Absence of clinical abnormalities suggesting renal involvement during the long-term course of visceral Leishmaniasis

Abnormalities of renal function have been demonstrated inpatients with visceral leishmaniasis; although there was a trend toward normalization following antiparasitic therapy, some abnormalities persisted. With thepurpose of studying the long- term clinical course of renal involvement in visceral leishmaniasis, 32 patients with a diagnosis of this parasitic disease were evaluated in the endemic area and at least 6 months after the clinical cure of the disease and compared with a control group of 28 individuals. No patient had a history or clinical findings suggestive of renal disease and all were normotensive. Laboratory evaluation was normal in all except 3 patients with abnormal urinalysis. Mild proteinuria and microscopic hematuria were seen in a single urinalysis in one patient (although three other urinalysis were normal), and leucocyturia in two female patients. It was concluded that the renal involvement in visceral leishmaniasis is mild and transient, with normal renal function observed on long-term follow-up after cure of the parasitic infection.

Atherogenesis and atherosclerosis in primary antiphospholipid syndrome

ABSTRACT: In the late seventies the term “Haematological Stress Syndrome” defined some haematological abnormalities appearing in the course of acute and chronic disorders, such as raised plasma levels of fibrinogen (FNG) and factor VIII, reduced fibrinolytic activity and hyperviscosity. In the early nineties the “Membrane stress syndrome hypothesis” proposed the unification of the concepts of haematological stress syndrome with those of oxidation, inflammation and immune activation to explain the pathogenesis of the antiphospholipid syndrome (APS) Antiphospholipid antibodies, coagulation, fibrinolysis and thrombosis. This chapter investigated the occurrence of the “Haematological Stress Syndrome” and thrombosis in 144 participants positive for aPL detected by clotting and immune tests. Among the clotting assays for the detection of lupus anticoagulant, dilute Russell's viper venom time better correlated with a history of venous thrombosis than activated partial thromboplastin time (p<0.0002 vs p<0.009) and was the only test correlated with a history of arterial thrombosis (p<0.01). By regression analysis, serum levels of IgG anticardiolipin antibodies (aCL) associated with the number of venous occlusions (p<0.001). With regards to FNG and von Willebrand factor (vWF), the former rose by 36% (95% CI; 21%, 53%) and the latter by 50% (95% CI; 29%, 75%) at the first venous occlusion and remained unchanged after subsequent occlusions. At variance FNG rose by 45% (95% CI; 31%, 60%) per arterial occlusion and vWF by 27% (95% CI; 10%, 47%) per arterial occlusion throughout. The coagulation/fibrinolytic balance was cross-sectionally evaluated on 18 thrombotic PAPS patients, 18 subjects with persistence of idiopathic aPL and in healthy controls. Markers of thrombin generation prothrombin fragment 1+2 (F1+2), thrombin-antithrombin complex (TAT) and of fibrin turnover D-Dimer (D-D) were higher in thrombotic (p=0.006)and non-thrombotic subjects (p=0.0001) than in controls as were those of D-D (p<0.0001 and p=0.003 respectively). TAT levels did not differ. Gender analysed data revealed blunted tPA release (hence a negative venous occlusion test) in thrombotic females but neither in thrombotic males (p=0.01) nor in asymptomatic subjects of either sex. Also, in both patient groups females had higher mean PAI than males (p<0.0002) and control females (p<0.02). The activity of factor XIII (FXIIIa) was evaluated was evaluated in 29 patients with PAPS, 14 persistent carriers of aPL without thrombosis, 24 thrombotic patients with inherited thrombophilia, 28 healthy controls and 32 patients with mitral and aortic valve prosthesis as controls for FXIII only. FXIIIa was highest in PAPS (p=0.001), particularly in patients with multiple (n=12) than single occlusion (p=0.02) and in correlation with PAI (p=0.003) and FNG (p=0.005). Moreover FXIIIa was strongly associated with IgG aCL and IgG anti-2GPI (p=0.005 for both) in the PAPS group and to a lesser degree in the aPL group (FXIIIa with IgG aCL, p=0.02, with IgG anti-2GPI, p=0.04). Altogether these results indicate: 1) a differential relationship of aPL, vWF and FNG with venous and arterial thrombosis; 2) heightened thrombin generation, accelerated fibrin turnover and fibrinolysis abnormalities also in asymptomatic carriers of aPLs; 3) enhanced FXIIIa that may contribute to atherothrombosis via increased fibrin/fibrinogen cross-linking. Lipid profile, lipid peroxidation and anti-lipoprotein antibodies in thrombotic primary antiphospholipid syndrome. Given the atherogenic lipid profile of SLE, the same possibility was explored in PAPS by comparing high-density lipoprotein (HDL), low-density lipoprotein (LDL), total cholesterol (CHO), apolipoprotein AI (ApoAI), apolipoprotein B (ApoB), triglycerides (TG), anti-lipoprotein antibodies, beta-2-glycoprotein I complexed to oxidized low-density lipoprotein (oxLDL-2GPI) and C-reactive protein (CRP) in 34 thrombotic PAPS patients compared to 36 thrombotic patients with inherited thrombophilia (IT), to 18 subjects persistently positive for antiphospholipid antibodies (aPL) with no underlying autoimmune or non-autoimmune disorders and to 28 healthy controls. Average concentrations of HDL (p<0.0001), LDL (p<0.0001), CHO (p=0.0002), ApoAI (p=0.002) were lower in PAPS whereas average TRY was higher (p=0.01) than other groups. Moreover PAPS showed higher IgG anti-HDL (p=0.01) and IgG anti-ApoAI (p<0.0001) as well as greater average oxLDL-2GPI (p=0.001) and CRP (p=0.003). Within PAPS, IgG anti-HDL correlated negatively to HDL (p=0.004) and was an independent predictor of oxLDL-2GPI (p=0.009). HDL and ApoAI correlated negatively with CRP (p=0.001 and p=0.007, respectively). IgG anti-HDL may hamper the antioxidant and anti-inflammatory effect of HDL favouring low-grade inflammation and enhanced oxidation in thrombotic PAPS. Indeed plasma 8-epi-prostaglandin F2α (a very specific marker of lipid peroxidation) was significantly higher in 10 patients with PAPS than 10 age and sex matched healthy subjects (p=0.0002) and strongly related to the titre of plasma IgG aCL (r=0.89, p=0.0004). Hence oxidative stress, a major player in atherogenesis, also characterises PAPS. Nitric oxide and nitrative stress in thrombotic primary antiphosholipid syndrome. Oxidative stress goes hand in hand with nitrative stress and to address the latter plasma nitrotyrosine (NT, marker of nitrative stress), nitrite (NO2-) and nitrate (NO3-) were measured in 46 thrombotic PAPS patients, 21 asymptomatic but persistent carriers of antiphospholipid antibodies (PCaPL), 38 patients with inherited thrombophilia (IT), 33 patients with systemic lupus erythematosus (SLE) and 29 healthy controls (CTR). Average crude NT was higher in PAPS and SLE (p=0.01) whereas average plasma NO2- was lower in PAPS and average NO3- highest in SLE (p<0.0001). In PAPS, IgG aCL titer and number of vascular occlusions negatively predicted NO2-, (p=0.03 and p=0.001, respectively) whereas arterial occlusions and smoking positively predicted NO3- (p=0.05 and p=0.005). Moreover CRP (an inflammatory marker) positively predicted NT (p=0.004). Nitric oxide metabolites relates to type and number of vascular occlusions and to aPL titers, whereas nitrative stress relates to low grade marker) positively predicted NT (p=0.004). Nitric oxide metabolites relates to type and number of vascular occlusions and to aPL titers, whereas nitrative stress relates to low grade inflammation and both phenomena may have implications for thrombosis and atherosclerosis in PAPS Inflammation and immune activation in thrombotic primary antiphospholipid syndrome. To investigate inflammation and immune activation in thrombotic PAPS high-sensitivity CRP (hs-CRP), serum amyloid A (SAA), oxLDL-2GPI, CRP bound to oxLDL-2GPI (CRP-oxLDL-2GPI) (as inflammatory markers) neopterin (NPT) and soluble CD14 (sCD14) (as immune activation markers) were measured by ELISA in 41 PAPS patients, in 44 patients with inherited thrombophilia (IT) and 39 controls (CTR). Compared to other groups, PAPS presented with higher plasma concentrations of inflammatory, hs-CRP (p=0.0004), SAA (p<0.01), CRP-oxLDL-2GPI (p=0.0004) and immune activation markers, NPT (p<0.0001) and sCD14 (p=0.007). By regression analysis SAA independently predicted thrombosis number (p=0.003) and NPT independently predicted thrombosis type (arterial, p=0.03) and number (p=0.04). These data confirm that low-grade inflammation and immune activation occur and relate to vascular features of PAPS. Antiphosholipid antibodies, haemostatic variables and atherosclerosis in thrombotic primary antiphospholipid syndrome To evaluate whether IgG aCL titre, haemostatic variables and the lipid profile bore any relationship to the intima media thickness (IMT) of carotid arteries high-resolution sonography was applied to the common carotid (CC), carotid bifurcation (CB) and internal carotid (IC) of 42 aPL subjects, 29 with primary thrombotic antiphospholipid syndrome and 13 with persistence of aPL in the absence of any underlying disorder. The following were measured: plasma FNG, vWF, PAI, homocysteine (HC), CHO, TG, HDL, LDL, platelet numbers and aCL of IgG and IgM isotype. By multiple regression analysis, IgG aCL titre independently predicted IMT at all carotid segments examined (p always <0.005). Plasma FNG and HC independently predicted IMT at the CB (p=0.001 and p<0.0001, respectively) and IC (p=0.03 and p<0.0001, respectively). These data strongly support an atherogenic role for IgG aCL in patients with aPL in addition to traditional risk factors. The atherosclerosis hypothesis was investigated in an age and sex-matched case-double-control study including 49 thrombotic PAPS patients (18 M, 31 F, mean age 37 ± 11), 49 thrombotic patients for IT and 49 healthy subjects. Average IMT was always greater in PAPS than control patients (CC: p=0.004, CB: p=0.013, IC: p=0.001). By dividing participants into age tertiles the IMT was greater in the second (CC: p=0.003, CB: p=0.023, IC: p=0.003) and third tertiles (CC: p=0.03, CB: p=0.004, IC: p=0.007). Conclusion: Coagulation activation, fibrinolysis depression, hightened fibrin turnover, oxidative and nitrative stress in parallel with low grade inflammation and immune activation characterise thrombotic PAPS: all these are early atherogenic processes and contribute to the demonstrated premature atherosclerosis that should be considered a clinical feature of PAPS.

Reduction of spleen size in a child with Hyperreactive Malarious Splenomegaly (HMS) treated outside the Brazilian endemic area of malaria with only one course of quinine

We report the clinical picture, treatment and evolution of a child with hyperreactive malarious splenomegaly treated outside the endemic area of malaria. The patient presented gross splenomegaly, proceeded from an area where malaria is endemic, showed increased immunoglobulins levels, high antimalarial antibody titres and hepatic sinusoidal lymphocytosis. The child did not return to an area where malaria is endemic and showed a favorable response to only one course of quinine. The response of this patient to limited antimalarial therapy suggests the importance of reinfection with malaria in the development and maintenance of this syndrome.

Body and transcendence in Virginia Woolf and Clarice Lispector = Corpo e transcendência em Virgínia Woolf e Clarice Lispector

Virginia Woolf and Clarice Lispector belong to quite different historical, political and cultural contexts. Beyond its antecedents and roots in European modernism, Brazilian modernism developed according to peculiar patterns and lines, cultivating, for example, more clearly political, nationalist and regionalist tendencies than happened in the British area. Molly Hite’s essay “Virginia Woolf’s Two Bodies” suggests the existence of two kinds of body represented and perhaps experienced by Virginia Woolf: “one kind was the body for others, the body cast in social roles”, the other, the “visionary body”, a second physical presence, which brings into play new perspectives on the female modernist body and new strategies of political and aesthetic representation. It is this “visionary body”, that, in many moments, intersects with transcendence. These two kinds of body are also present in Clarice Lispector’s work, structured, of course, around other complexities and gradations, explained by a different temporal context, but still touching common seminal questions. In Lispector, it is through the body cast in social roles that you reach the “visionary body” and transcendence. The movement is not a flight, as in Woolf, on the contrary it is a necessity, a condition to get to the essence.

Data-centric concurrency control on the java programming language

Dissertação para obtenção do Grau de Mestre em Engenharia Informática

Maintaining the correctness of transactional memory programs

Dissertação para obtenção do Grau de Doutor em Engenharia Informática

Predictors of an unsatisfactory response to pentavalent antimony in the treatment of American visceral leishmaniasis

Although treatment of visceral leishmaniasis with pentavalent antimony is usually successful, some patients require second-line drug therapy, most commonly with amphotericin B. To identify the clinical characteristics that predict an inadequate response to pentavalent antimony, a case-control study was undertaken in Teresina, Piaui, Brazil. Over a two-year period, there were 19 cases of VL in which the staff physicians of a hospital prescribed second-line therapy with amphotericin B after determining that treatment with pentavalent antimony had failed. The control group consisted of 97 patients that were successfully treated with pentavalent antimony. A chart review using univariate and multivariate analysis was performed. The cure rate was 90% with amphotericin B. The odds ratio for the prescription of amphotericin B was 10.2 for children less than one year old, compared with individuals aged over 10 years. Patients who presented coinfection had an OR of 7.1 while those on antibiotics had an OR of 2.8. These data support either undertaking a longer course of therapy with pentavalent antimony for children or using amphotericin B as a first-line agent for children and individuals with coinfections. It also suggests that chemoprophylaxis directed toward bacterial coinfection in small children with VL may be indicated.

Child programming: an adequate domain specific language for programming specific robots

Dissertação para obtenção do Grau de Mestre em Engenharia Informática

The Impact of Bilingualism on Acquiring Second Language Vocabulary: A Case Study

Trabalho de Projecto apresentado para cumprimento dos requisitos necessários à obtençao do grau de Mestre em Didáctica do Inglês,

The Course of Conflict. A Study in the Thought of Paul Ricoeur

Esta tese leva a cabo uma clarificação conceptual e uma reconstrução histórica da noção de conflito, tal como ela aparece na filosofia. Num primeiro momento, analisa-se o fenómeno do conflito na fonte Grega (em Homero, Heraclito, Platão, nas tragédias gregas e nas formas de interação agonística no espaço público) e na filosofia moderna (principalmente em Kant, Hegel e Marx). Num segundo momento, estabelece-se, nos seus traços gerais, uma cartografia da recuperação desta noção na contemporaneidade através da discussão das contribuições provenientes da teoria crítica (Habermas, Honneth, Hunyadi), da sociologia pragmática (Boltanski, Thévenot) e da filosofia política anglo-saxónica (Rawls, Walzer, Taylor), entre outras. Estas partes iniciais da tese desembocam numa análise aprofundada da obra do filósofo francês Paul Ricoeur e das muitas instanciações do conflito nessa obra, naquilo a que chamo o “percurso do conflito” no pensamento de Ricoeur. Neste “percurso do conflito” o objetivo é duplo: por um lado, provar que o conflito é a pedra de toque não só da filosofia de Ricoeur, mas também de um grande conjunto de outros autores; por outro lado, que é necessário reavaliar o papel desta noção no debate contemporâneo e que nesse contexto a filosofia de Ricoeur e as suas análises finas e plurais podem ser de uma grande utilidade. Assim sendo, este “percurso do conflito” divide-se em três partes, as quais lidam com diferentes tipos de conflito: conflitos “existenciais”, “hermenêuticos” e “práticos”. Ao longo destas partes, várias disciplinas são chamadas à colação, como a hermenêutica, a psicanálise e a filosofia prática (ética, filosofia política e filosofia social), numa tentativa de esclarecer os diferentes fenómenos em causa. Em última instância, chega-se à conclusão que o conflito é inevitável em filosofia, tal como na vida, mas que este não é (pelo menos não em todas as suas formas e instanciações) um fenómeno estritamente negativo; por vezes, os conflitos podem ser criativos e positivos. Porém, aceitar este facto implica igualmente consentir que o reconhecimento dos conflitos está intrinsecamente ligado à busca de soluções para eles, formas de lidar com eles e torná-los criativos e positivos. Para que possa ser compreendido, em traços gerais, como é que estes procedimentos funcionam, esta tese elabora uma tipologia de diferentes tipos de conflito e respetivas formas de lidar com eles, mediando-os, conciliando-os ou, nalguns casos, apenas aceitando a sua existência e mesmo multiplicando-os. A busca da melhor solução tem sempre de ser operada caso a caso. Nas partes finais da tese, e partindo das análises de Ricoeur e dos outro autores apresentadas ao longo da mesma, delineia-se o projeto de uma filosofia social hermenêutica e argumenta-se que aquilo de que precisamos hoje em dia é de uma nova crítica da razão, uma “crítica da razão miserável” que possa repensar o mundo social em novos termos e que, ao fazê-lo, possa evitar os perigos do reducionismo nas suas múltiplas formas.

Towards an algorithmic skeleton framework for programming the Intel R Xeon PhiTM processor

The Intel R Xeon PhiTM is the first processor based on Intel’s MIC (Many Integrated Cores) architecture. It is a co-processor specially tailored for data-parallel computations, whose basic architectural design is similar to the ones of GPUs (Graphics Processing Units), leveraging the use of many integrated low computational cores to perform parallel computations. The main novelty of the MIC architecture, relatively to GPUs, is its compatibility with the Intel x86 architecture. This enables the use of many of the tools commonly available for the parallel programming of x86-based architectures, which may lead to a smaller learning curve. However, programming the Xeon Phi still entails aspects intrinsic to accelerator-based computing, in general, and to the MIC architecture, in particular. In this thesis we advocate the use of algorithmic skeletons for programming the Xeon Phi. Algorithmic skeletons abstract the complexity inherent to parallel programming, hiding details such as resource management, parallel decomposition, inter-execution flow communication, thus removing these concerns from the programmer’s mind. In this context, the goal of the thesis is to lay the foundations for the development of a simple but powerful and efficient skeleton framework for the programming of the Xeon Phi processor. For this purpose we build upon Marrow, an existing framework for the orchestration of OpenCLTM computations in multi-GPU and CPU environments. We extend Marrow to execute both OpenCL and C++ parallel computations on the Xeon Phi. We evaluate the newly developed framework, several well-known benchmarks, like Saxpy and N-Body, will be used to compare, not only its performance to the existing framework when executing on the co-processor, but also to assess the performance on the Xeon Phi versus a multi-GPU environment.

Wind Power in the Portuguese Landscape: Global Concerns and Local Costs

Wind turbines and solar panels are becoming second nature in Portugal, as its occurrence in the country becomes ubiquitous. Somehow, one could argue that renewable energy in Portugal is in the process of ‘naturalisation’ as part of a new – mechanised, but environmentally benign – landscape. Portuguese Institute for the Conservation of Nature and Biodiversity (ICNB) has shown an ambiguous stance on this issue, defending global concerns towards renewable energy, while at the same time attempting to engage locals in the preservation of extensive ‘classified areas’. In the course of this research, we tried to focus on these incongruities and to analyse how they are impacting local communities during the process of wind power installation.

Utopia III or an Ambiguous Humanist Utopia for the Second Millenium

Portuguese literature does not have many examples of successful and renowned utopias, though the considerable amount of published utopias written in foreign languages and translated to Portuguese language being quite relevant. However, in the last quarter of the twentieth century, almost at the eve of the second millennium an important Portuguese utopia was published: Utopia III, written by Pina Martins (1998). This long novel is structured as being the sequel of More’s Utopia, presenting the history and actual status of the mother of all literary utopias. The question at the basis of the whole novel is, “What would More’s Utopia be like today?” The main goal of this text will be to presente a literary analysis of Utopia III, focusing on the humanist principles and their adaptation to contemporary society, the search for a harmonious relationship between city and nature, the defence of a Portuguese identity and the appeal to a humanist renewal.