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- Alterações morfométricas na retina, coroide e nervo ótico após infeção por SARS-CoV-2Publication . Lino, Pedro; Camacho, Pedro; Mendonça, Paula; Silva, Carina; Cunha, João Paulo; Barroqueiro, Olga; Condado, P.; Nicho, I.; Carmo, R.; Castelhano, M.; Carvalho, F.; Almeida, J. C.; Prieto, I.; Poças, Ilda MariaO novo coronavírus responsável pela síndrome respiratória aguda grave (SARS-CoV- 2) surgiu associado à pandemia por COVID-19. A enzima conversora da angiotensina 2 (ACE-2), com aparente importância na COVID-19, pela interação com as proteínas na superfície do vírus, tem expressão em vários tecidos oculares e várias alterações como conjuntivite, uveíte, vasculite e neurite foram descritas inicialmente em modelos animais. Em estudos mais recentes, embora na maioria em doentes COVID-19 moderados/grave, tem sido descrito o comprometimento da superfície ocular anterior e do polo posterior reforçando a ideia de neurotropismo (pela facilidade de envolvimento do sistema nervoso central) que classicamente é descrito em outros coronavirus. Algumas alterações do polo posterior incluem o compromisso vascular/ isquémico tornando relevante também a observação da coroide. A SARS-CoV-2 tem sido associada à diminuição das camadas internas da retina e à presença de lesões hiperrefletivas, micro-hemorragias e manchas algodonosas. No entanto, o envolvimento da retina e a coróide em doentes previamente infetados com COVID-19 ainda não é totalmente compreendido. De forma a clarificar o envolvimento dos fatores de neuro-degeneração e vasculares, descritos em indivíduos recuperados de COVID-19 moderada/grave, é fundamental perceber que alterações existem ao nível da retina interna e da coroide, em indivíduos recuperados de COVID-19 ligeira. Questão de investigação: Existem alterações morfométricas da retina, coroide e nervo ótivo em indivíduos recuperados de COVID-19 ligeira?
- Prevalência de fibrilhação auricular na Província do Bengo, Angola: resultados de um estudo de base populacionalPublication . Gonçalves, Mauer A. A.; Pedro, João Mário; Silva, Carina; Magalhães, Pedro; Brito, MiguelIntrodução: A fibrilhação auricular é a arritmia sustentada mais comum na população adulta com significado clínico, representando um importante problema de saúde pública. Não existe na literatura dados publicados acerca da prevalência da fibrilhação auricular em Angola. Objetivo: O presente estudo foi realizado com o objetivo de determinar a prevalência de fibrilhação auricular numa população do Bengo, uma província do norte de Angola, estratificada por sexo e idade e análise da sua relação com alguns fatores de risco cardiovascular. Materiais e Métodos: Os dados são provenientes do estudo CardioBengo, um estudo transversal de base comunitária, do qual foi selecionada uma amostra aleatória de indivíduos com idades compreendidas entre os 15 e os 84 anos. No total foram incluídos 2 379 indivíduos na análise final. Resultados: A idade média dos participantes foi de 35 anos e 63% da amostra era do sexo feminino. Verificou-se que a frequência de consumo de álcool era de 35,8%, a prevalência de acidente vascular isquémico ou acidente isquémico transitório foi de 0,4%; insuficiência cardíaca congestiva, 0,3%; doença cardíaca isquémica, 0,3% e hipertrofia ventricular esquerda, 37,2%. A fibrilhação auricular foi identificada em dois indivíduos, o que representa uma prevalência de 0,084%. Conclusão: O nosso estudo mostra uma baixa prevalência de fibrilhação auricular, quando comparada com as encontradas em estudos realizados em países desenvolvidos, mas semelhante à encontrada em estudos da África Subsariana.
- Perceptions of online teaching in the academic community at a higher education health institutionPublication . Poças, Ilda Maria; Grilo, Ana; Silva, Carina; Homem, Ana; Rodrigues, Carolina; Francisco, Inês; Nogueira, PatríciaPurpose: Faced with the COVID-19 pandemic situation, higher education institutions needed to adapt, moving from face-to-face teaching to distance learning online. The aim is to analyze the perception of the academic community in a higher education health institution (students' and lecturers' perception; and lecturers' perception of students) in the face of transition, emotional states, and visual changes.
- Ocular repercussions in COVID-19 patients: structural changes of the retina and choroidPublication . Poças, Ilda Maria; Cunha, João Paulo; Camacho, Pedro; Silva, Carina; Ribeiro, Edna; Brito, Miguel; Mendonça, Paula; Barroqueiro, Olga; Lino, Pedro Miguel; Condado, Patrícia; Nicho, Inês; Carmo, Rita; Castelhano, Mariana; Carvalho, Francisca; Almeida, Júlio Costa; Prieto, IsabelPurpose: In March 2022, after 1 year of the emergence of the pandemic by Covid-10 in Portugal, 3413013 positive cases were recorded. The eye can be not only the gateway for coronaviruses (CoV) but also one of their target organs. Conjunctivitis, uveitis, vasculitis, retinitis, and optic neuritis have been documented in animal models. Although most studies focus on respiratory tract involvement, ocular surface involvement such as tears are also reported in other CoVs and their relationship should be valued and studied as a form of treatment, contagion, and transmission. Also, the neurotropism of CoVs, not only through hematogenous dissemination but also through the retrograde neuronal route, associated or not with vascular/ischemic compromise of COVID-19 and its brain sequela may justify the use of non-invasive methodologies to characterize the retina and choroid of patients infected with COVID-19. The possible neurodegeneration associated with the coronavirus will be important to assess the thickness of the innermost layers of the upper hemiretin, with involvement described in other neurodegenerative diseases.
- Are genetic modifiers the answer to different responses to hydroxyurea treatment? A pharmacogenetic study in sickle cell anemia Angolan childrenPublication . Ginete, Catarina; Delgadinho, Mariana; Santos, Brígida; Pinto, Vera; Silva, Carina; Miranda, Armandina; Brito, MiguelSickle cell anemia (SCA) is an inherited disease affecting the hemoglobin that is particularly common in sub-Saharan Africa. Although monogenic, phenotypes are markedly heterogeneous in terms of severity and life span. Hydroxyurea is still the most common treatment for these patients, and the response to treatment is highly variable and seems to be an inherited trait. Therefore, identifying the variants that might predict hydroxyurea response is important for identifying patients who will have a poorer or non-response to treatment, and the ones that are more prone to suffer from severe side effects. In the present pharmacogenetic study, we analyzed the exons of 77 genes described in the literature as potentially associated with hydroxyurea metabolism in Angolan children treated with hydroxyurea and evaluated the drug response considering fetal hemoglobin levels, other hematological and biochemical parameters, hemolysis, number of vaso-occlusive crises and hospitalizations. Thirty variants were identified in 18 of those genes as possibly associated with drug response, five of them in gene DCHS2. Other polymorphisms in this gene were also associated with hematological, biochemical, and clinical parameters. Further research examining the maximum tolerated dose and fixed-dose with a larger sample size is necessary to corroborate these findings.
- Glucose homeostasis in obese women is not associated to unacylated ghrelin plasma levelsPublication . Veiga, Luisa; Brito, Miguel; Silva, Carina; Silva-Nunes, JoséIntroduction: Unacylated ghrelin (UAG) is the major form of circulating ghrelin. Initially considered as a nonfunctional peptide, soon after, UAG has been associated with an insulin-sensitizing action and to negative action on energy balance. The aim of this study was to analyze the association between the serum levels of UAG and glucose metabolism parameters in obese women, independently from the eventual influence of anthropometrics. Methods: One hundred lean and 254 obese Caucasian women were studied. Each woman was characterized by anthropometrics, fasting glucose, insulin, HbA1c, and UAG. In addition, obese women were subjected to a classic oral glucose tolerance test (oGTT) to assess glucose and insulin at 120 minutes. Insulin resistance was assessed by the homeostasis model assessment (HOMA-IR). Obese women were classified into three glycemic status subgroups (normoglycemia, prediabetes, and diabetes) according to HbA1c and fasting, and oGTT glucose values. Results: In comparison with the lean group, significantly lower levels of UAG were observed in obese women. However, no significant difference was observed through obesity classes I to III. UAG levels were not significantly different among glycemic status subgroups and did not show any association with glucose, insulin, HOMA-IR, or HbA1c. Conclusions: Although anthropometry can influence the level of the unacylated form of ghrelin, UAG plasma levels do not associate with glucose homeostasis parameters.
- Determinants influencing distance learning at health technology higher education institutions in PortugalPublication . Teresa Ribeiro, Ricardo; Cunha, Gilda; Silva, Carina; Medeiros, Nuno; Viegas, Cláudia; Borges-Ferro, A; Poças, Ilda Maria; Raposo, Hélder António; Eiras, MargaridaIntroducing distance learning within higher education institutions (HEIs) is a key societal issue, especially in the health sector, due to its in vivo learning nature. Public policies play an important role in these digital environments. This study aims to identify the determinants influencing national public policies that foster digital learning transformation in Health HEIs in Portugal. A prospective survey, using the structural analysis of Godet’s method, is conducted, and data are gathered from different health sector stakeholders. Despite the efforts to increase digital literacy and funding for digital learning in HEIs, a weak strategy and implementation of a national plan for distance learning in Health HEIs are still prevalent. The driver to success is grounded on national and international cooperation between health professionals, hospitals, and HEIs through transferability processes of innovative practices.
- Normal limits of the electrocardiogram in AngolansPublication . Gonçalves, Mauer; Pedro, João Mário; Silva, Carina; Magalhães, Pedro; Brito, MiguelIntroduction: Studies on the normal electrocardiogram limits in African populations are limited, especially in sub-Saharan Africa. There is no literature describing normal ECG limits in Angolans. Objectives: The aim of this study is to establish the normal ECG limits for adult Angolans, without established heart disease, stratified by gender and age. Methods: A cross-sectional study was performed, involving 2179 participants from a population in northern Angola, without established heart disease, aged between 15 and 74 years. A 12‑lead ECG and a rhythm strip were recorded for all participants and analyzed and processed by the University of Glasgow software and encoded by the Minnesota Code. The normal range of the electrocardiographic parameters was established as the 2nd and 98th percentiles of the measurement distribution per age group and gender. Mann-Whitney and Kruskal-Wallis tests were used for two independent groups and Bonferroni adjustments were used for multiple testing. GAMLSS models were used to obtain the continuous age-dependent percentile curves. Results: The normal range of the ECG differed between men and women: heart rate 49 to 100 bpm vs. 55 to 108 bpm, P wave duration 81 to 130 ms vs. 84 to 130 ms, PR interval 119 to 210 ms vs. 120 to 202 ms, QRS duration 74 to 110 ms vs. 70 to 104 ms, QT interval 324 to 441 ms vs. 314 and 438 ms, P-wave axis − 29 to 850 vs. -18 to 810, QRS-wave axis − 13 to 850 vs. -180 and 820, T-wave axis 0 to 720 vs. -8 to 730, Sokolow-Lyon index 2.13 to 6.21 mV vs. 1.60 to 4.87 mV, Cornell index 0.17 to 6.24 mV vs. 0.14 mV to 4.35 mV. Conclusions: The values described for the electrocardiographic measurements above can act as a reference framework for Angolan adults without established heart disease. Our study suggests that the normal range of most ECG parameters varies according to age and sex and the ECG diagnostic criteria must therefore be specific for these demographic measures.
- Patient safety culture in Portuguese dentistry: instrument validity and reliabilityPublication . Figueira, Catarina; Bizarra, Fátima; Eiras, Margarida; Silva, CarinaObjetivos: Este estudo teve como objetivo adaptar, validar e analisar a fiabilidade do Medical Office Survey on Patient Safety Culture (MOSPSC) para os cuidados de medicina dentária em Portugal. Métodos: A versão portuguesa do MOSPSC, da Agency for Healthcare Research and Quality (AHRQ), foi adaptada para os cuidados de medicina dentária em Portugal. Seis especialistas foram responsáveis pela análise semântica e validade de conteúdo. Para a análise de fiabilidade foi calculado o alfa de Cronbach e a average inter-item correlation (AIIC). A análise fatorial confirmatória (AFC) avaliou a qualidade do ajustamento do modelo associado ao modelo teórico proposto pela AHRQ. Os testes de ajustamento utilizados foram o quociente entre o qui-quadrado e o número de graus de liberdade (χ2/df), o índice goodness-of-fit (GFI), o índice comparative fit (CFI), o índice Tucker-Lewis (TLI), o parsimony GFI e o índice root mean square error of approximation (RMSEA). Resultados: Na amostra inicial procedeu-se à análise de valores omissos, resultando numa amostra final de 143 participantes. O modelo proposto pela AFC correspondeu à junção de dois pares de dimensões (dimensões “comunicação acerca do erro” e “abertura na comunicação”; “processos e padronização” e “pressão e ritmo de trabalho”). O modelo proposto obteve uma boa consistência global (alfa de Cronbach α=0,93; AIIC=0,27) e um ajustamento global moderado face à amostra em estudo (χ2/df=5,63; GFI=0,90; CFI=0,90; TLI=0,88; PGFI=0,67; RMSEA=0,18; p<0,001; IC de 90% RMSEA [0,175;0,186]). Conclusões: A estrutura do modelo proposto resultou em oito dimensões, que obtiveram uma boa fiabilidade e uma validade de constructo moderada.
- An integrated cybernetic awareness strategy to assess cybersecurity attitudes and behaviours in school contextPublication . Antunes, Mário; Silva, Carina; Marques, FredericoDigital exposure to the Internet among the younger generations, notwithstanding their digital abilities, has increased and raised the alarm regarding the need to intensify the education on cybersecurity in schools. Understanding the human factor and its influence on children, namely their attitudes and behaviors online, is pivotal to reinforce their awareness towards cyberattacks and to promote their digital citizenship. This paper aims to present an integrated cybersecurity and cyber awareness strategy composed of three major steps: (1) Cybersecurity attitude and behavior assessment, (2) self-diagnosis, and (3) teaching/learning activities. The following contributions are made: Two questionnaires to assess risky attitudes and behaviors regarding cybersecurity; a self-diagnosis to measure students’ skills on cybersecurity; a lesson plan addressing cyber awareness to be applied on Information and Communications Technology (ICT) and citizenship education curricular units. Cybersecurity risky attitudes and behaviors were evaluated in a junior high school population of 164 students attending the sixth and ninth grades. The assessment focused on two main subjects: To identify the attitudes and behaviors that raise the risk of cybersecurity among the participating students; to characterize the acquired students’ cybersecurity and cyber awareness skills. Global and individual scores and the histograms for attitudes and behaviors are presented. The items in which we have observed significant differences between sixth and ninth grades are depicted and quantified by their corresponding p-values obtained through the Mann–Whitney non-parametric test. Regarding the results obtained on the assessment of attitudes and behaviors, although positive, we observed that the attitudes and behaviors in ninth-grade students are globally inferior compared to those attained by sixth-grade students. The deployed strategy for cyber awareness was applied in a school context; however, the same approach is suitable to be applied in other types of organizations, namely enterprises, healthcare institutions, and the public sector.