Metabolomics reveals novel biomarkers of illegal 5-nitromimidazole treatment in pigs. Further evidence of drug toxicity uncovered

The aim of the study was to investigate the potential of a metabolomics platform to distinguish between pigs treated with ronidazole, dimetridazole and metronidazole and non-medicated animals (controls), at two withdrawal periods (day 0 and 5). Livers from each animal were biochemically profiled using UHPLC–QTof-MS in ESI+ mode of acquisition. Several Orthogonal Partial Least Squares-Discriminant Analysis models were generated from the acquired mass spectrometry data. The models classified the two groups control and treated animals. A total of 42 ions of interest explained the variation in ESI+. It was possible to find the identity of 3 of the ions and to positively classify 4 of the ionic features, which can be used as potential biomarkers of illicit 5-nitroimidazole abuse. Further evidence of the toxic mechanisms of 5-nitroimidazole drugs has been revealed, which may be of substantial importance as metronidazole is widely used in human medicine.

Alpha-2 agonists for sedation of mechanically ventilated adults in intensive care units: a systematic review

BACKGROUND: Care of critically ill patients in intensive care units (ICUs) often requires potentially invasive or uncomfortable procedures, such as mechanical ventilation (MV). Sedation can alleviate pain and discomfort, provide protection from stressful or harmful events, prevent anxiety and promote sleep. Various sedative agents are available for use in ICUs. In the UK, the most commonly used sedatives are propofol (Diprivan(®), AstraZeneca), benzodiazepines [e.g. midazolam (Hypnovel(®), Roche) and lorazepam (Ativan(®), Pfizer)] and alpha-2 adrenergic receptor agonists [e.g. dexmedetomidine (Dexdor(®), Orion Corporation) and clonidine (Catapres(®), Boehringer Ingelheim)]. Sedative agents vary in onset/duration of effects and in their side effects. The pattern of sedation of alpha-2 agonists is quite different from that of other sedatives in that patients can be aroused readily and their cognitive performance on psychometric tests is usually preserved. Moreover, respiratory depression is less frequent after alpha-2 agonists than after other sedative agents.

OBJECTIVES: To conduct a systematic review to evaluate the comparative effects of alpha-2 agonists (dexmedetomidine and clonidine) and propofol or benzodiazepines (midazolam and lorazepam) in mechanically ventilated adults admitted to ICUs.

DATA SOURCES: We searched major electronic databases (e.g. MEDLINE without revisions, MEDLINE In-Process & Other Non-Indexed Citations, EMBASE and Cochrane Central Register of Controlled Trials) from 1999 to 2014.

METHODS: Evidence was considered from randomised controlled trials (RCTs) comparing dexmedetomidine with clonidine or dexmedetomidine or clonidine with propofol or benzodiazepines such as midazolam, lorazepam and diazepam (Diazemuls(®), Actavis UK Limited). Primary outcomes included mortality, duration of MV, length of ICU stay and adverse events. One reviewer extracted data and assessed the risk of bias of included trials. A second reviewer cross-checked all the data extracted. Random-effects meta-analyses were used for data synthesis.

RESULTS: Eighteen RCTs (2489 adult patients) were included. One trial at unclear risk of bias compared dexmedetomidine with clonidine and found that target sedation was achieved in a higher number of patients treated with dexmedetomidine with lesser need for additional sedation. The remaining 17 trials compared dexmedetomidine with propofol or benzodiazepines (midazolam or lorazepam). Trials varied considerably with regard to clinical population, type of comparators, dose of sedative agents, outcome measures and length of follow-up. Overall, risk of bias was generally high or unclear. In particular, few trials blinded outcome assessors. Compared with propofol or benzodiazepines (midazolam or lorazepam), dexmedetomidine had no significant effects on mortality [risk ratio (RR) 1.03, 95% confidence interval (CI) 0.85 to 1.24, I (2) = 0%; p = 0.78]. Length of ICU stay (mean difference -1.26 days, 95% CI -1.96 to -0.55 days, I (2) = 31%; p = 0.0004) and time to extubation (mean difference -1.85 days, 95% CI -2.61 to -1.09 days, I (2) = 0%; p < 0.00001) were significantly shorter among patients who received dexmedetomidine. No difference in time to target sedation range was observed between sedative interventions (I (2) = 0%; p = 0.14). Dexmedetomidine was associated with a higher risk of bradycardia (RR 1.88, 95% CI 1.28 to 2.77, I (2) = 46%; p = 0.001).

LIMITATIONS: Trials varied considerably with regard to participants, type of comparators, dose of sedative agents, outcome measures and length of follow-up. Overall, risk of bias was generally high or unclear. In particular, few trials blinded assessors.

CONCLUSIONS: Evidence on the use of clonidine in ICUs is very limited. Dexmedetomidine may be effective in reducing ICU length of stay and time to extubation in critically ill ICU patients. Risk of bradycardia but not of overall mortality is higher among patients treated with dexmedetomidine. Well-designed RCTs are needed to assess the use of clonidine in ICUs and identify subgroups of patients that are more likely to benefit from the use of dexmedetomidine.

STUDY REGISTRATION: This study is registered as PROSPERO CRD42014014101.

FUNDING: The National Institute for Health Research Health Technology Assessment programme. The Health Services Research Unit is core funded by the Chief Scientist Office of the Scottish Government Health and Social Care Directorates.

Environmental occurrence and fate of psychiatric pharmaceuticals

Os fármacos são importantes contaminantes ambientais. Nas últimas duas décadas, o número de estudos sobre a ocorrência destes poluentes emergentes em matrizes ambientais aumentou significativamente. Esta ocorrência generalizada preocupa a comunidade científica devido a evidências que comprovam a sua capacidade de interferir nos ecossistemas, mesmo em concentrações muito baixas. No caso particular dos fármacos psiquiátricos é expectável que constituam um risco ecológico significativo. Para uma melhor compreensão do impacto real destes poluentes é essencial que se proceda a uma avaliação extensiva da sua persistência e destino em matrizes ambientais. Os estudos apresentados nesta tese pretendem contribuir para melhorar o conhecimento acerca da ocorrência, persistência e destino ambiental de fármacos psiquiátricos. Para este efeito, foram seleccionados, como objecto de estudo, dois grupos de fármacos: anti-epilépticos (carbamazepina) e fármacos com efeitos ansiolíticos e sedativos (as benzodiazepinas diazepam, oxazepam, lorazepam e alprazolam). A fotodegradação é o principal processo que afecta a persistência de poluentes orgânicos em ambientes aquáticos. Consequentemente, a persistência dos cinco fármacos seleccionados foi avaliada através de estudos de fotodegradação directa e indirecta, tendo em consideração a influência de parâmetros relevantes tais como pH, nível de oxigenação e matéria orgânica dissolvida. Os estudos de fotodegradação aqui descritos foram seguidos por cromatografia micelar electrocinética com a aplicação de um capilar com revestimento dinâmico. Adicionalmente, os fotoprodutos resultantes de fotodegradação directa foram identificados por espectrometria de massa. O estudo da carbamazepina no ambiente é particularmente relevante uma vez que esta foi proposta como um potencial marcador de poluição antropogénica. A sua ocorrência em água superficiais, de sub-solo e residuais foi investigada através da implementação de um ensaio imunológico (ELISA), optimizado para a aplicação a triagens ambientais e amostras com matrizes complexas. O destino deste fármaco na interface água/solo foi também investigado usando solos agrícolas submetidos a fertilizações de longo prazo; este estudo permitiu tirar conclusões acerca da contaminação de águas adjacentes por solos contaminados. O trabalho aqui descrito constitui uma abordagem multidisplinar à problemática da ocorrência de fármacos psiquiátricos no ambiente, contribuindo de forma relevante para esta área de estudo.

Acute electronic cigarette use: nicotine delivery and subjective effects in regular users

Rationale Electronic cigarettes are becoming increasingly popular among smokers worldwide. Commonly reported reasons for use include the following: to quit smoking, to avoid relapse, to reduce urge to smoke, or as a perceived lower-risk alternative to smoking. Few studies, however, have explored whether electronic cigarettes (e-cigarettes) deliver measurable levels of nicotine to the blood. Objective This study aims to explore in experienced users the effect of using an 18-mg/ml nicotine first-generation e-cigarette on blood nicotine, tobacco withdrawal symptoms, and urge to smoke. Methods Fourteen regular e-cigarette users (three females), who are abstinent from smoking and e-cigarette use for 12 h, each completed a 2.5 h testing session. Blood was sampled, and questionnaires were completed (tobacco-related withdrawal symptoms, urge to smoke, positive and negative subjective effects) at four stages: baseline, 10 puffs, 60 min of ad lib use and a 60-min rest period. Results Complete sets of blood were obtained from seven participants. Plasma nicotine concentration rose significantly from a mean of 0.74 ng/ml at baseline to 6.77 ng/ml 10 min after 10 puffs, reaching a mean maximum of 13.91 ng/ml by the end of the ad lib puffing period. Tobacco-related withdrawal symptoms and urge to smoke were significantly reduced; direct positive effects were strongly endorsed, and there was very low reporting of adverse effects. Conclusions These findings demonstrate reliable blood nicotine delivery after the acute use of this brand/model of e-cigarette in a sample of regular users. Future studies might usefully quantify nicotine delivery in relation to inhalation technique and the relationship with successful smoking cessation/harm reduction.

Nutrition and farming practices as modulators of quality in gilthead seabream (Sparus aurata)

Gilthead seabream is the most important farmed species in the Mediterranean, and knowledge on how common farming practices impact its quality is limited. As such, this Thesis aimed to evaluate how gilthead seabream flesh quality is affected by some of these practices. In Chapter 2, the influence of nutritional factors was evaluated, specifically the high replacement of traditional marine-derived ingredients, both fishmeal and fish oil, with vegetable sources. We have seen that the vegetable-based diets tested did not greatly impact seabream flesh quality, although some alterations were seen in the fatty acid profile of the muscle. However, and despite having caused no alterations in flesh texture, vegetable ingredients reduced the amount of sulphated glycosaminoglycans in the extracellular matrix, affected muscle pH and reduced the activity of proteolytic enzymes. Throughout this Thesis, we measured for the first time the activity of proteolytic enzymes in seabream muscle, and cathepsin B was found to play a pivotal role in post-mortem muscle degradation. In Chapter 3, we evaluated the effect of harvesting and slaughter stress on seabream quality, and contrary to what is seen in most farmed species, our results show that gilthead seabream muscle structure is highly resistant to changes caused by stressful events. Nonetheless, considering that welfare is an increasingly important quality criterion, the use of a zero-withdrawal anaesthetic as a rested harvest technique or even slaughter method could prove valuable to the industry. In Chapter 4, we used maslinic acid as a dietary supplement, to modulate the muscle’s energetic status pre-mortem. As a finishing strategy, maslinic acid failed to increase levels of glycogen and ATP in the muscle. However, supplementation resulted in higher muscle fibre diameter and lower cathepsin B activity, and maslinic acid is likely to be useful to promote growth in this species. In general our Thesis has generated new knowledge to a major challenge facing the aquaculture industry, which is to find a compromise between the trends towards intensive rearing and consumer demand for healthy, high quality seafood being ethically acceptable and having a low impact on the environment.

The intra-industry effects of going concern withdrawn audit reports

Dissertação de mestrado, Finanças Empresariais, Faculdade de Economia, Universidade do Algarve, 2014

Organização flexível do conhecimento : estratégias para a retenção e transmissão do conhecimento e do saber-fazer nas empresas do sector metalúrgico, metalomecânico e electromecânico

Trabalho de projecto de mestrado, Ciências da Educação (Formação de Adultos), Universidade de Lisboa, Instituto de Educação, 2011

The effect of smoking nicotine tobacco versus smoking deprivation on motion sickness

BACKGROUND: The experienced smoker maintains adequate nicotine levels by 'puff-by-puff self-control' which also avoids symptomatic nauseating effects of nicotine overdose. It is postulated that there is a varying 'dynamic threshold for nausea' into which motion sickness susceptibility provides an objective toxin-free probe. Hypotheses were that: (i) nicotine promotes motion sickness whereas deprivation protects; and (ii) pleasurable effects of nicotine protect against motion sickness whereas adverse effects of withdrawal have the opposite effect. METHODS: Twenty-six healthy habitual cigarette smokers (mean±SD) 15.3±7.6cigs/day, were exposed to a provocative cross-coupled (coriolis) motion on a turntable, with sequences of 8 head movements every 30s. This continued to the point of moderate nausea. Subjects were tested after either ad-lib normal smoking (SMOKE) or after overnight deprivation (DEPRIV), according to a repeated measures design counter-balanced for order with 1-week interval between tests. RESULTS: Deprivation from recent smoking was confirmed by objective measures: exhaled carbon monoxide CO was lower (P<0.001) for DEPRIV (8.5±5.6ppm) versus SMOKE (16.0±6.3ppm); resting heart rate was lower (P<0.001) for DEPRIV (67.9±8.4bpm) versus SMOKE (74.3±9.5bpm). Mean±SD sequences of head movements tolerated to achieve moderate nausea were more (P=0.014) for DEPRIV (21.3±9.9) versus SMOKE (18.3±8.5). DISCUSSION: Tolerance to motion sickness was aided by short-term smoking deprivation, supporting Hypothesis (i) but not Hypothesis (ii). The effect was was approximately equivalent to half of the effect of an anti-motion sickness drug. Temporary nicotine withdrawal peri-operatively may explain why smokers have reduced risk for postoperative nausea and vomiting (PONV).

“An Absurdly Quiet Spot”: The Spatial Justice of WW1 Fraternizations

Recent research on WW1 shows that incidents of fraternization across enemy lines took place regularly. However, fraternization remains a taboo in many contexts. The fact that the 2005 film Joyeux Noel by Christian Caron, which explicitly deals with the subject, encountered resistance from the authorities, is an indication of the kind of difficulty associated with the issue. I am drawing my inspiration from the way fraternizations are depicted in the film and in the literature in order to explore the concept of spatial justice. I define spatial justice as the question that emerges when a body desires to occupy the same space at the same time as another body. Defined like this, the question of spatial justice opens up in the dread of No Man’s Land and in particular the exchange of affects, objects and narratives that went on during fraternizations. I trace the movement of spatial justice as one of withdrawal from the asphyxiating atmosphere of the war and the propaganda machine. This withdrawal is not one of unpatriotic stance but of a courageous and difficult detachment from the supposed legality of the war that could only function on the basis of hate and demonization. While fraternizations did not end the war, they allowed for the possibility of spatial justice to emerge, as an opportunity to reorient the space and the bodies within.

Withdrawing from Atmosphere: An Ontology of Air partitioning and Affective Engineering

The main objective of this text is to warn against atmospherics. However comfortable it might appear, an atmosphere is politically suspicious because it numbs a body into an affective embrace of stability and permanence. It becomes doubly suspicious because a body desires to be part of the atmosphere. For this reason, I rethink both affect and atmosphere ontologically rather than phenomenologically. I argue that an atmosphere is engineered by subsuming individual affects to what I call, following Sloterdijk, an atmospheric glasshouse. I suggest that this happens in four steps: a distinction between inside and outside through partitioning; inclusion of the outside inside; illusion of synthesis; and dissimulation. In order to do this, I begin with air as the elemental paradox of ontological continuum and rupture. I carry on with the passage from air to atmosphere while retaining the discourse around continuum and rupture. Finally, I indicate a way of rupturing the atmospheric continuum through the ontological movement of withdrawal from the atmosphere. The ultimate goal of the article is to sketch a problematic of atmospherics that puts together without synthesising an elemental ontology of continuum and rupture.

Withdrawing from atmosphere: An ontology of air partitioning and affective engineering

The main objective of this text is to warn against atmospherics. However comfortable it might appear, an atmosphere is politically suspicious because it numbs a body into an affective embrace of stability and permanence. It becomes doubly suspicious because a body desires to be part of the atmosphere. For this reason, I rethink both affect and atmosphere ontologically rather than phenomenologically. I argue that an atmosphere is engineered by subsuming individual affects to what I call, following Sloterdijk, an atmospheric glasshouse. I suggest that this happens in four steps: a distinction between inside and outside through partitioning; inclusion of the outside inside; illusion of synthesis; and dissimulation. In order to do this, I begin with air as the elemental paradox of ontological continuum and rupture. I carry on with the passage from air to atmosphere while retaining the discourse around continuum and rupture. Finally, I indicate a way of rupturing the atmospheric continuum through the ontological movement of withdrawal from the atmosphere. The ultimate goal of the article is to sketch a problematic of atmospherics that puts together without synthesising an elemental ontology of continuum and rupture.

Rentabilidade e risco na comercialização agregada de energia elétrica

Dissertação para obtenção do grau de Mestre em Engenharia Electrotécnica na Área de Especialização de Energia

Palaeontological data about the climatic trends from Chattian to present along the Northeastern Atlantic frontage

Climatic changes that affected the Northeastern Atlantic frontage are analyzed on the basis of the evolution of faunas and floras from the late Oligocene onwards. The study deals with calcareous nannoplankton, marine micro- and macrofaunas, some terrestrial vertebrates and vegetal assemblages. The climate, first tropical, underwent a progressive cooling (North-South thermic gradient). Notable climatic deteriorations (withdrawal towards the South or disappearance of taxa indicative of warm climate and appearance of "cold" taxa) are evidenced mainly during the Middle Miocene and the late Pliocene. Faunas and floras of modern pattern have regained, after the Pleistocene glaciations, a new climatic ranging of a temperate type in the northern part.

Optimização do processo de devolução de medicamentos fora do prazo de validade

RESUMO - Durante todo o seu ciclo de vida, o medicamento está sujeito a padrões de qualidade, segurança e eficácia, alicerçados numa atuação conjunta dos responsáveis pela sua colocação no mercado, das autoridades competentes nacionais e comunitárias. Os diferentes intervenientes estão sujeitos a um conjunto de obrigações e procedimentos que englobam também a sua fase final de retirada do mercado, devolução, recolha e valorização ou reciclagem. Neste trabalho é caracterizada a cadeia de distribuição do medicamento assim como o seu fluxo físico no sentido inverso, ou seja, o processo de devolução e de tratamento ambientalmente adequado para os resíduos de medicamentos. A maioria da literatura a respeito das devoluções de medicamentos enfatiza a vertente ecológica do sistema de logística inversa. Neste trabalho, as questões ambientais são discutidas , mas o objectivo primário focaliza questões económicas relacionadas com o processo de devoluções. São apresentadas as possíveis vantagens teóricas da criação de um sistema centralizado de gestão de devoluções, por oposição ao atual sistema de circuitos dispersos. Com a aplicação de um inquérito a armazenistas com larga responsabilidade no processo de devoluções, pretendeu-se avaliar os custos inerentes ao atual modelo. Os resultados obtidos indicam que existe margem potencial para reduzir custos neste processo, para a grande maioria dos armazenistas. Na área específica dos medicamentos fora de prazo de validade, o crescente desenvolvimento e aperfeiçoamento dos processos de devolução poderá direcionar-se no sentido da criação de centrais de devolução centralizadas.

O direito de arrependimento nos contratos celebrados à distância e fora do estabelecimento

This dissertation aims to analyze the right of withdrawal and its implications on distance and off-premises contracts, due to the importance of these contracts in our society. Our main goal is, first of all, to explain the meaning and characteristics of both distance and off-premises contracts and the reason why a right of withdrawal is granted. Secondly, we intend to explain all of the relevant aspects related to this right, such as its legal concept and main characteristics, the origin and evolution of the right of withdrawal on both European and Portuguese legislation, its implications in the contracting parties and, finally, a brief analysis of the applicable law. In a nutshell, the right of withdrawal allows the consumer to withdraw from a distance or off-premises contract, unilaterally, without having to indicate any motive to justify the decision, after a cooling-off period of 14 calendar days. In these two types of contracts such right exists due to the reasons or circumstances that lead to the conclusion of the contract.