Infection and immune-mediated meningococcal-associated arthritis: combination features in the same patient

We present a case of a 16-year-old male patient with sudden-onset, rash, arthritis and meningitis by Neisseria meningitidis one week after an acute upper respiratory infection. On the 10th day of treatment followed by neurological and arthritis clinical improvement, he presented once again a tender and swollen left knee with a moderate effusion, and active and passive range of motion was severely limited secondary to pain, and when he was submitted to surgical drainage and synovial fluid analysis he showed inflammatory characteristics. A non-steroidal anti-inflammatory drug was taken for five days with complete improvement of symptoms. The case is notable for its combination of features of septic and immune-mediated arthritis, which has rarely been reported in the same patient.

Impact of dams and irrigation schemes in Anopheline (Diptera: Culicidae) bionomics and malaria epidemiology

Irrigation schemes and dams have posed a great concern on public health systems of several countries, mainly in the tropics. The focus of the present review is to elucidate the different ways how these human interventions may have an effect on population dynamics of anopheline mosquitoes and hence, how local malaria transmission patterns may be changed. We discuss different studies within the three main tropical and sub-tropical regions (namely Africa, Asia and the Pacific and the Americas). Factors such as pre-human impact malaria epidemiological patterns, control measures, demographic movements, human behaviour and local Anopheles bionomics would determine if the implementation of an irrigation scheme or a dam will have negative effects on human health. Some examples of successful implementation of control measures in such settings are presented. The use of Geographic Information System as a powerful tool to assist on the study and control of malaria in these scenarios is also highlighted.

Histoplasmosis presenting with multiple pulmonary nodules. A case mimicking radiological features of pulmonary metastasis

We present a case of histoplasmosis with multiple pulmonary nodules in a patient with a history of melanoma. This case closely simulated malignancy, including the presence of feeding vessel sign, which occurs in pulmonary metastasis. We emphasize the need to be aware of this infection in areas where histoplasmosis is endemic.

Transplant Glomerulopathy: Clinico-Pathologic Features

Transplant glomerulopathy is a sign of chronic kidney allograft damage. It has a distinct morphology and is associated with poor allograft survival. We aimed to assess the prevalence and clinic-pathologic features of transplant glomerulopathy, as well as determine the functional and histological implications of its severity. We performed a single-centre retrospective observational study during an eight-year period. Kidney allograft biopsies were diagnosed and scored according to the Banff classification, coupled with immunofluorescence studies. The epidemiology, clinical presentation, outcomes (patient and graft survival) and anti-HLA alloantibodies were evaluated. Transplant glomerulopathy was diagnosed in 60 kidney transplant biopsies performed for clinical reasons in 49 patients with ABO compatible renal transplant and a negative T-cell complement dependent cytotoxicity crossmatch at transplantation. The estimated prevalence of transplant glomerulopathy was 7.4% and its cumulative prevalence increased over time. C4d staining in peritubular capillaries (27.6%) was lower than the frequency of anti-HLA antibodies (72.5%), the majority against both classes I and II. Transplant glomerulopathy was associated with both acute (mainly glomerulitis and peritubular capillaritis) and chronic histologic abnormalities. At diagnosis, 30% had mild, 23.3% moderate and 46.7% severe transplant glomerulopathy. The severity of transplant glomerulopathy was associated with the severity of interstitial fibrosis. Other histological features, as well as clinical manifestations and graft survival, were unrelated to transplant glomerulopathy severity.

Post-MAPS: An interactive acquisition platform for gastroenterology

Post-MAPS is a web platform that collects gastroenterological exam data from several european hospital centers, to be used in future clinical studies and was developed in partnership with experts from the gastroenterological area and information technology (IT) technicians. However, although functional, this platform has some issues that are crucial for its functioning, and can render user interaction unpleasant and exhaustive. Accordingly, we proposed the development of a new web platform, in which we aimed for an improvement in terms of usability, data uni cation and interoperability. Therefore, it was necessary to identify and study different ways of acquiring clinical data and review some of the existing clinical databases in order to understand how they work and what type of data they store, as well as their impact and contribution to clinical knowledge. Closely linked to the data model is the ability to share data with other systems, so, we also studied the concept of interoperability and analyzed some of the most widely used international standards, such as DICOM, HL7 and openEHR. As one of the primary objectives of this project was to achieve a better level of usability, practices related to Human Computer-Interaction, such as requirement analysis, creation of conceptual models, prototyping, and evaluation were also studied. Before we began the development, we conducted an analysis of the previous platform, from a functional point of view, which allowed us to gather not only a list of architectural and interface issues, but also a list of improvement opportunities. It was also performed a small preliminary study in order to evaluate the platform's usability, where we were able to realize that perceived usability is different between users, and that, in some aspects, varies according to their location, age and years of experience. Based on the information gathered during the platform's analysis and in the conclusions of the preliminary study, a new platform was developed, prepared for all potential users, from the inexperienced to the most comfortable with technology. It presents major improvements in terms of usability, also providing several new features that simplify the users' work, improving their interaction with the system, making their experience more enjoyable.

PREVALENCE OF DRUG RESISTANCE AND VIRULENCE FEATURES IN Salmonella spp. ISOLATED FROM FOODS ASSOCIATED OR NOT WITH SALMONELLOSIS IN BRAZIL

Salmonella is the most common etiological agent of cases and outbreaks of foodborne diarrheal illnesses. The emergence and spread of Salmonella spp., which has become multi-drug resistant and potentially more pathogenic, have increased the concern with this pathogen. In this study, 237 Salmonella spp., associated or not with foodborne salmonellosis in Brazil, belonging mainly to serotype Enteritidis, were tested for antimicrobial susceptibility and the presence of the virulence genes spvC, invA, sefA and pefA. Of the isolates, 46.8% were sensitive to all antimicrobials and 51.9% were resistant to at least one antimicrobial agent. Resistance to more than one antimicrobial agent was observed in 10.5% of the strains. The highest rates of resistance were observed for streptomycin (35.9%) and nalidixic acid (16.9%). No strain was resistant to cefoxitin, cephalothin, cefotaxime, amikacin, ciprofloxacin and imipenem. The invA gene was detected in all strains. Genes spvC and pefA were found in 48.1% and 44.3% of strains, respectively. The gene sefA was detected in 31.6% of the strains and only among S. Enteritidis. Resistance and virulence determinants were detected in Salmonella strains belonging to several serotypes. The high rates of antibiotic-resistance in strains isolated from poultry products demonstrate the potential risk associated with the consumption of these products and the need to ensure good food hygiene practices from farm to table to reduce the spread of pathogens relevant to public health.

INSECTICIDE-TREATED BED NETS IN RONDÔNIA, BRAZIL: EVALUATION OF THEIR IMPACT ON MALARIA CONTROL

Mosquito nets treated with long-lasting insecticide (LLINs), when used in compliance with guidelines of the World Health Organization, may be effective for malaria vector control. In 2012, approximately 150,000 LLINs were installed in nine municipalities in the state of Rondônia. However, no studies have assessed their impact on the reduction of malaria incidence. This study analyzed secondary data of malaria incidence, in order to assess the impact of LLINs on the annual parasite incidence (API). The results showed no statistically significant differences in API one year after LLIN installation when compared to municipalities without LLINs. The adoption of measures for malaria vector control should be associated with epidemiological studies and evaluations of their use and efficiency, with the aim of offering convincing advantages that justify their implementation and limit malaria infection in the Amazon Region.

LEPROSY NEPHROPATHY: A REVIEW OF CLINICAL AND HISTOPATHOLOGICAL FEATURES

Leprosy is a chronic disease caused by Mycobacterium leprae, highly incapacitating, and with systemic involvement in some cases. Renal involvement has been reported in all forms of the disease, and it is more frequent in multibacillary forms. The clinical presentation is variable and is determined by the host immunologic system reaction to the bacilli. During the course of the disease there are the so called reactional states, in which the immune system reacts against the bacilli, exacerbating the clinical manifestations. Different renal lesions have been described in leprosy, including acute and chronic glomerulonephritis, interstitial nephritis, secondary amyloidosis and pyelonephritis. The exact mechanism that leads to glomerulonephritis in leprosy is not completely understood. Leprosy treatment includes rifampicin, dapsone and clofazimine. Prednisone and non-steroidal anti-inflammatory drugs may be used to control acute immunological episodes.

The impact of questions rotation in response accuracy

Dissertação apresentada como requisito parcial para obtenção do grau de Mestre em Estatística e Gestão de Informação

Impulsive buying and self-regulation: the impact of hetero-impulsivity on consumers buying behavior

Dissertação apresentada como requisito parcial para obtenção do grau de Mestre em Estatística e Gestão de Informação.

Algorithm for the Parkinson’s disease behavioural models characterization using a biosensor

Dissertação para obtenção do Grau de Mestre em Engenharia Biomédica

Exergames - Jogos Sérios para Promover o Exercício Físico

As novas tecnologias, em particular os meios de entretimento digital, oferecem diferentes soluções de interação para que as pessoas se possam divertir. O elevado (e crescente) número de jogos digitais disponíveis no mercado permitiu o aparecimento de um novo tipo de jogos digitais, os jogos sérios, com uma finalidade menos lúdica. O intuito desses jogos é usar as caraterísticas associadas aos jogos normais, mas direcioná-los para uma finalidade séria. Assim, além de divertir o utilizador estes jogos também possibilitam a transmissão de informação e conhecimento que de outra forma não teria o mesmo impacto, por falta de interesse e menor motivação dos utilizadores. Exergames são jogos digitais utilizados para o desenvolvimento pessoal como o propósito de melhorar o bem-estar das pessoas quer a nível físico quer a nível mental. Esses jogos requerem que partes do corpo estejam em constante movimento, sendo que alguns utilizam dispositivos de rastreio de movimentos do corpo como forma de interação com os sistemas. Os exergames são o foco desta tese, com uma análise das suas potencialidades e das diferentes áreas possíveis para a sua aplicabilidade. São analisados diferentes tipos de exergames consoante o dispositivo que irá permitir a utilização do jogo. Também são estudados algumas ferramentas externas que possibilitam a interação de aplicações móveis com equipamentos de exercício físico específicos. A componente prática da tese contempla a criação de um exergame para dispositivos móveis com o intuito de incentivar as pessoas para a prática de corridas de forma regular, para que possam ter um estilo de vida ativo e que contribui de forma direta para o bem-estar deles. Os testes realizados junto a um conjunto de pessoas conduziram a resultados positivos quer do jogo desenvolvido quer da utilidade deste tipo de jogos no desenvolvimento físico, o que permite afirmar que os exergames devido ao seu carácter sério, mas nunca deixando de parte a diversão e a interatividade, são motivadores extras para as pessoas praticarem exercício físico.

Estudo de vulnerabilidades em aplicações web e o seu reflexo em domínios Portugueses

Muito se tem falado sobre revolução tecnológica e do aparecimento constante de novas aplicações Web, com novas funcionalidades que visam facilitar o trabalho dos utilizadores. Mas será que estas aplicações garantem que os dados transmitidos são tratados e enviados por canais seguros (protocolos)? Que garantias é que o utilizador tem que mesmo que a aplicação utilize um canal, que prevê a privacidade e integridade de dados, esta não apresente alguma vulnerabilidade pondo em causa a informação sensível do utilizador? Software que não foi devidamente testado, aliado à falta de sensibilização por parte dos responsáveis pelo desenvolvimento de software para questões de segurança, levam ao aumento de vulnerabilidades e assim exponenciam o número de potenciais vítimas. Isto aliado ao efeito de desinibição que o sentimento de invisibilidade pode provocar, conduz ao facilitismo e consequentemente ao aumento do número de vítimas alvos de ataques informáticos. O utilizador, por vezes, não sabe muito bem do que se deve proteger, pois a confiança que depõem no software não pressupõem que os seus dados estejam em risco. Neste contexto foram recolhidos dados históricos relativos a vulnerabilidades nos protocolos SSL/TLS, para perceber o impacto que as mesmas apresentam e avaliar o grau de risco. Para além disso, foram avaliados um número significativo de domínios portugueses para perceber se os mesmos têm uma vulnerabilidade específica do protocolo SSL/TLS.

Coreceptor Usage by HIV-1 and HIV-2 Primary Isolates: The Relevance of CCR8 Chemokine Receptor as an Alternative Coreceptor

The human immunodeficiency virus replication cycle begins by sequential interactions between viral envelope glycoproteins with CD4 molecule and a member of the seven-transmembrane, G-protein-coupled, receptors' family (coreceptor). In this report we focused on the contribution of CCR8 as alternative coreceptor for HIV-1 and HIV-2 isolates. We found that this coreceptor was efficiently used not only by HIV-2 but particularly by HIV-1 isolates. We demonstrate that CXCR4 usage, either alone or together with CCR5 and/or CCR8, was more frequently observed in HIV-1 than in HIV-2 isolates. Directly related to this is the finding that the non-usage of CXCR4 is significantly more common in HIV-2 isolates; both features could be associated with the slower disease progression generally observed in HIV-2 infected patients. The ability of some viral isolates to use alternative coreceptors besides CCR5 and CXCR4 could further impact on the efficacy of entry inhibitor therapy and possibly also in HIV pathogenesis.

Sustainability of systems interoperability in dynamic business networks

Dissertação para obtenção do Grau de Doutor em Engenharia Electrotécnica e de Computadores