Outdoor airborne allergens: Characterization, behavior and monitoring in Europe.

Aeroallergens or inhalant allergens, are proteins dispersed through the air and have the potential to induce allergic conditions such as rhinitis, conjunctivitis, and asthma. Outdoor aeroallergens are found predominantly in pollen grains and fungal spores, which are allergen carriers. Aeroallergens from pollen and fungi have seasonal emission patterns that correlate with plant pollination and fungal sporulation and are strongly associated with atmospheric weather conditions. They are released when allergen carriers come in contact with the respiratory system, e.g. the nasal mucosa. In addition, due to the rupture of allergen carriers, airborne allergen molecules may be released directly into the air in the form of micronic and submicronic particles (cytoplasmic debris, cell wall fragments, droplets etc.) or adhered onto other airborne particulate matter. Therefore, aeroallergen detection strategies must consider, in addition to the allergen carriers, the allergen molecules themselves. This review article aims to present the current knowledge on inhalant allergens in the outdoor environment, their structure, localization, and factors affecting their production, transformation, release or degradation. In addition, methods for collecting and quantifying aeroallergens are listed and thoroughly discussed. Finally, the knowledge gaps, challenges and implications associated with aeroallergen analysis are described.

A pessoa com baixa autoestima: utilização de mediadores expressivos pelo enfermeiro especialista / The person with low self-esteem: use of expressive mediators by specialist nurses

A autoestima corresponde à perceção e avaliação que cada um faz de si, interferindo com todas as dimensões da experiência pessoal. É um processo dinâmico, contínuo e estruturado desde a infância, consequente de experiências que decorrem do relacionamento com a família, pares e sociedade, sujeito a alterações ao longo da vida. Com repercussões na vida afetiva, social, no bem-estar e qualidade de vida, corresponde a um indicador de saúde mental. Constitui um fator de risco que torna a pessoa vulnerável ao desenvolvimento de doença mental. Por sua vez, pessoas com experiência de doença mental, apresentam maior suscetibilidade para uma autoavaliação negativa. A abordagem holística do Modelo de Sistemas de Betty Neuman torna-o particularmente aplicável em pessoas que experimentam stressores complexos, que afetam múltiplas variáveis. Permite analisar como o cliente interage e dá resposta aos stressores, se adapta às mudanças, e aumenta a colaboração interdisciplinar. As intervenções de Enfermagem de Saúde Mental e Psiquiátrica com pessoas com baixa autoestima apresentam enfoque no autoconhecimento, na reestruturação cognitiva e na definição de objetivos de vida realistas, adequando o modo como a pessoa se valoriza e direcionando-a para ações construtivas. O desenho e a pintura foram utilizados, como mediadores expressivos, para representação de caraterísticas pessoais; do autoconceito e autoimagem; identificação de recursos pessoais e estratégias de coping utilizadas; reformulação de pensamentos; expressão de emoções e sentimentos; estimulação da criatividade; estimulação da interação social através de partilha ou discussão de uma opinião, agradecimento ou solicitação de ajuda. Com a realização das intervenções ao longo do estágio foi possível avaliar que estas facilitaram a tomada de consciência de si, a autoexploração e autodescoberta, a identificação de qualidades, estratégias de coping mais eficazes, a catarse, o estabelecimento de objetivos realistas para o futuro, e desenvolvimento de competências sociais, tornando-se assim evidente os contributos positivos destes mediadores expressivos.

Self-esteem corresponds to the perception and evaluation that each one makes of himself, interfering with all dimensions of personal experience. It is a dynamic, continuous and structured process since childhood, resulting from experiences that arise from the relationship with family, peers and society, subject to changes throughout life. With repercussions on affective and social life, well-being and quality of life, it corresponds to an indicator of mental health. It constitutes a risk factor that makes the person vulnerable to the development of mental illness. In turn, people with experience of mental illness are more susceptible to a negative self-assessment. The holistic approach of Betty Neuman's Model of Systems makes it particularly applicable to people who experience complex stressors that affect multiple variables. It allows analyzing how the client interacts and responds to stressors, adapts to changes, and increases interdisciplinary collaboration. Mental Health and Psychiatric Nursing interventions with people with low self esteem focus on self-knowledge, cognitive restructuring and the definition of realistic life goals, adapting the way the person values himself and directing him towards constructive actions. Drawing and painting were used as expressive mediators to represent personal characteristics; of self-concept and self-image; identification of personal resources and coping strategies used; reformulation of thoughts; expression of emotions and feelings; stimulation of creativity; stimulation of social interaction through sharing or discussing an opinion, thanking or asking for help. With the interventions carried out during the internship, it was possible to assess that they facilitated self-awareness, self-exploration and self-discovery, the identification of qualities, more effective coping strategies, catharsis, the establishment of realistic goals for the future, and development of social skills, thus making evident the positive contributions of these expressive mediators.

Recent advances in the understanding of the aetiology and therapeutic strategies in burning mouth syndrome: Focus on the actions of cannabinoids.

Burning mouth syndrome (BMS) is a neuropathic pain disorder associated with a burning sensation on oral mucosal surfaces with frequently reported xerostomia, dysgeusia and tingling or paraesthetic sensations. However, patients present no clinically evident causative lesions. The poor classification of the disorder has resulted in a diagnostic challenge, particularly for the clinician/dentist evaluating these individuals. Major research developments have been made in the BMS field in recent years to address this concern, principally in terms of the pathophysiological mechanisms underlying the disorder, in addition to therapeutic advancements. For the purpose of this review, an update on the pathophysiological mechanisms will be discussed from a neuropathic, immunological, hormonal and psychological perspective. This review will also focus on the many therapeutic strategies that have been explored for BMS, including antidepressants/antipsychotics, non-steroidal anti-inflammatories, hormone replacement therapies, phytotherapeutic compounds and non-pharmacological interventions, overall highlighting the lack of controlled clinical studies to support the effectiveness of such therapeutic avenues. Particular focus is given to the cannabinoid system and the potential of cannabis-based therapeutics in managing BMS patients.

UC-USP collaborative exercise on photobiomodulation therapy in neurological orofacial disturbances.

BACKGROUND: Neurosensory peripheral disorders are one of the most common risks associated with iatrogenic and/or post-traumatic injuries. It is often related to disability. Photobiomodulation therapy (PBMT) is a nonsurgical and safe procedure which can accelerate and improve the regeneration of injured biological tissue. This study aims to analyze the impact of PBMT, in the quality of life and impairment of individuals with orofacial neurological peripheral disturbance. MATERIAL AND METHODS: A retrospective analysis in the database of the dental traumatology clinic of the Hospital Centre of the University of Coimbra/Faculty of Medicine of the University of Coimbra was performed.5 out of 50 individuals were selected, according to the selection criteria. The neurosensory activity was assessed by a pinprick nociceptive test and the EQ-5D-5L self-report questionnaire was used to analyse the quality of life. The study was performed in two phases:1) inactive laser or placebo phase, for one month and 2) active laser or treatment phase. A diode low-level laser device (SIROLaserBlue;Sirona,Germany) was used, according to our protocol. A collaborative protocol in the PBMT influence in individuals with neurosensory peripheral disturbances was studied. RESULTS: There was no improvement in the neurosensory activity nor in the quality of life, in the placebo phase. After the treatment phase, the EQ-5D-5L final results reported no problems in all of the five dimensions, except for anxiety/depression in individuals with long-standing neurosensory peripheral disturbances. The EQ-VAS scores increased in all the individuals. CONCLUSIONS: Our results supported the improvement of quality of life and impairment reduction in the individuals submitted to PBMT. Key words:Low-level light therapy, peripheral nerve injuries, sensation disorders, quality of life, forensic medicine.

Desenvolvimento e validação do protocolo de autocuidado em doença falciforme (PAUT@-DF) para apoio educacional aos jovens pelo Aplicativo Móvel Globin / Development and validation of the sickle-cell self-care protocol (PAUT @ -DF) for educational support to young people through the Globin Mobile Application

Objetivo: elaborar e validar o protocolo de autocuidado em doença falciforme - PAUT@-DF e implementá-lo no aplicativo móvel Globin. Métodos: estudo observacional, exploratório e descritivo com delineamento de uma pesquisa aplicada, abrangendo quatro etapas. Primeira etapa: abrange dois momentos: 1- Revisão integrativa sobre os aplicativos móveis em doença falciforme. 2- Identificação do conteúdo de autocuidado e preferências das funcionalidades do aplicativo móvel a ser desenvolvido. Segunda etapa: envolveu a construção, validação de conteúdo e adequação cultural do protocolo. Terceira etapa: constou do desenvolvimento do aplicativo Globin no sistema móbile, gestão Web e ilustração. Quarta etapa: avaliações da usabilidade e utilidade. A usabilidade foi avaliada em duas iterações: 1- avaliação heurística e classificação do grau de severidade por especialistas; 2- avaliação da usabilidade pelo público-alvo; a utilidade do aplicativo foi verificada por meio da aplicação de um questionário, via ligação telefônica à população-alvo. Resultados: são apresentados de acordo com cada etapa. Primeira etapa: a revisão foi composta por 12 artigos publicados na literatura internacional. Não foram identificados estudos brasileiros, apesar da alta incidência da doença, o que aponta para a necessidade de desenvolvimento de aplicativos móveis de doença falciforme no país. Quanto ao conteúdo de autocuidado e as funcionalidades do aplicativo, 21 jovens com idade entre 13 e 24, contribuíram para a identificação dos domínios físico, emocional e social do autocuidado que puderam ser relacionados aos recursos tecnológicos do aplicativo a ser desenvolvido. A escolha do nome Globin para o aplicativo foi unânime entre os participantes. Segunda etapa: o protocolo de autocuidado em doença falciforme nomeado como Paut@-DF constou de 6 domínios: 1º- primeiras aproximações (dados pessoais, clínicos e prática de autocuidado); 2º- Blogin (informações peculiares à doença na adolescência;); 3º- acompanhamento diário dos sentimentos (de neutralidade, alegria, tristeza, raiva, preocupação, confusão, rejeição); 4º- acompanhamento diário (dor, cansaço, febre e sono); 5º- outras situações (priapismo, menstruação, internações e outras dificuldades); 6º- plano de ação (hidratação, uso do medicamento hidroxiureia e suplementação de ácido fólico). A variação das médias do IVC de clareza e relevância dos itens avaliado pelos especialistas e jovens ficou entre 0,90 e 1,0. Terceira etapa: a partir dos domínios do Paut@-DF, o Globin foi estruturado nos itens: missões, acompanhamento, histórico, perfil, agenda e jogo. O módulo gestão foi estruturado para receber e processar os dados dos usuários do aplicativo. Quarta etapa: a avaliação heurística do Globin gerou uma média de 53,97 pontos. A classificação do grau de severidade das heurísticas violadas permitiu ajustes nas interfaces. A avaliação da usabilidade foi realizada por oito jovens e a média obtida foi de 90,3 pontos, considerada uma usabilidade excelente. A partir da avaliação da utilidade, emergiram três categorias temáticas: 1) Fonte de conhecimento; 2) Apoio para compreender a necessidade de se cuidar; 3) Aprimoramento da prática de autocuidado. Conclusão: este estudo fornece o protocolo Paut@-DF com conteúdo validado, configurando-se em uma ferramenta de gestão para o apoio à prática de autocuidado dos jovens com doença falciforme. A aquisição de novas informações e o refinamento de conhecimento sobre a doença falciforme a partir do Paut@-DF implementado no aplicativo móvel Globin foram fundamentais para que os jovens passassem a compreender melhor sobre a necessidade de cuidados, bem como aprimorar a prática do autocuidado.

Objective: to elaborate and validate the PAUT@-DF self-care protocol for sickle cell disease and implement it in the Globin mobile application. Methods: observational, exploratory and descriptive study, with an applied research design, including four stages. First stage: includes two moments: 1- Integrative review regarding the mobile applications for sickle cell disease; 2- Content identification on self-care and preferences for the functionalities of the mobile application to be developed. Second stage: encompassed the construction, content validation and cultural adequation of the protocol. Third stage: comprised the development of the Globin application in the mobile system, web management and illustration. Fourth stage: assessment of the usability and utility. The usability was assessed in two iterations: 1- heuristic evaluation and ranking of the severity grade by specialists; 2- evaluation of the usability by the target public; The utility of the application was checked by means of a questionnaire, made by phone call to the target-public. Results: are presented regarding each stage. First Stage: the review was comprised by 12 articles published in the international literature. There were no Brazilian studies identified, despite the high occurrence of the disease, which points towards the need to develop mobile applications for the sickle cell disease. Regarding the self-care content and the application's functionality, 21 youngsters with age ranging from 13 to 24, contributed for the identification of the physical, emotional and social domains of self-care that were than related to the technological resources of the application being developed. The choice of the name Globin for the application was unanimous among the participants. Second stage: the protocol for self-care of the sickle cell disease named as Paut@-DF was comprised of 6 domains: 1st- first approaches (personal, clinical and self-care data); 2nd- Blogin (information particular to the disease during teenage years); 3rd- daily follow-up of the feelings (of neutrality, joy, sadness, anger, worry, confusion, rejection); 4th- daily follow-up (pain, exhaustion, fever and sleep); 5th- other situations (priapism, menstruation, hospitalizations and other difficulties); 6th- action plan (hidration, use of hydroxyurea and folic acid supplement medication). Variation of the IVC clarity and relevance means of the items assessed by the specialists and youngsters was between 0,9 and 1,0. Third stage: from the Paut@-DF, the Globin was structured in the following items: missions, follow-up, history, profile, schedule and game. The management module was structured to receive and process the user data from the application. Fourth stage: the heuristic evaluation of the Globin generated an average of 53,97 points. The ranking of the severity grade of the violated heuristics allowed interface adjustments. The usability assessment was made by eight youngsters and the mean obtained was of 90,3 points, which is considered an excellent usability. From the utility evaluation, three thematic categories emerged: 1) Knowledge source; 2) Support to comprehend the need to take care of oneself; 3) Improvement of the self-care habit. Conclusion: this study provides the Paut@-DF protocol with validated content, making it a management tool for the support to self-care practice by youngsters with sickle cell disease. The acquisition of new information and the refinement of knowledge about the sickle cell disease from the Paut@-DF implemented in the Globin mobile application were key so the youngsters could better comprehend the need of care, as well as improve the practice of self-care.

Economic analysis of rivaroxaban for the treatment and long-term prevention of venous thromboembolism in Portugal.

INTRODUCTION: Venous thromboembolism is a burden on healthcare systems. The aim of this analysis was to project the long-term costs and outcomes for rivaroxaban compared to standard of care (enoxaparin/warfarin) in Portugal for the treatment and secondary prevention of venous thromboembolism. MATERIAL AND METHODS: A Markov model was developed using event rates extracted from the EINSTEIN trials supplemented with literature-based estimates of longer-term outcomes. Core outcomes included per patient costs and quality-adjusted life years reported separately per treatment arm and incrementally, as well as cost per quality-adjusted life years gained. The deep vein thrombosis and pulmonary embolism indications were analysed separately. The analyses were conducted from the Portuguese societal perspective and over a 5-year time horizon. Costs and outcomes were discounted at a 5% annual rate. Several scenario analyses were undertaken to explore the impact on results of varying key modeling assumptions. RESULTS: Rivaroxaban treatment was associated with cost-savings for the treatment of deep vein thrombosis and was both cost-saving and more effective for the treatment of pulmonary embolism, compared with enoxaparin/warfarin. DISCUSSION: The results of the sensitivity and scenario analyses further supported that rivaroxaban is a cost-effective alternative to standard of care treatment. The use of an expert panel to derive some input values and the lack of Portuguese specific utilities were the main limitations. CONCLUSION: Rivaroxaban represents an efficient alternative to using enoxaparin/warfarin in Portugal, as it's associated with lower costs (for both indications) and greater quality adjusted life years (for the pulmonary embolism indication).

Introdução: O tromboembolismo venoso representa uma carga substancial para os sistemas de saúde. O objectivo foi estimar os resultados clínicos e económicos a longo-prazo associados a rivaroxabano relativamente à prática clínica (enoxaparina/varfarina) no tratamento e prevenção secundária de tromboembolismo venoso em Portugal.Material e Métodos: Foi desenvolvido um modelo de Markov baseado nos ensaios clínicos EINSTEIN e dados da literatura para complicações a longo-prazo. Foram avaliados custos e anos de vida ajustados pela qualidade de vida totais e incrementais e rácio custo-efectividade incremental. As indicações trombose venosa profunda e embolismo pulmonar foram analisados separadamente. Adoptou-se a perspectiva da sociedade portuguesa e um horizonte temporal de cinco anos. Aplicou-se uma taxa de actualização de cinco por cento para custos e consequências. Foram desenvolvidas análises de sensibilidade e diversas análises de cenário para avaliação da variação dos resultados em função de determinados pressupostos.Resultados: Rivaroxabano está associado a menores custos na trombose venosa profunda e constitui uma alternativa associada a menores custos e a maior eficácia no tratamento de embolismo pulmonar, relativamente a enoxaparina/varfarina.Discussão: O recurso a um painel de peritos para identificação de alguns recursos e a ausência de utilidades específicas para Portugal constituem as principais limitações.Conclusão: Rivaroxabano constitui uma alternativa eficaz, estando associado a menores custos (para ambas as indicações) e a mais anos de vida ajustados pela qualidade de vida (para embolismo pulmonar) relativamente a enoxaparina/varfarina em Portugal.

Absorption, distribution, metabolism and excretion of selenium following oral administration of elemental selenium nanoparticles or selenite in rats.

A suspension of nanoparticles of BSA-stabilized red amorphous elemental selenium (Se) or an aqueous solution of sodium selenite was repeatedly administered by oral gavage for 28 days at 0.05 mg kg(-1) bw per day (low dose) or at 0.5 mg kg(-1) bw per day (high dose) as Se to female rats. Prior to administration, the size distribution of the Se nanoparticles was characterized by dynamic light scattering and transmission electron microscopy, which showed that the particles' mean diameter was 19 nm and ranged in size from 10 to 80 nm. Following administration of the high dose of Se nanoparticles or selenite the concentration of Se was determined by ICP-MS in the liver, kidney, urine, feces, stomach, lungs, and plasma at the µg g(-1) level and in brain and muscle tissue at the sub-µg g(-1) level. In order to test if any elemental Se was present in the liver, kidney or feces, an in situ derivatization selective to elemental Se was performed by treatment with sulfite, which resulted in formation of the selenosulfate anion. This Se species was selectively and quantitatively determined by anion exchange HPLC and ICP-MS detection. The results showed that elemental Se was present in the livers, kidneys and feces of animals exposed to low and high doses of elemental Se nanoparticles or to selenite, and was also detected in the same samples from control animals. The fraction of Se present as elemental Se in livers and kidneys from the high dose animals was significantly larger than the similar fraction in samples from the low dose animals or from the controls. This suggested that the natural metabolic pathways of Se were exhausted when given the high dose of elemental Se or selenite resulting in a non-metabolized pool of elemental Se. Both dosage forms of Se were bioavailable as demonstrated by the blood biomarker selenoprotein P, which was equally up-regulated in the high-dose animals for both dosage forms of Se. Finally, the excretion of Se in urine and its occurrence as Se-methylseleno-N-acetyl-galactosamine and the trimethylselenonium-ion demonstrated that both dosage forms were metabolized and excreted. The results of the study showed that both forms of Se were equally absorbed, distributed, metabolized and excreted, but the detailed mechanism of the fate of the administered elemental Se or selenite in the gastro-intestinal tract of rats remains unclear.

Prevalence and molecular epidemiology of imipenem-resistant Pseudomonas aeruginosa carrying metallo-beta-lactamases from two central hospitals in Portugal.

Metallo-beta-lactamases (MBLs) can confer broad-spectrum beta-lactam resistance, including carbapenems. The aim of this work was to document the occurrence of MBLs in 122 imipenem-resistant Pseudomonas aeruginosa isolates collected in two Portuguese central hospitals, to determine their antimicrobial susceptibility, and to observe if there were intra- and interhospital epidemic spread. About 20.5% of these isolates presented blaVIM-2, which was found to be widespread in both hospitals. Clonal diversity was observed within hospitals, and no interhospital spread was observed. Ten of the blaVIM-2-positive isolates (44%), from both hospitals, presented one or two class 1 integrons. Two of those contained a VIM-2 gene, one from each hospital, which is indicative for the possibility of MBL gene transfer. No interhospital spread of integrons was observed. Regular screening and surveillance is needed to prevent spread of this worrisome resistance determinant.

Pullulanibacillus uraniitolerans sp. nov., an acidophilic, U(VI)-resistant species isolated from an acid uranium mill tailing effluent and emended description of the genus Pullulanibacillus.

Two Gram-positive-staining, rod-shaped, endospore-forming isolates (UG-2(T) and UG-3), with an optimum growth temperature of around 37 °C and an optimum pH for growth of about 4, were recovered from an acidic effluent of the uranium mill tailing at Urgeiriça in Central Portugal. On the basis of 16S rRNA gene sequence similarity, the strains belonged to the family Sporolactobacillaceae and were closely related to Pullulanibacillus naganoensis ATCC 53909(T) (97.9 %). Unlike P. naganoensis, strains UG-2(T) and UG-3 grew in medium containing up to 5000 p.p.m. U(VI) but did not hydrolyse pullulan. Chemotaxonomic data also supported the affiliation of strains UG-2(T) and UG-3 to the genus Pullulanibacillus. Physiological and biochemical tests along with fatty acid composition allowed differentiation of strains UG-2(T) and UG-3 from P. naganoensis. It is suggested that strains UG-2(T) and UG-3 represent a novel species, for which the name Pullulanibacillus uraniitolerans is proposed; the type strain is UG-2(T) (=DSM 19429(T) = LMG 24205(T)). An emended description of the genus Pullulanibacillus is also proposed.

The Campylobacter jejuni response regulator, CbrR, modulates sodium deoxycholate resistance and chicken colonization.

Two-component regulatory systems play a major role in the physiological response of bacteria to environmental stimuli. Such systems are composed of a sensor histidine kinase and a response regulator whose ultimate function is to affect the expression of target genes. Response regulator mutants of Campylobacter jejuni strain F38011 were screened for sensitivity to sodium deoxycholate. A mutation in Cj0643, which encodes a response regulator with no obvious cognate histidine kinase, resulted in an absence of growth on plates containing a subinhibitory concentration of sodium deoxcholate (1%, wt/vol). In broth cultures containing 0.05% (wt/vol) sodium deoxycholate, growth of the mutant was significantly inhibited compared to growth of the C. jejuni F38011 wild-type strain. Complementation of the C. jejuni cbrR mutant in trans restored growth in both broth and plate cultures supplemented with sodium deoxycholate. Based on the phenotype displayed by its mutation, we designated the gene corresponding to Cj0643 as cbrR (Campylobacter bile resistance regulator). While the MICs of a variety of bile salts and other detergents for the C. jejuni cbrR mutant were lower, no difference was noted in its sensitivity to antibiotics or osmolarity. Finally, chicken colonization studies demonstrated that the C. jejuni cbrR mutant had a reduced ability to colonize compared to the wild-type strain. These data support previous findings that bile resistance contributes to colonization of chickens and establish that the response regulator, CbrR, modulates resistance to bile salts in C. jejuni.

Assessment of acute and subchronic oral toxicity of ethanolic extract of Pothomorphe umbellata L. Miq (Pariparoba)

Existe uma grande preocupação quanto ao uso seguro de extratos vegetais e, por esta razão, a necessidade de estudos toxicológicos pré-clínicos e clínicos destes extratos. O objetivo deste trabalho foi o de avaliar a toxicidade aguda e subcrônica do extrato hidroalcoólico liofilizado de Pothomorphe umbellata L. Miq., administrado por via oral para animais de laboratório. O potencial mutagênico do extrato foi também avaliado pelo teste do micronúcleo. Os resultados dos estudos a curto e médio prazo demonstraram que o extrato não apresenta propriedades tóxicas.