Publications by authors named "Ana Prata"

47 Publications

Renal abnormalities in rheumatoid arthritis: an insight on IgA nephropathy.

Rheumatol Adv Pract 2022 27;6(1):rkab109. Epub 2021 Dec 27.

Rheumatology Unit, Hospitais da Universidade de Coimbra-Centro Hospitalar e Universitário de Coimbra, Coimbra.

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http://dx.doi.org/10.1093/rap/rkab109DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8730354PMC
December 2021

Prevalence and predictive factors for fear of childbirth in pregnant Portuguese women: A cross-sectional study.

Sex Reprod Healthc 2021 Nov 26;31:100687. Epub 2021 Nov 26.

Universidade Católica Portuguesa, Centre for Interdisciplinary Research in Health: Institute of Health Sciences, Porto, Portugal. Electronic address:

Objective: To measure the prevalence of the fear of childbirth (FOC) and determine which factors predict severe FOC among pregnant Portuguese women.

Methods: An online cross-sectional study among pregnant Portuguese women aged ≥ 20 years who were recorded using a convenience sampling. Self-administered questionnaires were used for data collection: socio-demographic and obstetric questionnaire and European Portuguese version of Wijma Delivery Expectancy Questionnaire-version A (WDEQ-A). Data of 669 participants were collected successfully from June 9 to October 30, 2019. Predictive factors for severe FOC were investigated using a multivariate logistic regression analysis. Odds ratios (OR) and 95% confidence intervals were calculated.

Results: The prevalence of severe FOC (WDEQ-A ≥ 85) among pregnant Portuguese women was 10%. Severe FOC was significantly associated with lower educational level, single/divorced marital status, and negative previous childbirth experience. Multivariate logistic regression analysis indicated that being single or divorced and having a negative previous childbirth experience were predictive variables for severe FOC.

Conclusion: Pregnant Portuguese women have FOC, although with varying severity. The data suggest that marital status and women's perceptions of previous childbirth experience may be useful variables to predict severe FOC. Further research for extending the predictive factors of FOC should be refined. The results are clinically relevant for midwifery care, as they should be used in the sense of early identification of fearful pregnant women to provide adequate support strategies to reduce FOC.
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http://dx.doi.org/10.1016/j.srhc.2021.100687DOI Listing
November 2021

Antimalarial treatment and minimizing prednisolone are associated with lower risk of infection in SLE: a 24-month prospective cohort study.

Clin Rheumatol 2021 Nov 16. Epub 2021 Nov 16.

Rheumatology Unit, Hospitais da Universidade de Coimbra-Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.

Introduction/objectives: Infections are a major cause of morbidity and death in systemic lupus erythematosus (SLE). Perfecting the understanding of contributors to infection burden in SLE is pivotal to improve management and outcomes. This study aims to identify clinical predictors of infection in SLE.

Method: We conducted a prospective cohort study at a referral SLE clinic. Infections were identified at each visit and categorized as (a) any type, (b) serious, (c) non-serious, and (d) bacterial. Survival analysis followed by multivariate Cox regression with an estimation of hazard ratios (HR) with 95% confidence intervals (95%CI) was performed.

Results: We included 259 patients during a mean follow-up of 23.3 ± 5.7 months. The incidence rate of infection of any type was 59.3 cases per 100 patient-years. Multivariate Cox models showed that (a) prednisolone ≥ 7.5 mg/day (HR = 1.95, 95%CI 1.26-3.03) and female gender (HR = 2.08, 95%CI 1.12-3.86) were associated with higher risk of infection of any type; (b) prednisolone ≥ 10 mg/day was associated with higher (HR = 4.32, 95%CI 1.39-13.40), and antimalarials with lower risk (HR = 0.18, 95%CI 0.06-0.51) of serious infection; (c) female gender (HR = 1.92, 95%CI 1.04-3.57) and prednisolone ≥ 7.5 mg/day (HR = 1.89, 95%CI 1.21-2.96) were associated with higher risk of non-serious infection; (d) antimalarials were associated with lower (HR = 0.49, 95%CI 0.26-0.93) and female gender (HR = 5.12; 95%CI 1.62-16.18) with higher risk of bacterial infection.

Conclusions: The risk of infection was higher in females in this young, well-controlled, low-comorbidity SLE cohort. Antimalarials were associated with lower and prednisolone ≥ 7.5 mg with higher risk of infection. Key Points • Lupus patients treated with prednisolone ≥ 7.5 mg/day were 89% more likely to present infections. • Lupus patients receiving prednisolone ≥ 10 mg/day were four times more likely to present serious infections. • Lupus patients receiving antimalarials were 82% less likely to present serious infections.
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http://dx.doi.org/10.1007/s10067-021-05988-xDOI Listing
November 2021

Physical aspects of orange essential oil-contaning particles after vacuum spray drying processing.

Food Chem X 2021 Dec 15;12:100142. Epub 2021 Oct 15.

Department of Food Engineering, School of Food Engineering, State University of Campinas, P.O. Box 6121, 13083-862 Campinas, SP, Brazil.

Vaccum spray drying has been shown as an alternative for drying sensitive compounds at lower temperatures than the conventional spray drying. Here, powders produced by both processes are compared considering their physical aspects and storage conditions. Orange essential oil-containing particles were produced by spray drying (190 °C/90 °C) and by vacuum spray drying (30 °C). The particles produced by vacuum spray dryer presented lower porosity and lower water adsorption than spray dried particles. Particles produced by both processes presented amorphous characteristics and no interaction between the wall material and encapsulated oil was observed. However, a lower oxidative stability during accelerated shelf life tests, in a period of 48 h, which can be related to the enhancement of oil retention. This study has significance for understanding the effect of the pressure and temperature over sensitive compounds and structural changes in the particles.
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http://dx.doi.org/10.1016/j.fochx.2021.100142DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8550986PMC
December 2021

Retro-odontoid pseudotumor: a rare complication of Diffuse Idiopathic Skeletal Hyperostosis.

Acta Reumatol Port 2021 Jul-Sep;46(3):279-280

Rheumatology Department, Centro Hospitalar e Universitário de Coimbra.

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October 2021

Fructans with different degrees of polymerization and their performance as carrier matrices of spray dried blue colorant.

Carbohydr Polym 2021 Oct 25;270:118374. Epub 2021 Jun 25.

School of Food Engineering, University of Campinas, Rua Monteiro Lobato, 80, Campinas, SP CEP:13083-862, Brazil.

Inulin-type fructans with different degrees of polymerization (DPs) were used as wall materials for the blue colorant produced from the crosslinking between genipin and milk proteins. The impact of using fructooligosaccharides (FOS) with DP = 5 and inulins with DP ≥ 10 (GR-In) and DP ≥ 23 (HP-In) on the physical (microstructure, size, water activity, wettability, solubility, water adsorption, glass transition temperature, and color), chemical (free genipin retention and moisture), and technological (colorant power, pH stability, and thermal stability) properties of the powdered blue colorant was examined. Inulins were more efficient carriers as seen from the physical characteristics of the microparticles. FOS and GR-In promoted higher retention of free genipin than HP-In. Additionally, their lower DP influenced the rehydration proprieties as well as the color intensity and colorant power. The DP did not affect the physical stability of the colorant at different pH conditions or at high temperature. Our findings demonstrated that the DP of the fructan exhibited a strong impact on the blue intensity of the samples and also their rehydration capacity.
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http://dx.doi.org/10.1016/j.carbpol.2021.118374DOI Listing
October 2021

Polyarthritis and fever-a clinical conundrum.

Rheumatology (Oxford) 2021 12;60(12):e438-e440

Rheumatology Unit, Centro Hospitalar e Universitário de Coimbra EPE.

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http://dx.doi.org/10.1093/rheumatology/keab592DOI Listing
December 2021

Psychometric properties of the European Portuguese version of the Wijma Delivery Expectancy/Experience Questionnaire in pregnant women.

Health Care Women Int 2021 Jul 20:1-18. Epub 2021 Jul 20.

Centre for Interdisciplinary Research in Health: Institute of Health Sciences, Universidade Católica Psortuguesa, Porto, Portugal.

The researchers' aim is to examine the psychometric properties of the European Portuguese version of the Wijma Delivery Expectancy/Experience Questionnaire version A (WDEQ-A). Data from 669 pregnant Portuguese women was collected between June and October of 2019. From the initial 33-item Portuguese version of the WDEQ-A, a 27-item instrument was developed. Five-factor solution explained 63.8% of the total variance. The factors defined by the researchers were: fear/lack of self-efficacy, loneliness, negative appraisal, lack of positive anticipation and concern for the child. Cronbach's alpha coefficient was 0.934. The European Portuguese version of the WDEQ-A is a reliable and valid tool to measure fear of childbirth on both nulliparous and multiparous women and can be a useful tool for cross-cultural research. Moreover, researchers support the use of this tool in clinical practice to recognize and address fearful women during prenatal period.
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http://dx.doi.org/10.1080/07399332.2021.1932892DOI Listing
July 2021

Patient-Physician discordance in assessment of disease activity in Rheumatoid Arthritis patients.

Acta Reumatol Port 2021 Apr-Jun;46(2):103-109

Serviço de Reumatologia, Centro Hospitalar e Universitário de Coimbra.

Background: In rheumatoid arthritis (RA), global disease activity is commonly evaluated, from the patient's and the physician's perspective, through a 100mm visual analogue scale (VAS) and plays an important role in the assessment of diseases activity and treatment decisions. Our aim was to determine patient-physician discordance in the assessment of disease activity and to explore its determinants.

Methods: Cross sectional study including RA patients (ACR/EULAR 2010 classification criteria). The discrepancy between patients-physicians (∆PPhGA) was defined as PGA minus PhGA, and a difference > |20mm| was considered as "discordant". Correlation between ∆PPhGA and other variables was assessed through Pearson's correlation and comparison between groups through t-test. Variables with p < 0.05 or considered clinically relevant were included in multivariable linear regression analysis to identify determinants for ∆PPhGA. A p < 0.05 was considered statistically significant.

Results: In total, 467 patients with RA were included (81.2% female; mean age 63.9% ± 12.2 years). PGA and PhGA were discordant in 61.7% of the cases. The proportion of concordance increased (p < 0.01) when considering only patients in remission (DAS 28 3V < 2.6). In multivariable analysis (R2adjusted=0.27), VAS-pain-patient (β 0.74, 95% CI 0.62-0.88, p=0.00) and TJC (β 0.16, 95% CI 0.45-0.48, p=0.02) remained associated with a higher ∆PPhGA.

Conclusion: Our study confirmed that a significant discrepancy between patients and physicians in the assessment of global disease activity is frequent in clinical practice, and is probably due to valorization of different parameters by the two groups.
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November 2021

Juvenile Paget's Disease: Report of a successful treatment throughout the complete growth of a patient with a missense TNFRSF11B mutation.

Joint Bone Spine 2021 Dec 21;88(6):105243. Epub 2021 Jun 21.

Pediatric Rheumatology Unit, Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Avenida Afonso Romão, 3000-602 Coimbra, Portugal.

Introduction: Juvenile Paget's Disease (JPD) is an ultra-rare inherited osteopathy featuring markedly accelerated bone turnover. Several clinical characteristics have been reported, including bone deformities developing in childhood and hearing loss.

Case Report: We report the case of a 2 ¾-year-old girl that presented with progressive bowing of both legs since the age of 2, lower limb pain and frequent falls with one consequent femur fracture. Plain radiographs revealed osteoectasia of the long bone's diaphysis, and laboratory tests showed extremely high serum total alkaline phosphatase levels. A missense mutation on the gene TNFRSF11B was identified in homozygosity, and the diagnosis of JPD was made. Treatment with bisphosphonates was initiated early and markedly improved lower limb bowing and pain. The patient reached adulthood with normal height, minor bone deformities, and no functional impairment. Despite the good skeletal symptom's response, bisphosphonates failed to prevent or improve sensorineural hearing loss.

Conclusions: In this clinical case, early treatment with bisphosphonates was effective for the treatment of JPD skeletal deformities. New therapeutic strategies need to be developed to better control the extraskeletal manifestations of JPD.
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http://dx.doi.org/10.1016/j.jbspin.2021.105243DOI Listing
December 2021

Impact of vacuum spray drying on encapsulation of fish oil: Oxidative stability and encapsulation efficiency.

Food Res Int 2021 05 9;143:110283. Epub 2021 Mar 9.

Department of Food Engineering, Faculty of Food Engineering, University of Campinas, P.O. Box 6121, 13083-862 Campinas, SP, Brazil. Electronic address:

This study aimed to evaluate the potential of vacuum spray drying technology for the microencapsulation of an oxidation-sensitive ingredient, in order to minimize lipid oxidation and maximize encapsulation efficiency. For this purpose, an emulsion containing fish oil was used for particles production. Maltodextrin and modified starch were employed as wall materials at a 75:25 ratio. The process was carried out on a vacuum spray dryer (VSD) and a spray dryer (SD) to compare the particles recovered by both processes. The particles produced by the VSD presented the best protection of the active material against lipid oxidation according to the methods evaluated, while the poorer protection was obtained for SD particles, which also showed the lowest encapsulation efficiency. All samples were hollow with continuous walls and no apparent fissures or cracks in their structures. The type of process significantly affected the physicochemical and structural properties of the microparticles.
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http://dx.doi.org/10.1016/j.foodres.2021.110283DOI Listing
May 2021

Remission and low disease activity matrix tools: results in real-world rheumatoid arthritis patients under anti-TNF therapy.

Acta Reumatol Port 2020 Oct-Dec;45(4):245-252

Centro Hospitalar e Universitário de São João ; Faculdade de Medicina da Universidade do Porto, Porto, Portugal.

Background: Remission/ low disease activity (LDA) are the main treatment goals in rheumatoid arthritis (RA) patients. Two tools showing the ability to predict golimumab treatment outcomes in patients with RA were published.

Objectives: To estimate the real-world accuracy of two quantitative tools created to predict RA remission and low disease activity.

Methods: Multicenter, observational study, using data from the Rheumatic Diseases Portuguese Register (Reuma.pt), including biologic naïve RA patients who started an anti-TNF as first-line biologic and with at least 6 months of follow-up. The accuracy of two matrices tools was assessed by likelihood-ratios (LR), sensitivity (SN), specificity (SP), positive predictive value (PPV), negative predictive value (NPV) and area under the ROC curve (AUC).

Results: 674 RA patients under first-line anti-TNF (266 etanercept, 186 infliximab, 131 adalimumab, 85 golimumab, 6 certolizumab pegol) were included. The median (IQR) age was 53.4 (44.7-61.1) years and the median disease duration was 7.7 (3.7-14.6) years. The majority were female (72%). Most patients were RF and/or ACPA positive (75.5%) and had erosive disease (54.9%); 58.6% had comorbidities. At 6-months, 157 (23.3%) patients achieved remission (DAS28 ESR < 2.6) and 269 (39.9%) LDA (DAS28 ESR ≤ 3.2). Area under the curve for remission in this real-world sample was 0.756 [IC 95% (0.713-0.799)] and for LDA was 0.724 [IC 95% (0.686 -0.763)]. The highest LR (8.23) for remission state was obtained at a cut-off ≥ 67%, with high specificity (SP) (99.6%) but low sensitivity (SN) (3.2%). A better balance of SN and SP (65.6% and 73.9%, respectively) was observed for a cut-off >30%, with a LR of 2.51, PPV of 43.3% and NPV of 87.6%.

Conclusion: In this population, the accuracy of the prediction tool was good for remission and LDA. Our results corroborate the idea that these matrix tools could be helpful to select patients for anti-TNF therapy.
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January 2021

Fear of childbirth in time of the new coronavirus pandemic.

Rev Bras Enferm 2020 13;73(Suppl 2):e20200551. Epub 2020 Nov 13.

Escola Superior de Enfermagem do Porto, Centro de Investigação em Tecnologia e Serviços de Saúde. Porto, Portugal.

Objective: Reflect on how the new coronavirus pandemic triggered or accentuated the fear of childbirth in pregnant women and affected childbirth care practices.

Methods: Reflective analysis of women's pregnancy and childbirth experiences during the current pandemic, supported by the latest scientific evidence and recommendations on the topic.

Results: Pregnancy and childbirth are life-changing events for women, but during the new coronavirus pandemic, fear and uncertainty have taken on an unprecedented dimension in the negative way that many pregnant women have anticipated and experienced childbirth.

Final Considerations: The current period has accentuated a chronic problem: a paternalistic system of health institutions in the approach to childbirth, dense with additional levels of fear in pregnant women. In this context, addressing the fear of childbirth means not giving up the promotion of safe and positive birth experiences for women.
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http://dx.doi.org/10.1590/0034-7167-2020-0551DOI Listing
November 2020

Conflict management strategies used by Portuguese nurse managers.

Rev Bras Enferm 2020 28;73(suppl 6):e20190336. Epub 2020 Oct 28.

Escola Superior de Enfermagem do Porto. Porto, Portugal.

Objectives: to analyze the perception and conflict management strategies used by nurses in the management of people in Portuguese health services.

Methods: descriptive, correlational study, carried out in Portuguese health services, with an intentional non-probabilistic sample, totaling 95 nurse managers. A questionnaire and Conflict Management Scale were used, analyzing the variables of managerial activities and conflict management, with the aid of software.

Results: it was identified that 60% of the managers, report having to mediate conflicts daily, and the majority report adopting dialogue in conduct. However, through the Kruskal-Wallis test, it was shown that enforcement strategies in conflict management prevail (p = 0.008), with collaborative ones being more restricted to monthly intervals (p = 0.049).

Conclusions: managers perceive the importance of collaboration in the mediation of conflicts, however, in their daily lives; they tend to maintain imposing behaviors, signaling for a little transformational leadership style.
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http://dx.doi.org/10.1590/0034-7167-2019-0336DOI Listing
May 2021

Prognostic Factors and Life Expectancy in Canine Leishmaniosis.

Vet Sci 2020 Sep 4;7(3). Epub 2020 Sep 4.

Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, UNL, R. da Junqueira 100, 1349-008 Lisbon, Portugal.

Canine leishmaniosis (CanL) is a chronic and potentially fatal disease. The prognosis of CanL depends on the severity of the clinical signs and clinicopathological abnormalities presented by the dog at the time of diagnosis. This study aims to estimate the survival time of dogs with CanL, determining the prognostic value of different clinical and clinicopathological parameters. Medical records of 99 dogs diagnosed with CanL in five veterinary centers of the Alentejo region (Portugal) were examined retrospectively. The majority of dogs presented hyperproteinemia, moderate normocytic normochromic anemia, normal blood urea and creatinine levels and were classified as stage 1 according to the International Interest Society (IRIS) guidelines at the time of diagnosis. The severity of anemia, presence of concomitant infectious diseases at the time of diagnosis and the anti- therapy were correlated with the survival time. The influence of renal dysfunction was evaluated by Receiver Operating Characteristic (ROC) curve and survival analysis. Survival analysis demonstrated that patients classified as IRIS 1 at the time of diagnosis survived more than four years, in contrast with dogs classified as IRIS 2 that survived around two and half years and dogs classified as IRIS 3-4 that survived around one month. IRIS stage deteriorated during the course of CanL in one third of the dogs and was the principal cause of death or euthanasia in a high proportion of animals. In some cases, dogs did not receive anti- treatment or abandoned the veterinary follow-ups, which may have considerable repercussions for animal wellbeing and public health. This study reinforces the value of blood urea and creatinine levels as prognostic factors in CanL.
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http://dx.doi.org/10.3390/vetsci7030128DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7559807PMC
September 2020

Midwifery interventions to reduce fear of childbirth in pregnant women: a scoping review protocol.

JBI Evid Synth 2020 09;18(9):2045-2057

Nursing School of Porto, Porto, Portugal.

Objective: The objective of the review is to map and analyze midwifery interventions to reduce fear of childbirth in pregnant women.

Introduction: Fear of childbirth is a phenomenon negatively affecting women's health and well-being before and during pregnancy, as well as after childbirth. During the previous few decades, there has been a growing interest in research into interventions to reduce the fear of childbirth in childbearing women. Currently, providing an appropriate model of care for pregnant women with fear of childbirth is a challenge in midwifery care. Therefore, further efforts are needed to identify and examine the characteristics of different midwifery interventions to reduce fear of childbirth in pregnant women.

Inclusion Criteria: This scoping review will consider studies that include interventions to reduce fear of childbirth in pregnant women, led and implemented by midwives, during the antenatal period, in all possible birth scenarios. Quantitative, qualitative, and mixed methods studies will be included.

Methods: The JBI methodology for conducting scoping reviews will be employed. Published and unpublished literature in English, Portuguese, and Spanish, from 1981 to the present, will be included. MEDLINE, CINAHL Complete, Scopus, Web of Science, Embase, and Cochrane Library databases will be searched. Searches for gray literature will be performed. Data will be extracted using a tool developed specifically for the scoping review objectives.
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http://dx.doi.org/10.11124/JBISRIR-D-19-00198DOI Listing
September 2020

Antenatal care policies for low-risk pregnant women in high-income countries with a universal health system: a scoping review protocol.

JBI Evid Synth 2020 07;18(7):1537-1545

1Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal 2UICISA:E - Unidade de Investigação em Ciências da Saúde: Enfermagem, Portugal 3Portugal Centre for Evidence Based Practice: A JBI Centre of Excellence 4Escola Superior de Enfermagem do Porto, Porto, Portugal 5CINTESIS - Innovation & Development in Nursing: Center for Health Technology and Services Research, Porto, Portugal 6School of Health Sciences, Division of Midwifery and Radiography, City, University of London, London, United Kingdom.

Objective: The aim of this scoping review is to map the available evidence on the nature, extent, and range of antenatal care policies for low-risk pregnant women in high-income countries with a health system founded on the Beveridge Model.

Introduction: Low-risk women in high-income countries have good evolutionary perinatal outcomes but high intervention rates in pregnancy and childbirth, which ultimately leads to high morbidity. This has implications at all levels including families, the health care system, and society. This review aims to inform future policy and identify the viability of the adoption of alternative models to the Portuguese context that can reduce unnecessary interventions.

Inclusion Criteria: Studies, protocols, guidelines, and policies that provide guidance on antenatal care for low-risk pregnant women in high-income countries with a health system founded on the Beveridge Model (universal health care) will be considered. Documents from 2005 to present will be included, and no language restrictions will be imposed.

Methods: An initial search will be conducted in databases including MEDLINE (via PubMed) and CINAHL (via EBSCOhost), followed by a manual search of the reference lists from the documents accepted for inclusion, and a hand search of gray literature. For the countries whose policies are not available through the earlier steps, key persons from health ministries and academia will be contacted. Search results will be exported and data extracted using charting forms. Data will be synthesized using narrative description.
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http://dx.doi.org/10.11124/JBISRIR-D-19-00197DOI Listing
July 2020

Performance of oil-in-water emulsions stabilized by different types of surface-active components.

Colloids Surf B Biointerfaces 2020 Jun 3;190:110939. Epub 2020 Mar 3.

Department of Food Engineering, School of Food Engineering, UNICAMP, Campinas, SP, Brazil.

The emulsion stability depends on the physicochemical properties of the dispersed phase and their interaction with the continuous phase. Surface-active compounds (SAC) are added in emulsions to reduce the interfacial tension (IT) between these phases and keep the oil droplets stabilized. Moreover, small amounts of SAC can occupy intermolecular voids in the dried matrix, reducing the oxidation. However, the formulation must reflect a trade-off between protection and emulsion stabilization. Therefore, this work aimed to identify the minimum concentration of SAC (modified starch-MS, gelatin-GE, and whey protein isolate-WPI) ranging from 0.48 to 6 % (w/w) to form and stabilize droplets of an unsaturated triglyceride (fish oil-FO) or a volatile oil (orange essential oil-OEO). GE did not change the IT (6.7 mN/m) and stabilized the emulsions only through an increase of the viscosity (∼42 mPas for FO-emulsions and ∼97 mPas for OEO-emulsions), presenting high droplet size (∼10 μm) and low surface charge (∼1.5 mV). WPI reduced the IT to a limit value (4.5 mN/m at 1.2 % w/w for OEO and 5.3 mN/m at 2.4 % w/w for FO), whereas MS reduce constantly the IT with the increase of the concentration for both oils (∼4.2 mN/m at 6 % w/w). Both WPI and MS-emulsions presented similar droplet size (∼2.0 μm), but WPI presented higher surface charge of WPI-emulsions (-45 mV) than MS-emulsions (-30 mV). This study allowed to gain a consistent understanding of structure-property relationships on the use of SAC in emulsions.
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http://dx.doi.org/10.1016/j.colsurfb.2020.110939DOI Listing
June 2020

The child and adolescent psychiatry: study of training in Europe (CAP-STATE).

Eur Child Adolesc Psychiatry 2020 Jan 16;29(1):11-27. Epub 2019 Dec 16.

Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Essen, University of Duisburg-Essen, Duisburg, Germany.

There is great cultural diversity across Europe. This is reflected in the organisation of child and adolescent mental health (CAMH) services and the training of the respective professionals in different countries in Europe. Patients and their parents will want a high quality, knowledgeable, and skillful service from child and adolescent psychiatrists (CAPs) wherever they see them in Europe. A European comparison of training programs allows all stakeholders in different European countries to assess the diversity and to initiate discussions as to the introduction of improvements within national training programs. Major issues to be addressed in comparing child and adolescent psychiatric training programs across Europe include: (1) formal organisation and content of training programs and the relationship to adult psychiatry and paediatrics; (2) flexibility of training, given different trainee interests and that many trainees will have young families; (3) quality of governance of training systems; (4) access to research; and (5) networking. The Child and Adolescent Psychiatry-Study of Training in Europe (CAP-State) is a survey of training for child and adolescent psychiatrists (CAPs) across European countries. It aims to revisit and extend the survey carried out in 2006 by Karabekiroglu and colleagues. The current article is embedded in a special issue of European Child + Adolescent Psychiatry attempting to for the first time address training in CAP at the European and global levels. Structured information was sought from each of 38 European and neighboring countries (subsequently loosely referred to as Europe) and obtained from 31. The information was provided by a senior trainee or recently qualified specialist and their information was checked and supplemented by information from a senior child and adolescent psychiatry trainer. Results showed that there is a very wide range of provision of training in child and adolescent psychiatry in different countries in Europe. There remains very substantial diversity in training across Europe and in the degree to which it is subject to national oversight and governance. Some possible reasons for this variation are discussed and some recommendations made.
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http://dx.doi.org/10.1007/s00787-019-01416-3DOI Listing
January 2020

The impact of demographic and clinical characteristics on diabetic painful neuropathy.

Rom J Intern Med 2020 Mar;58(1):13-19

FHU Vale do Sorraia,Coruche, Portugal.

Introduction: Diabetic neuropathy (DN) is one of the most devastating complications of diabetes mellitus; however, in contrast to other countries, there are no scientific studies in Portugal evaluating the impact of demographic and clinical characteristics of this pathological entity. The aim of this study was to evaluate the impact of gender, metabolic control, age of diabetic patients, as well as time of disease progression, the appearance of complaints related to neuropathic pain.

Material And Methods: A multicentre study with a non-probabilistic, convenience sample of 359 patients was performed employing the quantitative method, using the Statistical Package for Social Science 24 software. The p-value of p < 0.05 was defined to consider a result statistically significant. The Spearman correlation coefficient (r) was determined to determine the relationship between categorical variables.

Results: There was no statistically significant difference in the prevalence of DN between genders (p = 0.633 and r = 0.025). There was a statistically significant relationship between the value of HbA1c and DN, with p = 0.010 and r = 0.136. There is a relationship between age and complaints of neuropathic pain, with p = 0.034 and r = 0.112. The variable, time of disease progression, is also correlated with the appearance of complaints of neuropathic pain with p = 0.020 and r = 0.112.

Conclusion: The prevalence of neuropathic pain in subjects with diabetes is not negligible and is associated with modifiable risk factors that can be identified, possibly modified and prevented. The correct approach for these patients, which involves screening and early treatment, is decisive improving functionality and quality of life.
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http://dx.doi.org/10.2478/rjim-2019-0019DOI Listing
March 2020

Complexation of chitosan with gum Arabic, sodium alginate and κ-carrageenan: Effects of pH, polymer ratio and salt concentration.

Carbohydr Polym 2019 Nov 23;223:115120. Epub 2019 Jul 23.

School of Food Engineering, University of Campinas (UNICAMP), 80, Monteiro Lobato Street, ZIP 13083-862, Campinas, SP, Brazil. Electronic address:

The effects of pH, ionic strength and polymer ratio in the complexation of chitosan (CHI) with different anionic polysaccharides, namely gum Arabic (GA), sodium alginate (ALG) and κ-carrageenan (CRG), were investigated. This was made using titration techniques, which allowed the determination of stoichiometry and binding constant of complexes. The sulfated polysaccharide interacted more strongly with CHI than carboxylated polysaccharides. The increase of ionic strength (0-100 mM NaCl) in the polysaccharides complexation resulted in a significant reduction in the binding constant of GA:CHI and CRG:CHI, but did not influence the complexation of ALG with CHI. The pH and polymer ratio affected the formation and solubility of complexes GA:CHI, while for ALG:CHI and CRG:CHI, insoluble complexes were observed in all pH and polymer ratio evaluated. A phase transition of coacervate to gel was proposed to ALG:CHI and CRG:CHI, which can be related to the self-association of anionic polymers, when these are in excess.
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http://dx.doi.org/10.1016/j.carbpol.2019.115120DOI Listing
November 2019

Carvedilol-Induced Liver Injury, a Rare Cause of Mixed Hepatitis: A Clinical Case.

GE Port J Gastroenterol 2019 May 10;26(3):196-201. Epub 2018 Jul 10.

Serviço de Medicina Interna B, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.

Introduction: Drug-induced liver injury is an increasingly prevalent consequence of the diversification of available therapeutic weapons, mostly idiosyncratic and with several possible mechanisms and patterns of specific damage for each drug. Carvedilol, a widely used non-selective alpha and beta blocker leads, in very rare cases, to injury of the bile ducts by toxic metabolites, resulting in a mixed-pattern hepatitis with possible progression to chronic cholestatic syndrome and cirrhosis. The authors report the second known case of this important toxicity.

Clinical Case: An 83-year-old woman was admitted to the Internal Medicine ward for etiological clarification of a mixed-pattern hepatitis. Clinical history was unremarkable and structural, infectious, and autoimmune causes were excluded by blood tests and imaging exams, ultimately leading to the diagnosis of toxic hepatitis that was further confirmed by liver biopsy with morphologic findings of mixed-pattern liver injury. Carvedilol, started 6 months before, was deemed the causal agent since it was the only drug with a clinically, temporally, analytically, and histologically compatible pattern. The withdrawal of the drug resulted in slow reversal of the referred abnormalities.

Conclusion: In very rare cases, carvedilol can cause important liver toxicity as a chronic cholestatic syndrome which can evolve to cirrhosis. It should be taken in consideration as causal agent in similar cases and stopped immediately upon suspicion, as the timely withdrawal results in reversion of the pathological findings.
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http://dx.doi.org/10.1159/000490205DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6528078PMC
May 2019

Obtaining functional powder tea from Brazilian ginseng roots: Effects of freeze and spray drying processes on chemical and nutritional quality, morphological and redispersion properties.

Food Res Int 2019 02 11;116:932-941. Epub 2018 Sep 11.

DEA (Department of Food Engineering), FEA (School of Food Engineering), UNICAMP (University of Campinas), R. Monteiro Lobato, 80, 13083-862 Campinas, São Paulo, Brazil.

In this work, the aqueous extract obtained from Brazilian ginseng (Pfaffia glomerata) roots (BGR), rich in beta-ecdysone and fructooligosaccharides (FOS), was powdered by spray drying and freeze drying techniques aiming to obtain a novel functional food product. The effects of these drying techniques on the chemical and nutritional quality, morphological and redispersion properties of the BGR powders were evaluated. The BGR powders obtained by both spray drying and freeze drying techniques maintained their beta-ecdysone and FOS contents after drying, demonstrating the stability of these functional compounds. It was found that the wettability of the powders obtained by different treatments was affected by the drying technique because freeze-dried particles reached the lower values (66 ± 5 s) while spray-dried particles showed a greater time for dispersion into water (150 ± 25 s). This behavior was mainly associated with differences between powder morphological properties since the freeze-dried particles presented a more porous structure, resulting in a greater water diffusivity into microstructure during the redispersion process. Drying process did not affect the storage stability of powders because the glass transition temperature (Tg) for both samples was approximately 160 °C at a relative humidity of 56%. Thus, both BGR powders presented adequate redispersion properties to constitute a new functional tea or even to be used as a functional ingredient in food products.
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http://dx.doi.org/10.1016/j.foodres.2018.09.030DOI Listing
February 2019

Locoregional recurrence of Frantz' tumor: a case report and review of the literature.

Rev Assoc Med Bras (1992) 2018 Jul;64(7):577-580

Imaging Department, A.C.Camargo Cancer Center, São Paulo, Brasil.

Frantz' tumours or solid pseudopapillary tumours of the pancreas are rare neoplasms with low malignant potential. Young women in the second to third decades of life are more frequently affected. The treatment of choice is resection of the lesion, which is often curative. The recurrence is uncommon when radical surgical resection is used. Radiological characteristics are important for the correct diagnosis, since the preoperative planning is fundamental to obtain the cure. The objective of this study is to report a rare case of locoregional recurrence and to review the radiological findings of solid pseudopapillary tumours of the pancreas in the literature, as well to know the incidence and risk factors of tumor recurrence. This case report is from a 37-year-old female patient evaluated at an Oncologic Hospital, in the city of São Paulo, Brazil, who presented an uncommon evolution of the disease, characterized by local recurrence despite the complete resection of the primary lesion with free margins.
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http://dx.doi.org/10.1590/1806-9282.64.07.577DOI Listing
July 2018

Chitosan coated nanostructured lipid carriers (NLCs) for loading Vitamin D: A physical stability study.

Int J Biol Macromol 2018 Nov 29;119:902-912. Epub 2018 Jul 29.

Department of Food Engineering, School of Food Engineering, University of Campinas (UNICAMP), 80, Monteiro Lobato Street, P.O. Box 6121, 13083-862 Campinas, SP, Brazil.

A nanostructured lipid carrier (NLC) has been developed as a loading system for Vitamin D (VD). The NLCs were obtained by melt-emulsification method and coated with chitosan (CHI) by electrostatic deposition. The lipids used in the formulations were selected in order to provide higher encapsulation efficiency. Thermophysical properties of particles were evaluated by differential scanning calorimetry; particle stability was characterized by size distribution, polydispersity index, zeta-potential and light backscattering. The coating over NLCs was carried out by potentiometric titration with CHI at concentrations of 1.0, 1.5, 2.0 and 2.5% (w/v). Stearic (SA) and oleic acids (OA) were the lipids that showed higher compatibility with VD. The NLC 70(SA):30(OA) was the particle with the lowest polydispersity, size variation and less tendency to physical instability during the storage time. This formulation also presented encapsulation efficiency higher than 98%. In the particles coating, CHI adsorption into the colloidal dispersion provided an initial electrostatic stabilization of the system. A long-term steric barrier was established through further incorporation of CHI. Coated NLCs showed a core-shell structure and a positive zeta-potential (+30 mV), remaining stable for 60 days at 25 °C. During storage time, no expulsion of VD out of the particle was observed.
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http://dx.doi.org/10.1016/j.ijbiomac.2018.07.174DOI Listing
November 2018

Comparison of microparticles produced with combinations of gelatin, chitosan and gum Arabic.

Carbohydr Polym 2018 Sep 9;196:427-432. Epub 2018 May 9.

School of Food Engineering, Unicamp, Campinas, Brazil. Electronic address:

The complexation between proteins and/or polysaccharides has been studied during decades and despite the knowledge of how these interactions occur provides a basis for identifying the conditions of microparticle formation, the presence of the oil phase complicates the application of available theory to explain the complexation between polymers. In this work, we identified some parameters which can interfere with this interaction, highlighting the influence of molecular arrangements by modifying the combination of gelatin (GE) and gum Arabic (GA) including the chitosan (CHI), a comparatively stronger polycation, to form particles in the presence or not of an essential oil. The results indicated the influence of the polymeric system in the morphological structure of particles as well as in the capacity of oil retention. The encapsulation of oil was more efficient for systems containing GA, due to the ability of these systems to form complexes. However, GE-GA particles presented as multinucleous while CHI-GA as a mononucleous structure.
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http://dx.doi.org/10.1016/j.carbpol.2018.05.027DOI Listing
September 2018

Improving the performance of transglutaminase-crosslinked microparticles for enteric delivery.

Food Res Int 2016 Oct 28;88(Pt A):153-158. Epub 2016 Feb 28.

Department of Foods and Nutrition, Faculty of Food Engineering, University of Campinas, Campinas, São Paulo 13083-862, Brazil.

Various agents for cross-linking have been investigated for stabilizing and controlling the barrier properties of microparticles for enteric applications. Transglutaminase, in addition to being commercially available for human consumption, presents inferior cross-linking action compared to glutaraldehyde. In this study, the intensity of this enzymatic cross-linking was investigated in microparticles obtained by complex coacervation between gelatin and gum Arabic. The effectiveness of cross-linking in these microparticles was evaluated based on swelling, release of a model substance (parika oleoresin: colored and hydrophobic) and gastrointestinal assays. The cross-linked microparticles remained intact under gastric conditions, whereas the uncross-linked microparticles have been dissolved. However, all of the microparticles have been dissolved under intestinal conditions. The amount of oily core that was released decreased as the amount of transglutaminase increased. For the most efficient microparticles (50U/g of protein), the performance was improved by increasing the pH of cross-linking from 4.0 to 6.0, resulting in a release of 17.1% rather than 32.3% of the core material. These results were considerably closer to the 10.3% of core material released by glutaraldehyde-cross-linked microparticles (1mM/g of protein).
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http://dx.doi.org/10.1016/j.foodres.2016.02.020DOI Listing
October 2016

Encapsulated thyme (Thymus vulgaris) essential oil used as a natural preservative in bakery product.

Food Res Int 2017 06 4;96:154-160. Epub 2017 Mar 4.

Department of Food Engineering, School of Food Engineering, UNICAMP, Campinas, São Paulo 13083-862, Brazil. Electronic address:

The objective of this work was to design a particle using thyme (Thymus vulgaris) essential oil through complex coacervation. In vitro activity against bacteria and molds of free oil as well as the encapsulated oil was verified and then in situ assay was done. The free thyme oil presented high in vitro activity, with values below 0.50mg/mL for almost all the microorganisms tested. Also, MIC values for the encapsulated oil was lower than for the free oil, probably due to the protective micro-environment promoted by the particle wall. The microparticles applied to cakes samples conferred protection against the volatilization of the encapsulated oil and promoted a minimum shelf life of 30days without the use of synthetic preservatives.
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http://dx.doi.org/10.1016/j.foodres.2017.03.006DOI Listing
June 2017
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