Repositório RCAAP

Carbapenem-resistant Enterobacteriaceae (CRE), Acinetobacter baumannii (CRAB), and Pseudomonas aeruginosa (CRPsA) are a serious cause of healthcare-associated infections, although the evidence for their control remains uncertain. We conducted a systematic review and reanalysis to assess infection prevention and control (IPC) interventions on CRE-CRAB-CRPsA in inpatient healthcare facilities to inform World Health Organization guidelines. Six major databases and conference abstracts were searched. Before-and-after studies were reanalyzed as interrupted time series if possible. Effective practice and organization of care (EPOC) quality criteria were used. Seventy-six studies were identified, of which 17 (22%) were EPOC-compatible and interrupted time series analyses, assessing CRE (n = 11; 65%), CRAB (n = 5; 29%) and CRPsA (n = 3; 18%). IPC measures were often implemented using a multimodal approach (CRE: 10/11; CRAB: 4/5; CRPsA: 3/3). Among all CRE-CRAB-CRPsA EPOC studies, the most frequent intervention components included contact precautions (90%), active surveillance cultures (80%), monitoring, audit and feedback of measures (80%), patient isolation or cohorting (70%), hand hygiene (50%), and environmental cleaning (40%); nearly all studies with these interventions reported a significant reduction in slope and/or level. The quality of EPOC studies was very low to low.

Epithelial⁻mesenchymal transition (EMT) is a cellular process by which differentiated epithelial cells undergo a phenotypic conversion to a mesenchymal nature. The EMT has been increasingly recognized as an essential process for tissue fibrogenesis during disease and normal aging. Higher levels of EMT proteins in aged tissues support the involvement of EMT as a possible cause and/or consequence of the aging process. Here, we will highlight the existing understanding of EMT supporting the phenotypical alterations that occur during normal aging or pathogenesis, covering the impact of EMT deregulation in tissue homeostasis and stem cell function.

Introdução: O Burnout no estudante refere-se ao exceder dos recursos emocionais devido à exigência do estudo, cinismo e desempenho acadêmico reduzido. As consequências são relevantes, pelo que os fatores de risco e proteção do burnout não devem ser negligenciados. Há poucos estudos sobre as variáveis psicológicas e influência no burnout em estudantes de medicina em Portugal. Foi desenhado um modelo estrutural para estimar os efeitos das estratégias de coping, satisfação com o suporte social, distress geral, no envolvimento académico, burnout do aluno e intenção de abandono do curso, numa amostra de estudantes de medicina portugueses, com a intenção de planear intervenções futuras para prevenir o Burnout. Métodos: Neste estudo transversal, a amostra foi composta por 532 alunos, matriculados no 1.º e 2.º ano do Mestrado Integrado em Medicina da Faculdade de Medicina da Universidade de Lisboa em 2020. Os dados foram recolhidos através de instrumentos psicométricos de autorrelato online (Maslach Burnout Inventory - Student Survey, Social Support Satisfaction Scale for College Students, Brief COPE Scale for College Students, University Student Engagement Inventory, e Depression, Ansiety and Stress Scale) juntamente com variáveis sociodemográficas e académicas. Os dados foram analisados por meio de modelos de equações estruturais (análise fatorial confirmatória e modelo estrutural latente). Resultados: O modelo estrutural das variáveis latentes apresentou um bom ajuste aos dados e confirmou que em relação à intenção de abandono, o efeito da satisfação com o suporte social e coping adaptativo é negativo, enquanto o efeito do coping desadaptativo, depressão, stress e ansiedade é positivo. Conclusão: A satisfação com suporte o social, o distress geral, o coping adaptativo e mal-adaptativo são preditores de burnout do aluno, que por sua vez, prediz a intenção de abandono. O envolvimento académico atua como um protetor das intenções de abandono e atenua o efeito do burnout na intenção de abandono.

Autoimmune/autoinflammatory syndrome induced by adjuvants (ASIA) is a new entity in which exposure to an adjuvant triggers an aberrant autoimmune response. Metallosis is a rare condition characterized by the deposition and build-up of metal debris in the soft tissues of the body associated with metal-on-metal (MOM) prosthetic devices. It can present with local/systemic symptoms and signs due to a chronic inflammatory host response. The authors present the case of a 51-year-old woman with a 6-month history of systemic complaints due to intoxication with metal ions from hip metallosis. This case highlights the importance of follow-up and continuous monitoring of patients with a hip prosthesis. As this is a rare condition, a patient presenting with unspecific symptoms such as ASIA syndrome induced by metallosis requires a high level of clinical suspicion as the removal of the adjuvant can resolve the condition. Learning points: Asia syndrome is a new entity in which exposure to an adjuvant triggers an aberrant autoimmune response.Metallosis is an uncommon condition with local and systemic presentation.A high level of suspicion and close monitoring is needed in patients with vague systemic complaints.

Purpose of review: This article reviews recent literature regarding the neurological manifestations of cardiac tumors, including diagnosis, pathophysiology, and treatment. Recent findings: Clinical cases of patients with acute ischemic stroke due to cardiac tumors who were treated with intravenous alteplase show a favorable safety profile. Mechanical thrombectomy seems to be a reasonable treatment alternative for these patients, when there is a large vessel occlusion. Histopathology analysis of mechanical thrombectomy specimens may allow the diagnosis of a cardiac tumor. Prolonged time interval between stroke and tumor excision surgery is significantly associated with stroke recurrence. Myxomatous aneurysms are a late complication of cardiac myxomas, which commonly demand imaging follow-up after excision of the primary tumor. Aneurysms are more frequent in patients who present with other embolic complications. Conservative treatment of myxomatous aneurysms is a reasonable strategy, as the majority of aneurysms remain stable over many years. Spontaneous regression of these formations has been documented after excision of the primary tumor. Other complications recently described include acute psychosis and mononeuropathy multiplex. Cardiac tumors are rare. There are mainly case reports and retrospective case series describing the neurological manifestations of cardiac tumors. Hyperacute stroke treatment seems to be safe, and mechanical thrombectomy is a reasonable treatment. A conservative approach towards myxomatous aneurysms should be considered.

Ataxia telangiectasia mutated and Rad3-related (ATR) kinase is a key factor activated by DNA damage and replication stress. An alternative pathway for ATR activation has been proposed to occur via stalled RNA polymerase II (RNAPII). However, how RNAPII might signal to activate ATR remains unknown. Here, we show that ATR signaling is increased after depletion of the RNAPII phosphatase PNUTS-PP1, which dephosphorylates RNAPII in its carboxy-terminal domain (CTD). High ATR signaling was observed in the absence and presence of ionizing radiation, replication stress and even in G1, but did not correlate with DNA damage or RPA chromatin loading. R-loops were enhanced, but overexpression of EGFP-RNaseH1 only slightly reduced ATR signaling after PNUTS depletion. However, CDC73, which interacted with RNAPII in a phospho-CTD dependent manner, was required for the high ATR signaling, R-loop formation and for activation of the endogenous G2 checkpoint after depletion of PNUTS. In addition, ATR, RNAPII and CDC73 co-immunoprecipitated. Our results suggest a novel pathway involving RNAPII, CDC73 and PNUTS-PP1 in ATR signaling and give new insight into the diverse functions of ATR.

Introduction: Respiratory function is a critical predictor of survival in amyotrophic lateral sclerosis (ALS). We aimed to determine if slow vital capacity (SVC) is a predictor of functional loss in ALS as compared to forced vital capacity (FVC). Methods: Consecutive ALS patients in whom respiratory tests were performed at baseline and 6 months later were included. All patients were evaluated with revised ALS functional rating scale (ALSFRS-R) and the respiratory tests, SVC, and FVC. Significant independent variables of functional decay were assessed by univariate Kaplan-Meier log-rank test and multivariate Cox proportional hazards model. A monthly decay not exceeding 0.92 in ALSFRS was considered as the time event. Results: We included 232 patients (134 men; mean onset-age 59.1 ± 11.23 years; mean disease duration from first symptoms to first visit: 14.5 ± 12.9 months; 166 spinal and 66 bulbar onset). All variables studied declined significantly between the two evaluations (p < 0.001). FVC and SVC were strongly correlated at study entry (r 2 = 0.98, p < 0.001) and FVC and SVC decays between first evaluation and 6 months after were the only significant prognostic variables of functional decay (p < 0.001). Conclusion: FVC and SVC decay are inter-changeable in predicting functional decay in ALS. Pharmacological interventions reducing the decline rate of FVC and SVC can have a positive impact on the global functional impairment, with relevant implications for clinical trials' design and interpretation.

A realização deste tipo de investigação é fundamental para se obter informação clara acerca das práticas relacionadas com o CI em Portugal e se poder implementar ações de melhoria nas áreas em que se detetarem lacunas. Tal como referido pelos autores, é fundamental que este tipo de trabalho tenha um alcance multicêntrico e maior abrangência para verdadeiramente se caraterizar a realidade nacional. O conceito de ghost surgery consiste na realização de procedimentos invasivos, cirúrgicos ou outros, por elementos que não obtiveram explicitamente consentimento para a realização do mesmo independentemente da presença do ‘médico supervisor’.

A presente revisão tem como objetivo estudar o impacto da pandemia COVID-19 na saúde mental dos profissionais de saúde, com particular atenção para a associação entre a depressão, ansiedade e burnout nos profissionais de saúde e a pandemia COVID-19. A metodologia utilizada foi a de uma revisão não sistemática da literatura, tendo sido realizada uma pesquisa com os termos “COVID-19”, “anxiety”, “depression”, “burnout”, “mental health” e “healthcare workers”, na PubMed e na Cochrane. Os resultados indicam que os profissionais de saúde, antes do início da pandemia COVID-19, apresentavam uma maior prevalência de depressão, ansiedade e burnout comparativamente à população em geral. Durante a pandemia, observou-se um aumento da prevalência das patologias referidas acima, especialmente em profissionais de saúde com contacto direto com doentes com COVID-19. Foram ainda identificadas várias estratégias, que têm sido sugeridas e implementadas, de modo a diminuir o impacto da pandemia na saúde mental dos profissionais de saúde, apesar da escassa evidência científica disponível acerca da sua eficácia. Assim, é essencial a realização de estudos adicionais sobre o tema de modo a controlar fatores de risco e desenvolver estratégias, passíveis de serem adotadas pelas organizações de saúde, para diminuir os níveis de burnout, ansiedade e depressão, garantindo que os profissionais de saúde se encontram nas melhores condições para combater a pandemia COVID-19.

Background: the European Union of Medical Specialists (UEMS-GMS) recommendations for training in Geriatric Medicine were published in 1993. The practice of Geriatric Medicine has developed considerably since then and it has therefore become necessary to update these recommendations. Methods: under the auspices of the UEMS-GMS, the European Geriatric Medicine Society (EuGMS) and the European Academy of Medicine of Ageing (EAMA), a group of experts, representing all member states of the respective bodies developed a new framework for education and training of specialists in Geriatric Medicine using a modified Delphi technique. Thirty-two expert panel members from 30 different countries participated in the process comprising three Delphi rounds for consensus. The process was led by five facilitators. Results: the final recommendations include four different domains: 'General Considerations' on the structure and aim of the syllabus as well as quality indicators for training (6 sub-items), 'Knowledge in patient care' (36 sub-items), 'Additional Skills and Attitude required for a Geriatrician' (9 sub-items) and a domain on 'Assessment of postgraduate education: which items are important for the transnational comparison process' (1 item). Conclusion: the current publication describes the development of the new recommendations endorsed by UEMS-GMS, EuGMS and EAMA as minimum training requirements to become a geriatrician at specialist level in EU member states.

Introdução: As hormonas tiroideias têm um papel importante na manutenção da temperature corporal enquanto ocorrem variações da temperatura ambiente. Tanto a idade como a estação do ano podem infulenciar a função e autoimunidade tiroideias. Objectivos: Explorar os efeitos da idade, tempo de evolução da doença e estação do ano na função e autoimunidade tiroideias. Doentes e Métodos: Análise retrospetiva da base de dados da consulta externa de endocrinologia de um hospital central público. Foram selecionados doentes com tiroidite de Hashimoto (HT) e Bócio Nodular Simples (SNG) sem tratamento com hormonas tiroideias e com análises laboratoriais colhidas no verão ou inverno. A análise estatística foi realizada para detetar diferenças na função e autoimunidade tiroideias ao longo do tempo e entre estações do ano. Resultados: Verificou-se uma redução significativa dos níveis de T4 em doentes com SNG e dos níveis de T4, T3 e TPOAb em doentes com HT, ao longo do tempo. Não foram encontradas diferenças estatisticamente significativas na função e autoimunidade tiroideias quando comparadas avaliações do verão e inverno. No entanto, há uma tendência estatística para a redução de T4, FT4 e TgAb no verão. Foi observada uma redução estatisticamente significativa dos níveis de T4 do inverno para o verão. Conclusão: A idade/tempo parece ser um fator relevante na função tiroideia com uma redução dos níveis de T4 em doentes com SNG e redução dos níveis de T3 e T4 em doentes com HT, sendo que estas alterações não causam disfunção tiroideia. Uma redução da função e autoimunidade tioirdeia é sugerida pela tendência estatística para a redução dos níveis de T4, FT4 e TgAb no verão e redução estatisticamente significativa dos níveis de T4 observada do inverno para o verão.

Brain atrophy as measured from structural MR images, is one of the primary imaging biomarkers used to track neurodegenerative disease progression. In diseases such as frontotemporal dementia or Alzheimer's disease, atrophy can be observed in key brain structures years before any clinical symptoms are present. Atrophy is most commonly captured as volume change of key structures and the shape changes of these structures are typically not analysed despite being potentially more sensitive than summary volume statistics over the entire structure. In this paper we propose a spatiotemporal analysis pipeline based on Large Diffeomorphic Deformation Metric Mapping (LDDMM) to detect shape changes from volumetric MRI scans. We applied our framework to a cohort of individuals with genetic variants of frontotemporal dementia and healthy controls from the Genetic FTD Initiative (GENFI) study. Our method, take full advantage of the LDDMM framework, and relies on the creation of a population specific average spatiotemporal trajectory of a relevant brain structure of interest, the thalamus in our case. The residuals from each patient data to the average spatiotemporal trajectory are then clustered and studied to assess when presymptomatic mutation carriers differ from healthy control subjects. We found statistical differences in shape in the anterior region of the thalamus at least five years before the mutation carrier subjects develop any clinical symptoms. This region of the thalamus has been shown to be predominantly connected to the frontal lobe, consistent with the pattern of cortical atrophy seen in the disease.

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The identification that T follicular helper (Tfh) cells is critical for the emergence of germinal centre responses prompted the study of CXCR5-expressing CD4+ T cell subsets in autoimmunity. However, circulating CXCR5-expressing T cells are heterogeneous by containing Forkhead box protein 3 (FoxP3)+ T follicular regulatory (Tfr) cells in addition to bona fide Tfh cells. Such heterogeneity may hamper the analysis of the contribution of specific follicular T cell subsets for autoimmune pathogenesis. Therefore, separate assessment of Tfh and Tfr populations offer greater opportunities for stratification of autoimmune patients, such as Sjögren's syndrome patients.

This article intents to offer a panoramic view of the field of Iberian Studies, a fairly young academic field devoted to the study of Iberian literatures and cultures, which has gained some level of recognition and visibility in recent years. I will present its multiple genealogy, its different origins and theoretical foundations in diverse geographical and academic spaces; its current state, with a quantitative and qualitative analysis of its publications and of its level of institutionalization, and some proposals for its future development, based on the most recent debates and criticisms about this discipline. I will try to show that, without any intention of becoming homogenic or hegemonic, Iberian Studies have promoted new ways of studying Iberian cultures superseding linguistic, political or academic barriers.

No summary/description provided

No summary/description provided

Os grandes temas recebidos dos gregos são convocados por Al Berto sobre o horizonte da percepção da imanência, a percepção das coisas como inscritas numa matéria única. A meditação sobre o espaço, o movimento dos corpos, ou a meditação sobre os tempos, os devires indeterminados das coisas no crepúsculo, ou ainda as experiências em negativo do ser, os abismos de um corpo em desaparecimento a partir do seu próprio interior tudo isso é registado no plano da univocidade do ser. Essa percepção da imanência tem, na sua poesia, a forma da experiência de um devir-texto do corpo, de um devir-anjo que convoca com o seu silêncio o devir-imperceptível. Pelo tempo e pelo espaço a poesia de Al Berto se deixa pensar. Mas há muito mais ressonâncias dessa metafísica da imanência que podem ser descobertas em O Medo ou em O Anjo Mudo. A estrutura dos afectos é desde a raiz pensada no registo da imanência. Ao contrário de Heidegger e da sua distinção entre a angústia e o medo distinção que remete para uma diferença entre o ser afectado pelo nada, por algo que não pertence à esfera da percepção, e o ser vítima da representação aterradora de algo que nos aparece como hostil ou ameaçador Al Berto, como Deleuze, faz sempre da paixão, da estrutura da passividade, do poder de ser afectado, algo de material, de imanente ao mundo dos corpos e da coisas. O modo essencial de estar no mundo não é a angústia, mas o medo, essa promiscuidade permanente entre a nossa vida e o mundo que nos toca, invade, ou que simplesmente nos abandona. Do nada não há angústia mas medo, porque o nada tem, para Al Berto, a condição, não de algo que se dá na sua não aparência, mas a da ausência, do desaparecimento.

The field of urban creativity studies has a broad range of interests including, but not limited to, street art, graffiti, urban foraging, parkour, skateboarding and guerrilla gardening. However, as with any field, once it starts to settle, a dominant paradigm tends to emerge. This will to some degree influence what is considered the core of the field, not only in terms of objects of study, but also in terms of method and theoretical approaches

The field of urban creativity studies has a broad range of interests including, but not limited to, street art, graffiti, urban foraging, parkour, skateboarding and guerrilla gardening. However, as with any field, once it starts to settle, a dominant paradigm tends to emerge. This will to some degree influence what is considered the core of the field, not only in terms of objects of study, but also in terms of method and theoretical approaches.