The End-Organ Impairment in Liver Cirrhosis: Appointments for Critical Care

Liver cirrhosis (LC) can lead to a clinical state of liver failure, which can exacerbate through the course of the disease. New therapies aimed to control the diverse etiologies are now more effective, although the disease may result in advanced stages of liver failure, where liver transplantation (LT) remains the most effective treatment. The extended lifespan of these patients and the extended possibilities of liver support devices make their admission to an intensive care unit (ICU) more probable. In this paper the LC is approached from the point of view of the pathophysiological alterations present in LC patients previous to ICU admission, particularly cardiovascular, but also renal, coagulopathic, and encephalopathic. Infections and available liver detoxifications devices also deserve mentioning. We intend to contribute towards ICU physician readiness to the care for this particular type of patients, possibly in dedicated ICUs.

DIFFERENTIATION BETWEEN Nocardia spp. AND Mycobacterium spp.: CRITICAL ASPECTS FOR BACTERIOLOGICAL DIAGNOSIS

New methodologies were developed for the identification of Nocardia but the initial diagnosis still requires a fast and accurate method, mainly due to the similarity to Mycobacterium, both clinical and bacteriologically. Growth on Löwenstein-Jensen (LJ) medium, presence of acid-fast bacilli through Ziehl-Neelsen staining, and colony morphology can be confusing aspects between Nocardia and Mycobacterium. This study describes the occurrence of Nocardia spp. in a mycobacterial-reference laboratory, observing the main difficulties in differentiating Nocardia spp. from Mycobacterium spp., and correlating isolates with nocardiosis cases. Laboratory records for the period between 2008 and 2012 were analyzed, and the isolates identified as Nocardia sp. or as non-acid-fast filamentous bacilli were selected. Epidemiological and bacteriological data were analyzed as well. Thirty-three isolates identified as Nocardia sp. and 22 as non-acid-fast bacilli were selected for this study, and represented 0.12% of isolates during the study period. The presumptive identification was based on macroscopic and microscopic morphology, resistance to lysozyme and restriction profiles using the PRA-hsp65 method. Nocardia spp. can grow on media for mycobacteria isolation (LJ and BBL MGIT™) and microscopy and colony morphology are very similar to some mycobacteria species. Seventeen patients (54.8%) were reported and treated for tuberculosis, but presented signs and symptoms of nocardiosis. It was concluded that the occurrence of Nocardia sp. during the study period was 0.12%. Isolates with characteristics of filamentous bacilli, forming aerial hyphae, with colonies that may be pigmented, rough and without the BstEII digestion pattern in PRA-hsp65 method are suggestive of Nocardia spp. For a mycobacterial routine laboratory, a flow for the presumptive identification of Nocardia is essential, allowing the use of more accurate techniques for the correct identification, proper treatment and better quality of life for patients.

Relatório de estágio em ensino do 1.º ciclo do ensino básico

Relatório EPE - Relatório de estágio em Educação Pré-Escolar: O trabalho realizado no relatório de estágio tem como propósito a reflexão e análise crítica de todo o processo desenvolvido no contexto de educação pré-escolar, no âmbito da Unidade Curricular (UC) de Prática Pedagógica Supervisionada, Ao longo do presente relatório será mobilizado o quadro teórico e conceptual da formanda que sustentou e orientou as práticas desenvolvidas no decorrer do período de estágio, evocando autores conceituados como Piaget, Vygotsky, Oliveira-Formosinho, Zabalza, Roldão, entre muitos outros. Deste modo, será mencionado o papel da criança bem como a natureza do seu processo de desenvolvimento e de construção, evidenciando o seu papel ativo, participativo e construtivo. Também, será referida a importância do papel do Educador de infância, bem como os princípios deontológicos que o orientam na sua construção profissional e pessoal. Torna-se, também, fundamental referir os referenciais legais que norteiam a Educação Pré-Escolar referindo a sua importância no desenvolvimento das crianças, assim como os modelos curriculares e pedagógicos que orientam a práxis pedagógica, permitindo a construção de práticas fundamentadas e conscientes. Para isso é, também, imprescindível adotar uma atitude indagadora de caráter investigativo, crítico e reflexivo, permitindo responder de forma adequada às necessidades individuais de cada criança, numa perspetiva diferenciada e individualizada, mas também global. Neste sentido, ao longo de todo o período de estágio, foi adotada, a metodologia de investigação-ação, denotando a importância dos momentos de observação, planificação, ação e reflexão. Só desta forma foi possível compreender a realidade, de modo a transformá-la com o intuito de melhorar a qualidade da Educação

Relatório de estágio em Ensino do 1.º Ciclo do Ensino Básico

Relatório EPE - Relatório de estágio em Educação Pré-Escolar: O presente relatório foi realizado no âmbito da unidade curricular Prática Pedagógica Supervisionada, inserida no Mestrado em Educação Pré-Escolar e Ensino do 1.º Ciclo do Ensino Básico, da Escola Superior de Educação do Porto, durante o ano letivo 2013/2014, atribuindo qualificação profissional no contexto de pré-escolar. Este documento pretende descrever e analisar o percurso formativo desenvolvido pela mestranda ao longo da sua prática pedagógica supervisionada, numa perspetiva reflexiva sobre a construção dos saberes profissionais para a Educação. Este percurso formativo comprometeu uma atitude investigativa, bem como a mobilização de saberes científicos e legais por forma a articular as vertentes de teoria e prática, perspetivando uma construção integrada dos saberes. A prática pedagógica foi sustentada numa perspetiva construtivista, atribuindo um papel ativo à criança na construção das suas aprendizagens. Esta baseou-se num trabalho de equipa cooperativo, o qual se concretiza através do debate e da partilha de ideias, entre os vários intervenientes da ação, como meio para a transformação da realidade educativa. Ao longo da prática foi, ainda, atribuído um papel fundamental à observação do contexto, sendo esta essencial para a compreensão e conhecimento pleno da criança. Em suma, todo o percurso formativo no qual está englobado a prática pedagógica, levou a uma problematização das questões emergentes da prática, desenvolvendo uma atitude indagadora e reflexiva. Apesar da significante contribuição para a aquisição de competências pessoais e profissionais, o percurso formativo deve ser assumido como uma construção contínua, fundamentado num princípio da aprendizagem ao longo da vida.

Relatório de estágio

O presente relatório foi desenvolvido no âmbito de Prática Pedagógica Supervisionada no 1ºCiclo do Ensino Básico, Unidade Curricular do Mestrado em Educação Pré-Escolar e Ensino do 1ºCiclo do Ensino Básico, na Escola Superior de Educação do Instituto Politécnico do Porto. Assim sendo, diz respeito à intervenção da mestranda numa turma de 4ºano do 1ºCiclo do Ensino Básico, numa instituição de ensino público, na zona metropolitana do Porto. A Unidade Curricular em questão, de cariz teórico-prático, permitiu mobilizar pressupostos teóricos fundamentais para o desenvolvimento da prática pedagógica, dando a conhecer as competências desejáveis do profissional de ensino. A metodologia utilizada ao longo do percurso da mestranda assentou na vertente da investigação e ação, pelo que envolve um conjunto de etapas que permitem a melhoria das práticas e, consequentemente, do desenvolvimento profissional e da aprendizagem dos alunos. O relatório espelha todo o processo formativo, destacando conceções teóricas e legais e o contexto da prática, evidenciando, de forma crítica e reflexiva, momentos do estágio que marcaram o desenvolvimento profissional e pessoal da futura professora. Destaca-se a valorização do aluno como indivíduo único, repleto de características que o caracterizam, bem como do processo de ensino-aprendizagem, pelo que se utilizaram metodologias socioconstrutivistas e recursos diversificados com vista à aprendizagem de sucesso. Deste modo, realça-se que este mestrado contribuiu para o desenvolvimento de competências essenciais no que concerne à profissão docente, sendo que a vivência de situações concretas permitiram a construção fundamentada do pensamento crítico e de um conjunto de saberes científicos, pedagógicos e didáticos da mestranda.

A Comparative Study of Cardiovascular Tolerability with Slow Extended Dialysis Versus Continuous Haemodiafiltration in the Critical Patient

Background: In the haemodynamically unstable patient the method of treatment of acute renal failure is still largely controversial. The purpose of our study was to compare slow extended dialysis with continuous haemodiafiltration in the critical patient with indication for renal replacement therapy and haemodynamic instability. Patients and Methods: This is a cohort study comparing in 63 ventilated critical patients a 12 month period when only continuous haemodiafiltration was used (n=25) with an equal period of slow extended dialysis (n=38). Our primary objective was to evaluate the impact of the dialytic procedure on cardiovascular stability in those patients. As secondary aims we considered system coagulation/thrombosis and predictors of mortality. In the two groups we analysed the first session performed, the second session performed and the average of all the sessions performed in each patient. Results: In these patients, mortality in the intensive care unit was high (68% in the continuous haemodiafiltration group and 63% in the slow extended dialysis group). We did not find any association between the dialytic technique used and death; only the APACHE score was a predictor of death. Slow extended dialysis was a predictor of haemodynamic stability, a negative predictor of sessions that had to be interrupted for haemodynamic instability, and a predictor of achieving the volume removal initially sought. Slow extended dialysis was also associated with less coagulation of the system. Conclusions: Our data suggested that slow extended dialysis use was not inferior to continuous haemodiafiltration use in terms of cardiovascular tolerability.

Acute Otitis Media a Reliable Warning Sign for Primary Immunodeficiencies?- A Critical Appraisal

Acute otitis media (AOM) is the most common infection in childhood, resulting from both anatomic and immunologic specificities of this age group. Recurrent AOM has been defined as one of the warning signs for primary immunodeficiencies (PID), In this study we evaluated the strength of recurrent AOM as clinical predictor of PID. Methods: Retrospective study (August 2010 - December 2013) which included all patients referred to PID appointment because of recurrent AOM (= 8 AOM episodes/year). Syndromic patients or those presenting with another warning sign for PID were excluded. Clinical, demographic and laboratory results were analized and statistical analysis was made using SPSS 20. Results: Seventy-five patients were included (median age 37,8 months; 62,7% male gender), corresponding to 15% of all first appointments. Other comorbidities were present in 20% of the patients and 17% had ORL surgery prior to PID referral. In most patients, the immunologic screening consisted on the evaluation of humoral function, but in selected cases other studies were performed (namely complement and lymphocyte immunophenotyping). A PID was identified in 12 children (16,0%) and the majority of these patients had other distinctive feature (personal or familiar antecedent of infection or auto-immunity, 66,7%, p<0,05). Nine children (12,0%) underwent prophylactic cotrimoxazole. The average length of follow-up was 11,2 months. Conclusion: Despite being a very frequent cause of immunologic screening, in this study recurrent AOM was not found to be a good predictor of underlying PID, unless the patients presents other significant personal or family history.

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

Why management consultants? : Between functionalist and critical perspectives

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

The effectiveness of the Media Smart Program on promoting the critical thinking of children towards the use of celebrities in television advertising

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

How effective is dog culling in controlling zoonotic visceral leishmaniasis? a critical evaluation of the science, politics and ethics behind this public health policy

INTRODUCTION: Zoonotic kala-azar, a lethal disease caused by protozoa of the genus Leishmania is considered out of control in parts of the world, particularly in Brazil, where transmission has spread to cities throughout most of the territory and mortality presents an increasing trend. Although a highly debatable measure, the Brazilian government regularly culls seropositive dogs to control the disease. Since control is failing, critical analysis concerning the actions focused on the canine reservoir was conducted. METHODS: In a review of the literature, a historical perspective focusing mainly on comparisons between the successful Chinese and Soviet strategies and the Brazilian approach is presented. In addition, analyses of the principal studies regarding the role of dogs as risk factors to humans and of the main intervention studies regarding the efficacy of the dog killing strategy were undertaken. Brazilian political reaction to a recently published systematic review that concluded that the dog culling program lacked efficiency and its effect on public policy were also reviewed. RESULTS: No firm evidence of the risk conferred by the presence of dogs to humans was verified; on the contrary, a lack of scientific support for the policy of killing dogs was confirmed. A bias for distorting scientific data towards maintaining the policy of culling animals was observed. CONCLUSIONS: Since there is no evidence that dog culling diminishes visceral leishmaniasis transmission, it should be abandoned as a control measure. Ethical considerations have been raised regarding distorting scientific results and the killing of animals despite minimal or absent scientific evidence

Design, implementation, and performance of a distributed and scalable sensor system for critical distance measurements in the CMS detector at LHC

The “CMS Safety Closing Sensors System” (SCSS, or CSS for brevity) is a remote monitoring system design to control safety clearance and tight mechanical movements of parts of the CMS detector, especially during CMS assembly phases. We present the different systems that makes SCSS: its sensor technologies, the readout system, the data acquisition and control software. We also report on calibration and installation details, which determine the resolution and limits of the system. We present as well our experience from the operation of the system and the analysis of the data collected since 2008. Special emphasis is given to study positioning reproducibility during detector assembly and understanding how the magnetic fields influence the detector structure.

Cutaneous leishmaniasis in northeastern Brazil: a critical appraisal of studies conducted in State of Pernambuco

American cutaneous leishmaniasis (ACL) is a complex disease with clinical and epidemiological features that may vary from region to region. In fact, at least seven different Leishmania species, including Leishmania (Viannia) braziliensis, Leishmania (Viannia) guyanensis, Leishmania (Viannia) lainsoni, Leishmania (Viannia) naiffi, Leishmania (Viannia) shawi, Leishmania (Viannia) lindenbergi, and Leishmania (Leishmania) amazonensis, have been implicated in the etiology of ACL in Brazil, and numerous phlebotomine sandfly species of the genus Lutzomyia have been regarded as putative or proven vectors. Because ACL is a focal disease, understanding the disease dynamics at the local level is essential for the implementation of more effective control measures. The present paper is a narrative review about the ACL epidemiology in Pernambuco, northeastern Brazil. Furthermore, the need for more effective diagnosis, treatment, control and prevention strategies for the affected populations is highlighted. This paper will provide researchers with a critical appraisal of ACL in Pernambuco. Hopefully, it will also be helpful for public health authorities to improve current control strategies against ACL at the state and country levels.

Southern Modernisms. Critical Stances through Regional Appropriations. Conference proceedings

The hegemonic definition of Modernism has been subjected to an intense critical revision process that began several decades ago. This process has contributed to the significant broadening of the modernist canon by challenging its primal essentialist assumptions and formalist interpretations in the fields of both the visual arts and architecture. This conference aims to further expand this revision, as it seeks to discuss the notion of “Southern Modernisms” by considering the hypothesis that regional appropriations, both in Southern Europe and the Southern hemisphere, entailed important critical stances that have remained unseen or poorly explored by art and architectural historians. In association with the Southern Modernisms research project (FCT – EXPL/CPC-HAT/0191/2013), we want to consider the entrenchment of southern modernisms in popular culture (folk art and vernacular architecture) as anticipating some of the premises of what would later become known as critical regionalism. It is therefore our purpose to explore a research path that runs parallel to key claims on modernism’s intertwinement with bourgeois society and mass culture, by questioning the idea that an aesthetically significant regionalism – one that resists to the colonization of international styles and is supported by critical awareness – occurred only in the field of architecture, and can only be represented as a postmodernist turn. (...)

Gold nanoprobes for assessing expression of critical genes in the infection pathway of MRSA

Staphylococcus aureus is an important opportunistic pathogen that can cause a wide variety of diseases from mild to life-threatening conditions. S. aureus can colonize many parts of the human body but the anterior nares are the primary ecological niche. Its clinical importance is due to its ability to resist almost all classes of antibiotics available together with its large number of virulence factores. MRSA (Methicillin-Resistant S. aureus) strains are particularly important in the hospital settings, being the major cause of nosocomial infections worldwide. MRSA resistance to β-lactam antibiotics involves the acquisition of the exogenous mecA gene, part of the SCCmec cassette. Fast and reliable diagnostic techniques are needed to reduce the mortality and morbidity associated with MRSA infections, through the early identification of MRSA strains. The current identification techniques are time-consuming as they usually involves culturing steps, taking up to five days to determine the antibiotic resistance profile. Several amplification-based techniques have been developed to accelerate the diagnosis. The aim of this project was to develop an even faster methodology that bypasses the DNA amplification step. Gold-nanoprobes were developed and used to detect the presence of mecA gene in S. aureus genome, associated with resistance traits, for colorimetric assays based on non-crosslinking method. Our results showed that the mecA and mecA_V2 gold-nanoprobes were sensitive enough to discriminate the presence of mecA gene in PCR products and genomic DNA (gDNA) samples for target concentrations of 10 ng/μL and 20 ng/μL, respectively. As our main objective was to avoid the amplification step, we concluded that the best strategy for the early identification of MRSA infection relies on colorimetric assays based on non-crosslinking method with gDNA samples that can be extracted directly from blood samples.