Infections After Liver Transplantation: A Retrospective, Single-Center Study

Objective. To access the incidence of infectious problems after liver transplantation (LT). Design. A retrospective, single-center study. Materials and Methods. Patients undergoing LT from January 2008 to December 2011 were considered. Exclusion criterion was death occurring in the first 48 hours after LT. We determined the site of infection and the bacterial isolates and collected and compared recipient���s variables, graft variables, surgical data, post-LT clinical data. Results. Of the 492 patients who underwent LT and the 463 considered for this study, 190 (Group 1, 41%) developed at least 1 infection, with 298 infections detected. Of these, 189 microorganisms were isolated, 81 (51%) gram-positive bacteria (most frequently Staphylococcus spp). Biliary infections were more frequent (mean time of 160.4 167.7 days after LT); from 3 months after LT, gram-negative bacteria were observed (57%). Patients with infections after LT presented lower aminotransferase levels, but higher requirements in blood transfusions, intraoperative vasopressors, hemodialysis, and hospital stay. Operative and cold ischemia times were similar. Conclusion. We found a 41% incidence of all infections in a 2-year follow-up after LT. Gram-positive bacteria were more frequent isolated; however, negative bacteria were commonly isolated later. Clinical data after LT were more relevant for the development of infections. Donors��� variables should be considered in future analyses.

Pro poor tourism for community development on Atauro Island, Timor-Leste

A Work Project, presented as part of the requirements for the Award of a Masters Degree in Management from the NOVA ��� School of Business and Economics

Pneumonias adquiridas durante o internamento hospitalar : impacte na sa��de e implica����o nos custos

RESUMO - Introdu����o: O presente estudo pretende analisar o impacte na sa��de e a implica����o nos custos da Pneumonia adquirida durante o internamento hospitalar. Est�� comprovado que as infe����es hospitalares constituem um problema de Sa��de p��blica dos hospitais em todo o mundo. Metodologia: A popula����o em estudo abrange 97 033 epis��dios de internamento, ocorridos em 10 hospitais, no ano de 2010. O trabalho compreende tr��s fases: i) caracteriza����o da popula����o em estudo; ii) identifica����o das vari��veis que influenciam os resultados em sa��de; iii) estima����o dos custos do internamento com Pneumonia. Resultados: Os epis��dios de internamento com Pneumonia ocorreram maioritariamente no sexo masculino (58.1%). A faixa et��ria com mais epis��dios foi a dos 80 aos 89 anos. A taxa de Preval��ncia foi de 4.16% e a taxa de Mortalidade foi de 34.56%. Os doentes com Pneumonia tiveram uma demora m��dia superior em 13 dias em rela����o aos doentes sem Pneumonia para o mesmo conjunto de GDH. Pertencer ao sexo masculino e os epis��dios de internamento ocorridos em hospitais n��o universit��rios levam a um aumento da probabilidade de morrer. Por sua vez apresentar uma maior dura����o de internamento e um n��mero superior de comorbilidades levam a uma diminui����o deste risco. Os custos em excesso dos epis��dios de internamento devido �� aquisi����o de Pneumonia como doen��a secund��ria foram de aproximadamente 18 milh��es de euros. Conclus��o: O trabalho foi elaborado tendo em vista a quantifica����o do fen��meno em Portugal, tanto em termos da carga da doen��a, como das implica����es financeiras. Os valores encontrados s��o preocupantes, pelo que se torna necess��rio tomar medidas e introduzir pr��ticas na atividade hospitalar que minimizem as infe����es hospitalares em geral e da Pneumonia em particular. Por sua vez �� expect��vel, face ao descrito na literatura internacional, que a introdu����o destas pr��ticas melhor os resultados em sa��de e o desempenho financeiro dos hospitais.

A CSR communication strategy for Continente: Improving brand image and reinforcing local community bonds

A Work Project, presented as part of the requirements for the Award of a Masters Degree in Management from the NOVA ��� School of Business and Economics

Effects of levamisole on experimental infections by Plasmodium berghei in mice

Levamisole (phenylimidothiazol), considered a strong immunostimulant, when administered to healthy Swiss mice did not cause a significant increase in -the weight of their thymus, liver and spleen, even though the drug was used at different times before removing such organs. High doses ofdrug used in the 4-day prophylactic scheme had no antimalarial effect. However, when given to malaria infected mice 24 hours before, at the same time, and 24 hours after the inoculation of a chloroquine-sensitive or a chloroquine-resistant strain of Plasmodium berghei small doses of the drug induced a somewhat decreased parasitemia, the dose of 1 mg/kg body weight before the inoculum being the best scheme. The mortality rates by malaria in the levamisole treated groups were also delayed although all mice finally died. The data suggest that levamisole may display a stimulant effect on the depressed immune response caused by malaria.

The impact of online brand community on electronic word-of-mouth communications

A Work Project, presented as part of the requirements for the Award of a Masters Degree in Management from the NOVA ��� School of Business and Economics

Ascaris lumbricoides: reinfection in children bearing an established worm burden

To clarify the existance of reinfection in children bearing an established Ascaris lumbricoides infection, the authors evaluated the weight and the length of worms collected from ten cases of ascaridiasis. The worm burden was greater than 27 worms in nine cases. In seven cases the weight and the length of worms showed little variation, with unimodal distribution of values, suggesting that all the worms in each case belong to the same population, originated from a single brood infection or from successive infections over small time intervals. In three cases there was great variation in worm size indicated by the different values for the means and medians and by the high values for the standard deviation and coefficient of variation. In these three cases there was a bimodal distribution of worm's size suggesting the coexistance of two distinct populations: one, less numerous, composed of mature worms and the other, more numerous, composed ofimmature worms, in two cases, and two distinct populations of immature worms in one case. The existance of worms in different stages of maturation indicates that the less mature population was acquired when the mature worms were established in the gut. These results indicate that the reinfection with Ascaris in children bearing an established infection is not rare and resistance induced by a preexisting infection is not the rule.

The impact of Ireland���s current Mental Health Policy on the profile of community mental Health Services

RESUMO: Em 2006, foi aprovada uma nova pol��tica governamental para a sa��de mental intitulada ���Uma Vis��o para a Mudan��a���, a qual est�� neste momento no s��timo ano de implementa����o. A pol��tica descreve um enquadramento para o desenvolvimento e promo����o da sa��de mental positiva para toda a Comunidade e para a presta����o de servi��os acess��veis, baseados na comunidade, servi��os especializados para pessoas com doen��a mental. A implementa����o da pol��tica e o tornar a ���Vision for Change��� uma realidade t��m sido problem��ticos, com cr��ticas consider��veis por parte dos intervenientes, relativas �� lenta e desconexa implementa����o. Este estudo fornece informa����o sobre as caracter��sticas dos servi��os de tr��s importantes tipos de institui����es de sa��de mental comunit��ria a n��vel nacional, nomeadamente Hospitais de Dia, Centros de Dia e resid��ncias comunit��rias operantes 24 horas. A pesquisa analisa objetivos e fun����es, perfis dos pacientes, atividades terap��uticas, a efic��cia das redes de comunica����o e beneficia da perspectiva dos funcion��rios sobre o que mudou no terreno ao longo dos ��ltimos sete anos. As quest��es identificadas a partir das caracter��sticas dos tr��s servi��os dizem respeito a todos. Os participantes indicaram que o ethos da recupera����o parece ter alcan��ado um papel mais central no tratamento do paciente na comunidade mas reconheceram que o desafio de integrar os princ��pios de recupera����o na pr��tica cl��nica se mant��m presente. Parece ser reconhecida a import��ncia da planifica����o do cuidado individual nos servi��os comunit��rios e os entrevistados indicaram que existe um empenho para garantir o envolvimento do usu��rio do servi��o. H�� diferen��as entre os ���pontos de vista do pessoal��� e os ���pontos de vista dos representantes��� sobre uma s��rie de aspetos da presta����o de servi��os. Este �� o primeiro estudo irland��s deste g��nero a examinar a presta����o de servi��os das tr��s principais institui����es comunit��rias de sa��de mental num s�� estudo. Estes servi��os representam um enorme investimento em recursos, quer a n��vel monet��rio, quer humano. O estudo examinou os desafios e as quest��es fundamentais que lhe s��o aplic��veis e que t��m impacto nestes tr��s tipos de presta����o de servi��os. Tamb��m forneceu informa����es sobre os elementos de mudan��a positiva, os quais se come��am a focar lentamente na presta����o do servi��o, assim como na import��ncia da centralidade do utilizador do servi��o e na promo����o de um ethos da recupera����o.----------ABSTRACT: In 2006, a new Government policy for mental health ���A Vision for Change��� was endorsed and is currently in the seventh year of implementation. The policy describes a comprehensive framework for building and fostering positive mental health across the entire community and for providing accessible, community based, specialist services for people with mental illness. The implementation of the policy and turning ���Vision for Change��� into reality has been problematic with considerable criticism from stakeholders concerning slow and disjointed implementation. This study provides information on three key community mental health service settings, namely Day Hospitals, Day Centres and 24 Hour Community Residences at a national level. The research looks at aims and functions, patient profiles, therapeutic activities, effectiveness of key communication networks and gains an insight from staff on what has changed on the ground over the past seven years. Issues identified from the three service settings pertain to all. Participants indicated that the recovery ethos appears to have moved to a more central role in patient care in the community but acknowledged that the challenge of integrating recovery principles in clinical practice remains present. The importance of individual care planning appears to be recognised in community services and respondents indicated that efforts are being made to ensure service user involvement. There were differences between ���staff views��� and ���advocate views��� on a number of aspects of service provision. This is the first Irish study of its kind to examine service provision across the three main community mental health settings in one study. These services represent a huge investment in resources both on a monetary and human level. This study has examined the challenges and key issues which are applicable and impacting on all three types of service provision. It has also provided information on the elements of positive change, which are slowly embedding themselves in service provision such as the importance of the centricity of the service user and the promotion of a recovery ethos.

Control of parasitic infections among school children in the peri-urban area of Botucatu, S��o Paulo, Brazil

Tide prevalence of intestinal parasitosis ivas investigated in a primaiy school located in Rubi��o J��nior, a peri-urban district of Botucatu, S��o Paulo slate, Brazil, in order to assess the effect of treatment and practical measures of prophylaxis in the control of parasitic infections among 7-to- 18-year-old school children of a low socio-economic status. The first series of parasitological examinations included 219 school children, ef which 123 (56.1 %) were found to be infected with one or more parasite species. Eighty- four children canying pathogenic parasites were submitted to various anti-parasitic treatment schedules. We re-evaluated 15 (89 %) students after 4 to 6 months post- chemotherapy. The results indicate that the combination of treatment with prophylactic measures has been successful in the control of parasitic infections, since reinfection rates were generally low (< 5-3 %), except for Giardia lamblia infections (18.6 %), and a marked reduction oti the prevalence rates was obsewed with a significant percentage of cure (&gt; 73-1 %) in children infected with most parasite species. The reasons for the apparent failure in the control of infections caused by Hymenolepis nana and Strongyloides stercoralis are discussed.

Human parvovirus B19 infections among exanthematic diseases notified as measles

A total of 1397 sera collected from 1095 cases of exanthematic disease notified as measles in ES and RJ states during July 1992 to December 1994 were investigated. These sera were first tested for measles and rubella specific IgM. When they proved negative, they were tested for B19 specific IgM by an enzyme immunoassay. B19 infection was confirmed in 27 (2.5%) of these cases. Sera from 194 negative cases for measles and rubella IgM received from other Brazilian states were also investigated and B19 infection was confirmed for 11 of them. Sera from these 38 IgM positive cases for B19, were tested for anti-B19 IgG by an enzyme immunoassay and for B19 DNA by dot blot hybridization. Anti-B19 IgG antibodies were detected in most of the acute sera. B19 DNA was detected in the acute serum of one patient that had been splenectomized before. As the exanthem caused by human parvovirus infection may be clinically diagnosed as rubella, it could be important to diagnose B19 infection in Brazil since it is becoming prevalent as the cause of rash in countries where rubella is controlled by vaccination.

Prevalence of IgG and IgM anti-Toxoplasma antibodies in patients with HIV and acquired immunodeficiency syndrome (AIDS)

With the emergence of the human immunodeficiency virus (HIV), in patients with acquired immunodeficiency syndrome (AIDS), Toxoplasma gondii has arisen as an important opportunist pathogenic agent, especcially in the central nervous system, being the most common cause of intracerebral lesions. The incidence of Toxoplasma gondii in HIV-infected patients depends principally on the existence of latent Toxoplasma parasitosis in the population affected. Through the enzyme-linked immunosorbent assay (ELISA), IgG and IgM anti-Toxoplasma antibodies were found in 92 patients of which 46 (50.0%) were IgG seropositive, and only one case (1.0%) had IgM antibodies.Of the 92 patients: 53 were HIV seropositives and 39 had AIDS. The detection and monitoring of anti-Toxoplasma antibodies in HIV patients is essential, since in this group there is a high percentage risk of developing cerebral toxoplasmosis, which is the second cause of death in this type of patients.

A longitudinal study on enteropathogenic infections of livestock in Trinidad

A longitudinal study was conducted on selected livestock farms to determine the prevalence of enteropathogens in diarrhoeic and non-diarrhoeic animals. The enteropathogens assayed from faecal samples and rectal swabs were bacteria (Escherichia coli, Campylobacter spp. Salmonella spp. and Yersinia enterocolitica), parasites (coccidia, gastrointestinal nematodes and Cryptosporidium spp.) and viruses (group A rotavirus and parvovirus). The prevalence of the enteropathogens in various animal species was related to age and month of the year. Generally, younger animals presented a higher prevalence of infection by enteropathogens than older animals while most infections occurred between the months of January and April.