Repositório RCAAP

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Background: This study aimed to validate a semi-quantitative composite score tool, "Headache Gauge" (HG), to monitor the treatment effect in primary headaches in everyday clinic practice, adjustable to any chosen timeframe. Method: A cohort validation study of HG was performed in primary headache patients, recovering their clinical data and patient-related outcome measures (PROMs) for headache (HIT-6, MIDAS, HURT), work impact (WPAIQ), quality-of-life (SF-12), and mood (STAI, ZUNG). HG score distribution, its relation to clinical variables, its internal consistency, and its convergent validity were determined. Results: HG was plotted in 233 patients: 90.1% females, age average 37 years, 86% with migraine, 27% with chronic headaches, and 28% with medication overuse. HG ranged from 0.21 to 58.3 in this sample, higher in chronic headaches (HG 16) and medication overuse (HG 15). HG presented good concurrent validity, significantly correlating with HIT-6 (p < 0.0001), SF-12 (p = 0.001), WPAIQ (p < 0.0001), MIDAS (p < 0.0001), and HURT (p < 0.0001). Good sensitivity to change (p < 0.001) and moderate test-retest reliability (p = 0.001) were calculated after reassessment of 147 patients (63.1% of the initial sample). Conclusions: Headache Gauge is a clinical data-based outcome measure that conceptually translates the percentage of lost time to headache in any given timeframe. It relates to headache impact, therefore bearing the potential to be relevant in real-life clinical monitoring.

Several studies show that many water bodies in developing countries are increasingly affected by anthropogenic pressure, such as agricultural activities, domestic and industrial wastewater. However, data is scarce in several of such countries, including Panama. Thus, in this work, the ecotoxicological status of selected rivers in Panama with distinct input sources were evaluated using the zebrafish (Danio rerio) embryo bioassays combined with a liquid chromatography-high resolution mass spectrometry screening of contaminants of emerging concern (CECs), using a library of over 3200 chemicals. A total of 68 CECs, including pharmaceuticals and metabolites, pesticides and several industrial chemicals, could be tentatively identified. Additionally, the zebrafish embryo bioassays showed a significant increase (p < 0.05) in embryo mortality/abnormalities when incubated with water samples from two rivers, Matasnillo and Curundú (47.5% and 32%, respectively). Importantly, a positive correlation between ecotoxicological endpoints and some of the detected CECs was observed. The findings demonstrate that both rivers are under strong anthropogenic pressure, and therefore, management actions are urgently needed to decrease their level of contamination. Overall, this study further supports the use of the zebrafish embryo bioassay as a fast, high throughput approach for screening the toxicity of water samples, and highlights the advantages of combining ecotoxicological assays with high-resolution mass spectrometry to an expedite assessment of the ecotoxicological status of water bodies.

O presente estudo pretende analisar o modo como o processo de secularização abriu portas para um mundo onde é possível uma convivência mútua entre fé e razão e onde as dinâmicas de laicidade procuram funcionar como garantia da existência de um diálogo pacífico entre fé e razão. No entanto, apesar dos resultados dos processos de secularização e da laicidade o mundo contemporâneo é muitas vezes caracterizado como um mundo onde não há espaço para a religião, e a mesma é muitas vezes perspetivada como causadora de violência, intolerância e preconceitos. E, apesar da vasta crença que a religião vai deixar de existir, com a soberania da ciência e da razão, tal não é visível em muitas das sociedades contemporâneas, designadamente em Portugal. Acompanhando e sistematizando aquele debate do ponto de vista contextual, o nosso estudo detém-se sobre a problemática do ensino da religião como desempenhando um papel fundamental na quebra daqueles preconceitos, quando transmite a religião de forma histórica e crítica. Partindo da premissa de que o homem para além de racional é também um ser religioso, averiguamos da pertinência da religião, como criação humana, fazer parte integrante dos programas escolares como o fazem outras áreas das humanidades e das ciências.

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Nesta dissertação procura‑se entender, sob as luzes das Investigações de Wittgenstein, a linguagem como uma partida ou um jogo, cuja cintura se exercita a partir da utilização de determinadas regras, da assimilação de costumes e técnicas que propulsionam os rebentos de homens à integração no mundo. Para isso, pretende‑se demonstrar que o processo de aprendizagem, que não se coaduna com um sistema automático de impressão direta de informação – tendo em vista que as crianças não se assemelham de forma alguma a autómatos programáveis, tais como a fita Kynodontas as simula –, deve passar pela Filosofia, em virtude do seu papel insubstituível na formação e no desenvolvimento, por um lado, de clareza e elucidação do mundo nos rebentos, por outro, do pensamento, da imaginação, da individualidade das crianças. Então, perceber‑se‑á que aquilo que compete aos educadores e aos demais pedagogos não é nada mais senão apresentar aos rebentos o mundo tal como é visto e concebido, mediante aquilo que é conhecido e através do que efetivamente é, mas principalmente convidá‑los a compartilhá‑lo.

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Streptococcus agalactiae (group B streptococci, GBS) is primarily a colonizing agent of the genitourinary and gastrointestinal tracts of a significant proportion of the human population. It is, however, well established as a leading cause of bacterial sepsis and meningitis in neonates and is increasingly associated with invasive infections in adults. While vertical transmission is commonly accepted to be the cause of early-onset disease, the source of bacterial strains causing infection in the late-onset period is less well understood. Administration of intrapartum antimicrobial prophylaxis to colonized women has resulted in a striking decline in early-onset and maternal GBS disease, but late-onset infections have mostly remained unchanged. Moreover, antimicrobial prophylaxis raised concerns as to selection and emergence of GBS resistant strains and alternative prevention strategies have focused on the development of vaccines that hold promising, although still preliminary results. The aim of the work presented in this thesis was to characterize the population structure of GBS in Portugal, and to assess the genetic diversity of isolates recovered from vaginal colonization and invasive disease in different age groups, to contribute to the global epidemiology of GBS and our understanding of GBS population biology. To this end a set of common techniques was chosen, including serotyping, antimicrobial susceptibility testing, pulsed field gel electrophoresis (PFGE), multilocus sequence typing (MLST) and surface protein gene profiling. In combination, these methods allowed the identification of the main genetic lineages circulating in Portugal and Barcelona, providing the means for an appropriate comparison of both. These studies started with the comparison of 64 isolates recovered from invasive infections in newborns in the Lisbon area with 269 isolates colonizing women in the third trimester of pregnancy, from the same period. The genetic lineages defined by both PFGE and MLST identified very diverse populations with reported differences in the prevalence of serotypes and clones in carriage and invasive disease. A major finding concerned the identification of an unusually high proportion of ST24 isolates among serotype Ia, further strengthened by the independent study of another population (212 neonatal isolates) from the Barcelona area. Despite the geographic distance, both studies from Barcelona and Lisbon revealed extensive similarity in terms of clonal structure and genetic lineages. The high prevalence in both the studies of a particular lineage serotype Ia, defined by ST24 and the surface protein gene bca, highlighted the importance of local dynamics, indicating that genetic evolution of GBS presents with a geographic structure and may depend on local factors. The subsequent analysis of 225 isolates recovered from non-pregnant adults in Portugal revealed a GBS population dominated by a more diverse clonal composition when compared to that of neonates, consistent with the broader spectrum of disease presentation in these patients and consequent multiplicity of genetic lineages. Invasive disease in this population increased with age and was more frequent among men. The dominance of serotype Ia in this population, regardless of age, highlighted the importance of this serotype in GBS pathogenesis as a leading cause of invasive infections in adults, not reported elsewhere but already noted among neonatal infections in the Iberian Peninsula. Furthermore, the high prevalence of ST24 in all these studies, as opposed to rare descriptions elsewhere, suggested that this lineage had enhanced invasiveness and was probably expanding as a regionally successful clone that may disseminate more globally. Macrolide resistance rates in Portugal did not show significant trends, even if macrolides have been used in intrapartum prophylaxis increasing the selective pressure on GBS. Macrolide resistance is disseminated in Portugal by both a multiclonal mechanism resulting from the spread of resistance genes throughout most serotypes and genetic backgrounds, as well as by clonal expansion of particular lineages, such as the serotype V ST1/alp3. One of the main purposes of the analysis of a significant number of GBS isolates was their classification into lineages sharing the same genetic background, which would allow the inference of genetic relationships between strains and their contextualization in the global epidemiology of GBS. However, the associations of phenotype-genotype or between different genetic traits were never absolute, highlighting the role of horizontal genetic transfer in the evolution of GBS. Capsular switching was anticipated to occur frequently within GBS, even though this species is not recognized to be naturally competent for the acquisition of foreign DNA. Substantial evidence provided by the epidemiological studies performed on the Portuguese GBS collections drove the search for capsular transformants within these populations. The results obtained confirmed the existence of capsular switching in GBS, but questioned the high frequency of these events estimated from previous studies. Serotyping errors probably justified the overrepresentation of capsular switching in epidemiological studies. The mechanism for these genetic transfer events involved the replacement of the whole capsular locus instead of the previously proposed genetic transfer of only the serotypespecific genes. Globally, the results presented in this thesis suggest that GBS has an apparent remarkably stable, both temporally and geographically, clonal structure. Against this, background diversification is ongoing and can depend on local factors. Capsular switching is likely contributing to diversification, however not as frequently as initially thought and may impact on the vaccine formulations currently under development. Despite increasing information on maternal colonization and invasive disease, a better understanding of colonization in adults and natural reservoirs of GBS is required for the appropriate management of the GBS infections.

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Objetivo: Quantificar a permeabilidade dentinária, medida em termos de condutividade hidráulica, do sistema adesivo universal Prime&Bond active® (Dentsply Sirona), aplicado na dentina de acordo com a técnica total-etch, introduzindo desvios no protocolo de aplicação definido pelo fabricante. Materiais e Métodos: Trinta dentes (N=30) foram preparados e divididos aleatoriamente por três grupos de estudo - Grupo I (controlo), seguindo as instruções do fabricante; Grupo II, reduzindo o tempo de aplicação do adesivo para 5 segundos; Grupo III, aumentando o tempo de secagem do adesivo para 10 segundos. Foi medida a permeabilidade máxima de cada espécime após a aplicação de ácido fosfórico 37% durante 15 segundos. De seguida, foi aplicado o adesivo universal pela técnica total-etch de acordo com o protocolo do grupo no qual o espécime se inseria. A taxa de fluxo em milímetros por minuto foi calculada tendo por base a observação do fluxo ao longo de um intervalo de 6 minutos, permitindo assim o cálculo da redução da permeabilidade dentinária. Os resultados foram analisados com o teste não-paramétrico de Kruskal-Willis, tendo a normalidade sido verificada pelo teste de Kolmogorov-Smirnov e a homogeneidade das variâncias pelo teste de Levene. Resultados: O Grupo III obteve os valores de redução de permeabilidade dentinária mais elevados (88±20,98%), seguido do Grupo I (controlo) (80±25,82%) e, por último, o Grupo II (28,67±35,94%). A diferença na redução de permeabilidade dentinária foi estatisticamente significativa entre os Grupos I e II (p=0,005), mas não entre os Grupos I e III (p=0,616). Conclusão: A redução do tempo de aplicação do adesivo para 5 segundos afeta significativamente os valores de redução de permeabilidade dentinária. O aumento do tempo de secagem para 10 segundos não revelou afetar significativamente os valores de redução de permeabilidade dentinária.

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