Adesão terapêutica em doentes submetidos a transplante hepático e renal

RESUMO - Introdução - A não adesão à terapêutica nos doentes transplantados foi identificada em diversos estudos e constitui um fator preditivo de morbilidade e mortalidade. Como em Portugal não existe um conhecimento aprofundado sobre os comportamentos de não adesão nos doentes transplantados, este estudo tem como objetivo a avaliação da adesão terapêutica nos doentes submetidos a transplante hepático e renal e a identificação de fatores associados à não adesão. Metodologia - Foi elaborado e aplicado um questionário a uma amostra de doentes com mais de 18 anos submetidos a transplante renal ou hepático há mais de seis meses. Foi analisada a associação entre o comportamento de não adesão e fatores relacionados com o doente, condição, terapêutica e acesso aos serviços de saúde. Resultados - Dos 75 inquiridos, 60% eram doentes transplantados de fígado e 40% transplantados renais, com uma média de 48 anos e maioritariamente do sexo masculino (65,3%). Entre os inquiridos, verificou-se que 44% admitiu ter tido um comportamento de não adesão aos medicamentos prescritos. Os doentes que reportaram comportamento de não adesão tinham uma média de idades de 44 anos, possuíam como escolaridade o ensino secundário ou curso profissional, trabalhavam ou estudavam, tomavam menos de oito comprimidos por dia e tinham sido transplantados há mais de 5 anos. Adicionalmente, verificou-se que a dieta (28,8%), o exercício físico (33,3%) e o deixar de fumar (10,7%) são as indicações dadas pelos profissionais de saúde que os doentes referiram ter mais dificuldade em cumprir. Conclusão - Com este estudo esperamos ter contribuído para aumentar o conhecimento sobre a adesão à terapêutica nos doentes transplantados, o qual deve ser aprofundado para permitir o desenvolvimento de estratégias efetivas de melhoria da adesão aos planos terapêuticos.

The hamster (mesocricetus auratus) as experimental model in chagas' disease: parasitological and histopathological studies in acute and chronic phases of Trypanosoma cruzi infection

This research characterizes the acute and chronic phases of Chagas ' disease in hamster through parasitological and histopathological studies. The acute phase was achieved with 44 young hamsters injected intraperitoneally with 100.000 blood trypomastigotes of Benedito and Y strains of T. cruzi. The chronic phase was induced in 46 hamsters injected intraperitoneally with 35.000 trypomastigotes ofVicentina, Benedito and Y strains. Animals were sacrificed at regular intervals of 24 hours of acute phase and from the 3rd to the 10th month of infection ofchronic phase. In the acute phase, parasites were easily recoveredfrom all animals and there was an inflammatory reaction characterized by mononuclear and polymorphous leukocyte infiltration of variable degree in the majority of tissues and organs, specially in the connective loose and fatty tissues, smooth muscle myocardium and skeletal muscle. In the chronic phase the lesions occurred in the same tissues and organs, but the inflammatory response was less severe and characterized by mononuclear infiltration mainly with focal or zonalfibrosis in the myocardiun. In 50% of infected animals parasites were found inmyocardiun and recoveredfrom pericardic, peritoneal and ascitic fluids in some animals. Signs of heart failure, sudden death and enlargement of bowel were observed regularly. We concluded that the hamster is an useful model for Chagas' disease studies.

Enhancing physical activity coaching through personalized motivational strategies and self-adaptive goal-setting: development of self-adaptive processes in a monitoring and coaching smartphone application

Dissertação para obtenção do Grau de Mestre em Engenharia Biomédica

Performance assessment of waste fibre-reinforced mortar

Materials Science Forum Vols. 730-732 (2013) pp 617-622

Evaluation of pathogenic potential of Aeromonas spp. strains using in vitro methodologies

Dissertation to obtain a Master Degree in Molecular Genetics and Biomedicine

Establishing a cell biology platform: isolation and preservation of human blood products

Dissertação para obtenção do Grau de Mestre em Genética Molecular e Biomedicina

Introducing Mobile Money in Rural Mozambique: Evidence from a Field Experiment*

The limitations of access to finance in Africa, together with the recent boom in cell phone use in that continent, created high expectations regarding the introduction of mobile money in many African countries. The success story of M-PESA in Kenya raised the bar further. We designed and conducted a field experiment to assess the impact of randomized mobile money dissemination in rural Mozambique. For this purpose we benefit from the fact that mobile money was only recently launched in the country, allowing for the identification of a pure control group. This paper reports on the first results of this ongoing project after the first wave of dissemination efforts in rural locations, which included the recruitment and training of mobile money agents, community meetings and theaters, as well as individual rural campaigning. Administrative and behavioral data both show clear adherence to the services in the treatment group. Financial literacy and trust outcomes are also positively affected by the treatment. We present behavioral evidence that the marginal willingness to remit was increased by the availability of mobile money. Finally, we observe a tendency for mobile money to substitute traditional alternatives for both savings and remittances.

The value of in vitro cell culture of granulocytes in the detection of Ehrlichia

Peripheral blood leukocytes from different animals were isolated from whole blood and maintained in Dulbeco's medium containing homologous serum without antibiotics. After 72 hrs microscopic examination of these cells showed that most animals were infected with Ehrlichia. Observation of thin blood smears from the same animals showed that only two were positive for Ehrlichia. The results of this investigation show that leukocyte culture is superior to the traditional thin blood film method in the detection of Ehrlichia and that asymptomatic carriers are easily detected. The method is inexpensive and does not require specific cell lines although it is necessary to use sterile sera.

An intermittent schedule is better than continuous regimen of antimonial therapy for cutaneous leishmaniasis in the municipality of Rio de Janeiro, Brazil

This study reviews a series of cutaneous leishmaniasis cases diagnosed and treated in outpatient units in the municipality of Rio de Janeiro, where the intermittent schedule of antimonial therapy was replaced by the continuous regimen. Both schedules were based on daily intramuscular injections of pentavalent antimonial. Forty-nine subjects received the intermittent regimen, consisting of three ten-day series alternated with ten-day rest intervals whereas seventy-one patients received the continuous regimen during 20 consecutive days. The study groups had similar composition regarding age, sex and clinical condition. The cure rate was significantly higher in the group receiving the intermittent schedule than in the group receiving continuous therapy (89.8% vs 63.3%). Moreover, loss to follow-up was significantly more frequent in the group receiving continuous therapy (19.7% vs 4.1% in the intermittent therapy). Under field conditions, the intermittent regimen provided higher effectiveness and adherence than the continuous schedule.

Transitional dynamics of an endogenous growth model with an erosion effect

The convergence features of an Endogenous Growth model with Physical capital, Human Capital and R&D have been studied. We add an erosion effect (supported by empirical evidence) to this model, and fully characterize its convergence properties. The dynamics is described by a fourth-order system of differential equations. We show that the model converges along a one-dimensional stable manifold and that its equilibrium is saddle-path stable. We also argue that one of the implications of considering this “erosion effect” is the increase in the adherence of the model to data.

Bioinspired polyethersulfone-based hollow fiber membranes as the scaffolds in renal assist device for protein-bound toxins removal from blood

Dissertation for obtaining the Master degree in Membrane Engineering

Comparative study of survivor and nonsurvivor sepsis patients in a university hospital

To determine parameters associated with the evolution of sepsis, a five-year retrospective study was conducted in a university hospital. One hundred and four consecutive sepsis patients were evaluated, of whom 55.8% were men. The mortality was 68.3% and was associated with older age (p<0.05). Chronic comorbidities and infection site were not associated with prognosis. Gram-positive bacteria were more frequently identified in survivors (p<0.05), while non-detection of the germ was associated with mortality (p<0.01). Appropriate use of antibiotics (germ sensitive to at least one drug administered) was associated with survival (p<0.0001) while inappropriate use (p<0.05) or empirical use (p<0.01) were more frequent in nonsurvivors. Leukocytosis was the main abnormality (54.8%) detected on diagnosis, from the leukocyte count. During the evolution, normal leukocyte count was associated with survival (p<0.01) and leukocytosis with mortality (p<0.05). In conclusion, mortality was associated with nondetection of the pathogen, leukocytosis during the evolution of the sepsis and inappropriate or empirical use of antimicrobials. Evidence-based treatment that is directed towards modifiable risk factors might improve the prognosis for sepsis patients.

Stages of in vitro phagocytosis of Plasmodium falciparum-infected erythrocytes by human monocytes

Monocytes/macrophages play a critical role in the defense mechanisms against malaria parasites, and are the main cells responsible for the elimination of malaria parasites from the blood circulation. We carried out a microscope-aided evaluation of the stages of in vitro phagocytosis of Plasmodium falciparum-infected erythrocytes, by human monocytes. These cells were obtained from healthy adult individuals by means of centrifugation through a cushion of Percoll density medium and were incubated with erythrocytes infected with Plasmodium falciparum that had previously been incubated with a pool of anti-plasmodial immune serum. We described the stages of phagocytosis, starting from adherence of infected erythrocytes to the phagocyte membrane and ending with their destruction within the phagolisosomes of the monocytes. We observed that the different erythrocytic forms of the parasite were ingested by monocytes, and that the process of phagocytosis may be completed in around 30 minutes. Furthermore, we showed that phagocytosis may occur continuously, such that different phases of the process were observed in the same phagocyte.

Equidade na utilização de medicamentos em Portugal

RESUMO - Este estudo teve como objectivo contribuir para o conhecimento sobre a equidade no sector do medicamento, com uma análise empírica aplicada ao sistema de saúde português. Para o efeito avaliou-se se indivíduos com as mesmas necessidades em saúde, mas com diferentes níveis de rendimento, tiveram idêntica prestação no que diz respeito ao medicamento. Adicionalmente, aprofundou-se esta análise através da identificação de factores associados ao sistema de prestação ou ao utente que contribuíram para gerar iniquidades, com particular destaque para os comportamentos de não aquisição de medicamentos – não adesão primária. A avaliação da equidade foi efectuada através de duas abordagens distintas, mas complementares: uma sob a perspectiva da utilização e outra sob a perspectiva da distribuição da despesa pública com medicamentos. Para estas análises aplicaram-se métodos baseados nos índices de concentração, utilizando dados do Inquérito Nacional de Saúde 2005/06 e dados relativos aos encargos do Serviço Nacional de Saúde com medicamentos. Os resultados revelaram que, perante as mesmas necessidades, o sistema de prestação tende a favorecer os indivíduos de nível socioeconómico superior, quer na utilização quer na distribuição de recursos do Estado com medicamentos. Adicionalmente, a aplicação do método da decomposição do índice de concentração revelou que tanto o rendimento como o nível educacional são atributos individuais que estão associados à iniquidade na utilização de medicamentos. A iniquidade observada neste estudo pode resultar de barreiras em diferentes fases do processo terapêutico, entre as quais se destacam o não acesso à prescrição médica ou a não aquisição dos medicamentos prescritos. Foi este comportamento - designado de não adesão primária - que se analisou na segunda parte da tese. Para tal cruzaram-se os dados de prescrição electrónica com os dados de dispensa no Serviço Nacional de Saúde. Os resultados revelaram que a taxa de não adesão primária foi cerca de 20% e que este comportamento está associado ao sexo feminino ou ser jovem, assim como a características do sistema de prestação como o valor dos copagamentos. Estes dados indiciam que as barreiras na aquisição podem ser indutoras de iniquidades na utilização de medicamentos. A identificação de iniquidade na utilização de medicamentos e dos factores que contribuem para esta situação constituem o primeiro passo para uma estratégia de redução da iniquidade que, de acordo com os resultados desta tese, deve abranger não só o sistema de saúde mas também outras áreas das políticas públicas em Portugal.

Extração de DNA a partir de sangue humano coagulado para aplicação nas técnicas de genotipagem de antígenos leucocitários humanos e de receptores semelhantes à imunoglobulina

O objetivo deste estudo foi padronizar uma metodologia de extração de DNA de alta qualidade a partir de amostras de sangue coagulado. Quarenta e oito amostras de sangue humano coagulado foram utilizadas para a extração de DNA pelo kit comercial EZ-DNA® (Biological Industries, Beit Haemek, Israel), pelo kit de coluna Neoscience® (One Lambda Inc., San Diego, CA) e pelo método modificado de salting out. Apenas o método de salting out foi capaz de extrair altas concentrações de DNA (média, 180ng/µL), as quais foram medidas pelo detector de fluorescência Qubit® (Invitrogen, USA). Este método permitiu a amplificação dos genes HLA (human leukocyte antigens) pela tecnologia PCR-SSO (polymerase chain reaction - specific sequence of oligonucleotides) Luminex, a qual exige DNA de boa qualidade, e de genes KIR (killer cell immunoglobulin-like receptors) pela técnica made in house PCR-SSP (polymerase chain reaction-sequence specific of primers), a qual demanda uma concentração específica de DNA (10ng/µL). Concluímos que a técnica de salting out modificada foi muito eficiente, simples e rápida para a extração de DNA de amostras de sangue humano coagulado, com o objetivo de realizar a genotipagem de genes HLA e KIR.