Trombocitopenia imune primária crónica : palavra-passe incompleta

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2014

Potencial da ressonância magnética multiparamétrica na deteção de carcinoma da próstata localizado e valor do coeficiente de difusão aparente como possível preditor da agressividade tumoral : revisão de uma técnica em expansão

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2014

Síndrome de Guillain-Barré: epidemiologia, prognóstico e fatores de risco

Introduction. Guillain-Barré syndrome (GBS) is an immune-mediated polyneuropathy and the principal cause of acute neuromuscular paralysis. The most prominent GBS subtypes are: acute inflammatory demyelinating polyneuropathy (AIDP), acute motor axonal neuropathy (AMAN), acute motor-sensory axonal neuropathy (AMSAN) and Fisher syndrome (FS). Differences in geographical distribution of variants have been reported. In Brazil, there are few studies describing the characteristics of GBS, but none on the frequency of GBS variants and their clinical manifestations. Infection-induced aberrant immune response resulting from molecular mimicry and formation of cross-reacting antibodies, contribute to complement activation. Functional biallelic polymorphism in immunoglobulin receptors that influence the affinity of IgG subclasses and the type of immune response have been described, suggesting genetic susceptibility to developing disease. It remains unclear whether individuals carrying different FCGR alleles have differential risk for GBS and⁄or disease severity. The goals of this study were: (1) To characterize GBS and describe the clinical findings in a cohort of patients with GBS from the state of Rio Grande do Norte, Brazil; (2) to determine whether polymorphism in FCGR were associated with development of GBS, and (3) to tease out whether the global gene expression studies could be a tool to identify pathways and transcriptional networks which could be regulated and decrease the time of disease. Methods. Clinical and laboratory data for 149 cases of GBS diagnosed from 1994 to 2013 were analyzed. Genomic DNA and total RNA were extracted from whole blood. Antigangliosides antibodies were determined in the sera. In addition, we also assessed whether FCGR polymorphism are present in GBS (n=141) and blood donors (n=364), and global gene expressions were determined for 12 participants with GBS. Blood samples were collected at the diagnosis and post-recovery. Results. AIDP was the most frequent variant (81.8%) of GBS, followed by AMAN (14.7%) and AMSAN (3.3%). The incidence of GBS was 0.3 ⁄ 100,000 people for the state of Rio Grande do Norte and cases occurred at a younger age. GBS was preceded by infections, with the axonal variant associated with episodes of diarrhea (P = 0.025). Proximal weakness was more frequent in AIDP, and distal weakness predominant in the axonal variant. Compared to 42.4% of cases with AIDP (P<0.0001), 84.6% of cases with the axonal variant had nadir in <10 days. Individuals with the axonal variant took longer to recover deambulation (P<0.0001). The mortality of GBS was 5.3%. A worse outcome was related to an axonal variant (OR17.063; P=0.03) and time required to improve one point in the Hughes functional scale (OR 1.028; P=0.03). The FCGR genotypes and allele frequencies did not differ significantly between the patients with GBS and the controls (FCGR2A p=0.367 and FCGR3A p=0.2430). Global gene expression using RNAseq showed variation in transcript coding for protein isoforms during acute phase of disease. Conclusions. The annual incidence of GBS was 0.3 per 100,00 and there was no seasonal pattern. A predominance of the AIDP variant was seen, and the incidence of the disease decreased with age. The distribution of weakness is a function of the clinical variants, and individuals with the axonal variant had a poorer prognosis. Early diagnosis and variant identification leads to proper intervention decreasing in long-term morbidity. FCGR polymorphisms do not seem to influence susceptibility to GBS in this population. This study found deregulated genes and signs of transcriptional network alterations during the acute and recovery phases in GBS. Identification of pathways altered during disease might be target for immune regulation and with potential to ameliorate symptoms.

As tecnologias de informação e comunicação (TIC) como ferramentas cognitivas

A utilização das Tecnologias da Informação e Comunicação (TIC) como ferramentas cognitivas foi o propósito deste projeto. A problemática da introdução das TIC na sala de aula numa perspetiva construtivista levou-nos ao nosso estudo empírico, onde utilizamos uma metodologia de investigação quantitativa e qualitativa numa triangulação que nos pareceu mais adequada a este estudo. Como método foi adotado o estudo de caso e utilizamos como fontes de recolha de dados o inquérito por questionário a professores e alunos e uma entrevista a um especialista na área das TIC. O resultado do estudo efetuado permitiu-nos verificar que da parte dos docentes existe uma necessidade de formação e informação na área das TIC como ferramentas cognitivas, mais partilha de boas práticas e também mais utilização de meios tecnológicos na sua ação de ensino e aprendizagem. Quanto aos alunos, pensamos que com a mudança de atitude dos professores, mudaremos também a sua forma de utilizar as TIC na sua aprendizagem. Na operacionalização do plano de ação, criamos três etapas de trabalho: a) Oficina de Formação, b) Informação e c) promoção de atividades online. Pensamos que com este plano daremos resposta à nossa questão de partida, e criaremos um ambiente de ensino/aprendizagem onde as TIC se transformem em ferramentas cognitivas de apoio à construção das aprendizagens significativas dos alunos.

Electroencephalogram cepstral distances in alzheimer’s disease diagnosis

Alzheimer's disease (AD) represents one ofthe greatest public health challenges worldwide nowadays, because it affects millions of people ali o ver the world and it is expected that the disease will increase considerably in the near future. This study is the first application attempt of cepstral analysis on Electroencephalogram (EEG) signals to find new parameters in arder to achieve a better differentiation belween EEGs of AD patients and Control subjects. The results show that the methodology that uses a combined Wavelet (WT) Biorthogonal (Bior) 3.5 and cepstrum analysis was able to describe the EEG dynamics with a higher discriminative power than the other WTs/spectmm methodologies m previous studies. The most important significance figures were found in cepstral distances between cepstrums oftheta and alpha bands (p=0. 00006<0. 05).