Cutaneous anthrax in Lima, Peru: retrospective analysis of 71 cases, including four with a meningoencephalic complication

Anthrax is a zoonosis produced by Bacillus anthracis, and as an human infection is endemic in several areas in the world, including Peru. More than 95% of the reported naturally acquired infections are cutaneous, and approximately 5% of them can progress to meningoencephalitis. In this study we review the clinical and epidemiological characteristics of the patients with diagnosis of cutaneous anthrax evaluated between 1969 and 2002 at the Hospital Nacional Cayetano Heredia (HNCH) and the Instituto de Medicina Tropical Alexander von Humboldt in Lima, Peru. Seventy one patients were included [49/71 (69%) of them men], with a mean age of 37 years. The diagnoses were classified as definitive (44%) or probable (56%). The most common occupation of the patients was agriculture (39%). The source of infection was found in 63 (88.7%) patients. All the patients had ulcerative lesions, with a central necrosis. Most of the patients (65%) had several lesions, mainly located in the upper limbs (80%). Four patients (5.6%) developed meningoencephalitis, and three of them eventually died. In conclusion, considering its clinical and epidemiological characteristics, cutaneous anthrax must be included in the differential diagnosis of skin ulcers. A patient with clinical suspicion of the disease should receive effective treatment soon, in order to avoid neurological complications which carry a high fatality rate.

Hepatitis C in patients co-infected with human immunodeficiency virus. A review and experience of a Brazilian ambulatory

Hepatitis C virus (HCV) and human immunodeficiency virus (HIV) share the same transmission mechanisms. The prevalence of HCV in the HIV-infected population varies from region to region, throughout the world, depending on different exposure factors to both viruses. Co-infection with HIV accelerates the progression of the disease caused by HCV, appears to worsen the progression of the HIV infection and increases HCV transmission. Therefore, clinical management and treatment of HCV is a priority in medical facilities that receive HIV-infected patients. Clinical management of these patients involves specific diagnostic procedures and appropriately trained medical staff. The indication of treatment should meet specific clinical and laboratory criteria. There are a number of drugs currently available to treat hepatitis C in co-infected patients.

Introducing numerical analysis tools in engineering: a Scilab user case in electronics course

Software tools in education became popular since the widespread of personal computers. Engineering courses lead the way in this development and these tools became almost a standard. Engineering graduates are familiar with numerical analysis tools but also with simulators (e.g. electronic circuits), computer assisted design tools and others, depending on the degree. One of the main problems with these tools is when and how to start use them so that they can be beneficial to students and not mere substitutes for potentially difficult calculations or design. In this paper a software tool to be used by first year students in electronics/electricity courses is presented. The growing acknowledgement and acceptance of open source software lead to the choice of an open source software tool – Scilab, which is a numerical analysis tool – to develop a toolbox. The toolbox was developed to be used as standalone or integrated in an e-learning platform. The e-learning platform used was Moodle. The first approach was to assess the mathematical skills necessary to solve all the problems related to electronics and electricity courses. Analysing the existing circuit simulators software tools, it is clear that even though they are very helpful by showing the end result they are not so effective in the process of the students studying and self learning since they show results but not intermediate steps which are crucial in problems that involve derivatives or integrals. Also, they are not very effective in obtaining graphical results that could be used to elaborate reports and for an overall better comprehension of the results. The developed tool was based on the numerical analysis software Scilab and is a toolbox that gives their users the opportunity to obtain the end results of a circuit analysis but also the expressions obtained when derivative and integrals calculations, plot signals, obtain vector diagrams, etc. The toolbox runs entirely in the Moodle web platform and provides the same results as the standalone application. The students can use the toolbox through the web platform (in computers where they don't have installation privileges) or in their personal computers by installing both the Scilab software and the toolbox. This approach was designed for first year students from all engineering degrees that have electronics/electricity courses in their curricula.

A Fractional Calculus Perspective in the Evolutionary Design of Combinational Circuits

This paper analyses the performance of a genetic algorithm (GA) in the synthesis of digital circuits using two novel approaches. The first concept consists in improving the static fitness function by including a discontinuity evaluation. The measure of variability in the error of the Boolean table has similarities with the function continuity issue in classical calculus. The second concept extends the static fitness by introducing a fractional-order dynamical evaluation.

Cirurgias de Derivação do Ventrículo Pulmonar

Cavopulmonary connections have been extensively used in the palliation of complex forms of congenital heart disease requiring some form of right heart bypass. We examine the mid term outcomes of pulmonary ventricle bypass operations in a single institution and performed by the same surgical team. POPULATION: Between March 1999 and April 2006, 62 patients underwent pulmonary ventricle bypass operations: bidirectional cavopulmonary anastomosis (Glenn procedure), total cavopulmonary connections (Fontan procedure) and one and a half ventricle correction in two cases. Age at operation averaged three years (range: 0.42-25 years) for the Glenn procedure and seven years (range: 3-14 years) for the Fontan procedure. There were 36 male patients (58%) and 26 female patients (42%). The most common indication for surgery was the single ventricle defect, present in 66% of patients. Associated lesions included: transposition of the great arteries in 16 patients (35.6%), bilateral superior vena cava in four patients (8.9%), situs ambigus in five patients (11%), situs inversus in another patient (2.2%), Ebstein disease in one patient (2.2) and coronary fistula in another patient (2.2%). Sub-aortic stenosis was present in one patient (2.2%). Palliative surgery was performed in all, but three patients (5%), before the Fontan procedure. RESULTS: Thirty two patients underwent bidirectional cavopulmonary anastomosis and thirty patients underwent cavopulmonary connections, total or 2nd stage. Mean cardiopulmonary bypass times were 50.6+/-21.9 minutes for the Glenn procedure and 88.5+/-26.3 minutes for the Fontan procedure. There was no intra-operative mortality, but two patients (3.2% (died in the first month after surgery; one due to failure of the Glenn circuit and sepsis and the other due to a low cardiac output syndrome and multi-organ dysfunction. Mean ventilation time was 5.2+/-1.7 hours for the Glenn operation and 6.2+/-3.2 hours for the Fontan operation. The mean length of stay in ICU was 3.4+/-2.8 days for patients undergoing the Glenn operation and 4.6+/-3.1 days for patients undergoing the Fontan operation and the mean length of hospital stay was 10.6+/-5.8 days for the Glenn operation and 19.1+/-12.6 days for the Fontan operation respectively. The mean follow up time was 4+/-2.1 years (minimum 0 years and maximum seven years), most patients being in NYHA class I. Epicardiac pacemakers were implanted in three patients due to arrhythmias. Two re-operations (6.7%) were needed, both in the same patient, after the Fontan procedure, this patient eventually died a few years after surgery. CONCLUSIONS: The immediate and mid term outcomes of pulmonary ventricle bypass operations can have excellent results. From our point of view there has been an improvement, namely in the use of the extracardiac conduit technique in the 2nd stage of the Fontan operation.

Ball Sensing in a Leg Like Robotic Kicker

The trend to have more cooperative play and the increase of game dynamics in Robocup MSL League motivates the improvement of skills for ball passing and reception. Currently the majority of the MSL teams uses ball handling devices with rollers to have more precise kicks but limiting the capability to kick a moving ball without stopping it and grabbing it. This paper addresses the problem to receive and kick a fast moving ball without having to grab it with a roller based ball handling device. Here, the main difficulty is the high latency and low rate of the measurements of the ball sensing systems, based in vision or laser scanner sensors.Our robots use a geared leg coupled to a motor that acts simultaneously as the kicking device and low level ball sensor. This paper proposes a new method to improve the capability for ball sensing in the kicker, by combining high rate measurements from the torque and energy in the motor and angular position of the kicker leg. The developed method endows the kicker device with an effective ball detection ability, validated in several game situations like in an interception to a fast pass or when chasing the ball where the relative speed from robot to ball is low. This can be used to optimize the kick instant or by the embedded kicker control system to absorb the ball energy.

Bites by coral snakes (Micrurus spp.) in Campinas, State of São Paulo, Southeastern Brazil

Coral snakes (Micrurus spp.) are the main representatives of the Elapidae in South America. However, bites by these snakes are uncommon. We retrospectively reviewed the data from 11 individuals bitten by coral snakes over a 20-year period; four were confirmed (snake brought for identification) and seven were highly suspected (neuromuscular manifestations) cases of elapid envenoming. The cases were classified as dry-bite (n = 1, caused by M. lemniscatus; did not receive antivenom), mild (n = 2, local manifestations with no acute myasthenic syndrome; M. frontalis and Micrurus spp.), moderate (n = 5, mild myasthenia) or severe (n = 3, important myasthenia; one of them caused by M. frontalis). The main clinical features upon admission were paresthesia (local, n = 9; generalized, n = 2), local pain (n = 8), palpebral ptosis (n = 8), weakness (n = 4) and inability to stand up (n = 3). No patient developed respiratory failure. Antivenom was used in ten cases, with mild early reactions occurring in three. An anticholinesterase drug was administered in the three severe cases, with a good response in two. No deaths were observed. Despite the high toxicity of coral snake venoms, the prognosis following envenoming is good. In serious bites by M. frontalis or M. lemniscatus, the venom of which acts postsynaptically, anticholinesterases may be useful as an ancillary measure if antivenom is unavailable, if there is a delay in obtaining a sufficient amount, or in those patients given the highest recommended doses of antivenom without improvement of the paralysis or with delayed recovery.

Energy Harvesting for Autonomous Underwater Vehicles

In this study, energy production for autonomous underwater vehicles is investigated. This project is part of a bigger project called TURTLE. The autonomous vehicles perform oceanic researches at seabed for which they are intended to be kept operational underwater for several months. In order to ful l a long-term underwater condition, powerful batteries are combined with \micro- scale" energy production on the spot. This work tends to develop a system that generates power up to a maximum of 30 W. Latter energy harvesting structure consists basically of a turbine combined with a generator and low-power electronics to adjust the achieved voltage to a required battery charger voltage. Every component is examined separately hence an optimum can be de ned for all, and subsequently also an overall optimum. Di erent design parameters as e.g. number of blades, solidity ratio and cross-section area are compared for di erent turbines, in order to see what is the most feasible type. Further, a generator is chosen by studying how ux distributions might be adjusted to low velocities, and how cogging torque can be excluded by adapted designs. Low-power electronics are con gured in order to convert and stabilize heavily varying three-phase voltages to a constant, recti ed voltage which is usable for battery storage. Clearly, di erent component parameters as maximum power and torque are matched here to increase the overall power generation. Furthermore an overall maximum power is set up for achieving a maximum power ow at load side. Due to among others typical low velocities of about 0.1 to 0.5 m/s, and constructing limits of the prototype, the vast range of components is restricted to only a few that could be used. Hence, a helical turbine is combined in a direct drive mode to a coreless-stator axial- ux permanent-magnet generator, from which the output voltage is adjusted subsequently by a recti er, impedance matching unit, upconverter circuit and an overall control unit to regulate di erent component parameters. All these electronics are combined in a closed-loop design to involve positive feedback signals. Furthermore a theoretical con guration for the TURTLE vehicle is described in this work and a solution is proposed that might be implemented, for which several design tests are performable in a future study.

Sistema de Controlo Remoto de Luzes de Aeródromo

Este relatório apresenta o trabalho realizado no âmbito da unidade curricular de Dissertação do Mestrado em Engenharia Electrotécnica e de Computadores – área de especialização de Automação e Sistemas. O trabalho realizado consiste no desenvolvimento de um Sistema de Controlo Remoto de Luzes de Aeródromo (SCRLA) que pode ser aplicado em paralelo aos comandos locais de controlo das luzes de aproximação, pista ou circulação, entre outras, de uma infra-estrutura aeroportuária. O objectivo fundamental deste sistema consiste em permitir ao piloto de uma aeronave o acendimento das luzes do aeródromo desde a própria aeronave, recorrendo apenas ao equipamento de rádio VHF existente a bordo da mesma e que é normalmente usado para comunicações com os serviços de controlo de tráfego aéreo. Este sistema, em aeródromos com possível operação nocturna (e.g., heliportos de hospitais), permite uma redução dos custos associados a despesas com eventual pessoal técnico ou a redução da carga de trabalho neste, e uma diminuição do consumo de energia eléctrica, uma vez que as luzes apenas são acendidas quando necessário. Este sistema permite também reduzir a poluição luminosa no ambiente e contribui positivamente para a longevidade dos equipamentos luminosos. No desenvolvimento do sistema, foram adquiridos e/ou aplicados conhecimentos nas áreas de navegação aérea, infra-estruturas aeroportuárias, telecomunicações, normalização e estandardização, electrónicas analógica e digital, programação de baixo nível em microcontroladores, desenho e construção de circuitos impressos, desenho e construção mecânica.

Melhoria do Processo Produtivo da Pietec Através das Ferramentas Kaizen

Esta Tese de Mestrado foi realizada na empresa Pietec Cortiças S.A.. A empresa Pietec Cortiças S.A. é a unidade industrial responsável pela produção de rolhas técnicas de cortiça do Grupo Piedade. O objetivo desta tese prende-se com a melhoria do processo produtivo de uma das suas secções, a secção da Marcação. Esta secção é responsável pela marcação da superfície da rolha, pela aplicação do tratamento de superfície e pelo embalamento das rolhas. A otimização do processo da secção de Marcação, na qualidade de última secção do processo produtivo, permitirá à empresa obter vantagens competitivas. De forma a atingir o objetivo proposto, foi realizado um levantamento exaustivo do processo produtivo e das respetivas operações. Esta análise permitiu a identificação dos possíveis pontos de desperdício, a sua avaliação e a definição de possíveis melhorias que visam o aumento de produtividade e a redução do número de produtos não conformes. Uma vez identificados os pontos críticos do processo, procedeu-se à definição das ações de melhoria a implementar de forma a melhorar o processo produtivo. As ações tomadas assentam na filosofia Lean e nos seus princípios, utilizando-se algumas das ferramentas desta filosofia para concretizar os objetivos traçados. A ferramenta de análise Plan-Do-Check-Act (PDCA) foi a ferramenta base do projeto, acompanhando na elaboração do plano de ação, na implementação das ferramentas 5S e Single Minute Exchange of Die (SMED), na verificação dos resultados e no plano de manutenção das melhorias alcançadas. Após a implementação das medidas definidas no processo de marcação da superfície das rolhas, foi mensurada uma melhoria de 23 % no tempo médio de setup da máquina de marcação. Esta melhoria global foi alcançada através de intervenções no processo de vazamento do circuito da máquina de marcação, no procedimento de armazenamento dos moldes de marcação e na alteração dos mecanismos de ajuste da máquina de marcar e de orientar. No processo de embalamento das rolhas, as medidas implementadas produziram um aumento de 1,7 % no número de rolhas produzidas e uma redução do número de rolhas não conformes de 3,6 %. Os resultados obtidos no projeto demonstram que é possível continuar a melhorar o estado atual dos processos. Constatou-se ainda que, com a adoção de ferramentas de análise e de proposta de melhoria adequadas, é possível atuar sobre os processos e obter melhorias a curto prazo, sem que para isso seja necessário efetuar grandes investimentos.

Estado da Arte da Computação Evolutiva Aplicada à Eletrónica

A Computação Evolutiva enquadra-se na área da Inteligência Artificial e é um ramo das ciências da computação que tem vindo a ser aplicado na resolução de problemas em diversas áreas da Engenharia. Este trabalho apresenta o estado da arte da Computação Evolutiva, assim como algumas das suas aplicações no ramo da eletrónica, denominada Eletrónica Evolutiva (ou Hardware Evolutivo), enfatizando a síntese de circuitos digitais combinatórios. Em primeiro lugar apresenta-se a Inteligência Artificial, passando à Computação Evolutiva, nas suas principais vertentes: os Algoritmos Evolutivos baseados no processo da evolução das espécies de Charles Darwin e a Inteligência dos Enxames baseada no comportamento coletivo de alguns animais. No que diz respeito aos Algoritmos Evolutivos, descrevem-se as estratégias evolutivas, a programação genética, a programação evolutiva e com maior ênfase, os Algoritmos Genéticos. Em relação à Inteligência dos Enxames, descreve-se a otimização por colônia de formigas e a otimização por enxame de partículas. Em simultâneo realizou-se também um estudo da Eletrónica Evolutiva, explicando sucintamente algumas das áreas de aplicação, entre elas: a robótica, as FPGA, o roteamento de placas de circuito impresso, a síntese de circuitos digitais e analógicos, as telecomunicações e os controladores. A título de concretizar o estudo efetuado, apresenta-se um caso de estudo da aplicação dos algoritmos genéticos na síntese de circuitos digitais combinatórios, com base na análise e comparação de três referências de autores distintos. Com este estudo foi possível comparar, não só os resultados obtidos por cada um dos autores, mas também a forma como os algoritmos genéticos foram implementados, nomeadamente no que diz respeito aos parâmetros, operadores genéticos utilizados, função de avaliação, implementação em hardware e tipo de codificação do circuito.

Caracterização de Particulas de Desgaste do Rolamentos por Ferrografia e Ferrometria

Avarias em rolamentos são causas comuns de falhas em máquinas e equipamentos industriais. Portanto, é importante a aplicação de técnicas que permitam a deteção e a identificação do problema o mais cedo possível a fim de evitar a destruição do rolamento e consequente paragem da máquina. Logo, o processo de monitorização do estado dos rolamentos deve receber uma atenção especial no plano de manutenção de qualquer indústria. Este trabalho tem, assim, como principal objetivo a caracterização das partículas de desgaste provenientes de rolamentos através da análise dos seus lubrificantes por ferrometria e ferrografia analítica. Estas técnicas permitem identificar e caracterizar as várias partículas de desgaste presentes numa amostra de lubrificante, permitindo não só avaliar o grau de severidade do desgaste mas também identificar o tipo de desgaste predominante (fadiga, abrasão, corrosão,etc.), e até identificar os diferentes materiais das partículas que se podem associar a componentes específicos com falhas. A criação de uma base de dados para armazenar os resultados, os comentários e as informações mais importantes obtidos nos ensaios experimentais, assim como a análise de alguns casos práticos, foram também realizados no âmbito deste trabalho. Para desenvolver um conhecimento mais profundo sobre as técnicas utilizadas foi importante fazer uma análise aos diversos tipos de rolamentos, a sua lubrificação e as causas e tipos principais de avarias encontradas.

Terapêutica Trombolítica no Enfarte Agudo do Miocárdio: Motivos de Inelegibilidade

STUDY OBJECTIVE: to establish the reasons of ineligibility for thrombolytic therapy (TL) in a group of patients with acute myocardial infarction (AMI). DESIGN: retrospective analysis of protocols and clinical records. SETTING: the medical intensive care unit (ICU) of a tertiary care hospital. PATIENTS AND METHODS: we studied the records from patients with AMI admitted to the ICU during a five-year period (1987-91) and excluded from TL, to determine the cause(s) of ineligibility. RESULTS: we found 1669 patients with AMI, 89 of which were excluded from the study. Of the remaining 1580 patients, 1274 (80.6%) did not receive TL. Mean age was 64.4 years; 66.4% were men. Mortality was 24.6%. Mean duration of chest pain was 19.4 hours. Chief reasons for exclusion from TL were advanced age (43.1% of patients) and delayed presentation (55.7%); one of these was present in 79.2%. CONCLUSIONS: this study confirmed the high mortality of patients with AMI who do not receive TL. Advanced age and delayed presentation were the main causes of ineligibility. As age is being abandoned as an exclusion criterion, efforts for expansion of TL should center on the earlier arrival of patients to centers where it is available.

Impacto da Idade no Tratamento e Resultados Após Enfarte Agudo do Miocárdio em Particular nos Muito Idosos

INTRODUCTION: The elderly population admitted for acute myocardial infarction is increasing. This group is not well studied in international trials and is probably treated with a more conservative approach. OBJECTIVES: To evaluate the presentation and treatment of myocardial infarction according to age, particularly in very elderly patients. METHODS: We studied 1242 consecutive patients admitted with acute myocardial infarction, assessing in-hospital, 30-day and one-year mortality during follow-up for each age-group. Patients were divided into four groups according to age: <45 years (7.6%); 45-64 years (43.3%); 65-74 years (23.4%); and ≥75 years (25.7%). RESULTS: Elderly patients had a worse risk profile (except for smoking), more previous history of coronary disease and a worse profile on admission, with the exception of lipid profile, which was more favorable. With regard to treatment of the elderly, although less optimized than in other age-groups, it was significantly better compared to other registries, including for percutaneous coronary angioplasty. Both complications and mortality were worse in the older groups. In elderly patients (≥75 years), adjusted risk of mortality was 4.9-6.3 times higher (p<0.001) than patients in the reference age-group (45-64 years). In these patients, the independent predictors of death were left ventricular function and renal function, use of beta-blockers being a predictor of survival. CONCLUSIONS: Elderly patients represent a substantial proportion of the population admitted with myocardial infarction, and receive less evidenced-based therapy. Age is an independent predictor of short- and medium-term mortality.

Matrix fractional systems

This paper addresses the matrix representation of dynamical systems in the perspective of fractional calculus. Fractional elements and fractional systems are interpreted under the light of the classical Cole–Cole, Davidson–Cole, and Havriliak–Negami heuristic models. Numerical simulations for an electrical circuit enlighten the results for matrix based models and high fractional orders. The conclusions clarify the distinction between fractional elements and fractional systems.