Rickettsial Infection Caused by Accidental Conjunctival Inoculation

The most common transmission route of tick-borne Rickettsia is through tick bite; nevertheless, other transmission routes should also be considered. We report a case of rickettsial infection in a 15-year-old boy caused by accidental contamination of the conjunctiva through the infected fluid of a crushed engorged tick removed from a dog. Right eye pain, conjunctival hyperaemia with mucopurulent exudate, chemosis and eyelid oedema were the first signs and symptoms. Two days later, the boy developed fever, myalgia, headache, abdominal pain and was vomiting; physical examination showed multiple cervical adenopathies but no rash. He was treated with doxycycline (200 mg/day) for 7 days with progressive resolution of clinical signs. Rickettsial infection was confirmed by immunofluorescence assay with serological seroconversion in two consecutive samples. Rickettsia conorii or Rickettsia massiliae were the possible causal agents since they are the Rickettsia spp found in the Rhipicephalus sanguineus dog tick in Portugal.

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.

Acidentes em Crianças e Jovens, Que Contexto e Que Abordagem? Experiência de Nove Meses no Serviço de Urgência num Hospital de Nível II

Introdução: Os acidentes constituem uma importante causa de morbimortalidade infantil e de recurso ao serviço de urgência pediátrica. A nível nacional conhecem-se apenas alguns dados epidemiológicos. Métodos: Estudo observacional transversal com análise da coorte das crianças observadas no serviço de urgência pediátrica de um hospital nível II por motivo de acidente, durante um período de nove meses, com dados obtidos através de um inquérito e submetidos a análise estatística. Resultados: Das 22502 admissões de crianças até aos 14 anos registadas, 1746 (7,8%) foram por acidentes. A maioria era do sexo masculino e tinha mais de 5 anos. Os acidentes ocorreram maioritariamente no exterior da escola (29,1%) e interior de casa (25%), predominando a queda como tipo de acidente (55,5%) e a contusão como mecanismo de lesão (54,2%). A maioria das crianças (77,3%) foi submetida a exames complementares de diagnóstico destacando-se os radiológicos. Os diagnósticos mais frequentes foram os traumatismos superficiais (47,9%) e os ferimentos (24,8%). Em 6,6% (115) dos casos os acidentes foram considerados graves. Estas admissões por acidentes associaram-se a uma despesa imediata estimada de 124 mil euros. Discussão: A frequência elevada e o local de ocorrência dos acidentes coincidiram com a literatura. Apesar do predomínio das lesões minor superficiais (47,9%) verificou-se um número significativo de crianças com necessidade de cuidados hospitalares. Não foram registados óbitos. Os autores concluem que os acidentes em crianças foram um motivo frequente de ida ao serviço de urgência pediátrica com importante consumo de recursos. A sensibilização dos cuidadores é essencial na prevenção dos acidentes.

The Support Role in Clinical Supervision of Nursing Students: Determinant in the Development of Emotional Skills

The problematic situation faced by clients, associated to the processes of health and disease, is expressed through emotions that nursing students have to deal with in the course of care and their formative experiences in clinical teaching. Students have learning needs not only to manage emotions in the context of customer care, but also in terms of their own internal world, emotional conflicts, emotional stress and burn-out. With the present literature review, we intend to explore existing evidence regarding the ways in which the nurse supervisor's support towards nursing students potentiates the development of their competences for the performance of emotional labour. These skills prove to be the key in the ability to manage the emotionally intense situations of care practice and the support function of the nursing supervisor contributes to the development of such competences.

The Effect of Long-Chain Polyunsaturated Fatty Acids Intake During Pregnancy on Adiposity of Healthy Full-Term Offspring at Birth

OBJECTIVE: The adjusted effect of long-chain polyunsaturated fatty acid (LCPUFA) intake during pregnancy on adiposity at birth of healthy full-term appropriate-for-gestational age neonates was evaluated. STUDY DESIGN: In a cross-sectional convenience sample of 100 mother and infant dyads, LCPUFA intake during pregnancy was assessed by food frequency questionnaire with nutrient intake calculated using Food Processor Plus. Linear regression models for neonatal body composition measurements, assessed by air displacement plethysmography and anthropometry, were adjusted for maternal LCPUFA intakes, energy and macronutrient intakes, prepregnancy body mass index and gestational weight gain. RESULT: Positive associations between maternal docosahexaenoic acid intake and ponderal index in male offspring (β=0.165; 95% confidence interval (CI): 0.031-0.299; P=0.017), and between n-6:n-3 LCPUFA ratio intake and fat mass (β=0.021; 95% CI: 0.002-0.041; P=0.034) and percentage of fat mass (β=0.636; 95% CI: 0.125-1.147; P=0.016) in female offspring were found. CONCLUSION: Using a reliable validated method to assess body composition, adjusted positive associations between maternal docosahexaenoic acid intake and birth size in male offspring and between n-6:n-3 LCPUFA ratio intake and adiposity in female offspring were found, suggesting that maternal LCPUFA intake strongly influences fetal body composition.

Development of a pediatric eosinophilic esophagitis activity index (ped-EEsAI): International experts propose dysphagia, whitish exudates on endoscopy , and intraepithelial eosinophili count as major items related to EoE activity

Background and Aims: The international EEsAI study group aims to develop, validate and evaluate the first pediatric EoE activity index (ped-EEsAI). We report on results of phase 1, which aims to generate candidate items. Methods: This study involves 3 phases: (1) item generation, (2) index derivation and testing on a first patient cohort, and (3) validation in a second cohort. In phase 1, item generation, weighting and reduction are achieved through a Delphi process with an international EoE expert group. The experts proposed and ranked candidate items on a 7-point Likert scale (0 = no, 6 = perfect relationship with EoE activity). Results: 23 international EoE experts proposed and ranked 39 items (20 clinical, 6 endoscopic, 8 histologic, 5 laboratory items). Rank order for clinical items: dysphagia related to food consistencies (median 5, range 2-6), severity of dysphagia (5, 3-6), frequency of dysphagia episodes (5, 3-6), regurgitation and vomiting (4, 2-5), response to dietary restrictions (4, 1-6); endoscopic items: whitish exudates (5, 3-6), furrowing (4, 3-6), corrugated rings (4, 2-6), linear shearing (4, 2-6), strictures (3, 2-6); histologic items: intraepithelial eosinophil count (5, 4-6), lamina propria fibrosis (3, 2-6), basal layer enlargement (3, 1-5); laboratory items: % blood eosinophils (3, 0-5). Conclusions: These items will now be reduced in further Delphi rounds, tested on a cohort of 100 pediatric EoE patients and validated in a second independent cohort, resulting in a robust, broadly accepted disease activity index for use in clinical trials and daily care.

Banque mondiale et développement. Pertinences scientifiques des discours et pratiques de développement de la Banque mondiale dans les PED des années 80 à nos jours.

RÉSUMÉ « De nos jours, notent Samoff et Carrol, la Banque mondiale doit être considérée à la fois comme une banque, une agence de développement et un institut de recherche » (2004, p9). L’institution de Bretton Woods est en effet devenue notamment dans le cadre du développement des PED, à la fois une banque de prêt et une institution de savoir ; « le laboratoire d’idées sur le développement le plus important au monde », précisent Wilks et Lefrançois (2002). Cependant, si elle reste un partenaire idéologique et financier pour le développement de ces pays, la Banque mondiale est aussi en même temps dans le paysage des relations économiques internationales contemporaines une véritable superpuissance, une figure importante de la dominance mondiale d’aujourd’hui. Les programmes de développement qu’elle professe et met en œuvre dans les PED y sont de ce fait également les discours et pratiques de développement dominants. Mais le discours de développement de la Banque mondiale dans les PED, outre qu’il y soit le savoir dominant du développement, se veut aussi par ailleurs un discours d’érudition : un corps de connaissances savant de développement, qui dans sa formulation comme dans son contenu revendique l’appartenance à une certaine rationalité, vise à une certaine « scientificité ». Partant, la question autour de laquelle s’organise la présente thèse et qui est au cœur de sa problématique est la suivante : le programme de développement que la Banque mondiale destine aux PED dans sa dimension discursive en particulier, est-il pour autant rationnel et raisonnable ? En d’autres termes : de quel crédit scientifique et moral peut jouir ce programme; de quelle cohérence, de quel réalisme, et de quelle adéquation sociale, peut se prévaloir un tel système de pensées et d’actions de développement ? Mais interroger les bien-fondés épistémologiques de son programme de développement dans les PED revient aussi au plans politique et social à questionner cette position de dominance qu’occupe la Banque mondiale dans ces pays. Aussi notre questionnement général s’enchaîne-t-il comme suit: ce pouvoir d’autorité de la Banque mondiale dans les PED, tire t-il sa légitimité d’un fondement rationnel convaincant, capable de résister à la critique, ou plutôt, s’enracine t-il dans une confusion idéologique sciemment instaurée et entretenue ou comme dit Rist, dans le « pouvoir de celui qui parvient à l’imposer» ?

Hincha sin violencia : aplicación del proyecto PED en la escuela.

Presenta el programa 'Hincha sin violencia' -dentro del programa PED (Fundación Prevención Escolar contra la Droga)- generado en 1996 con el título 'Seguidor si Ira' y desarrollado en varios países europeos e iberoamericanos, con el fin de prevenir problemas de violencia y consumo de drogas. El artículo se centra en la experiencia desarrollada en el CEP El Olivar de Coslada, titulada 'Disfrutar con el movimiento y educar a través de él', presenta sus bases teóricas y las aplicaciones prácticas destinadas a la ayuda y orientación de padres para tratar con sus hijos el problema de la drogadicción.

The Ped-APS registry: The antiphospholipid syndrome in childhood

In recent years, antiphospholipid syndrome (APS) has been increasingly recognised in various paediatric autoimmune and nonautoimmune diseases, but the relatively low prevalence and heterogeneity of APS in childhood made it very difficult to study in a systematic way. The project of an international registry of paediatric patients with APS (the Ped-APS Registry) was initiated in 2004 to foster and conduct multicentre, controlled studies with large number of paediatric APS patients. The Ped-APS Registry is organised as a collaborative project of the European Forum on Antiphospholipid Antibodies and Juvenile Systemic Lupus Erythematosus Working Group of the Paediatric Rheumatology European Society. Currently, it documents a standardised clinical, laboratory and therapeutic data of 133 children with antiphospholipid antibodies (aPL)-related thrombosis from 14 countries. The priority projects for future research of the Ped-APS Registry include prospective enrolment of new patients with aPL-related thrombosis, assessment of differences between the paediatric and adult APS, evaluation of proinflammatory genotype as a risk factor for APS manifestations in childhood and evaluation of patients with isolated nonthrombotic aPL-related manifestations. © The Author(s), 2009.

Curso de procesamiento electronico de datos (PED) aplicado a temas de poblacion

El curso de Procesamiento Electronico de Datos aplicado a temas de poblacion dictado por CELADE en 1976 se estructuro con el objeto de entregar, por un lado, una base solida en computacion y, por otro, el uso intensivo de un paquete de programas utiles en el procesamiento de censos y encuestas. Contempla 5 modulos que se desarrollan a traves de actividades teorico-practicas y esta especialmente dirigido al personal de institutos nacionales de estadistica u otras oficinas gubernamentales de los paises de la region

Direttiva PED: iter tecnico-procedurale ed elementi di analisi di rischio per la valutazione di conformità delle attrezzature e degli insiemi a pressione

Il presente elaborato ha ad oggetto la direttiva PED (Pressure Equipment Directive) relativa agli apparecchi a pressione. Tale norma è stata recepita in Italia con il D.Lgs. n. 93/2000 ed è entrata in vigore definitivamente nel 2002. Essa è finalizzata alla libera circolazione delle attrezzature a pressione nella comunità europea e ne disciplina la progettazione, la costruzione, l'equipaggiamento e l'installazione in sicurezza, definendo per ciascuna delle fasi sopra elencate quali siano i documenti da presentare, gli accorgimenti da rispettare e i controlli a cui sottostare. Il presente lavoro di tesi, svolto presso lo stabilimento di Ravenna di ENI Versalis, ha avuto l’obiettivo di individuare i punti di contatto fra quanto richiesto dalla direttiva PED e quanto solitamente emerge dall’applicazione delle tecniche per l’analisi di rischio, degli standard internazionali e aziendali e delle norme di buona tecnica. Il risultato del lavoro consiste nella definizione di un iter tecnico-procedurale standardizzato ad uso dell’utilizzatore delle attrezzature a pressione tramite la quale l’azienda possa procedere alla compilazione delle Note Tecniche destinate al fabbricante delle attrezzature stesse, secondo quanto richiesto dalla direttiva. Tali Note Tecniche devono contenere le indicazioni relative ai valori progettuali di temperatura e pressione e ai Requisiti Essenziali di Sicurezza (RES) che devono essere soddisfatti, permettendo così al fabbricante di poter svolgere una corretta analisi di rischio e all’utilizzatore di ottenere la massima sicurezza negli impianti. L’elaborato è strutturato come segue. Dopo il Capitolo 1, avente carattere introduttivo, nel Capitolo 2 vengono illustrate le principali novità introdotte dalla direttiva PED e descritti i punti cardine della procedura di valutazione della conformità richiesta per le attrezzature a pressione. Nel Capitolo 3 viene esaminata l’integrazione della direttiva PED con la direttiva Macchine e la direttiva ATEX. Nel Capitolo 4 sono descritte le principali tecniche di analisi di rischio che possono essere utilizzate per rispondere ai Requisiti Essenziali di Sicurezza (RES) richiesti in fase di compilazione della Nota Tecnica. Nel Capitolo 5 si fornisce una descrizione dettagliata dell’iter tecnico-procedurale messo a punto per la valutazione di conformità delle attrezzature e degli insiemi a pressione. Nel Capitolo 6 vengono illustrati ad uno ad uno i punti che devono essere presenti in una Nota Tecnica, ciascuno dei quali costituisce un Requisito Essenziale di Sicurezza. Nel Capitolo 7 viene approfondito uno dei Requisiti più critici, l’incendio esterno. Infine nel Capitolo 8 sono riportate le considerazioni conclusive.