Association of metabolic syndrome components and NAFLD with quality of life: Insights from a cross-sectional study.

AIM: Metabolic syndrome (MetS) is associated with higher cardiovascular and metabolic risks, as well as with psychosocial disorders. Data regarding quality of life (QoL) in patients with MetS, point towards a significative association between MetS and a worse QoL. It remains unclear whether MetS components and non-alcoholic fatty liver disease (NAFLD) are associated with QoL in these individuals. We aimed to evaluate the association between QoL of patients with MetS and prespecified metabolic parameters (anthropometric, lipidic and glucose profiles), the risk of hepatic steatosis and fibrosis, and hepatic elastography parameters. METHODS: Cross-sectional study including patients from microDHNA cohort. This cohort includes patients diagnosed with MetS, 18 to 75 years old, followed in our tertiary center. The evaluation included anamnesis, physical examination, a QoL questionnaire (Short-Form Health Survey, SF-36), blood sampling and hepatic elastography. We used ordered logistic regression models adjusted to sex, age and body mass index to evaluate the associations between the QoL domains evaluated by SF-36 and the prespecified parameters. RESULTS: We included a total of 65 participants with MetS, with 54% being female and the mean age 61.9 ± 9.6 years old. A worse metabolic profile, specifically higher waist circumference, lower HDL, higher triglycerides, and more severe hepatic steatosis, were associated with worse QoL scores in several domains. We found no significant association of hepatic fibrosis with QoL. CONCLUSION: Our data suggests that there is a link between a worse metabolic profile (specifically poorer lipidic profile and presence of hepatic steatosis) and a worse QoL in patients with MetS.

Effects of Triiodothyronine Treatment in an Animal Model of Heart Failure with Preserved Ejection Fraction.

Background: Low levels of triiodothyronine (T3) are common in patients with heart failure (HF). Our aim was to evaluate the effects of supplementation with low and replacement doses of T3 in an animal model of HF with preserved ejection fraction (HFpEF). Methods: We evaluated four groups: ZSF1 Lean (n = 8, Lean-Ctrl), ZSF1 Obese (rat model of metabolic-induced HFpEF, n = 13, HFpEF), ZSF1 Obese treated with a replacement dose of T3 (n = 8, HFpEF-T3high), and ZSF1 Obese treated with a low-dose of T3 (n = 8, HFpEF-T3low). T3 was administered in drinking water from weeks 13 to 24. The animals underwent anthropometric and metabolic assessments, echocardiography, and peak effort testing with maximum O2 consumption (VO2max) determination at 22 weeks, and a terminal hemodynamic evaluation at 24 weeks. Afterwhile myocardial samples were collected for single cardiomyocyte evaluation and molecular studies. Results: HFpEF animals showed lower serum and myocardial thyroid hormone levels than Lean-Ctrl. Treatment with T3 did not normalize serum T3 levels, but increased myocardial T3 levels to normal levels in the HFpEF-T3high group. Body weight was significantly decreased in both the T3-treated groups, comparing with HFpEF. An improvement in glucose metabolism was observed only in HFpEF-T3high. Both the treated groups had improved diastolic and systolic function in vivo, as well as improved Ca2+ transients and sarcomere shortening and relaxation in vitro. Comparing with HFpEF animals, HFpEF-T3high had increased heart rate and a higher rate of premature ventricular contractions. Animals treated with T3 had higher myocardial expression of calcium transporter ryanodine receptor 2 (RYR2) and α-myosin heavy chain (MHC), with a lower expression of ß-MHC. VO2max was not influenced by treatment with T3. Myocardial fibrosis was reduced in both the treated groups. Three animals died in the HFpEF-T3high group. Conclusions: Treatment with T3 was shown to improve metabolic profile, myocardial calcium handling, and cardiac function. While the low dose was well-tolerated and safe, the replacement dose was associated with increased heart rate, and increased risk of arrhythmias and sudden death. Modulation of thyroid hormones may be a potential therapeutic target in HFpEF; however, it is important to take into account the narrow therapeutic window of T3 in this condition.

Early Season Symptoms on Stem, Inflorescences and Flowers of Grapevine Associated with Botryosphaeriaceae Species.

Botryosphaeria dieback caused by several Botryosphaeriaceae species is one of the most important grapevine trunk diseases affecting vineyards worldwide. These fungi cause wedge-shaped perennial cankers and black streaking of the wood and have also been associated with intervein leaf chlorosis, dried or mummified berries, and eventually, the death of the plant. Early season symptoms may sometimes be disregarded by growers, being mistaken with symptoms from other diseases such as downy mildew or botrytis rot. Currently, few studies are available to determine what species may be causing these early season symptoms in grapevines. During the 2018 season, during the flowering period, grapevine samples showing necrosis on green shoots, dried inflorescences, and flowers, were collected in vineyards throughout the central regions of Portugal. Isolations were performed from symptomatic organs, and twenty-three isolates of Botryosphaeriaceae were selected. An analysis of the ITS and part of the translation elongation factor 1-α sequences was performed, revealing that the two main species apparently responsible for these symptoms were Diplodia seriata and Neofusicoccum parvum. In pathogenicity tests conducted on 1-year-old plants grown under controlled conditions in a greenhouse and on field-grown clusters, symptoms were reproduced, confirming the pathogenic behavior of the selection of isolates.

Screening for preeclampsia in the first trimester and aspirin prophylaxis: our first year / Rastreio de pré-eclâmpsia no primeiro trimestre e profilaxia com aspirina: o nosso primeiro ano

Abstract Objective Preeclampsia is a major cause of perinatal and maternal morbidity and mortality. Our objective is to assess the performance of a combined screening test for preeclampsia in the first trimester and the prophylactic use of low-dose aspirin. Methods Prospective study of all women attending our hospital for the first-trimester screening of aneuploidies, between March 2017 and February 2018 (n = 1,297). The exclusion criteria weremultiple pregnancy andmajor fetal abnormalities. Preeclampsia screening was performed with an algorithm that includes maternal characteristics, and biophysical and biochemical biomarkers. High-risk was defined as a risk ≥ 1:50 of earlyonset preeclampsia (before 34 weeks), in which cases low-dose aspirin (150mg at night) was offered to these women from screening until 36 weeks. Results From the 1,272 enrolled participants, the majority were Caucasian (1,051; 82.6%) and multiparous (658, 51.7%). Fifty patients (3.9%) screened high-risk for preeclampsia, and all started a low-dose aspirin regimen, with good compliance (96%). Early-onset preeclampsia was found in 3 pregnant women (0.24%), and total preeclampsia was diagnosed in 25 (2.02%), compared with 28 (0.75%) cases of early preeclampsia (p = 0.0099) and 98 (2.62%) of total preeclampsia (p = 0.2904) before the implementation of screening. Conclusion There was a lower incidence of both, early-onset and total preeclampsia, after the introduction of universal screening and prophylactic use of low-dose aspirin. This reduction was statistically significant in early-onset preeclampsia. The association of a first-trimester combined screening model and aspirin prophylaxis appears to be useful in predicting and reducing the incidence of early-onset preeclampsia, in a routine care setting.

Resumo Objetivo A pré-eclâmpsia é uma causa importante de morbi-mortalidade materna e perinatal. Os objetivos do nosso estudo foram avaliar a implementação do rastreio combinado de pré-eclâmpsia no primeiro trimestre e o uso profilático de aspirina em baixa dose. Métodos Estudo prospetivo das mulheres referenciadas ao nosso hospital para realização do rastreio do primeiro trimestre de aneuploidias, entre março de 2017 e fevereiro de 2018 (n = 1.297). Os critérios de exclusão foram gravidez múltipla e anomalias fetais graves. O algoritmo usado no rastreio da pré-eclâmpsia combina características maternas, e marcadores biofísicos e bioquímicos. Definiu-se alto risco como risco de pré-eclâmpsia precoce (antes das 34 semanas) ≥ 1:50, tendo sido recomendada aspirina em baixa dose (150 mg à noite) desde o rastreio até às 36 semanas. Resultados Das 1.272 participantes, a maioria era caucasiana (1.051; 82,6%) e multípara (658; 51,7%). Cinquenta grávidas (3,9%) foram consideradas de alto risco para pré-eclâmpsia e todas iniciaram aspirina em baixa dose, com boa adesão (96%). Pré-eclampsia precoce foi diagnosticada em 3 grávidas (0,24%), e no total foram diagnosticados 25 casos de pré-eclâmpsia (2,02%), comparativamente com 28 (0,75%) casos de pré-eclampsia precoces (p = 0,0099) e 98 (2,62%) casos totais de préeclâmpsia (p = 0,2904) observados antes da implementação do rastreio. Verificou-se uma menor incidência de pré-eclâmpsia precoce e total após introdução do rastreio universal e uso profilático de aspirina. A redução da pré-eclâmpsia precoce foi estatisticamente significativa. Conclusão A associação de um modelo de rastreio combinado no primeiro trimestre com o uso profilático de aspirina é aparentemente eficaz na redução do risco de préeclâmpsia precoce.

Screening for Preeclampsia in the First Trimester and Aspirin Prophylaxis: Our First Year.

OBJECTIVE: Preeclampsia is a major cause of perinatal and maternal morbidity and mortality. Our objective is to assess the performance of a combined screening test for preeclampsia in the first trimester and the prophylactic use of low-dose aspirin. METHODS: Prospective study of all women attending our hospital for the first-trimester screening of aneuploidies, between March 2017 and February 2018 (n = 1,297). The exclusion criteria were multiple pregnancy and major fetal abnormalities. Preeclampsia screening was performed with an algorithm that includes maternal characteristics, and biophysical and biochemical biomarkers. High-risk was defined as a risk ≥ 1:50 of early-onset preeclampsia (before 34 weeks), in which cases low-dose aspirin (150 mg at night) was offered to these women from screening until 36 weeks. RESULTS: From the 1,272 enrolled participants, the majority were Caucasian (1,051; 82.6%) and multiparous (658, 51.7%). Fifty patients (3.9%) screened high-risk for preeclampsia, and all started a low-dose aspirin regimen, with good compliance (96%). Early-onset preeclampsia was found in 3 pregnant women (0.24%), and total preeclampsia was diagnosed in 25 (2.02%), compared with 28 (0.75%) cases of early preeclampsia (p = 0.0099) and 98 (2.62%) of total preeclampsia (p = 0.2904) before the implementation of screening. CONCLUSION: There was a lower incidence of both, early-onset and total preeclampsia, after the introduction of universal screening and prophylactic use of low-dose aspirin. This reduction was statistically significant in early-onset preeclampsia. The association of a first-trimester combined screening model and aspirin prophylaxis appears to be useful in predicting and reducing the incidence of early-onset preeclampsia, in a routine care setting.

OBJETIVO: A pré-eclâmpsia é uma causa importante de morbi-mortalidade materna e perinatal. Os objetivos do nosso estudo foram avaliar a implementação do rastreio combinado de pré-eclâmpsia no primeiro trimestre e o uso profilático de aspirina em baixa dose. MéTODOS: Estudo prospetivo das mulheres referenciadas ao nosso hospital para realização do rastreio do primeiro trimestre de aneuploidias, entre março de 2017 e fevereiro de 2018 (n = 1.297). Os critérios de exclusão foram gravidez múltipla e anomalias fetais graves. O algoritmo usado no rastreio da pré-eclâmpsia combina características maternas, e marcadores biofísicos e bioquímicos. Definiu-se alto risco como risco de pré-eclâmpsia precoce (antes das 34 semanas) ≥ 1:50, tendo sido recomendada aspirina em baixa dose (150 mg à noite) desde o rastreio até às 36 semanas. RESULTADOS: Das 1.272 participantes, a maioria era caucasiana (1.051; 82,6%) e multípara (658; 51,7%). Cinquenta grávidas (3,9%) foram consideradas de alto risco para pré-eclâmpsia e todas iniciaram aspirina em baixa dose, com boa adesão (96%). Pré-eclampsia precoce foi diagnosticada em 3 grávidas (0,24%), e no total foram diagnosticados 25 casos de pré-eclâmpsia (2,02%), comparativamente com 28 (0,75%) casos de pré-eclampsia precoces (p = 0,0099) e 98 (2,62%) casos totais de pré-eclâmpsia (p = 0,2904) observados antes da implementação do rastreio. Verificou-se uma menor incidência de pré-eclâmpsia precoce e total após introdução do rastreio universal e uso profilático de aspirina. A redução da pré-eclâmpsia precoce foi estatisticamente significativa. CONCLUSãO: A associação de um modelo de rastreio combinado no primeiro trimestre com o uso profilático de aspirina é aparentemente eficaz na redução do risco de pré-eclâmpsia precoce.

The intervention of Occupational Therapy in drug addiction: a case study in the Comunidade Terapêutica Clínica do Outeiro - Portugal. / Intervenção da Terapia Ocupacional na toxicodependência: estudo de caso na Comunidade Terapêutica Clínica do Outeiro ­ Portugal.

Therapeutic communities emerged to respond to individuals with substance use disorders. The studies carried out emphasize the importance of the Occupational Therapist in the process of constructing occupational meaning. However, there is a paucity of studies addressing the relevance of this profession in this specific context. To understand the intervention of Occupational Therapy in the Therapeutic Community "Clínica do Outeiro - Portugal", describing the perception of individuals with substance use disorders, Occupational Therapists and other team members. Descriptive-exploratory study with a qualitative approach, by means of a case study research. We used interviews with clients and Occupational Therapists and focus group with the multidisciplinary team to collect data. Occupational Therapy is characterized by the greater proximity it establishes with users, as well as by the dynamism, creativity and motivation it infuses, playing a preponderant role in the (re) structuring of routines, performance of ADL and IADL, leisure and social participation of individuals with substance use disorders. The OT emerges as essential in this community, as a professional who is dedicated to the work of adapting and including the individual in the therapeutic community through the acquisition of the necessary occupational performance skills essential for everyday life in society.

As comunidades terapêuticas surgiram para dar resposta a indivíduos com perturbações por uso de substâncias. O artigo tem por objetivo entender a intervenção da Terapia Ocupacional na Comunidade Terapêutica "Clínica do Outeiro - Portugal", descrevendo a perceção dos indivíduos com perturbações por uso de substâncias, dos Terapeutas Ocupacionais e dos restantes elementos da equipe. Estudo descritivo-exploratório de abordagem qualitativa, por meio de estudo de caso. Foram utilizadas entrevistas junto dos clientes e Terapeutas Ocupacionais e grupo focal com a equipe multidisciplinar para a recolha de dados. A Terapia Ocupacional destaca-se pela maior proximidade que estabelece com os utentes, bem como pelo dinamismo, criatividade e pela motivação que incute, desempenhando um papel preponderante ao nível da (re)estruturação de rotinas, desempenho das Atividades de Vida Diária (AVD) e Atividades de Vida Diária Instrumentais (AVDI), lazer e participação social dos indivíduos com perturbações por uso de substâncias. O TO surge como essencial nesta comunidade, como profissional vocacionado para um trabalho de adaptação e inclusão do indivíduo na comunidade terapêutica através da aquisição das necessárias competências de desempenho ocupacional necessárias para a vida quotidiana em sociedade .

Intervenção da Terapia Ocupacional na toxicodependência: estudo de caso na Comunidade Terapêutica Clínica do Outeiro - Portugal / The intervention of Occupational Therapy in drug addiction: a case study in the Comunidade Terapêutica Clínica do Outeiro - Portugal

Resumo As comunidades terapêuticas surgiram para dar resposta a indivíduos com perturbações por uso de substâncias. O artigo tem por objetivo entender a intervenção da Terapia Ocupacional na Comunidade Terapêutica "Clínica do Outeiro - Portugal", descrevendo a perceção dos indivíduos com perturbações por uso de substâncias, dos Terapeutas Ocupacionais e dos restantes elementos da equipe. Estudo descritivo-exploratório de abordagem qualitativa, por meio de estudo de caso. Foram utilizadas entrevistas junto dos clientes e Terapeutas Ocupacionais e grupo focal com a equipe multidisciplinar para a recolha de dados. A Terapia Ocupacional destaca-se pela maior proximidade que estabelece com os utentes, bem como pelo dinamismo, criatividade e pela motivação que incute, desempenhando um papel preponderante ao nível da (re)estruturação de rotinas, desempenho das Atividades de Vida Diária (AVD) e Atividades de Vida Diária Instrumentais (AVDI), lazer e participação social dos indivíduos com perturbações por uso de substâncias. O TO surge como essencial nesta comunidade, como profissional vocacionado para um trabalho de adaptação e inclusão do indivíduo na comunidade terapêutica através da aquisição das necessárias competências de desempenho ocupacional necessárias para a vida quotidiana em sociedade .

Abstract Therapeutic communities emerged to respond to individuals with substance use disorders. The studies carried out emphasize the importance of the Occupational Therapist in the process of constructing occupational meaning. However, there is a paucity of studies addressing the relevance of this profession in this specific context. To understand the intervention of Occupational Therapy in the Therapeutic Community "Clínica do Outeiro - Portugal", describing the perception of individuals with substance use disorders, Occupational Therapists and other team members. Descriptive-exploratory study with a qualitative approach, by means of a case study research. We used interviews with clients and Occupational Therapists and focus group with the multidisciplinary team to collect data. Occupational Therapy is characterized by the greater proximity it establishes with users, as well as by the dynamism, creativity and motivation it infuses, playing a preponderant role in the (re) structuring of routines, performance of ADL and IADL, leisure and social participation of individuals with substance use disorders. The OT emerges as essential in this community, as a professional who is dedicated to the work of adapting and including the individual in the therapeutic community through the acquisition of the necessary occupational performance skills essential for everyday life in society.

Cell-free DNA and contingent screening: Our first year.

INTRODUCTION: Analysis of cell-free DNA (cfDNA) from maternal blood has showed a great potential as a screening method for fetal aneuploidies. cfDNA can be used as a first line screening tool or in a contingent model, after the combined test. METHODS: Prospective study of women attending for first trimester combined screening in our Hospital, in the first year of contingent cfDNA screening. According to the combined screening test result patients were divided in high-risk (offered invasive test or routine follow-up), intermediate-risk (counselled for cfDNA, invasive or routine follow-up) or low-risk (routine ultrasound follow-up). Pregnancy outcomes and performance of screening were evaluated. A cost-effectiveness analysis was also done. RESULTS: The majority of the 1272 enrolled participants were Caucasian (82,6%), multiparous (51,7%) and the median maternal age was 30 years old. Thirty women screened high-risk and 83,3% of them opted for an invasive test. Forty-nine patients had an intermediate risk and 75,5% of them choose cfDNA testing. Our rate of invasive tests decreased from 3.5% to 2.4%. DISCUSSION: The cut-offs used to determine high and intermediate-risk are based on a compromise between detection rate, pregnancy lost rate and cost. Above a determined cut-off in the intermediate-risk group, the cost for each additional detected trisomy case is very high. One major benefit of this contingent model was the decrease in invasive testing. CONCLUSION: The contingent cfDNA screening model can be easily implemented in a public hospital with a low-risk population. Since cost/benefit is an important issue, further studies are needed to determine the ideal cut-off for our country.

Gastrointestinal diseases during pregnancy: what does the gastroenterologist need to know?

Pregnancy is characterized by numerous physiological changes that may lead to a diversity of symptoms and frequently to gastrointestinal complaints, such as heartburn, nausea and vomiting, or constipation. Chronic gastrointestinal diseases require treatment maintenance during this period, raising the challenging question whether outcomes beneficial to the mother may be harmful for the fetus. In addition, certain diseases, such as acute fatty liver of pregnancy, only develop during pregnancy and may require urgent procedures, such as fetus delivery. Even though they are not present in our day-to-day practice, knowledge of pregnancy-related diseases is fundamental and collaboration between gastroenterologists and obstetricians is often necessary. Herein, we review pregnancy-related diseases and systematize the most appropriate treatment choices according to the recent literature and guidelines, so that the article can serve as a guide to the gastroenterologist regarding the medical approach to pregnancy-related gastrointestinal and liver diseases and their therapeutic management.

Wild mushroom extracts as inhibitors of bacterial biofilm formation.

Microorganisms can colonize a wide variety of medical devices, putting patients in risk for local and systemic infectious complications, including local-site infections, catheter-related bloodstream infections, and endocarditis. These microorganisms are able to grow adhered to almost every surface, forming architecturally complex communities termed biofilms. The use of natural products has been extremely successful in the discovery of new medicine, and mushrooms could be a source of natural antimicrobials. The present study reports the capacity of wild mushroom extracts to inhibit in vitro biofilm formation by multi-resistant bacteria. Four Gram-negative bacteria biofilm producers (Escherichia coli, Proteus mirabilis, Pseudomonas aeruginosa, and Acinetobacter baumannii) isolated from urine were used to verify the activity of Russula delica, Fistulina hepatica, Mycena rosea, Leucopaxilus giganteus, and Lepista nuda extracts. The results obtained showed that all tested mushroom extracts presented some extent of inhibition of biofilm production. Pseudomonas aeruginosa was the microorganism with the highest capacity of biofilm production, being also the most susceptible to the extracts inhibition capacity (equal or higher than 50%). Among the five tested extracts against E. coli, Leucopaxillus giganteus (47.8%) and Mycenas rosea (44.8%) presented the highest inhibition of biofilm formation. The extracts exhibiting the highest inhibitory effect upon P. mirabilis biofilm formation were Sarcodon imbricatus (45.4%) and Russula delica (53.1%). Acinetobacter baumannii was the microorganism with the lowest susceptibility to mushroom extracts inhibitory effect on biofilm production (highest inhibition-almost 29%, by Russula delica extract). This is a pioneer study since, as far as we know, there are no reports on the inhibition of biofilm production by the studied mushroom extracts and in particular against multi-resistant clinical isolates; nevertheless, other studies are required to elucidate the mechanism of action.