Prevalence and associated risk factors for Giardia lamblia infection among children hospitalized for diarrhea in Goiânia, Goiás State, Brazil

The objective of this study was to determine the prevalence and to identify risk factors associated with Giardia lamblia infection in diarrheic children hospitalized for diarrhea in Goiânia, State of Goiás, Brazil. A cross-sectional study was conducted and a comprehensive questionnaire was administered to the child's primary custodian. Fixed effects logistic regression was used to determine the association between infection status for G. lamblia and host, sociodemographic, environmental and zoonotic risk factors. A total of 445 fecal samples were collected and processed by the DFA methodology, and G. lamblia cysts were present in the feces of 44 diarrheic children (9.9%). A variety of factors were found to be associated with giardiasis in these population: age of children (OR, 1.18; 90% CI, 1.0 - 1.36; p = 0.052), number of children in the household (OR 1.45; 90% CI, 1.13 - 1.86; p = 0.015), number of cats in the household (OR, 1.26; 90% CI, 1.03 -1.53; p = 0.059), food hygiene (OR, 2.9; 90% CI, 1.34 - 6.43; p = 0.024), day-care centers attendance (OR, 2.3; 90% CI, 1.20 - 4.36; p = 0.034), living on a rural farm within the past six months prior hospitalization (OR, 5.4; CI 90%, 1.5 - 20.1; p = 0.03) and the number of household adults (OR, 0.59; 90% CI, 0.42 - 0.83; p = 0.012). Such factors appropriately managed may help to reduce the annual incidence of this protozoal infection in the studied population.

Message-oriented middleware for smart grids

In order to increase the efficiency in the use of energy resources, the electrical grid is slowly evolving into a smart(er) grid that allows users' production and storage of energy, automatic and remote control of appliances, energy exchange between users, and in general optimizations over how the energy is managed and consumed. One of the main innovations of the smart grid is its organization over an energy plane that involves the actual exchange of energy, and a data plane that regards the Information and Communication Technology (ICT) infrastructure used for the management of the grid's data. In the particular case of the data plane, the exchange of large quantities of data can be facilitated by a middleware based on a messaging bus. Existing messaging buses follow different data management paradigms (e.g.: request/response, publish/subscribe, data-oriented messaging) and thus satisfy smart grids' communication requirements at different extents. This work contributes to the state of the art by identifying, in existing standards and architectures, common requirements that impact in the messaging system of a data plane for the smart grid. The paper analyzes existing messaging bus paradigms that can be used as a basis for the ICT infrastructure of a smart grid and discusses how these can satisfy smart grids' requirements.

Formação para a literacia da informação: uma interactividade necessária com os media

Our aim is to analyse the relationship between interactive media and its use in Education when applied to formal training for information literacy. Contextualizing the notion of literacy in an evolving framework and emphasizing the recognition of its importance, we highlight some desirable skills in the current information society, including, inevitably, technological competencies. When considering the notion of literacy within an evolving framework and emphasizing the acknowledgement of its significance some desirable skills stand out in the current information society including, inevitably, the technological skills. We emphasize media literacy and select some strategies for teaching and learning practices recommended for the development of new skills, highlighting the contribution of some international literacy standards and describing some of the good practices in Education. We also underline the need for training within an holistic perspective, integrating student’, teachers and staff cooperation in the educational process. In this process, the potential of the Web 2.0, which grants the new information users – the prosumers (consumers and producers) a new statute, new powers and obligations, is indeed worth mentioning. Regarding the situation, we shall quote the reports on the experiences of virtual learning communities that use the moodle platform and mention several activities and programs managed by the Portuguese government to increase the citizens’ literacy’s levels. In conclusion, we point out the need for lifelong learning and the ability of individuals to “learn to learn” who therefore provide literacy with a dynamic component.

Temporomandibular Joint Ankylosis in an Infant: A Rare Cause of Difficult Airway

1.Pre-assessment data of the patient A 2-year-old boy, weighing 15 kg was admitted with a history of limited mouth opening(inter-incisor distance of 6 mm), hypoplastic and retrognathic mandible (bird face deformity) and facial asymmetry from left temporomandibular joint ankylosis (TMJA). He was born at term, after an uneventful pregnancy, and there was no report of trauma during caesarean section. No other possible aetiologies were identified. He was scheduled for mandibular osteotomy. Preoperative ENT examination revealed adenotonsillar hypertrophy. 2. Anaesthetic Plan A fiberoptic nasal intubation was performed under deep inhalation anaesthesia with sevoflurane, with the patient breathing spontaneously. Midazolam (0.05 mg.kg-1) and alfentanil (0.03 mg.kg-1) were given and anaesthesia was maintained with O2/air and sevoflurane. No neuromuscular blocking agent was administered since the surgical team needed facial nerve monitoring. 3. Description of incident During surgery an accidental extubation occurred and an attempt was made to reintubate the trachea by direct laryngoscopy. Although the osteotomy was nearly completed, the vocal cords could not be visualized (Cormack-Lehane grade IV laryngoscopic view). 4. Solving the problem Re-intubation was finally accomplished with the flexible fiberscope and the procedure was concluded without any more incidents. Extubation was performed 24 hours postoperatively with the patient fully awake. After surgery mouth opening improved to inter-incisor gap of 15 mm. 5. Lessons learned and take home message Two airways issues present in this case can lead to difficultventilation and intubation: TMJA and adenotonsillar hypertrophy. These difficulties were anticipated and managed accordingly. The accidental extubation brought to our attention the fact that, even after surgical correction, this airway remains challenging. Even with intensive jaw stretchingexercises there is a high incidence of re-ankylosis, especially in younger patients. One should bear that in mind when anaesthetizing patients with TMJA.

Melanoides tuberculata (Mollusca: Thiaridae) as an intermediate host of Centrocestus formosanus (Trematoda: Heterophyidae) in Brazil

Pleurolophocercous cercariae emerged from naturally infected Melanoides tuberculata from Minas Gerais State, Brazil, were used to perform experimental infection of laboratory-reared Poecilia reticulata. Mature metacercariae were obtained from the gills of fishes and force-fed to Mus musculus. The adult parasites which recovered from small intestines of mice were identified as Centrocestus formosanus. This is the first report of M. tuberculata as intermediate host of this heterophyid in Brazil.

Melanoides tuberculata as intermediate host of Philophthalmus gralli in Brazil

Melanoides tuberculata that naturally harbored trematode larvae were collected at the Pampulha dam, Belo Horizonte (Minas Gerais, Brazil), during malacological surveys conducted from 2006 to 2010. From 7,164 specimens of M. tuberculata collected, 25 (0.35%) were infected by cercariae, which have been morphologically characterized as belonging to the Megalurous group, genus Philophthalmus. Excysted metacercariae were used for successful experimental infection of Gallus gallus domesticus, and adult parasites recovered from the nictitating membranes of chickens were identified as Philophthalmus gralli. This is the first report of P. gralli in M. tuberculata in Brazil.

Auditoria de recursos humanos nas PME portuguesas

Ao longo dos tempos que a economia tem sofrido mudanças a nível global, e é possível verificar que as empresas estão constantemente a adaptar-se a essa mudança. Fruto dessa adaptação, os recursos humanos, que são uma das partes fundamentais de uma empresa pois representam a sua mão-de-obra, têm tido um papel junto da mesma significativamente alterado ao longo do tempo. De facto, não só o papel dos recursos humanos tem sido diferente ao longo do tempo, a própria gestão de recursos humanos evoluiu significativamente, a par da própria evolução das várias estruturas organizacionais. Tudo isto se relaciona com a necessidade de encontrar métodos de diferenciação, de adquirir vantagem competitiva, ou de conseguir obter mais valor num mercado cada vez mais competitivo a todos os níveis. Assim, embora hoje em dia se assuma de um modo geral que os recursos humanos são realmente uma fonte de valor, capazes de fazer com que a sua empresa se diferencie, e capazes de criar vantagem competitiva, a verdade é que para que tal seja possível é necessário uma gestão dos mesmos que o possibilite. A gestão de recursos humanos traduz-se sobretudo nas suas práticas, tais como o recrutamento ou a formação, e para que essas práticas tenham o melhor efeito possível é necessário que as mesmas sejam avaliadas de forma imparcial, ou seja, independente. É neste contexto que surge a Auditoria de Recursos Humanos, que se pode resumir a uma avaliação aos recursos humanos e à sua gestão dos pontos de vista legal, funcional, e estratégico. Com o objectivo de verificar se, no contexto português, as empresas pensam nos seus recursos humanos como um recurso que acrescenta valor se gerido adequadamente, e se apostam neste tipo de auditoria como forma de avaliar o paradigma dos seus recursos humanos, foi elaborado um questionário e enviado a empresas distinguidas com os estatutos PME Líder 2014 e PME Excelência 2014 pelo IAPMEI. As conclusões do estudo indicaram que embora as empresas acreditem que os recursos humanos acrescentam valor, apostando na sua motivação, formação, avaliação de desempenho e satisfação, as mesmas não fazem questão em obter a certificação dos seus sistemas de gestão de recursos humanos e não utilizam a auditoria de recursos humanos como uma ferramenta de gestão.

Clinical Dilemma in the Treatment of a Patient with Microangiopathic Haemolytic Anaemia, Thrombocytopaenia and Severe Hypertension

While haemolytic uraemic syndrome in children is predominantly associated with Shiga toxin -producing Escherichia coli (typically 0157:H7), some cases occur without associated diarrhoea, or as the manifestation of an underlying disorder other than infection. Haemolytic uraemic syndrome is characterised by microangiopathic anaemia, thrombocytopaenia and renal failure, on occasion accompanied by severe hypertension. Malignant hypertension is a syndrome that sometimes exhibits the same laboratory abnormalities as haemolytic uraemic syndrome as it may share the same pathological findings: thrombotic microangiopathy. As clinical features of both entities overlap, the distinction between them can be very difficult. However, differentiation is essential for the treatment decision, since early plasma exchange dramatically reduces mortality in haemolytic uraemic syndrome not associated with diarrhoea. An increasing number of genetic causes of this pathology have been described and may be very useful in differentiating it from thrombotic microangiopathy due to other aetiologies. Despite advances in the understanding of the pathophysiology of haemolytic uraemic syndrome not associated with diarrhoea, the management often remains empirical. We describe a patient with simultaneous microangiopathic haemolytic anaemia, thrombocytopaenia and severe hypertension managed in the acute period of illness with plasma exchange.

Cirurgia Obliterativa do Prolapso dos Órgãos Pélvicos - uma Opção ainda Válida?

Objective: To investigate the results of vaginal obliterate surgery in elderly women with pelvic organ prolapse. Design: observational retrospective study. Material and Methods: a total of 69 women with the diagnosis of pelvic prolapse were submitted to obliterative surgery in the urogynecology unit of a tertiary care hospital centre over the course of 8 years (2001 to 2008). The following data were collected from their clinical records: age, number of vaginal births, body mass index (BMI), hormone therapy, other existing diseases, type of prolapse and stage, anaesthetic risk score, duration of surgery, length of hospital stay, and short-term complications. Results: Of the 69 women studied, 31 were submitted to colpocleisis and the remaining 38 were managed by the LeFort technique. Mean age was 74.8 years with a standard deviation (sd) of 7.14 years. Average BMI was 26.2 (sd =3.76). Vaginal births were recorded in all patients. Only three patients were taking hormone therapy at the time of surgery. Sixty-three women were classified as having and anesthetic risk of II or III and 55 underwent local-regional anesthesia. Complications were reported in five cases, four of which in the first days after surgery. Nearly all were mild and resolved within the first 6 weeks. Conclusion: Complication rates appear to be low after obliterative surgery for pelvic organ prolapse in elderly women.

EXPERIMENTAL INFECTION OF SWISS AND AKR/J MICE WITH Centrocestus formosanus (TREMATODA: HETEROPHYIDAE)

In order to better understand the biology of Centrocestus formosanus in a definitive host model, mice of Swiss and AKR/J strains were experimentally infected with 100 metacercariae of the parasite. Fourteen days post-infection, the rodents were killed and adult trematodes were recovered from the small intestine. The percentage of parasite recovery from AKR/J mice (11.4%) was significantly higher than that from Swiss mice (5.3%). Moreover, trematodes recovered from the AKR/J strain were more developed and had greater fecundity. Peculiarities concerning the mice’s immune system could explain the difference in susceptibility and in worm development seen in the present study. The data obtained confirm that mice are susceptible to infection with C. formosanus and indicate that the AKR/J strain provides a more favorable environment for parasite development.

Avaliação de Riscos para a Segurança da Informação no ISEP Aplicação ao Processo de Notas

Desde que existe informação, há necessidade de criar um sistema que permita gerir e garantir que a informação está segura e que cumpre os requisitos básicos de segurança. Como tal, é necessário desenvolver técnicas e mecanismos para que os requisitos sejam testados e melhorados continuamente. Com esta necessidade em vista, apareceram padrões que dão resposta a um conjunto vasto de problemas, em diferentes sistemas e aplicações diversas. Estes tornaram-se guias de reflexão para quem os analisava, de arquitetura para quem os implementava e modelos para quem os geria. O padrão ISO 27001 dá resposta aos cuidados a ter para se conseguir um sistema de gestão da segurança da informação eficaz e eficiente. Esta norma preocupa-se com os detalhes de aplicação até à forma como é implementado e arquitetado o sistema. Os processos, atividades, fluxos de trabalho são essenciais para que esta norma seja cumprida. É necessário um bom escrutínio dos processos e suas atividades, assim como um fluxo de trabalho bem definido com papéis e responsabilidades de cada ator. É necessário também assegurar a forma como é gerido, a sua verificação e melhoria contínua. Foi aplicado no ISEP um exercício com o qual se pretendeu verificar se os processos e outros aspetos seguiam estes cuidados e se estavam de acordo com a norma. Durante o exercício foram verificados processos dentro de um certo âmbito, todas as suas atividades, papéis e responsabilidades, verificação de recursos, aplicação de controlos e aplicação de uma análise de risco. Esta análise tem como objetivo verificar o nível de segurança dos recursos, algo que a norma ISO 27001 propõe mas não especifica em que moldes. No final deste exercício pretendeu-se melhorar o sistema de gestão de informação do ISEP em vertentes tais como a documentação, a qual especifica quais os passos realizados no decorrer do mesmo.

21st century quality: Looking into the “Crystal ball”

The discussion of possible scenarios for the future of Quality is on the priority list of major Quality Practitioners Societies. EOQ – European Organization for Quality (EOQ, 2014) main team for its 58th EOQ-Congress held June 2014 in Göteborg was “Managing Challenges in Quality Leadership” and ASQ - American Society for Quality (ASQ, 2015) appointed “the Future of Quality” for Quality Progress Magazine November 2015 issue. In addition, the ISO 9001:2008 revision process carried by ISO/TC 176 aims to assure that ISO 9001:2015 International Standard remains stable for the next 10 years (ISO, 2014) contributing to an increased discussion on the future of quality. The purpose of this research is to review available Quality Management approaches and outline, adding an academic perspective, expected developments for Quality within the 21st Century. This paper follows a qualitative approach, although data from international organizations is used. A literature review has been undertaken on quality management past and potential future trends. Based on these findings a model is proposed for organization quality management development and propositions for the future of quality management are advanced. Firstly, a state of the art of existing Quality Management approaches is presented, for example, like Total Quality Management (TQM) and Quality Gurus, ISO 9000 International Standards Series (with an outline of the expected changes for ISO 9001:2015), Six Sigma and Business Excellence Models.Secondly, building on theoretical and managerial approaches, a two dimensional matrix – Quality Engineering (QE - technical aspects of quality) and Quality Management (QM: soft aspects of quality) - is presented, outlining five proposed characterizations of Quality maturity levels and giving insights for applications and future developments. Literature review highlights that QM and QE may be addressing similar quality issues but their approaches are different in terms of scope breadth and intensity and they ought to complement and reciprocally reinforce one another. The challenges organizations face within the 21st century have stronger uncertainty, complexity, and differentiation. Two main propositions are advanced as relevant for 21st Century Quality: - QM importance for the sustainable success of organizations will increase and they should be aware of the larger ecosystem to be managed for improvement, possibly leading to the emergence of a new Quality paradigm, The Civilizacional Excellence paradigm. - QE should get more attention from QM and the Quality professionals will have to: a) Master and apply in wider contexts and in additional depth the Quality Tools (basic, intermediate and advanced); b) Have the soft skills needed for its success; c) Be results oriented and better understand and demonstrate the relationships between approaches and results These propositions challenge both scholars and practitioners for a sustained and supported discussion on the future of Quality. “All things are ready, if our mind be so.” (Shakespeare, Henry V, circa 1599).

Vulvar Lichen Sclerosus: Efficacy of Photodynamic Therapy Under Conscious Sedation with Inhaled 50% Nitrous Oxide and Oxygen Mixture

Anogenital lichen sclerosus is a chronic, inflammatory, mucocutaneous disorder of significant morbidity. Common symptoms include pruritus, pain, dysuria, and dyspareunia, frequently of difficult control. Photodynamic therapy (PDT) may be an effective therapeutic option in selected cases refractory to first--‐line treatment options. However, procedure--‐related pain is a limiting factor in patient adherence to treatment. Conscious sedation and analgesia with a ready--‐to--‐use gas mixture of nitrous oxide and oxygen is useful in short--‐term procedures. It provides a rapid, effective, and short--‐lived effect, without the need for anesthesiology support. A 75--‐year--‐old woman presented with a highly symptomatic, histologically confirmed vulvar lichen sclerosus, with at least 15 years of evolution. Pain, pruritus, and dysuria were intense and disabling. Treatment with ultrapotent topical corticosteroids proved to be ineffective despite patient compliance. She was then referred for PDT. A total of 3 sessions were performed, held at a mean interval of 9 weeks, and under the analgesic and sedative effect of nitrous oxide/oxygen gas. Response to treatment was evaluated through a daily, self--‐reported pain rating scale. Dysuria remitted completely after the first PDT session. An 80% reduction in pruritus and pain was observed after the third session, and has been sustained for the past six months without further need for topical corticotherapy. Treatment sessions were well tolerated and pain-- free, with no side effects to report. PDT appears to be effective in the symptomatic treatment of vulvar lichen sclerosus. To the authors’ knowledge this is the first case reporting the use of inhaled nitrous oxide/oxygen gas mixture during PDT performed in the genital area. Its analgesic and sedative effects may increase patients’ adherence to this painful procedure. Furthermore, given its safety, it can be easily managed in outpatient clinics by trained dermatologists.

Divertículos da uretra feminina: uma revisão contemporânea

Introduc¸ão: Os divertículos uretrais femininos (DUF) afetam de 0,6 a 4,7% das mulheres, causam frequentemente sintomas urinários persistentes e podem associar-se a complicac¸ões como litíase e transformac¸ão maligna. Existe ainda elevado subdiagnóstico de DUF, bem como atraso diagnóstico e terapêutico. O objetivo deste trabalho é analisar o estado de arte em relac¸ão à etiologia, diagnóstico e terapêutica desta patologia. Materiais e métodos: Revisão bibliográfica de artigos obtidos até janeiro/2014 na base de dados Medline utilizando as palavras-chave: «female urethral diverticula», «female urethral diverticulum», «urethral diverticula», «urethral diverticulum» e «female urethra»; e após pesquisa de referências bibliográficas relevantes nos artigos obtidos. Resultados: A maioria dos DUF parecem surgir secundariamente à infec¸ão das glândulas periuretrais e uretrais. Apesar da associac¸ão clássica à tríade de disúria, dispareunia e gotejo pós-miccional, as manifestac¸ões clínicas são diversas e inespecíficas. Mais de um terc¸o são palpáveis ao exame ginecológico. Os métodos imagiológicos disponíveis, nomeadamente a ressonância magnética e a ecografia, apresentam elevada capacidade diagnóstica e contribuem para o planeamento cirúrgico. Dependendo da localizac¸ão, conformac¸ão e sintomatologia associada, a terapêutica dos DUF poderá ser conservadora ou, na maioria dos casos, cirúrgica. Discussão: A avaliac¸ão clínica permanece essencial para o diagnóstico de DUF. A ressonância magnética é a modalidade com maior taxa de diagnóstico e de exclusão de complicac¸ões pré ou pós-operatórias. Foram descritas técnicas menos invasivas, porém a diverticulectomia uretral transvaginal permanece a terapêutica com maior cura sintomática. Conclusão: A sensibilizac¸ão da comunidade médica é a melhor arma no combate ao subdiagnóstico e atraso diagnóstico dos DUF.

Colesteatoma em idade pediátrica: análise retrospectiva de 12 anos de experiência do Hospital Fernando Fonseca

Objectivo: revisão de casos de colesteatoma em idade pediátrica do HFF durante um período de 12 anos. Desenho do estudo: retrospectivo. Material e métodos: análise de 30 casos de cirurgia para colesteatoma em doentes dos 0 - 18 anos de Janeiro de 2000 a Dezembro de 2011. Resultados: o colesteatoma inicial foi extenso na maioria dos casos. Realizou-se mastoidectomia com técnica aberta (66,7%), mastoidectomia com técnica fechada (26,7%), aticomia transmeática (3,3%) e remoção de colesteatoma da membrana timpânica (3,3%). O GAP pós-operatório médio foi de 22,5 dB, com GAP 0-10dB em 16,7%, GAP 11-20dB em 10%, GAP 21-30 dB em 30%, mais de 30dB em 16,7% e desconhecido em 26,7%. A taxa de recorrência de colesteatoma foi de 23,3% Conclusões: Na nossa amostra o colesteatoma foi extenso e agressivo. Realizámos mastoidectomia com técnica aberta na maioria dos casos. Para obter bons resultados a abordagem deverá ser individualizada, atendendo a factores clínicos, anatómicos e capacidade de adesão à terapêutica.