Browsing by Issue Date, starting with "2022-07-06"
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- Fibrose Pulmonar após ARDS – Revisão da LiteraturaPublication . Rocha, Marcelo Filipe Figueiredo; Sousa, Miguel Castelo Branco Craveiro deA fibrose pulmonar consiste na degradação compacta da matriz extracelular no interstício dos pulmões associada à destruição do parênquima pulmonar, resultando na perda de função pulmonar, podendo ser esta uma das consequências da Síndrome de Dificuldade Respiratória Aguda (SDRA) em doentes internados numa Unidade de Cuidados Intensivos (UCI). Tendo por base o exposto, objetiva-se validar evidência científica sobre a fibrose pulmonar em doentes pós SDRA. Foi realizada uma revisão literária segundo a metodologia proposta pela Joanna Briggs Institute. Procedeu-se à pesquisa de estudos datados entre 2014 e 2022, nos idiomas português e inglês, recorrendo às seguintes bases de dados: Medline/Pubmed, Web of Science e LILACS. Dois revisores independentes realizam a avaliação crítica, extração e síntese dos dados. Foram incluídos cinco estudos. Os resultados dos mesmos evidenciaram casos de fibrose pulmonar em doentes pós SDRA, com maior duração do uso de ventilador e com tempo na UCI significativamente mais elevado. A mortalidade hospitalar é também mais elevada no grupo de doentes com fibrose pulmonar.
- Evolution of the Online Grocery Shopping Experience during the COVID-19 Pandemic: Empiric Study from PortugalPublication . Gomes, Sofia; Lopes, JoãoOnline shopping has intensified in the last decade. The COVID-19 pandemic has imposed circulation limitations and more restrictive behaviors on consumers due to fears of contracting the virus, boosting online grocery shopping. This study aims to assess the relationship between the online food purchasing experience during the pandemic and the intention to purchase food online after the pandemic. The sample of this quantitative study is composed of 358 Portuguese consumers who carried out grocery shopping online during the pandemic and was collected through an online questionnaire. First, a cross-sectional description of the variables was applied to this sample and then an analytical cross-sectional survey was carried out using the partial least squares method. Due to health concerns, food and beverage consumption behaviors changed positively during the pandemic compared to before. Healthier consumer behavior towards food and beverages during the pandemic, compared to before the pandemic, may influence a greater propensity for online grocery shopping. Sociodemographic characteristics (age, education, income) were also determinants of the propensity to shop online during the pandemic. Specifically, the results of this study demonstrate a positive influence of young male consumers, with higher levels of education and income, regarding the online supermarket shopping experience. The results also demonstrate that a good online shopping experience during the pandemic can positively influence online shopping intentions after the pandemic. This study makes it possible to identify determinants of the online food shopping experience, serving as guidance and preparation for strategic marketing for retail grocery companies that wish to position themselves online. It also helps marketers and policymakers understand the potential influence of sociodemographic characteristics such as age, income, and education on building a relationship with consumers. Finally, the relationship between personal characteristics and the online grocery shopping experience requires further substantiation and this study contributes to this gap in the literature.
- Acidose lática associada à metformina: revisão de revisõesPublication . Lopes, Pedro Soares; Sousa, Miguel Castelo Branco Craveiro deA acidose lática associada à metformina é uma situação rara, ocorrendo em doentes diabéticos tratados com metformina. Sendo grave necessita ser suspeitada, confirmada e tratada com celeridade.
- A arte da persuasão: a comunicação política no regime de Oliveira SalazarPublication . Costa, Cláudia Sofia dos Santos; Madeira, Luis Filipe da SilvaAs técnicas de persuasão foram os maiores aliados dos regimes ditatoriais. António Oliveira Salazar conseguiu influenciar os comportamentos e ideologias dos cidadãos através do seu discurso. Desta forma, possibilitou que a sociedade se familiariza-se com o chefe de estado. Através dos tipos e modos de propaganda que se assumiram como motor vital para a construção e duração do Estado Novo, a imagem pública apesar de volátil, foi um grande aliado da opinião pública. Ou seja, através do sucesso como Ministro das Finanças, Salazar, desenvolveu e conservou a sua imagem pública. Assim, pode-se afirmar que a comunicação tem um papel preponderante na política. É através dela que os cidadãos estabelecem relações de confiança e de proximidade. Sendo exercida em grande parte por via rádio e através da televisão onde adquiriu um lugar privilegiado, lugar esse crucial para o seu reconhecimento perante a nação. Desta forma, partindo da revisão da literatura sobre comunicação política, propaganda, persuasão e opinião pública, o objetivo primordial desta dissertação foi analisar o papel da comunicação política do ditador e avaliar de que maneira as técnicas de persuasão influenciaram o comportamento da sociedade e os indivíduos da época.
- Ecografia Point-of-Care na Emergência Médica Pré-Hospitalar: Aplicações, Currículos e Perspetivas em PortugalPublication . Pais, João Luís Vicente; Lito, Pedro Filipe Roque Martins; Almeida, Renato José Gonçalves deA ecografia ao serviço da medicina surgiu em meados do século XX e sofreu uma notória evolução até aos dias de hoje, permitindo o surgimento da ecografia à cabeceira do doente, a “Ecografia Point-of-Care” (EPOC). Esta consiste num exame de execução célere, que fornece informação em tempo real, respondendo a dúvidas clínicas diretas, e que permite uma maior acuidade diagnóstica e segurança procedimental. No sentido de a otimizar, foram desenvolvidos protocolos que orientam a avaliação perante uma determinada situação clínica. Dadas as suas caraterísticas, a EPOC tem um papel importante na abordagem de doentes agudos, pelo que tem sido tentada a sua transição para a emergência pré-hospitalar. Através desta revisão integrada da literatura, é possível perceber que a EPOC, na sua designação “Ecografia Pré-Hospitalar” (EPH), está já implementada em alguns serviços de emergência médica pré-hospitalar, principalmente em sistemas franco-germânicos, e que o interesse por esta tem vindo a aumentar, potenciando o desenvolvimento de inúmeros estudos acerca da sua aplicabilidade e benefícios. Os resultados apontam no sentido da EPH poder ser utilizada tanto por médicos como por outros profissionais, apesar de ser notória uma grande heterogeneidade na sua utilização, evidenciando-se a ausência de recomendações e regulamentação neste sentido, problema que sucede também quando são analisados os seus currículos. Portugal, por possuir um sistema de emergência pré-hospitalar com influência francogermânica, poderá estar numa posição privilegiada para a introdução desta tecnologia. A tal, alia-se a geografia do território, que marca grandes assimetrias nos tempos de socorro pré-hospitalar, pelo que dispor de um meio complementar de diagnóstico a bordo dos veículos de emergência médica poderá ser vantajoso. Em suma, pode afirmar-se que a EPH é possível e apresenta diversos benefícios, nomeadamente no diagnóstico precoce, realização de procedimentos com maior segurança, na reavaliação e orientação de doentes, preparação das equipas hospitalares, entre outros. Os maiores desafios à sua implementação relacionam-se com a ausência de orientações formativas acerca da mesma e os custos associados. Portugal não é exceção, e para avaliar a pertinência da EPH são necessários estudos que demonstrem diretamente os benefícios na morbimortalidade que advêm da sua utilização, assim como estudos de custo-benefício. Assim, faria sentido recolher informação acerca do interesse na aplicação desta tecnologia, bem como da formação dos médicos com papel ativo na emergência pré-hospitalar, com vista a estudar os potenciais benefícios da sua implementação neste contexto em Portugal.
- Immune monitoring of relapsing-remitting multiple sclerosis patients submitted to interferon beta treatmentPublication . Monteiro, Andreia Sofia dos Reis; Paiva, Artur Augusto; Fonseca, Ana Mafalda LoureiroTraditionally, the central nervous system (CNS) is described as an immune-privileged site that receives limited immune surveillance by peripheral lymphocytes under physiological conditions. The discovery of the CNS lymphatic system suggests that the CNS is an immune competent organ, closely interacting with the systemic immune compartment under physiological conditions, in which almost all pathological changes in the CNS elicit a prominent inflammatory reaction. Multiple Sclerosis (MS) is a chronic inflammatory disease of the CNS which affects the white and gray matter. MS is believed to be an autoimmune disorder, but the antigen specificity of the immune response is unknown. The pathological hallmark of chronic MS is demyelinated plaque or lesions, which results from an attack on the CNS by immune cells, relative preservation of axons, and the formation of astrocytic scars. Complex multifactorial factors are implicated, in which the environmental are hypothesized to interact with genetically susceptible individuals. In Portugal it is estimated that around 5000 people are affected with MS. The notion that MS is primarily a CD4+ T cell-mediated disease arises from the similarities between the experimental autoimmune encephalomyelitis (EAE) and MS, including the fact that T lymphocytes greatly outnumber B lymphocytes within MS lesions. Diagnosis of MS depends on clinical and paraclinical exams; there is no single diagnostic test to recognize the disease. 85% of patients present a relapse-remitting (RR) MS form, characterized by discrete episodes of neurological dysfunction (relapses or exacerbations) separated by clinical stable periods with lack of disease progression (remissions). Interferon (IFN)-β is the most widely prescribed treatment for MS. IFN-β is a highly pleiotropic cytokine which antagonizes the proinflammatory milieu by increasing production of anti-inflammatory factors. It inhibits leukocyte trafficking and regulates expression of the adhesion molecule. The mechanism of action of IFN-β is complex and multifactorial but has been shown to reduce the biological activity of RRMS in several clinical class I trials. CNS tissue is difficult to access and immune responses within this tissue cannot be easily monitored. Peripheral blood seems to mirror the immunological disturbances that underlie MS, which could represent the migration patterns between the periphery and other tissues according to the clinical phase of the disease. Based on this assumption, the main aim of this thesis was to characterize the circulating immune cell populations of RRMS patients submitted to IFN-β treatment in remission and relapse phases of the disease and compared with healthy subjects. Several studies point to significant alterations in peripheral blood homeostasis of different subpopulations of T cells, like γδ T cells or T helper (Th) 1, Th2, Th17 and T cytotoxic (Tc) 1, Tc2, Tc17 functional subsets; of B cells subpopulations; and of innate cells like monocytes and dendritic cells (DCs). First, we started with the selection of the RRMS patients and collected blood from each one after an informed consent was signed. Through direct immunofluorescence membrane and intracytoplasmic staining protocols, by flow cytometry, were identified and characterized the circulating cell subsets. For the functional assessment of the cells intracellular cytokines at single cell level were measured after in vitro stimulation. To evaluate gene expression, RNA isolation and quantitative real-time reverse transcriptase-polymerase chain reaction was performed. The systemic circulation of IFN-β-treated RRMS patients in remission showed lower frequency of the (myeloid dendritic cells) mDCs subset and higher frequency in the relapse phase, while the frequency of the (plasmacytoid dendritic cells) pDCs subset remains unchanged. Consequently, the mDCs/pDCs ratio decreases in remission and increases in relapse episodes. In remission RRMS patients, the DCs subsets increased their capability to interact with T cells revealed through the increased expression of the HLA-DR and decreased in relapse episodes. In RRMS, the mDCs/pDCs ratio and the activation status of both DCs subsets constitutes a good peripheral biomarker between phases. In circulation of remission RRMS patients, the total monocyte cells and intermediate monocyte (iMo) subset increased and the non-classical monocyte (ncMo) subset decreased. In the relapse phase, the ncMo subset remains decreased. The monocyte subsets present the same pattern of the expression of HLA-DR as the DCs subsets, increasing in remission and decreasing in relapse. The frequency of immature/transitional B cells increases in circulation of remission IFN-β treated RRMS patients. Inside the memory B cell subsets, there was an increase in CD27− B cell subset, more precisely the CD27−IgG+ cells, and a decrease in CD27−IgA+ cells. Relapse RRMS patients showed lower total B cells when compared with remission phase patients, accompanied by an increase in the CD27- memory B cell phases were the increase in the plasmablast B cell subset. The ratio between immature/transitional B cells and plasmablasts decreased in relapse when compared with remission RRMS. The T cell subsets exhibit a shift toward Th2 and Tc2 polarization with a reduction of the Th1 and Tc1 functional subset, in remission episodes. This is accompanied by a reduction in the production of proinflammatory cytokines, mainly IFNγ. Conversely, the frequency of the Th17, Tc17 subsets and the serum level of IL17 increased. In the relapse phase, the Th17 subset decreases the cytokines produced, while the Tc17 subset maintains high levels of tumor necrosis factor (TNF)-α production. The signature of cytokines produced by Th(c)1 and Th(c)17 cells was different. The present study demonstrates that the action mode of IFN-β on Th(c)1 and Th(c)17 cells promotes different results in systemic circulation of RRMS patients. IFN-β therapy supports the decrease in pro-inflammatory cytokines produced by Th(c)1 cells and increase the production of pro-inflammatory cytokines by the Th(c)17. Th17 subset perpetuates and promote the chronic inflammation in periphery in remission RRMS patients, through the production of IL-17 and Th1 type cytokines. No differences were found between the frequency of regulatory T and T follicular helper -like subsets. However, CXCR5+CD4+T cells exhibit a more proinflammatory activity, presenting higher frequencies of TNF-α+ cells in both phases of RRMS. CXCR5+CD8+T cells exhibited an increased ability to produce IL-2 (assuming a Th1 profile) in the remission phase of the disease, thus decreasing in relapsing episodes. The frequency of γδ T cells was the same between healthy subjects and RRMS patients. In remission phase, the central memory γδ T (TCM) subset decreased, and the naive compartment increased. In relapse RRMS patients, the terminally differentiated effector memory γδ T (TEMRA) subset decreased when compared with remission episodes. CCR5+ γδ TEMRA cells were significantly depleted, as a consequence of the migratory pattern in order to play effector functions. This subset presents as a possible participator in the demyelination process and an attractive peripheral blood biomarker between RRMS phases. The identification and characterization of circulating cells can contribute to clarify the pathophysiology of MS, their progression, and the function of each subset in this process. Some of the more relevant results obtained in this study could have the potential to be considered as peripheral biomarkers between remission and relapse RRMS patients treated with IFN-β, namely: the mDCs/pDCs ratio, the activation profile of DCs and monocyte subsets, the commitment of the Th17 cells with a Th1 signature, the CCR5+γδTEMRA cell subset and the ratio between immature/transitional B cells and plasmablasts. In both phases of RRMS, the ncMo subset was decreased and the IgM+CD27+ memory B cells and the compartment CD27- memory B cells increased in RRMS patients. The identification of peripheral markers that could reflect the clinical course of MS and the efficacy of treatment is a stimulating field of research and debate. In the future, further studies including larger cohorts of patients and a larger follow-up are needed in order to establish whether this immune shift correlates with a favorable clinical response.
- Non-surgical treatments for androgenetic alopecia in adult men: indications, adverse effects and efficacy: Systematic ReviewPublication . Moreira, Diogo Fernando Sousa Oliveira; Simões, José Augusto Rodrigues; Craveiro, José FilipeBackground: Androgenetic alopecia is the most common cause of hair loss in humans. It is mediated by dihydrotestosterone [DHT], a form of testosterone. It usually appears in adolescence and tends to evolve into progressive hair loss that follows a pattern distribution. The frequency of men suffering from androgenetic alopecia increases with age, affecting up to 80 % of Caucasian men. In recent years, several surgical and non-surgical treatments have been developed to treat and prevent this condition. Objective: Determine the efficacy and safety of existing non-surgical therapies for androgenetic alopecia. This paper intends to summarize the therapeutic evidence of these therapies, providing doctors with a tool that allows them to medicate their patients based on the evidence shown. Methods: A search was performed in PubMed, Scopus and Cochrane of clinical trials published in English, dated between 2011 and 2021. The search strategy used was “(Androgenetic alopecia AND ((therapeutics) OR (therapy) OR (treatment))”, with the added filter of clinical trials involving only men over 18 years of age. The main outcome was the evaluation of the effectiveness of the different therapies and the secondary outcome was the analysis of the safety of these therapies. Results: 14 studies were included in this systematic review, of which 11 are randomized controlled trials and 3 are non-randomized clinical trials. Of these studies, 4 analysed the efficacy and safety of 5 alpha Reductase enzyme inhibitors, 5 addressed minoxidil therapies, and 5 focused on the analysis of low-level laser therapy (LLLT). These studies seem to demonstrate that the 3 therapies mentioned above have some effectiveness in fighting androgenetic alopecia. The adverse effects of these therapies are also described in the included studies, however, to more precisely assess the safety level of the different treatments, further studies are suggested. It is also worth noting that 11 of the studies presented have a moderate risk of bias, 2 have a high risk of bias and 1 of the studies has a very high risk of bias. Conclusion: The analysed therapies seem to be promising in the treatment of androgenetic alopecia, since all seem to demonstrate efficacy in this use.
- Episiotomia: devemos realizar? Revisão da literaturaPublication . Sabbo, Catarina de Mendonça; Santos, Renata Gonçalves Martello dos; Martins, Renato Alessandre Silva; Cruz, Ana Rita LeiteDurante o parto vaginal podem ocorrer lacerações vaginais e perineais que são classificadas em diferentes graus e comportam diferentes consequências. A episiotomia é um procedimento cirúrgico que consiste na realização de uma incisão no períneo que visa aumentar o orifício vaginal, executado durante a segunda fase do trabalho de parto, com a finalidade de prevenir lacerações perineais de maior gravidade e possíveis complicações associadas. Tanto as lacerações perineais espontâneas como as episiotomias podem ser acompanhadas por dor, dispareunia, incontinência urinária, entre outras, pelo que é importante entender qual a pertinência da aplicação da episiotomia e em que situações esta se torna necessária. Atualmente, o papel deste procedimento cirúrgico é controverso, chegando a sua utilização a ser considerada como prática de violência obstétrica, pelo que é importante entender as situações em que a sua aplicação se mostra vantajosa e é imperativo que a necessidade do procedimento seja explicada à grávida para que esta se sinta informada e segura. Este trabalho tem como objetivo efetuar uma revisão da literatura com a finalidade de entender quais as possíveis indicações para a realização desta técnica e quais as complicações e benefícios associados.