A metafísica de Isaac Newton

The general objective of this dissertation is to analyze the metaphysical aspects of "rational mechanics" of Isaac Newton, clarifying, by scientific and philosophical discourse, their main elements, with emphasis to the presence of one entity infinitely rational behind all the phenomena of nature, and to the Newton's insight as certain empiricist which, however, accepts deductions metaphysics; a philosopher-scientist. The specific objectives are detailed below: a) brief presentation of the development of modern science, since the Pre-Socratics, seeking to understand the historical conjecture that enabled the rise of Newtonian mechanics; b) presentation of the elements of scientific methodology and philosophical, aimed at comprehension of certain "Newtonian methodology", understanding how this specific methodology able to present empirical aspects, mathematics, philosophic and religious in communion; c) to understand, from the Newtonian concepts, both concerning man's role in the world as the "notional notions" of mass, space, time and movement, necessary for analysis and understanding of certain metaphysical aspects in the Newtonian physics; d) to present the Newtonian concepts related to the ether, to understand why it necessarily assumes metaphysics characteristics and mediation between the bodies; e) to present and understand the factors that lead the empiricist Newton to assume the religion in his mechanics, as well as, the existence and functions of God in nature, to object to the higher content of his metaphysics; f) to highlight the metaphysical elements of his classical mechanics, that confirm the presence of concepts like God Creator and Preserver of the natural laws; g) at last, to analyze the importance of Newton to the modern metaphysics and the legacy to philosophy of science at sec. XVII to science contemporary

Assessment of informatization for the dispensing of medications at a university hospital

INTRODUCTION: Informatics and automation are important tools for the reduction of work, errors and costs in a hospital pharmacy. OBJECTIVES: To describe the structuring and function of an informatized system for the dispensing of medications and to assess its effect on nursing and pharmacy services during the period from 1997 to 2003. MATERIALS and METHODS: In this descriptive and retrospective study, we performed an analysis of documents addressing the structuring and implementation of the informatized medication dispensing system. In addition, we analyzed the perceptions of nurses, pharmacists and pharmacy assistants who participated in the structuring phase of the system when interviewed about the effect of informatization on administrative aspects (e.g., requisition of medications, presentation of the dispensed medication and system operationalization). RESULTS: The major advantages provided by the new system were 1) the elimination of manual transcripts for prescribed medications, 2) increased speed, 3) better identification of the doses prescribed by physicians, 4) medication labels containing all necessary identification and 5) practicality and safety of optical bar code-based verification of the requested and dispensed medications. CONCLUSIONS: The great majority of the interviewees considered the informatized medication supply system to be of good quality. Analysis of the data provided information that could contribute to the expansion and refinement of the system, provide support for studies regarding the utilization of medications and offer new perspectives for work and productivity.

Fisioterapia respiratória em crianças com pneumonia: revisão sistemática

Introduction: Pneumonia is an inflammatory lung disease and it is the greatest cause of deaths in children younger than five years of age worldwide. Chest physiotherapy is widely used in the treatment of pneumonia because it can help to eliminate inflammatory exudates and tracheobronchial secretions, remove airway obstructions, reduce airway resistance, enhance gas exchange and reduce the work of breathing. Thus, chest physiotherapy may contribute to patient recovery as an adjuvant treatment even though its indication remains controversial. Objectives: To assess the effectiveness of chest physiotherapy in relation to time until clinical resolution in children (from birth up to 18 years old) of either gender with any type of pneumonia. Methods: We searched CENTRAL 2013, Issue 4; MEDLINE (1946 to May week 4, 2013); EMBASE (1974 to May 2013); CINAHL (1981 to May 2013); LILACS (1982 to May 2013); Web of Science (1950 to May 2013); and PEDro (1950 to May 2013). We consulted the ClinicalTrials.gov and the WHO ICTRP registers to identify planned, ongoing and unpublished trials. We consulted the reference lists of relevant articles found by the electronic searches for additional studies. We included randomised controlled trials (RCTs) that compared chest physiotherapy of any type with no chest physiotherapy in children with pneumonia. Two review authors independently selected the studies to be included in the review, assessed trial quality and extracted data. Results: Three RCTs involving 255 inpatient children are included in the review. They addressed conventional chest physiotherapy, positive expiratory pressure and continuous positive airway pressure. The following outcomes were measured: duration of hospital stay, time to clinical resolution (observing the following parameters: fever, chest indrawing, nasal flaring, tachypnoea and peripheral oxygen saturation levels), change in adventitious sounds, change in chest X-ray and duration of cough in days. Two of the included studies found a significant improvement in respiratory rate and oxygen saturation whereas the other included study failed to show that standardised respiratory physiotherapy and positive expiratory pressure decrease the time to clinical resolution and the duration of hospital stay. No adverse effects related to the interventions were xvi described. Due to the different characteristics of the trials, such as the duration of treatment, levels of severity, types of pneumonia and the techniques used in children with pneumonia, as well as differences in their statistical presentation, we were not able to pool data. Two included studies had an overall low risk of bias whereas one included study had an overall unclear risk of bias. Conclusion: Our review does not provide conclusive evidence to justify the use of chest physiotherapy in children with pneumonia due to a lack of data. The number of included studies is small and they differed in their statistical presentation

A percepção da fiscalização dos contratos de mão de obra terceirizada pelos agentes envolvidos nesse processo no âmbito da Universidade Federal do Rio Grande do Norte: uma análise sob o modelo do principal-agente

Outsourcing has emerged as one of the new ways of guiding the work. For its advantages and be consistent with the paradigms of managerial reform, outsourcing also started to be used in the Public Administration. However, taking into account the particularities of the latter, some issues are relevant when outsourcing concluded with the State. Gains notoriety, for example, the step of monitoring these contracts, to the extent that, from this activity, we can avoid the negative effects of outsourcing like the fact that the state will pay for labor and wage liens that are obligation of the company providing the services. This study aims to understand the perception that this process is under the Federal University of Rio Grande do Norte, from the point of view of different stakeholders, also explaining the motivations that these agents have to perform the supervisory process. As a theoretical basis was used the Agency Theory, which reinforces the supervisory activities as a necessary means to minimize moral hazard and adverse selection, seeking to understand not only the different motivations tax contracts to properly perform their duties, but also analyze other phenomena arising from this contractual relationship. To achieve the proposed objectives, were taken a literature review and a presentation of how to organize the management and oversight of contracts in UFRN. The methodological procedures included questionnaires and interviews with those involved in the process. After analyzing the results obtained in the survey instruments , and also based on the laws, regulations and instructions governing the procurement process within the UFRN, it was concluded that the process of overseeing the outsourcing of labor contracts in UFRN is not fully institutionalized, some points should be strengthened in order to have the consolidation of this process, highlighting the need for training of UFRN servers that act as tax, the knowledge that the contractual penalties are applied effectively, the need that there is a supervisor of tax of contractors and also the realization of the rotation system of outsourced employees

Peritonitis in recent years: clinical findings and predictors of treatment response of 170 episodes at a single Brazilian center

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Paracoccidioidomycosis: an unusual presentation in a young girl disclosing an unnoted HIV-infection

The association of paracoccidioidomycosis with AIDS is apparently less frequent than expected. The authors present an unusual case of paracoccidioidomycosis in a 13-year-old female student which was later found to be the first opportunistic infection in the course of the patient's HIV-infection. The clinical presentation followed an accidental incised wound on the palmar region initially described as a 'sporotrichotic-chancre'. After good response under sulfamethoxazole-trimethoprin, the patient relapsed and presented an associated oral candidiasis. HIV-infection was documented and additional investigation showed CD4(+) T-cells=22/mm(3), CD8(+)=280 cell/mm(3) and viral load=4,043 log. This case report presents an uncommon dermatological-clinical picture in the youngest patient in which such association has been reported to date.

Exuberant clinical presentation of probable Malassezia folliculitis in a young nonimmunosuppressed patient

Malassezia folliculitis is an inflammatory disorder observed in both immunocompetent and immunosuppressed patients. The authors describe an unusual and exuberant presumed case affecting the face, trunk and upper limbs of a 12-year-old nonimmunosuppressed patient. Although the agent was not identified by culture, the clinical and histopathological aspects plus the response to specific treatment support the diagnosis of Malassezia folliculitis. The only possible predisponent cause observed on the patient was greasy skin. Repetitive cultures were negative. Treatment with itraconazol promoted apparent cure, however, the patient relapsed twelve months later.

Idiopathic pulmonary hemosiderosis with cystic lesions: A rare presentation

This report describes a case of a 49-year-old man with cough, recurrent hemoptysis, and dyspnea during 18 months, presenting with radiological findings of alveolar infiltrate and cystic lesions in left upper lobe. Laboratory studies revealed normocytic hypochromic anemia and normal coagulation tests. C-reactive protein and mucoproteins were negative. Serum protein electrophoresis and complement, urinalysis, serum creatinine, creatinine clearance, and 24-hour urine protein were normal. Tests for antineutrophil cytoplasmic antibodies and anti-glomerular-basement membrane antibodies were negative. Tests for connective tissue diseases were all negative. Histological findings were consistent with those of idiopathic pulmonary hemosiderosis. Radiological findings are discussed.

Clinical presentation and salivary gland histopathology of paediatric primary Sjogren's syndrome

ObjectiveExplore the presentation, diagnostic criteria and exocrine gland histopathology of paediatric primary Sjogren's syndrome (PPSjS).MethodsA case series of 8 children is reported and American-European Consensus Group (AECG-2002) criteria were examined, as well as minor labial salivary and lachrymal gland biopsies, which were scored by a pathologist blinded to outcome. For all cases, connective tissue diseases and parotid-related infectious disease were excluded.ResultsAge at onset varied from 5-13 years old; 6 were females, all followed from diagnosis up to the last visit (1-10 years). The main features at presentation were recurrent tender parotid swelling and sialectasis imaging, with decreased salivary function assessed by Tc-99 scintigraphy. Mild sicca symptoms were observed in 4/8 cases. Systemic features, including fatigue, myalgia, arthritis, tenosynovitis, joint contractures, transient Raynaud's and high ESR, were recorded at onset. Autoantibody profile was unremarkable for diagnosis, while lymphocytic infiltration of labial salivary glands and sialectasis were observed in all biopsies (8/8). In lachrymal glands, massive lymphocytic infiltration and lymphocytic gastritis were observed during complementary assessment. Flares were treated with low dose steroids and long-term use of hydroxychloroquine (5/8), although only 318 fulfilled AECG-2002 diagnostic criteria, throughout the disease course.ConclusionPPSjS is rare, slowly progressive and its early presentation is variable. Standardised diagnostic algorithms should include recurrent parotid swelling and early diagnosis should rely mostly on salivary and lachrymal gland histopathology in this age group.

Clinical presentation of tuberculoid leprosy in an epidermodysplasia verruciformis patient

Epidermodysplasia verruciformis (EV) is triggered by a variety of mechanisms that at least partly include genetic background. We present a Brazilian man with a 30-year history of flat, wart-like lesions with clinical, histopathological, and evolutive aspects consistent with papillomavirus (HPV)-associated EV. Histological analysis of the wart lesions showed epidermis with hyperkeratosis, regular acanthosis, hypergranulosis, and cells with abundant basophilic cytoplasm. Moreover, a perivascular lymphocytic infiltrate was found in the superficial dermis, consistent with a viral wart. Type-2-HPV DNA was detected in various fragments of skin-wart lesions using the polymerase chain reaction (PCR). Two years after the EV diagnosis, the patient presented with an anesthetic well-demarcated, erythematous and mildly scaly plaque on his right forearm. A histopathological analysis of this lesion demonstrated the presence of a compact tuberculoid granuloma. Ziehl-Neelsen staining demonstrated the presence of rare acid-fast bacilli and confirmed the tuberculoid leprosy diagnosis. The patient's Mitsuda Intradermal Reaction was positive. To elucidate the possible mechanism involved in this case of EV, we genotyped the HLA genes of this patient. DQB genotyping showed the polymorphic HLA alleles DQB1*0301 and 0501. The patient was treated with a paucibacillary multidrug therapy scheme, and the disease was cured in six months. This report describes an EV patient with an M. leprae infection, confirming that tuberculoid leprosy patients possess a relatively specific and efficient cell-mediated immunity against the bacillus and, therefore, localized forms of the disease. Moreover, we show the possible involvement of the polymorphic HLA alleles DQB1*0301 and 0501 in EV induction mechanisms.

The central repeat domain 1 of Kaposi's sarcoma-associated herpesvirus (KSHV) latency associated-nuclear antigen 1 (LANA1) prevents cis MHC class I peptide presentation

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Autoinflammatory diseases: Mimics of Autoimmunity or part of its spectrum? Case presentation

Introduction: Autoinflammatory diseases are very rare diseases presenting within a wide clinical spectrum. Recognition of the main clinical features are challenging due to overlapping or mimicking with autoimmune diseases. Discussion: A case series is reviewed to illustrate typical and atypical features and the difficulties of these diagnoses in the low prevalence areas-a typical unrecognized case of familial Mediterranean fever (FMF) in a youngster, an atypical adult case with overlapping of IMF with Behcet disease, and an early presentation of FMF in infant presenting with inflammatory colitis, as well as the overlapping features within the cryopirin diseases spectrum in an 8-year-old boy who presented with systemic onset arthritis. Conclusion: These cases may represent examples of a very puzzling relationship among disorders of innate and adaptive immune systems and inflammation.

Late presentation of posterior urethral valve: two case reports

CONTEXTO: Válvula de uretra posterior (VUP) é uma conhecida malformação congênita urinária, geralmente diagnosticada em exames ultra-sonográficos pré-natais ou ao nascimento. Raramente, esta doença pode ser encontrada em adolescentes e em adultos. RELATO DE CASOS: Este artigo mostra dois casos de VUP, encontrados em um adolescente e em um adulto. Ambos apresentavam sinais clínicos de infecção do trato urinário e sintomas obstrutivos infravesicais. Os diagnósticos foram realizados por uretrocistografia miccional e uretrocistoscopia. Fulguração endoscópica das válvulas foi o tratamento de escolha para ambos os casos. O acompanhamento demonstrou melhora importante dos sintomas após o tratamento.