Comparação de dois protocolos de reabilitação após reconstrução cirúrgica do ligamento cruzado anterior

Mestrado em Fisioterapia

A importância da espirometria na deteção precoce de alterações ventilatórias obstrutivas em adultos

Mestrado em Gestão e Avaliação de Tecnologias em Saúde

Pine processionary moth (Thaumetopoea pityocampa) and great tit (Parus major) in Portugal

In the present work, we studied a common outbreaking Lepidoptera species in Portuguese pine stands – Thaumetopoea pityocampa (Den. & Schiff.) - and one of its potential predators – Parus major (L.). The population dynamics of the immature stages of the Lepidoptera was studied in several types of Pinus pinaster (Aiton) plantations in three different areas: Setúbal Peninsula, Abrantes and National Pine Forest of Leiria. Location and plantation structure was the most important factors determining population density of T. pityocampa. Setubal and Abrantes was highly susceptible to attacks by the Lepidoptera, whereas Leiria had lower densities. Young and homogeneous pine stands was more susceptible to attacks than older and more heterogeneous pines stands. However, a desynchronized population of T. pityocampa, in which the larvae develops during summer instead of during winter, reached high densities also in Leiria. The impact of several mortality factors and climatic conditions on the immature stages of the insect (eggs and larvae), in normal and desynchronized populations are discussed, as well as possible evolutionary implications of the sudden appearance of the new version of T. pityocampa. The break of the pupa diapause and adult emergence times the annual life cycle of this insect. Adults from the desynchronized population emerged earlier than adults from the normal population, which in turn determined the change in the larvae development period. Different factors, potentially affecting the timing of adult emergence in both normal and abnormal populations are also discussed. To study P. Major, nest-boxes were placed in the areas of Setúbal and Leiria and they were monitored during three seasons. The nest-boxes increased the density of breeding and wintering birds in the studied pine plantations, indicating that a lack of natural holes are in fact a limiting factor for this populations. The earliest breeding start for this species was recorded in my study area, indicating that Portuguese coastal pines provide good breeding conditions earlier than in other areas of Europe and North Africa. This leads to an overlap between the end of the larvae stage of T. pityocampa and the beginning of the breeding season of P. major. Key-words: Thaumetopoea pityocampa, Parus major, Pinus pinaster, population dynamics, Portugal.

Memória de longo prazo nos retornos acionistas dos índices de referência da euronext, implicações para a hipótese de mercados eficientes e contributo fractal para aperfeiçoamento do capital asset pricing model

Não existe uma definição única de processo de memória de longo prazo. Esse processo é geralmente definido como uma série que possui um correlograma decaindo lentamente ou um espectro infinito de frequência zero. Também se refere que uma série com tal propriedade é caracterizada pela dependência a longo prazo e por não periódicos ciclos longos, ou que essa característica descreve a estrutura de correlação de uma série de longos desfasamentos ou que é convencionalmente expressa em termos do declínio da lei-potência da função auto-covariância. O interesse crescente da investigação internacional no aprofundamento do tema é justificado pela procura de um melhor entendimento da natureza dinâmica das séries temporais dos preços dos ativos financeiros. Em primeiro lugar, a falta de consistência entre os resultados reclama novos estudos e a utilização de várias metodologias complementares. Em segundo lugar, a confirmação de processos de memória longa tem implicações relevantes ao nível da (1) modelação teórica e econométrica (i.e., dos modelos martingale de preços e das regras técnicas de negociação), (2) dos testes estatísticos aos modelos de equilíbrio e avaliação, (3) das decisões ótimas de consumo / poupança e de portefólio e (4) da medição de eficiência e racionalidade. Em terceiro lugar, ainda permanecem questões científicas empíricas sobre a identificação do modelo geral teórico de mercado mais adequado para modelar a difusão das séries. Em quarto lugar, aos reguladores e gestores de risco importa saber se existem mercados persistentes e, por isso, ineficientes, que, portanto, possam produzir retornos anormais. O objetivo do trabalho de investigação da dissertação é duplo. Por um lado, pretende proporcionar conhecimento adicional para o debate da memória de longo prazo, debruçando-se sobre o comportamento das séries diárias de retornos dos principais índices acionistas da EURONEXT. Por outro lado, pretende contribuir para o aperfeiçoamento do capital asset pricing model CAPM, considerando uma medida de risco alternativa capaz de ultrapassar os constrangimentos da hipótese de mercado eficiente EMH na presença de séries financeiras com processos sem incrementos independentes e identicamente distribuídos (i.i.d.). O estudo empírico indica a possibilidade de utilização alternativa das obrigações do tesouro (OT’s) com maturidade de longo prazo no cálculo dos retornos do mercado, dado que o seu comportamento nos mercados de dívida soberana reflete a confiança dos investidores nas condições financeiras dos Estados e mede a forma como avaliam as respetiva economias com base no desempenho da generalidade dos seus ativos. Embora o modelo de difusão de preços definido pelo movimento Browniano geométrico gBm alegue proporcionar um bom ajustamento das séries temporais financeiras, os seus pressupostos de normalidade, estacionariedade e independência das inovações residuais são adulterados pelos dados empíricos analisados. Por isso, na procura de evidências sobre a propriedade de memória longa nos mercados recorre-se à rescaled-range analysis R/S e à detrended fluctuation analysis DFA, sob abordagem do movimento Browniano fracionário fBm, para estimar o expoente Hurst H em relação às séries de dados completas e para calcular o expoente Hurst “local” H t em janelas móveis. Complementarmente, são realizados testes estatísticos de hipóteses através do rescaled-range tests R/S , do modified rescaled-range test M - R/S e do fractional differencing test GPH. Em termos de uma conclusão única a partir de todos os métodos sobre a natureza da dependência para o mercado acionista em geral, os resultados empíricos são inconclusivos. Isso quer dizer que o grau de memória de longo prazo e, assim, qualquer classificação, depende de cada mercado particular. No entanto, os resultados gerais maioritariamente positivos suportam a presença de memória longa, sob a forma de persistência, nos retornos acionistas da Bélgica, Holanda e Portugal. Isto sugere que estes mercados estão mais sujeitos a maior previsibilidade (“efeito José”), mas também a tendências que podem ser inesperadamente interrompidas por descontinuidades (“efeito Noé”), e, por isso, tendem a ser mais arriscados para negociar. Apesar da evidência de dinâmica fractal ter suporte estatístico fraco, em sintonia com a maior parte dos estudos internacionais, refuta a hipótese de passeio aleatório com incrementos i.i.d., que é a base da EMH na sua forma fraca. Atendendo a isso, propõem-se contributos para aperfeiçoamento do CAPM, através da proposta de uma nova fractal capital market line FCML e de uma nova fractal security market line FSML. A nova proposta sugere que o elemento de risco (para o mercado e para um ativo) seja dado pelo expoente H de Hurst para desfasamentos de longo prazo dos retornos acionistas. O expoente H mede o grau de memória de longo prazo nos índices acionistas, quer quando as séries de retornos seguem um processo i.i.d. não correlacionado, descrito pelo gBm(em que H = 0,5 , confirmando- se a EMH e adequando-se o CAPM), quer quando seguem um processo com dependência estatística, descrito pelo fBm(em que H é diferente de 0,5, rejeitando-se a EMH e desadequando-se o CAPM). A vantagem da FCML e da FSML é que a medida de memória de longo prazo, definida por H, é a referência adequada para traduzir o risco em modelos que possam ser aplicados a séries de dados que sigam processos i.i.d. e processos com dependência não linear. Então, estas formulações contemplam a EMH como um caso particular possível.

Efficient computation of min and max sensor values in multihop networks

Consider a wireless sensor network (WSN) where a broadcast from a sensor node does not reach all sensor nodes in the network; such networks are often called multihop networks. Sensor nodes take individual sensor readings, however, in many cases, it is relevant to compute aggregated quantities of these readings. In fact, the minimum and maximum of all sensor readings at an instant are often interesting because they indicate abnormal behavior, for example if the maximum temperature is very high then it may be that a fire has broken out. In this context, we propose an algorithm for computing the min or max of sensor readings in a multihop network. This algorithm has the particularly interesting property of having a time complexity that does not depend on the number of sensor nodes; only the network diameter and the range of the value domain of sensor readings matter.

Exploiting a prioritized MAC protocol to efficiently compute min and max in multihop networks

Consider a wireless sensor network (WSN) where a broadcast from a sensor node does not reach all sensor nodes in the network; such networks are often called multihop networks. Sensor nodes take sensor readings but individual sensor readings are not very important. It is important however to compute aggregated quantities of these sensor readings. The minimum and maximum of all sensor readings at an instant are often interesting because they indicate abnormal behavior, for example if the maximum temperature is very high then it may be that a fire has broken out. We propose an algorithm for computing the min or max of sensor reading in a multihop network. This algorithm has the particularly interesting property of having a time complexity that does not depend on the number of sensor nodes; only the network diameter and the range of the value domain of sensor readings matter.

Estrabismo, acuidade visual e erro refrativo não corrigido na criança em idade escolar

Preventable visual loss in children is an important public health problem. The critical period of susceptibility to deprivation or abnormal visual experience has been identified since the early 1970s. Preventable visual loss caused by amblyopia (0.3%–4%) and its risk factors such as strabismus (2.1%–4.6%) and uncorrected refractive errors (5%–7.7%) represent an important public health problem. Thus the primary justification for preschool vision screening is the detection of amblyopia or amblyogenic refractive, strabismic, or ocular disease conditions. However in Portugal there has been little investigation regarding prevalence of visual anomalies among school-age children. Data on the prevalence are lacking but are needed for planning vision services. Aims: 1) Determine the prevalence of strabismus; 2) Determine the prevalence of decreased visual acuity; 3) Determine the prevalence of uncorrected refractive error.

Human biomonitoring: biomarkers, susceptibility, and nutrigenetics

The methods of molecular biology applied in epidemiological research lead us to the realm of molecular epidemiology, where there is immense potential for the establishment of associations between cancer and exposure to risk factors in lifestyle, profession, or pollution. Human biomonitoring consists, on the one hand, in research and identification of hazardous environmental conditions and, on the other hand, in the assessment of cancer risk following exposure to such conditions. Since carcinogenesis is a lengthy process, the biomarkers used to recognize biological abnormalities are selected and developed in the realm of molecular epidemiology. Such biomarkers are quantifiable and allow for the recognition of progression from normal to abnormal biological conditions at the molecular level. They can be categorized in biomarkers of exposure, effect, and genetic susceptibility. Genotoxicity biomarkers are a particular subset of effect biomarkers and are used to assess genomic instability caused by environmental or occupational exposure, being considered useful carcinogenesis predictors.

Tratamento da cisticercose subcutânea co praziquantel: um novo agente cestoidicida

Twenty adult patients presenting dermal cysticercosis without cerebral or ocular involvement were treated with praziquantel. The first eleven cases received 60 mg/kg/day and the last nine cases 30 mg/kg/day. In both groups the daily dose was split into three oral intakes 4 to 6 hours apart and the drug administration lasted for 6 consecutive days. The latter group of patients also got dexamethasone, 3 mg daily, from one day before until four days after the treatment period with praziquantel. The drug proved to be 100% efficacious as demonstrated histopathologically by the death of the cysticerci of Taenia solium (Cysticercus cellulosae) in serial biopsies taken from the 2nd week on after the end of treatment, as well as clinically by the steady disappearence of the dermal nodules during the 6 months following the therapy. Tolerance of praziquantel was good as the incidence and severity of side-effects were not relevant. The drug safety was confirmed through laboratory tests which failed to detect any abnormal findings related to the hematopoietic, liver and kidney functions.

The resting electrocardiogram of t. cruzi-infected rats

A total of 125 rats were infected with the Colômbia strain of T. cruzi (2000 parasites/g) shortly after weaning. Of these, 58 survived the acute phase and were used in the present experiment. Twenty eight similar but not infected rats served as controls. All rats were submitted to the resting ECG When they were 6 months old. Classic and 3 precordial leads were employed in order to record the ECG as completely as possible. Electrocardiographic changes similar to those found in human chronic Chagas' heart disease and not previously described in this model were found in 44% of the T. cruzi-infected rats: left axis deviation (22%), right axis deviation (7%), lengthened and bizarre QRS complex (14%) and abnormal J point elevation (3%). On the basis of these results, we believe that the resting ECG constitutes a valuable tool for studying experimental chronic Chagas' heart disease in rats.

Hypoprothrombinemia in the compensated form of hepatosplenic schistosomiasis: further studies

Coagulation abnormality is frequently observed in schistosomiasis patients but its pathophysiology has not been established. We measured, by immunodiffusion. the prothrombin-antigen concentration in 56 individuals; of these 19 with demonstrated compensated form of hepatosplenic schistosomiasis, 17 with cirrhosis and 20 were control subjects. Transaminases, albumin, transthyretin, prothrombin time, antithrombin III, factor VII, and fibrinogen were also evaluated. All parameters were altered in the cirrhotic group but only albumin, prothrombin and antithrombin III levels were altered in the schistosomiasis group. Ninety percent of the patients with cirrhosis and sixty percent of the patients with schistosomiasis had abnormal plasma levels of albumin, transthyretin, prothrombin-antigen, and/or antithrombin III; an impaired hepatic synthesis was responsible for these results. Conversely forty percent of the schistosomiasis patients with normal plasma concentrations of both albumin and transthyretin had decreased mean plasma levels of both prothrombin and antithrombin III. These results suggest that either proth rombin and antithrombin III are more sensitive markers of impaired hepatic synthesis in schistosomiasis than are levels of albumin and transthyretin combined, or a low grade chronic consumption of clotting proteins also occurs. Considering the latter hypothesis it is possible that the thrombin formed would be inhibited by antithrombin III with the complexed thrombin-antithrombin III being cleared by the liver. Consequently the plasma levels of both prothrombin and antithrombin would be decreased, but the level of fibrinogen would be preserved.

18F-FDG measurement in primary lung cancer: SUV normalization to different distribution volumes

Introduction: Standard Uptake Value (SUV) is a measurement of the uptake in a tumour normalized on the basis of a distribution volume and is used to quantify 18F-Fluorodeoxiglucose (FDG) uptake in tumors, such as primary lung tumor. Several sources of error can affect its accuracy. Normalization can be based on body weight, body surface area (BSA) and lean body mass (LBM). The aim of this study is to compare the influence of 3 normalization volumes in the calculation of SUV: body weight (SUVW), BSA (SUVBSA) and LBM (SUVLBM), with and without glucose correction, in patients with known primary lung tumor. The correlation between SUV and weight, height, blood glucose level, injected activity and time between injection and image acquisition is evaluated. Methods: Sample included 30 subjects (8 female and 22 male) with primary lung tumor, with clinical indication for 18F-FDG Positron Emission Tomography (PET). Images were acquired on a Siemens Biography according to the department’s protocol. Maximum pixel SUVW was obtained for abnormal uptake focus through semiautomatic VOI with Quantification 3D isocontour (threshold 2.5). The concentration of radioactivity (kBq/ml) was obtained from SUVW, SUVBSA, SUVLBM and the glucose corrected SUV were mathematically obtained. Results: Statistically significant differences between SUVW, SUVBSA and SUVLBM and between SUVWgluc, SUVBSAgluc and SUVLBMgluc were observed (p=0.000<0.05). The blood glucose level showed significant positive correlations with SUVW (r=0.371; p=0.043) and SUVLBM (r=0.389; p=0.034). SUVBSA showed independence of variations with the blood glucose level. Conclusion: The measurement of a radiopharmaceutical tumor uptake normalized on the basis of different distribution volumes is still variable. Further investigation on this subject is recommended.

Influência da experiência profissional e da função visual do operador no processamento semiautomático da cintigrafia de perfusão do miocárdio: variabilidade intra e interoperador na determinação dos parâmetros quantitativos

Introdução – A cintigrafia de perfusão do miocárdio (CPM) desempenha um importante papel no diagnóstico, avaliação e seguimento de pacientes com doença arterial coronária, sendo o seu processamento realizado maioritariamente de forma semiautomática. Uma vez que o desempenho dos técnicos de medicina nuclear (TMN) pode ser afetado por fatores individuais e ambientais, diferentes profissionais que processem os mesmos dados poderão obter diferentes estimativas dos parâmetros quantitativos (PQ). Objetivo – Avaliar a influência da experiência profissional e da função visual no processamento semiautomático da CPM. Analisar a variabilidade intra e interoperador na determinação dos PQ funcionais e de perfusão. Metodologia – Selecionou-se uma amostra de 20 TMN divididos em dois grupos, de acordo com a sua experiência no software Quantitative Gated SPECTTM: Grupo A (GA) – TMN ≥600h de experiência e Grupo B (GB) – TMN sem experiência. Submeteram-se os TMN a uma avaliação ortóptica e ao processamento de 21 CPM, cinco vezes, não consecutivas. Considerou-se uma visão alterada quando pelo menos um parâmetro da função visual se encontrava anormal. Para avaliar a repetibilidade e a reprodutibilidade recorreu-se à determinação dos coeficientes de variação, %. Na comparação dos PQ entre operadores, e para a análise do desempenho entre o GA e GB, aplicou-se o Teste de Friedman e de Wilcoxon, respetivamente, considerando o processamento das mesmas CPM. Para a comparação de TMN com visão normal e alterada na determinação dos PQ utilizou-se o Teste Mann-Whitney e para avaliar a influência da visão para cada PQ recorreu-se ao coeficiente de associação ETA. Diferenças estatisticamente significativas foram assumidas ao nível de significância de 5%. Resultados e Discussão – Verificou-se uma reduzida variabilidade intra (<6,59%) e inter (<5,07%) operador. O GB demonstrou ser o mais discrepante na determinação dos PQ, sendo a parede septal (PS) o único PQ que apresentou diferenças estatisticamente significativas (zw=-2,051, p=0,040), em detrimento do GA. No que se refere à influência da função visual foram detetadas diferenças estatisticamente significativas apenas na fração de ejeção do ventrículo esquerdo (FEVE) (U=11,5, p=0,012) entre TMN com visão normal e alterada, contribuindo a visão em 33,99% para a sua variação. Denotaram-se mais diferenças nos PQ obtidos em TMN que apresentam uma maior incidência de sintomatologia ocular e uma visão binocular diminuída. A FEVE demonstrou ser o parâmetro mais consistente entre operadores (1,86%). Conclusão – A CPM apresenta-se como uma técnica repetível e reprodutível, independente do operador. Verificou-se influência da experiência profissional e da função visual no processamento semiautomático da CPM, nos PQ PS e FEVE, respetivamente.

Auditory event-related potentials in children with benign epilepsy with centro-temporal spikes

Benign focal epilepsy in childhood with centro-temporal spikes (BECTS) is one of the most common forms of idiopathic epilepsy, with onset from age 3 to 14 years. Although the prognosis for children with BECTS is excellent, some studies have revealed neuropsychological deficits in many domains, including language. Auditory event-related potentials (AERPs) reflect activation of different neuronal populations and are suggested to contribute to the evaluation of auditory discrimination (N1), attention allocation and phonological categorization (N2), and echoic memory (mismatch negativity – MMN). The scarce existing literature about this theme motivated the present study, which aims to investigate and document the existing AERP changes in a group of children with BECTS. AERPs were recorded, during the day, to pure and vocal tones and in a conventional auditory oddball paradigm in five children with BECTS (aged 8–12; mean = 10 years; male = 5) and in six gender and age-matched controls. Results revealed high amplitude of AERPs for the group of children with BECTS with a slight latency delay more pronounced in fronto-central electrodes. Children with BECTS may have abnormal central auditory processing, reflected by electrophysiological measures such as AERPs. In advance, AERPs seem a good tool to detect and reliably reveal cortical excitability in children with typical BECTS.

Characterization of middle-ear condition of Oporto daycare children up-to 3 years-old: A cross sectional study

Objective The aim of this study was to determine tympanometric values of children who attend Oporto daycare centers and further analyze any relations with host and environmental factors. Methods Cross sectional study in a randomly selected sample of 117 daycare children up-to 3-years old from Oporto. Tympanometric measures were collected. Results Children presented in left ear (LE) a mean peak pressure (PP) of −156.53 daPa and a mean compliance of 0.16 cm3. Right ear (RE) revealed a PP of −145.61 daPa and a compliance of 0.19 cm3. Normal tympanograms (type A) had a lower frequency than abnormal tympanograms (type B and type C). There was a positive association between age and compliance (LE: p = 0.016; RE: p = 0.013) and between the presence of rhinorrhea and PP (LE: p = 0.002; RE: p < 0.05). Abnormal tympanograms were more frequent in Spring (RE: p = 0.009), in younger children (LE: p = 0.03) and in children that had rhinorrhea (LE: p = 0.002; RE: p = 0.044). Healthy children had a mean PP of −125.19 daPa and a mean compliance of 0.21 cm3 in LE and a mean PP of −144.27 daPa and a mean compliance of 0.22 cm3 in RE. Conclusion Tympanometric measures presented in this paper may be applicable to Oporto daycare children up-to 3 years-old. Most of daycare children revealed abnormal tympanograms. Age, rhinorrhea and season influenced children's middle-ear condition.