Obsessive-compulsive symptoms among alcoholics in outpatient treatment: prevalence, severity and correlates

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Epidemiologia molecular do vírus da Hepatite C: análise comparativa de diferentes regiões subgenômicas aplicadas a estudos de associação genética

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Severe distal cytomegalovirus esophagitis with aerodigestive symptoms in an immunocompetent infant

We report a case of an immunocompetent infant, with no evidence of neurological disorders, which developed clinical manifestation of recurrent crisis of choking, dysphagia, laryngeal stridor and sub costal retractions since the first day of life. Direct laryngoscopy was unremarkable. Upper gastrointestinal series showed a dilated tortuous esophagus with severe peristalsis impairment and reflux episodes till the proximal third of the esophagus. An upper gastrointestinal endoscopy showed a moderately dilated esophagus with erosive lesions in the distal esophagus. Esophageal biopsy specimens revealed CMV inclusion bodies associated to moderate inflammation and immunohistochemistry was positive for CMV early antigen. Prolonged 24 h esophageal pH metry was within normal limits. Antiviral therapy with intravenous ganciclovir was introduced and was associated with rapid improvement of the symptoms. Child gradually increased oral intake and weight gain, and there were no side effects related to therapy. Thus, the respiratory symptoms could have been a supra esophageal manifestation of a non-acid reflux disease related to the CMV esophagitis.

Shared Feed as a Means of Deer-to-Deer Transmission of Mycobacterium bovis

To determine the ability of experimentally inoculated white-tailed deer (Odocoileus virginianus) to transmit Mycobacterium bovis to naive deer through the sharing of feed, four deer were intratonsillarly inoculated with 4x105 colony-forming units of M. bovis. On a daily basis, feed not consumed by inoculated deer after approximately 8 hr was offered to four naıve deer maintained in a separate pen, where direct contact, aerosol transmission, or transmission through personnel were prevented. After 150 days, naıve deer were euthanized and examined. All naıve deer had lesions consistent with tuberculosis and M. bovis was isolated from various tissues. The most commonly affected tissues were lung, tracheobronchial lymph nodes, and mediastinal lymph nodes. This study demonstrates the potential for indirect transmission of M. bovis through the sharing of feed. Intentional or unintentional feeding of deer by wildlife or agricultural interests in regions where M. bovis infection is endemic should be avoided because both direct and indirect transmission through sharing of feed are enhanced.

Survivable Lightpath Provisioning in WDM Mesh Networks Under Shared Path Protection and Signal Quality Constraints

This paper addresses the problem of survivable lightpath provisioning in wavelength-division-multiplexing (WDM) mesh networks, taking into consideration optical-layer protection and some realistic optical signal quality constraints. The investigated networks use sparsely placed optical–electrical–optical (O/E/O) modules for regeneration and wavelength conversion. Given a fixed network topology with a number of sparsely placed O/E/O modules and a set of connection requests, a pair of link-disjoint lightpaths is established for each connection. Due to physical impairments and wavelength continuity, both the working and protection lightpaths need to be regenerated at some intermediate nodes to overcome signal quality degradation and wavelength contention. In the present paper, resource-efficient provisioning solutions are achieved with the objective of maximizing resource sharing. The authors propose a resource-sharing scheme that supports three kinds of resource-sharing scenarios, including a conventional wavelength-link sharing scenario, which shares wavelength links between protection lightpaths, and two new scenarios, which share O/E/O modules between protection lightpaths and between working and protection lightpaths. An integer linear programming (ILP)-based solution approach is used to find optimal solutions. The authors also propose a local optimization heuristic approach and a tabu search heuristic approach to solve this problem for real-world, large mesh networks. Numerical results show that our solution approaches work well under a variety of network settings and achieves a high level of resource-sharing rates (over 60% for O/E/O modules and over 30% for wavelength links), which translate into great savings in network costs.

A Load-Balancing Shared-Protection-Path Reconfiguration Approach in WDM Wavelength-Routed Networks

Wavelength-routed networks (WRN) are very promising candidates for next-generation Internet and telecommunication backbones. In such a network, optical-layer protection is of paramount importance due to the risk of losing large amounts of data under a failure. To protect the network against this risk, service providers usually provide a pair of risk-independent working and protection paths for each optical connection. However, the investment made for the optical-layer protection increases network cost. To reduce the capital expenditure, service providers need to efficiently utilize their network resources. Among all the existing approaches, shared-path protection has proven to be practical and cost-efficient [1]. In shared-path protection, several protection paths can share a wavelength on a fiber link if their working paths are risk-independent. In real-world networks, provisioning is usually implemented without the knowledge of future network resource utilization status. As the network changes with the addition and deletion of connections, the network utilization will become sub-optimal. Reconfiguration, which is referred to as the method of re-provisioning the existing connections, is an attractive solution to fill in the gap between the current network utilization and its optimal value [2]. In this paper, we propose a new shared-protection-path reconfiguration approach. Unlike some of previous reconfiguration approaches that alter the working paths, our approach only changes protection paths, and hence does not interfere with the ongoing services on the working paths, and is therefore risk-free. Previous studies have verified the benefits arising from the reconfiguration of existing connections [2] [3] [4]. Most of them are aimed at minimizing the total used wavelength-links or ports. However, this objective does not directly relate to cost saving because minimizing the total network resource consumption does not necessarily maximize the capability of accommodating future connections. As a result, service providers may still need to pay for early network upgrades. Alternatively, our proposed shared-protection-path reconfiguration approach is based on a load-balancing objective, which minimizes the network load distribution vector (LDV, see Section 2). This new objective is designed to postpone network upgrades, thus bringing extra cost savings to service providers. In other words, by using the new objective, service providers can establish as many connections as possible before network upgrades, resulting in increased revenue. We develop a heuristic load-balancing (LB) reconfiguration approach based on this new objective and compare its performance with an approach previously introduced in [2] and [4], whose objective is minimizing the total network resource consumption.

A Heuristic with Bounded Guarantee to Compute Diverse Paths under Shared Protection in WDM Mesh Networks

Establishing a fault-tolerant connection in a network involves computation of diverse working and protection paths. The Shared Risk Link Group (SRLG) [1] concept is used to model several types of failure conditions such as link, node, fiber conduit, etc. In this work we focus on the problem of computing optimal SRLG/link diverse paths under shared protection. Shared protection technique improves network resource utilization by allowing protection paths of multiple connections to share resources. In this work we propose an iterative heuristic for computing SRLG/link diverse paths. We present a method to calculate a quantitative measure that provides a bounded guarantee on the optimality of the diverse paths computed by the heuristic. The experimental results on computing link diverse paths show that our proposed heuristic is efficient in terms of number of iterations required (time taken) to compute diverse paths when compared to other previously proposed heuristics.

Survivable Virtual Topology Routing under Shared Risk Link Groups in WDM Networks

Network survivability is one of the most important issues in the design of optical WDM networks. In this work we study the problem of survivable routing of a virtual topology on a physical topology with Shared Risk Link Groups (SRLG). The survivable virtual topology routing problem against single-link failures in the physical topology is proved to be NP-complete in [1]. We prove that survivable virtual topology routing problem against SRLG/node failures is also NP-complete. We present an improved integer linear programming (ILP) formulation (in comparison to [1]) for computing the survivable routing under SRLG/node failures. Using an ILP solver, we computed the survivable virtual topology routing against link and SRLG failures for small and medium sized networks efficiently. As even our improved ILP formulation becomes intractable for large networks, we present a congestion-based heuristic and a tabu search heuristic (which uses the congestion-based heuristic solution as the initial solution) for computing survivable routing of a virtual topology. Our experimental results show that tabu search heuristic coupled with the congestion based heuristic (used as initial solution) provides fast and near-optimal solutions.

The Quality of Spousal Social Support as a Moderator of the Associations Between Child Maltreatment Severity and Adult Trauma Symptoms

Child maltreatment has been linked to a myriad of long-term difficulties, including trauma symptomatology. However, not all victims experience long-term distress. Thus, a burgeoning area of research focuses on factors that may impede or facilitate resiliency to the psychological correlates of child maltreatment. Specifically, the severity of the abusive acts may be associated with greater long-term difficulties. To date, however, with the exception of child sexual abuse, few studies have examined the severity of maltreatment as a risk factor in the development of trauma symptoms. In contrast, social support has been theorized to contribute to resiliency following abuse. However, to date, the majority of studies examining positive social support as a protective factor have relied on self-report measures of perceived social support, rather than observational measures of received social support. Moreover, no study to date has examined the role that negative social support (i.e, blaming, criticizing) may play in potentiating trauma symptoms among victims of child maltreatment. Because child maltreatment involves serious boundary violations by a trusted person, a marital relationship is an important domain in which to examine these constructs. That is, it may serve as an arena for the manifestation of psychological disturbances related to maltreatment. Thus, the present study examined whether observationally measured positive and negative spousal social support moderated the relationship between child maltreatment severity (i.e., sexual, physical, psychological abuse; neglect) and trauma symptomatology in women and men. Results indicated that the severity of each type of child maltreatment significantly predicted increased adult trauma symptomatology. Contrary to hypothesized outcomes, positive spousal social support did not predict decreased trauma symptomatology. However, negative spousal social support generally did predict increased trauma symptomatology. There were no consistent patterns of interactions between child maltreatment severity and either type of social support. Future directions for research will be discussed and clinical implications with regard to the intrapersonal and interpersonal functioning of child maltreatment victims will be highlighted.

Behavior problems and prevalence of asthma symptoms among Brazilian children

Objective: Asthma is the most common chronic disease in childhood and has been designated a public health problem due to the increase in its prevalence in recent decades, the amount of health service expenditure it absorbs and an absence of consensus about its etiology. The relationships among psychosocial factors and the occurrence, symptomatology, and severity of asthma have recently been considered. There is still controversy about the association between asthma and a child`s mental health, since the pathways through which this relationship is established are complex and not well researched. This study aims to investigate whether behavior problems are associated with the prevalence of asthma symptoms in a large urban center in Latin America. Methods: It is a cross-section study of 869 children between 6 and 12 years old, residents of Salvador, Brazil. The International Study of Allergy and Asthma in Childhood (ISAAC) instrument was used to evaluate prevalence of asthma symptoms. The Child Behavior Checklist (CBCL) was employed to evaluate behavioral problems. Results: 19.26% (n = 212) of the children presented symptoms of asthma. 35% were classified as having clinical behavioral problems. Poisson`s robust regression model demonstrated a statistically significant association between the presence of behavioral problems and asthma symptoms occurrence (PR: 1.43; 95% Cl: 1.10-1.85). Conclusion: These results suggest an association between behavioral problems and pediatric asthma, and support the inclusion of mental health care in the provision of services for asthma morbidity. (C) 2011 Elsevier Inc. All rights reserved.

Dyspeptic symptoms and delayed gastric emptying of solids in patients with inactive Crohn's disease

Background: Patients with Crohn's disease (CD) have been shown to present dyspeptic symptoms more frequently than the general population. Some of these symptoms could be related to motility disorders to some degree. Then, we propose to investigate whether gastric emptying of solids in patients with inactive CD is delayed and to determine the relationships between gastric emptying and dyspeptic symptoms in inactive CD. Methods: Twenty-six patients with inactive Crohn's disease, as defined by a Crohn's Disease Activity Index (CDAI) < 150, underwent a gastric emptying test by breath test using C-13 octanoic acid coupled to a solid meal and answered a validated questionnaire (The Porto Alegre Dyspeptic Symptoms Questionnaire) to assess dyspeptic symptoms. Patients with scores >= 6 were considered to have dyspepsia. The control group was composed by 19 age-and sex-matched healthy volunteers. Results: Patients with CD had a significantly longer t 1/2 and t lag (p<0.05) than the controls. CD patients with dyspepsia had significantly (p<0.05) prolonged gastric emptying when compared to patients without dyspeptic symptoms. When the individual symptom patterns were analyzed, only vomiting was significantly associated with delayed gastric emptying (p<0.05). There was no difference between the subgroups of patients with respect to gender, CDAI scores, disease location, clinical behavior (obstructive/obstructive) or previous gastrointestinal surgery. Conclusion: Delayed gastric emptying in inactive Crohn's disease patients seems to be associated with dyspeptic symptoms, particularly vomiting, even without any evidence of gastrointestinal obstruction.

DEFICIENCY SYMPTOMS AND UPTAKE OF MICRONUTRIENTS BY CASTOR BEAN GROWN IN NUTRIENT SOLUTION

Castor bean is a nutrient-demanding species, but there is still little information on its micronutrient requirements. The objectives of this study were to evaluate the effects of levels of B (2.5, 12.5 and 25.0 mu mol L-1), Cu (0.05, 0.25 and 0.50 mu mol L-1), Mn (0.2, 1.0 and 2.0 mu mol L-1) and Zn (0.2, 1.0 and 2.0 mu mol L-1) in a nutrient solution on plant B, Cu, Mn and Zn concentrations and uptake, vegetative growth and fruit yield of castor bean "Iris", grown in greenhouse. The experiment was arranged in a completely randomized block design with three replicates. The first deficiency symptoms were observed for B, followed by Zn, Cu and Mn. The main changes in the cell ultrastructure due to lack of B were thickening of the cell walls and middle lamellae, distorted chloroplasts and tightly stacked thylakoids, besides the absence of starch grains. The Mn, Zn and Cu deficiencies led to disruption of chloroplasts, disintegration of thylakoids and absence of amyloplasts. The concentration and uptake of B, Cu, Mn, and Zn in castor bean plants increased with micronutrient supply in the solution. Fruit yield was drastically reduced by B and Mn deficiencies. On the other hand, the dry matter yield of the shoot and root of castor bean plants was not. In the treatment with full nutrient solution, the leaves accumulated 56 and 48 % of the total B and Mn taken up by the plants, respectively, and the seeds and roots 85 and 61 % of the total Cu and Zn taken up, respectively. This shows the high demand of castor bean Iris for B and Mn for fruit yield.

Respiratory rehabilitation: a physiotherapy approach to the control of asthma symptoms and anxiety

OBJECTIVES: The objectives of this study were to verify the degree of anxiety, respiratory distress, and health-related quality of life in a group of asthmatic patients who have experienced previous panic attacks. Additionally, we evaluated if a respiratory physiotherapy program (breathing retraining) improved both asthma and panic disorder symptoms, resulting in an improvement in the health-related quality of life of asthmatics. METHODS: Asthmatic individuals were assigned to a chest physiotherapy group that included a breathing retraining program held once a week for three months or a paired control group that included a Subtle Touch program. All patients were assessed using the Diagnostic and Statistical Manual of Mental Disorders IV, the Sheehan Anxiety Scale, the Quality of Life Questionnaire, and spirometry parameter measurements. RESULTS: Both groups had high marks for panic disorder and agoraphobia, which limited their quality of life. The Breathing Retraining Group program improved the clinical control of asthma, reduced panic symptoms and agoraphobia, decreased patient scores on the Sheehan Anxiety Scale, and improved their quality of life. Spirometry parameters were unchanged. CONCLUSION: Breathing retraining improves the clinical control of asthma and anxiety symptoms and the health-related quality of life in asthmatic patients.

Minocycline benefits negative symptoms in early schizophrenia: a randomised double-blind placebo-controlled clinical trial in patients on standard treatment

The onset and early course of schizophrenia is associated with subtle loss of grey matter which may be responsible for the evolution and persistence of symptoms such as apathy, emotional blunting, and social withdrawal. Such 'negative' symptoms are unaffected by current antipsychotic therapies. There is evidence that the antibiotic minocycline has neuroprotective properties. We investigated whether the addition of minocycline to treatment as usual (TAU) for 1 year in early psychosis would reduce negative symptoms compared with placebo. In total, 144 participants within 5 years of first onset in Brazil and Pakistan were randomised to receive TAU plus placebo or minocycline. The primary outcome measures were the negative and positive syndrome ratings using the Positive and Negative Syndrome Scale. Some 94 patients completed the trial. The mean improvement in negative symptoms for the minocycline group was 9.2 and in the placebo group 4.7, an adjusted difference of 3.53 (s.e. 1.01) 95% CI: 1.55, 5.51; p < 0.001 in the intention-to-treat population. The effect was present in both countries. The addition of minocycline to TAU early in the course of schizophrenia predominantly improves negative symptoms. Whether this is mediated by neuroprotective, anti-inflammatory or others actions is under investigation.

Symptoms of depression in patients with cancer of the head and neck undergoing radiotherapy treatment: a prospective study

This study aimed to investigate the frequency of symptoms of depression in patients with cancer of the head and neck undergoing radiotherapy treatment, in the initial, middle and final stages of the treatment. This is a prospective exploratory quantitative study of 41 patients with head and neck cancer, undergoing radiotherapy treatment in the Oncology Outpatient Clinic of the Beneficencia Portuguese Hospital of Ribeirao Preto. Data were collected through the Beck Depression Inventory instrument, and analyzed quantitatively by means of the Statistical Package for the Social Sciences. Symptoms of dysphoria were found to increase throughout the treatment, as well as the number of patients with depression. The results show the importance for the healthcare professionals to detect the prevalence and the levels of the symptoms of depression, since these symptoms tend to increase and may lead to consequences such as a lack of adherence to treatment and a decrease in the quality of life of these patients.