diseases, while highlighting emerging healthcare access challenges and future research needs.

Urban green spaces (UGS) provide multiple benefits, and public parks in particular have a key role in supporting ecological and social sustainability in cities, contributing to human-nature interactions. We studied the interrelationships between uses, experiences and the environment by adopting a novel concept of urban biocultural diversity (BCD). The concept identifies three interlinked spheres of urban BCD: materialised, lived and stewardship. We conducted place-based research in 33 parks located in four European capitals: Helsinki, Berlin, Bucharest and Lisbon. A total of 1474 visitors were interviewed concerning their motivations to use the park and their experiences during the visit. Using an open-ended survey, we revealed more than 50 motivations for park use and over 100 features people enjoyed during their visits. On the other hand, visitors mentioned far fewer things that disturbed them (60). We revealed that despite the fact motivations to use parks were strongly human-oriented, visitors widely enjoyed the environmental characteristics of parks, and especially nature. We found that parks located in neighbourhoods with low socio-economic status and outside the central area of the city were structurally less diverse than parks located in the city core. The structurally diverse parks enhanced motivations to use them, and increased overall enjoyments of the environment. We revealed clear differences in motivations and enjoyments between cities, implying that the day-to-day practices of people using and experiencing nature varies between cities.

A investigação em Didática da Matemática é um campo científico relativamente recente, que se apoia em teorias e metodologias de outros campos das ciências sociais e humanas, mas lida com os seus problemas próprios, que resultam do seu objeto de estudo – o ensino-aprendizagem da Matemática e a formação dos respetivos professores. As suas questões assumem em cada país especificidades próprias, mas muitos conceitos e modelos desenvolvidos internacionalmente têm grande relevância para Portugal e, certamente, também para o Brasil. Este artigo revisita contributos fundamentais da investigação neste campo, cruzando ideias de autores internacionais com projetos e realizações portuguesas. Aborda também o modo como estes contributos influenciam em Portugal as práticas profissionais dos professores e os seus processos de formação e desenvolvimento profissional. Finalmente, discute o modo como pode evoluir a relação entre a investigação e o ensino, para que os professores se sintam mais capacitados na sua atividade profissional e, em conjunto com os investigadores (muitos dos quais são também professores ou formadores de professores), tenham mais condições para gerar conhecimento relevante e robusto para a melhoria do ensino da Matemática para todos os alunos.

O presente artigo apresenta os resultados de uma pesquisa inserida em um ciclo de intervenção de uma Investigação Baseada em Design (IBD) sobre o desenvolvimento do conhecimento didático de professores de Matemática, nomeadamente no que diz respeito à Estatística. Tem por objetivo compreender de que forma a articulação de um conjunto de princípios de design no contexto de uma experiência de formação pode contribuir para promover o conhecimento didático dos participantes. A análise de dados tem por base os seguintes princípios de design: utilização de tarefas de natureza exploratória; uso de situações autênticas de sala de aula; e uso da tecnologia. Os resultados sugerem que os princípios de design assumidos na experiência de formação contribuíram para o desenvolvimento do conhecimento dos professores no que se refere às potencialidades da abordagem exploratória da Estatística, de modo a expandir o seu conhecimento sobre as tarefas que possam subsidiar este ensino.

A 61-year-old male, former smoker and diabetic patient with a previous medical history noted for an inferior myocardial infarction complicated with left ventricular free wall rupture that had been surgically corrected 6 years prior, presented to the cardiology unit complaining of a new-onset dyspnoea, orthopnoea and fatigue which had started over the month prior to presenting.

Introduction: The understanding of the social representations about the functions of deliberate self-harm can be an important factor for the comprehension of this phenomenon. Nonetheless, only a few studies focused on this topic and specifically on the social representations from adolescents with and without a history of deliberate self-harm and their parents. Methods: This article presents two studies that analysed these representations. Study 1 compared the social representations from 411 Portuguese adolescents (219 females and 192 males, aged 12–19 years), from which 109 reported having a history of deliberate self-harm. Study 2 focused on the comparison of the social representations from 471 parents (265 mothers and 206 fathers, aged 33–62 years) of Portuguese adolescents. Of the parents in Study 2, 120 had children with a history of deliberate self-harm. Results: In Study 1, adolescents without a history of deliberate self-harm perceived most interpersonal functions as more relevant than adolescents with a history of these behaviours, while adolescents with a history of deliberate self-harm emphasized one intrapersonal function. In Study 2, no differences were found between parents of adolescents with and without a history of deliberate self-harm. However, results revealed differences between the representations of mothers and fathers in several intrapersonal functions. Conclusions: This research provides important insight regarding the social representations about the functions of deliberate self-harm from adolescents with and without a reported history of these behaviours and their parents. The impact for clinical intervention and prevention programs is discussed.

With the increased awareness about deliberate self-harm, the understanding of its social representations can be important for clinical intervention and prevention. However, there is still a lack of instruments to assess the social representations of the functions of these behaviors. This research focuses on the validation of the Questionnaire of Representations of the Functions of Deliberate Self-Harm for adolescents with and without a history of these behaviors. The basis for this questionnaire was the translation and adaptation of the Inventory of Statements About Self-Injury. To access adolescents' social representations, we conducted semidirective interviews and an analysis of the Portuguese written press, which complemented the questionnaire with new items and functions. Study 1 consisted of an exploratory factor analysis with a sample of 434 adolescents. Results revealed a 2-factor structure of interpersonal and intrapersonal dimensions. After item reduction, the factorial analysis of the independent functions showed acceptable psychometric values. This structure was corroborated in Study 2 by a confirmatory factor analysis with a new sample of 405 adolescents, which revealed an acceptable model fit. This questionnaire presents a relatively solid structure and is based on acceptable psychometric properties, which allows its use in future research.

Background: A transient postoperative drop in platelet count is an expected finding after aortic valve replacement using extracorporeal circulation. The implantation of the Perceval valve has been associated with a more intense drop of platelet count compared to other bio-prostheses. This study analyses and compares the platelets progression associated with the Perceval and Intuity valves. Methods: The data was collected retrospectively for patients submitted to isolated aortic valve replacement with the Perceval valve (80 patients) and the Intuity valve (141 patients) in our institution between March 2014 and December 2018. The groups were further divided into those who receive platelet transfusion and those who did not. Results: The minimum values of platelet count were 54% and 67% of the preoperative platelet count in the patients treated with a Perceval and an Intuity valves, respectively (p<0.001). In the patients transfused with platelets, the minimum values were 52% and 79% of the preoperative platelet count, respectively (p<0.01). Recovery of the count was faster in the patients treated with an Intuity valve. Abnormal bleeding and transfusion of packed red blood cells were not significantly different between groups (without platelet transfusion: p=0.71 and p=0.99, respectively; with platelet transfusion: p=0.58 and p=0.99, respectively). Conclusion: Compared to the Intuity valve, the Perceval valve is associated with a transient, but significant, drop in platelet count. This drop was not associated to an increased risk of bleeding. Platelet transfusion, in this setting, should be judicious and not only ruled by absolute values.

Estudo da sociedade portuguesa nos alvores da Época Moderna, a partir da análise, na sua totalidade, da obra do grande dramaturgo português Gil Vicente, aprofundando-se a explicação de perspectivas com base tanto na observação das suas estratégias discursivas quanto no confronto com outros testemunhos epocais. Prefaciado por Luís de Albuquerque (UC). Divulga-se no Repositório um excerto, com autorização da Autora e do Editor.

Background and purpose: Pregnancy and puerperium are associated with an increased risk of venous thrombotic events (VTEs), including cerebral venous thrombosis (CVT). We aimed to systematically review, in pregnant woman with previous CVT, (1) the risk of recurrence of CVT or other VTE; (2) the result of pregnancy; and (3) the association of antithrombotic prophylaxis with these outcomes. Methods: We searched MEDLINE, Cochrane Database of Systematic Reviews, clinicaltrials.gov (from inception to July 2015), and reference lists of included studies and review articles. We considered observational studies reporting original data on the frequency of CVT or other VTE associated with pregnancy or puerperium in women with history of CVT. Results: Thirteen studies were included. A simple pooled analysis of individual patient data and meta-analysis of proportions using a random effect model were performed. (1) 1 CVT recurrences/217 pregnancies (9 per 1000; 95% confidence interval, 3-33) and 5 noncerebral VTE/186 pregnancies (27 per 1000; 95% confidence interval, 12-61). (2) Pregnancy outcome: 33 spontaneous abortions/186 pregnancies (17.7%; 95% confidence interval, 13-24). (3) Data on the risk of CVT/extracerebral VTE according to antithrombotic prophylaxis was limited. Miscarriage did not differ significantly in women undergoing antithrombotic therapy or not (11.3% versus 18.8%; P=0.34). Conclusions: In women with previous CVT, the absolute risk of pregnancy-related venous thrombosis is low but the relative risk of noncerebral VTE is 16-fold higher and the recurrence of CVT is 80-fold higher than the baseline risk described in general population studies. The rate of miscarriage is not significantly different from that estimated for the general population.

Objective: To identify characteristics, predictors, and outcomes of acute symptomatic seizures (ASS) in cerebral venous thrombosis (CVT), we investigated 1,281 consecutive adult patients with CVT included from 12 hospitals within the International CVT Consortium. Methods: We defined ASS as any seizure between symptom onset and 7 days after diagnosis of CVT. We stratified ASS into prediagnosis and solely postdiagnosis ASS. Status epilepticus (SE) was also analyzed separately. We analyzed predictors for ASS and the association between ASS and clinical outcome (modified Rankin Scale) with multivariable logistic regression. Results: Of 1,281 eligible patients, 441 (34%) had ASS. Baseline predictors for ASS were intracerebral hemorrhage (ICH; adjusted odds ratio [aOR] 4.1, 95% confidence interval [CI] 3.0-5.5), cerebral edema/infarction without ICH (aOR 2.8, 95% CI 2.0-4.0), cortical vein thrombosis (aOR 2.1, 95% CI 1.5-2.9), superior sagittal sinus thrombosis (aOR 2.0, 95% CI 1.5-2.6), focal neurologic deficit (aOR 1.9, 95% CI 1.4-2.6), sulcal subarachnoid hemorrhage (aOR 1.6, 95% CI 1.1-2.5), and female-specific risk factors (aOR 1.5, 95% CI 1.1-2.1). Ninety-three (7%) patients had solely postdiagnosis ASS, best predicted by cortical vein thrombosis (positive/negative predictive value 22%/92%). Eighty (6%) patients had SE, independently predicted by ICH, focal neurologic deficits, and cerebral edema/infarction. Neither ASS nor SE was independently associated with outcome. Conclusion: ASS occurred in one-third of patients with CVT and was associated with brain parenchymal lesions and thrombosis of the superficial system. In the absence of prediagnosis ASS, no subgroup was identified with sufficient risk of postdiagnosis ASS to justify prophylactic antiepileptic drug treatment. We found no association between ASS and outcome.

Herpes simplex virus 2 (HSV-2) is a very rare cause of central nervous system (CNS) infections. We report a case of a young woman with a left middle cerebral artery (MCA) ischemic stroke. The patient had history of HIV-1 infection, with periods of therapeutic non-compliance. Initial computed tomography (CT) imaging studies showed stenosis of the M1 segment of the left MCA, and magnetic resonance imaging (MRI) confirmed infarction of the MCA territory. Serial transcranial Doppler ultrasound revealed progressive occlusion of the MCA and stenosis of the left anterior cerebral artery. Systemic investigation for other causes of stroke was normal. Lumbar puncture revealed a mildly inflammatory cerebrospinal fluid, and HSV-2 DNA was identified by PCR, with a positive viral load in favor of active replication. No other viral or microbiological infections were identified. MRI angiography confirmed a vasculitic process involving the left carotid artery, and a HSV-2 vasculitis diagnosis was assumed. The patient started acyclovir with improvement of clinical features and imaging abnormalities. In the HIV-infected patient, stroke is a multifactorial common cause of morbidity. The physician should take into account a broad differential diagnosis including rare causes and atypical presentations of common etiologies, including HSV-1 and HSV-2 CNS infection.

As a medical student, I have now almost 6 years of academic studies and clinical interaction with numerous patients, though sometimes brief and superficial. I have found that sometimes it is truly hard to grasp how humane a person is behind their sickness. Fortunately, I have been hitherto able to avoid the almost natural desensitization our degree imposes upon us, either through my own process of thought or through a kind warning of some of "my" patients. Having been particularly thrown aback by the keen eye of a patient I had the opportunity to meet in an Oncology ward, I realized that I had much more to consider when studying a clinical case and that rarely a cancer (or a disease whatever it may be) is but a cancer. In fact, a disease needs a patient to be diagnosed upon and that patient has most often a life besides their disease.