ABSTRACT Patient and Public Involvement (PPI) in research should focus on the engagement of patients/carers in every stage of the research cycle. However, the inconsistent level of education and research experience may compromise this involvement and training and support are recommended. In Portugal, consistent training to empower patients in their health decisions, or to be involved in research is neither available nor adapted for the patients and public. Our main goal is to develop and deliver the first high-quality and comprehensive online educational programme for adult patients with asthma and their carers, based on patients’/carers’ needs and preferences. The project includes four tasks. In Task 1, we will identify and organise the most important topics on asthma and health research, based on the identification of educational needs of adult patients/carers with asthma and the expertise of asthma specialists, using Delphi methodology. In Task 2, we will design and implement a high-quality, free, online self-learning programme based on reliable sources of information and on patients’/carers’ preferences. In Task 3, we will assess its feasibility, satisfaction and impact. Finally, Task 4 will be centred on the management and dissemination. Patients and carers will be actively engaged in all stages of this project as co-researchers, including the writing of this protocol. By the end of this project, we expect to have implemented the first high-quality, free-of-charge, online self-learning programme on asthma and health research, adapted for adult patients with asthma and their carers. It will be available for all patients/carers not only from Portugal but also from all Lusophone countries. This programme will empower patients and carers to increase their knowledge about the disease, develop new skills and have the opportunity to learn about research. Ultimately, it will introduce the knowledge patients/carers need to represent themselves and influence health policies in Portugal successfully.

RESUMO O envolvimento dos doentes e cidadãos na investigação (PPI) deve ocorrer em todas as etapas do ciclo de investigação. No entanto, a inconsistência nos níveis educacionais e na experiência de investigação pode ser um entrave significativo de uma participação ativa. Assim, ações de formação e suporte são recomendadas. Em Portugal, não existe formação específica para capacitar os doentes nas suas decisões de saúde, ou para se envolverem em investigação. O objetivo principal é desenvolver e tornar acessível o primeiro programa educacional online de elevada qualidade para doentes adultos com asma e seus cuidadores, com base nas suas necessidades e preferências. O projeto inclui 4 tarefas. Na tarefa 1 iremos identificar os tópicos mais importantes na área da asma e investigação em saúde, a partir da identificação das necessidades educacionais de doentes/cuidadores e da experiência de especialistas em asma, usando o método Delphi. Na tarefa 2 pretendemos desenhar e implementar um programa de elevada qualidade, gratuito e online, baseado em fontes de informação fiáveis e nas preferências de doentes/cuidadores. Na tarefa 3 vamos disseminar o programa e avaliar a sua exequibilidade, aceitabilidade e impacto. A tarefa 4 irá incidir na gestão e disseminação do projeto. Doentes e cuidadores estarão ativamente envolvidos em todas as tarefas do projeto como coinvestigadores, onde se inclui a escrita deste protocolo. No final deste projeto, esperamos ter implementado o primeiro programa de auto-aprendizagem de elevada qualidade, gratuito e online para a asma e investigação em saúde, adaptado para doentes/cuidadores com asma. Este programa irá capacitar doentes e cuidadores para aumentar o seu conhecimento sobre a doença, para desenvolver novas competências, e será uma oportunidade para aprenderem sobre investigação. Este programa permitirá também a introdução a conhecimentos necessários para doentes e cuidadores se fazerem representar e influenciarem as políticas em saúde em Portugal.

ABSTRACT Introduction: Systemic Mastocytosis comprises a group of neoplastic diseases characterized by clonal expansion and infiltration of mast cells into several organs. The diagnosis and treatment of this disease may be challenging for non-specialists. Objective: Make suggestions or recommendations in Systemic Mastocytosis based in a panel of Brazilian specialists. Method and results: An online expert panel with 18 multidisciplinary specialists was convened to propose recommendations on the diagnosis and treatment of Systemic Mastocytosis in Brazil. Recommendations were based on discussions of topics and multiple-choice questions and were graded using the Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence Chart. Conclusion: Twenty-two recommendations or suggestions were proposed based on a literature review and graded according to the findings.

Nos quatro meses desde a emergência duma infeção pandémica por uma nova estirpe altamente patogénica de coronavírus beta em humanos, a COVID-19, assistimos a uma rápida partilha nas plataformas digitais das mais diversas publicações científicas, numa experiência que se vive também pela primeira vez na comunidade internacional. Neste trabalho, fazemos uma revisão descritiva das mais recentes informações sobre a imunobiologia do SARS-CoV-2, focando as hipóteses que suportam uma deficiência nos mecanismos da imunidade inata e adquirida ao vírus, e o contributo de uma resposta imunitária disfuncional na progressão e mortalidade associadas à doença. Com base nessa nova informação, apontamos as principais estratégias imunológicas nas terapêuticas dirigidas ao vírus, à resposta imune disfuncional e à profilaxia da infeção (imunização). O aprofundar do conhecimento sobre as interações patogénio-hospedeiro, abrirá o caminho para identificar as melhores estratégias para o diagnóstico, terapêutica e controlo da COVID-19, bem como para a sua prevenção.

In the last four months, since the emergence of a pandemic infection by a new highly pathogenic strain of beta coronavirus in humans, COVID-19, we have witnessed the fast sharing on digital platforms of the most diverse scientific publications, an experience also lived for the first time by the international medical community. In this review of the latest information on SARS-COV-2 immunobiology, we focused on the hypotheses that support a defective innate and acquired immunity to the virus, and the contribution of a dysfunctional immune response for the progression and mortality associated with the disease. Based on this new information, we point out the main immunotherapy strategies targeting the virus, the dysfunctional immune response and the disease prophylaxis (immunization). Improving our knowledge on the pathogen-host interactions will open the way to identify the best strategies for the diagnosis, treatment and control of COVID-19, as well as to the best preventive measures

INTRODUÇÃO: A asma é considerada a doença crônica mais comum na infância. Entretanto, há poucos estudos sobre sua prevalência em nosso meio. OBJETIVO: Avaliar prevalência e gravidade de sintomas de asma em escolares e adolescentes de Duque de Caxias (RJ). MÉTODO: Estudo transversal utilizando o questionário do International Study of Asthma and Allergies in Childhood. A amostra foi composta por alunos de 6, 7, 13 e 14 anos. RESULTADOS: Foram avaliados 4.040 alunos de 13 e 14 anos e 2.334 de 6 e 7 anos. A freqüência de sibilos nos últimos doze meses foi de 27,7% entre os mais jovens e de 19% entre os adolescentes (p < 0,0001). No primeiro grupo houve predomínio do sexo masculino (29,9% vs 25,6%, p = 0,01) e no segundo do feminino (21,9% vs 15,8%, p < 0,0001). Não existiram diferenças entre as faixas etárias relacionadas ao diagnóstico prévio de asma (cerca de 10%). Sibilância aos exercícios físicos foi mais prevalente entre os adolescentes (21,4% vs 7,8%, p < 0,0001). A gravidade dos sintomas foi maior entre as adolescentes (asma grave: 6,6% vs 4,4%, p = 0,001), não havendo diferenças entre gêneros aos 6 e 7 anos. CONCLUSÃO: A prevalência de asma em Duque de Caxias é alta, comparável à de outros municípios brasileiros e latino-americanos. Os valores são superiores aos 6 e 7 anos, quando os sintomas predominam no sexo masculino. Entre os adolescentes, a prevalência e a gravidade dos sintomas são maiores no gênero feminino, fato de observação recente e que parece representar novo comportamento epidemiológico da asma.

BACKGROUND: Asthma is considered the most common chronic childhood disease. However, there have been few studies on the prevalence of asthma in Brazil. OBJECTIVE: To assess the prevalence and severity of asthma symptoms in school-age children and adolescents living in the city of Duque de Caxias, located in the greater metropolitan area of Rio de Janeiro. METHOD: Cross-sectional transversal study using the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. The sample comprised students of 6, 7, 13 and 14 years of age. RESULTS: One group of 2334 students between the ages of 6 and 7 and another composed of 4040 students between the ages of 13 and 14 were evaluated. The prevalence of wheezing within the last 12 months in the younger children was 27.7%, vs. 19% among the adolescents (p < 0.0001). There was a predominance of males in the 6-7 age group (29.9% vs. 25.6%; p = 0.01) and of females in the 13-14 age group (21.9% vs. 15.8%; p < 0.0001). The proportion of previously diagnosed cases of asthma was similar (approximately 10%) for both age brackets. Wheezing upon physical exertion was more prevalent among the adolescents (21.4% vs. 7.8%; p < 0.0001). Symptom severity was higher among female adolescents (severe asthma: 6.6% vs. 4.4%; p = 0.001), although no differences among genders were seen in the 6-7 age group. CONCLUSION: Asthma prevalence in Duque de Caxias is high, as it is in other Brazilian and Latin American cities. Values are higher in the 6-7 age group, in which symptoms were seen predominantly in males. Among the adolescents, the prevalence and severity of symptoms were higher in females, a recent observation that seems to be a new epidemiological trend of asthma.

OBJECTIVE - To assess the incidence of fatal pulmonary embolism (FPE), the accuracy of clinical diagnosis, and the profile of patients who suffered an FPE in a tertiary University Hospital. METHODS - Analysis of the records of 3,890 autopsies performed at the Department of General Pathology from January 1980 to December 1990. RESULTS - Among the 3,980 autopsies, 109 were cases of clinically suspected FPE; of these, 28 cases of FPE were confirmed. FPE accounted for 114 deaths, with clinical suspicion in 28 cases. The incidence of FPE was 2.86%. No difference in sex distribution was noted. Patients in the 6th decade of life were most affected. The following conditions were more commonly related to FPE: neoplasias (20%) and heart failure (18.5%). The conditions most commonly misdiagnosed as FPE were pulmonary edema (16%), pneumonia (15%) and myocardial infarction (10%). The clinical diagnosis of FPE showed a sensitivity of 25.6%, a specificity of 97.9%, and an accuracy of 95.6%. CONCLUSION - The diagnosis of pulmonary embolism made on clinical grounds still has considerable limitations.