Development of an integrative approach for the characterization of ecological risk on marine transition ecosystems: the Sado Estuary as a case study

Estuaries and other transitional waters are complex ecosystems critically important as nursery and shelter areas for organisms. Also, humans depend on estuaries for multiple socio-economical activities such as urbanism, tourism, heavy industry, (taking advantage of shipping), fisheries and aquaculture, the development of which led to strong historical pressures, with emphasis on pollution. The degradation of estuarine environmental quality implies ecologic, economic and social prejudice, hence the importance of evaluating environmental quality through the identification of stressors and impacts. The Sado Estuary (SW Portugal) holds the characteristics of industrialized estuaries, which results in multiple adverse impacts. Still, it has recently been considered moderately contaminated. In fact, many studies were conducted in the past few years, albeit scattered due to the absence of true biomonitoring programmes. As such, there is a need to integrate the information, in order to obtain a holistic perspective of the area able to assist management and decision-making. As such, a geographical information system (GIS) was created based on sediment contamination and biomarker data collected from a decade-long time-series of publications. Four impacted and a reference areas were identified, characterized by distinct sediment contamination patterns related to different hot spots and diffuse sources of toxicants. The potential risk of sediment-bound toxicants was determined by contrasting the levels of pollutants with available sediment quality guidelines, followed by their integration through the Sediment Quality guideline Quotient (SQG-Q). The SQG-Q estimates per toxicant or class was then subjected to georreferencing and statistical analyses between the five distinct areas and seasons. Biomarker responses were integrated through the Biomarkers Consistency Indice and georreferenced as well through GIS. Overall, in spite of the multiple biological traits surveyed, the biomarker data (from several organisms) are accordant with sediment contamination. The most impacted areas were the shipyard area and adjacent industrial belt, followed by urban and agricultural grounds. It is evident that the estuary, although globally moderately impacted, is very heterogeneous and affected by a cocktail of contaminants, especially metals and polycyclic aromatic hydrocarbon. Although elements (like copper, zinc and even arsenic) may originate from the geology of the hydrographic basin of the Sado River, the majority of the remaining contaminants results from human activities. The present work revealed that the estuary should be divided into distinct biogeographic units, in order to implement effective measures to safeguard environmental quality.

Dynamic stiffness of the piled foundation of a onshore wind turbine

One of today's biggest concerns is the increase of energetic needs, especially in the developed countries. Among various clean energies, wind energy is one of the technologies that assume greater importance on the sustainable development of humanity. Despite wind turbines had been developed and studied over the years, there are phenomena that haven't been yet fully understood. This work studies the soil-structure interaction that occurs on a wind turbine's foundation composed by a group of piles that is under dynamic loads caused by wind. This problem assumes special importance when the foundation is implemented on locations where safety criteria are very demanding, like the case of a foundation mounted on a dike. To the phenomenon of interaction between two piles and the soil between them it's given the name of pile-soil-pile interaction. It is known that such behavior is frequency dependent, and therefore, on this work evaluation of relevant frequencies for the intended analysis is held. During the development of this thesis, two methods were selected in order to assess pile-soil-pile interaction, being one of analytical nature and the other of numerical origin. The analytical solution was recently developed and its called Generalized pile-soil-pile theory, while for the numerical method the commercial nite element software PLAXIS 3D was used. A study of applicability of the numerical method is also done comparing the given solution by the nite element methods with a rigorous solution widely accepted by the majority of the authors.

Burden experienced by families of patients with schizophrenia and its related factors

RESUMO: Objetivo: Este estudo teve como objetivo avaliar a carga dos cuidadores de doentes com Esquizofrenia e avaliar a correlação com determinadas características demográficas dos doentes e dos cuidadores, assim como com o nível de emoção expressa na família. Métodos: Este estudo descritivo-analítico foi realizado em 172 doentes com Esquizofrenia e seus cuidadores primários, que foram selecionados em ambulatório, a partir da consulta externa do Hospital Psiquiátrico em Teerão, no Irão, mediante uma amostra de conveniência. Os cuidadores foram entrevistados utilizando as escalas Zarit Burden Interview e Family Questionnaire, de forma a avaliar a sobrecarga sentida pelos cuidadores e o nível de emoção expressa na família, respectivamente. Os dados foram analisados por meio de testes de Mann-Whitney, Kruskal-Wallis, e Spearman. Resultados: O nível de sobrecarga vivenciada pela maioria dos cuidadores primários foi moderada a grave. A pontuação obtida nas sub-escalas de comentários emocionais, envolvimento excessivo e comentários críticos foram maiores do que o ponto de corte em 51,7% e 64,5% dos cuidadores, respectivamente. Os resultados mostraram que as pontuações obtidas nas duas subescalas do questionário família tinham uma correlação significativa e direta com a carga experimentada pelos cuidadores. O nível de carga experimentada pelos cuidadores foi significativamente diferente entre os grupos de idade e estado civil dos cuidadores, e género, status ocupacional e estado civil dos doentes. O número de membros da família, as condições 5 de alojamento, o tempo gasto pelo cuidador com o paciente diariamente, o nível de renda familiar e a duração da doença afetaram significativamente o nível de carga experimentada pelo cuidador. Conclusão: Com base nos resultados, alguns fatores demográficos dos cuidadores, pacientes e seus familiares afetam significativamente a carga experimentada pelos cuidadores primários. A maioria das famílias dos pacientes têm alto nível de emoção expressa e existe uma significativa associação direta entre as emoções expressas e a carga experimentada.------------ABSTRACT: Aim: This study aimed to assess the burden experienced by the caregiver of patients with Schizophrenia, and evaluate its correlation with some demographic characteristics of patients, their caregivers, and the level of expressed emotion in the family. Methods: This descriptive-analytic study was conducted on 172 schizophrenic patients and their primary caregivers selected from the outpatient clinic of a mental hospital in Tehran, Iran using convenience sampling. Caregivers were evaluated with Zarit Burden Interview and Family Questionnaire to assess the burden experienced by the caregivers and the level of expressed emotion in the family, respectively. Data were analyzed using Mann-Whitney, Kruskal-Wallis, and Spearman’s tests. Results: The level of burden experienced by the majority of primary caregivers was moderate to severe. The scores obtained in the subscales of emotional over-involvement and critical comments were higher than the cutoff point in 51.7% and 64.5% of caregivers respectively. The results showed that the scores obtained in the two subscales of family questionnaire had a significant, direct correlation with the burden experienced by the caregivers. The level of burden experienced by the caregivers was significantly different between the subgroups of age and marital status of the caregivers, and gender, occupational status and marital status of the patients. Number of family members, home ownership status, time spent by the caregiver with the patient daily, level of family income and duration of disorder significantly affected the level of burden experienced by the caregiver. Conclusion: Based on the results, some demographic factors of the primary caregivers, patients and their family significantly affect the burden experienced by the primary caregivers. Most of the families of patients have high expressed emotions and a significant, direct association exists between the expressed emotions and the burden experienced.

Planning and verification of multipath routing protocols

Conventionally the problem of the best path in a network refers to the shortest path problem. However, for the vast majority of networks present nowadays this solution has some limitations which directly affect their proper functioning, as well as an inefficient use of their potentialities. Problems at the level of large networks where graphs of high complexity are commonly present as well as the appearing of new services and their respective requirements, are intrinsically related to the inability of this solution. In order to overcome the needs present in these networks, a new approach to the problem of the best path must be explored. One solution that has aroused more interest in the scientific community considers the use of multiple paths between two network nodes, where they can all now be considered as the best path between those nodes. Therefore, the routing will be discontinued only by minimizing one metric, where only one path between nodes is chosen, and shall be made by the selection of one of many paths, thereby allowing the use of a greater diversity of the present paths (obviously, if the network consents). The establishment of multi-path routing in a given network has several advantages for its operation. Its use may well improve the distribution of network traffic, improve recovery time to failure, or it can still offer a greater control of the network by its administrator. These factors still have greater relevance when networks have large dimensions, as well as when their constitution is of high complexity, such as the Internet, where multiple networks managed by different entities are interconnected. A large part of the growing need to use multipath protocols is associated to the routing made based on policies. Therefore, paths with different characteristics can be considered with equal level of preference, and thus be part of the solution for the best way problem. To perform multi-path routing using protocols based only on the destination address has some limitations but it is possible. Concepts of graph theory of algebraic structures can be used to describe how the routes are calculated and classified, enabling to model the routing problem. This thesis studies and analyzes multi-path routing protocols from the known literature and derives a new algebraic condition which allows the correct operation of these protocols without any network restriction. It also develops a range of software tools that allows the planning and the respective verification/validation of new protocols models according to the study made.

Visceral leishmaniasis in Rio de Janeiro, Brazil: eco-epidemiological aspects and control

From 1977 (index case) to 2006, 87 cases of visceral leishmaniasis were confirmed in the municipality of Rio de Janeiro, Brazil, in periurban areas on the continental and coastal slopes of the Pedra Branca massif and the continental slopes of the Gericinó massif. The majority (65.5%) of the patients were more than five years old, predominantly males (61.5%), but without any difference between the sexes below the age of 14 years. The overall fatality rate was 10.4%. Two cases of visceral leishmaniasis/human immunodeficiency virus coinfection were detected. Leishmania chagasi was isolated from human and canine cases. The associations between the presence of phlebotomines and human and canine migrations, disorderly occupation involving degradation of environmental preservation areas and poor socioeconomic conditions may have created a favorable setting for the establishment and propagation of the disease. Close epidemiological surveillance associated with traditional control measures and others (active case researches, land clearing and health education), reduced the incidence of human cases from 2.8 per 100,000 inhabitants in 1981 to less than 0.01 per 100,000 since 1997. The canine infection rates decreased from 4.6% in 1984 to 1.6% in 2008. Lutzomyia longipalpis was not detected in some locations where human and canine cases occurred. In the years 2007 and 2008, no new human cases were reported, but there is a persistent and worrisome residual canine seroprevalence.

Entomological surveillance of Chagas disease in Berilo municipality, Jequitinhonha Valley, State of Minas Gerais, Brazil

This study aimed to evaluate the Chagas Disease Control Program which has operated since 1982 in the municipality of Berilo in the Jequitinhonha Valley, Minas Gerais, Brazil, based on evaluation of 5,242 domiciliary units (DUs) and 7,807 outbuildings over an eight-year period of epidemiological surveillance implanted in 1997. A total of 391 triatomines (280 Panstrongylus megistus and 111 Triatoma pseudomaculata) were captured, indicating the continued predominance of the former species. However, Triatoma pseudomaculata is clearly becoming more important in this region, with intradomiciliary colonies being detected in recent years. Entomological parameters, such as dispersion (17%) and intradomiciliary infestation (0.15%) indices, are compatible with the results of the epidemiological surveillance. The majority of DUs were of construction type A (plaster over bricks) or C (plaster over adobe). Twenty-five percent of the inhabitants of the DUs infested by triatomines were reactive in ELISA, IHA and IIF tests for Trypanosoma cruzi antigens.

Archaeometallurgical study of the Proto-historic collection of Moinhos de Golas (North Portugal): a forecast for technological changes?

This work presents the archaeometallurgical study of a group of metallic artefacts found in Moinhos de Golas site, Vila Real (North of Portugal), that can generically be attributed to Proto-history (1st millennium BC, Late Bronze Age and Iron Age). The collection is composed by 35 objects: weapons, ornaments and tools, and others of difficult classification, as rings, bars and one small thin bent sheet. Some of the objects can typologically be attributed to Late Bronze Age, others are of more difficult specific attribution. The archaeometallurgical study involved x-ray digital radiography, elemental analysis by micro-energy dispersive X-ray fluorescence spectrometry and scanning electron microscopy with energy dispersive spectroscopy, microstructural observations by optical microscopy and scanning electron microscopy. The radiographic images revealed structural heterogeneities frequently related with the degradation of some artefacts and the elemental analysis showed that the majority of the artefacts was produced in a binary bronze alloy (Cu-Sn) (73%), being others produced in copper (15%) and three artefacts in brass (Cu-Zn(-Sn-Pb)). Among each type of alloy there’s certain variability in the composition and in the type of inclusions. The microstructural observations revealed that the majority of the artefacts suffered cycles of thermo-mechanical processing after casting. The diversity of metals/alloys identified was a discovery of great interest, specifically due to the presence of brasses. Their presence can be interpreted as importations related to the circulation of exogenous products during the Proto-history and/or to the deposition of materials during different moments at the site, from the transition of Late Bronze Age/Early Iron Age (Orientalizing period) onwards, as during the Roman period.

Echocardiographic parameters associated with pulmonary congestion in Chagas cardiomyopathy

INTRODUCTION: Discrepancy between the intensity of pulmonary congestion and the grade of cardiomegaly seems to be a common finding of Chagas cardiomyopathy, in spite of significant systolic dysfunction of the left ventricle. Its mechanism has not been established. The aim of this study was to investigate pulmonary congestion and to analyze if it correlated with Doppler echocardiographic parameters in patients with Chagas dilated cardiomyopathy. METHODS: Fifty-five patients with positive serology tests for Trypanosoma cruzi and Chagas dilated cardiomyopathy were studied. Chest x-rays, Doppler echocardiogram and plasmatic brain natriuretic peptide levels were obtained in all patients. The degree of pulmonary venous vessels changes on chest x-ray was graded using a pulmonary congestion score, and then compared to Doppler echocardiographic parameters. RESULTS: Mean age was 48.5 ± 11.2 years and 29% were women. The majority (95%) of patients were in NYHA functional class I and II. Mild pulmonary congestion by chest x-ray was found in 80% of the patients. In a multivariate analysis, left ventricular ejection fraction, right ventricular TEI index and the color M-mode velocity correlated with the degree of pulmonary congestion. CONCLUSIONS: Pulmonary venous changes on chest x-rays are frequent, but usually mild in patients with Chagas dilated cardiomyopathy. The degree of pulmonary congestion correlates with Doppler echocardiographic left and right ventricular dysfunction and with color M-mode velocity.

Caracterização clínica e económica das úlceras por pressão em ambiente hospitalar : contributos para a melhoria da segurança do doente e da qualidade dos cuidados

RESUMO - Prestar cuidados a um doente que além da patologia de base apresenta úlceras por pressão (UPP) implica um esforço acrescido por parte da Instituição de saúde e equipa multidisciplinar, custos acrescidos no tratamento e reactualizações frequentes, para que se prestem cuidados que primem pela excelência. OBJETIVOS: caracterizar o impacto clinico e económico das UPP e relacioná-los com as temáticas da Segurança do Doente e Qualidade em Saúde. METODOLOGIA: estudo observacional retrospetivo longitudinal, com uma população do estudo constituída por 164 adultos que estiveram internados entre 1 de janeiro a 31 de dezembro de 2012 no CHMT e que desenvolveram UPP durante o internamento. RESULTADOS: com uma população do estudo maioritariamente masculina (57,3%), e uma média de idades de 81 anos, a taxa de incidência de UPP foi de 1,4%. A maior parte de UPP desenvolvidas durante o internamento foram as de categoria II e a localização anatómica mais frequente os membros inferiores. Em termos de impacto económico, 842.609 euros foi o montante estimado correspondente aos custos totais associados às UPP. CONCLUSÃO: o contínuo investimento na Segurança do Doente e na Qualidade em Saúde e, em especial, na prevenção das UPP devem ser mantidos para que se continuem a mobilizar esforços que minimizem a frequência da ocorrência das últimas. Mais do que tratar pretende-se prevenir tendo em conta que as consequências, quer para a díade doente-família como para as Instituições de saúde, são significativas.

Gestão integrada da doença renal crónica em Portugal : o panorama atual e o papel do profissional de nutrição na obtenção de melhores resultados em saúde

RESUMO - A doença renal crónica (DRC) resulta da perda de função renal, sendo necessário a terapêutica de substituição, no estádio terminal. Em Portugal está atualmente em vigor o modelo de Gestão Integrada da Doença, que tem inerente o cumprimento de objetivos e metas pelas unidades de diálise. Uma alimentação adequada é um pilar fundamental ao sucesso do tratamento desta doença, o que torna o profissional de nutrição indispensável. Este trabalho pretendeu avaliar o cumprimento das metas e objetivos estabelecidos no modelo referido, e relacionar os resultados obtidos com a existência de contacto entre o profissional de nutrição e os pacientes. Para a persecução dos objetivos, foram analisadas duas bases de dados disponibilizadas pela Direção Geral da Saúde: a base de dados da Plataforma de Gestão Integrada da Doença Renal Crónica em 2012 e a do Questionário de Avaliação da Satisfação dos Doentes em Hemodiálise em 2013. Verificou-se uma melhoria contínua ao longo dos anos do cumprimento das metas e objetivos preconizados em Portugal para o tratamento da DRC, com um cumprimento da maioria no ano de 2012. No entanto, os parâmetros ferritina e albumina sérica ficaram aquém da recomendação. Observou-se um nível elevado de satisfação do paciente quanto ao trabalho do profissional de nutrição, apesar de ser frequente a inexistência de contacto entre ambas as partes. Os resultados obtidos demonstram também que o profissional de nutrição tem um papel importante para a obtenção de melhores resultados de saúde nos pacientes em tratamento por hemodiálise, pelo que se sugere um acompanhamento da totalidade deste tipo de população por este profissional.

Land cover mapping analysis and urban growth modeling using remote sensing techniques

The rapid growth of big cities has been noticed since 1950s when the majority of world population turned to live in urban areas rather than villages, seeking better job opportunities and higher quality of services and lifestyle circumstances. This demographic transition from rural to urban is expected to have a continuous increase. Governments, especially in less developed countries, are going to face more challenges in different sectors, raising the essence of understanding the spatial pattern of the growth for an effective urban planning. The study aimed to detect, analyse and model the urban growth in Greater Cairo Region (GCR) as one of the fast growing mega cities in the world using remote sensing data. Knowing the current and estimated urbanization situation in GCR will help decision makers in Egypt to adjust their plans and develop new ones. These plans should focus on resources reallocation to overcome the problems arising in the future and to achieve a sustainable development of urban areas, especially after the high percentage of illegal settlements which took place in the last decades. The study focused on a period of 30 years; from 1984 to 2014, and the major transitions to urban were modelled to predict the future scenarios in 2025. Three satellite images of different time stamps (1984, 2003 and 2014) were classified using Support Vector Machines (SVM) classifier, then the land cover changes were detected by applying a high level mapping technique. Later the results were analyzed for higher accurate estimations of the urban growth in the future in 2025 using Land Change Modeler (LCM) embedded in IDRISI software. Moreover, the spatial and temporal urban growth patterns were analyzed using statistical metrics developed in FRAGSTATS software. The study resulted in an overall classification accuracy of 96%, 97.3% and 96.3% for 1984, 2003 and 2014’s map, respectively. Between 1984 and 2003, 19 179 hectares of vegetation and 21 417 hectares of desert changed to urban, while from 2003 to 2014, the transitions to urban from both land cover classes were found to be 16 486 and 31 045 hectares, respectively. The model results indicated that 14% of the vegetation and 4% of the desert in 2014 will turn into urban in 2025, representing 16 512 and 24 687 hectares, respectively.

Comparison of Bothropoides jararaca bites with and without envenoming treated at the Vital Brazil Hospital of the Butantan Institute, State of São Paulo, Brazil

INTRODUCTION: This study analyses the cases of all bites (including dry bites) caused by Bothropoides jararaca attended at the Vital Brazil Hospital of the Butantan Institute, State of São Paulo, Brazil. METHODS: A retrospective study was conducted of patients bitten by Bothropoides jararaca (n=792) from January 1990 to December 2004. The characteristics of the snake specimen, data related to the accident and clinical manifestations on admission were obtained from patient medical records. RESULTS: The majority of the cases in this study were caused by female and juvenile snakes. No stomach contents were found in 93.4% of the snake specimens after dissection. No statistical difference was observed between the occurrence of dry bites and the maturity or sex of the snake. The median SVL of snakes in mild and moderate cases was 40.5cm and in severe cases, SVL increased to 99cm. Necrosis was more common in the digits of the feet and hands (4.8%) compared to the other body regions (1.8%). A significant difference was verified between severity and a time interval greater than six hours from the bite to hospital admission. A significant association was verified between gingival bleeding and abnormal blood coagulability. In accidents caused by adult snakes, necrosis was more frequent (7.2%) compared to accidents caused by juvenile snakes (1%). CONCLUSIONS: In this work, the association between certain epidemiological data and the evolution of biological parameters in the clinical course of Bothrops sensu latu accidents were highlighted, contributing to the improvement of snake bite assistance.

Analyzing Geospatial patterns of syrian refugee flows in southeastern Turkey by use of remote sensing and complementary data

Crisis-affected communities and global organizations for international aid are becoming increasingly digital as consequence geotechnology popularity. Humanitarian sector changed in profound ways by adopting new technical approach to obtain information from area with difficult geographical or political access. Since 2011, turkey is hosting a growing number of Syrian refugees along southeastern region. Turkish policy of hosting them in camps and the difficulty created by governors to international aid group expeditions to get information, made such international organizations to investigate and adopt other approach in order to obtain information needed. They intensified its remote sensing approach. However, the majority of studies used very high-resolution satellite imagery (VHRSI). The study area is extensive and the temporal resolution of VHRSI is low, besides it is infeasible only using these sensors as unique approach for the whole area. The focus of this research, aims to investigate the potentialities of mid-resolution imagery (here only Landsat) to obtain information from region in crisis (here, southeastern Turkey) through a new web-based platform called Google Earth Engine (GEE). Hereby it is also intended to verify GEE currently reliability once the Application Programming Interface (API) is still in beta version. The finds here shows that the basic functions are trustworthy. Results pointed out that Landsat can recognize change in the spectral resolution clearly only for the first settlement. The ongoing modifications vary for each case. Overall, Landsat demonstrated high limitations, but need more investigations and may be used, with restriction, as a support of VHRSI.

Métodos de avaliação do impacto económico dos eventos adversos em meio hospitalar

RESUMO - O sistema de saúde é constantemente sujeito a pressões sendo as mais relevantes a pressão para o aumento da qualidade e a necessidade de contenção de custos. Os Eventos Adversos (EAs) ocorridos em meio hospitalar constituem um sério problema de qualidade na prestação de cuidados de saúde, com consequências clinicas, sociais, económicas e de imagem, que afectam pacientes, profissionais, organizações e o próprio sistema de saúde. Os custos associados à ocorrência de EAs em meio hospitalar, incrementam significativamente os custos hospitalares, representando cerca de um em cada sete dólares gastos no atendimento dos doentes. Só na última década surgiram estudos com o objectivo principal de avaliar esse impacto em meio hospitalar, subsistindo ainda uma grande indefinição quanto às variáveis e métodos a utilizar. O objectivo principal deste trabalho de projecto foi conhecer e caracterizar as diferentes metodologias utilizadas para avaliação dos custos económicos, nomeadamente dos custos directos, relacionados com a ocorrência de eventos adversos em meio hospitalar. Tendo em atenção as dificuldades referidas, utilizou-se como metodologia a revisão narrativa da literatura, complementada com a realização de uma técnica de grupo nominal. Os resultados obtidos foram os seguintes: i) a metodologia utilizada na maioria dos estudos para determinar a frequência, natureza e consequências dos EAs ocorridos em meio hospitalar, utiliza matrizes de base observacional, analítica, com base em estudos de coorte retrospectivo recorrendo aos critérios definidos pelo Harvard Medical Practice Study; ii) a generalidade dos estudos realizados avaliam os custos directos dos EAs em meio hospitalar, iii) verificou-se a existência de uma grande diversidade de métodos para a determinação dos custos associados aos EAs. A generalidade dos estudos determina esse valor com base na contabilização do número de dias adicionais de internamento, resultantes do EA, valorizados com base em custos médios; iv) o grupo de peritos, propôs como metodologia para a determinação do custo associado a cada EA, a utilização de sistemas de custeio por doente; v) propõe-se o desenvolvimento de uma plataforma informática, que permita o cruzamento da informação disponível no registo clinico electrónico do doente com um sistema automático de identificação de EAs, a desenvolver, e com sistemas de custeio por doente, de modo a valorizar os custos por doente e por tipo de EA. A avaliação dos custos directos associados à ocorrência de EAs em contexto hospitalar, pelo impacto económico e social que tem nos doentes e organizações, será seguramente uma das áreas de estudo e investigação futuras, no sentido de melhorar a eficiência do sistema de saúde e a qualidade e segurança dos cuidados prestados aos doentes.

Oropharyngeal histoplasmosis: report of eleven cases and review of the literature

INTRODUCTION: Histoplasmosis is a systemic mycosis endemic in Brazil, especially in the State of Rio Grande do Sul, where Histoplasma capsulatum was isolated from the soil. H. capsulatum may compromise unusual areas, including the oropharynx, particularly in patients presenting disseminated histoplasmosis; which is associated with a state of immunosuppression, such as AIDS. METHODS: During database analysis of a total of 265 cases of histoplasmosis, the medical records of 11 patients with histological or microbiological diagnoses of oral histoplasmosis (OH) between 1987 and 2008 were retrospectively reviewed. RESULTS: This work reports 11 cases of OH, the majority presenting histopathological or microbiological evidence of disseminated histoplasmosis (DH). In the patients with DH, OH was the first manifestation of histoplasmosis. Five of the 11 patients discussed were HIV-seropositive with clinical and laboratory findings of AIDS. Four patients presented active pulmonary tuberculosis concomitant with histoplasmosis. Treatment was based on the use of itraconazole and amphotericin B deoxycholate. Eight patients responded successfully to therapy after one year, two did not come back for reevaluation and one died despite adequate therapy. CONCLUSIONS: Oral histoplasmosis is closely associated with immunosuppression status, especially in patients presenting AIDS; moreover, in many cases, OH is the first sign of disseminated histoplasmosis.