Molecular evidence of sporadic Coxiella burnetii excretion in sheep milk, central Portugal.

Coxiella burnetii is the etiologic agent of Q fever, a worldwide zoonosis. Cattle, sheep and goats are considered the main reservoirs of the disease. Transmission to humans occurs mainly through the inhalation of infectious aerosols from milk, faeces, urine, and birth products from infected ruminants. In this study, a 2-year longitudinal approach was performed to ascertain the excretion of C. burnetii in bulk tank milk samples of sheep from a mountain plateau in central Portugal, with sampling conducted during the years 2015 and 2016. From a total of 156 bulk tank milk samples tested by qPCR, only one showed to be positive for C. burnetii (1.28% [95%CI: 0.03-6.94]), from 2015, the first year of collection. Bidirectional sequencing and phylogenetic analysis of IS1111 transposase partial region confirmed the presence of C. burnetii DNA. The presence of C. burnetii in raw milk samples highlights the necessity for additional research to determine if raw milk is a potential source for human infection. Animal health surveillance and prevention measures against this zoonotic disease should be considered.

A multivariate multilevel approach to unravel the associations between individual and school factors on children's motor performance in the REACT project.

OBJECTIVE: The aim was to (1) estimate the relationship between physical fitness (PF) and object control fundamental movement skills (FMS), (2) identify child characteristics that relate with PF and FMS, and (3) examine associations between the school environment, PF, and FMS. METHODS: The sample included 1014 Portuguese children aged 6-10 years from the REACT project. PF was assessed via running speed, shuttle run, standing long jump, handgrip, and the PACER test. Object control FMS were assessed with stationary dribble, kick, catch, overhand throw, and underhand roll. Test performances were transformed into z-scores, and their sum was expressed as overall PF and FMS. Child-level variables included body mass index (BMI) z-scores, accelerometer-measured sedentary time and moderate-to-vigorous physical activity, and socioeconomic status (SES). School size, physical education classes, practice areas, and equipment were also assessed. RESULTS: Approximately, 90% of the variance in object control PF and FMS was at the child level, and 10% at the school level. The correlation between PF and object control FMS was .62, which declined to .43 with the inclusion of covariates. Older, more active, and higher SES children had higher object control PF and FMS, and boys outperformed girls. BMI was negatively associated with PF but not with object control FMS. Sedentary time and number of physical education classes were not significant predictors. Most school predictors did not jointly associate with PF and object control FMS. CONCLUSION: PF and object control FMS z-scores were moderately related. Not all child characteristics were associated with both PF and object control FMS, and their effect sizes were different. School characteristics only explained 10% of the total variation in PF and object control FMS.

Pulmonary and Gastrointestinal Parasitic Infections in Small Ruminant Autochthonous Breeds from Centre Region of Portugal-A Cross Sectional Study.

The production of small ruminant autochthonous breeds in the Centre region of Portugal is practiced in a semi-extensive husbandry system, exposing animals to parasitic infections. The main objective of this study was to estimate the prevalence of lungworm infection and identify risk factors. Fecal samples of 203 goats and 208 sheep from 30 herds were collected per rectum and subjected to the modified Baermann test. The overall prevalence of infection was 57.7%, significantly higher in goats (95.6%) than in sheep (20.7%) (p < 0.001). According to the binary logistic regression model, sheep dewormed with albendazole, mebendazole plus closantel, or ivermectin plus clorsulon presented a risk of Protostrongylidae infection 29.702, 7.426, or 8.720 times higher, respectively, than those dewormed with eprinomectin. Additionally, the presence of gastrointestinal parasites was investigated in 307 fecal samples using Mini-FLOTAC®. The overall prevalence of infection was 86.3%, also significantly higher in goats (93.2%) than in sheep (79.9%) (p < 0.001). Strongyle-type eggs were the most frequently identified, both in sheep (69.8%) and goats (87.8%), followed by Eimeria oocysts (40.3% in sheep and 68.9% in goats). Considering the high prevalence and the burden of lungworm parasitic infection, it is urgent to determine its economic impact and the repercussions in animal health in the Centre region of Portugal to establish appropriate therapeutic guidelines.

Individual and school correlates of body mass index and cardiorespiratory fitness in primary school children from the REACT project: A multivariate multilevel analysis.

OBJECTIVE: This paper examines the relationship between body mass index (BMI) and cardiorespiratory fitness (CRF) using a multivariate multilevel approach and investigates the links between individual and school-related correlates with children's BMI and CRF. METHODS: This cross-sectional sample included 1014 children (6-10 years) from 25 Portuguese primary schools. BMI was calculated, and CRF was assessed with the PACER test. Fundamental movement skills (FMS) included five object control tasks. Moderate-to-vigorous physical activity (MVPA), sleep, and sedentary time were assessed with the ActiGraph wGT3X-BT accelerometer. Socioeconomic status (SES) and school variables were also obtained. A multivariate multilevel model was used, and alpha was set at 5%. RESULTS: BMI and CRF systematically increased with age. Most of the joint variance (94.4%) was explained at the child level, and BMI and CRF were correlated at this level (ρ = -.37). More active children demonstrated higher CRF levels and had lower BMI levels; sedentary and sleep time were not significantly associated with BMI or CRF. FMS were positively associated with CRF but were not significantly associated with BMI. Children at higher SES were more fit and had lower BMI than their peers of lower SES. Finally, school-level variables were not significantly related to BMI and CRF. CONCLUSION: BMI and CRF had a low but statistically significant negative correlation in this sample of children. Most of the variation in BMI and CRF was explained by child-level characteristics.

Extensively drug-resistant Pseudomonas aeruginosa: clinical features and treatment with ceftazidime/avibactam and ceftolozane/tazobactam in a tertiary care university hospital center in Portugal - A cross-sectional and retrospective observational study.

Introduction: Extensively drug-resistant Pseudomonas aeruginosa (XDR-PA) is a growing concern due to its increasing incidence, limited therapeutic options, limited data on the optimal treatment, and high mortality rates. The study aimed to characterize the population, the outcome and the microbiological characteristics of XDR-PA identified in a Portuguese university hospital center. Methods: All XDR-PA isolates between January 2019 and December 2021 were identified. XDR-PA was defined as resistance to piperacillin-tazobactam, third and fourth generation cephalosporins, carbapenems, aminoglycosides and fluoroquinolones. A retrospective analysis of the medical records was performed. Results: One hundred seventy-eight individual episodes among 130 patients with XDR-PA detection were identified. The most common sources of infection were respiratory (32%) and urinary tracts (30%), although skin and soft tissue infections (18%) and primary bacteremia (14%) were also prevalent. Colonization was admitted in 64 cases. Several patients had risk factors for complicated infections, most notably immunosuppression, structural lung abnormalities, major surgery, hemodialysis or foreign intravascular or urinary devices. XDR-PA identification was more frequent in male patients with an average age of 64.3 ± 17.5 years. One non-susceptibility to colistin was reported. Only 12.4% were susceptible to aztreonam. Ceftazidime-avibactam (CZA) was susceptible in 71.5% of the tested isolates. Ceftolozane-tazobactam (C/T) was susceptible in 77.5% of the tested isolates. Antibiotic regimens with XDR-PA coverage were reserved for patients with declared infection, except to cystic fibrosis. The most frequently administered antibiotics were colistin (41 cases), CZA (39 cases), and C/T (16 cases). When combination therapy was used, CZA plus colistin was preferred. The global mortality rate among infected patients was 35.1%, significantly higher in those with hematologic malignancy (50.0%, p < 0.05), followed by the ones with bacteremia (44.4%, p < 0.05) and those medicated with colistin (39.0%, p < 0.05), especially the ones with respiratory infections (60.0%). Among patients treated with CZA or C/T, the mortality rate seemed to be lower. Discussion: XDR-PA infections can be severe and difficult to treat, with a high mortality rate. Even though colistin seems to be a viable option, it is likely less safe and efficient than CZA and C/T. To the best of the authors' knowledge, this is the first description of the clinical infection characteristics and treatment of XDR-PA in Portugal.

Polymyxin Resistance in Salmonella: Exploring Mutations and Genetic Determinants of Non-Human Isolates.

Until 2015, polymyxin resistance was primarily attributed to chromosomal mutations. However, with the first report of mobile colistin resistance (mcr-1) in commensal Escherichia coli from food animals in China, the landscape has changed. To evaluate the presence of polymyxin resistance in Salmonella spp., a drop screening test for colistin and polymyxin B was carried out on 1156 isolates of non-human origin (animals, food, and the environment), received in Brazil, between 2016 and 2021. Subsequently, 210 isolates with resistant results in the drop test were subjected to the gold-standard test (broth microdilution) for both colistin and polymyxin B. Whole-genome sequencing (WGS) of 102 resistant isolates was performed for a comprehensive analysis of associated genes. Surprisingly, none of the isolates resistant to colistin in the drop test harbored any of the mcr variants (mcr-1 to mcr-10). WGS identified that the most common mutations were found in pmrA (n= 22; T89S) and pmrB (n = 24; M15T, G73S, V74I, I83A, A111V). Other resistance determinants were also detected, such as the aac(6')-Iaa gene in 72 isolates, while others carried beta-lactamase genes (blaTEM-1blaCTX-M-2, blaCMY-2). Additionally, genes associated with fluoroquinolone resistance (qnrB19, qnrS1, oqxA/B) were detected in 11 isolates. Colistin and polymyxin B resistance were identified among Salmonella from non-human sources, but not associated with the mcr genes. Furthermore, the already-described mutations associated with polymyxin resistance were detected in only a small number of isolates, underscoring the need to explore and characterize unknown genes that contribute to resistance.

The effect of Galilean magnification loupes on the visual acuity and working distance of dental students.

OBJECTIVE: This study aimed to evaluate the visual acuity and working distance of dental students using Galilean loupes at different magnification levels. METHODS: The participants included 50 undergraduate dentistry students selected from each class in the second to fifth years (N = 200) of São Paulo State University, School of Dentistry, Araraquara. The response variables were (i) the working distance between the operator's eyes and the mouth of the dental phantom head, and (ii) visual acuity. The independent variables were the five levels of the Galilean magnification system (naked eye, Galilean loupe simulator without magnification, and Galilean loupes with 2.5×, 3.0×, or 3.5× magnification) and academic year. Visual acuity was measured using a miniature Snellen eye chart inserted into the Class I cavities of the maxillary molars. After verifying the assumptions of normality and sphericity, a mixed repeated measures analysis was performed (α = 0.05). RESULTS: Statistical significance was found between the "magnification system" and "academic year" for visual acuity (p < 0.001). For the second-, fourth-, and fifth-year participants, there were no significant differences in visual acuity between the naked eye and different magnifications of the Galilean loupes, which were superior to and significantly different from that of the loupe simulator. For the working distance, statistical significance was observed in the interaction between "magnification system" and "academic year" (p = 0.008). For the third-, fourth-, and fifth-year participants, there was no significant difference in the working distance between the naked eye and different magnifications of the Galilean loupes, which were superior to and significantly different from that of the simulator. CONCLUSION: It was concluded that the different magnification levels of the Galilean loupes did not influence the visual acuity or distance between the eyes of the operator and the mouth of the dental phantom head in the evaluated students.

Oral health-care practices and dental assistance management strategies for people with autism spectrum disorder: An integrative literature review.

ABSTRACT: Autism spectrum disorder requires a careful approach from professionals and a favorable clinical environment for dental care and assistance. This article aims To perform a literature review about oral health among people with autism spectrum disorder and dental management strategies for this group. An integrative literature review was carried out in three databases, associating the descriptors: (autism or autism spectrum disorder) with (oral health or oral diseases) and (dental care or dental services). After identification and screening steps, 32 articles were included in the study. The most prevalent subjects were oral health conditions, parents' understanding and practical attitudes about oral health, treatment and management strategies, and the use of technology. The principal barriers to dental care were the scarcity of specialized professionals, unpreparedness in the referral system, poor accessibility of the clinics, and lack of specific care protocols. The world literature on the subject is scarce, and there is still a need for investment and scientific production due to the incidence of autism in the world population and the maintenance of difficulties and barriers in offering quality health care to this group.

Post-COVID-19 syndrome: An investigation of speech-language-hearing symptoms / Síndrome Pós-COVID-19: investigação de sintomas fonoaudiológicos

ABSTRACT Purpose: to investigate speech-language-hearing symptoms in adults after the acute phase of COVID-19 and the impact of these persistent symptoms on their physical and emotional aspects, functional capacity, and social relationships. Methods: 204 adults who tested positive for COVID-19 between January 2021 and July 2022 and who completed an online questionnaire, addressing different variables. Data were analyzed with descriptive statistics. Results: the most prevalent symptoms up to 30 days after infection were tiredness (46%), memory loss (40.2%), and ageusia (26.5%). The most found long-term symptoms were memory loss (34.3%), tiredness (21.1%), and difficulties in starting a sentence or conversation (10.1%). Anosmia and ageusia were also cited. These persistent symptoms had an impact on their emotional aspect (33.3%), followed by the physical (26%) and occupational (25%) ones. Conclusion: this study found persistent symptoms after the acute phase of COVID-19, which can lead to speech-language-hearing disorders, such as impaired oral language and eating. These persistent symptoms impacted the participants' emotional, physical, and occupational aspects.

RESUMO Objetivo: investigar a presença de sintomas fonoaudiológicos em adultos após o período da fase aguda da COVID-19, além do impacto da manutenção desses sintomas nos aspectos físicos, emocionais, capacidade funcional e relações sociais. Métodos: participaram 204 adultos que testaram positivo para COVID-19 no período de janeiro de 2021 a julho de 2022 e que preencheram um questionário on- line, abordando diferentes variáveis. Os dados foram analisados por meio de estatística descritiva. Resultados: os sintomas mais prevalentes até 30 dias após a infecção foram cansaço (46%), perda de memória (40,2%) e ageusia (26,5%). Os sintomas de longa duração mais observados foram perda de memória (34,3%), cansaço (21,1%) e dificuldades para iniciar um diálogo ou frase (10,1%). Anosmia e ageusia também foram citadas. Houve impacto da manutenção desses sintomas no aspecto emocional (33,3%), seguido dos aspectos físicos (26%) e ocupacionais (25%). Conclusão: neste estudo foram encontrados sintomas persistentes após o período da fase aguda da COVID-19 que podem levar a alterações fonoaudiológicas, como prejuízo na linguagem oral e nas questões alimentares. A manutenção desses sintomas impactou nos aspectos emocionais, físicos e ocupacionais dos participantes.

Moringa oleifera Oil Nutritional and Safety Impact on Deep-Fried Potatoes.

Aiming to understand the nutritional impact of Moringa oleifera oil (MOO) on the quality of fried potatoes as consumed, a frying study using intermittent frying at 180 °C was conducted over 5 days, with a total heating time of 15 h, against olive (OO) and sunflower (SFO) oils. Additionally, due to MOO's higher costs, a SFO/MOO blend (80/20 w/w) was tested. With similar fat incorporation and moisture contents, potato lipid composition revealed the impact of oil oxidation over the frying time, gradually decreasing the content of unsaturated fatty acids and antioxidants, including vitamin E, carotenoids and ascorbic acid, and increasing the incorporation of trans fatty acids (TFAs) and volatile aldehydes. When the potatoes fried at the ninth hour of heating are compared, MOO and OO were still able to protect potato ascorbic acid better than SFO, due to the low oxidative stress imposed by their fatty-acid composition. SFO, on the contrary, with linoleic acid as the main fatty acid, and despite its higher content of vitamin E, demonstrated higher oxidative stress and increased incorporation of alkenals and alkadienals. Acrylamide content was generally low, as were the trans fatty acids formed and incorporated with frying time, with MOO fried potatoes having lower amounts of all these process contaminants. Interestingly, the blend SFO/MOO (80/20 w/w) doubled the amount of vitamin E in fried potatoes when compared with SFO alone, increased the ascorbic acid protection and reduced by half the amounts of volatile aldehydes, indicative of an efficient reduction of the oxidative status of the SFO-fried potatoes, with benefits to the consumer from a health point of view.

Detection and genomic characterization of a multidrug-resistant Salmonella Newport co-harbouring blaCMY-2, qnrB19 and mcr-9 from the diarrheic faeces of a foal.

OBJECTIVES: This study reports the genomic characterization of the multidrug resistant Salmonella Newport strain 195_20 recovered from the diarrheic faeces of a foal in Brazil and co-harbouring the mcr-9, blaCMY-2 and qnrB19 antibiotic resistance genes. METHODS: Bacterial isolate positive for mobile colistin resistance gene (mcr-9) was submitted to antimicrobial susceptibility testing by disk diffusion and broth microdilution for colistin and polymyxin B. The isolate was submitted to whole genome sequencing by Illumina technology and Nanopore Sequencing. Conjugation assays, plasmid sizes determined by S1-PFGE and plasmid content were investigated by hybrid assembly after MinIon long reads sequencing. RESULTS: Isolate 195_20 was identified as sequence type ST45, resistant to penicillin and cephalosporins (ampicillin, ceftazidime, ceftriaxone and cefotaxime), aminoglycosides (streptomycin and gentamicin), phenicol (chloramphenicol), quinolones and fluoroquinolones (nalidixic acid, ciprofloxacin, and pefloxacin), folate pathway antagonists (sulfonamides and trimethoprim-sulfamethoxazole), and tetracycline. A transferable IncHI2/IncHI2A plasmid sized ca. 262kb was found to carry the mcr-9 gene in a module consisting of IS903-mcr-9-wbuC-IS26. In addition, an 174kb IncC and a 48kb IncN plasmid were also identified in the 195_20 isolate, carrying blaCMY-2 and qnrB19, respectively. CONCLUSIONS: Not surprisingly, isolate 195_20 was susceptible to polymyxins, possibly due to absence of qseBC regulatory operon. Presence of mobile colistin resistance (mcr-9), third-generation cephalosporins (blaCMY-2) and quinolone (qnrB19) resistance determinants in zoonotic pathogens from animals in close contact with humans alerts for the possible route of transmission between these different reservoirs.

Ceftolozane/tazobactam for the treatment of Pseudomonas aeruginosa infections: A multicenter case series analysis / Ceftolozano/tazobactam para el tratamiento de infecciones por Pseudomonas aeruginosa: una serie de casos multicéntrica

Introduction Pseudomonas aeruginosa displays resistance to several available antibiotics. Infections caused by this pathogen are associated with a high mortality, morbidity, and considerable healthcare resource utilization and costs. This study was aimed at describing the use of ceftolozane/tazobactam (C/T) for the treatment of patients with P. aeruginosa infections. Methods Case series analysis of hospitalized patients treated with C/T for P. aeruginosa infections in five public Portuguese hospitals. Patients presenting with infections caused by this pathogen and receiving C/T for at least 72h during hospitalization were eligible. Results Sixty-four hospitalized patients with P. aeruginosa infections treated with C/T were evaluated between December 2016 and July 2019. Most patients were aged between 60 and 79 years (53.9%). Patients presented a total of 68 P. aeruginosa infections, with respiratory infections being the most common (28.1%, 18 out of 64). Most P. aeruginosa strains (85.9%, 55 out of 64) were extensively drug-resistant (XDR). C/T was mostly used as targeted therapy (98.4%, 63 out of 64 patients) and as monotherapy (72.7%, 47 out of 64 patients). Combination therapy was used in 47.4% (9 out of 19) of patients with bacteriemia. Most patients had successful microbiological (79.2%, 42 out of 53) and clinical (78.7%, 48 out of 61) outcomes. All-cause in-hospital mortality rate was 34.4%. Conclusion The present case series contributes to the body of evidence suggesting that C/T is an effective and safe option for treating P. aeruginosa infections, namely those caused by XDR strains, both when used as mono- or combination therapy (AU)

Introducción Pseudomonas aeruginosa presenta mecanismos de resistencia a diversos antibióticos. Las infecciones causadas por este patógeno aumentan la morbimortalidad, el uso de recursos y los costos asociados. Este estudio tuvo como objetivo describir el uso de ceftolozano/tazobactam (C/T) para el tratamiento de pacientes con infecciones por P. aeruginosa. Métodos Serie de casos de pacientes hospitalizados con infecciones por P. aeruginosa que fueron tratados con C/T en 5 hospitales portugueses. Fueron incluidos pacientes que presentaban infecciones por este patógeno y recibían terapéutica con C/T durante al menos 72 horas. Resultados Entre diciembre de 2016 y julio de 2019 fueron analizados 64 pacientes hospitalizados con infecciones por P. aeruginosa tratados con C/T. La mayoría tenían entre 60 y 79 años (53,9%). Se aislaron 68 infecciones por P. aeruginosa, siendo más frecuentes las respiratorias (28,1%; 18/64). La mayoría de las cepas de P. aeruginosa (85,9%; 55764) eran extremadamente resistentes. El C/T se utilizó principalmente como terapia dirigida (98,4%; 63/64 pacientes) y en monoterapia (72,7%; 47/64 pacientes). La terapia combinada se utilizó en el 47,4% (9/19) de los pacientes con bacteriemia. La mayoría de los pacientes tuvieron resultados microbiológicos (79,2%; 42/53) y clínicos (78,7%; 48/61) satisfactorios. La tasa de mortalidad intrahospitalaria por todas las causas fue del 34,4%. Conclusión La presente serie de casos sustenta que la terapéutica con C/T es una alternativa efectiva y segura para las infecciones por P. aeruginosa, particularmente por cepas extremadamente resistentes, en monoterapia o en terapia combinada (AU)

Unveiling the electronic properties of native solid electrolyte interphase layers on Mg metal electrodes using local electrochemistry.

Magnesium-ion batteries (MIBs) are of considerable interest as environmentally more sustainable, cheaper, and safer alternatives to Li-ion systems. However, spontaneous electrolyte decomposition occurs due to the low standard reduction potential of Mg, leading to the deposition of layers known as native solid electrolyte interphases (n-SEIs). These layers may inhibit the charge transfer (electrons and ions) and, therefore, reduce the specific power and cycle life of MIBs. We propose scanning electrochemical microscopy (SECM) as a microelectrochemical tool to locally quantify the electronic properties of n-SEIs for MIBs. These interphases are spontaneously formed upon contact of Mg metal disks with organoaluminate, organoborate, or bis(trifluoromethanesulfonyl)imide (TFSI)-based electrolyte solutions. Our results unveil increased local electronic and global ionic insulating properties of the n-SEI formed when using TFSI-based electrolytes, whereas a low electronically protecting character is observed with the organoaluminate solution, and the organoborate solution being in between them. Moreover, ex situ morphological and chemical characterization was performed on the Mg samples to support the results obtained by the SECM measurements. Differences in the electronic and ionic conductivities of n-SEIs perfectly correlate with their chemical compositions.

Nutrition and Outcome of 100 Endoscopic Gastrostomy-Fed Citizens with Severe Dementia.

Dementia is a rising public health concern. Feeding and nutritional problems increase as the disease progresses, affecting the clinical course and caregiver burden. While some guidelines advise against percutaneous endoscopic gastrostomy (PEG) and tube feeding in advanced dementia, conflicting evidence exists. This study aims to evaluate the nutritional status and influence of PEG feeding on the outcome and evolution of nutritional/prognosis markers of patients with severe dementia (PWSD) who underwent gastrostomy for nutritional support. We conducted a 16-year retrospective study on 100 PEG-fed PWSD with strong familial support. We evaluated the survival PEG-feeding period, safety, and objective nutritional/prognosis data on the gastrostomy day and after 3 months: Body Mass Index (BMI), Mid Upper Arm Circumference, Tricipital Skinfold, Mid-Arm Muscle Circumference, albumin, transferrin, total cholesterol, and hemoglobin. Most patients presented low values in these nutritional/prognosis parameters. No major life-threatening PEG complications were reported. The mean survival time after gastrostomy was 27.9 months (median of 17 months). Female sex, BMI recovery at 3 months, and higher baseline hemoglobin levels were associated with a reduced risk of death and increased survival time. The study concluded that, in carefully selected PWSD with strong familial support, PEG feeding can improve nutritional status and have a positive impact on survival.

Atypical Unilateral Birdshot Chorioretinitis in a Hispanic Female.

A 62-year-old female patient was evaluated for gradual vision loss, floaters, and photopsia in her left eye. A left fundus examination revealed vitreous cells, hypopigmented lesions, and retinal vasculitis, and a workup revealed a positive HLA-A29 serology, all of which findings were consistent with birdshot chorioretinopathy. The patient was treated with oral prednisone and mycophenolate mofetil, which resulted in the adequate control of her uveitis. Even though unilateral cases are exceedingly rare and do not meet the established research criteria, this case highlights the importance of not minimizing the significance of birdshot lesions in the differential of patients with unilateral multifocal chorioretinitis.

A importância de uma equipa comunitária de suporte em cuidados paliativos num hospital privado / The importance of a community palliative care support team in a private hospital

A vivência de uma doença grave em estado avançado e sem perspetiva de cura, repercute-se efetivamente, na pessoa em toda a sua integridade, enquanto ser único e irrepetível, com uma história de vida, também ela, ímpar. Contudo, a medicina assumiu o compromisso de lutar contra a morte e procura formas de a combater, o que gera ao profissional de saúde um sentimento de derrota quando enfrenta o fim de vida do doente, em que a morte é a maior certeza. Surgem assim, os cuidados paliativos como uma prioridade da política de saúde, cuidados ativos, rigorosos, que combinam princípios científicos e humanos, que investem na vida. Mas, que precisam de profissionais de saúde com competências específicas nesta área. Partindo destes pressupostos, optamos por realizar em Estágio de Natureza Profissional numa unidade de cuidados paliativos de um hospital privado, de forma a desenvolver competências especializadas e promover as necessárias sinergias interinstitucionais, com consequentes ganhos em saúde. No decurso do estágio de natureza profissional, desenvolvemos competências especializadas no âmbito da prestação de cuidados, como: gestão de sintomas, apoio e acompanhamento familiar; apoio no processo de luto, comunicação e trabalho em equipa e, competências gerais, como: intervenção na formação, gestão de cuidados e investigação no contexto da prática clínica, de forma a contribuir para a humanização do fim de vida e educar os outros para a construção de um fim de vida condigno. No domínio da prestação de cuidados delineamos intervenções com base nas necessidades presentes do doente e família, com os seus próprios valores e prioridades. Gerimos os sintomas presentes, assumindo-se a comunicação como uma estratégia terapêutica de intervenção na minimização do sofrimento, favorecemos o suporte emocional da família, baseamo-nos no trabalho em equipa, avaliamos resultados, a eficácia, a eficiência e a satisfação das intervenções implementadas. Através do diagnóstico de situação, emerge a necessidade de investigar sobre a importância da existência de uma equipa comunitária de suporte em cuidados paliativos num hospital privado, com o objetivo de conhecer as vantagens da integração de uma equipa comunitária de suporte em cuidados paliativos num hospital privado, de forma a contribuir para a continuidade de cuidados e para a acessibilidade das pessoas a cuidados ativos, rigorosos, cientificamente competentes e humanos. Estudo de natureza qualitativo, com recurso à entrevista semiestruturada dirigida a profissionais de saúde de um hospital privado. Os achados foram submetidos à análise de conteúdo segundo Bardin (2015). Respeitados os princípios éticos e legais. Verificamos que prestar cuidados de alta qualidade com base nas necessidades dos doentes e familiares, é indispensável uma colaboração multiprofissional baseada numa visão partilhada da essência dos CP. Foram identificadas vantagens ao nível da existência de uma Equipa Comunitária de Suporte em CP, nomeadamente para o desenvolvimento de habilidades nos familiares, assegurando a continuidade de cuidados no domicílio, bem como a promoção de uma maior confiança entre quem cuida e é cuidado. Contudo, consideram alguns aspetos dificultadores como os custos que acarretam e a falta de recursos com formação em cuidados paliativos. Como aspetos facilitadores dão ênfase à integração do doente no seu meio familiar. Sugerem uma aposta no marketing dos cuidados paliativos. No domínio da formação desenvolvemos um Guia de Cuidados Após Alta Hospitalar para o Doente e sua Família e no domínio da gestão tivemos como foco o desenvolvimento de um Projecto para a criação de Uma Equipa Comunitária de Suporte em Cuidados Paliativos. Considera-se ter desenvolvido competências especializada em cuidados paliativos.

The experience of a severe disease at an advanced stage and with no prospect of cure effectively affects the person in all his/her integrality, as a unique and unrepeatable being, with a unique life history. However, medicine has assumed the commitment to fight against death and seeks ways to combat it, which generates a feeling of defeat for the health professional when facing the end of life of the patient, in which death is the greatest certainty. Thus, palliative care emerges as a priority in health policy, active, rigorous care that combines scientific and human principles, that invests in life. But it needs health professionals with specific skills in this area. Based on these assumptions, we chose to carry out an Internship of Professional Nature in a palliative care unit of a private hospital, in order to develop specialized skills and promote the necessary inter-institutional synergies, with consequent gains in health. During the professional internship, we developed specialized skills in care provision, such as: symptom management, family support and follow-up, support in the bereavement process, communication and teamwork, and general skills, such as: intervention in training, care management and research in the context of clinical practice, in order to contribute to the humanization of the end of life and educate others for the construction of a dignified end of life. In the field of care delivery, we design interventions based on the present needs of the patient and family, with their own values and priorities. We manage the present symptoms, assuming communication as a therapeutic strategy of intervention to minimize suffering, we favor the emotional support of the family, we are based on teamwork, we evaluate results, the effectiveness, efficiency and satisfaction of the interventions implemented. Through the diagnosis of the situation, the need emerges to investigate the importance of the existence of a community palliative care support team in a private hospital, with the purpose of knowing the advantages of integrating a community palliative care support team in a private hospital, so as to contribute to the continuity of care and the accessibility of people to active, rigorous, scientifically competent and humane care. This is a qualitative study, using semi-structured interviews with health professionals from a private hospital. The findings were submitted to content analysis according to Bardin (2015). The ethical and legal principles were respected. We found that providing high quality care based on the needs of patients and families requires a multidisciplinary collaboration based on a shared vision of the essence of PC. The advantages of the existence of a Community PC Support Team were identified, namely for the development of skills in family members, ensuring continuity of care at home, as well as promoting greater trust between those who care and those who are cared for. However, they consider some of the complicating aspects to be the costs involved and the lack of resources with training in palliative care. As facilitating aspects, they emphasize the integration of the patient in his or her family environment. They suggest a focus on the marketing of palliative care. In terms of training, we developed a Post-Discharge Care Guide for the Patient and his Family and in terms of management, we focused on the development of a Project for the creation of a Community Support Team in Palliative Care. It is considered to have developed specialized skills in palliative care

Validity of a booklet to promote the health of people with diabetes in the face of COVID-19.

OBJECTIVES: to validate the content and appearance of a booklet to promote the health of people with diabetes mellitus in the face of COVID-19. METHODS: a methodological study, carried out in a virtual environment with experts who had practical and scientific experience in diabetes mellitus, from November 2021 to February 2022. Data were analyzed using the Content Validity Ratio. RESULTS: twenty-seven experts from different states of Brazil and with different academic backgrounds participated in the study. In content validity, reviews were suggested in items in relation to objectives and structure, in appearance validity, adjustments in layout were suggested. CONCLUSIONS: the results showed that the booklet achieved adequate content and appearance validity rates. Therefore, when adapting to experts' suggestions, it becomes an accurate tool.

Polymorphisms in the MBL2 gene are associated with the plasma levels of MBL and the cytokines IL-6 and TNF-α in severe COVID-19.

Introduction: Mannose-binding lectin (MBL) promotes opsonization, favoring phagocytosis and activation of the complement system in response to different microorganisms, and may influence the synthesis of inflammatory cytokines. This study investigated the association of MBL2 gene polymorphisms with the plasma levels of MBL and inflammatory cytokines in COVID-19. Methods: Blood samples from 385 individuals (208 with acute COVID-19 and 117 post-COVID-19) were subjected to real-time PCR genotyping. Plasma measurements of MBL and cytokines were performed by enzyme-linked immunosorbent assay and flow cytometry, respectively. Results: The frequencies of the polymorphic MBL2 genotype (OO) and allele (O) were higher in patients with severe COVID-19 (p< 0.05). The polymorphic genotypes (AO and OO) were associated with lower MBL levels (p< 0.05). IL-6 and TNF-α were higher in patients with low MBL and severe COVID-19 (p< 0.05). No association of polymorphisms, MBL levels, or cytokine levels with long COVID was observed. Discussion: The results suggest that, besides MBL2 polymorphisms promoting a reduction in MBL levels and therefore in its function, they may also contribute to the development of a more intense inflammatory process responsible for the severity of COVID-19.