Effects of Sevelamer Hydrochloride and Calcium Carbonate on Renal Osteodystrophy in Hemodialysis Patients

Disturbances in mineral metabolism play a central role in the development of renal bone disease. In a 54-wk, randomized, open-label study, 119 hemodialysis patients were enrolled to compare the effects of sevelamer hydrochloride and calcium carbonate on bone. Biopsy-proven adynamic bone disease was the most frequent bone abnormality at baseline (59%). Serum phosphorus, calcium, and intact parathyroid hormone were well controlled in both groups, although calcium was consistently lower and intact parathyroid hormone higher among patients who were randomly assigned to sevelamer. Compared with baseline values, there were no changes in mineralization lag time or measures of bone turnover (e.g., activation frequency) after 1 yr in either group. Osteoid thickness significantly increased in both groups, but there was no significant difference between them. Bone formation rate per bone surface, however, significantly increased from baseline only in the sevelamer group (P = 0.019). In addition, of those with abnormal microarchitecture at baseline (i.e., trabecular separation), seven of 10 in the sevelamer group normalized after 1 yr compared with zero of three in the calcium group. In summary, sevelamer resulted in no statistically significant changes in bone turnover or mineralization compared with calcium carbonate, but bone formation increased and trabecular architecture improved with sevelamer. Further studies are required to assess whether these changes affect clinical outcomes, such as rates of fracture.

First report of rabies in vampire bats (Desmodus rotundus) in an urban area, Ubatuba, São Paulo state, Brazil

The purpose of this report is to record the first case of a hematophagous bat (Desmodus rotundus) infected with rabies virus in an urban area in Brazil. To the authors' knowledge, this is the first such case in Latin America. After discovering a bat in his garden at 10 o'clock in the morning, a resident of Ubatuba municipality asked the Zoonosis Control Center team to visit his home. The animal was caught alive on the same day and sent to the Pasteur Institute laboratory, where it was identified as a Desmodus rotundus specimen. Standard tests for rabies diagnosis were carried out (direct immunofluorescence and viral isolation), and the results were positive. The presence of different species of (primarily insectivorous) bats in urban areas represents a serious public health problem. This case, however, is indicative of a much greater risk because the species in question has hematophagous habits, what means this animals has a low energy reserves and, therefore, its need to feed daily.

Does Metabolic Syndrome Predict Significant Angiographic Coronary Artery Disease?

INTRODUCTION: Metabolic syndrome (MS) is an independent predictor of acute cardiovascular events. However, few studies have addressed the relationship between MS and stable angiographic coronary artery disease (CAD), which has a different pathophysiological mechanism. We aimed to study the independent predictors for significant CAD, and to analyze the impact of MS (by the AHA/NHLBI definition) on CAD. METHODS: We prospectively included 300 patients, mean age 64±9 years, 59% male, admitted for elective coronary angiography (suspected ischemic heart disease), excluding patients with known cardiac disease. All patients underwent assessment of demographic, anthropometric, and laboratory data and risk factors, and subsequently underwent coronary angiography. RESULTS: In the study population, 23.0% were diabetic, 40.5% had MS (and no diabetes) and 36.7% had neither diagnosis. Significant CAD was present in 51.3% of patients. CAD patients were older and more frequently male and diabetic, with increased triglycerides and glucose and lower HDL cholesterol. Abdominal obesity was also less prevalent. MS was not associated with the presence of CAD (OR 0.94, 95% CI 0.59-1.48, p=0.778). Of the MS components, the most important predictors of CAD were increased glucose and triglycerides. Abdominal obesity was associated with a lower risk of CAD. In a multivariate logistic regression model for CAD, independent predictors of CAD were age, male gender, glucose and triglycerides. Body mass index had a protective effect. CONCLUSIONS: Although MS is associated with cardiovascular events, the same was not found for stable angiographically proven CAD. Age, gender, diabetes and triglycerides are the most influential factors for CAD, with abdominal obesity as a protective factor.

Sistema de Recomendação: Share GFS Games, Films & Series

Esta dissertação incide sobre o estudo e análise de uma solução para a criação de um sistema de recomendação para uma comunidade de consumidores de media e no consequente desenvolvimento da mesma cujo âmbito inicial engloba consumidores de jogos, filmes e/ou séries, com o intuito de lhes proporcionar a oportunidade de partilharem experiências, bem como manterem um registo das mesmas. Com a informação adquirida, o sistema reúne condições para proceder a sugestões direccionadas a cada membro da comunidade. O sistema actualiza a sua informação mediante as acções e os dados fornecidos pelos membros, bem como pelo seu feedback às sugestões. Esta aprendizagem ao longo do tempo permite que as sugestões do sistema evoluam juntamente com a mudança de preferência dos membros ou se autocorrijam. O sistema toma iniciativa de sugerir mediante determinadas acções, mas também pode ser invocada uma sugestão directamente pelo utilizador, na medida em que este não precisa de esperar por sugestões, podendo pedir ao sistema que as forneça num determinado momento. Nos testes realizados foi possível apurar que o sistema de recomendação desenvolvido forneceu sugestões adequadas a cada utilizador específico, tomando em linha de conta as suas acções prévias. Para além deste facto, o sistema não forneceu qualquer sugestão quando o histórico destas tinha provado incomodar o utilizador.

Envenomation by Micrurus coral snakes in the Brazilian Amazon region: report of two cases

Two cases of proven coral snake bites were reported in Belém, Pará State, Brazil. The first case was a severe one caused by Micrurus surinamensis. The patient required mechanical ventilation due to acute respiratory failure. The second case showed just mild signs of envenomation caused by Micrurus filiformis. Both patients received specific Micrurus antivenom and were discharged without further complications. Coral snake bites are scarcely reported in the Amazon region and there is a broad spectrum of clinical manifestations, varying from extremely mild to those which may rapidly lead to death if the patient is not treated as soon as possible.

Cutaneous sporotrichosis treatment with potassium iodide: a 24 year experience in São Paulo state, Brazil

BACKGROUND: Sporotrichosis is a subacute or chronic disease caused by a dimorphic fungus, Sporothrix schenckii. The first and most traditional treatment is potassium iodide in satured solution (SSKI) used by DE BEURMANN in 1907. For its effectiveness, it is still used for cutaneous sporotrichosis. OBJECTIVE: To evaluate the treatment of cutaneous sporotrichosis with SSKI in relation to clinical cure, side effects, length of treatment and reactivation. METHODS: We conducted a retrospective analysis of medical records over a 24-year period (1981-2005). Patients of all ages who were treated in the hospital´s division of dermatology were included in the study providing that they had a positive culture of S. schenckii. Satured solution of potassium iodide (3 to 6g per day) was the treatment prescribed. For children, half of the dose was prescribed. RESULTS: The lymphocutaneous disease was prevalent, the cure rate was 94.7%, side effects were described in 5.5% of the cases, mean length of treatment was 3.5 months and possible reactivation was observed in 11.1%. CONCLUSION: SSKI is an effective drug, with many side effects, but with low frequency. Resolution was for maximum six months of treatment. SSKI has been found to be a very effective drug in this retrospective study of culture-proven cases of cutaneous and lymphocutaneous sporotrichosis. It should be used as first drug of choice especially in resource-limited settings.

Prognostic Factors in Adult Patients with Idiopathic IgA Nephropathy

Introduction. IgA nephropathy is the dominant primary glomerular disease found throughout the majority of the world’s developed countries. Accurately identifying patients who are at risk of progressive disease is challenging. We aimed to characterise clinical and histological features that predict poor prognosis in adults. Patients and Methods. We performed a single-centre retrospective observational study of biopsy-proven IgA nephropathy. The primary outcome was renal survival and death from any cause, and the secondary outcome was proteinuria remission. Results. Data from 49 cases were available for analysis with a median follow-up of 4 years. There were no deaths. Univariable analyses identified acute renal failure, low estimated glomerular filtration rate for ≥3 months (low eGFR), arterial hypertension, baseline proteinuria, glomerular sclerosis >50% and interstitial fibrosis >50% as poor prognostic markers. Low eGFR persisted significant by multivariable model that used only clinical parameters. Multivariable models with histopathologic parameters observed that tubular atrophy/interstitial fibrosis >50% was independently associated with the primary outcome. Proteinuria remission throughout follow-up had no prognostic value in our revision. Conclusions. Two independent predictors of poor renal survival at time of biopsy were found: low eGFR and tubular atrophy/interstitial fibrosis >50%.

ABO-Incompatible Liver Transplantation in Acute Liver Failure: A Single Portuguese Center Study

INTRODUCTION: ABO-incompatible liver transplantation (ABOi LT) is considered to be a rescue option in emergency transplantation. Herein, we have reported our experience with ABOi LT including long-term survival and major complications in these situations. PATIENT AND METHODS: ABOi LT was performed in cases of severe hepatic failure with imminent death. The standard immunosuppression consisted of basiliximab, corticosteroids, tacrolimus, and mycophenolate mofetil. Pretransplantation patients with anti-ABO titers above 16 underwent plasmapheresis. If the titer was above 128, intravenous immunoglobulin (IVIG) was added at the end of plasmapheresis. The therapeutic approach was based on the clinical situation, hepatic function, and titer evolution. A rapid increase in titer required five consecutive plasmapheresis sessions followed by administration of IVIG, and at the end of the fifth session, rituximab. RESULTS: From January 2009 to July 2012, 10 patients, including 4 men and 6 women of mean age 47.8 years (range, 29 to 64 years), underwent ABOi LT. At a mean follow-up of 19.6 months (range, 2 days to 39 months), 5 patients are alive including 4 with their original grafts. One patient was retransplanted at 9 months. Major complications were infections, which were responsible for 3 deaths due to multiorgan septic failure (2 during the first month); rejection episodes (4 biopsy-proven of humoral rejections in 3 patients and 1 cellular rejection) and biliary. CONCLUSION: The use of ABOi LT as a life-saving procedure is justifiable in emergencies when no other donor is available. With careful recipient selection close monitoring of hemagglutinins and specific immunosuppression we have obtained acceptable outcomes.

O financiamento nas cooperativas

As cooperativas, enquanto entidades pertencentes ao setor da economia social, são organizações com características próprias e distintas das sociedades comerciais, destacando-se o seu escopo mutualístico e o caráter variável do seu capital social, por confronto com o escopo lucrativo e o princípio da conservação do capital social que caraterizam as sociedades. Estas especificidades das cooperativas condicionam a obtenção de meios de financiamento por parte destas. Em virtude do seu caráter variável, o capital social não representa uma garantia para os credores, pelo que serão as reservas, designadamente as reservas obrigatórias, que se apresentarão como o recurso financeiro de melhor qualidade na cooperativa. Nas cooperativas são identificáveis outros instrumentos financeiros, tais como: títulos de investimento e obrigações, os resultados provenientes das operações com terceiros, que são obrigatoriamente afetados a reservas irrepartíveis, os excedentes, os membros investidores, subsídios e benefícios fiscais. Para além da identificação das principais fontes de financiamento, foi ainda objeto de estudo repensar os instrumentos existentes e, eventualmente, a criação de novos instrumentos de financiamento nas cooperativas. Em termos metodológicos, a opção recaiu na conjugação de dois métodos: quantitativo e qualitativo. A técnica da investigação quantitativa selecionada para a recolha de dados, foi a base de dados, e para a investigação qualitativa as técnicas escolhidas foram a análise de conteúdo, a entrevista e o registo áudio. Os resultados da investigação confirmam a indispensabilidade de criação de novos instrumentos de financiamento para as cooperativas. Constatou-se a necessidade de modelos de financiamento que se adaptem à finalidade mutualista da cooperativa. Demonstrou-se que a principal fonte de financiamento são os recursos internos, sob forma de reservas.

Análise das determinantes da e-lealdade no comércio eletrónico

Objetivo – O objetivo deste trabalho é analisar e medir os determinantes da e-lealdade de um cliente no comércio eletrónico em Portugal. Metodologia – Foi realizado um estudo quantitativo empírico confirmatório e explicativo, a partir da identificação de um modelo teórico, suportado pelo levantamento bibliográfico sobre variáveis latentes, suscetível de investigar as relações entre os determinantes da e-lealdade. Os dados foram recolhidos através de um instrumento de medida, disponível online, o qual, permitiu obter uma amostra válida de 394 respondentes. As hipóteses foram testadas através de um modelo de equações estruturais. Resultados e conclusões – Estudaram-se e comprovaram-se a maioria das relações previstas e hipóteses, nomeadamente, a relação positiva das várias dimensões da e-confiança, e-satisfação e da e-qualidade de serviço na e-lealdade. A e-satisfação e a e-qualidade de serviço apresentam, também, um contributo interessante para a e-confiança que os consumidores têm nos produtos/serviços online. Quanto à e-satisfação dos consumidores foi possível verificar que a mesma apresenta uma variação, de acordo com a e-qualidade de serviço e a e-confiança, por parte dos consumidores online. Foi cumprida a validade convergente e discriminante das escalas de medida e a boa qualidade psicométrica das variáveis. Estas evidenciaram bons níveis de correlação e capacidades preditivas. Limitações/implicações – Os resultados obtidos precisam ser analisados com toda a precaução, não podendo ser objeto de generalizações, face ao uso de uma amostra de conveniência. O facto de os inquiridos avaliarem um website que estão já familiarizados pode constituir uma outra limitação. A ausência de estudos nacionais homólogos teve algumas implicações na discussão dos resultados. Originalidade/valor – O principal contributo deste estudo é constituir o primeiro realizado em Portugal, à data, onde se investigou e estimou um modelo proposto sobre os determinantes e antecedentes da e-lealdade no comércio eletrónico.

Long-term biosignals visualization and processing

Thesis submitted in the fulfillment of the requirements for the Degree of Master in Biomedical Engineering

O tratamento jurídico e contabilístico das reservas nas cooperativas

Este estudo pretende aferir a relevância das reservas na estrutura financeira da cooperativa e compará-las com a relevância das reservas numa sociedade comercial, de idêntica estrutura financeira. Para o efeito, depois de uma reflexão sobre o tratamento jurídico e contabilístico das reservas nas cooperativas, procede-se a um estudo empírico, tendo por referência a Cooperativa dos Pedreiros. Tendo em conta um conjunto de vertentes construídas a partir do enquadramento jurídico e contabilístico – constituição e utilização das reservas, as suas finalidades (quer durante a vida das cooperativas quer no momento da dissolução e liquidação do seu património), as funções das reservas, e o seu enquadramento contabilístico, – realizou-se uma entrevista em profundidade e procedeu-se à análise dos Estatutos da Cooperativa dos Pedreiros, com vista a analisar tais vertentes na atividade desenvolvida pela mesma e refletida nos relatórios de contas dos anos 2010, 2011, 2012, 2013 e 2014. Os resultados do estudo confirmam que as reservas nas cooperativas têm um regime jurídico diferente face ao das sociedades comerciais, nomeadamente quanto ao destino da reserva legal, que nas cooperativas se circunscreve à cobertura de perdas, bem como a sua irrepartibilidade entre os cooperadores. Tal diferença é, igualmente, visível quando se estabeleceu o paralelismo entre o regime das reservas na cooperativa e na sociedade comercial. Constata-se que as reservas apresentam maior importância na estrutura financeira da cooperativa do que na sociedade comercial. Por fim, refira-se que o caráter pioneiro deste estudo empírico poderá contribuir para uma futura alteração ao normativo jurídico português aplicável às cooperativas quanto a aspetos particulares do seu regime, destacando-se a importância da contínua dotação das reservas irrepartíveis, nomeadamente da reserva legal.

Projeto de internacionalização de uma microempresa do setor de venda de componentes de elevadores

Trabalho de Projeto de Mestrado apresentado ao Instituto Superior de Contabilidade e Administração do Porto para a obtenção do grau de Mestre em Empreendedorismo e Internacionalização sob orientação da Doutora Celsa Maria Carvalho Machado

Evaluation of different natural ingredients as satiety inductors

Dissertation to obtain a Master’s Degree in Chemical and Biochemical Engineering

MOLECULAR TYPING OF Candida albicans ISOLATES FROM HOSPITALIZED PATIENTS

SUMMARYIntroduction: The majority of nosocomial fungal infections are caused by Candida spp. where C. albicans is the species most commonly identified. Molecular methods are important tools for assessing the origin of the yeasts isolated in hospitals.Methods: This is a study on the genetic profifiles of 39 nosocomial clinical isolates of C. albicans using two typing methods: random amplifified polymorphic DNA (RAPD) and microsatellite, two different primers for each technique were used.Results: RAPD provided 10 and 11 different profiles with values for SAB of 0.84 ± 0.126 and 0.88 ± 0.08 for primers M2 and P4, respectively. Microsatellite using two markers, CDC3 and HIS3, allowed the observation of six and seven different alleles, respectively, with combined discriminatory power of 0.91.Conclusions: Although genetic variability is clear, it was possible to identify high similarity, suggesting a common origin for at least a part of isolates. It is important to emphasize that common origin was proven from yeasts isolated from colonization (urine, catheter or endotracheal secretions) and blood culture from the same patient, indicating that the candidemia must have started from a site of colonization. The combination of RAPD and microsatellite provides a quick and efficient analysis for investigation of similarity among nosocomial isolates of C. albicans.