Serological survey for Chagas' disease in school children in the Rio de Janeiro State, Brazil

A serological survey for Chagas' disease was carried out in school children in the Rio de Janeiro State, a zone considered as non-endemic for the infection. A total of 168 schools in 20 municipalities have been visited and 13,254 blood samples were obtained. The blood eluates were screened by the indirect fluorescence test (IFT), and all positive samples were checked and confirmed in sera by the complement fixation test (CFT). AH serologically positive children were subject to a clinical scrutiny, and the houses where the children lived have been searched for triatomine bugs. Only in two municipalities, Magé and Araruama, there was a significant number of children found positive. The total number of reactive samples by IFT and CFT from 13,004 blood samples screened was 143 (1.00 per cent). No serious clinicai symptoms suggestive of Chagas' disease have been found in any of the positive children, and no triatomine bugs were discovered in the dwellings where the children lived. The overall small percentage of children with positive serology postulates that the infection is not a serious health problem in the area investigated. It is recommended, however, to carry out a more detailed study in Magé and Araruama to find the reason for the relatively high percentage of serologically positive children encountered in these two municipalities.

A modification of the indirect fluorescence test (IFT) for Paracoccidioidomycosis

A modification of the indirect fluorescence test (IFT) for serological diagnosis of Paracoccidioidomycosis is described in which formolized budding forms (yeast cells) of the fungus Paracoccidioides brasiliensis are used as antigen. A further modification introduced is a less eiaborate technical procedure of the test without lowering the sensitivity of the reaction. The test may be considered as adequateiy accurate and easy to perform in any laboratory with immunofluorescence facilities.

Portfolio optimization with options

A Work Project, presented as part of the requirements for the Award of a Masters Degree in Finance from the NOVA – School of Business and Economics

Validation of NASA rotor 67 with openFOAM's transonic density-based solver

Dissertação para obtenção do Grau de Mestre em Engenharia Mecânica

Product communication strategies: Emotional versus rational communication strategies and attitude change on children consumers

A Work Project, presented as part of the requirements for the Award of a Masters Degree in Management from the NOVA – School of Business and Economics

Sintomas somatoformes em Medicina Geral e Familiar

RESUMO: Os doentes que vão à consulta com sintomas físicos para os quais o médico não encontra uma causa orgânica, são frequentes na Medicina Geral e Familiar, embora não sejam específicos, e são o objecto de estudo do presente trabalho. Não deixar uma doença por diagnosticar (erro de tipo II) sem contudo rotular pessoas saudáveis como doentes (erro de tipo I) é um dos mais difíceis problemas da prática clínica diária e para o qual não existe uma orientação infalível e não é previsível que alguma vez venha a existir. Mas se o diagnóstico de doença ou não-doença é difícil, o tratamento dos que não tem doença, embora com sofrimento, também não é mais fácil, sobretudo, se estivermos conscientes do sofrimento que determina a medicalização e a iatrogenia. O presente trabalho está estruturado em 3 partes. Na primeira parte descrevemos a nossa visão integrada do que apreendemos da leitura da literatura publicada e à qual tivemos acesso. À semelhança do que se verifica na maioria das áreas da Medicina esta é também uma em que o conhecimento cresce a ritmo exponencial. No entanto, à falta de conceitos precisos e de definições consensuais sucede um conhecimento, por vezes, pouco consistente, tanto mais que estamos na fronteira entre a cultura leiga e a cultura erudita médica em que os significados devem, a todo o momento, ser validados. Fizemos uma revisão sobre as definições do que está em questão, sobre o que se sabe sobre a frequência dos sintomas físicos na população, quantos recorrem aos serviços de saúde e o que lhes é feito. Passámos por uma revisão da fisiologia destes sintomas e algumas explicações fisiopatológicas para terminarmos sobre o que os doentes pensam sobre os seus sintomas e os cuidados que recebem e o que os profissionais pensam sobre estes doentes. Esta parte termina com uma revisão das propostas de abordagem para este tipo de doentes. Na segunda parte, descrevemos os estudos empíricos focados no problema dos pacientes com sintomas físicos mas sem evidência de doença orgânica. Começa por uma apresentação dos aspectos processuais e metodológicos dos estudos realizados, mais especificamente, de dois estudos quantitativos e um qualitativo. No primeiro estudo pretendeu-se avaliar quais são os sintomas físicos e a sua frequência na população em geral e a frequência de pacientes que procuram (ou não) os serviços de saúde tendo como motivo este tipo de sintomas. O objectivo deste estudo é contribuir para a demonstração que este tipo de sintomas faz parte da vida do dia-a-dia e que, na maioria das vezes, só por si não significa doença, sem contudo negar que representa sofrimento, por vezes até maior do que quando há patologia orgânica. Se no primeiro estudo era demonstrar que os sintomas físicos são frequentes na população, no segundo estudo o objectivo é demonstrar que pacientes com este tipo de sintomas são igualmente frequentes e que o tipo de sintomas apresentados na consulta não difere dos referidos pela população em geral. Pretendia-se ainda saber o que é feito ou proposto pelo médico a estes doentes e se estes doentes traziam ou não, junto com os sintomas, ideias explicativas para os mesmos. Finalmente e não menos importante, é avaliar o grau de fidedignidade do diagnóstico de sintoma somatoforme, chamando assim ao sintoma físico que foi “levado” à consulta e que o médico diagnosticou como não tendo causa orgânica. O terceiro estudo parte do conhecimento adquirido que a Medicina tem muitas respostas para este problema, mas poucas que se possam considerar satisfatórias se usadas isoladamente. Que a maioria das soluções é procurada entre a cultura médica e num paradigma reducionista de separação mente-corpo. Contudo, se o sintoma é “construído” pelo doente, se o principal problema não está no sintoma mas na forma como o paciente o vê, então pareceu-nos lógico que a solução também tem que passar por integrarmos no plano de abordagem o que o doente entende ser melhor para si. Nesta sequência, entrevistaram-se alguns doentes cujo diagnóstico de sintomas somatoformes estava demonstrado pelo teste do tempo. Por isso, entrevistaram-se doentes que já tinham ido à consulta de MGF há mais de 6 meses por sintomas somatoformes e, na data da entrevista, o diagnóstico se mantinha inalterado, independentemente da sua evolução. As entrevistas visaram conhecer as ideias dos doentes sobre o que as motivou a procurarem a consulta, o que pensavam da forma como foram cuidados e que ideias tinham sobre o que os profissionais de saúde devem fazer para os ajudar a restabelecer o equilíbrio com o seu ambiente evitando a medicalização, a iatrogenia e a evolução para a cronicidade. Na terceira parte, discutem-se e integram-se os resultados encontrados no conhecimento previamente existente. Tenta-se teorizar, fazer doutrina sobre o tema e contribuir para abordagens terapêuticas mais personalizadas, abrangentes, variadas e multimodais, baseadas sempre no método clínico centrado no paciente, ou de modo menos correcto mas enfático, baseadas no método centrado na relação. Apresentam-se algumas hipóteses de trabalhos futuros sobre o tema e, sobretudo, esperamos ter contribuído para o reconhecimento da necessidade de a comunicação médico-doente ser uma aprendizagem transversal a todos os profissionais de saúde e ao longo da vida, com a ideia que é sempre possível fazer melhor, caso contrário tenderemos, inexoravelmente, a fazer cada vez pior.-----------ABSTRACT: Patients who go to consultation with physical symptoms, for which the doctor does not find an organic cause, are the subject of the present study. They are common in family medicine, although not specific. Do not let an undiagnosed disease (type II error), but without labeling healthy people as patients with disease (type I error) is one of the most difficult problems in clinical practice and for which doesn’t exist an infallible guide and it is unlikely that any since coming into existence. But, if the diagnosis of disease or non-disease is difficult, the treatment of those who do not have the disease, though suffering, it is not easy, especially if we are aware of the suffering that medicalization and iatrogenic determines. This work is structured in three parts. In the first part we describe our integrated view of what we grasp from reading the published literature and to which we had access. Similar to that found in most areas of medicine, this is also one in which knowledge grows exponentially. However, the absence of precise concepts and consensual definitions determines an inconsistent knowledge, especially because we're on the border between secular culture and medical culture where, at all times, the meaning must be validated. We did a review on the definitions of what is at issue, what is known about the frequency of physical symptoms in the population, how many use the services of health and what they receive as care. We went through a review of the physiology of these symptoms and some pathophysiological explanations, to finish on what patients think about their symptoms and how they perceived the care they received and, finally, what professionals think about these patients. This part ends with a review of the approaches proposed for such patients. In the second part, we describe the empirical studies focused on the problem of patients with physical symptoms but no evidence of organic disease. Begins with a presentation of the procedural and methodological aspects of studies, more specifically, two quantitative and one qualitative. The first study sought to assess which are the physical symptoms, their incidence in the general population and the frequency they seek (or not) health services on behalf of those symptoms. The aim behind this study was to contribute to the demonstration that this type of symptoms is part of life's day-to-day and that, in most cases, does not represent disease by itself, without denying that they represent suffering, sometimes even greater than when there are organic disease. The first study endeavor to demonstrate that the physical symptoms are common in the population. The second study aspires to demonstrate that patients with such symptoms are also common and that the type of symptoms presented in the consultation does not differ from those in the general population. The aim was also to know what is done or proposed by the physician for these patients and if these patients brought or not, along with the symptoms, explanatory ideas for them. Finally and not least, it would try to assess the degree of reliability of diagnosis of somatoform symptoms, thus drawing the physical symptom that patient presents in the consultation and that the doctor diagnosed as having no organic cause. The third study starts from the acquired knowledge that medicine has many answers to this problem, but few can be considered satisfactory if used in isolation. The most solutions are sought in the medical culture and based on a reductionist paradigm of mind-body. However, if the symptom is "built" by the patient, if the main problem is not the symptom but the way the patient sees it, then it seemed logical to us that the solution must integrate the approaches that patients believes are best for them. Subsequently, a few patients, whose diagnosis of somatoform symptoms was demonstrated by the test of time, were interviewed. Therefore, patients who were interviewed had gone to the consultation of family medicine more than 6 months before for somatoform symptoms and. at the moment of the interview, the diagnosis remained unchanged, regardless of their evolution. The interviews aimed to ascertain the patients' ideas about what motivated them to seek consultation, what they thought about the care they got and which ideas they have about what health professionals should do to help these patients to re-establish equilibrium with its environment avoiding medicalization, iatrogenic effects and the evolution to chronicity. In the third section, we discuss and integrate the results found in previously existing knowledge. Attempts to theorize on the subject and contribute to more personalized treatment, comprehensive, varied and multi-modal approaches, always based on patient-centered clinical method, with emphasis on the relationship. We presents some hypotheses for future work on the subject and,above all, defend the recognition of the importance of lifelong learning communication skills for all health professionals, with the idea that we can always do better, otherwise we tend inexorably to do worse.

Evaluation of a direct immunofluorescent antibody (difma) test using Leishmania genus - specific monoclonal antibody in the routine diagnosis of cutaneous leishmaniasis

A direct immunofluorescent antibody (DIFMA) test using a Leishmania genus- specific monoclonal antibody was evaluated in the routine diagnosis of cutaneous leishmaniasis (CL) in Ecuador. This test was compared with the standard diagnostic techniques of scrapings, culture and histology. Diagnostic samples were taken from a total of 90 active dermal ulcers from patients from areas of Ecuador known to be endemic for cutaneous leishmaniasis. DIFMA was positive in all lesions. It was shown to be significantly superior to standard diagnostic methods either alone or in combination. The sensitivity of DIFMA did not diminish with chronicity of lesions. This test proved to be extremely useful in the routine diagnosis of CL because it is highly sensitive, is easy to use and produces rapid results.

Dependence of IVIM-DWI estimations on acquisition parameters

Dissertação para obtenção do Grau de Mestre em Engenharia Biomédica

The Edges of Areal Units: a case study in the heterogeneous effects of assessment district edges

Dissertation submitted in partial fulfillment of the requirements for the Degree of Master of Science in Geospatial Technologies

Business model analysis of Mobitto: How to solve the chicken and egg problem of a multi-sided platform?

A Work Project, presented as part of the requirements for the Award of a Masters Degree in Management from the NOVA – School of Business and Economics

The usefulness of Umelosa hepatitis C vírus qualitative kit as supplemental test for confirmation of hepatitis C virus infection

Forty voluntary blood donors from two different blood banks in Havana, Cuba, who were repeatedly reactive on the routine screening of antibodies to hepatitis C virus, by Umelisa HCV test, were analyzed for the presence of HCV RNA using a nested PCR assay of the HCV 5' untranslated region, Umelosa HCV qualitative. Sera from 45 patients of a specialized gastroenterology consultation, positive to Umelisa HCV, were also assayed with the Umelosa HCV qualitative, to establish their condition related to the presence of HCV RNA previously to the indication of a treatment or after three, six or twelve months of antiviral therapy. Serum HCV-RNA was detected in 21/40 (52.5%) donors who had repeatedly positive ELISA results, confirming the HCV infection for them. In specialized consultation HCV-RNA was detected by PCR analysis in 30/45 (66%) analyzed sera.

Evaluation of a commercial test based on ligase chain reaction for direct detection of Mycobacterium tuberculosis in respiratory specimens

A ligase chain reaction DNA amplification method for direct detection of Mycobacterium tuberculosis (Abbott LCx MTB) in respiratory specimens was evaluated. Results from LCx MTB Assay were compared with those from acid fast bacilli smear, culture, and final clinical diagnosis for each patient. A total of 297 respiratory specimens (sputum and bronchial lavage) from 193 patients were tested. The sensitivity, specificity, positive predictive value and negative predictive value of LCx vs culture were 92.7%, 93%, 67.8% and 98.7%, respectively. When compared to the clinical final diagnosis, the sensitivity, specificity, PPV and NPV for LCx were 88.9%, 96.8%, 86.5% and 97.4%, respectively. The sensitivity of LCx MTB assay was 75% for smear-negative, culture positive samples. The results indicate that LCx MTB assay is a rapid, simple and valuable technique as a complementary tool for the diagnosis of tuberculosis.

Evaluation of an immunochromatography test for malaria diagnosis under different storage conditions

This study aimed to evaluate the second-generation OptiMal test for malaria diagnosis under various storage conditions. It detected all the positive samples, except for two Plasmodium malariae samples. Further research evaluating diverse environmental conditions are important for ICT test applicability in Brazilian malaria areas.

Evaluation and optimization of a session-based middleware for data management

Dissertação para obtenção do Grau de Mestre em Engenharia Informática