Serratia marcescens bacteremia associated with schistosomiasis mansoni

The case of a 21 -year-old man coming from rural Paraíba, northeastern Brazil, with schistosomiasis mansoni associated with Serratia marcescens bacteremia, is reported. His main complaints on admission were fever, diaphoresis and chills for ten days, and diarrhoea that lasted for four days. On physical examination he hadjaundice and hepatosplenomegaly. Diagnosis of S. marcescens bacteremia was made by isolation of the bacterium in blood culture, and schistosomiasis was diagnosed by rectal and liver biopsies. This is the first time that the association of S. marcescens bacteremia and schistosomiasis mansoni is recognized. Although our case does not fit into the classic definition of prolonged bacteremia associated with schistosomiasis, it can be considered as a mild form of this association. With the improvement of medical assistance and laboratory facilities, early diagnosis of this association will be made more frequently, cases with short duration will be diagnosed few days after the start of the symptoms, and classic prolonged cases will become rarer.

Sintomas somatoformes em Medicina Geral e Familiar

RESUMO: Os doentes que vão à consulta com sintomas físicos para os quais o médico não encontra uma causa orgânica, são frequentes na Medicina Geral e Familiar, embora não sejam específicos, e são o objecto de estudo do presente trabalho. Não deixar uma doença por diagnosticar (erro de tipo II) sem contudo rotular pessoas saudáveis como doentes (erro de tipo I) é um dos mais difíceis problemas da prática clínica diária e para o qual não existe uma orientação infalível e não é previsível que alguma vez venha a existir. Mas se o diagnóstico de doença ou não-doença é difícil, o tratamento dos que não tem doença, embora com sofrimento, também não é mais fácil, sobretudo, se estivermos conscientes do sofrimento que determina a medicalização e a iatrogenia. O presente trabalho está estruturado em 3 partes. Na primeira parte descrevemos a nossa visão integrada do que apreendemos da leitura da literatura publicada e à qual tivemos acesso. À semelhança do que se verifica na maioria das áreas da Medicina esta é também uma em que o conhecimento cresce a ritmo exponencial. No entanto, à falta de conceitos precisos e de definições consensuais sucede um conhecimento, por vezes, pouco consistente, tanto mais que estamos na fronteira entre a cultura leiga e a cultura erudita médica em que os significados devem, a todo o momento, ser validados. Fizemos uma revisão sobre as definições do que está em questão, sobre o que se sabe sobre a frequência dos sintomas físicos na população, quantos recorrem aos serviços de saúde e o que lhes é feito. Passámos por uma revisão da fisiologia destes sintomas e algumas explicações fisiopatológicas para terminarmos sobre o que os doentes pensam sobre os seus sintomas e os cuidados que recebem e o que os profissionais pensam sobre estes doentes. Esta parte termina com uma revisão das propostas de abordagem para este tipo de doentes. Na segunda parte, descrevemos os estudos empíricos focados no problema dos pacientes com sintomas físicos mas sem evidência de doença orgânica. Começa por uma apresentação dos aspectos processuais e metodológicos dos estudos realizados, mais especificamente, de dois estudos quantitativos e um qualitativo. No primeiro estudo pretendeu-se avaliar quais são os sintomas físicos e a sua frequência na população em geral e a frequência de pacientes que procuram (ou não) os serviços de saúde tendo como motivo este tipo de sintomas. O objectivo deste estudo é contribuir para a demonstração que este tipo de sintomas faz parte da vida do dia-a-dia e que, na maioria das vezes, só por si não significa doença, sem contudo negar que representa sofrimento, por vezes até maior do que quando há patologia orgânica. Se no primeiro estudo era demonstrar que os sintomas físicos são frequentes na população, no segundo estudo o objectivo é demonstrar que pacientes com este tipo de sintomas são igualmente frequentes e que o tipo de sintomas apresentados na consulta não difere dos referidos pela população em geral. Pretendia-se ainda saber o que é feito ou proposto pelo médico a estes doentes e se estes doentes traziam ou não, junto com os sintomas, ideias explicativas para os mesmos. Finalmente e não menos importante, é avaliar o grau de fidedignidade do diagnóstico de sintoma somatoforme, chamando assim ao sintoma físico que foi “levado” à consulta e que o médico diagnosticou como não tendo causa orgânica. O terceiro estudo parte do conhecimento adquirido que a Medicina tem muitas respostas para este problema, mas poucas que se possam considerar satisfatórias se usadas isoladamente. Que a maioria das soluções é procurada entre a cultura médica e num paradigma reducionista de separação mente-corpo. Contudo, se o sintoma é “construído” pelo doente, se o principal problema não está no sintoma mas na forma como o paciente o vê, então pareceu-nos lógico que a solução também tem que passar por integrarmos no plano de abordagem o que o doente entende ser melhor para si. Nesta sequência, entrevistaram-se alguns doentes cujo diagnóstico de sintomas somatoformes estava demonstrado pelo teste do tempo. Por isso, entrevistaram-se doentes que já tinham ido à consulta de MGF há mais de 6 meses por sintomas somatoformes e, na data da entrevista, o diagnóstico se mantinha inalterado, independentemente da sua evolução. As entrevistas visaram conhecer as ideias dos doentes sobre o que as motivou a procurarem a consulta, o que pensavam da forma como foram cuidados e que ideias tinham sobre o que os profissionais de saúde devem fazer para os ajudar a restabelecer o equilíbrio com o seu ambiente evitando a medicalização, a iatrogenia e a evolução para a cronicidade. Na terceira parte, discutem-se e integram-se os resultados encontrados no conhecimento previamente existente. Tenta-se teorizar, fazer doutrina sobre o tema e contribuir para abordagens terapêuticas mais personalizadas, abrangentes, variadas e multimodais, baseadas sempre no método clínico centrado no paciente, ou de modo menos correcto mas enfático, baseadas no método centrado na relação. Apresentam-se algumas hipóteses de trabalhos futuros sobre o tema e, sobretudo, esperamos ter contribuído para o reconhecimento da necessidade de a comunicação médico-doente ser uma aprendizagem transversal a todos os profissionais de saúde e ao longo da vida, com a ideia que é sempre possível fazer melhor, caso contrário tenderemos, inexoravelmente, a fazer cada vez pior.-----------ABSTRACT: Patients who go to consultation with physical symptoms, for which the doctor does not find an organic cause, are the subject of the present study. They are common in family medicine, although not specific. Do not let an undiagnosed disease (type II error), but without labeling healthy people as patients with disease (type I error) is one of the most difficult problems in clinical practice and for which doesn’t exist an infallible guide and it is unlikely that any since coming into existence. But, if the diagnosis of disease or non-disease is difficult, the treatment of those who do not have the disease, though suffering, it is not easy, especially if we are aware of the suffering that medicalization and iatrogenic determines. This work is structured in three parts. In the first part we describe our integrated view of what we grasp from reading the published literature and to which we had access. Similar to that found in most areas of medicine, this is also one in which knowledge grows exponentially. However, the absence of precise concepts and consensual definitions determines an inconsistent knowledge, especially because we're on the border between secular culture and medical culture where, at all times, the meaning must be validated. We did a review on the definitions of what is at issue, what is known about the frequency of physical symptoms in the population, how many use the services of health and what they receive as care. We went through a review of the physiology of these symptoms and some pathophysiological explanations, to finish on what patients think about their symptoms and how they perceived the care they received and, finally, what professionals think about these patients. This part ends with a review of the approaches proposed for such patients. In the second part, we describe the empirical studies focused on the problem of patients with physical symptoms but no evidence of organic disease. Begins with a presentation of the procedural and methodological aspects of studies, more specifically, two quantitative and one qualitative. The first study sought to assess which are the physical symptoms, their incidence in the general population and the frequency they seek (or not) health services on behalf of those symptoms. The aim behind this study was to contribute to the demonstration that this type of symptoms is part of life's day-to-day and that, in most cases, does not represent disease by itself, without denying that they represent suffering, sometimes even greater than when there are organic disease. The first study endeavor to demonstrate that the physical symptoms are common in the population. The second study aspires to demonstrate that patients with such symptoms are also common and that the type of symptoms presented in the consultation does not differ from those in the general population. The aim was also to know what is done or proposed by the physician for these patients and if these patients brought or not, along with the symptoms, explanatory ideas for them. Finally and not least, it would try to assess the degree of reliability of diagnosis of somatoform symptoms, thus drawing the physical symptom that patient presents in the consultation and that the doctor diagnosed as having no organic cause. The third study starts from the acquired knowledge that medicine has many answers to this problem, but few can be considered satisfactory if used in isolation. The most solutions are sought in the medical culture and based on a reductionist paradigm of mind-body. However, if the symptom is "built" by the patient, if the main problem is not the symptom but the way the patient sees it, then it seemed logical to us that the solution must integrate the approaches that patients believes are best for them. Subsequently, a few patients, whose diagnosis of somatoform symptoms was demonstrated by the test of time, were interviewed. Therefore, patients who were interviewed had gone to the consultation of family medicine more than 6 months before for somatoform symptoms and. at the moment of the interview, the diagnosis remained unchanged, regardless of their evolution. The interviews aimed to ascertain the patients' ideas about what motivated them to seek consultation, what they thought about the care they got and which ideas they have about what health professionals should do to help these patients to re-establish equilibrium with its environment avoiding medicalization, iatrogenic effects and the evolution to chronicity. In the third section, we discuss and integrate the results found in previously existing knowledge. Attempts to theorize on the subject and contribute to more personalized treatment, comprehensive, varied and multi-modal approaches, always based on patient-centered clinical method, with emphasis on the relationship. We presents some hypotheses for future work on the subject and,above all, defend the recognition of the importance of lifelong learning communication skills for all health professionals, with the idea that we can always do better, otherwise we tend inexorably to do worse.

The influence of brick residues in the behaviour of lime mortars

XXXVI IAHS World Congress on Housing - National Housing Programs-New Visions, November 03–07, 2008, Kolkata, India

Earth mortars constructive use on Neolithic domestic structures. Some case studies in Alentejo.

HMC08 - 1st Historical Mortars Conference: Characterization, Diagnosis, Conservation, Repair and Compatibility, LNEC, Lisbon, 24-26 September 2008

Study on the valorization routes of ashes from thermoelectric power plants working under mono-and co-combustion regimes

Thesis submitted to obtain the Doctoral degree in Energy and Bioenergy

Fast screening for diagnostic of heart ischemic episodes

Dissertação para obtenção do Grau de Doutor em Química Sustentável

How to potentiate the business model of Mobitto for B2B?

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

Integrated approach to assess vulnerability of the Coastal Region of Bangladesh due to climate change

Dissertation submitted in partial fulfillment of the requirements for the Degree of Master of Science in Geospatial Technologies.

Suicide study : a psychological autopsy

RESUMO: O'suicídio'é'atualmente'um'problema'de'saúde'pública.'Estimarse'que'um'milhão'de'pessoas' morra'anualmente'devido'ao'suicídio.'De'acordo'com'diversas'agências'e'organizações'estimar 'que'ocorram'entre'20'a'40'tentativas'de'suicídio'por'cada'suicídio'consumado.'Os'custos'associados'ao'suicídio,'quer'humanos'quer'económicos'são'enormes'e'estendemrse'à'família,'emprego,'economia'e'finanças.'Os'números'oficiais'do'suicídio'em'Portugal'indicam'uma'taxa ligeiramente'acima'dos'10'por' cada'100'000'habitantes'mas' comportando' regiões'onde' são'observadas' taxas' muito' elevadas,' como' no' Sudoeste' de' Portugal' onde' se' observam particularmente taxas 3'vezes'acima'da'média'nacional.' Investigámos' o' fenómeno' com' os' objetivos' de' validar' a' técnica' de' autópsia' psicológica' em' contexto' comunitário' nunca' realizado' em' Portugal,' e' dar' um' contributo' para' uma' compreensão'mais'alargada'deste'problema'de'saúde'pública,'especialmente'nesta'região'de' Odemira.' A' autópsia' psicológica' consiste' em' reunir' detalhadamente' informação' sobre' a'personalidade' e' vida' de' alguém' que' morreu' em' circunstâncias' equívocas' (por' suicídio,' homicídio' ou' acidente)'recorrendo'ainda'a'registos'e'documentação,'bem'como'procedendo'a entrevistas' com' familiares,' colegas' ou' amigos.' Foi' feita' uma' adaptação' de' uma' entrevista' semirestruturada' para' o' efeito.' Foram' recrutados' 2' grupos' de' participantes:' um' grupo' de familiares de pessoas que cometeram'suicídio'(n=30)'e'um'grupo'de'familiares'de'pessoas'que morreram de causas' naturais' (n=24).' O' estudo' decorreu' em' 3' momentos' com' sessões' de' apresentação' (i),' sessões' de' preparação' (ii)' e' entrevistas' para' recolha' de' informação' e'monitorização.'' Os' principais' resultados'mostram' que' existiram' dificuldades' na' obtenção' da' informação' a'partir' dos' entrevistados,' a'maioria' dos' suicidas' eram'homens' acima' dos' 40' anos' de' idade,' afetados' por' lesões' graves' ou' doenças' graves' ' no' período' adulto' embora' apresentassem'condições' válidas' para' trabalhar,' reformados,' vivendo' em' família,' com' traços' de'personalidade' amargurados,' tristes' ou' pessimistas,' com' escassas' atividades' nos' tempos' de' lazer,' sem' problemas' somáticos' significativos' ou' perturbações'mentais' que' comunicaram' a intenção de morrer previamente'e'provenientes'de'famílias'sem'dificuldades'económicas'ou'relações'familiares'desadequadas.' Tendo'em'conta'a'literatura,'algumas'das'características'parecem'ser'muito'particulares'desta'população.'Aparentemente'o'suicídio'poderá'ter'implicações'genéticas'que'deveriam'ser'tidas'em'conta'em'futuras'investigações.' A'integração'da'saúde'mental'nos'cuidados'de'saúde'primários'afigurarse'urgente'tendo'em' conta' que' a' escassez' de' profissionais' de' saúde'mental' é' enorme' numa' parte' do' país' onde'ocorre' o'maior'número'de' suicídios.'Mudar'de'modelo'e'reorganizar'os' serviços'de' forma'a' poder' dar' uma' resposta' ao' défice' de' tratamento' de' saúde' mental' e' ter' em' conta' os' determinantes'sociais'da'saúde'para'fazer'face'ao'isolamento'é'fundamental.' ---------------ABSTRACT: Suicide' is,'nowadays,' a'public'health'problem.'A'million'dies' annually'by' suicide'worldwide.' According'to'several'agencies'and'organizations'an'estimation'of'20'to'40'suicide'attempts'is advanced for each complete' suicide. Associated'costs'to'suicide,'both'human'and'economic,'are' huge' and' spread' on' family,' jobs,' economy,' and' finances.' Official' available' figures' for' suicide' in' Portugal' indicate' a' rate' slightly' over' 10' for' each' 100' 000' inhabitants,' but' with'regions'where'one' can' actually' find'extremely'high' rates,' like' for' instance' in' the'Southwest' part' of' the' country,' where' are' regularly' found' rates' 3' times' higher,' when' compared' to'national'average.'' We' have' investigated' the' phenomenon' aiming' to' validate' the' technique' of' psychological'autopsy' in' a' community' context' never' explored' before' in' Portugal' and' to' contribute' for' a' wider' understanding' of' this' public' health' problem,' especially' in' this' region' of' Odemira.' Psychological'autopsy'consists'into'a'detailed'gathering'of'information'about'the'personality'and' life' of' someone' died' in' equivocal' circumstances' (suicide,' homicide,' accident),' registries and other'documentation'as'well'as'interviews'with'family'members,'corworkers'and'friends.' An' adaptation' of' a' semirstructured' interview' was' made.' Two' groups' of' participants' were'recruited: a'group of'relatives'of'people'committing'suicide'(n=30),'and'a'group'of'relatives'of'people' whose' death' was' after' natural' causes' (n=24).' Study' was'made' in' 3'moments' with'presentation'sessions;'(i)'preparation'sessions;'(ii)'interviewing'data'collection'and'monitoring' iii).'' Main'results'showed'difficulties'to'obtain'information'from'interviewees,'most'suicides'were' from males over 40 years old, affected'by'serious'illness'or'severe'injury'in'adulthood'but'valid'to'work,'retired,'living'in'family,'with'bitterness,'sad'or'pessimistic'as'personality'traits,'with'few' leisure' activities,' without' significant' health' somatic' problems' or' mental' disorders,'communicating'intention'to'die'previously,'coming'from'families'with'no'indication'of'financial'distress'or'inadequate'family'relationship.' Taking'into'account'the'literature'it'looks'like'some'features'seem'to'be'quiet'particular'from'this'population.'Apparently'one'might'say'that'suicide'could'have'genetic'implications'which'further'research'should'account'in'the'future.' Integration' of'mental' health' into' primary' care' is' urgent' once' the' scarcity' of'mental' health' professionals' is' enormous' in' a' part' of' the' country' where' most' suicides' occur.' Scaling' up services must go in order'to'address'to'treatment'gap'and'social'determinants'of'health'should'be'taken'into'account'to'face'isolation.' Results' show' that' the' profile' of' the' suicidal' in' the' region' of' Odemira' is' particular' and'implications' of' genetics' should' be' taken' into' account.' Moreover' much' can' be' done' in'organization' of' services' in' the' region' where' we' performed' the' present' study' in' order' to'address'to'treatment'gap'for'mental'disorders'and'to'the'social'determinants'of'health.

Hole cleaning performance monitoring during the drilling of directional wells

During drilling operation, cuttings are produced downhole and must be removed to avoid issues which can lead to Non Productive Time (NPT). Most of stuck pipe and then Bottom-Hole Assembly (BHA) lost events are hole cleaned related. There are many parameters which help determine hole cleaning conditions, but a proper selection of the key parameters will facilitate monitoring hole cleaning conditions and interventions. The aim of Hole Cleaning Monitoring is to keep track of borehole conditions including hole cleaning efficiency and wellbore stability issues during drilling operations. Adequate hole cleaning is the one of the main concerns in the underbalanced drilling operations especially for directional and horizontal wells. This dissertation addresses some hole cleaning fundamentals which will act as the basis for recommendation practice during drilling operations. Understand how parameters such as Flowrate, Rotation per Minute (RPM), Rate of Penetration (ROP) and Mud Weight are useful to improve the hole cleaning performance and how Equivalent Circulate Density (ECD), Torque & Drag (T&D) and Cuttings Volumes coming from downhole help to indicate how clean and stable the well is. For case study, hole cleaning performance or cuttings volume removal monitoring, will be based on real-time measurements of the cuttings volume removal from downhole at certain time, taking into account Flowrate, RPM, ROP and Drilling fluid or Mud properties, and then will be plotted and compared to the volume being drilled expected. ECD monitoring will dictate hole stability conditions and T&D and Cuttings Volume coming from downhole monitoring will dictate how clean the well is. T&D Modeling Software provide theoretical calculated T&D trends which will be plotted and compared to the real-time measurements. It will use the measured hookloads to perform a back-calculation of friction factors along the wellbore.

High prevalence of methicillin-resistant Staphylococcus aureus with SCCmec type III in cystic fibrosis patients in southern, Brazil

INTRODUCTION: Bacterial colonization of the lungs is the main cause of morbidity in cystic fibrosis (CF). Pathogens such as Staphylococcus aureus are very well adapted to the pulmonary environment and may persist for years in the same patient. Genetic determinants of these bacteria, such as the presence of SCCmec have recently emerged as a problem in this population of patients. METHODS: Staphylococcus aureus isolates obtained from different clinical materials coming from CF and non-CF patients attended at a cystic fibrosis reference hospital were compared according to SCCmec type and antibiotic susceptibility profile. RESULTS: Three hundred and sixty-four single-patient Staphylococcus aureus isolates were collected, of which 164 (45%) were from CF patients. Among the latter, 57/164 (44.5%) were MRSA, and among the non-CF patients, 89/200 (35%) were MRSA. Associated pathogens were found in 38 CF patients. All 57 MRSA from CF patients harbored the multiresistant cassette type III. In contrast, 31/89 MRSA from non-CF patients harbored SCCmec type I (35%) and 44/89 harbored type III (49%). The antibiotic susceptibility pattern was similar between CF and non-CF patients. CONCLUSIONS: The high prevalence of multiresistant SCCmec type III among CF patients compared with non-CF patients in our institution may make it difficult to control disease progression through antibiotic therapy for promoting the survival of this kind of patient.

Maritime Security in the Gulf of Guinea: Issues and Solutions for the 21st Century

A producer of 5.4 M bbl/d, totalling almost half of the consumption of the entire European Union, the Gulf of Guinea is a fundamental lifeline and maritime link between Europe, the Americas and Africa. Geographically positioned as a staging post for transit originating in Latin America and coupled with its relatively porous borders, the region is also the perfect stepping stone for contraband heading to European shores. While blessed with an enviable wealth of marine and mineral resources, the region is also plagued by an ever-increasing spectre of maritime piracy; accounting for around 30% of incidents in African waters from 2003 to 2011. It is for these reasons that this research centres around the issues of maritime security in the Gulf of Guinea, with a particular focus on the first two decades of the 21st century. This research looks to examine the overall picture of the present state of play in the area, before going on to provide an analysis of potential regional developments in maritime security. This research begins with the analysis of concepts/phenomena that have played a notable role in the shaping of the field of maritime security, namely Globalisation and security issues in the post-Cold War era. The ensuing chapter then focuses in on the Gulf of Guinea and the issues dominating the field of maritime security in the region. The penultimate chapter presents a SWOT analysis, undertaken as part of this research with the aim of correlating opinions from a variety of sectors/professions regarding maritime security in the Gulf of Guinea. The final chapter builds upon the results obtained from the abovementioned SWOT analysis, presenting a series of potential proposals/strategies that can contribute to the field of maritime security in the region over the coming years. This research draws to a close with the presentation of conclusions taken from this particular investigation, as well as a final overview of the earlier presented proposals applicable to the field of maritime security during the second decade of the 21st century.

Accident caused by Centruroides testaceus (DeGeer, 1778) (Scorpiones, Buthidae), native to the Caribbean, in Brazilian airport

Describes the case of a 6-year-old girl who was stung by a Centruroides testaceus, a scorpion native to the Lesser Antilles, in the Guarulhos International Airport, São Paulo, Brazil, as she disembarked from a flight coming from the Caribbean. The patient presented only local symptoms (a small area of erythema and pain at the sting site), which were resolved after a few hours with analgesics, without the need for antivenom. Physicians who treat patients stung by scorpions should be alert to the possibility of such accidents being caused by non native species, especially those cases that occur near airports or ports.

Internationalization of UniPlaces to the Spanish market: Internationalization plan to Madrid, Spain

Field Lab in Entrepreneurial Innovative Ventures

NHL 3.5 mortars with scrap tire rubber

The use of wastes and industrial by-products as building materials is an important issue in order to decrease costs with waste management and the embodied energy of building products. Scrap tire rubber has been studied as aggregate for cementitious materials. Natural hydraulic limes are natural binders with particular characteristics of both air and hydraulic binders. Their specifications became stricter with the last version of EN 459-1:2010. In this study scrap tire rubber was used as additional aggregate of mortars, based on NHL3.5 and natural sand. Different particle size fractions and proportions of scrap tire rubber were used: a mix obtained almost directly from industry (only after sieving for preparation of particle sizes similar to mortar aggregate) and separated fine, medium and coarse fractions; 0%, 18%, 36% and 54% weight of binder, corresponding to 2.5%, 5% and 7.5% weight of sand. The influence of the rubbers´ additions on the mortars´ fresh state, mechanical and physical performance is presented, namely by flow table consistency, water retention, fresh bulk density, dynamic elasticity modulus, flexural and compressive strength, open porosity and bulk density, capillary absorption, drying and thermal conductivity. The use of the rubber mix coming from the waste tire industry seems advantageous and may open possibilities for use as raw material by the mortars industry.