Amazonian fermentations: an analysis of industrial and social technology as tools for the development of bioeconomy in the region.

This review article explores the potential of fermentations in the Amazon region as catalysts for economic and social development. It highlights the rich cultural and gastronomic diversity of the Amazon, focusing on indigenous fermented products. Two main products, tucupi and caxiri, are discussed in detail, emphasizing their significance in local cuisine and culture. The review examines the challenges and opportunities for industrial applications of these products, as well as their potential for social technology initiatives, particularly in the context of family farming. The sustainable production of native fermented products in the Amazon is seen as a means to preserve biodiversity, empower local communities, and promote cultural heritage. The article concludes that both industrial and social technologies have complementary roles in promoting economic growth, cultural preservation, and the well-being of the Amazon region, making it a promising hub for innovative and sustainable fermented food products on a global scale.

[Actual adherence to dimethyl fumarate in patients with relapsing-remitting multiple sclerosis]. / Adhesión real al dimetilfumarato en pacientes con esclerosis múltiple remitente-recurrente.

INTRODUCTION: Multiple sclerosis is a chronic neurological disease with numerous disease-modifying treatments available, including dimethyl fumarate (DMF), a first-line therapy for relapsing-remitting multiple sclerosis. Although rates of discontinuation of DMF are generally low in clinical trials, non-adherence to treatment is associated with poorer clinical outcomes. Assessing real-world adherence and predictive factors is critical to be able to improve clinical outcomes for patients. This study evaluated adherence to DMF over 24 months in a cohort of patients treated in a Portuguese healthcare centre. PATIENTS AND METHODS: A prospective, non-interventional, single-centre study with 24 months' follow-up was conducted. The study included adult patients with relapsing-remitting multiple sclerosis treated with DMF in routine clinical practice. Adherence to DMF was calculated and patients were considered to have adhered if the value was above 80%. Clinical and socio-demographic variables were compared between groups. RESULTS: Of the 80 patients included, 74% were women, with a mean age of 39 years and a mean age of 32 years at diagnosis. Twenty-six patients had not received any previous treatment. Adherence varied between 93, 82 and 87.5% at 6, 12 and 24 months, respectively. No differences were found between patients who had not received any prior treatment and those who had been treated. CONCLUSION: This real-world analysis showed significant adherence to DMF treatment by Portuguese patients over a period of two years. However, these results must be interpreted in the light of the substantial changes in outpatient consultations and the various periodic restrictions due to the COVID-19 pandemic, which had an important effect on patient follow-up and data collection.

TITLE: Adhesión real al dimetilfumarato en pacientes con esclerosis múltiple remitente-recurrente.Introducción. La esclerosis múltiple es una enfermedad neurológica crónica con numerosos tratamientos modificadores de la enfermedad disponibles, incluido el dimetilfumarato (DMF), una terapia de primera línea para la esclerosis múltiple remitente-recurrente. Aunque las tasas de discontinuación del DMF suelen ser bajas en los ensayos clínicos, la falta de adhesión al tratamiento se asocia con peores resultados clínicos. Evaluar la adhesión en el mundo real y los factores predictivos es fundamental para mejorar los resultados clínicos de los pacientes. Este estudio evaluó la adhesión al DMF durante 24 meses en una cohorte de pacientes tratados en un centro portugués. Pacientes y métodos. Estudio prospectivo no intervencionista, de un solo centro, con un seguimiento de 24 meses. El estudio incluyó a pacientes adultos con esclerosis múltiple remitente-recurrente tratados con DMF en la práctica clínica habitual. Se calculó la adhesión al DMF y se consideró que los pacientes eran adherentes si el valor estaba por encima del 80%. Se compararon variables clínicas y sociodemográficas entre grupos. Resultados. De los 80 pacientes incluidos, el 74% eran mujeres, con una edad media de 39 años y una edad media en el momento del diagnóstico de 32 años. Veintiséis pacientes no habían recibido tratamiento previo. La adhesión varió entre el 93, el 82 y el 87,5% a los 6, 12 y 24 meses, respectivamente. No se encontraron diferencias entre los pacientes que no habían recibido tratamiento previo y los que sí lo habían recibido. Conclusión. Este análisis en el mundo real mostró una adhesión significativa al tratamiento con DMF durante dos años por parte de los pacientes portugueses. No obstante, estos resultados deben interpretarse considerando los cambios sustanciales en las consultas externas y las diversas restricciones periódicas debidas a la pandemia de COVID-19, que afectaron en gran medida al seguimiento de los pacientes y a la recopilación de datos.

REALMS study: real-world effectiveness and safety of fingolimod in patients with relapsing-remitting multiple sclerosis in Portugal.

BACKGROUND: Fingolimod, an oral sphingosine 1-phosphate receptor modulator, is approved by EMA for relapsing-remitting multiple sclerosis (RRMS). OBJECTIVES: To assess the effectiveness and safety of fingolimod in patients with RRMS in real-world clinical practice in Portugal. METHODS: Retrospective, multicentre, non-interventional study, reporting 3 years follow-up of data collected from October 2015 to July 2016. Sociodemographic data and previous treatments at baseline and data regarding disease evolution, including number of relapses, annualised relapse rates (ARR) and Expanded Disability Status Scale (EDSS), were collected. RESULTS: Two-hundred and seventy-five participants were enrolled in the REALMS study. Results showed that the main reason to switch to fingolimod was failure of previous treatment (56.7%) and only 3.6% were naïve patients. In the total population, there was a significant decrease in ARR of 64.6% in the first year of treatment, 79.7% in the second year and 82.3% in the third year, compared with baseline. More than 67.0% of patients had no relapses during the 3 years after switching to fingolimod. EDSS remained stable throughout the study. CONCLUSIONS: Therapy with fingolimod showed a sustained effectiveness and safety over the 3 years, particularly on patients switched from first-line drugs (BRACE). No new safety issues were reported.

The efficacy and safety of natalizumab for the treatment of multiple sclerosis in Portugal: a retrospective study.

INTRODUCTION: Studies have shown that natalizumab is an effective treatment for relapsing-remitting multiple sclerosis (RRMS). To date, no data are available in Portuguese patients. AIM: To determine the efficacy and safety of natalizumab in patients with RRMS in routine clinical practice in Portugal. PATIENTS AND METHODS: Clinical data for adult patients with RRMS treated with natalizumab at specialist neurology centres in Portugal were entered retrospectively into a database for analysis between October 2010 and February 2012. Changes in annualized relapse rates (ARR), Expanded Disability Status Scale (EDSS) scores and disability status were analysed. RESULTS: A total of 383 patients from 20 centres were included. Prior to starting natalizumab, the baseline median EDSS score was 4 and the mean ARR was 1.64. Most patients had previously received multiple sclerosis treatment (93.0%). Median natalizumab treatment duration was 12 months. Natalizumab treatment was associated with significant (p < 0.001) reductions from baseline in the mean ARR and EDSS scores in patients treated with natalizumab for >= 12 months (n = 288) and for >= 24 months (n = 160). Natalizumab was more effective in patients with less disability (EDSS < 3) and in those who had not previously received disease-modifying treatments. Two cases of progressive multifocal leukoencephalopathy were reported. No new unexpected adverse events occurred. CONCLUSION: Natalizumab is well tolerated, and is effective in reducing relapse rate and stabilising disease in patients with RRMS in the clinical practice setting in Portugal. Its efficacy persists with continued treatment, and it may be particularly effective in patients with less disability and without prior disease modifying therapy.

TITLE: Estudio retrospectivo de la eficacia y seguridad del natalizumab en el tratamiento de la esclerosis multiple en Portugal.Introduccion. Los estudios han demostrado que el natalizumab constituye un tratamiento eficaz contra la esclerosis multiple remitente recurrente (EMRR). Hasta la fecha, no habia datos de pacientes portugueses. Objetivo. Determinar la eficacia y la seguridad del natalizumab en pacientes con EMRR atendidos en la practica clinica ordinaria en Portugal. Pacientes y metodos. Los datos clinicos de adultos con EMRR tratados con natalizumab en centros especializados de neurologia en Portugal se introdujeron de forma retrospectiva en una base de datos para llevar a cabo un analisis entre octubre de 2010 y febrero de 2012. Se analizo el cambio en la tasa anualizada de brotes (TAB), en las puntuaciones de la escala ampliada de discapacidad (EDSS) y en el estado de discapacidad. Resultados. Se admitio un total de 383 pacientes atendidos en 20 centros. Antes de iniciar el tratamiento con natalizumab, la mediana inicial de la EDSS era de 4,0 y la TAB media, de 1,64. La mayor parte de los pacientes ya habia recibido tratamiento contra la esclerosis multiple (93,0%). La duracion media del tratamiento con natalizumab era de 12 meses. El tratamiento propicio reducciones significativas (p < 0,001) de los valores iniciales de la TAB media y de las puntuaciones EDSS en los tratados con el anticuerpo durante >= 12 meses (n = 288) y durante >= 24 meses (n = 160). El natalizumab resulto mas eficaz en los pacientes que presentaban un menor grado de discapacidad (EDSS < 3,0) y en los que no habian recibido ningun tratamiento modificador de la enfermedad. Se notificaron dos casos de leucoencefalopatia multifocal progresiva. No hubo efectos adversos inesperados. Conclusion. El natalizumab presenta una tolerabilidad satisfactoria y se muestra eficaz en la reduccion de las recidivas y la estabilizacion de la EMRR en el marco de la practica clinica ordinaria en Portugal. Conserva su eficacia con el tratamiento continuado y podria ser eficaz especialmente en los pacientes con menos discapacidad y en aquellos que no han recibido ningun tratamiento modificador de la enfermedad hasta el momento.

Reparación de aneurisma de aorta abdominal en paciente con riñón en herradura y oclusión ilíaca. ¿Es el tratamiento endovascular la única opción? / Repair of an abdominal aortic aneurysm in a patient with a horseshoe kidney and iliac occlusion. Is endovascular treatment the only option?

No disponible

Seudoaneurisma micótico de la arteria carótida interna / Mycotic pseudoaneurysm of the internal carotid artery

No disponible

Capture-recapture as a potentially useful procedure for assessing prevalence of multiple sclerosis: methodologic exercise using Portuguese data.

BACKGROUND: Capture-recapture methods (CRMs) are well established in epidemiologic surveillance and considered useful for the task of correcting for case-finding limitations in multiple sclerosis (MS) prevalence surveys. To date, however, CRMs have been exclusively applied to crude prevalence figures. This study therefore sought to explore an age-specific application of this method to an urban Portuguese population of 229,342. METHODS: We used a CRM to correct for the age-specific prevalence of MS obtained from two data sources, i.e. general practitioners in three primary-care districts and a neurology unit at the referral hospital. The corrected figures were adjusted for age using the European standard population as reference. RESULTS: When applied to 95 MS patients, the CRM impact was highest at ages 50-59 years, with a 110% increase in cases where the corrected prevalence was highest, i.e. 181.8 (95% CI 75.7-287.9) per 100,000, and lowest, nil, at ages ≥70 years, with an unchanged corrected prevalence of 13.8. The crude prevalence of 41.4 per 100,000 increased by 36% to 56.20 per 100,000 when it was CRM- and age-adjusted. Source independence was poor. CONCLUSIONS: CRMs can be differentially applied to MS counts. Valid comparisons may require simultaneous adjustment for age and other variables, such as diagnostic delay and diagnostic criteria. CRM applications to crude figures and dependent sources should be approached with caution.

Mineral inadequacy of oral diets offered to patients in a Brazilian hospital.

INTRODUCTION: While enteral diets for hospitalized patients normally follow nutrient composition guidelines, more than 90% of hospitalized patients receive oral diets with unknown mineral composition. OBJECTIVE: To evaluate the mineral contents and adequacy of three types of oral diets (regular, blend and soft) and complementary snacks offered to patients of a Brazilian hospital. METHODS: The amount of minerals was determined in two non-consecutive days in duplicate samples of breakfast, collation, lunch, snack, dinner, supper and a complementary snack meal. Dietary Reference Intakes (DRIs) were used to determine the adequacy of the daily amounts served to patients. RESULTS AND DISCUSSION: The regular diet met the RDA (Recommended Dietary Allowances) requirements only for Mn, P and Se, while the blend diet was deficient in Ca, K and Mg, and the soft diet met RDA requirements only for P and Zn. Iron was below the RDA requirement in all diets for women in fertile age, and Na was above the safe limit of intake (UL) in all the diets. The use of complementary snack was effective in meeting RDA requirements for Cu in the regular diet, and Mn and Se in the soft diet, but promoted overconsumption of Na. CONCLUSIONS: Evident nutritional imbalances have been detected at a key interphase between nutrition and public health services, but a solution does not appear to be insurmountable. A permanent nutritional evaluation of hospital oral diets should be an integral part of routine health care in order to speed the recovery of the hospitalized patient and dispel eventual risks due to critical mineral imbalances.

Complicaciones de la arteria poplítea tras la artroplastia total de rodilla / Popliteal artery complications after total knee arthroplasty

Las complicaciones arteriales tras la artroplastia total de rodilla aparecen en el 0,25% de las intervenciones, pero su riesgo para la extremidad condiciona la necesidad de un manejo agresivo. Presentamos tres lesiones de la arteria poplítea tras dicha intervención: una trombosis, un pseudoaneurisma y una disección intimal. Los dos primeros casos se trataron con cirugía convencional y el último se manejó de manera conservadora. El resultado fue satisfactorio en los tres pacientes. Con los datos publicados consideramos necesario un diagnóstico precoz y un tratamiento agresivo ante una trombosis arterial aguda secundaria a artroplastia de rodilla, continuando con mejores resultados la cirugía de by-pass. Las técnicas intervencionistas para los pseudoaneurismas poplíteos presentan buenos resultados, aunque la falta de seguimiento a largo plazo no permite generalizar su indicación. Por último, existe un grupo de lesiones no oclusivas asintomáticas que permiten un manejo conservador(AU)

Arterial complications after total knee arthroplasty have an incidence of 0.25%, but the risk to the limb requires aggressive management. We present three cases of popliteal lesions after such surgery. One was a case of acute ischaemia due to popliteal thrombosis managed by an autologous vein by-pass. The second case consisted of a popliteal pseudoaneurysm with symptoms of knee pain and late functional impotence treated with a venous patch. The last case consisted of a non-occlusive intimal dissection managed with conservative treatment. In agreement with published data we believe that an early diagnosis and aggressive treatment of acute arterial thrombosis secondary to knee arthroplasty is necessary, surgical by-pass has the best results. Endovascular technics for popliteal pseudoaneurysm have good results, but due to the lack of long-term follow it is difficult to generalise their indication. Lastly, there is a group of non- occlusive, asymptomatic lesions which can be conservatively managed(AU)

Delayed kidney allograft function after simultaneous pancreas-kidney transplantation.

BACKGROUND: Simultaneous pancreas-kidney transplantation (SPKT) is one of the treatments for insulin-dependent chronic renal failure patients. METHODS: One-year patient and kidney allograft survival rates of 150 patients undergoing SPKT were subjected to Cox regression and Kaplan-Meier analyses. Uni- and multivariate methods identified risk factors involved in allograft and patient survival. RESULTS: One-year patient and kidney allograft survival rates were 82% and 80%, respectively. Delayed graft function (DGF) (P = .001; hazard ratio [HR]5.41) and acute kidney rejection episodes (P = .016; HR 3.36) were related to 1 year patient survival as well as intra-abdominal infection (IAI) rates. (IAI). One-year kidney allograft survival was related to DGF (P = .013; odds ratio [OR] 3.39), acute rejection (P = .001; OR 4.74), and IAI (P = .003, OR 6.29). DGF was related to a time on dialysis >27 months (P = .046; OR 2.59), cold kidney ischemia time >14 hours (P = .027; OR 2.94), donor age >25 years (P = .03; OR 2.82), and donor serum sodium concentration >155 mEq/L (P < .0001; OR 1.09). Female kidney to male recipient in 17% of the cases did not increase the risk of DGF. We observed an important correlation between donor serum sodium and creatinine (P < .0001), which suggested undertreatment of diabetes insipidus secondary to brain death. CONCLUSIONS: DGF, acute rejection, and IAI were the main determinants of survival after SPKT. Improving the care of deceased donors may reduce DGF occurrence.

Simultaneous pancreas-kidney transplantation: which organ should be transplanted first?

Simultaneous pancreas-kidney transplantation (SPKT) has been accepted as treatment for type I diabetic patients with end-stage renal disease. Its success depends largely on the surgical technique. This study sought to compare groups of SPKT with initial pancreas implantation versus initial kidney implantation. From December 2000 to September 2006, 151 SPKT were performed by a single center. In 85 cases, the pancreas was implanted first (group 1), and in 66 cases the order was inverted (group 2). Variables were implantation sequence, pancreas and kidney ischemia time, donor age, venous drainage, previous donor peritoneal dialysis, and recipient age and gender. Outcome variables included pancreas vascular thrombosis, 3-month graft survival, 3-month patient survival, pancreas rejection episodes, intra-abdominal infection, diabetes control and reoperations. We observed a 10.6% incidence of vascular thrombosis in group 1 but none in group 2 (P = .005). In groups 1 and 2, the 3-month pancreas survivals were 74.1% and 89.4% (P = .022), and the mean hospital stays were 24.3 and 15.8 days, respectively (P = .002). Our results suggested that, when 2 different teams are involved in SPKT, with >1 exposure and the need for retractor replacement, the kidney should be transplanted first, because the pancreas may be damaged during the surgical procedure.

Assessment of new application system in Portuguese patients with relapsing-remitting multiple sclerosis.

OBJECTIVE: To evaluate the satisfaction level of multiple sclerosis (MS) patients treated with interferon beta-1b (IFNbeta-1b, Betaferon*) using a newly developed application system compared to their currently used application system. METHODS: A survey was conducted in Portugal in patients treated with IFNbeta-1b for relapsing-remitting MS with the Betaject or Betaject Lite autoinjector. Nurses demonstrated the new application system and supervised the first injection. Patients rated their overall satisfaction retrospectively with their current application system and prospectively after the first, the seventh and the 15th injection with the newly developed application system. Additionally, the ease of use was evaluated for both application systems using a questionnaire consisting of 13 questions. Responses were compiled and descriptive analyses performed. RESULTS: A total of 249 patients evaluated the current and the new system after the first, 235 after the seventh and 174 after the 15th injection. The satisfaction level was high with the current system (70.3%, 'satisfied' or 'very satisfied'). However, compared with the current system, more patients were either 'satisfied' or 'very satisfied' (98%) with the new system after first injection. Only a minority of patients rated 'somewhat satisfied': 2.0% after the first, 8.6% after the seventh, and 4.4% after the 15th injection. Increased overall satisfaction level ('satisfied' or 'very satisfied') with the newly developed system was maintained over time (98% - first, 90.5% - seventh, 93.8% - 15th injection). The thinner, pre-attached 30-gauge needle and the visual signalling of injection completion were among the changes considered as strong improvements to the new system by up to 80.3% of patients. LIMITATION: Retrospective analysis of current system. CONCLUSIONS: This survey documented patient satisfaction with different application systems of IFNbeta-1b. The increased satisfaction with the new application system indicates an improvement to the currently used injection system, which may contribute to further advancement in adherence and consequently higher clinical efficacy of treatment.

The MEE principle in data classification: a perceptron-based analysis.

This letter focuses on the issue of whether risk functionals derived from information-theoretic principles, such as Shannon or Rényi's entropies, are able to cope with the data classification problem in both the sense of attaining the risk functional minimum and implying the minimum probability of error allowed by the family of functions implemented by the classifier, here denoted by min Pe. The analysis of this so-called minimization of error entropy (MEE) principle is carried out in a single perceptron with continuous activation functions, yielding continuous error distributions. In spite of the fact that the analysis is restricted to single perceptrons, it reveals a large spectrum of behaviors that MEE can be expected to exhibit in both theory and practice. In what concerns the theoretical MEE, our study clarifies the role of the parameters controlling the perceptron activation function (of the squashing type) in often reaching the minimum probability of error. Our study also clarifies the role of the kernel density estimator of the error density in achieving the minimum probability of error in practice.

Atrapamiento intravascular de un catéter de Swan-Ganz / No disponible

No disponible

Tratamiento endovascular de un pseudoaneurisma ilíaco postraumático: a propósito de un caso / Endovascular treament of a post-traumatic iliac pseudoaneurysm: A case report

Introducción. Los pseudoaneurismas ilíacos postraumáticos son un tipo poco frecuente de lesión arterial. Lareparación quirúrgica presenta dificultades técnicas y se asocia a una morbimortalidad que oscila entre el 10 y el 30%.La terapia endovascular tiene una morbimortalidad menor que la cirugía convencional con buenos resultados a medioplazo, por lo que es una alternativa que hay que tener en cuenta en pacientes con elevado riesgo quirúrgico o antecedentesde cirugía abdominal previa. Caso clínico. Varón de 64 años de edad con dolor lumbar irradiado a miembro inferiorizquierdo que presenta en la angiotomografía un aneurisma en la arteria ilíaca externa de morfología sacular y diámetromáximo de 10 cm. Como único antecedente de interés, refiere un traumatismo abdominal hace 20 años. La lesión seexcluyó con éxito mediante la colocación endovascular de dos stents recubiertos (Viabahn ® 8 × 10 y Advanta ® 8 × 59).El postoperatorio inmediato transcurrió sin incidencias. La angiotomografía a los seis meses muestra la exclusión adecuada,con una disminución de 6 cm del tamaño del saco aneurismático. Conclusión. Los pseudoaneurismas ilíacos postraumáticosson una patología poco frecuente. El tratamiento endovascular a este nivel tiene menor morbimortalidadque la cirugía convencional con unos resultados a medio plazo aceptables, por lo que, en el momento actual, la terapiaendovascular es una alternativa que hay que tener en cuenta en pacientes de alto riesgo o antecedentes de cirugía abdominalprevia(AU)

Introduction. Post-traumatic iliac pseudoaneurysms are a rare type of arterial injury. Surgical repair istechnically difficult and is associated to a morbidity and mortality rate that ranges between 10% and 30%.Endovascular therapy has a lower morbidity and mortality rate than conventional surgery with good medium-termoutcomes, which makes it an alternative that has to be taken into account in patients with a high surgical risk or ahistory of previous abdominal surgery. Case report. We report the case of a 64-year-old male with lower back pain thatirradiated to the lower left limb. The CT-angiography scan that was performed revealed the presence of an aneurysm inthe external iliac artery with a saccular shape and a maximum diameter of 10 cm. The only relevant past history was atraumatic injury to the abdomen 20 years earlier. The lesion was successfully excluded by endovascular placement oftwo covered stents (Viabahn® 8 × 10 and Advanta® 8 × 59). No adverse events occurred during the period immediatelyafter the operation. The CT-angiography scan at six months showed adequate exclusion, with a decrease of 6 cm in thesize of the aneurysmal sac. Conclusions. Post-traumatic iliac pseudoaneurysms are a rare pathology. Endovasculartreatment at this level has a lower morbidity and mortality rate than conventional surgery, with acceptable medium-termoutcomes. Therefore, today, endovascular therapy is an alternative that must be taken into account in patients with ahigh surgical risk or a history of previous abdominal surgery(AU)

Influence of climatic factors in the incidence of multiple sclerosis relapses in a Portuguese population.

BACKGROUND AND PURPOSE: Environmental factors are thought to be important in multiple sclerosis (MS) pathophysiology. We aimed to evaluate if there was an association between MS relapses and some climatic factors in a Portuguese population. METHODS: Four year retrospective study analyzing 414 MS relapses in 249 consecutive relapsing-remitting patients. Non-parametric statistics were used to compare the distribution of relapses across months and seasons. Spearman's coefficient was determined to evaluate the correlation between relapses frequency and maximum and minimum atmospheric temperatures, humidity and atmospheric pressure. RESULTS: The mean number of relapses was not significantly different between months or seasons. No correlation was found between relapse frequency and any climatic factor. CONCLUSION: Our series is one of the largest addressing the influence of specific climatic factors on MS relapses. The number of clinical MS relapses seems to be unrelated to climatic factors.

Data classification with multilayer perceptrons using a generalized error function.

The learning process of a multilayer perceptron requires the optimization of an error function E(y,t) comparing the predicted output, y, and the observed target, t. We review some usual error functions, analyze their mathematical properties for data classification purposes, and introduce a new one, E(Exp), inspired by the Z-EDM algorithm that we have recently proposed. An important property of E(Exp) is its ability to emulate the behavior of other error functions by the sole adjustment of a real-valued parameter. In other words, E(Exp) is a sort of generalized error function embodying complementary features of other functions. The experimental results show that the flexibility of the new, generalized, error function allows one to obtain the best results achievable with the other functions with a performance improvement in some cases.