Segmentectomia Pulmonar Anatómica por Videotoracoscopia: Experiência Inicial de um Centro

The use of minimally invasive surgery for the treatment of lung cancer has been growing worldwide. Between May 2008 and November 2012, we performed 24 videothoracoscopic anatomical lung resections in our department. This includes 22 lobectomies and 2 anatomic segmentectomies, which is known to be a more complex surgery, since it demands a finer dissection of sub-lobar structures. We report the clinical cases of two patients who underwent anatomic segmentectomies. The first one was a 63 year old woman, smoker and with a history of breast cancer 20 years earlier. An incidental 9 mm node was found in the lingula. The patient underwent an anatomic lingulectomy and the frozen section was suggestive of a primary lung cancer. Therefore, we proceeded to a full lymphadenectomy. The final pathology evaluation showed a typical carcinoid tumour (pT1aN0). The second patient was a 50 year old woman, a smoker and with a heavy family history of lung cancer. In a screening CT scan a 8 mm ground glass opacity was identified in the left lower lobe (segment VI). After a VATS wedge resection of the node the frozen section evaluation was compatible with adenocarcinoma. We then proceeded to an anatomic segmentectomy with lymphadenectomy. The definitive pathology evaluation confirmed that it was a pT1a N0 bronchioloalveolar adenocarcinoma. The patients now have 5 and 2 months of follow up respectivelly and neither of them has signs of recurrence and the surgical incision showed a good aesthetic result. Anatomic segmentectomy is the indicated surgery especially in patients with low grade tumours, in early stage lung cancers or in patients without pulmonary function for a lobar resection, and it can be done safely using VATS.

Novel transcription factors regulating the expression of the rice gene OsDREB1B

Dissertation presented to obtain the Ph.D degree in Biology

Cutaneous Infection by Different Alternaria Species in a Liver Transplant Recipient

Fungal invasive infections are rare in general population but are an emergent cause of infection in the immunocompromized population, especially in the solid organ transplant recipients. Herein the authors report a clinical case of a liver transplanted patient suffering a cutaneous co-existent infection with A. alternata as well as A. infectoria. To our knowledge this is the first case of cutaneous concomitant infection due to those two species reported not only in Portugal but also worldwide. The patient was treated with surgical excision of the lesions and oral itraconazol without relapse.

Percutaneous Treatment of Mitral Valve Regurgitation: Initial Experience with the MitraClip Device

INTRODUCTION: Mitral regurgitation (MR) is the most common valvular disease and has recently become the target of a number of percutaneous approaches. The MitraClip is virtually the only device for which there is considerable experience, with more than 20,000 procedures performed worldwide. OBJECTIVE: To describe our initial experience of the percutaneous treatment of MR with the MitraClip device. METHODS: We describe the first six MitraClip cases performed in this institution (mean age 58.5 ± 13.1 years), with functional MR grade 4+ and New York Heart Association (NYHA) heart failure class III or IV (n=3), with a mean follow-up of 290 ± 145 days. RESULTS: Procedural success (MR ≤ 2+) was 100%. Total procedure time was 115.8 ± 23.7 min, with no in-hospital adverse events and discharge between the fourth and eighth day, and consistent improvement in the six-minute walk test (329.8 ± 98.42 vs. 385.33 ± 106.95 m) and in NYHA class (three patients improved by two NYHA classes). During follow-up there were two deaths, in two of the four patients who had been initially considered for heart transplantation. CONCLUSION: In patients with functional MR the MitraClip procedure is safe, with both a high implantation and immediate in-hospital success rate. A longer follow-up suggests that the clinical benefit decreases or disappears completely in patients with more advanced heart disease, namely those denied transplantation or on the heart transplant waiting list.

How differently do our non-large companies listed on the Portuguese Stock Exchange perform?

A Work Project, presented as part of the requirements for the Award of a Masters Degree in Economics from the NOVA – School of Business and Economics

Shareholder activism worldwide: Evidence from voting

A Work Project, presented as part of the requirements for the Award of a Masters Degree in Finance from the NOVA – School of Business and Economics

Internationalization process of Gallo worldwide: Introduction of olive in a non-traditional market - China

A Work Project, presented as part of the requirements for the Award of a Masters Degree in Management from the NOVA – School of Business and Economics

Smells Like Spleen Spirit: O Decadentismo na América da Segunda Metade do Século XX

Dissertação apresentada para cumprimento dos requisitos necessários à obtenção do grau de Mestre em Línguas Literaturas e Culturas

Disclosing the caffeine dose to be administered that restores insulin sensitivity in prediabetes animal

The results discussed in this thesis originated the following communications in International and National congresses: Sacramento JF, Coelho JC, Melo BF, Guarino MP and Conde SV. (2014) Assessment of caffeine dose and time of administration required for resetting insulin sensitivity in high sucrose diet in rats. 50th Meeting of EASD (European Association for the study of Diabetes), 14-19 September, Vienna, Austria Coelho JC, Melo BF, Sacramento JF, Guarino MP and Conde SV (2014). Establishing the caffeine dose that chronically restores insulin sensitivity in animal model of prediabetes. Fundação Astrazeneca Innovate Competition, iMed conference 6.0®, 10-12 October, Lisboa, Portugal Also, during the last year I was involved in other ongoing projects that originated the following communications: Coelho JC, Melo BF, Sacramento JF, Ribeiro MJ, Guarino MP and Conde SV (2014). Are the effects of carotid sinus nerve resection on insulin sensitivity mediated by an increase in Glut4 expression in skeletal muscle?. XLIV Reunião Anual da Sociedade Portuguesa de Farmacologia, XXXII Reunião de Farmacologia Clínica e XIII Reunião de Toxicologia, 5-7 February, Coimbra, Portugal Sacramento JF, Rodrigues T, Coelho JC, Matafome P, Ribeiro MJ, Seiça RM, Guarino MP, Conde SV (2014). Elucidating the mechanism by which carotid sinus nerve resection restores insulin sensitivity in pre-diabetes animal models. International Society for Arterial Chemoreception (ISAC) XIX University of Leeds, 29th June - 3rd July, Leeds, United Kingdom

Divulgar ciência para diferentes públicos. Uma experiência no projeto STOL - Science Through Our Lives

O estágio que aqui se relata enquadra-se no âmbito do mestrado em Comunicação de Ciência, da Faculdade de Ciências Sociais Humanas (FCSH) da Universidade Nova de Lisboa (UNL) e do Instituto de Tecnologia Química e Biológica (ITQB). Foi realizado no projeto STOL – Science Through Our Lives, do Centro de Biologia Molecular e Ambiental (CBMA) da Escola de Ciências da Universidade do Minho (ECUM), e teve a duração de três meses. Esta componente prática do mestrado permitiu desenvolver um trabalho in loco, com o objetivo de servir, sobretudo, a comunicação de ciência informal. As principais atividades desenvolvidas foram exposições (Homo numericus; “Ponto a Ponto Enche a Ciência o Espaço), produção de materiais educativos (Objetos Educativos para a Casa das Ciências), campanhas de sensibilização (Comemoração do Dia Mundial da Água), auscultação do público (Vox Pop), crónicas de jornal (coluna “Aqui há Ciência”) e estabelecimento de parcerias estratégicas entre o STOL e outras forças vivas da região (AVianense e “Diário do Minho”). Ao integrar as atividades a decorrer no projeto STOL, foi possível contribuir com sugestões e novos materiais, e implementar projetos cujo principal objetivo foi o contacto direto com o público. De todo o trabalho se obteve um feedback positivo, conforme se documenta neste relatório e respetivos anexos. Se alguns constrangimentos podem ser enunciados (falta de recursos económicos e humanos, fraca tradição de envolvimento da população com a ciência e vice-versa, e a considerável falta de apoio institucional a atividades de divulgação de ciência), também devem ser evidenciados aspetos muito positivos como a dinâmica do grupo STOL, a capacidade de envolver diferentes públicos nas suas atividades, diferenciar estratégias para esses grupos, e finalmente, avaliar, sempre que possível, o seu desempenho, incluindo os resultados nas atividades seguintes. Neste contexto foram aplicados os conhecimentos adquiridos durante o primeiro ano curricular do mestrado, permitindo o ganho de experiência na área de trabalho onde a autora se sente realizada e pretende permanecer.

Wound Healing: a genetic approach in Drosophila

The wound healing response is an essential mechanism to maintain the integrity of epithelia and protect all organisms from the surrounding milieu. In the “purse-string” mechanism of wound closure, an injured epithelial sheet cinches its hole closed via an intercellular contractile actomyosin cable.(...)

Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) in Portugal:

Methicillin-resistant Staphylococcus aureus (MRSA), a human pathogen confined to hospitals (HAMRSA) for over 30 years have been emerging worldwide in the last two decades as a leading cause of severe infections in healthy individuals in the community (CA-MRSA). Despite its clinical significance, in the beginning of our studies no information existed on the prevalence, and population structure of CA-MRSA in Portugal. Moreover, it remained to be clarified how CA-MRSA emerged in our country. In particular, it was not known if CA-MRSA emerged locally by acquisition of the staphylococcal cassette chromosome mec (SCCmec) by established methicillin-susceptible S. aureus (MSSA) in the community, if they were imported from abroad or have escaped from the hospital.(...)

Integrated care approaches and skills mix policies in Europe

ABSTRACT - Background: Integration of health care services is emerging as a central challenge of health care delivery, particularly for patients with elderly and complex chronic conditions. In 2003, the World Health Organization (WHO) already began to identify it as one of the key pathways to improve primary care. In 2005, the European Commission declared integrated care as vital for the sustainability of social protection systems in Europe. Nowadays, it is recognized as a core component of health and social care reforms across European countries. Implementing integrated care requires coordination between settings, organizations, providers and professionals. In order to address the challenge of integration in such complex scenario, an effective workforce is required capable of working across interdependent settings. The World Health Report 2006 noted that governments should prepare their workforce and explore what tasks the different levels of health workers are trained to do and are capable of performing (skills mix). Comparatively to other European countries, Portugal is at an early stage in what integrated care is concerned facing a growing elderly population and the subsequent increase in the pressure on institutions and professionals to provide social and medical care in the most cost-effective way. In 2006 the Portuguese government created the Portuguese Network for Integrated Care Development (PNICD) to solve the existing long-term gap in social support and healthcare. On what concerns health workforce, the Portuguese government already recognized the importance of redefine careers keeping professional motivation and satisfaction. Aim of the study: This study aims to contribute new evidence to the debate surrounding integrated care and skills mix policies in Europe. It also seeks to provide the first evidence that incorporates both the current dynamics of implementing integrated care in Portugal and the developments of international literature. The first ambition of our study is to contribute to the growing interest in integrated care and to the ongoing research in this area by identifying its different approaches and retrieve a number of experiences in some European countries. Our second goal of this research is to produce an update on the knowledge developed on skills mix to the international healthcare management community and to policy makers involved in reforming healthcare systems and organizations. To better inform Portuguese health policies makers in a third stage we explore the current dynamics of implementing integrated care in Portugal and contextualize them with the developments reported in the international literature. Methodology: This is essentially an exploratory and descriptive study using qualitative methodology. In order to identify integrated care approaches in Europe, a systematic literature review was undertaken which resulted in a paper published in the Journal of Management and Marketing in Health care titled: Approaches to developing integrated care in Europe: a systematic literature review. This article was recommended and included into a list of references identified by The King's Fund Library. A second systematic literature review was undertaken which resulted in a paper published in the International Journal of Healthcare Management titled: Skills mix in healthcare: An international update for the management debate. Semi-structured interviews were performed on experts representing the regional coordination teams of the Portuguese Network for Integrated Care Development. In a last stage a questionnaire survey was developed based on the findings of both systematic literature reviews and semi-structured interviews. Conclusions: Even though integrated care is a worldwide trend in health care reforms, there is no unique definition. Definitions can be grouped according to their sectorial focus: community-based care, combined health and social care, combined acute and primary care, the integration of providers, and in a more comprehensive approach the whole health system. Indeed, models that seek to apply the principles of integrated care have a similar background and are continually evolving and depend on the different initiatives taken at national level. . Despite the fact that we cannot argue that there is one single set typology of models for integrated care, it is possible to identify and categorize some of the basic approaches that have been taken in attempts to implement integrated care according to: changes in organizational structure, workforce reconfiguring, and changes in the financing system. The systematic literature review on skills mix showed that despite the widely acknowledged interest on skills mix initiatives there is a lack of evidence on skills mix implications, constraints, outcomes, and quality impact that would allow policy makers to take sustained and evidence-based decisions. Within the Portuguese health system, the integrated care approach is rather organizational and financial, whereas little attention is given to workforce integration. On what concerns workforce planning Portugal it is still in the stage of analyzing the acceptability of health workforce skills mix. In line with the international approaches, integration of health and social services and bridging primary and acute care are the main goals of the national government strategy. The findings from our interviews clarify perceptions which show no discrepancy with the related literature but are rather scarce comparing to international experience. Informants hold a realistic but narrow view of integrated care related issues. They seem to be limited to the regional context, requiring a more comprehensive perspective. The questionnaire developed in this thesis is an instrument which, when applied, will allow policy makers to understand the basic set of concepts and managerial motivations behind national and regional integrated care programs. The instrument developed can foster evidence on the three essential components of integrated care policies: organizational, financial, and human resources development, and can give additional input on the context in which integrated care is being developed, the type of providers and organizations involved, barriers and constraints, and the workforce skills mix planning related strategies. The thesis was successful in recognizing differences between countries and interventions and the instrument developed will allow a better comprehension of the international options available and how to address the vital components of integrated care programs.