Physiology education in the medical program at Mandume Ya Ndemufayo University: content description and critical overview.

The Faculty of Medicine at Mandume Ya Ndemufayo University began teaching in 2009, taking on the challenge of outcomes-based education and aiming to train qualified professionals according to the needs of the community. This article aims to describe and analyze how the teaching of physiology is organized in the medical program at this university. This is a descriptive study of the course pedagogical plan from 2009 to 2020. The results revealed that there is a correspondence between learning outcomes of the Physiology course, the competencies set out in the Profile of the Angolan Doctor, and internationally established sets of competencies. Some weaknesses were identified in relation to the development of skills, pedagogical methodology, and the evaluation process. The recent educational context of this medical school poses great challenges, which require the contextualization and periodic adjustment of its pedagogical plans.NEW & NOTEWORTHY An Angolan faculty of medicine has taken on the challenge of outcomes-based education, aiming to train qualified professionals according to the needs of the community. This article aims to describe and analyze how the teaching of physiology is organized. The results revealed a correspondence between learning outcomes, the competencies set out in the Profile of the Angolan Doctor, and internationally established sets of competencies. The educational context requires contextualization and periodic adjustment of pedagogical plans.

Comparing empathy in medical students of two Portuguese medicine schools.

BACKGROUND: Empathy is paramount in the doctor-patient relationship being a comprehensive and multidimensional concept. Self-ratings of empathy change across the years of medical education only when the Jefferson Scale of Physicians Empathy is used, with a worrying decrease being found throughout the years in Medicine Schools. As there are only few studies on the factors influencing medical student's empathy, particularly of the curricular model, this study aimed to compare the levels of empathy of medicine students of two Schools with different curricular models in central Portugal, the Faculty of Medicine - University of Coimbra (FMUC) and the Faculty of Health Sciences - University of Beira Interior (FCS-UBI). METHODS: Cross-sectional observational study with the Jefferson Scale of Physician Empathy - students' Portuguese version (JSPE - spv) to 1st, 3rd and 6th year students of the 2017/2018 academic year with descriptive and inferential statistical analysis (p < 0.05). RESULTS: Size representative sample of 795 students. Higher total empathy score (TES) (p = 0.008) and "Perspective taking" (p = 0.001) in FCS-UBI were found. JSPE-TES was higher in FCS-UBI, 3rd year (p = 0.038). Higher FCS-UBI "Perspective taking" in the 1st year (p = 0.030) and 6th year (p = 0.044), for "Compassionate care" in the 3rd (p = 0.019) and for "Standing in the patient's shoes" in the 1st year (p = 0.018) and in FMUC for "Compassionate care" in the 1st year (p = 0.037) and the "Standing in the patient's shoes" in year 3 (p = 0.002) were found. Higher levels of empathy were found in FCS-UBI female students, for JSPE-TES (p = 0.045) and "Perspective taking" (p = 0.001). CONCLUSION: Higher empathy levels in FCS-UBI were found, with different results in the third year suggesting influence of the medical course teaching characteristics between the two Medicine schools, student's empathy levels being higher when earlier and more intense contact with patients accompanied by skilled tutors was developed.

Alternative chelating agents: evaluation of the ready biodegradability and complexation properties.

The ready biodegradability of four chelating agents, N,N'-(S,S)-bis[1-carboxy-2-(imidazol-4-yl)ethyl]ethylenediamine (BCIEE), N'-ethylenedi-L-cysteine (EC), N,N'-bis (4-imidazolymethyl)ethylenediamine (EMI) and 2,6-pyridine dicarboxylic acid (PDA), was tested according to the OECD guideline for testing of chemicals. PDA proved to be a readily biodegradable substance. However, none of the other three compounds were degraded during the 28 days of the test. Chemical simulations were performed for the four compounds in order to understand their ability to complex with some metal ions (Ca, Cd, Co, Cu, Fe, Mg, Mn, Ni, Pb, Zn) and discuss possible applications of these chelating agents. Two different conditions were simulated: (i) in the presence of the chelating agent and one metal ion, and (ii) in the simultaneous presence of the chelating agent and all metal ions with an excess of Ca. For those compounds that were revealed not to be readily biodegradable (BCIEE, EC and EMI), applications were evaluated where this property was not fundamental or even not required. Chemical simulations pointed out that possible applications for these chelating agents are: food fortification, food process, fertilizers, biocides, soil remediation and treatment of metal poisoning. Additionally, chemical simulations also predicted that PDA is an efficient chelating agent for Ca incrustations removal, detergents and for pulp metal ions removal process.

Vernonia britteniana Root Phytochemical Studies, In Vitro Cercaricidal Activity on the Larval Stage of Schistosoma mansoni and Antioxidant Activities.

Vernonia britteniana Hiern. (Asteraceae) is a medicinal plant used in traditional Angolan medicine against schistosomiasis. Our study aimed to investigate the phytochemical composition and the cercaricidal and antioxidant activities in vitro of a traditional herbal preparation (Water-Vbr) and a 70% hydroethanolic extract (EtOH70%-Vbr) prepared with this medicinal plant. The activity of the extracts against Schistosoma mansoni cercariae was assessed at different extract concentrations (500, 438, and 125 µg/mL) and at different time intervals, and the phytochemical profiles were obtained by LC-UV-ESI/MS-MS. In addition, the major chemical classes of the identified metabolites were quantified by colorimetry, and the antioxidant potential was assessed using the DPPH and FRAP methods. After 30 min, 100% cercarial mortality was observed at a concentration of 500 µg/mL after exposure, and after 120 min, an LC50 of 438 µg/mL was observed for both extracts. Phenolic acid derivatives (chlorogenic acid, caffeic acid; 3,4-di-O-caffeoylquinic acid; 3,5-di-O-caffeoylquinic acid; and 4,5-di-O-caffeoylquinic acid) and triterpenoids (stigmastane-type steroidal saponins; vernoamyoside D and vernonioside D1; vernoamyoside B; and vernoniamyoside A and C) were identified as the main secondary metabolites. The Water-Vbr extract showed the highest antioxidant activity-DPPH: IC50 = 1.769 ± 0.049 µg/mL; FRAP: mean = 320.80 ± 5.1325 µgAAE/g.

Palliative care and its own identity, through an autoethnography: do you recognize these patterns?

Introduction: After more than 25 years working in palliative care (PC) observing thousands of patients and family behaviors, I use my long experience and notes as a source of data for a qualitative research study. The aim is to identify frequent families' behavior patterns in PC and better describe the culture in PC. Methods: This article is part of a larger project, using autoethnography as methodology, with the aim of helping doctors and interested health professionals better understand the culture and reality of PC. The focus is not the author but patients and families' patterns of social behavior - the social context - within the end-of-life period and how to deal with these professionally. Confidentiality and privacy of patients' data were guaranteed. Results: The vast number of treated cases, the regular observation and recording, and the continuous reflection and analysis over many years have led to these results. Due to editorial restrictions, in this article I only describe four of at least eight typical scenarios I have identified. Each is given a short title and I explore some of their inside-issues, integrating previous knowledge, research, and explanations, with practical suggestions on how to deal with them. Significance: As far as we know, these scenarios/patterns have never been described in this way. This work expands knowledge, innovates, and contributes to better describing PC culture. The final goal is to create a set of scripts that can be used to help clinicians quickly identify the clinical situation and how to deal with it in clinical practice. Reflecting on how patients and families frequently behave in PC can be very useful and then teach other professionals to better deal with these challenges.

Malignant Peritoneal Mesothelioma: A Challenging Case for Palliative Care.

Malignant peritoneal mesothelioma (MPM) is a rare and very aggressive malignancy of serosal membranes, which typically presents with abdominal pain, distension, and ascites. Due to its rarity and nonspecific symptoms, it is usually diagnosed late, when the disease burden is extensive and the therapy is inevitably palliative. It represents a complex challenge for clinicians because the treatment options are very poor and the illness has a great impact on patients' life. We present a complex case of a young patient with MPM who was admitted to our palliative care unit.

Allergic conjunctivitis and conjunctival provocation tests in atopic dogs.

INTRODUCTION: Canine atopic dermatitis (cAD) is a very common disease, but little is known about eye involvement. The conjunctival provocation test (CPT) is used in human to study the ocular response to allergenic stimuli and to evaluate anti-allergic therapy. To our knowledge it has not been used in dogs. OBJECTIVES: To evaluate the prevalence of ocular signs in a population of atopic dogs and relate these with clinical cAD scores; and the usefulness of CPT for dust mites in atopic dogs with itchy eyes. PROCEDURES: Sixty cAD patients were evaluated for (i) ocular signs of allergic conjunctivitis including conjunctival hyperemia, chemosis, epiphora, ocular discharge, pruritus and corneal involvement, graded 0 to 3 according to severity, and (2) cAD Extent and Severity Index (CADESI-03). Additionally, CPTs for Dermatophagoides farinae (n = 12) and Dermatophagoides pteronyssinus (n = 12) were performed in sensitized atopic dogs and 24 control dogs. RESULTS: Periocular and ocular signs of allergy were present in 60% (36/60) of cases. Conjunctival hyperemia (90%) was the most common sign. Severity of ocular signs was significantly correlated with eye pruritus (r(s) = 0.690, P = <0.001) and skin lesions score for head region (r(s) = 0.261, P = 0.04). A highly significant difference (P < 0.001, Fisher test) was found in CPTs between the test and the control groups. CONCLUSION: Allergic conjunctivitis signs associated with cAD seem under valuated so these patients would benefit from an ophthalmologic evaluation. Furthermore, we found CPT to be a reliable, easy to perform and safe test for the etiologic diagnosis of allergic conjunctivitis in the dog.

The Impact of COVID-19 on Palliative Care: Perspective of Healthcare Professionals.

The COVID-19 pandemic has negatively impacted the provision of Palliative Care (PC), challenging the teams aiming to provide adequate care. This is a qualitative study that intends to know, from the perspective of health professionals of a Palliative Care Unit (PCU), the main challenges in providing PC during a pandemic and describes the strategies to be adopted to solve the identified difficulties. We utilized the content analysis, according to Bardin, for data analysis of written narratives of health professionals from a PCU (n=14). In the analysis of the difficulties in providing PC, from the perspective of health professionals, were identified five themes: 1) Altered relationship between healthcare professional and patients, 2) altered relationship between healthcare professional and family, 3) altered communication with patients and their family, 4) altered working dynamic within the PCU, and 5) altered use of healthcare resources. Concerning the strategies to be implemented, the health professionals identified two themes: 1) Strategies to implement between the patient and family members and 2) strategies to implement for the healthcare professionals. The provision of PC is affected by changes in the relationship between the health professional and the patient/caregiver or family, in communication with the patient/caregiver or family, and the use of health resources. In an attempt to lessen the impact of these changes, participants identified strategies to improve PC delivery in these circumstances. During this pandemic, it is imperative to implement rigorous strategies for managing specialized human resources. Physical distance and personal protective equipment are barriers to communication and emotional support, which is essential in PC and this barrier is further accentuated by the required physical distance from family members and caregivers. PC´s main aim continues to be the mitigation of suffering.

Simple and near-zero-waste processing for recycling gold at a high purity level from waste printed circuit boards.

This work proposes an efficient and simple hydrometallurgical process based on a chlorination step followed by an ion-exchange step for recycling gold (Au) from a waste printed circuit boards (WPCBs) enriched in Au resulting from a first leaching step under mild oxidizing conditions for extracting Cu and other base metals. Under optimized [3.5 mol/L HCl and 0.46 mol/L NaClO, with a liquid/solid (L/S) ratio of 40, at 40 °C for 3 h with agitation] leaching conditions, 95% Au was extracted from the residue originating a multi-metal solution containing 1.0% Au. Subsequently, Au (initial concentration: 38 µmol/L) present in the multimetal-leached solution was purified in continuous mode using two strong anionic exchange resins: DOW™ XZ-91419.00 and Purogold™ A194. Both resins were suitable in purifying Au from the multimetal-leaching solution, with at least 70% of Au recovered relative to the initial residue. When the DOW™ XZ-91419.00 resin was used, a solution containing 1.7 mmol/L Au with a purity grade of 94% was obtained, with Pb and Sn being the major contaminants (3.3 and 2.4%, respectively). For Purogold™ A194 resin, a solution containing 0.73 mmol/L Au with a purity grade of 92% was achieved; Ag, Pb and Pd were the major contaminants (1.4, 3.6 and 1.8%, respectively). In conclusion, this work demonstrates a novel hydrometallurgical strategy for recycling Au with a high grade from WPCBs, minimizing the number of leaching and purification steps and the amount of waste created.

Unveiling patterns of viral pathogen infection in free-ranging carnivores of northern Portugal using a complementary methodological approach.

Pathogen surveillance in free-ranging carnivores presents challenges due to their low densitie and secretive nature. We combined molecular and serological assays to investigate infections by viral pathogens (Canine parvovirus (CPV), Canine distemper virus (CDV) and Canine coronavirus (CCoV)) in Portuguese carnivores (Canis lupus, Vulpes vulpes, Lutra lutra, Martes foina, M. martes, Meles meles, and Genetta genetta) over a period of 16 years. Additionally we explored spatio-temporal patterns of virus occurrence in Canis lupus. Our study identified CPV DNA in all carnivore species with an overall prevalence of 91.9 %. CPV was detected in all sampled years and seasons in Canis lupus, supporting its enzootic nature. CDV RNA was mainly detected in the Canidae family, with viral nucleic acid recorded between 2005 and 2008 with a peak prevalence of 67 % among the wolf population, followed by a sharp decline, suggesting an epizootic behaviour of the virus. Antibodies show that mustelids and viverrids were often exposed to CDV. CCoV was first recorded by molecular methods in wolf samples in 2002, remaining in the wolf populations with marked fluctuations over time. The dual serological and molecular approach provided important epidemiological data on pathogens of wild carnivores in Portugal. These programmes should also include monitoring of other potential reservoir hosts such as domestic cats and dogs.

Palliative approach to leptomeningeal carcinomatosis in oesophagogastric junction cancer.

Leptomeningeal carcinomatosis (LC) is rare in solid tumours, particularly in gastrointestinal cancers. While other treatment strategies remain undefined, inclusion of palliative care is essential due to its very poor prognosis and variable manifestations. We report a case of oesophagogastric junction adenocarcinoma, previously submitted to surgery and chemotherapy, diagnosed with LC and followed in a palliative care unit. Treatment was comanaged with the oncology team and a palliative approach was decided. In this report, we review the literature and evaluate treatment options, with focus on the importance of palliative care and its potential benefits in patients diagnosed with this rare entity.

Identification of dysfunctional human-dog dyads through dog ownership histories.

The human-dog relationship is at least 16,000-years old and is mutually beneficial to both dyadic members. When the human-dog relationship becomes dysfunctional, however, there can be serious consequences for both parties and for society. Unfortunately, dysfunctional dyads are normally only identified after consequences have been felt (e.g., dog-human aggression) limiting the action that can be taken to prevent such occurrences. To evaluate whether these dysfunctional dyads can be preemptively identified, a questionnaire analyzing the owners' dog health care histories was administered to an urban dog owning population. Multiple correspondence analysis (n = 1,385) was conducted and identified three clusters accounting for 37.1% of the total variance, while four moderate positive correlations were found: "unspecified trauma" with "vehicular trauma" (r = 0.303, p < 0.001), "bitten" with "bit other animal" (r = 0.345, p < 0.001), "bit a person" with "bit other animal" (r = 0.369, p < 0.001), and "chronic illness" with "hospitalized" (r = 0.297, p < 0.001). These results suggest that a simple questionnaire can identify potential characteristics of functional and dysfunctional dyads. In functional dyads, humans tend to be responsible for their dogs' well-being, while dysfunctional dyads show the opposite characteristics, reporting experience with trauma and dog aggression.

[Delirium: The 7th Vital Sign?] / Delirium: O 7º Parâmetro Vital?

INTRODUCTION: Delirium is an acute, transient and fluctuating neuropsychiatric syndrome that is common in medical wards, particularly in the geriatric and palliative care population. MATERIAL AND METHODS: We present a brief literature review of the definition, pathophysiology, aetiology, diagnosis, prevention and treatment of delirium and its social and economic impact. RESULTS AND DISCUSSION: Delirium is under-recognized, especially by health professionals, and is associated with higher morbidity, mortality and economic burden. Moreover, the presence of delirium interferes with the evaluation and approach to other symptoms. Furthermore, it causes significant distress in patient's families and health professionals. The best treatment for delirium is prevention which is based on multidisciplinary interventions that addresses the main risk factors. The scientific evidence for the treatment of delirium is scarce. Non-pharmacological approaches are usually the first choice, and includes environmental, behavioural and social strategies. Pharmacological options, mainly antipsychotics, are a second-line treatment used essentially to prevent self harm. CONCLUSION: The recognition and prevention of delirium are crucial. Health professional education and training, patient clinical monitoring and families support are mandatory. Considering the impact of delirium on patients, relatives, health services and professionals we must be more aware of delirium and, why not, make it the 7th vital sign.

Introdução: O delirium é uma síndrome neuropsiquiátrica transitória e flutuante com início súbito frequente nos doentes internados, em particular na população geriátrica e paliativa. Material e Métodos: Através de uma breve revisão da literatura, os autores propuseram-se a sistematizar a definição, fisiopatologia e etiologia do delirium, principais ferramentas para o seu diagnóstico, prevenção e tratamento, bem como o seu impacto socio-económico.Resultados e Discussão: O delirium é uma entidade pouco reconhecida pelos profissionais de saúde, que se associa a maior morbi-mortalidade e custos, interfere com a avaliação e abordagem da dor e de outros sintomas e acarreta elevado distress nos doentes, famílias e profissionais de saúde. O melhor tratamento do delirium é a prevenção, que se baseia em intervenções multidisciplinares sob os principais fatores de risco para o seu desenvolvimento. A evidência científica para o tratamento do delirium existe, mas é escassa, sendo a terapêutica preferencial a não farmacológica, com implementação de estratégias ambientais, comportamentais e sociais. O tratamento farmacológico é de segunda linha e deverá ser instituído de forma a prevenir que o doente se coloque em risco, nomeadamente através do uso de antipsicóticos. Conclusão: O reconhecimento e prevenção do delirium são essenciais, pelo que é fundamental a educação e formação dos profissionais de saúde, bem como o acompanhamento e apoio aos familiares. É por todo o impacto que tem nos serviços de saúde, nos profissionais e, sobretudo, nos doentes e seus familiares, que sugerimos maior atenção ao delirium e, porque não, passar a considerá-lo como o 7º sinal vital.

Symptomatic Control in End-of-Life Patients.

End-of-life patients present a variety of symptoms that cause suffering for them and their respective families. Health professionals throughout their university, internship and medical careers are ill-prepared to manage and improve the quality of life of these patients. This article aims to provide basic skills in the symptomatic management of end-of-life patients, focusing in particular on the control of pain, dyspnoea, fatigue, nausea, vomiting and anorexia. It also aims to draw attention to basic concepts of control concerning refractory symptoms and palliative sedation.

Doentes em fim de vida apresentam uma multiplicidade de sintomas que são causa de sofrimento para os próprios e respetivas famílias. Os profissionais de saúde ao longo da faculdade, internato e carreira médica são pouco preparados para gerir e melhorar a qualidade de vida destes doentes. O presente artigo pretende fornecer competências básicas no controlo sintomático dos doentes em fim de vida, focando em particular o controlo da dor, dispneia, fadiga, náuseas, vómitos e anorexia. Pretende-se ainda alertar para conceitos básicos sobre controlo de sintomas refratários e a sedação paliativa.

Selective leaching of Zn from spent alkaline batteries using environmentally friendly approaches.

The main aim of this work was to evaluate the possibility of using microwave or ultrasound to assist the efficient and selective leaching of Zn from spent alkaline batteries and compare the results with those obtained using the conventional method. Two different strategies were applied: acid leaching of a washed residue and alkaline leaching of the original residue. In both (acid and alkaline) approaches, the use of microwave- or ultrasound-assisted leaching increased the extraction of Zn compared with the best results obtained using conventional leaching [acid leaching (1.5mol/L H2SO4, 3h, 80°C), 90% of Zn extracted; alkaline leaching (6mol/L NaOH, 3h, 80°C), 42% of Zn extracted]. With acid leaching, 94% of the Zn was extracted using microwave-assisted leaching (1 cycle, 30s, 1mol/L H2SO4), and 92% of the Zn was extracted using ultrasound-assisted leaching (2min, 0.1p, 20% amplitude, 1mol/L H2SO4). Ultrasound-assisted leaching resulted in a more selective (Zn/Mn ratio of 5.1) Zn extraction than microwave-assisted leaching (Zn/Mn ratio of 3.5); both processes generated a concentrated Zn solution (⩾18.7g/L) with a purity (83.3% and 77.7%, respectively) that was suitable for electrowinning. With alkaline leaching, microwave- (1 cycle, 3 min, 4mol/L NaOH) and ultrasound-assisted (14min, 0.1p, 20% amplitude, 4mol/L NaOH) leaching extracted about 80% of the Zn and less than 0.01% of the Mn, which resulted in lesser concentrated Zn solutions (approximately 16.5g/L) but with high purity (>99.5%) that was suitable for the recovery of Zn by precipitation. The microwave- and ultrasound-assisted leaching strategies used in this work proved to be efficient and environmentally-friendly approaches for the extraction of Zn from spent alkaline residues since a concentrated Zn solution with adequate purity for subsequent Zn recovery was obtained using significantly decreased leaching times and concentrations of chemicals.