The Intensive Care Global Study on Severe Acute Respiratory Infection (IC-GLOSSARI): a Multicenter, Multinational, 14-Day Inception Cohort Study

PURPOSE: In this prospective, multicenter, 14-day inception cohort study, we investigated the epidemiology, patterns of infections, and outcome in patients admitted to the intensive care unit (ICU) as a result of severe acute respiratory infections (SARIs). METHODS: All patients admitted to one of 206 participating ICUs during two study weeks, one in November 2013 and the other in January 2014, were screened. SARI was defined as possible, probable, or microbiologically confirmed respiratory tract infection with recent onset dyspnea and/or fever. The primary outcome parameter was in-hospital mortality within 60 days of admission to the ICU. RESULTS: Among the 5550 patients admitted during the study periods, 663 (11.9 %) had SARI. On admission to the ICU, Gram-positive and Gram-negative bacteria were found in 29.6 and 26.2 % of SARI patients but rarely atypical bacteria (1.0 %); viruses were present in 7.7 % of patients. Organ failure occurred in 74.7 % of patients in the ICU, mostly respiratory (53.8 %), cardiovascular (44.5 %), and renal (44.6 %). ICU and in-hospital mortality rates in patients with SARI were 20.2 and 27.2 %, respectively. In multivariable analysis, older age, greater severity scores at ICU admission, and hematologic malignancy or liver disease were independently associated with an increased risk of in-hospital death, whereas influenza vaccination prior to ICU admission and adequate antibiotic administration on ICU admission were associated with a lower risk. CONCLUSIONS: Admission to the ICU for SARI is common and associated with high morbidity and mortality rates. We identified several risk factors for in-hospital death that may be useful for risk stratification in these patients.

Regulatory Cells, Cytokine Pattern and Clinical Risk Factors for Asthma in Infants and Young Children with Recurrent Wheeze

Several risk factors for asthma have been identified in infants and young children with recurrent wheeze. However, published literature has reported contradictory findings regarding the underlying immunological mechanisms. OBJECTIVES: This study was designed to assess and compare the immunological status during the first 2 years in steroid-naive young children with >or= three episodes of physician-confirmed wheeze (n=50), with and without clinical risk factors for developing subsequent asthma (i.e. parental asthma or a personal history of eczema and/or two of the following: wheezing without colds, a personal history of allergic rhinitis and peripheral blood eosinophilia >4%), with age-matched healthy controls (n=30). METHODS: Peripheral blood CD4(+)CD25(+) and CD4(+)CD25(high) T cells and their cytotoxic T-lymphocyte-associated antigen-4 (CTLA-4), GITR and Foxp3 expression were analysed by flow cytometry. Cytokine (IFN-gamma, TGF-beta and IL-10), CTLA-4 and Foxp3 mRNA expression were evaluated (real-time PCR) after peripheral blood mononuclear cell stimulation with phorbol 12-myristate 13-acetate (PMA) (24 h) and house dust mite (HDM) extracts (7th day). RESULTS: Flow cytometry results showed a significant reduction in the absolute number of CD4(+)CD25(high) and the absolute and percentage numbers of CD4(+)CD25(+)CTLA-4(+) in wheezy children compared with healthy controls. Wheezy children at a high risk of developing asthma had a significantly lower absolute number of CD4(+)CD25(+) (P=0.01) and CD4(+)CD25(high) (P=0.04), compared with those at a low risk. After PMA stimulation, CTLA-4 (P=0.03) and Foxp3 (P=0.02) expression was diminished in wheezy children compared with the healthy children. After HDM stimulation, CTLA-4 (P=0.03) and IFN-gamma (P=0.04) expression was diminished in wheezy children compared with healthy children. High-risk children had lower expression of IFN-gamma (P=0.03) compared with low-risk and healthy children and lower expression of CTLA-4 (P=0.01) compared with healthy children. CONCLUSIONS: Although our findings suggest that some immunological parameters are impaired in children with recurrent wheeze, particularly with a high risk for asthma, further studies are needed in order to assess their potential as surrogate predictor factors for asthma in early life.

Tuberculose e infecção VIH/SIDA : uma análise comparativa em Portugal continental no biénio 2008-2009

RESUMO - Introdução: Actualmente 11,3 milhões de indivíduos estão co-infectados pela Tuberculose/Vírus Imunodeficiência Humana (TB/VIH), uma das principais causas de incapacidade e morte no mundo. É determinada pela exposição dos indivíduos aos factores de risco e condições/determinantes sociais de saúde. Várias são as medidas criadas a nível nacional e internacional na luta contra TB e a infecção VIH. Objectivo: Caracterizar e comparar os casos de TB entre os indivíduos não infectados com VIH e os infectados com VIH, considerando as características sócio-demográficas, o tratamento, patologias associadas e factores de risco. Método: Estudo descritivo, quantitativo e observacional. A informação foi obtida a partir da base de dados do Sistema Nacional de Vigilância Epidemiológica da Tuberculose dos casos de TB notificados entre 1 de Janeiro de 2008 a 31 de Dezembro de 2009. Para tratamento e análise estatística (descritiva e inferencial) o programa usado foi o SPSS versão 18,0. Resultados: 12,8% dos indivíduos estavam co-infectados com TB/VIH e 87,2% não estavam co-infectados. A presença de VIH nos casos de tuberculose apresenta evidência de relação com quase todas variáveis em estudo (p<0,00) excepto a presença de insuficiência renal (p<0,307). Apresentam maior probalidade de risco da co-infecção TB/VIH os homens, a faixa etária [35;44[, os estrangeiros, os desempregados, estar em retratamento e fumar. Os indivíduos com Doença Hepática (OR= 5,238; IC95%: 3,706;7,403; ORA = 3,104; IC95%: 2,164;4,454), patologias associadas (OR=13,199; IC95%: 11,246; 15,491; ORA=21,348; IC95%:17,569; 25,940) e factores de risco (OR=3,237; IC95%: 2,968; 3,531; ORA=2,644; IC95%: 2,414; 2,985) tem maior probalidade da co-infecção TB/VIH. O ajustamento para o sexo e a idade interferiu em todas variáveis em estudo. Conclusão: Os homens, da faixa etária [35;44 [, desempregados, estrangeiros, em retratamento, fumadores apresentam maior probalidade de risco de estar co-infectado com TB/VIH.

Key success factors of replicated social businesses

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

Critical analysis: Portuguese 9th grade exam results and socioeconomic factors

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

Factors affecting adolescents’ choice of branded vs. fashionable clothing

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