Microbiological contamination of a hemodialysis center water distribution system

The microbiological monitoring of the water used for hemodialysis is extremely important, especially because of the debilitated immune system of patients suffering from chronic renal insufficiency. To investigate the occurrence and species diversity of bacteria in waters, water samples were collected monthly from a hemodialysis center in upstate São Paulo and tap water samples at the terminal sites of the distribution system was sampled repeatedly (22 times) at each of five points in the distribution system; a further 36 samples were taken from cannulae in 19 hemodialysis machines that were ready for the next patient, four samples from the reuse system and 13 from the water storage system. To identify bacteria, samples were filtered through 0.22 µm-pore membranes; for mycobacteria, 0.45 µm pores were used. Conventional microbiological and molecular methods were used in the analysis. Bacteria were isolated from the distribution system (128 isolates), kidney machine water (43) and reuse system (3). Among these isolates, 32 were Gram-positive rods, 120 Gram-negative rods, 20 Gram-positive cocci and 11 mycobacteria. We propose the continual monitoring of the water supplies in hemodialysis centers and the adoption of effective prophylactic measures that minimize the exposure of these immunodeficient patients to contaminated sources of water.

Factors associated to infection by Toxoplasma gondii in pregnant women attended in Basic Health Units in the city of Rolândia, Paraná, Brazil

The aim of the present work was to determine the prevalence of IgG and IgM anti-Toxoplasma gondii antibodies and the factors associated to the infection in pregnant women attended in Basic Health Units in Rolândia, Paraná, Brazil. The sample was divided in two groups: group I (320 pregnant women who were analyzed from July 2007 to February 2008) and group II (287 pregnant women who were analyzed from March to October 2008). In group I, it was found 53.1% of pregnant women with IgG reactive and IgM non-reactive, 1.9% with IgG and IgM reactive, 0.3% with IgG non-reactive and IgM reactive and 44.7% with IgG and IgM non-reactive. In group II, it was found 55.1% with IgG reactive and IgM non-reactive and 44.9% with IgG and IgM non-reactive. The variables associated to the presence of IgG antibodies were: residence in rural areas, pregnant women between 35-40 years old, low educational level, low family income, more than one pregnancy, drinking water which does not originate from the public water supply system and the habit of handling soil or sand. Guidance on primary prevention measures and the quarterly serological monitoring of the pregnant women in the risk group are important measures to prevent congenital toxoplasmosis.

Transoesophageal Echocardiography for Monitoring Liver Surgery: Data from a Pilot Study

A pilot study aimed to introduce intraoperative monitoring of liver surgery using transoesophageal echocardiography (TEE) is described. A set of TEE measurements was established as a protocol, consisting of left atrial (LA) dimension at the aortic valve plane; mitral velocity flow integral, calculation of stroke volume and cardiac output (CO); mitral annular plane systolic excursion; finally, right atrial area. A total of 165 measurements (on 21 patients) were performed, 31 occurring during hypotension. The conclusions reached were during acute blood loss LA dimension changed earlier than CVP, and, in one patient, a dynamic left ventricular (LV) obstruction was observed; in 3 patients a transient LV systolic dysfunction was documented. The comparison between 39 CO paired measurements obtained by TEE and PiCCO2 revealed a statistically significant correlation (P < 0.001, r = 0.83). In this pilot study TEE successfully answered the questions raised by the anesthesiologists. Larger cohort studies are needed to address this issue.

Circulation of human papillomavirus (HPV) genotypes in women from Córdoba, Argentina, with squamous intraepithelial lesions

Human papillomavirus (HPV) can induce a wide spectrum of squamous intraepithelial lesions (SIL) of varying severity. The aim of the present study was to establish the frequency of HPV infection and identify the genotypes circulating in women from Córdoba, Argentina, in relation to age and cytology. A total of 186 women, between 18 and 65 years old, with antecedents of SIL, underwent a pelvic examination and had cervical cells collected for cytology and HPV DNA detection. Ninety-six samples (51.6%) were positive for HPV detection, and sixty-three (65.6%) of them showed the presence of at least one HR-HPV. Low- and high-grade SIL showed significant association in patients younger than 35 years of age. We found 18 different genotypes, with a greater presence of HR-HPV. Genotypes 16 and 6 were the most frequent. Seven (7.3%) multiple infections, 85.7% of which had at least one HR-HPV, were detected. The detection of a large number of different HPV genotypes is a warning sign. It is thus necessary to strengthen the monitoring of the circulation of high-risk genotypes, currently less prevalent in intraepithelial lesions, as a control measure for the possible impact of the implementation of vaccines against genotypes 16 and 18.

Discrepancies and consequences of indirect hemagglutination, indirect immunofluorescence and Elisa tests for the diagnosis of Chagas disease

Using the indirect hemagglutination (IH), indirect immunofluorescence (IIF) and enzyme linked immunosorbent assay (ELISA) tests for the diagnosis of Chagas disease, 4000 serum samples were examined. This study was conducted with different purposes: clinical interest, research support and parasitological monitoring of those patients with Chagas disease who were treated with heart transplantations. The tests occurred without patient selection and in accordance with the medical requests. The results showed discrepancies and brought about several questions, considering the different results that all three methods showed when considered together. What was found brought about concerns and we suggest the adoption of different measures, aiming to avoid these mismatches in the context of this disease.

Environmental Decision-making utilizing a Web GIS to Monitor Hazardous Industrial Emissions in the Valencian community of Spain

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

SUSCEPTIBILITY OF Candida spp. ISOLATED FROM BLOOD CULTURES AS EVALUATED USING THE M27-A3 AND NEW M27-S4 APPROVED BREAKPOINTS

The high mortality rates associated with candidemia episodes and the emergence of resistance to antifungal agents necessitate the monitoring of the susceptibility of fungal isolates to antifungal treatments. The new, recently approved, species-specific clinical breakpoints (SS-CBPs)(M27-S4) for evaluating susceptibility require careful interpretation and comparison with the former proposals made using the M27-A3 breakpoints, both from CLSI. This study evaluated the susceptibility of the different species of Candida that were isolated from candidemias based on these two clinical breakpoints. Four hundred and twenty-two isolates were identified and, among them, C. parapsilosis comprised 46.68%, followed by C. albicans (35.78%), C. tropicalis (9.71%), C. glabrata (3.55%), C. lusitaniae (1.65%), C. guilliermondii (1.65%) and C. krusei (0.94%). In accordance with the M27-A3 criteria, 33 (7.81%) non-susceptible isolates were identified, of which 16 (3.79%) were resistant to antifungal agents. According to SS-CBPs, 80 (18.95%) isolates were non-susceptible, and 10 (2.36%) of these were drug resistant. When the total number of non-susceptible isolates was considered, the new SS-CBPs detected 2.4 times the number of isolates that were detected using the M27-A3 interpretative criteria. In conclusion, the detection of an elevated number of non-susceptible species has highlighted the relevance of evaluating susceptibility tests using new, species-specific clinical breakpoints (SS-CBPs), which could impact the profile of non-susceptible Candida spp. to antifungal agents that require continuous susceptibility monitoring.

Conceção e Análise de um Demonstrador para a Monitorização Estrutural

Os sistemas de monitorização de estruturas fornecem diversas vantagens, não só no que diz respeito à durabilidade da obra, ao aumento da segurança e do conhecimento relativamente ao comportamento das estruturas ao longo do tempo, à otimização do aspeto estrutural, bem como aos aspetos económicos do processo de construção e manutenção. A monitorização deve realizar-se durante a fase de construção e/ou de exploração da obra para permitir o registo integral do seu comportamento no meio externo. Deve efetuar-se de forma contínua e automática, executando intervenções de rotina para que se possa detetar precocemente sinais de alterações, respetivamente à segurança, integridade e desempenho funcional. Assim se poderá manter a estrutura dentro de parâmetros aceitáveis de segurança. Assim, na presente dissertação será concebido um demonstrador experimental, para ser estudado em laboratório, no qual será implementado um sistema de monitorização contínuo e automático. Sobre este demonstrador será feita uma análise de diferentes grandezas em medição, tais como: deslocamentos, extensões, temperatura, rotações e acelerações. Com carácter inovador, pretende-se ainda incluir neste modelo em sintonia de medição de coordenadas GNSS com o qual se torna possível medir deslocamentos absolutos. Os resultados experimentais alcançados serão analisados e comparados com modelos numéricos. Conferem-se os resultados experimentais de natureza estática e dinâmica, com os resultados numéricos de dois modelos de elementos finitos: um de barras e outro de casca. Realizaram-se diferentes abordagens tendo em conta as características identificadas por via experimental e calculadas nos modelos numéricos para melhor ajuste e calibração dos modelos numéricos Por fim, recorre-se a algoritmos de processamento e tratamento do respetivo sinal com aplicação de filtros, que revelam melhorar com rigor o sinal, de forma a potenciar as técnicas de fusão multisensor. Pretende-se integrar o sinal GNSS com os demais sensores presentes no sistema de monitorização. As técnicas de fusão multisensor visam melhor o desempenho deste potencial sistema de medição, demonstrando as suas valências no domínio da monitorização estrutural.

Acompanhamento das Técnicas de Construção na Obra do Aproveitamento Hidroelétrico de Foz Tua

O presente trabalho foi desenvolvido na obra do Aproveitamento Hidroelétrico de Foz Tua onde a autora teve oportunidade de realizar o estágio curricular junto da equipa da Fiscalização no período de 2 de Fevereiro de 2015 a 31 de Julho de 2015. A elaboração do presente trabalho pretende transmitir conhecimentos adquiridos relacionados com a constituição de um Aproveitamento Hidroelétrico, os tipos de barragens existentes, monitorização e controlo da segurança da estrutura da Barragem, controlo de qualidade de betão e o processo construtivo de uma Barragem. A construção da Barragem do Aproveitamento Hidroelétrico de Foz Tua tem sido realizada através do método tradicional, que consiste na aplicação de betão convencional compactado por vibração interna. Ao longo deste processo, foram aplicadas diversas técnicas construtivas, nomeadamente: escavação, betonagem, refrigeração artificial, injeção de juntas e tratamento de fundações. Neste trabalho foram ainda analisados os cuidados de segurança necessários neste tipo de estruturas, tendo como base o Regulamento de Segurança de Barragens. Este regulamento define as regras a seguir durante a execução da barragem e a monotorização que deve ser efetuada à mesma, permitindo assim o controlo da segurança da estrutura na sua construção e vida útil. É necessário ainda existir um controlo da qualidade, produção e aplicação do betão na estrutura de modo a aumentar a segurança, qualidade e durabilidade da mesma.

Genomic Signatures and Antiviral Drug Susceptibility Profile of A(H1N1)pdm09

Background: Genetic changes in influenza surface and internal genes can alter viral fitness and virulence. Mutation trend analysis and antiviral drug susceptibility profiling of A(H1N1)pdm09 viruses is essential for risk assessment of emergent strains and disease management. Objective: To profile genomic signatures and antiviral drug resistance of A(H1N1)pdm09 viruses and to discuss the potential role of mutated residues in human host adaptation and virulence. Study design: A(H1N1)pdm09 viruses circulating in Portugal during pandemic and post-pandemic periods and 2009/2010 season. Viruses were isolated in MDCK-SIAT1 cell culture and subjected to mutation analysis of surface and internal proteins, and to antiviral drug susceptibility profiling. Results: The A(H1N1)pdm09 strains circulating during the epidemic period in Portugal were resistant to amantadine. The majority of the strains were found to be susceptible to oseltamivir and zanamivir, with five outliers to neuraminidase inhibitors (NAIs) identified. Specific mutation patterns were detected within the functional domains of internal proteins PB2, PB1, PA, NP, NS1, M1 and NS2/NEP, which were common to all isolates and also some cluster-specific. Discussion: Modification of viral genome transcription, replication and apoptosis kinetics, changes in antigenicity and antiviral drug susceptibility are known determinants of virulence. We report several point mutations with putative roles in viral fitness and virulence, and discuss their potential to result in more virulent phenotypes. Monitoring of specific mutations and genetic patterns in influenza viral genes is essential for risk assessing emergent strains, disease epidemiology and public health implications.

SIXTEEN YEARS OF PITYRIASIS VERSICOLOR IN METROPOLITAN AREA OF PORTO ALEGRE, SOUTHERN BRAZIL

SUMMARY Pityriasis versicolor is the most common of the diseases caused by Malasseziayeasts. The aim of this study is to determine the prevalence of pityriasis versicolor and its etiological aspects in the metropolitan area of Porto Alegre, Brazil. A retrospective crosssectional study with data from patients of a reference hospital from 1996 to 2011 was performed. Collected data included: date, age, gender, ethnicity, anatomical region of lesion and the direct mycological examination results. Among the positive results in the direct mycological examination, 5.8% (2,239) were positive for pityriasis versicolor. The angular coefficient (B) was -0.3%/year, showing a decrease over the years. The disease was more prevalent in men (7.1% of men versus 5.1% of women that underwent the direct mycological examination); younger age (median 31 years old); "pardo" and black people (3.7% more than expected in the sample); trunk (73.44% of the affected anatomic sites). Lesions in rare sites (groin, genitals, legs, feet and hands) were also observed in this study. In conclusion, due to the decrease in the prevalence of pityriasis versicolor, long-term epidemiological studies in the metropolitan area of Porto Alegre, Brazil, are needed to continue the monitoring of this disease.

Reorganização do layout e reajustamento dos recursos humanos de um armazém

O projeto descrito no presente relatório, desenvolvido no contexto do Mestrado em Logística da APNOR, surgiu com vista a colmatar as necessidades identificadas pela empresa acolhedora na área da armazenagem. A empresa identificou como objetivo principal a reorganização do armazém de modo a satisfazer em tempo útil os pedidos efetuados pela unidade de produção. Em simultâneo foi identificada a necessidade de ajustar os recursos humanos do armazém às necessidades do mesmo. Durante o último ano de atividade verificou-se um crescimento exponencial do volume de produção, assim como do número de clientes. O crescimento acelerado dificultou a adaptação das estruturas da empresa à nova realidade, designadamente no que respeita à disposição do armazém, ao fluxo de informação e físico entre o armazém e a produção, assim como um correto dimensionamento do número de colaboradores afetos ao armazém. No início do estágio foi efetuado um acompanhamento próximo dos colaboradores e das atividades desenvolvidas, por forma a encontrar os principais pontos de estrangulamento dentro do armazém e na relação entre o armazém e a produção. Durante o acompanhamento averiguou-se que a principal dificuldade era a capacidade do armazém em albergar a mercadoria remetida pelos clientes, o tempo dispensado nos percursos efetuados no armazém para a preparação das encomendas e o abastecimento da produção em tempo útil.

HIV-2 Integrase Polymorphisms and Longitudinal Genotypic Analysis of HIV-2 Infected Patients Failing a Raltegravir-Containing Regimen

To characterize the HIV-2 integrase gene polymorphisms and the pathways to resistance of HIV-2 patients failing a raltegravir-containing regimen, we studied 63 integrase strand transfer inhibitors (INSTI)-naïve patients, and 10 heavily pretreated patients exhibiting virological failure while receiving a salvage raltegravir-containing regimen. All patients were infected by HIV-2 group A. 61.4% of the integrase residues were conserved, including the catalytic motif residues. No INSTI-major resistance mutations were detected in the virus population from naïve patients, but two amino acids that are secondary resistance mutations to INSTIs in HIV-1 were observed. The 10 raltegravir-experienced patients exhibited resistance mutations via three main genetic pathways: N155H, Q148R, and eventually E92Q - T97A. The 155 pathway was preferentially used (7/10 patients). Other mutations associated to raltegravir resistance in HIV-1 were also observed in our HIV-2 population (V151I and D232N), along with several novel mutations previously unreported. Data retrieved from this study should help build a more robust HIV-2-specific algorithm for the genotypic interpretation of raltegravir resistance, and contribute to improve the clinical monitoring of HIV-2-infected patients.

Revealing fungal activity in the presence of ionic liquids

Dissertation presented to obtain the Ph.D degree in Biochemistry

Empirical models for quantification of machining damage in composite materials

Dissertação para obtenção do Grau de Doutor em Engenharia Mecânica