Occurrence of strongyloidiasis among patients with HTLV-1/2 seen at the outpatient clinic of the N��cleo de Medicina Tropical, Bel��m, State of Par��, Brazil

IntroductionThis study investigated the occurrence of Strongyloides stercoralis infestation and coinfection with HTLV-1/2 in Bel��m, Brazil.MethodsS. stercoralis was investigated in stool samples obtained from individuals infected with HTLV-1/2 and their uninfected relatives.ResultsThe frequency of S. stercoralis was 9% (9/100), including six patients infected with HTLV-1 (14.3%), two patients infected with HTLV-2 (11.1%), and one uninfected relative. Two cases of hyperinfestation by S. stercoralis were characterized as HTLV-1.ConclusionsThese results support the need for the routine investigation of S. stercoralis in patients with HTLV-1, in an attempt to prevent the development of severe forms of strongyloidiasis.

Current epidemiological profile of Chagasic megaesophagus in Central Brazil

Introduction Chagasic megaesophagus (CM) is the most common digestive manifestation of Chagas disease in Brazil, and the State of Goiás is one of the most affected regions. In recent decades, the Hospital das Clínicas (HC)/Universidade Federal de Goiás (UFG) has been a reference center for the study and treatment of CM. The objective of this study was to characterize the current epidemiological profile of patients with CM observed at the HC of the UFG from 1998 to 2010. Methods In total, 939 patient records were analyzed, and age, gender, place of birth, serology, symptoms and radiological classification according to Rezende et al. were analyzed. Results The median patient age was 55 years. Male patients were more (54%) prevalent than female patients. The prevalence of younger patients (less than 31 years of age) was 4.2%, but 82.1% of the younger patients were from State of Bahia. Patients older than 40 years were the majority (85.5%). The radiological groups were distributed as follows: Group I (35.9%), Group II (32.9%), Group III (17%) and Group IV (14.2%). Conclusions Compared with previous studies by the same group in 1975, 1994 and 1995, the number of younger patients decreased, and the frequency curve has shifted to older patients.

How to take advantage of wine tourism: Creation of a new concept for central Alentejo based on its potential and worldwide success factors

Wine Tourism is gaining importance in today���s world and more destinations and establishments have been arising. After understanding the importance of this economic activity and the factors it must have to succeed, a new project was conceived for Central Alentejo taking into account its potential. This project is an example of how to take advantage of Wine Tourism in wine regions that are underexplored, such as Aldeias de Montoito, the village near Redondo to which a Business Plan will be created, explaining the strategies to pursue in order to have a successful Wine Tourism destination.

Bloodstream infection in patients with end-stage renal disease in a teaching hospital in central-western Brazil

Introduction Vascular access in patients undergoing hemodialysis is considered a critical determinant of bloodstream infection (BSI) and is associated with high morbidity and mortality. The purpose of this study was to investigate the occurrence of BSI in patients with end-stage renal disease using central venous catheters for hemodialysis. Methods A cohort study was conducted in a public teaching hospital in central-western Brazil from April 2010 to December 2011. For every patient, we noted the presence of hyperemia/exudation upon catheter insertion, as well as fever, shivering, and chills during hemodialysis. Results Fifty-nine patients were evaluated. Thirty-five (59.3%) patients started dialysis due to urgency, 37 (62.7%) had BSI, and 12 (20%) died. Hyperemia at the catheter insertion site (64.9%) was a significant clinical manifestation in patients with BSI. Statistical analysis revealed 1.7 times more cases of BSI in patients with hypoalbuminemia compared with patients with normal albumin levels. The principal infective agents identified in blood cultures and catheter-tip cultures were Staphylococcus species (24 cases), non-fermentative Gram-negative bacilli (7 cases of Stenotrophomonas maltophilia and 5 cases of Chryseobacterium indologenes), and Candida species (6). Among the Staphylococci identified, 77.7% were methicillin-resistant, coagulase-negative Staphylococci. Of the bacteria isolated, the most resistant were Chryseobacterium indologenes and Acinetobacter baumannii. Conclusions Blood culture was demonstrated to be an important diagnostic test and identified over 50% of positive BSI cases. The high frequency of BSI and the isolation of multiresistant bacteria were disturbing findings. Staphylococcus aureus was the most frequently isolated microorganism, although Gram-negative bacteria predominated overall. These results highlight the importance of infection prevention and control measures in dialysis units.

Active and latent tuberculosis in prisoners in the Central-West Region of Brazil

Introduction Jailed populations exhibit high rates of tuberculosis (TB) infection and active disease. Methods A cross-sectional study was performed to estimate the prevalence of latent and active TB and to identify factors associated with latent infection in inmates. Results The prevalence of latent TB was 49%, and the prevalence of active TB was 0.4%. The presence of a Bacille Calmette-Guérin (BCG) scar (prevalence ratio (PR)=1.65; 95% confidence interval (CI): 1.09-2.50; p=0.0162) and the World Health Organization (WHO) score for active TB in prisons (PR=1.07; 95% CI: 1.01-1.14; p=0.0181) were correlated with infection. Conclusions The identification of associated factors and the prevalence of latent and active TB allows the development of plans to control this disease in jails.

Epidemiology of hepatitis B virus infection among recyclable waste collectors in central Brazil

Introduction: The collection of recyclable waste materials is a widespread activity among the urban poor. Today, this occupation attracts an increasingly large number of individuals. Despite its economic and environmental importance, this activity is associated with unsafe and unhealthy working conditions. The aim of this study was to investigate the seroepidemiological profile of hepatitis B virus (HBV) infection in a population of recyclable waste collectors in central Brazil. Methods: Recyclable waste collectors from all 15 recycling cooperatives in Goiânia City were invited to participate in the study. The participants (n = 431) were interviewed and screened for hepatitis B surface antigen (HBsAg) and antibodies against HBsAg (anti-HBs) and hepatitis B core antigen (anti-HBc) by enzyme-linked immunosorbent assay (ELISA). HBsAg- and anti-HBc-positive samples were tested for HBV DNA and genotyped. Results: The overall prevalence of HBV infection (HBsAg- and/or anti-HBc-positive) was 12.8%. An age over 40 years and illicit drug use were associated with HBV infection. HBV DNA was detected in 2/3 HBsAg-positive samples and in 1/52 anti-HBc-positive/HBsAg-negative samples (an occult HBV infection rate of 1.9%), in which the genotypes/subgenotypes A/A1, D/D3 and F/F2 were identified. Only 12.3% of the recyclable waste collectors had serological evidence of previous HBV vaccination. Conclusions: These findings highlight the vulnerability of recyclable waste collectors to HBV infection and reinforce the importance of public health policies that address the health and safety of this socially vulnerable population.

Psychological safety, authentic leadership and social networks : A psycho-structural approach to the study of groups

Tese de Doutoramento em Psicologia na ��rea de especializa����o de Psicologia das Organiza����es apresentada ao ISPA - Instituto Universit��rio

Tomada de decis��o em engenharia com base na teoria axiom��tica ��� caso de sele����o de banco de ensaios para atuadores hidr��ulicos

A atividade de engenharia implica uma constante necessidade de tomadas de decis��o. Na sua atividade profissional, o engenheiro est�� permanentemente a ter que tomar decis��es cuja dificuldade pode variar desde casos simples at�� situa����es de elevada complexidade, dependendo do n��mero de fatores envolvidos e da sua incerteza associada. A tomada de decis��o durante a parte conceptual do projeto �� uma destas situa����es, na medida em que as decis��es ent��o tomadas determinam fortemente os desenvolvimentos subsequentes. Por outro lado, a informa����o dispon��vel �� ainda escassa. Para al��m disso, quaisquer altera����es posteriores contribuir��o necessariamente para o encarecimento da solu����o final. �� sobre a tomada de decis��o na fase embrion��ria do projeto que se insere a presente disserta����o. Nela se enfoca a import��ncia da exist��ncia de ferramentas de suporte �� tomada de decis��o em projeto de engenharia contribuindo para a fundamenta����o das op����es tomadas. Como exemplo, neste trabalho �� feita a escolha de uma op����o, de entre quatro poss��veis apresentadas, para um banco de ensaios para atuadores hidr��ulicos usados no trem de aterragem dos avi��es Dornier 228. Inicialmente s��o apresentadas algumas das principais teorias e m��todos para apoio �� tomada de decis��o em engenharia, tendo sido eleita a Teoria Axiom��tica do Projeto como ferramenta de suporte para a sele����o da melhor op����o entre v��rias solu����es alternativas. A escolha da Teoria Axiom��tica reside no facto de esta se caracterizar por ter uma fundamenta����o te��rica de acordo com os padr��es da ci��ncia moderna e apresentar uma base anal��tica rigorosa para a condu����o da atividade de projeto. Depois de uma an��lise detalhada �� legisla����o aeron��utica aplic��vel aos ensaios e do levantamento das condi����es f��sicas e humanas existentes na empresa onde decorreu o presente estudo, foram geradas quatro solu����es alternativas para a instala����o de um banco de ensaios para atuadores hidr��ulicos. A op����o selecionada foi feita com base no conte��do de informa����o de cada alternativa, de acordo segundo axioma da Teoria Axiom��tica. A disserta����o termina com o desenvolvimento mais detalhado da solu����o eleita, ap��s o que s��o retiradas conclus��es e apontadas desej��veis a����es futuras.

Phenotypic and genotypic profile of pyrethroid resistance in populations of the mosquito Aedes aegypti from Goi��nia, Central West Brazil

ABSTRACTINTRODUCTION:The mosquito Aedes aegypti has evolved resistance to pyrethroid insecticides. The present study evaluated Ae. aegypti from Goi��nia for the resistant phenotype and for mutations associated with resistance.METHODS:Insecticide dose-response bioassays were conducted on mosquitoes descended from field-collected eggs, and polymerase chain reaction (PCR) was used to genotype 90 individuals at sites implicated in pyrethroid resistance.RESULTS:All mosquito populations displayed high levels of resistance to deltamethrin, as well as high frequencies of the 1016Ile kdr and 1534Cys kdrmutations.CONCLUSIONS:Aedes aegypti populations in the Goi��nia area are highly resistant to deltamethrin, presumably due to high frequencies of kdr(knockdown-resistance) mutations.

Presence of anti-Leishmania (Viannia) braziliensis antibodies in blood donors in the West-Central region of the State of Paran��, Brazil

ABSTRACTINTRODUCTION:Serological screening in blood banks does not include all transmittable diseases. American cutaneous leishmaniasis (ACL) has a high detection rate in the municipalities of the State of Paran��.METHODS:This study analyzed the presence of anti- Leishmania braziliensisantibodies in 176 blood donors who live in these endemic areas. The variables were analyzed with the χ2 test and Stata 9.1 software. RESULTS: Twenty (11.4%) samples were positive for the presence of anti- L. braziliensisantibodies. CONCLUSIONS: The high percentage of donors with anti- Leishmania spp. antibodies indicates the need to study the risk of ACL transmission through blood donors.

Infection of the central nervous system with dengue virus 3 genotype I causing neurological manifestations in Brazil

Abstract: A case of dengue virus 3 (DENV-3) genotype I infection with neurological manifestations occurred in Belo Horizonte, Minas Gerais in October 2012. The serotype was detected by PCR, and the genotype was assessed by sequencing and phylogenetic analysis of the C-prM region. The virus causing neurological manifestations clustered with other sequences of DENV-3 genotype I. Because neurological manifestations of DENV are possibly misdiagnosed in Brazil, this study serves as an alert of the importance of DENV diagnoses in CNS infections.

An��lise da injectabilidade do grout variando o meio poroso ao longo do escoamento

O envelhecimento do patrim��nio edificado que constitui a maioria dos centros hist��ricos e urbanos, n��o s�� em Portugal, como em toda a Europa, �� uma realidade. Parcela significativa destes edif��cios �� constitu��da por paredes de alvenaria de pedra em mau estado de conserva����o. A necessidade crescente de interven����o no sentido de optimizar as respectivas condi����es de seguran��a destes edif��cios �� por isso priorit��ria. Uma das t��cnicas mais comuns, usadas na consolida����o de alvenarias antigas e elementos arquitect��nicos danificados, �� a injec����o de grouts. A utiliza����o desta t��cnica tem como finalidade, n��o s�� o preenchimento de vazios existentes, de modo a aumentar a compacidade e resist��ncia mec��nica do n��cleo da estrutura, mas tamb��m a cria����o de uma boa liga����o com os panos exteriores, permitindo que a alvenaria recupere o seu comportamento monol��tico. No entanto, �� necess��rio ter em considera����o, antes de qualquer interven����o de reabilita����o, a compatibilidade entre os materiais originais e os materiais utilizados na interven����o. Deste modo, optou-se pela utiliza����o de um ligante, cuja as propriedades mec��nicas, f��sicas e qu��micas mais se assemelham aos materiais originais em alvenarias antigas, caso da cal hidr��ulica. Outro aspecto de grande import��ncia a ter em conta, na injec����o de grouts, �� o poder de penetra����o da mistura. Assim, a necessidade de avalia����o da efici��ncia da injec����o em diferentes meios porosos conduziu �� cria����o de modelos com diferentes composi����es que simulassem, com a maior fiabilidade poss��vel, meios porosos encontrados no pano interior de alvenarias antigas. O presente trabalho incide principalmente na realiza����o de ensaios de injec����o, tendo como objectivo a an��lise da influ��ncia da variabilidade do meio poroso ao longo da altura de injec����o de grout. Foram ainda realizados, de modo a avaliar a qualidade destas injec����es, ensaios de velocidade de propaga����o de ultra-sons, assim como, a utiliza����o da t��cnica de tomografia ultra-s��nica. A combina����o deste ensaio e t��cnica de an��lise n��o-destrutivas revelou-se de grande utilidade na avalia����o da morfologia interna dos modelos criados. De forma a conhecer as resist��ncias mec��nicas e as respectivas rela����es com a qualidade de injec����o dos meios porosos, realizaram-se ensaios de resist��ncia �� trac����o por compress��o diametral (tamb��m designados por Splitting Tensile Strength Test). Por fim, na ��ltima parte deste trabalho, de modo a simular os testes de injec����o realizados anteriormente em laborat��rio, foi usado um modelo anal��tico tendo como ponto de partida a teoria de fluxo laminar viscoso atrav��s de meios porosos, com base na lei de Darcy.

An��lise experimental da resist��ncia ao corte do n��cleo interior de alvenarias de pano m��ltiplo consolidadas com injec����o de grouts

A quantidade de edif��cios em degrada����o em Portugal que necessita de reabilita����o �� bastante elevada. As alvenarias antigas e hist��ricas por vezes apresentam um estado avan��ado de degrada����o por ineficiente concep����o ou por falta de manuten����o. Desta forma as alvenarias necessitam de ac����es de refor��o e consolida����o com o intuito de fortalecer as suas resist��ncias a diversos tipos de carregamentos. A presente disserta����o est�� relacionada com uma t��cnica de consolida����o das mais utilizadas e actuais, a injec����o de grouts em alvenarias. O refor��o por injec����o de grouts �� bastante utilizado em alvenarias de pano m��ltiplo, onde permite uma maior coes��o entre materiais, uniformidade de tens��es e continuidade de panos. Os principais objectivos de consolida����o de uma alvenaria atrav��s da t��cnica de injec����o de grouts s��o: a ocupa����o de espa��os vazios de forma a aumentar a sua rigidez e a sua resist��ncia; e o restabelecimento das liga����es entre panos que ao longo do tempo deixou de existir, ou seja, um comportamento monol��tico quando aplicado um carregamento vertical ou horizontal como um sismo. Da�� a import��ncia da an��lise de resist��ncia ao corte numa da alvenaria de pano m��ltiplo. O presente trabalho teve uma componente laboratorial muito extensa, onde se efectuou injec����es em modelos paralelipip��dicos simulando o n��cleo interior de uma parede de alvenaria antiga. O grout constitu��do por cal hidra��lica, superplastificante e ��gua foi injectado no molde com um dos meios porosos de um dos dois materiais, calc��rio ou cer��mico. Ap��s a cura cortaram-se em fatias os provetes e analisou-se a velocidade de propaga����o de ultra-sons com dois tipos de trandutores (cil��ndricos e c��nicos). Os ensaios mec��nicos utilizados foram o diagonal test e o ensaio de corte directo de modo a determinar a resist��ncia ao corte e finalmente comparou-se os valores dos ensaios para determina����o das propriedades. Ainda com o intuito de avaliar as liga����es grout-part��cula do meio poroso foram avaliadas algumas fotografias tiradas a partir da lupa binocular. A t��cnica de injec����o de grouts demonstrou-se uma t��cnica muito interessante e eficiente na an��lise de corte, no entanto esta t��cnica apresenta melhores resultados quando �� utilizada em conson��ncia com outras t��cnicas.

Carateriza����o e an��lise das admiss��es hospitalares na urg��ncia do Centro Hospitalar Lisboa Central, EPE : um estudo com os utentes inscritos no Agrupamento de Centros de Sa��de de Lisboa Central

RESUMO - Objetivo: Caraterizar e analisar o acesso dos utentes inscritos no Agrupamento de Centros de Sa��de Lisboa Central ao servi��o de urg��ncia do hospital de refer��ncia (Hospital de S. Jos��). Metodologia: O presente estudo �� do tipo observacional, descritivo, transversal e explorat��rio. A an��lise da informa����o incidiu sobre a base de dados cedida pelo CHLC que continha os registos de todas as admiss��es do ano de 2014 referentes ao Servi��o de Urg��ncia Polivalente do CHLC, foram analisados 81928 epis��dios e 15042 epis��dios referentes a utentes frequentadores. Resultados: A proximidade ao SU �� um fator que potencia a procura de cuidados hospitalares urgentes, no entanto, o facto de o utente n��o possuir m��dico de fam��lia n��o se encontra relacionado com a procura do servi��o de urg��ncia. Metades das admiss��es s��o consideradas ���pouco urgentes��� (pulseira verde), n��o existindo uma varia����o significativa entre as unidades funcionais e o tipo de modelo das mesmas (UCSP ou USF) no que respeita �� procura das urg��ncias por parte dos seus utentes. Conclui-se ainda que o hor��rio de funcionamento dos CSP encontra-se de acordo com as necessidades dos utentes considerando que a maior procura de cuidados urgentes ocorre durante o hor��rio de funcionamento dos centros de sa��de. Conclus��es: A procura de cuidados hospitalares urgentes por parte dos utentes do ACES Lisboa Central �� significativa e maioritariamente injustificada do ponto de vista cl��nico, pelo que revela-se necess��rio repensar nas estrat��gias ao n��vel dos CSP para responder ��s efetivas necessidades em sa��de.