Accidents caused by Bothrops and Bothropoides in the State of Paraiba: epidemiological and clinical aspects

INTRODUCTION: Bothrops and Bothropoides snakes cause 70% of the ophidic accidents in Brazil. The species that cause ophidic accidents in State of Paraíba are Bothropoides erythromelas, Bothrops leucurus and Bothropoides neuwiedi. METHODS: This is a prospective and transverse study, following a quantitative approach of accidents involving Bothrops and Bothropoides admitted to the Toxicological Assistance and Information Centers of Campina Grande and João Pessoa (Ceatox-CG and Ceatox-JP), aimed at identifying the epidemiological and clinical profile of such accidents. All of the patients admitted had medical diagnoses and were monitored at Ceatox-CG or Ceatox-JP. RESULTS: The genera Bothrops and Bothropoides caused 91.7% of the ophidic accidents reported. Snake bites were frequent in men (75.1%), rural workers (65.1%), literate individuals (69%) between 11 and 20 years-old (21.7%), and toes the most common area attacked (52.7%). Most (86.6%) patients were admitted within 6 hours after the accident/bite, with a predominance of mild cases (64.6%). The annual occurrence in Paraíba was 5.5 accidents/100,000 inhabitants and lethality was 0.2%. CONCLUSIONS: Positive changes in the profiles of these accidents were verified, such as the non-application of inadequate solutions, including the use of tourniquet, coffee grounds, garlic, suction and/or cutting the bitten area. Moreover, the Itinerant Laboratory project, linked to Paraíba State University in partnership with Ceatox-CG, has contributed positively, providing several cities of the state with information regarding the prevention of accidents involving venomous animals. The local press has also contributed, reporting the educational work developed by the centers.

Phlebotomine sand flies (Diptera: Psychodidae: Phlebotominae) in the State of Pernambuco

INTRODUCTION: Phlebotomine sand flies are small insects of great medical relevance. This article presents an updated list of the phlebotomine sand flies occurring in the State of Pernambuco, Brazil. METHODS: A review of literature published since the 1940s up to May 2010 was conducted and voucher material deposited in reference collections were studied. RESULTS: A total of 37 phlebotomine species have previously been reported as occurring in Pernambuco, but the record of six species needs confirmation. CONCLUSIONS: This work provides an updated list of phlebotomine sand flies of Pernambuco, with some notes on their taxonomy, ecology, distribution and epidemiological relevance.

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.

Improving downstream processing for viral vectors and viral vaccines

Viral vectors are playing an increasingly important role in the vaccine and gene therapy elds. The broad spectrum of potential applications, together with expanding medical markets, drives the e orts to improve the production processes for viral vaccines and viral vectors. Developing countries, in particular, are becoming the main vaccine market. It is thus critical to decrease the cost per dose, which is only achievable by improving the production process. In particular advances in the upstream processing have substantially increased bioreactor yields, shifting the bioprocess bottlenecks towards the downstream processing. The work presented in this thesis aimed to develop new processes for adenoviruses puri cation. The use of state-of-the-art technology combined with innovative continuous processes contributed to build robust and cost-e ective strategies for puri cation of complex biopharmaceuticals.(...)

Work satisfaction and affective commitment of classical musicians: The European Union Youth Orchestra

This work project investigates career paths in the music field, by testing the application of general career and social theories for musicians. Using a sample from the European Union Youth Orchestra’ Alumni, the Boundaryless Career Theory, Intelligent Career Framework and Social Identity Theory were analysed through the impact on individual outcomes - musicians’ Overall work satisfaction and Affective commitment to the orchestra. Results suggest support for the three theories, and show their applicability for classical musicians’ careers.

Candida spp. isolated from inpatients, the environment, and health practitioners in the pediatric unit at the Universitary Hospital of the Jundiaí Medical College, state of São Paulo, Brazil

INTRODUCTION: This study aimed to isolate and identify Candida spp. from the environment, health practitioners, and patients with the presumptive diagnosis of candidiasis in the Pediatric Unit at the Universitary Hospital of the Jundiaí Medical College, to verify the production of enzymes regarded as virulence factors, and to determine how susceptible the isolated samples from patients with candidiasis are to antifungal agents. METHODS: Between March and November of 2008 a total of 283 samples were taken randomly from the environment and from the hands of health staff, and samples of all the suspected cases of Candida spp. hospital-acquired infection were collected and selected by the Infection Control Committee. The material was processed and the yeast genus Candida was isolated and identified by physiological, microscopic, and macroscopic attributes. RESULTS: The incidence of Candida spp. in the environment and employees was 19.2%. The most frequent species were C. parapsilosis and C. tropicalis among the workers, C. guilliermondii and C. tropicalis in the air, C. lusitanae on the contact surfaces, and C. tropicalis and C. guilliermondii in the climate control equipment. The college hospital had 320 admissions, of which 13 (4%) presented Candida spp. infections; three of them died, two being victims of a C. tropicalis infection and the remaining one of C. albicans. All the Candida spp. in the isolates evidenced sensitivity to amphotericin B, nystatin, and fluconazole. CONCLUSIONS: The increase in the rate of hospital-acquired infections caused by Candida spp. indicates the need to take larger measures regarding recurrent control of the environment.

Assessment by doppler ultrasound of entheseal lesions in spondyloarthritis : a longitudial study to determine structural damage and disease activity lesions

RESUMO: Enthesitis is the hallmark of spondyloarthritis (SpA), and is observed in all subtypes. Wide information on SpA abnormalities, including synovitis, tendinitis and enthesitis, can be efficiently perceived by Doppler ultrasound. Furthermore, several studies on imaging of enthesis showed that imaging techniques are better than clinical examination to detect enthesis alterations; and vascularized enthesitis detected by Doppler ultrasound appears to be a valuable diagnostic tool to confirm SpA diagnosis. However, data published until now concerning entheseal elementary alterations that characterize SpA enthesitis (enthesis inflammatory activity) or enthesopathy (permanent structural changes) reflect rather the authors’ empiric opinion than a methodological validation process. In this sense it seems crucial to identify elementary entheseal lesions associated with activity or damage, in order to improve monitoring and treatment response in SpA patients. The development of better assessment tools is today a challenge and a need in SpA. The first study of this thesis focused on the analysis of the reliability of inter-lector and inter-ultrasonography equipment of Madrid sonography enthesitis index (MASEI). Fundamental data for the remaining unrolling project validity. In the second and third studies we concerned about two entheseal elemental lesions: erosions and bursa. In literature erosions represent a permanent structural damage, being useful for monitoring joint injury, disease activity and therapeutic response in many rheumatic diseases; and to date, this concept has been mostly applied in rheumatoid arthritis (RA). Unquestionably, erosion is a tissue-related damage and a structural change. However, the hypothesis that we decided to test was if erosions represent a permanent structural change that can only grow and worsen over time, as occurs in RA, or a transitory alteration. A longitudinal study of early SpA patients was undertaken, and the Achilles enthesis was used as a model. Our results strongly suggested that previously detected erosions could disappear during the course of the disease, being consistent with the dynamic behavior of erosion over time. Based on these striking results it seems reasonable to suggest that the new-bone formation process in SpA could be associated with the resolution of cortical entheseal erosion over time. These results could also be in agreement with the apparent failure of anti-tumor necrosis factor (TNF) therapies to control bone proliferation in SpA; and with the relation of TNF-α, Dickkopf-related protein 1 (Dkk-1) and the regulatory molecule of the Wnt signaling pathway in the bone proliferation in SpA. In the same model, we then proceeded to study the enthesis bursa. Interestingly, the Outcome Measures in Rheumatology Clinical Trials (OMERACT) enthesopathy definition does not include bursa as an elementary entheseal lesion. Nonetheless, bursa was included in 46% of the enthesis studies in a recently systematic literature review, being in agreement with the concept of “synovio-entheseal complex” that includes the link between enthesitis and osteitis in SpA. It has been clarified in recent data that there is not only a close functional integration of the enthesis with the neighboring bone, but also a connection between enthesitis and synovitis. Therefore, we tried to assess the prevalence and relevance of the bursa-synovial lesion in SpA. Our findings showed a significant increase of Achilles bursa presence and thickness in SpA patients compared to controls (healthy/mechanical controls and RA controls). These results raise awareness to the need to improve the enthesopathy ultrasonographic definition. In the final work of this thesis, we have explored new perspectives, not previously reported, about construct validity of enthesis ultrasound as a possible activity outcome in SpA. We performed a longitudinal Achilles enthesis ultrasound study in patients with early SpA. Achilles ultrasound examinations were performed at baseline, six- and twelve-month time periods and compared with clinical outcome measures collected at basal visit. Our results showed that basal erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are higher in patients with Doppler signal in enthesis, and even that higher basal ESR, CRP and Ankylosing Spondylitis Disease Activity Score (ASDAS) predicted a higher Doppler signal (an ultrasound alteration accepted as representative of inflammation) six months later. Patients with very high disease activity assessed by ASDAS (>3.5) at baseline had significantly higher Achilles total ultrasound score verified at the same time; and ASDAS <1.3 predicted no Doppler signal at six and twelve months. This seems to represent a connection between classical biomarkers and clinical outcomes associated with SpA activity and Doppler signal, not only at the same time, but also for the following months. Remarkably, patients with inactive disease (ASDAS < 1.3) at baseline had no Doppler signal at six and twelve months. These findings reinforce the potential use of ultrasound related techniques for disease progression assessment and prognosis purposes. Intriguingly, Ankylosing Spondylitis Disease Activity Index (BASDAI) didn’t show significant differences between different cut-offs concerning ultrasound lesions or Doppler signal, while verified with ASDAS. These results seem to indicate that ASDAS reflects better than BASDAI what happens in the enthesis. The work herein discussed clearly shows the potential utility of ultrasound in enthesis assessment in SpA patients, and can be important for the development of ultrasound activity and structural damage scores for diagnosis and monitoring purposes. Therefore, local promotion of this technique constitutes a medical intervention that is worth being tested in SpA patients for diagnosis, monitoring and prognosis purposes.

Indicadores de qualidade na emergência médica pré-hospitalar : painel operacional para o INEM, I.P.

RESUMO - A Emergência Médica Pré-Hospitalar é uma parte importante na cadeia de cuidados de saúde, quer pela gravidade das situações a que atende, quer por funcionar como gatekeeper. O estudo é dedicado a instrumentos de medição e em simultâneo a medições de qualidade como processo de melhoria contínua da qualidade na EMPH. Existem projetos a nível internacional para implementação de painéis de indicadores, alguns atribuem significativa relevância aos processos assistenciais. O European Emergency Data Project (EDD) foi selecionado para servir como painel de indicadores a explorar neste trabalho. Porque a nível científico está bem desenhado, as definições e variáveis estão bem explicitadas e interessa ao INEM, I.P. utilizar um painel que lhe permita um benchmarking. Criou-se um dashboard para os indicadores selecionados e com ele analisaram-se os dados para aferir a qualidade do SEM. Não foi possível, pela sua inexistência, coletar dados para dois dos indicadores propostos. Foram apresentadas propostas de melhoria no sistema de captação de dados do INEM, I.P. para que a instituição possa monitorizar periodicamente os indicadores selecionados. A existência de dados e a sua fiabilidade para utilizar na medição por indicadores é algo que se explorou neste trabalho de campo, e as fraquezas encontradas foram matéria para oportunidades, recomendações, e caminho para discussão e o fortalecimento da instituição.

Cuidados de saúde primários em Portugal

RESUMO - A evolução dos cuidados de saúde primários em Portugal nos últimos trinta anos conheceu várias fases. A partir de 1971 foram criados os primeiros centros de saúde — os centros de saúde de primeira geração, associados ao que então se entendia por saúde pública —, incluindo actividades como a vacinação, vigilância de saúde da mulher, da grávida e da criança, saúde escolar e ambiental, entre outras. Em 1983 os primeiros centros de saúde foram integrados com os numerosos postos dos ex-Serviços Médico- -Sociais («caixas»). Este processo de fusão conduziu a uma maior racionalidade formal, mas não resultou numa melhoria naquilo que eram as principais virtudes dos componentes integrados — acessibilidade a consultas e a visitas domiciliárias, por um lado, e, por outro, a programação de actividades com objectivos de saúde. Em 1999 foi publicada a legislação sobre os «centros de saúde de terceira geração». Esta aparece na sequência de experiências sobre o terreno — «projectos Alfa» e outras iniciativas semelhantes, baseados numa filosofia de «prática de grupo» — e do início de um regime remuneratório experimental para a clínica geral. As unidades operativas dos novos centros de saúde pressupõem um processo de mudança organizacional que não pode ser implementada pela via normativa clássica tipo top down. Embora necessite de um enquadramento «de cima», a sua realização dependerá essencialmente da capacidade de despoletar uma dinâmica de mudança em cada centro de saúde e de proporcionar acompanhamento e apoio técnico a esses processos de mudança locais.

Ethical leadership and unethical pro-organizational behavior: A moderated mediation model of affective commitment and authenticity at work

Recently, unethical conduct in the workplace has been a focus of literature and media. Unethical pro-organizational behavior (UPB) refers to unethical conduct that employees engage in to benefit the organization. Given the complexity of UPB, there is an increasing need to understand how and under what conditions this attitude originates within organizations. Based on a sample of 167 employees and seven organizations, results support the moderated mediation model. An ethical leader increases employees’ organizational affective commitment which increases the likelihood to engage in UPB. However, the indirect relationship diminishes when employees feel authentic at work.

Eco-epidemiologic study of emerging fungi related to the work of babaçu coconut breakers in the State of Maranhão, Brazil

Introduction: There are more than 300,000 extractors using the babaçu coconut as a source of income in the States of Maranhão, Pará, Tocantins and Piauí, and this activity is associated with fungal infections. The objective of this study was to examine the occurrence of emergent fungi in the conjunctiva, nails and surface and subcutaneous injuries of female coconut breakers in Esperantinópolis, Maranhão. Additionally, soil samples and palm structures were collected. Methods: The obtained samples were cultured in Petri dishes containing potato-dextrose-agar and chloramphenicol. The etiological agent was confirmed by a direct mycological exam and growth in culture. Results: In total, 150 domiciles were visited, and samples were collected from 80 patients. From the ground, the most frequently isolated fungus was Aspergillus niger (53. 8%). the most frequently detected fungus in babaçu coconut was Aspergillus niger (66.7%). Conjunctival fungal growth occurred in 76.3% of the women. The ocular fungal microbiota consisted of filamentous fungi (80.6%), and yeasts were present in 19.4% of cases. Onychomycosis was diagnosed in 44% (11/25) of the women. Conclusions: The identification of the genera Neosartorya, Rhizopus and Curvularia in onychomycoses shows that emergent filamentous fungi can be isolated. Aspergillus sp., Penicillium sp. and Scedosporium sp. were the predominant genera found in the babaçu coconut. From ocular conjunctiva, Candida spp. were the most prevalent species isolated, and Fusarium sp. was present only in one woman. The nearly permanent exposure of coconut breakers to the external environment and to the soil is most likely the reason for the existence of a mycotic flora and fungal infections, varying according to the individual's practices and occupation.

Do hospitals react to random demand pressure by early discharges?

This project tries to assess whether hospitals react to random demand pressure by discharging patients earlier than expected. As a matter of fact, combining an unpredictable demand for medical services with limited and, to some extent, fixed medical resources, generates strong incentives to discharge patients earlier than expected when demand is high − increasing the risk of readmission and decreasing the benefit from treatment. This work was conducted as a way to determine whether those incentives actually affect discharging decisions. Analysis of Portuguese hospitals data shows that hospital utilization levels at the time of admission, prior to the admission and post admission do have a negative impact over the length of stay in hospital, although this impact is quantitatively irrelevant. More than that, larger utilization levels have a positive impact over the probability of being discharged at certain days of the week, indicating that an early discharges problem may exist.

Exploring Literary Landscapes: From Texts to Spatiotemporal Analysis through Collaborative Work and GIS

This article argues that the study of literary representations of landscapes can be aided and enriched by the application of digital geographic technologies. As an example, the article focuses on the methods and preliminary findings of LITESCAPE.PT—Atlas of Literary Landscapes of Mainland Portugal, an on-going project that aims to study literary representations of mainland Portugal and to explore their connections with social and environmental realities both in the past and in the present. LITESCAPE.PT integrates traditional reading practices and ‘distant reading’ approaches, along with collaborative work, relational databases, and geographic information systems (GIS) in order to classify and analyse excerpts from 350 works of Portuguese literature according to a set of ecological, socioeconomic, temporal and cultural themes. As we argue herein this combination of qualitative and quantitative methods—itself a response to the difficulty of obtaining external funding—can lead to (a) increased productivity, (b) the pursuit of new research goals, and (c) the creation of new knowledge about natural and cultural history. As proof of concept, the article presents two initial outcomes of the LITESCAPE.PT project: a case study documenting the evolving literary geography of Lisbon and a case study exploring the representation of wolves in Portuguese literature.

UK Mental health professionals volunteering in LMIC-benefits to UK and host countries

RESUMO: O Royal College of Psychiatrists tem um programa de voluntariado internacional desde 2005. O interesse no Reino Unido tem crescido nos últimos 15 anos com muitos projetos novos. Os benefícios para vários países têm sido reconhecidos. O que está menos claro são os benefícios da experiência para o Reino Unido e do programa de voluntariado do Royal College of Psychiatrists. O objectivo desta dissertação é explorar os benefícios do voluntariado para o Sistema Nacional de Saúde focando principalmente, mas não exclusivamente, o programa de voluntariado do Royal College of Psychiatrists. Nesta dissertação abordamos primeiro o contexto antes de discutirmos dois grandes estudos de psiquiatras e hospitais do Sistema Nacional de Saúde no Reino Unido. Incluimos no estudo todos os psiquiatras registados como Voluntários no Royal College of Psychiatrists e o Grupo de Interesse Especial associado. Foi ainda possível incluir os Diretores Médicos de todos os hospitais do Reino Unido. Os estudos foram desenhados para analisar as opiniões dos Voluntários do Reino Unido sobre os benefícios para os países recetores de baixo e médio rendimento e para o Reino Unido. Todos os 60 hospitais do Sistema Nacional de Saúde foram incluí dos para analisar a opinião sobre Voluntariado. As limitações dos estudos foram a baixa taxa de resposta, mas esta foi comparável a outros estudos do College. É provável haver um enviezamento de resposta e favorecimento dos que estão envolvidos no Voluntariado. Os resultados mostraram um interesse forte no voluntariado e benefícios no Sistema Nacional de Saúde, nas. áreas de liderança, transculturalismo, gestão e recursos e capacidades pessoais. Os hospitais do Sistema Nacional de Saúde valorizaram o voluntariado e, em contrapartida, o valor acrescido para competências profissionais. Os obstáculos contra o Voluntariado a nível individual e dos hospitais foram maioritariamente de natureza prática, tais como obter dispensa do trabalho, substituição no trabalho e custos. As implicações destes estudos são que o programa de voluntariado do College precisa de ser fortalecido. Para assegurar que este trabalho continua é necessário existir uma sensibilização nacional e maior responsabilização sobre os benefícios para o Reino Unido e a nível global. -------------------------- ABSTRACT: The Royal College of Psychiatrists has had an international volunteering programme since 2005. The interest in UK has grown over the past 15 years with many new projects. The benefits in various countries has been acknowledged. What has been less clear are the benefits of the experience back in the UK and of the Royal College of Psychiatrists Volunteer Scheme. The aim of this dissertation is to explore the benefit of volunteering to the NHS focusing mainly, but not exclusively on the Royal College of Psychiatrists Volunteering scheme. In this dissertation we first look at background information before discussing two large surveys of Psychiatrists and NHS Trusts in UK. We surveyed all those registered as Volunteers at the Royal College of Psychiatrists and the associated Special Interest Group. We also were able to survey the Medical Directors of all UK Trusts. The Surveys were designed to assess views of UK Volunteers of benefits to hosts in LMIC and back in UK. All 60 NHS Trusts were surveyed to assess the view of Volunteering. Limitation of the surveys were the low response rate but this was comparable to other College surveys. There is likely to be a bias in response and favour those who are engaged in the Volunteering agenda. Results showed a strong interest in volunteering and perceived benefits in NHS. These areas included leadership, transcultural, resource management and personal skills. NHS trusts valued volunteering and added value to professional competencies on return. Obstacles to Volunteering at individual and Trust level were mainly practical issues such as getting time off, cover and costs. Implications of these surveys are that the College volunteering scheme needs strengthening. There needs to be a National advocacy to ensure that this work continues and greater accountability as to benefits in UK and globally.