Novel yeast-based biosensor for environmental monitoring of tebuconazole

Due to increasing demand for high and stable crop production, human populations are highly dependent on pesticide use for growing and storing food. Environmental monitoring of these agrochemicals is therefore of utmost importance, because of their collateral effects on ecosystem and human health. Even though most current-use analytical methods achieve low detection limits, they require procedures that are too complex and costly for routine monitoring. As such, there has been an increased interest in biosensors as alternative or complementary tools to streamline detection and quantification of environmental contaminants. In this work, we developed a biosensor for environmental monitoring of tebuconazole (TEB), a common agrochemical fungicide. For that purpose, we engineered S. cerevisiae cells with a reporter gene downstream of specific promoters that are expressed after exposure to TEB and characterized the sensitivity and specificity of this model system. After optimization, we found that this easy-to-use biosensor consistently detects TEB at concentrations above 5 μg L-1 and does not respond to realistic environmental concentrations of other tested azoles, suggesting it is specific. We propose the use of this system as a complementary tool in environmental monitoring programs, namely, in high throughput scenarios requiring screening of numerous samples. KEY POINTS: • A yeast-based biosensor was developed for environmental monitoring of tebuconazole. •The biosensor offers a rapid and easy method for tebuconazole detection ≥ 5 μg L-1. •The biosensor is specific to tebuconazole at environmentally relevant concentrations.

In vivo MRI and PET imaging in a translational ILD mouse model expressing non-resolving fibrosis and bronchiectasis-like pathology after repeated systemic exposure to bleomycin

Drug-induced interstitial lung disease (ILD) is crucial to detect early to achieve the best treatment outcome. Optimally, non-invasive imaging biomarkers can be used for early detection of disease progression and treatment follow-up. Therefore, reliable in vivo models are warranted in new imaging biomarker development to accelerate better-targeted treatment options. Single-dose bleomycin models have, for a long time, served as a reference model in fibrosis and lung injury research. Here, we aimed to use a clinically more relevant animal model by systemic exposure to bleomycin and assessing disease progression over time by combined magnetic resonance imaging (MRI) and positron emission tomography (PET) imaging.

Methods

C57BL/6 mice received bleomycin (i.p. 35iU/kg) or saline as control twice per week for 4 weeks. Mice were monitored until 2 weeks after cessation of bleomycin administration (w4 + 1 and w4 + 2), referred to as the resting period. MRI scans were performed in weeks 3 and 4 and during the resting weeks. [18F]FDG-PET was performed at the last week of dosing (w4) and 2 weeks after the last dosing (w4 + 2). Lung tissue sections were stained with Masson's trichrome and evaluated by modified Ashcroft scoring. Lung volume and lesion volumes were assessed using MRI, as well as 3D mapping of the central airways.

Results and discussion

Bleomycin-challenged mice showed increased lung weights (p < 0.05), while total lung volume was unchanged (w4 and onward). Histology analysis demonstrated fibrotic lesions emanating from the distal parts of the lung. Fibrosis progression was visualized by MRI with significantly increased high signal in bleomycin-exposed lungs compared to controls (p < 0.05). In addition, a significant increase in central airway diameter (p < 0.01) was displayed in bleomycin-exposed animals compared to controls and further continued to dilate as the disease progressed, comparing the bleomycin groups over time (p < 0.05-0.001). Lung [18F]FDG uptake was significantly elevated in bleomycin-exposed mice compared to controls (p < 0.05).

Conclusion

Non-invasive imaging displayed progressing lesions in the lungs of bleomycin-exposed mice, using two distinct MRI sequences and [18F]FDG-PET. With observed fibrosis progression emanating from distal lung areas, dilation of the central airways was evident. Taken together, this chronic bleomycin-exposure model is translationally more relevant for studying lung injury in ILD and particularly in the context of DIILD.

Effects of a music-based intervention on psychophysiological outcomes of patients undergoing medical imaging procedures: A systematic review and meta-analysis

INTRODUCTION

Musical intervention (MI) is a valuable strategy for addressing the psychological and emotional challenges faced by patients undergoing imaging procedures. This study explores MI's impact on psychophysiological outcomes during imaging procedures, detailing the sound repertoire and technical characteristics employed in MI.

METHODS

A systematic review (SR) and meta-analysis (MA) were conducted. Electronic database searches of PubMed, Web-of-Science, and Scopus were performed encompassing original randomised research and quasi-experimental articles published until June 2023.

RESULTS

Thirteen articles were included in this SR, scoring between 23 and 68 on the Joanna Briggs Institute (JBI) Checklist. Four articles were included to perform a MA concerning anxiety and heart rate (HR) outcomes. Most studies utilised digital playlists as the medium for MI. Headphones were commonly used, with an average volume of 50-60 dB and a musical frequency of 60-80 beats/min. While authors generally preferred selecting musical genres for the repertoire, two articles specifically chose Johann Pachelbel's "Canon in D major" as their musical theme. In terms of psychological parameters, the experimental groups exhibited lower anxiety values than the control groups, with further reductions after MI. However, MA shows that this trend is only marginally significant. Patient comfort and overall examination experience showed improvement with MI. Regarding physiological parameters, HR, especially in the final phase of the examination, was significantly lower in the experimental group compared to the control group.

CONCLUSION

Across multiple studies, MI demonstrated the ability to reduce anxiety and HR. However, no specific music repertoire emerged as the most effective.

IMPLICATIONS FOR PRACTICE

MI arises as a painless, reliable, low-cost, and side-effect-free strategy, presenting imaging departments with a practical means to enhance patient comfort and mitigate anxiety and stress during medical procedures.

Impact of annual TB screening on stone quarry workers in high-incidence Portuguese municipalities

SETTING

The Portuguese municipalities of Penafiel and Marco de Canaveses are high TB incidence areas, where stone quarry workers represent a vulnerable population.

OBJECTIVE

To assess the annual rate of TB infection (ARI) in stone quarry workers and to compare it with the TB notification rate in the general community.

DESIGN

An annual TB infection screening strategy using interferon-gamma release assay (IGRA) was implemented in 2018 for workers from high-risk stone quarries. A prospective cohort was enrolled and workers screened in periods of 2 years were included. IGRA-positive workers were referred for preventive treatment. ARI was calculated as the proportion of workers with IGRA conversion.

RESULTS

Of the 232 IGRA-negative workers in 2018, 20 tested positive in 2019 (8.6% ARI). Of 171 IGRA-negative workers in 2019, eight tested positive in 2021 (4.7% in 2 years). Two of the 150 IGRA-negative workers in 2021 tested positive in 2022 (1.3% ARI). ARI decreased by 84.9% between 2019 and 2022. In the two municipalities, the TB notification rate declined 23.9% between 2018 and 2021.

CONCLUSION

A more pronounced reduction in ARI was observed among stone quarry workers regularly screened for TB infection compared to the notification rate among the general population in high-incidence municipalities. A screening strategy for high-risk populations, together with enforced community measures, could foster risk reduction in the community..

The Role of Early Rehabilitation and Functional Electrical Stimulation in Rehabilitation for Cats with Partial Traumatic Brachial Plexus Injury: A Pilot Study on Domestic Cats in Portugal

This prospective observational cohort pilot study included 22 cats diagnosed with partial traumatic brachial plexus injury (PTBPI), aiming to explore responses to an early intensive neurorehabilitation protocol in a clinical setting. This protocol included functional electrical stimulation (FES), locomotor treadmill training and kinesiotherapy exercises, starting at the time with highest probability of nerve repair. The synergetic benefits of this multimodal approach were based on the potential structural and protective role of proteins and the release of neurotrophic factors. Furthermore, FES was parametrized according to the presence or absence of deep pain. Following treatment, 72.6% of the cats achieved ambulation: 9 cats within 15 days, 2 cats within 30 days and 5 cats within 60 days. During the four-year follow-up, there was evidence of improvement in both muscle mass and muscle weakness, in addition to the disappearance of neuropathic pain. Notably, after the 60 days of neurorehabilitation, 3 cats showed improved ambulation after arthrodesis of the carpus. Thus, early rehabilitation, with FES applied in the first weeks after injury and accurate parametrization according to the presence or absence of deep pain, may help in functional recovery and ambulation, reducing the probability of amputation.

Decline of tuberculosis notification rate in different populations and regions in Portugal, 2010-2017

BACKGROUND

Tuberculosis (TB) incidence declined in Portugal in recent decades, but trends differ between regions and population subgroups. We investigated these differences to inform prevention and control programmes.

METHODS

We extracted TB notifications from the Portuguese National TB Surveillance System (SVIG-TB) in 2010-2017, disaggregated by region, age group, nationality and HIV status. We calculated notification rates using denominators from the Portuguese National Institute of Statistics and the Joint United Nations Programme on HIV/AIDS and performed stratified time series analysis. We estimated interannual decline percentages and 95% confidence intervals (CI) using Poisson and binomial negative regression models.

RESULTS

The overall TB notification rate decreased from 25.7 to 17.5/100,000 population from 2010 to 2017 (5.2%/year) in Portugal. Interannual decline did not differ significantly between regions, but it was smaller amongst non-Portuguese nationals (-1.57% [CI: -4.79%, 1.75%] vs -5.85% [CI: -6.98%, -4.70%] in Portuguese nationals); children under five years of age (+1.77% [CI: -4.61%, 8.58%] vs -5.38% [CI: -6.33%, -4.42%] in other age groups); and HIV-negative people (-6.47% [CI: -9.10%, -3.77%] vs -11.29% [CI; -17.51%, -4.60%] in HIV-positive).

CONCLUSIONS

The decline in TB notification rates in Portugal during the study period has been steady. However, the decline amongst non-Portuguese nationals, children under five years of age and non-infected-HIV patients was lower. No significant differences were observed between regions. Changes in TB epidemiology in specific risk groups and geographical areas should be closely monitored to achieve the objectives of the End TB Strategy. We recommend intensifying screening of TB in the subpopulations identified.

Linking centennial scale anthropogenic changes and sedimentary records as lessons for urban coastal management

Coastal eutrophication and urban flooding are increasingly important components of global change. Although increased seawater renewal by barrier openings and channelizing are common mitigation measures in coastal lagoons worldwide, their effects on these ecosystems are not fully understood. Here, we evaluated the relationships between human interventions in the watershed, artificial connections to the sea, and the sediment burial rates in an urban coastal lagoon (Maricá lagoon, Southeastern Brazil). Sediment accretion along with nutrient and carbon burial rates were determined in two sediment cores representing the past ∼120 years (210Pb dating) and associated with anthropogenic changes as indicated by historical records and geoinformation analyses. Lagoon infilling and eutrophication, expressed by the average sediment accretion, TP, TN, and OC burial rates, respectively, increased ∼9-18, 13-15, 11-14 and 11-12-fold from the earliest (<1950) to the most recent (2000-2017) period. These multi-proxy records confirm mechanistic links between deforestation, urbanization, and untreated sewage discharges. In addition, our findings reveal artificial connections to the sea may contribute to lagoonal eutrophication and infilling, particularly when not integrated with sewage treatment and forest conservation or reforestation in the watershed. Therefore, increased seawater renewal by physical interventions commonly considered as mitigation measures may in contrast cause severe degradation in coastal lagoons, causing harmful consequences that should be not neglected when implementing management practices.

Spinal shock in severe SCI dogs and early implementation of intensive neurorehabilitation programs

Spinal shock is complex, paradoxical with sudden presentation, possibly leading to a guarded prognosis. Thus, it is suggested the need for early implementation of intensive neurorehabilitation. This prospective controlled blinded cohort study aims to understand the implication of spinal shock in neurorehabilitation of severe SCI dogs and the importance of its evaluation thought a spinal shock scale (SSS). 371 dogs were randomized by stratification according the presence of spinal shock in the SG (n = 245) or CG (n = 126). The SSS, a punctuation scale (0-7), was evaluated at admission and each 6 h for 3 days, each day for 15 days, each week for 6 weeks, each month until 3 months, followed by 3 monthly follow-ups. All dogs had similar land and underwater treadmill training with functional electrical stimulation. Observational dataset allowed an approximate level of power (1-β) of 0.90 and an α (Type I error) of 0.01, with a total of 11,088 SSS observations between two blinded observers and 18% of disagreement. 75% of the dogs were admitted in 24-48 h after injury, allowing early detection of spinal shock, and dogs admitted at 72 h with SSS ≥ 4 were not able to achieve ambulation. Regarding ambulation rate, there was a significant difference between groups, with 66.9% of ambulation in the SG and 97.6% in the CG. Also, there was a difference in regard to time until ambulation, with a mean of 31.57 days for the SG and 23.02 for the CG. The SSS estimated marginal means had an exponential decrease within the first 6 h, followed by a slower decrease, but always faster in spinal shock dogs diagnosed with non-compressive myelopathies. Thus, early intensive neurorehabilitation in dogs after severe SCI may benefit from SSS classifications at admission and during treatment to establish different therapeutic protocols according to each patient's needs, especially in deep pain negative dogs.

Preclinical quality, safety, and efficacy of a human embryonic stem cell-derived product for the treatment of Parkinson's disease, STEM-PD

Cell replacement therapies for Parkinson's disease (PD) based on transplantation of pluripotent stem cell-derived dopaminergic neurons are now entering clinical trials. Here, we present quality, safety, and efficacy data supporting the first-in-human STEM-PD phase I/IIa clinical trial along with the trial design. The STEM-PD product was manufactured under GMP and quality tested in vitro and in vivo to meet regulatory requirements. Importantly, no adverse effects were observed upon testing of the product in a 39-week rat GLP safety study for toxicity, tumorigenicity, and biodistribution, and a non-GLP efficacy study confirmed that the transplanted cells mediated full functional recovery in a pre-clinical rat model of PD. We further observed highly comparable efficacy results between two different GMP batches, verifying that the product can be serially manufactured. A fully in vivo-tested batch of STEM-PD is now being used in a clinical trial of 8 patients with moderate PD, initiated in 2022.

The robot eyes don't have it. The presence of eyes on collaborative robots yields marginally higher user trust but lower performance

Eye gaze is a prominent feature of human social lives, but little is known on whether fitting eyes on machines makes humans trust them more. In this study we compared subjective and objective markers of human trust when collaborating with eyed and non-eyed robots of the same type. We used virtual reality scenes in which we manipulated distance and the presence of eyes on a robot's display during simple collaboration scenes. We found that while collaboration with eyed cobots resulted in slightly higher subjective trust ratings, the objective markers such as pupil size and task completion time indicated it was in fact less comfortable to collaborate with eyed robots. These findings are in line with recent suggestions that anthropomorphism may be actually a detrimental feature of collaborative robots. These findings also show the complex relationship between human objective and subjective markers of trust when collaborating with artificial agents.

Intensive neurorehabilitation and allogeneic stem cells transplantation in canine degenerative myelopathy

Introduction

Degenerative myelopathy (DM) is a neurodegenerative spinal cord disease with upper motor neurons, with progressive and chronic clinical signs, similar to amyotrophic lateral sclerosis (ALS). DM has a complex etiology mainly associated with SOD1 gene mutation and its toxic role, with no specific treatment. Daily intensive rehabilitation showed survival time near 8 months but most animals are euthanized 6-12 months after clinical signs onset.

Methods

This prospective controlled blinded cohort clinical study aims to evaluate the neural regeneration response ability of DM dogs subjected to an intensive neurorehabilitation protocol with mesenchymal stem cells (MSCs) transplantation. In total, 13 non-ambulatory (OFS 6 or 8) dogs with homozygous genotype DM/DM and diagnosed by exclusion were included. All were allocated to the intensive neurorehabilitation with MSCs protocol (INSCP) group (n = 8) or to the ambulatory rehabilitation protocol (ARP) group (n = 5), which differ in regard to training intensity, modalities frequency, and MSCs transplantation. The INSCP group was hospitalized for 1 month (T0 to T1), followed by MSCs transplantation (T1) and a second month (T2), whereas the ARP group was under ambulatory treatment for the same 2 months.

Results

Survival mean time of total population was 375 days, with 438 days for the INSCP group and 274 for the ARP group, with a marked difference on the Kaplan-Meier survival analysis. When comparing the literature's results, there was also a clear difference in the one-sample t-test (p = 0.013) with an increase in time of approximately 70%. OFS classifications between groups at each time point were significantly different (p = 0.008) by the one-way ANOVA and the independent sample t-test.

Discussion

This INSCP showed to be safe, feasible, and a possibility for a long progression of DM dogs with quality of life and functional improvement. This study should be continued.

In Vitro Antiprotozoal Activity of Hibiscus sabdariffa Extract against a Ciliate Causing High Mortalities in Turbot Aquaculture

Philasterides dicentrarchi is an histophagous parasite that infects flatfish, namely turbot (Scophthalmus maximus), and cause significant losses in aquaculture units. The available measures for P. dicentrarchi control have limited efficiency, and some cause harm to fish. Hence, sustainable and natural control strategies are urgently needed. This study evaluated the in vitro bioactivity of the ethanol extract of Hibiscus sabdariffa calyces on P. dicentrarchi population growth rate (PGR), oxidative stress biomarkers (glutathione-S-transferases (GST), glutathione reductase (GR), glutathione peroxidase (GPx), total glutathione (TG) and catalase (CAT), neurotoxicity (acetylcholinesterase, AChE), activity and gene expression of proteases as major virulence factors. H. sabdariffa extract inhibited parasite PGR (IC₅₀ = 1.57 mg mL^-1), and caused significant changes in the activity of antioxidant enzymes (LOEC = 0.22 mg mL^-1), especially GPx, TG, and CAT. The activity of proteases was also severely inhibited (IC₅₀ = 0.76 mg mL^-1), and gene expression of catepsin 90 and leishmanolysin proteases was downregulated. Organic acids and phenolic phytochemicals in hibiscus extract are potentially responsible for the antiprotozoal bioactivity herein determined. Therefore, H. sabdariffa extract can be a promising disease-control alternative against the ciliate proliferation, cellular defense mechanisms and pathogenicity. Still, its applicability in aquaculture settings, and potential effects on farmed fish, should be further elucidated.

Is elevated blood glucose at admission associated with poor outcomes in hospitalized COVID-19 patients?

Objective

Hyperglycemia has been suggested as a risk factor for poor outcomes in coronavirus disease 2019 (COVID-19). The aim of our work was to evaluate the association between blood glucose levels at admission (BGA) and disease outcomes in hospitalized COVID-19 patients.

Subjects and methods

Retrospective study including all adult COVID-19 patients admitted to a Portuguese hospital from March to August 2020 with BGA measurement. Subjects were categorized into two groups: BGA < 140 mg/dL and ≥ 140 mg/dL. Statistical analysis was performed using SPSSv26® (significance defined as p < 0.05).

Results

We included 202 patients: median age 74 (60-86) years; 43.1% female; 31.2% with diabetes. The median BGA was 130.5 (108-158) mg/dL. When compared to normoglycemic, patients with BGA ≥ 140 mg/dL were older (p = 0.013), more vaccinated for influenza (p = 0.025) and had more comorbidities (hypertension, heart failure and peripheral arterial disease, p < 0.05). The last group presented higher leucocyte and neutrophile count, higher procalcitonin and prothrombin time, and lower lymphocyte count. Concerning prognosis, BGA ≥ 140 mg/dL was associated with higher rates of mechanical ventilation requirement and intensive care unit admission (p < 0.001), shock (p = 0.011), in-hospital mortality (p = 0.022) and 30-day mortality (p = 0.037). Considering only non-diabetic patients (n = 139), those with hyperglycemia presented higher rates of severity indicators (polypnea, SatO2 ≤ 93% and PaO2/FiO2 ≤ 300) and an association with poor outcomes was also found, namely mechanical ventilation requirement and in-hospital/30-day mortality (p < 0.05).

Conclusion

Hyperglycemia at admission was associated with poor outcomes in COVID-19 patients, even in those without known pre-existing diabetes. Glycemic testing should be recommended for all COVID-19 patients.

Clinical Occurrences in the Neurorehabilitation of Dogs with Severe Spinal Cord Injury

This prospective observational clinical study in a population of tetraplegic and paraplegic dogs (n = 488) with or without deep pain sensation, similar to humans ASIA A and B, investigated the prevalence of clinical occurrences in a rehabilitation center with a hospitalization regime between 15 days and 9 months. A checklist of occurrences was used for easy identification and monitoring, resulting in a total of 79.5% occurrences. There were 58% of dogs with neurogenic bladder, 35.5% with diarrhea, 21.3% with urinary incontinence, and 20.5% with fecal incontinence. A low incidence of respiratory problems (e.g., pneumonia) and urinary tract infections may suggest the efficacy of some applied measures in this study, such as thoracic and abdominal POCUS evaluation, positioning strategies, physical exercises, respiratory kinesiotherapy, and early implementation of a functional neurorehabilitation protocol. These can be essential measures to prevent clinical occurrences, mainly in breeds such as the French Bulldog and the Dachshund.

Approach to Small Animal Neurorehabilitation by Locomotor Training: An Update

Neurorehabilitation has a wide range of therapies to achieve neural regeneration, reorganization, and repair (e.g., axon regeneration, remyelination, and restoration of spinal circuits and networks) to achieve ambulation for dogs and cats, especially for grade 1 (modified Frankel scale) with signs of spinal shock or grade 0 (deep pain negative), similar to humans classified with ASIA A lesions. This review aims to explain what locomotor training is, its importance, its feasibility within a clinical setting, and some possible protocols for motor recovery, achieving ambulation with coordinated and modulated movements. In addition, it cites some of the primary key points that must be present in the daily lives of veterinarians or rehabilitation nurses. These can be the guidelines to improve this exciting exercise necessary to achieve ambulation with quality of life. However, more research is essential in the future years.

Utility of the Age Shock Index in 27312 patients with an acute coronary syndrome

Introduction

The Shock Index (SI), defined as the ratio of heart rate (HR) to systolic blood pressure (SBP), represents a bedside reflection of the integrated response from the cardiovascular and autonomic systems and has been reported to predict adverse prognosis in patients with acute coronary syndromes (ACS).

Age Shock Index (ASI), the product of SI multiplied with age, could also be useful in this setting, but its prognostic value is yet to be determined in ACS patients.

Methods

Acute myocardial infarction patients included in a national registry between October 2010 and January 2022. Optimal shock index cutoff was determined according to ROC curve analysis. Patients were categorized into two groups based on their initial ASI. Baseline characteristics, management and outcomes were compared between the two groups. The primary outcome was in-hospital cardiovascular death.

Results

A total of 27312 patients were included with a mean age of 66±13 years, 72.3% male, 47.5% with ST-elevation myocardial infarction. Based on ROC analysis, which showed AUC=0.80, the optimal ASI cutoff was 44 (with a sensitivity of 73% and a specificity of 74%); 19997 patients (73.2%) had an ASI &lt;44 and 26.8% had an ASI ≥44. The former group was older (mean age of 75±10.0 vs 63±13.0 years, p&lt;0.001), and had more comorbidities: arterial hypertension (77.3% vs 66.3%, p&lt;0.001), diabetes mellitus (39.8% vs 28.1%, p&lt;0.001), peripheral artery disease (7.1% vs 4.4%, p&lt;0.001) and previous history of heart failure (11.0% vs 4.3%, p&lt;0.001).

Patients with ASI ≥44 had higher Killip class at admission and worse left ventricular ejection fraction on discharge (46.0±13.0 vs 53.0±11.0, p&lt;0.001).

In a multivariate regression analysis, after adjusting for possible confounders, ASI ≥44 was an independent predictor of cardiovascular death (HR 3.09, 95% CI: 2.56–3.71, p&lt;0.001).

ASI was a significantly better predictor of cardiovascular death than Shock Index (AUCASI = 0,80 vs AUCSI = 0.72, p&lt;0,0001), but not in comparison to GRACE score (AUCASI=0.80 vs AUCGRACE=0.85, p&lt;0.001) and TIMI (score AUCASI=0.80 vs AUCGRACE=0.84, p&lt;0.001).

At one year, using a Kaplan Meyer survival analysis, mortality was higher in patients with ASI ≥44 (log rank p&lt;0.001)

Conclusion

ASI can identify almost immediately ACS patients at high risk of cardiovascular death, and combined with its simple use, makes it a practical tool for early risk stratification in these patients.

Funding Acknowledgement

Type of funding sources: None.

Beta-blockers in acute coronary syndrome: does rhythm matter?

Introduction

Beta-blockers (BB) are recommended in patients with previous acute myocardial infarction (AMI), aiming to reduce morbidity and mortality. Their benefit is greater in patients with associated left ventricular dysfunction. However, in patients with atrial fibrillation (AF) its prognostic benefit is controversial.

Purpose

To assess and compare the in-hospital and 1-year prognostic impact of BB prescription after acute coronary syndrome (ACS), in patients with previous or de novo AF, and in patients with sinus rhythm (SR).

Methods

This was a national multicentre retrospective study of patients hospitalized for ACS between October 2010 and December 2021. A total of 35279 patients was included, and divided in two groups according to the prescription or not of BB. Patients with previous history of ischemic heart disease (myocardial angina, AMI or coronary revascularization) or heart failure, as well as presenting in Killip class IV or submitted to coronary artery bypass graft during admission were excluded. The impact of BB prescription on in-hospital and 1 year mortality rates, in patients with AF versus SR, was compared.

Results

A total of 14906 patients was selected, 82.5% with and 17.5% without BB prescription. Most patients were in SR (90.2%), with 9.8% presenting previous or new-onset AF.

Patients without BB prescription were older (67±14 vs. 63±13 years) and had more comorbidities, namely valvular disease (2.3% vs. 1.2%, p&lt;0.001) and chronic pulmonary obstructive disease (7.1% vs. 3.1%). The mean left ventricular ejection fraction was 53±13% in patients without BB prescription and 52±11 in the group with BB prescription (p&lt;0.001). In-hospital and after discharge BB prescription was less frequent in AF patients (80.2% vs. 82.5% and 74.7% vs. 78.8%, respectively).

The in-hospital mortality rate was 2.2%, 1.3% in the BB group and 6.6% in patients without BB prescription (p&lt;0.001). At 1 year, mortality rate increased to 5.1%.

BB prescription was associated with lower in-hospital mortality rate regardless of the rhythm, with an 81% risk reduction in SR (OR = 0.19, 95% CI 0.14–0.24) and 79% in AF patients (OR = 0.21, 95% CI 0.13–0.35). In a multivariate regression analysis, after adjusting for all the possible confounders, in-hospital BB prescription was associated with 70% of mortality risk (OR = 0.30, 95% CI 0.23–0.35).

Overall, after discharge BB prescription was associated with reduced 1-year mortality risk (HR = 0.57, 95% CI 0.44–0.73), although it didn't reach statistical significance in AF patients (p=0.413). Nevertheless, in a bivariate Cox regression, rhythm showed no impact on BB protective effect (p-interaction = 0.335). As expected, AF had a negative prognostic impact (HR = 3.85, 95% CI 2.66–5.02).

Conclusion

BB prescription was associated with reduced in-hospital and 1 year mortality rates. The prognostic benefit of BB therapy was equivalent in ACS patients in sinus rhythm and with previous or new-onset AF.

Funding Acknowledgement

Type of funding sources: None.

Positive predictive value of the crusade score for bleeding events in patients with acute coronary syndromes on dual antiplatelet therapy with acetylsalicylic acid and clopidogrel

Introduction

Crusade score (CS) quantifies intrahospital major bleeding (IHMB) risk in patients admitted with acute coronary syndrome (ACS). Hemorrhagic risk after ACS increases with age, although, it's not considered in score estimation.

Purpose

Evaluate CS ability to predict IHBM risk according to different patient ages (higher or lower than 75 years) admitted with ACS diagnosis and submitted to double antiagreggation therapy with acetylsalicylic acid and Clopidogrel.

Methods

A retrospective study based on the Portuguese National Registry of ACS, including patients (pts) hospitalized with ACS and treated with double antiagreggation therapy with acetylsalicylic acid (AAS) and clopidogrel between October 2010 and January 2021 (n=8401). Were excluded patients submitted to coronary artery bypass grafting, with ticagrelor or prasugrel switch to clopidogrel during hospitalization.

Patients were divided into two groups according to their age (above or below 75 years) and then subdivided in 5 groups according to CS category of IHBM risk estimation: very low (CS ≤20, 3,1% risk predicted by the score), low (21 ≤ CS≤30, 5,5%), moderate (31 ≤ CS≤40, 8,6%), high (41 ≤ CS≤50, 11,9%) and very high risk (CS≥51, 19,5%). Then, the incidence of IHMB observed in each group during hospitalization (mean 5 days) was compared to the IHBM risk predicted by the CS.

Results

The IHMB rate was 1.78%, significantly lower than predicted by the Crusade score (7.1%, p&lt;0.001). Bleeding rates in each group of patients (above or below 75 years and according to CS calculation are depicted in Figure 1. CS revealed more power to predict IHMB in the prespecified group of patients older than 75 years, than in the group of patients younger than 75 years (see Figure 2).

Conclusion

As shown in different literature, crusade score overestimate bleeding risk after ACS compared to real-life cohorts. Despite the same trend observed in our cohort of patients, in this retrospective study, CS revealed more power to predict IHMB in the prespecified group of patients older than 75 years, than in the group of patients younger than 75 years in patients submitted to double antiaggregation with AAS and clopidogrel.

Funding Acknowledgement

Type of funding sources: None.

The diastolic blood pressure U-curve

Introduction

It is known that low diastolic blood pressure (DBP) at admission is associated with short-term cardiovascular events after acute coronary syndrome (ACS). However, there is a lack of further investigation into the nonlinear relationship between admission diastolic blood pressure (DBP) and adverse outcomes of ACS patients.

Objective

To investigate the relationship between admission diastolic blood pressure and subsequent cardiovascular mortality in patients with acute coronary syndrome.

Methods

Retrospective study of patients with ACS periodically included in our center registry between October/2012 and September/2018. Patients with class killip 4 at admission or that needed ionotropic support during hospitalization were excluded. The association between admission DBP and cardiovascular mortality during the follow-up period among this population was analyzed using multivariate COX regression model. Results were presented according to DBP quartiles: Q1, less than 70 mm Hg; Q2, from 71 to 80 mm Hg; Q3, from 81 to 90 mm Hg; Q4, above 90 mmHg.

Results

A total of 548 patients were included in this cohort study. Mean patient age was 65.9±13.1 years and 75.2% were men. A nonlinear relation was observed between DBP at admission and cardiovascular mortality over the follow-up.

During a median follow-up of 42 months (IQR: 27–59), 47 patients (8.6%) died from cardiovascular causes. After adjusting for potential confounders (age and diabetes mellitus), patients in Q3 had the lowest risk for cardiovascular death by Cox proportional hazard model (HR 0.44; 95% CI: 0.16–1.00). Meanwhile, compared with Q1, Q3 patients had significantly lower risk for cardiovascular death (HR 0.35, 95% CI: 0.13–0.92).

Conclusion

Among patients admitted for ACS, there is a U curve relationship between admission DBP and risk for cardiovascular death. These results could be explained by a reduction in diastolic coronary blood flow which influences myocardial oxygen supply relative to the necessary demand in an ACS.

Funding Acknowledgement

Type of funding sources: None.

Early Locomotor Training in Tetraplegic Post-Surgical Dogs with Cervical Intervertebral Disc Disease

Locomotor training (LT) is task-specific repetitive training, with sensorimotor stimulation and intensive exercises that promote neuromuscular reorganization. This study aimed to observe if LT could be initiated safely in the first 3−15 days after surgery in tetraplegic C1−C5 IVDD—Hansen type I dogs. This prospective blinded clinical study was conducted at two rehabilitation centers in Portugal, with 114 grade 1 (MFS/OFS) dogs, divided by the presence of spinal hyperesthesia into the SHG (spinal hyperesthesia group) (n = 74) and the NSHG (non-spinal hyperesthesia group) (n = 40), evaluated in each time point for two weeks according to a neurorehabilitation checklist by three observers for inter-agreement relation. LT was safely applied with 62.3% of the OFS ≥ 11 within 15 days and of these, 32.4% achieved a OFS ≥ 13. There were no new cases of hyperesthesia in the NSHG and from the SHG all recovered. Comparing groups, a significant difference was observed in their ability to achieve ambulatory status (p < 0.001), between the presence of hyperesthesia and days until ambulation (p < 0.006) and in each time point (p < 0.001; R2 = 0.809). Early LT may be a safe treatment to be applied in the first 3 days on these dogs and spinal hyperesthesia should be important to the rehabilitation team. This study should be continued.

Influence of Spinal Shock on the Neurorehabilitation of ANNPE Dogs

Acute noncompressive nucleus pulposus extrusion (ANNPE) is related to contusive spinal cord injuries, and dogs usually appear to be exercising vigorously at the time of onset. ANNPE has a characteristic peracute onset of clinical signs during exercise or following trauma, with non-progressive signs during the first 24 h and possibly signs of spinal shock. The main aim was to assess if the presence of spinal shock affects the neurorehabilitation outcomes of ANNPE dogs. This prospective controlled cohort clinical study was conducted at the Arrábida Rehabilitation Center. All of the dogs had T3−L3 injuries and were paraplegic/monoplegic with/without nociception, the study group (n = 14) included dogs with ANNPE spinal shock dogs, and the control group (n = 19) included ANNPE dogs without spinal shock. The study group was also evaluated using a new scale—the Spinal Shock Scale (SSS)—and both groups were under the same intensive neurorehabilitation protocol. Spinal shock was a negative factor for a successful outcome within less time. SSS scores > 4 required additional hospitalization days. The protocol was safe, tolerable, and feasible and accomplished 32% ambulation within 7 days, 29% in 14 days, and 29% in 30 days. The results were better than those obtained in previous studies—94% at 60 days—and 75% of the dogs without nociception recovered ambulation. Long-term follows-ups carried out 4 years later revealed a positive evolution.

Further Validation of the Short Form of the Self-Compassion Scale in a sample of Portuguese Medicine Students

Introduction

The Short Form of the Self-Compassion Scale (SCS-SF; Raes et al. 2011) is composed of 12 items that evaluate the same six dimensions (Self-Kindness/SK, Self-Judgement/SJ, Common Humanity/CH, Isolation, Mindfulness/M, Over-Identification/OI) as the long scale (26 items). The Portuguese version of the SCS-SF (Castilho et al. 2015) was validated in a vast sample from clinical and general populations, the latter being composed of students, other than from medicine courses.

Objectives

To analyze the psychometric properties of the Portuguese version of the SCS-SF in a sample of Medicine/Dentistry students.

Methods

Participants were 666 Portuguese medicine (82.6%) and dentistry (17.4%) students (81.8% girls); they answered an online survey including the SCS and other validated questionnaires from the OECD Study on Social and Emotional Skills/SSES: Stress resistance, Emotional control, Optimism and Persistence.

Results

Confirmatory Factor Analysis showed that the model composed of six factors, two second order factors (positive and negative) and one third order factor (total) presented good fit indexes (χ2/df=3.013; RMSEA=.0066, p<.001; CFI=.970; TLI=.948, GFI=.947). The Cronbach’s alfas were .892, .869 and .877 respectively for the total, self-compassion and self-criticism dimension. Pearson correlations of the SCS-SF total score, self-compassion and self-criticism dimensional scores were moderate to high with the SSES measures, from .272/-.236/.247 with Persistence to .709/-.634/.615 with Optimism.

Conclusions

Although reduced to less than half than the original SCS, the SCS–SF is a valid and useful alternative to measure general self-compassion and their positive and negative components in an ongoing longitudinal research with medicine/dentistry students.

Disclosure

No significant relationships.

Hyperbaric Oxygen Therapy in Systemic Inflammatory Response Syndrome

(1) Background: Systemic inflammatory response syndrome (SIRS) can occur due to a large number of traumatic or non-traumatic diseases. Hyperbaric oxygen therapy (HBOT) may be used as a main or adjuvant treatment for inflammation, leading to the main aim of this study, which was to verify the applicability of HBOT as a safe and tolerable tool in SIRS-positive dogs. (2) Methods: This prospective cohort study included 49 dogs who showed two or more parameters of SIRS, divided into the Traumatic Study Group (n = 32) and the Non-Traumatic Study Group (n = 17). All dogs were submitted to HBOT for 60–90 min sessions, with 2.4–2.8 ATA. (3) Results: This study revealed that 73.5% (36/49) of dogs showed improvement, and the minimum number of HBOT sessions was two, with a mean of 12.73. The number of days between diagnosis and the beginning of HBOT showed statistical significance (p = 0.031) relative to the clinical outcome. No dogs showed any major side effects. (4) Conclusions: We concluded that HBOT may be safe and tolerable for SIRS-positive dogs, and that it should be applied as early as possible.

Indole-Containing Pyrazino[2,1-b]quinazoline-3,6-diones Active against Plasmodium and Trypanosomatids

Malaria, leishmaniasis, and sleeping sickness are potentially fatal diseases that represent a real health risk for more than 3,5 billion people. New antiparasitic compounds are urgent leading to a constant search for novel scaffolds. Herein, pyrazino[2,1-b]quinazoline-3,6-diones containing indole alkaloids were explored for their antiparasitic potential against Plasmodium falciparum, Trypanosoma brucei, and Leishmania infantum. The synthetic libraries furnished promising hit compounds that are species specific (7, 12) or with broad antiparasitic activity (8). Structure-activity relationships were more evident for Plasmodium with anti-isomers (1S,4R) possessing excellent antimalarial activity, while the presence of a substituent on the anthranilic acid moiety had a negative effect on the activity. Hit compounds against malaria did not inhibit β-hematin, and in silico studies predicted these molecules as possible inhibitors for prolyl-tRNA synthetase both from Plasmodium and Leishmania. These results disclosed a potential new chemotype for further optimization toward novel and affordable antiparasitic drugs.

A Controlled Clinical Study of Intensive Neurorehabilitation in Post-Surgical Dogs with Severe Acute Intervertebral Disc Extrusion

Simple Summary

This study explores the potential intensive neurorehabilitation plasticity effects in post-surgical paraplegic dogs with severe acute intervertebral disc extrusion aiming to achieve ambulatory status. The intensive neurorehabilitation protocol translated in 99.4% (167/168) of recovery in deep pain perception-positive dogs and 58.5% (55/94) in deep pain perception-negative dogs. There was 37.3% (22/59) spinal reflex locomotion, obtained within a maximum period of 3 months. Thus, intensive neurorehabilitation may be a useful approach for this population of dogs, avoiding future euthanasia and promoting an estimated time window of 3 months to recover.

Abstract

This retrospective controlled clinical study aimed to verify if intensive neurorehabilitation (INR) could improve ambulation faster than spontaneous recovery or conventional physiotherapy and provide a possible therapeutic approach in post-surgical paraplegic deep pain perception-positive (DPP⁺) (with absent/decreased flexor reflex) and DPP-negative (DDP⁻) dogs, with acute intervertebral disc extrusion. A large cohort of T10-L3 Spinal Cord Injury (SCI) dogs (n = 367) were divided into a study group (SG) (n = 262) and a control group (CG) (n = 105). The SG was based on prospective clinical cases, and the CG was created by retrospective medical records. All SG dogs performed an INR protocol by the hospitalization regime based on locomotor training, electrical stimulation, and, for DPP⁻, a combination with pharmacological management. All were monitored throughout the process, and measuring the outcome for DPP⁺ was performed by OFS and, for the DPP⁻, by the new Functional Neurorehabilitation Scale (FNRS-DPP⁻). In the SG, DPP⁺ dogs had an ambulation rate of 99.4% (n = 167) and, in DPP⁻, of 58.5% (n = 55). Moreover, in DPP⁺, there was a strong statistically significant difference between groups regarding ambulation (p < 0.001). The same significant difference was verified in the DPP^– dogs (p = 0.007). Furthermore, a tendency toward a significant statistical difference (p = 0.058) regarding DPP recovery was demonstrated between groups. Of the 59 dogs that did not recover DPP, 22 dogs achieved spinal reflex locomotion (SRL), 37.2% within a maximum of 3 months. The progressive myelomalacia cases were 14.9% (14/94). Therefore, although it is difficult to assess the contribution of INR for recovery, the results suggested that ambulation success may be improved, mainly regarding time.

Better communication with migrant communities during COVID-19 pandemic:a portuguese experience

 

Odemira, in the southeast litoral of Portugal, has 33% of migrant citizens, mostly from Southeast Asia, going up to 50% counting transient citizens. Most of them do not speak English, making communication with health services difficult. They tend to live in overcrowded houses with unsanitary conditions. With the emergence of the COVID-19 pandemic, all the above resulted in high incidence and ineffective contact tracing (CT), testing and isolation by the public health teams. It was essential to develop strategies to manage and control outbreaks, and also to achieve health equity. Our experience can be useful for other countries in dealing with their multicultural communities. This intervention started in march 2020 and is still ongoing. The aims were to improve the accuracy of epidemiological surveys (ES) and CT, to more easily stop transmission, to develop the communication skills of health professionals and to improve migrant's healthcare access. For this, the focus was on digital written communication tools (Whatsapp, translation apps). It was created a toolkit to guide ES and CT tailored to the migrant population, with tips and best practices, and used translated information materials about preventive COVID-19 measures. Workshops were led with health professionals. It was stablished work with local NGOs, creating social media campaigns during crucial events (Holi holliday). As results. it was achieved a better ES output, more accurate CT and better transmission control, with noticeable differences between march 2020 and now. The relationship with this community improved, having better access to services and their needs met. Health professionals reported being more at ease dealing with these patients. Our experience shows it's possible to communicate effectively despite language and cultural barriers, that cultural knowledge is important in advancing public health goals and that multidisciplinary and intersectoral work is essential to effective interventions.

Key messages

This intervention allowed us to achieve a better output of epidemiological surveys, more accurate contact tracing and were more effective in breaking transmission chains and controlling outbreaks. It was achieved a better understanding and relationship with this community, with better ability to respond to their needs and promoting their access to healthcare.

Protocol design and preliminary evaluation of the REAL-Health Triple Aim, an open-cohort CVD-care optimisation initiative

Introduction

Effective treatment of cardiovascular disease (CVD) in primary care could be improved. We aim to assess the efficacy of a scalable treatment optimisation programme in unselected community populations in South East England, with the triple aim of improved blood pressure control in people with hypertension, increased high-intensity statin use in people with CVD and reduced gastrointestinal bleeding in patients on antithrombotic medication.

Method

This observational study comprises an open cohort of approximately 200,000 adults at high cardiovascular risk registered with general practitioners in five South East England Clinical Commissioning Groups (CCGs). An intervention programme is planned in four of these CCGs with a further non-intervention CCG acting as a control group. The intervention will consist of: clinical guidelines and educational outreach; virtual patient-reviews software; peer-performance “dashboards” and, where available, financial incentives.

The study will examine 3 primary outcomes: 1. Diagnosed hypertension with a blood pressure &lt;140/90mmHg; 2. Diagnosed CVD on a high-intensity statin; 3. A cardiovascular indication for antithrombotic therapy with one or more factors for increased risk of gastrointestinal bleeding (e.g. age ≥65) on gastroprotection. A further 17 secondary outcomes related to these three aims will be assessed.

Analysis

We will use an interrupted time series analysis over 18 months, representing the pre-implementation, implementation and the post-implementation phases with comparison to the control CCG and applicable national Quality and Outcomes Framework and national prescribing statistics (e.g. OpenPrescribing). Secondary outcomes include an equity impact analysis with results stratified by age, gender, ethnic group and index of deprivation.

Preliminary data

We present preliminary data on Key Performance Indicators (KPIs) collected from 191 GP practices including [percentage achievement on 01/09/2019, on 01/09/2020]: 1. Patients with hypertension and most recent blood pressure ≤140/90mmHg [68.7%, 60.6%]. 2. Patients eligible for treatment with a high-intensity statin on such treatment [53.8%, 55.8%]. 3. Patients on antithrombotics with ≥1 risk factors for gastrointestinal bleeding on gastroprotection [59.0%, 60.1%]. We also present our virtual patient-review software tool and outcome visualisation dashboard.

Conclusion

The REAL-Health Triple Aim initiative is a large-scale primary care cardiovascular risk reduction initiative which was launched almost contemporaneously with the United Kingdom's first SARS-CoV-2 related lockdown. Preliminary data justify the need for the Triple Aim initiative and give us an insight on the impact of the pandemic on its implementation.

Funding Acknowledgement

Type of funding sources: Other. Main funding source(s): Barts CharityBritish Heart Foundation

Benefits from optimised antihypertensive and statin treatment in high risk people

Background

Hypertension and hypercholesterolaemia are major modifiable risk factors for cardiovascular diseases (CVD) with available effective and low-cost treatments. However, their suboptimal treatment remains widespread. We characterise treatment gaps in a large urban population and quantify the potential long-term health and economic impact with optimised use.

Methods

We studied 1 million UK urban residents served by 123 primary care practices in 2019. We categorised antihypertensive treatment in adults with diagnosed hypertension, and statin treatment in adults with diagnosed CVD, into optimal, suboptimal and not treated following UK clinical guidelines. A long-term CVD model was used to project cardiovascular events avoided, years of life and quality-adjusted life years (QALYs) gained, and healthcare costs saved with optimised treatments for individual patients accounting for their socio-demographic characteristics and risk factors.

Results

21,954 (24%, mean age 59 years; 49% female) of the 91,828 adults with hypertension were either suboptimally treated (20%) or untreated (4%) and 9,062 (38%, mean age 69 years; 43% female) of the 23,723 adults with CVD were either suboptimally treated (24%) or untreated (14%). Per 1000 patients (95% CI) optimised over lifespan, hypertension treatment would prevent 154 (72–230) major vascular events (MVEs, including heart attack, stroke or arterial revascularisation) and 69 (28–103) vascular deaths, and gain 769 (436–1038) QALYs for those sub-optimally treated, and prevent 138 (68–201) MVEs and 50 (21–76) vascular deaths, and gain 674 (386–920) QALYs for those not treated; statin treatment would prevent 68 (46–88) MVEs and 17 (12–21) vascular deaths, and gain 145 (113–178) QALYs for those sub-optimally treated, and prevent 260 (190–319) MVEs and 55 (40–68) vascular deaths, and gain 535 (412–651) QALYs for those not treated (Figure). Hospital cost savings net of medication costs were about £1100 per person over their remaining lifespan.

Conclusion

Optimising preventive cardiovascular treatments in UK primary care is likely to cost-effectively reduce cardiovascular risk and improve life expectancy, while reducing population inequalities.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): Barts Charity, British Heart Foundation, and Health Data Research UK Predicted benefits from optimisation

Functional Neurorehabilitation in Dogs with an Incomplete Recovery 3 Months following Intervertebral Disc Surgery: A Case Series

Simple Summary

A non-invasive neurorehabilitation multimodal protocol (NRMP) may be applicable to chronic T3-L3 dogs 3 months after undergoing surgery for acute Intervertebral Disc Disease (IVDD) Hansen type I; this protocol has been shown to be safe, feasible, and potentially effective at improving ambulation in both open field score (OFS) 0 and OFS 1 dogs. The specific sample population criteria limit the number of dogs included, mainly due to owners withdrawing over time. Thus, the present case series study aimed to demonstrate that an NRMP could contribute to a functional treatment possibly based on synaptic and anatomic reorganization of the spinal cord.

Abstract

This case series study aimed to evaluate the safety, feasibility, and positive outcome of the neurorehabilitation multimodal protocol (NRMP) in 16 chronic post-surgical IVDD Hansen type I dogs, with OFS 0/DPP− (n = 9) and OFS 1/DPP+ (n = 7). All were enrolled in the NRMP for a maximum of 90 days and were clinically discharged after achieving ambulation. The NRMP was based on locomotor training, functional electrical stimulation, transcutaneous electrical spinal cord stimulation, and 4-aminopyridine (4-AP) pharmacological management. In the Deep Pain Perception (DPP)+ dogs, 100% recovered ambulation within a mean period of 47 days, reaching OFS ≥11, which suggests that a longer period of time is needed for recovery. At follow-up, all dogs presented a positive evolution with voluntary micturition. Of the DPP− dogs admitted, all achieved a flexion/extension locomotor pattern within 30 days, and after starting the 4-AP, two dogs were discharged at outcome day 45, with 78% obtaining Spinal Reflex Locomotion (SRL) and automatic micturition within a mean period of 62 days. At follow-up, all dogs maintained their neurological status. After the NRMP, ambulatory status was achieved in 88% (14/16) of dogs, without concurrent events. Thus, an NRMP may be an important therapeutic option to reduce the need for euthanasia in the clinical setting.

A comparative study on indirect costs of suicide in Portugal: productivity loss as an additional way to approach healthcare prioritization

Background

Suicide and voluntary self-harm (SVSA) accounted for 0.95% of all deaths in Portugal in 2017. Economic evaluation includes indirect costs analysis, relating to Years of Life Lost (YLL) and premature death. This study aimed to estimate and compare the indirect costs from loss of productivity due to SVSA and 12 other causes of death in 2017.

Methods

YLL were adapted to the working age (18–66 years-old) ‘Years of Productivity Lost’ (YPL) adjusting the groups 15–19 years-old and under, and disregarding the ages over 66 years-old. The causes of death were based on the European Shortlist. The loss of productivity from deaths was estimated from the YPL and the ‘Apparent Productivity of Work’, with an annual discount rate of 3%, translated into % of Gross Domestic Product (GDP) in 2017. The calculations were performed for the SVSA and for 12 causes of death selected from national Priority Health Programs. The INE and Pordata databases for the year 2017 were used. Calculations were performed using Microsoft Excel for Office 365 software version 2102.

Results

The estimated costs from loss of productivity by SLAV deaths in 2017 represented approximately 0.16% of GDP. It is the third highest among the 13 causes of death analyzed, ranking behind malignant neoplasm of larynx/trachea/bronchi/lung and ischaemic heart disease.

Conclusions

Prioritization of health resources may benefit by integrating lost productivity concepts with other indicators. Limitations include predictable increase of retirement age in the future and the oversimplified calculation of productivity costs. Future studies may include sensitivity assessments and other relevant variables.

Nurses' Strategies to Prevent and/or Decrease Work-Related Technostress: A Scoping Review

Although there is evidence of the impact of technostress on nurses' physical and psychological well-being, there is no clear understanding of what strategies are used by nurses to prevent/decrease work-related technostress. Thus, we aim to map existing literature that describe the strategies used by nurses to prevent or decrease work-related technostress. This review followed the methodology proposed by the Joanna Briggs Institute for scoping reviews. Data analysis, extraction, and synthesis were performed by two independent reviewers. After contrasting the found literature with the inclusion criteria outlined, no studies were found that address our review question. Overall, we found that technostress is a broad concept, thus becoming difficult to define. Given the complexity and demands of the clinical settings where nurses work, it may be that other stressors are more commonly identified and reported in the literature.

Semi-Synthesis of Small Molecules of Aminocarbazoles: Tumor Growth Inhibition and Potential Impact on p53

The tumor suppressor p53 is inactivated by mutation in approximately 50% of human cancers. Small molecules that bind and stabilize those mutants may represent effective anticancer drugs. Herein, we report the tumor cell growth inhibitory activity of carbazole alkaloids and amino derivatives, as well as their potential activation of p53. Twelve aminocarbazole alkaloids were semi-synthesized from heptaphylline (1), 7-methoxy heptaphylline (2), and 7-methoxymukonal (3), isolated from Clausena harmandiana, using a reductive amination protocol. Naturally-occurring carbazoles 1–3 and their amino derivatives were evaluated for their potential effect on wild-type and mutant p53 activity using a yeast screening assay and on human tumor cell lines. Naturally-occurring carbazoles 1–3 showed the most potent growth inhibitory effects on wild-type p53-expressing cells, being heptaphylline (1) the most promising in all the investigated cell lines. However, compound 1 also showed growth inhibition against non-tumor cells. Conversely, semi-synthetic aminocarbazole 1d showed an interesting growth inhibitory activity in tumor cells expressing both wild-type and mutant p53, exhibiting low growth inhibition on non-tumor cells. The yeast assay showed a potential reactivation of mutant p53 by heptaphylline derivatives, including compound 1d. The results obtained indicate that carbazole alkaloids may represent a promising starting point to search for new mutp53-reactivating agents with promising applications in cancer therapy.

Effects of hyperbaric oxygen therapy on wound healing in veterinary medicine: a pilot study

Background:

In veterinary medicine, wounds have a high incidence in clinical practice. A technique that can accelerate healing has been extensively studied, and the treatment with hyperbaric oxygen therapy (HBOT) is currently recognized as one of the best adjuvant treatments in this matter.

Aim:

The main objective of this pilot clinical study was to assess the therapeutic effect of HBOT in severe wounds classified according to the Modified Vancouver Scale (MVS) between 10 and 15 points or greater than 15 points (MVS > 10 and ≤ 15; MVS > 15).

Methods:

A study population of 41 patients was divided into the dog group and the cat group and were treated at Lisbon Animal Rehabilitation and Regeneration Center, with 100% oxygen and 2.4 atmospheres absolute for 90 minutes. The patients’ wounds were assessed using the MVS at the time of admission, in the first 24 hours, 48 hours, 72 hours after HBOT, and at the time of medical release. This study also sought to assess if HBOT is a safe therapy in small animal clinical practices by monitoring the major side effects (SEM) and minor side effects (SEm) observed throughout each session.

Results:

The results obtained showed that HBOT allowed a decrease in the MVS classification.

Conclusion:

The results suggested that HBOT may be an interesting complementary therapy to be prescribed in wounds that present difficulty in healing. Furthermore, it was considered a safe therapy since in 289 sessions of HBOT, no SEM was observed, and as for SEm, the highest incidence was the act of swallowing. However, more studies should be carried out with HBOT in small animal clinical practices to confirm these results.

Adenosine A2A and A3 Receptors as Targets for the Treatment of Hypertensive-Diabetic Nephropathy

Diabetic nephropathy (DN) and hypertension are prime causes for end-stage renal disease (ESRD) that often coexist in patients, but are seldom studied in combination. Kidney adenosine levels are markedly increased in diabetes, and the expression and function of renal adenosine receptors are altered in experimental diabetes. The aim of this work is to explore the impact of endogenous and exogenous adenosine on the expression/distribution profile of its receptors along the nephron of hypertensive rats with experimentally-induced diabetes. Using spontaneously hypertensive (SHR) rats rendered diabetic with streptozotocin (STZ), we show that treatment of SHR-STZ rats with an agonist of adenosine receptors increases A_2A immunoreactivity in superficial glomeruli (SG), proximal tubule (PCT), and distal tubule (DCT). Differently, treatment of SHR-STZ rats with a xanthinic antagonist of adenosine receptors decreases adenosine A₃ immunoreactivity in SG, PCT, DCT, and collecting duct. There is no difference in the immunoreactivity against the adenosine A₁ and A_2B receptors between the experimental groups. The agonist of adenosine receptors ameliorates renal fibrosis, probably via A_2A receptors, while the antagonist exacerbates it, most likely due to tonic activation of A₃ receptors. The reduction in adenosine A₃ immunoreactivity might be due to receptor downregulation in response to prolonged activation. Altogether, these results suggest an opposite regulation exerted by endogenous and exogenous adenosine upon the expression of its A_2A and A₃ receptors along the nephron of hypertensive diabetic rats, which has a functional impact and should be taken into account when considering novel therapeutic targets for hypertensive-diabetic nephropathy.

Completeness of TB notification in Portugal, 2015: an inventory and capture-recapture study

BACKGROUND: Despite the steady decline in the last few decades, Portugal remains the Western European country with the highest TB notification rates. The aim of this study was to estimate the completeness of notification to the National Tuberculosis Programme (NTP) Surveillance System (SVIG-TB) in 2015.METHODS: We implemented an inventory study and a three-source log-linear capture-recapture analysis using two additional data sources that were deterministic and probabilistically linked: the national notifiable diseases surveillance system (Sistema Nacional de Vigilância Epidemiológica SINAVE) and the national hospital discharge database (Grupos de Diagnósticos Homogéneos GDH).RESULTS: We identified 2328 unique probable/confirmed TB cases across the three data sources. We found a positive dependency between SVIG-TB and SINAVE (incidence rate ratio IRR 8.9, 95%CI 6.6-12.0) and between GDH and SINAVE (IRR 2.6, 95%CI 2.0-3.4). After adjusting for these dependencies, we estimated that 266 cases (95%CI 198-358) were not reported, indicating a notification (to SVIG-TB) completeness rate of 77.0%.CONCLUSION: True incidence rate of TB in Portugal in 2015 could have been as high as 26.1 per 100 000. This could be an overestimation because of false-positive cases recorded in both SINAVE and GDH or on a smaller scale, false non-matches. Studies aimed at validating potentially false-positive cases should be implemented to address these limitations.

The use of geospatial tools to study the evolution of TB incidence in North Portugal between 2008-18

Background

Tuberculosis continues to be a significant global health problem. Portugal isn't an exception to this health problem, being considered by the ECDC a high incidence country. According to the SDG target 3.3, the world must end the epidemics of tuberculosis by 2030. However, several parishes in Portugal continue to observe extremely high values of TB, taking into account the WHO goal for pre-elimination of 10 TB cases per million people.

Methods

A cross-sectional study was conducted with data from the Surveillance System of the National Program against Tuberculosis. Descriptive and regression analyses were carried out using R 3.6.1 and Rstudio 1.2.5033. The geospatial analysis was carried out with ArcMap 10.7.1 using a five-year average of TB incidence. Animations and videos were made with Microsoft Office365 PowerPoint v2002.

Results

In the period 2008-2012, 55,7% of parishes had registered cases of tuberculosis. That value decreased to 50,6% parishes in the period 2014-2018. For the period of 2014-18, 30,3% of parishes had a five-year average incidence above 20/100.000 people (value defined as high-incidence by the ECDC) and 45,0% parishes an incidence above 10/100.000 people. With ArcMap HotSpot analysis was possible to observe the existence of a significant cluster of TB in the southwest of North Portugal. With animation analysis, it was also possible to see the global spatial reduction of TB cases between 2008 and 2018, and the ongoing problem of a high incidence of TB in specific regions of North Portugal.

Conclusions

TB continues to be a significant health problem in North Portugal. The spatial analysis pointed to a specific area of North Portugal that needs priority action. Videos produced by the Department of Public Health may guide health professionals and policymakers for future strategies to be implemented to reach SDG3.

Key messages

The importance of desegregated spatial data for TB elimination. The elimination efforts must be scaled up in specific areas to achieve SDG3.

Tuberculosis: where and how fast are stone quarry workers infected?

Background

In 2018 an annual tuberculosis (TB) screening program targeting stone quarry workers was implemented in two municipalities in Northern Portugal. These have been hotspots for TB (76 and 59 cases per 100 000 population per year in 2012-2016, well above the 18 cases per 100 000 population observed in Portugal in 2016), with 30% of active TB cases occurring among stone quarry workers. Screening in this setting is recommended by the World Health Organization, as exposure to silica and silicosis increase the risk of TB. Occupational health services, TB outpatient centers, the hospital, a laboratory, primary health care and public health services work closely together with employers, employees, municipal council and the community promoting meetings and continuous training.

Screening activities included a symptom questionnaire, chest X-ray and sputum exam; and, after exclusion of active TB, interferon-gamma release assay (IGRA) for latent tuberculosis infection (LTBI). Preventive treatment was offered.

Objective

Assess annual rate of TB infection

Methods

Workers without history of TB/LTBI were IGRA tested in 2018, and retested in 2019. Annual rate of infection was calculated as the proportion of workers IGRA negative in 2018 becoming positive in 2019.

Results

In 2018-2019, 274 workers were screened yearly. In 2018, 22 were diagnosed with LTBI and 26 had previous history of TB/LTBI. Out of 226 IGRA negative workers in 2018, 19 tested positive in 2019 (8.4% annual rate of infection). These individuals were not identified as close contacts of any new TB case and no cases of active TB were reported in their stone quarries. Some active TB cases were regular customers of specific bars.

Conclusions

Active transmission of TB seems to be occurring among stone quarry workers. Workers that converted from IGRA negative to positive had no co-workers with active TB in the study period, suggesting they could have been infected away from the workplace, possibly in community public places.

Key messages

Stone quarry workers in a high-risk TB sub-region were infected at an 8.4% annual rate, and could have been infected in community public places such as bars. Besides screening close contacts and at workplace, more efforts should be made identifying social contacts of active TB cases.

Determinants of renal oxygen metabolism during low Na+ diet: effect of angiotensin II AT1 and aldosterone receptor blockade

KEY POINTS

Reducing Na⁺ intake reduces the partial pressure of oxygen in the renal cortex and activates the renin-angiotensin-aldosterone system. In the absence of high blood pressure, these consequences of dietary Na⁺ reduction may be detrimental for the kidney. In a normotensive animal experimental model, reducing Na⁺ intake for 2 weeks increased renal oxygen consumption, which was normalized by mineralocorticoid receptor blockade. Furthermore, blockade of the angiotensin II AT₁ receptor restored cortical partial pressure of oxygen by improving oxygen delivery. This shows that increased activity of the renin-angiotensin-aldosterone system contributes to increased oxygen metabolism in the kidney after 2 weeks of a low Na⁺ diet. The results provide insights into dietary Na⁺ restriction in the absence of high blood pressure, and its consequences for the kidney.

ABSTRACT

Reduced Na⁺ intake reduces the P O 2 (partial pressure of oxygen) in the renal cortex. Upon reduced Na⁺ intake, reabsorption along the nephron is adjusted with activation of the renin-angiotensin-aldosterone system (RAAS). Thus, we studied the effect of reduced Na⁺ intake on renal oxygen homeostasis and function in rats, and the impact of intrarenal angiotensin II AT₁ receptor blockade using candesartan and mineralocorticoid receptor blockade using canrenoic acid potassium salt (CAP). Male Sprague-Dawley rats were fed standard rat chow containing normal (0.25%) and low (0.025%) Na⁺ for 2 weeks. The animals were anaesthetized (thiobutabarbital 120 mg kg^-1 ) and surgically prepared for kidney oxygen metabolism and function studies before and after acute intrarenal arterial infusion of candesartan (4.2 μg kg^-1 ) or intravenous infusion of CAP (20 mg kg^-1 ). Baseline mean arterial pressure and renal blood flow were similar in both dietary groups. Fractional Na⁺ excretion and cortical oxygen tension were lower and renal oxygen consumption was higher in low Na⁺ groups. Neither candesartan nor CAP affected arterial pressure. Renal blood flow and cortical oxygen tension increased in both groups after candesartan in the low Na⁺ group. Fractional Na⁺ excretion was increased and oxygen consumption reduced in the low Na⁺ group after CAP. These results suggest that blockade of angiotensin II AT₁ receptors has a major impact upon oxygen delivery during normal and low Na⁺ conditions, while aldosterone receptors mainly affect oxygen metabolism following 2 weeks of a low Na⁺ diet.

Small for gestational age very preterm infants present a higher risk of developing bronchopulmonary dysplasia

INTRODUCTION

Several studies assessed the influence of a low birth weight on bronchopulmonary dysplasia (BPD), but not all could find a significant association. Our aim was to assess the association between low birth weight and BPD in preterm infants, prospectively recruited at 11 level III Portuguese neonatal centers.

METHODS

Obstetrical and neonatal data on mothers and preterm infants with gestational ages between 24 and 30 weeks, born during 2015 and 2016 after a surveilled pregnancy, were analyzed. Neonates were considered small for gestational age (SGA) when their birthweight was below the 10th centile of Fenton's growth chats and BPD was defined as the dependency for oxygen therapy until 36 weeks of corrected age. Statistical analysis was performed using IBM SPSS® statistics 23 and a p-value <0.05 was considered statistically significant.

RESULTS

Out of 614, a total of 494 preterm infants delivered from 410 women were enrolled in the study; 40 (8.0%) infants with SGA criteria. SGA were more often associated with a single pregnancy, had greater use of antenatal corticosteroids, increased prevalence of gestational hypertensive disorders, C-section, rupture of membranes below 18 hours, rate of intubation in the delivery room, use of surfactant treatment, oxygen therapy, mechanical ventilation need, BPD, cystic periventricular leukomalacia, nosocomial sepsis and pneumonia; had lower prevalence of chorioamnionitis, and lower Apgar scores. The multivariate analysis by logistic regression, adjusted for BPD risk factors revealed a significant association between SGA and BPD: OR = 5.2 [CI: 1.46-18.58]; p = 0.01.

CONCLUSION

The results of this study increase the scientific evidence that SGA is an independent risk factor for BPD.

The Diverse Piscidin Repertoire of the European Sea Bass (Dicentrarchus labrax): Molecular Characterization and Antimicrobial Activities

Fish rely on their innate immune responses to cope with the challenging aquatic environment, with antimicrobial peptides (AMPs) being one of the first line of defenses. Piscidins are a group of fish specific AMPs isolated in several species. However, in the European sea bass (Dicentrarchuslabrax), the piscidin family remains poorly understood. We identified six different piscidins in sea bass, performed an in-depth molecular characterization and evaluated their antimicrobial activities against several bacterial and parasitic pathogens. Sea bass piscidins present variable amino acid sequences and antimicrobial activities, and can be divided in different sub groups: group 1, formed by piscidins 1 and 4; group 2, constituted by piscidins 2 and 5, and group 3, formed by piscidins 6 and 7. Additionally, we demonstrate that piscidins 1 to 5 possess a broad effect on multiple microorganisms, including mammalian parasites, while piscidins 6 and 7 have poor antibacterial and antiparasitic activities. These results raise questions on the functions of these peptides, particularly piscidins 6 and 7. Considering their limited antimicrobial activity, these piscidins might have other functional roles, but further studies are necessary to better understand what roles might those be.

THU0567 HIP ABDUCTORS STRENGTH AND TRUNK, PELVIS, HIP AND KNEE FRONTAL PLANE KINEMATICS ANALYSIS DURING SINGLE-LEG SQUAT IN INDIVIDUALS WITH AND WITHOUT PATELLOFEMORAL OSTEOARTHRITIS

Background:

Previous studies have observed that individuals with patellofemoral pain (PFP) have decreased hip abduction torque, as well as increased hip adduction and knee abduction during activities with uniltateral weight bearing1,2. Considering that, a significant number of patients with patellofemoral osteoarthritis (PFOA) have a previous history of PFP3, it is speculated that the mechanical causes of PFP and PFOA may be similar. However, although alterations in hip muscle strength and lower limb kinematics during various functional activities have been reported in patients with PFP, they have not been explored in subjects with PFOA.

Objectives:

The objectives of this study were to compare the hip eccentric abductors torque and the trunk, pelvis, hip, and knee frontal plane kinematics in subjects with and without PFOA isolated during the single-leg squat.

Methods:

This is a cross-sectional study. The volunteers were divided into two groups: control group (CG - healthy individuals) and PFOA group (PFOAG - individuals with PFOA grade II or III). Eccentric peak torque of the hip abductors was evaluated using an isokinetic dynamometer Biodex Multi-Joint System 3, at angular speed of 30°/s. Trunk, pelvis, hip and knee kinematics were recorded during the single-leg squat using a 6-camera, 3-dimensional motion-analysis system (Vicon Motion Systems, Nexus System 2.1.1 and 3D Motion Monitor). The t-test Student was used to compare the variables between the groups. The significance level was set at 5% for all analyses (p ≤ 0.05).

Results:

The CG was composed by 12 participants (41.7% women). PFOA had 9 participants (44.4% women). Age (p = 0.1), height (p = 0.9) and body mass (p = 0.2) showed homogeneity between groups. Regardind body mass index, the OAPFG showed higher values (p = 0.02). PFOAG showed greater increased hip adduction than CG (p = 0.05) (Table 1). However, there were no differences among groups for trunk lean, contralateral pelvic elevation and knee abduction (p > 0.05). PFOAG showed lower hip abductor torque compared with the CG (p = 0.006).

Table 1

– Values of joint angles during single-leg squatting and hip abductors torque (normalized by body mass) in PFOA and healthy individuals

PFOAGCGpvalueContralateral trunk lean (°)4.7±1.34.8±1.10.94Contralateral pelvic elevation (°)1.4±1.22.6±1.00.45Hip adduction (°)14.9±2.28.9±1.60.05*Knee abduction (°)22.8±3.819.4±3.30.51Hip eccentric abdutor torque (Nm/kg·100)166.5±24.9204±27.70.006*

PFOAG: patellofemoral osteoarthritis group; CG: control group *Statistical difference between groups

Conclusion:

PFOA individuals showed greater hip adduction and lower hip abductors torque than the CG. Thus, it is suggested that muscle weakness may excessively influence hip adduction. Hip adduction is the main component of the knee valgus in the frontal plane. So, excessive dynamic valgus results in an increase Q-angle and, consequently, an increase in the lateral forces acting on the patella, causing greater stress on the lateral patellofemoral joint, which may contribute to disease progression. Therefore, we suggest that the hip abductor strengthening should be considered when treating individuals with PFOA.

References:

[1]Nakagawa TH, Moriya ÉTU, Maciel CD, Serrão FV. Trunk, Pelvis, Hip, and Knee Kinematics, Hip Strength, and Gluteal Muscle Activation During a Single-Leg Squat in Males and Females With and Without Patellofemoral Pain Syndrome.J Orthop Sport Phys Ther. 2012;42(6):491-501.

[2]Nakagawa TH, Moriya ÉTU, Maciel CD, Serrão FV. Frontal Plane Biomechanics in Males and Females with and without Patellofemoral Pain.Med Sci Sport Exerc. 2012;44(9):1747-1755.

[3]Utting MR, Davies G, Newman JH. Is anterior knee pain a predisposing factor to patellofemoral osteoarthritis?Knee. 2005;12(5):362-365.

Acknowledgments:

São Paulo Research Foundation (FAPESP) (Grant/Award Numbers: 2017/20057-8; 2017/25959-0; 2018/10329-3).

Disclosure of Interests:

None declared