Echocardiographic parameters associated with pulmonary congestion in Chagas cardiomyopathy

INTRODUCTION: Discrepancy between the intensity of pulmonary congestion and the grade of cardiomegaly seems to be a common finding of Chagas cardiomyopathy, in spite of significant systolic dysfunction of the left ventricle. Its mechanism has not been established. The aim of this study was to investigate pulmonary congestion and to analyze if it correlated with Doppler echocardiographic parameters in patients with Chagas dilated cardiomyopathy. METHODS: Fifty-five patients with positive serology tests for Trypanosoma cruzi and Chagas dilated cardiomyopathy were studied. Chest x-rays, Doppler echocardiogram and plasmatic brain natriuretic peptide levels were obtained in all patients. The degree of pulmonary venous vessels changes on chest x-ray was graded using a pulmonary congestion score, and then compared to Doppler echocardiographic parameters. RESULTS: Mean age was 48.5 ± 11.2 years and 29% were women. The majority (95%) of patients were in NYHA functional class I and II. Mild pulmonary congestion by chest x-ray was found in 80% of the patients. In a multivariate analysis, left ventricular ejection fraction, right ventricular TEI index and the color M-mode velocity correlated with the degree of pulmonary congestion. CONCLUSIONS: Pulmonary venous changes on chest x-rays are frequent, but usually mild in patients with Chagas dilated cardiomyopathy. The degree of pulmonary congestion correlates with Doppler echocardiographic left and right ventricular dysfunction and with color M-mode velocity.

Firmago S.A. - 2016: A deadline for succession

This paper, “Firmago S.A. - 2016: a deadline for succession”, is a case-based essay on a family business. It aims to provide the necessary tools for readers to best decide upon who should be chosen for the continuity of the family business after July 2016. Along with the case study the reader will have the opportunity to identify two main problems: blurred boundaries and the nonexistence of succession planning. In order to elaborate this case study I conducted several meetings with João Cabral, the current CEO of Firmago, who helped me understand the company’s background and the complexity of the family’s relationships. In order to fulfill the CEO’s requirement, all the real names and surnames of those from Firmago were replaced by fake names.

Zara: Marketing in Fast Fashion: A case-study

Zara was founded in 1975 by Amancio Ortega Gaona, soon becoming the largest and most successful chain of the Galician group Inditex (Industria de Diseño Textil) and a pioneer of the rising fashion category of Fast Fashion. Its innovative vertically-integrated strategies, combined with its emphasis on quality and demand-based offer have shaped the world of fashion and brought forth many questions on its future sustainability and growth. Zara has always relied on its store network for advertising its product offer; allowing its garments to “speak for themselves”. With the continued pressure felt in the industry, management has pressed some concerns about future company growth and creative, innovating solutions must be implemented to guarantee Zara’s future growth. The case-study narrative focuses on these issues and leaves readers with an open question regarding what decision to implement.

Echocardiographic parameters associated with pulmonary congestion in outpatients with Chagas' cardiomyopathy and non-chagasic cardiomyopathy

INTRODUCTION: Despite significant left ventricular (LV) systolic dysfunction and cardiomegaly, pulmonary congestion does not seem to be a major finding in Chagas' cardiomyopathy (CC). This study sought to identify echocardiographic parameters associated with pulmonary congestion in CC and in dilated cardiomyopathy of other etiologies, such as non-CC (NCC), and to compare pulmonary venous hypertension between the two entities. METHODS: A total of 130 consecutive patients with CC and NCC, with similar echocardiographic characteristics, were assessed using Doppler echocardiography and chest radiography. Pulmonary venous vessel abnormalities were graded using a previously described pulmonary congestion score, and this score was compared with Doppler echocardiographic parameters. RESULTS: NCC patients were older than CC patients (62.4 ± 13.5 × 47.8 ± 11.2, p = 0.00), and there were more male subjects in the CC group (66.2% × 58.5%, p = 0.4). Pulmonary venous hypertension was present in 41 patients in the CC group (63.1%) and in 63 (96.9%) in the NCC group (p = 0.0), the mean lung congestion score being 3.2 ± 2.3 and 5.9 ± 2.6 (p = 0.0), respectively. On linear regression multivariate analysis, the E/e' ratio (β = 0.13; p = 0.0), LV diastolic diameter (β = 0.06; p = 0.06), left atrial diameter (β = 0.51; p = 0.08), and right ventricular (RV) end-diastolic diameter (β = 0.02; p = 0.48) were the variables that correlated with pulmonary congestion in both groups. CONCLUSIONS: Pulmonary congestion was less significant in patients with CC. The degree of LV of systolic and diastolic dysfunction and the RV diameter correlated with pulmonary congestion in both groups. The E/e' ratio was the hallmark of pulmonary congestion in both groups.

CD8+ T cells in situ in different clinical forms of human cutaneous leishmaniasis

Introduction Leishmania braziliensis infection induces a large spectrum of lesions that clinically manifest as nodules or papules that progress to ulcers. Although it is already known that T helper cells predominate in the lesions, cytotoxic T cells have also been reported to be present, and their role in leishmaniasis immunopathogenesis is not well known. This study investigated the amounts of CD8+ and granzyme B+ cells in different clinical forms of human cutaneous leishmaniasis (CL). Methods Forty tissue fragments from early (E-CL) and late CL (L-CL) lesions and from disseminated leishmaniasis (DL) - papules and ulcers - were characterized. The inflamed area per fragment was calculated, and the CD8 and granzyme B expression levels in the infiltrates were quantified by counting positive cells in 15 fields. The localization of CD8 and granzyme B was graded subjectively. Results Inflammation was higher in L-CL and DL ulcers. CD8 expression was increased in late ulcerated lesions compared to recent lesions. The increase in CD8+ cells also correlated with the duration of the lesion. Papules had a higher frequency of granzyme B+ cells than E-CL lesions, although the frequency was similar to those for late and DL ulcers. CD8+ cells were mostly found in the papillary dermis. Conclusions CD8+ T and granzyme B+ cells are present in the inflammatory infiltrates of CL and DL and may participate in the immunopathogenesis of Leishmania infection.

Size of gastroesophageal varices: its behavior after the surgical treatment of portal hypertension

The size of gastroesophageal varices is one of the most important factors leading to hemorrhage related to portal hypertension. An endoscopic evaluation of the size of gastroesophageal varices before and after different operations for portal hypertension was performed in 73 patients with schistosomiasis, as part of a randomized trial: proximal splenorenal shunt (PSS n=24), distal splenorenal shunt (DSS n=24), and esophagogastric devascularization with splenectomy (EGDS n=25). The endoscopic evaluation was performed before and up to 10 years after the operations. Variceal size was graded according to Palmer's classification: grade 1 -- up to 3 mm, grade 2 -- from 3 to 6 mm, grade 3 -- greater than 6 mm, and were analyzed in four anatomical locations: inferior, middle or superior third of the esophagus, and proximal stomach. The total number of points in the pre-operative grading minus the number of points in the post-operative grading gave a differential grading, allowing statistical comparison among the surgical groups. Good results, in terms of disappearance or decrease of variceal size, were observed more frequently after PSS than after DSS or EGDS - 95.8%, 83.3%, and 72%, respectively. When differential grading was analyzed, a statistically significant difference was observed between PSS and EGDS, but not between proximal and distal splenorenal shunts. In conclusion, shunt surgeries were more efficient than devascularization in diminishing variceal size.

Assessment of medical courses in Brazil using student-completed questionnaires. Is it reliable?

INTRODUCTION: Debates about the quality of medical education have become more evident in the recent past, and as a result several different assessment methods have been refined for that purpose. The use of questionnaires filled out by medical students to assess the quality of lectures is one of the most common methods employed in our milieu. However, the reliability of this investigation method has not yet been systematically tested. The authors present the reliability of a specific form applied to the fourth grade medical students during the clinical psychiatry course. METHOD: Eighty-one fourth grade medical students were instructed to complete a form immediately after each clinical psychiatry lecture. Thirty-four students (42%) failed to turn in the forms after the final lecture. These students were given an identical form to assess the lectures in a retrospective fashion. The grades given by both groups of students for each performed lecture and the number of students who have graded an unperformed lecture were compared. Statistical significance for both groups was determined by means of the chi-square test (p< 0.05). RESULTS: Eighteen out of the 34 students who filled out the forms retrospectively (53%) rated the unperformed lecture, whereas only 5 out of the 47 students who filled out the forms during the course (11%) did so. This is statistically significant (p< 0.05). There was no statistical difference for the grades given to the lectures that were actually performed. DISCUSSION: The authors concluded the low reliability rate of the retrospective evaluation warrant a continuous assessment method during the course.

Guidelines on how to assess the validity of results presented in subgroup analysis of clinical trials

In observational studies, identification of associations within particular subgroups is the usual method of investigation. As an exploratory method, it is the bread and butter of epidemiological research. Nearly everything that has been learned in epidemiology has been derived from the analysis of subgroups. In a randomized clinical trial, the entire purpose is the comparison of the test subjects and the controls, and when there is particular interest in the results of treatment in a certain section of trial participants, a subgroup analysis is performed. These subgroups are examined to see if they are liable to a greater benefit or risk from treatment. Thus, analyzing patient subsets is a natural part of the process of improving therapeutic knowledge through clinical trials. Nevertheless, the reliability of subgroup analysis can often be poor because of problems of multiplicity and limitations in the numbers of patients studied. The naive interpretation of the results of such examinations is a cause of great confusion in the therapeutic literature. We emphasize the need for readers to be aware that inferences based on comparisons between subgroups in randomized clinical trials should be approached more cautiously than those based on the main comparison. That is, subgroup analysis results derived from a sound clinical trial are not necessarily valid; one must not jump to conclusions and accept the validity of subgroup analysis results without an appropriate judgment.

‘Fala connosco!’ : o jornalismo infantil e a participação das crianças, em Portugal e no Brasil

Esta tese se concentra na participação das crianças no jornalismo feito para elas. Buckingham (2009) entende que as crianças devem exercer os seus direitos de participação, estabelecidos na Convenção sobre os Direitos da Criança (1989), também na área da produção midiática. Isto significa que as crianças devem dizer, para os produtores e legisladores de mídia, os seus desejos e sugestões, críticas e concordâncias, além de produzir conteúdos próprios. Para o investigador britânico, isso está relacionado ao que ele chama de “direito das crianças à representação”, garantia que não está abarcada pela Convenção. O objetivo desse novo direito seria o de que as crianças não só sejam ouvidas mas também criem e defendam melhores formas de representação das infâncias contemporâneas, através da participação nos canais de mídia. Além disso, as representações das crianças apresentadas no discurso jornalístico são parte do quadro social e cultural que forma o que entendemos por infância contemporânea (e que a distingue do que é “ser adulto”). A imprensa voltada especificamente para as crianças pode entender melhor o cotidiano dos meninos e meninas e, através de representações da(s) infância(s) mais complexas, pode lembrar à sociedade que as crianças também estão envolvidas em questões gerais, como a organização cultural e socioeconômica de suas cidades, de seus países ou do mundo — expandindo o conceito de infância aceito atualmente. Os canais de participação oferecidos pelos meios de comunicação e as novas formas de comunicação que as crianças têm à sua disposição, através da internet, são possíveis formas de assegurar o direito defendido por Buckingham. Mas as crianças têm vindo a utilizar as novas formas digitais de participação para se comunicar com os jornalistas que escrevem para elas? Existe um interesse voluntário das crianças neste tipo de participação? São comentários enviados diretamente por elas ou por seus responsáveis, preocupados com os conteúdos dos veículos que oferecem aos seus filhos, netos e alunos? Para responder a essas questões, analisamos 515 cartas e e-mails enviados para duas revistas feitas para crianças, no Brasil (“Ciência Hoje das Crianças”) e em Portugal (“Visão Júnior”), em 2013-14. Entrevistamos ainda crianças de nove a 16 anos de idade em ambos os países. Analisando a amostra de mensagens, vimos que os leitores (a maioria crianças, e não adultos responsáveis por elas) escrevem intensamente para ambas as revistas e que eles estão usando mais o e-mail para esta atividade — embora no Brasil não tenham abandonado completamente o papel quando a comunicação é gerada na escola. Nesse país, o uso da internet por crianças nas escolas é menor do que em Portugal. Como conclusões, entendemos que a integração digital não tende a aumentar a comunicação on-line com essas revistas de papel, porém ela expande as fontes de informação acessadas pelas crianças — ainda que elas nem sempre consigam diferenciar entretenimento de informação jornalística. Esses meninos e meninas, voluntariamente ou incentivados pelos professores (aparentemente não por pais ou colegas), veem o espaço para publicação de cartas do leitor nas revistas como uma plataforma por meio da qual podem intervir na oferta editorial. Mas isso acontece de forma “reforçadora”, ou seja, pedindo mais do que eles já veem e apreciam. Acreditamos ser necessário investimento em literacia midiária, através da mediação dos pais e da escola, para estimular as crianças a pedirem um jornalismo melhor, de uma forma que elas ainda nem sabem ser possível. //

Cultural journalism in a digital environment : new models, practices and possibilities

Both culture coverage and digital journalism are contemporary phenomena that have undergone several transformations within a short period of time. Whenever the media enters a period of uncertainty such as the present one, there is an attempt to innovate in order to seek sustainability, skip the crisis or find a new public. This indicates that there are new trends to be understood and explored, i.e., how are media innovating in a digital environment? Not only does the professional debate about the future of journalism justify the need to explore the issue, but so do the academic approaches to cultural journalism. However, none of the studies so far have considered innovation as a motto or driver and tried to explain how the media are covering culture, achieving sustainability and engaging with the readers in a digital environment. This research examines how European media which specialize in culture or have an important cultural section are innovating in a digital environment. Specifically, we see how these innovation strategies are being taken in relation to the approach to culture and dominant cultural areas, editorial models, the use of digital tools for telling stories, overall brand positioning and extensions, engagement with the public and business models. We conducted a mixed methods study combining case studies of four media projects, which integrates qualitative web features and content analysis, with quantitative web content analysis. Two major general-interest journalistic brands which started as physical newspapers – The Guardian (London, UK) and Público (Lisbon, Portugal) – a magazine specialized in international affairs, culture and design – Monocle (London, UK) – and a native digital media project that was launched by a cultural organization – Notodo, by La Fábrica – were the four case studies chosen. Findings suggest, on one hand, that we are witnessing a paradigm shift in culture coverage in a digital environment, challenging traditional boundaries related to cultural themes and scope, angles, genres, content format and delivery, engagement and business models. Innovation in the four case studies lies especially along the product dimensions (format and content), brand positioning and process (business model and ways to engage with users). On the other hand, there are still perennial values that are crucial to innovation and sustainability, such as commitment to journalism, consistency (to the reader, to brand extensions and to the advertiser), intelligent differentiation and the capability of knowing what innovation means and how it can be applied, since this thesis also confirms that one formula doesn´t suit all. Changing minds, exceeding cultural inertia and optimizing the memory of the websites, looking at them as living, organic bodies, which continuously interact with the readers in many different ways, and not as a closed collection of articles, are still the main challenges for some media.

Os romances juvenis de Álvaro Magalhães

With his works translated in countries such as Spain, France and Brazil, Álvaro Magalhães is not only one of the great writers of Portuguese and Lusophone juvenile fiction, but also one of the most prominent names in European and world literature. Through the various thematic and narrative resources that he employs in the creation of a unique language, among the multiple and unusual senses of serious and humorous, among the elements of various domains of knowledge and universal culture that he invokes and contrasts, this author has a unique place in universe of novels aimed primarily at young readers.

Facebook como o novo canal de distribuição de notícias

As redes sociais estão a mudar a forma como os leitores acedem a conteúdos noticiosos e interagem com eles, não só recomendando notícias como facilitando conversas. Hoje, o Facebook é parte do quotidiano de um quinto da população mundial. Mas poderá esta rede social ser um canal de distribuição de notícias online? Esta investigação a que nos propomos tem por base o estudo de caso do Correio da Manhã, um dos jornais portugueses com maior circulação em papel e que se tornou líder no digital, em grande parte, graças à sua estratégia nas redes sociais. A análise e a aplicação de conceitos sobre o uso do Facebook, com vista ao aumento das audiências de um site noticioso, permitem tirar conclusões, quantitativas e qualitativas, sobre a problemática em questão. Como podem as publicações jornalísticas tirar melhor partido do Facebook? Deverá o jornalismo digital especializar-se na distribuição de notícias através das redes sociais? Quais as estratégias a aplicar para incrementar as audiências de um website através do Facebook como canal de distribuição? Neste contexto, pretendeu-se fazer uma análise sobre a forma como os meios de comunicação social estão a usar o Facebook para uma abordagem das melhores práticas jornalísticas nesta rede social. É nosso propósito examinar o papel das notícias no Facebook e a forma como os jornalistas se devem comportar, numa tentativa de criar regras para se tirar o melhor proveito do Facebook em função das audiências

Quando ler se torna um prazer: contributo da promoção da leitura literária na infância

Relatório de estágio de mestrado em Educação Pré-Escolar e Ensino do 1º Ciclo do Ensino Básico

O impacto dos blogs de moda no relacionamento com marcas de consumo simbólico

Dissertação de mestrado em Marketing e Estratégia

Enteroscopia por cápsula e doença de Crohn: Caminhos para a otimização

Tese de Doutoramento em Medicina