Prova de esforço cardiopulmonar em doentes com terapêutica de ressincronização cardíaca: que parâmetros ergométricos valorizar?

Trabalho final de mestrado integrado em Medicina (Cardiologia), apresentado à Faculdade de Medicina da Universidade de Coimbra.Introdução: Apesar da maioria dos doentes apresentar sucesso terapêutico à terapia de ressincronização cardíaca (TRC), 30 a 35% não respondem ao pacing. Não é consensual qual será o melhor critério para avaliar a resposta à TRC. A prova de esforço cardiopulmonar (PECP) permite uma apreciação objetiva da capacidade funcional e da resposta ventilatória, cardíaca e metabólica ao esforço. Objetivos: Descrever e caracterizar variáveis ergométricas obtidas na PECP numa população de doentes portadores de TRC, avaliar a associação entre essas variáveis após a implantação da TRC e as várias definições de resposta dos doentes à TRC e analisar a relação entre a resposta à TRC com a mortalidade e a realização de transplante cardíaco. Métodos: Setenta e nove doentes portadores de TRC submetidos a PECP após a implantação do dispositivo. Uma diminuição ≥1 classe funcional NYHA definiu os responders clínicos; um aumento ≥ 25% na FEVE definiu os responders ecocardiográficos. Foram avaliados parâmetros demográficos, electrocardiográficos, ecocardiográficos, clínicos pré e pós-TRC e ergométricos pós-TRC. Foi realizado um estudo estatístico para analisar a associação entre as variáveis pré e pós-TRC, estudando as suas diferenças de acordo com a resposta à terapia em estudo, bem como a sua capacidade como preditores de resposta à TRC. Resultados: Houve 65,6% de responders clínicos e 40,5% de responders ecocardiográficos. Observaram-se diferenças estatisticamente significativas entre responders e não responders clínicos na tolerância ao exercício (pico de VO2 de 17,9 ± 5,1 mL.kg-1.min-1 versus 14,8 ± 5,0 mL.kg-1.min-1 (p=0,022); declive de VE/VCO2 de 23,7 ± 15,5 versus 36,1 ± 17,1 (p=0,009); pulso de O2 de 12,0 ± 3,3 versus 10,0 ± 3,3 (p=0,025)); observaram-se diferenças relevantes na taxa de mortalidade durante o seguimento entre os dois subgrupos (4,8% versus 18,2%, p=0,080). Verificou-se que a VE/VCO2 prediz melhor a resposta à TRC, independentemente dos critérios adotados na definição de resposta (0,754 (p=0,007) e 0,790 (p=0,001)). O pulso de O2 e o pico de VO2 apresentam áreas sobre as curvas ROC inferiores (0,726 e 0,740 versus 0,708 e 0,693, respetivamente). O VO2 basal apresentou-se como o melhor preditor de mortalidade (0,784 (p=0,025)). O pico de VO2 apresentou-se como o melhor preditor para transplante cardíaco (0,688 (p=0,030)). Conclusões: O pico de VO2 e o índice de eficiência respiratória VE/VCO2 estão intimamente associados à resposta clínica e ecocardiográfica à TRC, com valores mais favoráveis nos doentes com resposta à TRC.Background: Although most of the patients treated with cardiac resynchronization therapy (CRT) respond to the therapy, 30 to 35% do not experience clinical improvement. The best criteria to evaluate response remain controversial. The cardiopulmonary exercise testing (CPX) allows an objective analysis of the functional, ventilator, cardiac and metabolic response during effort. Objectives: Analyze and characterize ergometric variables obtained during CPX in a population of patients with CRT, evaluate the association of those variables after CRT implantation with the definition of response and analyze the association between the response to CRT with mortality and heart transplant. Methods: Seventy nine patients with CRT who underwent CPX were studied. An improvement of ≥1 NYHA class defined clinical responders; a ≥25% improvement in left ventricular ejection fraction (LVEF) identified echocardiographic responders. We evaluated demographic, electrocardiographic, echocardiographic and clinical parameters before and after CTR implantation, as well as ergometric parameters after TRC implantation. It was made a statistical study to analyze the association between variables before and after TRC, studying their differences according to the response definitions and their ability to predict response to CRT. Results: There were 65,6% clinical responders and 40,5% echocardiographic responders. The differences observed in exercise tolerance between clinical responders and non responders were statistically significant (peak VO2 of 17,9 ± 5,1 mL.kg-1.min-1 versus 14,8 ± 5,0 mL.kg-1.min-1 (p=0,022); VE/VCO2 slope of 23,7 ± 15,5 versus 36,1 ± 17,1 (p=0,009); O2 pulse of 12,0 ± 3,3 versus 10,0 ± 3,3 (p=0,025)); there were observed important differences in mortality between both subgroups. (4,8% versus 18,2%, p=0,080). VE/VCO2 slope was the best to predict response to CRT, independently of the definition of response used (0,754 (p=0,007) e 0,790 (p=0,001)). O2 pulse and peak VO2 presented inferiors areas under the ROC curves (0,726 e 0,740 versus 0,708 e 0,693, respectively). Base VO2 was the best mortality predictor (0,784 (p=0,025)). Peak VO2 was the best predictor for the evaluation of patient’s need of heart transplant. (0,688 (p=0,030)). Conclusion: Peak VO2 and VE/VCO2 slope are inwardly associated with clinical and ecocardiographic response to CRT, with more favorable values on responders to CRT

Operational Impact of Driver Booking at Ifood: Driver Booking Systems in Food Delivery Platforms: data-centered approaches to exploring effects in supply predictability

Internship Report presented as the partial requirement for obtaining a Master's degree in Data Science and Advanced Analytics, specialization in Data ScienceFood Delivery Digital Platforms have been investigating novel approaches to leverage drivers’ interactions with the platforms to increase operational efficiency. At iFood, one such approach is the introduction of a Booking system, wherein drivers can get increased order priority for scheduling shifts in advance. The theoretical assumption is that this system can increase visibility of drivers’ intentions as well as influence their choice of working regimes, leading to an increase in supply predictability. The present internship report details the first steps towards the discovery and validation of the aforementioned assumption, by applying statistical inference tests to the relevant data, as well as training and testing predictive modeling that leverages the new information available by the system and comparing it to current operational models used internally. The results show the newly introduced variables are important, albeit the quantifiable impact is comparatively small. However, the applied models achieve better performance and test scores than the current internal models. Based on the findings of the project and observational insights from previous studies, future steps are proposed, which include the refinement of current operational models, and business initiatives with a positive impact on the importance and quality of specific variables related to the booking system

Etiologic agents isolated from companion animals with otitis

Objectives: Otitis externa is one of the most common types of infections seen in companion animals, particularly in dogs. This study aimed to determine the prevalence of etiologic agents in companion animals (dogs and cats) with otitis in Lisbon area between September 2023 and June 2024. Material and methods: A total of 71 companion animals with otitis were included in this study. Bacterial species identification was conducted by MALDI-TOF (VITEK® MS) and by PCR. For Staphylococcus spp. isolates, antimicrobial susceptibility testing was performed using the disc diffusion method following the CLSI guidelines. Results: Eighty-two bacterial isolates were obtained from the 71 animals included in this study. Among the bacteria isolates, most were Gram-positive bacteria (85.4%, n=70/82), while Gram-negative bacteria were 14.6% (n=12/82). Regarding Gram-positive bacteria Staphylococcus spp. was the most frequent bacteria isolated (91.4%, n=64/70), namely S. pseudintermedius, (64.1%, n=41/64), S. schleiferi (12.5%, n=8/64), S. felis (9.4%, n=6/64), S. aureus (3.1%, n=2/64), S. epidermidis (3.1%, n=4/64), S. haemoliticus, S.lugdunensis and S pettenkoferi (1.6%, n=1/64). About 8.6% (n=6/70) of the isolates were Enterococcus spp., consisting of 4 isolates of Enterococcus faecalis, one isolate of Enterococcus faecium, and one isolate of Enterococcus canintestini. Regarding Staphylococcus spp., 28.1% (n=18/64) were methicillin-resistant (MRSA). Among these isolates, 14 were S. pseudintermedius (MRSP), 2 were S. epidermidis (MRSE), and 2 were coagulase-negative staphylococci (CoNS), specifically S. haemolyticus. About Gram-negative bacteria the most common were Escherichia coli (41.7%, n=5/12), followed by Proteus mirabilis (33.3%, n=4/12), Pseudomonas aeruginosa (16.2%, n=2/12) and Klebsiella pneumoniae (8.3%, n=1/12). Conclusion: This study emphasizes the importance of identifying and characterizing pathogens with potential zoonotic risks for infection management and prevention. Healthcare providers must prioritize preventing the transmission and spread of MDR bacteria through active surveillance. Keywords: Companion animals, Otitis, Bacteria, Methicillin-resistant Staphylococcus spp.

Molecular epidemiology, virulence traits and antimicrobial resistance signatures of Aeromonas spp. in the critically endangered Iberochondrostoma lusitanicum follow geographical and seasonal patterns

This research was supported by CIISA—Centro de Investigação Interdisciplinar em Sanidade Animal, Faculdade de Medicina Veterinária, Universidade de Lisboa, Project UIDB/00276/2020 (funded by FCT—Fundação para a Ciência e Tecnologia IP) and by MARE (MARE-ISPA), MARE/UIDB/MAR/04292/2020 and strategic project MARE/UIDP/MAR/04292/2020 (also funded by FCT). M.L.G. thanks funding by the University of Lisbon (PhD fellowship C10571K). T.A.M. and C.S.M. thank partial support by CEAUL (funded by FCT, Portugal, through the project UIDB/00006/2020).Despite the fact that freshwater fish populations are experiencing severe declines worldwide, our knowledge on the interaction between endangered populations and pathogenic agents remains scarce. In this study, we investigated the prevalence and structure of Aeromonas communities isolated from the critically endangered Iberochondrostoma lusitanicum, a model species for threatened Iberian leuciscids, as well as health parameters in this species. Additionally, we evaluated the virulence profiles, antimicrobial resistance signatures and genomic relationships of the Aeromonas isolates. Lesion prevalence, extension and body condition were deeply affected by location and seasonality, with poorer performances in the dry season. Aeromonas composition shifted among seasons and was also different across river streams. The pathogenic potential of the isolates significantly increased during the dry season. Additionally, isolates displaying clinically relevant antimicrobial resistance phenotypes (carbapenem and fluroquinolone resistance) were detected. As it inhabits intermittent rivers, often reduced to disconnected pools during the summer, the dry season is a critical period for I. lusitanicum, with lower general health status and a higher potential of infection by Aeromonas spp. Habitat quality seems a determining factor on the sustainable development of this fish species. Also, these individuals act as reservoirs of important antimicrobial resistant bacteria with potential implications for public health.Publisher PDFPeer reviewe

Candida auris in Intensive Care Setting: The First Case Reported in Portugal

(This article belongs to the Special Issue Genomic Epidemiology of Fungal Diseases 2023)Candida auris is an opportunistic human pathogen that has rapidly spread to multiple countries and continents and has been associated with a high number of nosocomial outbreaks. Herein, we report the first case of C. auris in Portugal, which was associated with a patient transferred from Angola to an ICU in Portugal for liver transplantation after a SARS-CoV-2 infection. C. auris was isolated during the course of bronchoalveolar lavage, and it was subjected to antifungal susceptibility testing and whole-genome sequence analysis. This isolate presents low susceptibility to azoles and belongs to the genetic clade III with a phylogenetic placement close to African isolates. Although clade III has already been reported in Europe, taking into account the patient’s clinical history, we cannot discard the possibility that the patient’s colonization/infection occurred in Angola, prior to admission in the Portuguese hospital. Considering that C. auris is a fungal pathogen referenced by WHO as a critical priority, this case reinforces the need for continuous surveillance in a hospital settingThis work was supported by funding from the European Union EU4Health Programme under grant agreement no. 101113460 (GENEO) and by national funds through the Foundation for Science and Technology (FCT), I.P., under Individual CEEC 2022.00851.CEECIND/CP1748/CT0001.info:eu-repo/semantics/publishedVersio

O impacto da pandemia Covid-19 nos estudantes de Enfermagem

Poster apresentado nas II Jornadas Científicas Universitárias e Politécnicas Egas Moniz – “A Egas Moniz na Sociedade do Conhecimento.” Monte de Caparica, 29-30 de Abril de 2022N/

Synthesis, Dna Binding, And Antiproliferative Activity Of Novel Acridine-thiosemicarbazone Derivatives.

In this work, the acridine nucleus was used as a lead-compound for structural modification by adding different substituted thiosemicarbazide moieties. Eight new (Z)-2-(acridin-9-ylmethylene)-N-phenylhydrazinecarbothioamide derivatives (3a-h) were synthesized, their antiproliferative activities were evaluated, and DNA binding properties were performed with calf thymus DNA (ctDNA) by electronic absorption and fluorescence spectroscopies. Both hyperchromic and hypochromic effects, as well as red or blue shifts were demonstrated by addition of ctDNA to the derivatives. The calculated binding constants ranged from 1.74 × 10(4) to 1.0 × 10(6) M(-1) and quenching constants from -0.2 × 10(4) to 2.18 × 10(4) M(-1) indicating high affinity to ctDNA base pairs. The most efficient compound in binding to ctDNA in vitro was (Z)-2-(acridin-9-ylmethylene)-N- (4-chlorophenyl) hydrazinecarbothioamide (3f), while the most active compound in antiproliferative assay was (Z)-2-(acridin-9-ylmethylene)-N-phenylhydrazinecarbothioamide (3a). There was no correlation between DNA-binding and in vitro antiproliferative activity, but the results suggest that DNA binding can be involved in the biological activity mechanism. This study may guide the choice of the size and shape of the intercalating part of the ligand and the strategic selection of substituents that increase DNA-binding or antiproliferative properties.1613023-1304