'Iron lung': Distinctive bronchoscopic features of acute iron tablet aspiration

Three confirmed cases of acute iron tablet-induced necrosis due to a fulminant chemical burn injury to the tracheobronchial tree as a result of accidental inhalation and/or aspiration of iron tablets are described. Although histological confirmation has been relied upon for diagnosis, the distinctive bronchoscopic features may allow prompt recognition and treatment by bronchoscopists to prevent this potentially fatal condition.

Chagas disease in an area of recent occupation in Cochabamba, Bolivia

INTRODUCTION: A descriptive, entomological and seroepidemiological study on Chagas disease was conducted in a place of recent occupation on the outskirts of Cochabamba, Bolivia: Avaroa/Primer de Mayo (population:3,000), where the socio-economic level is low and no control measures have been made available. METHODS: The immunofluorescent antibody test (IFAT) was used for IgG and IgM anti-Trypanosoma cruzi antibodies in filter paper bloodspot eluates from 128 subjects (73 females, 55 males) selected by systematic sampling. Concerning each subject age, gender, birthplace, occupation, duration of residence and building materials used in their houses were recorded. Vectors were captured both in domestic and peridomestic environments. RESULTS: Seropositive, 12.5% (16/128): females, 15.1% (11/73); males, 9.1% (5/55). Average time of residence: 6.1 years for the whole population sample and 7.4 years for the seropositive subjects. Most houses had adobe walls (76.7% , n= 30), galvanized iron rooves (86.7%) and earthen floors (53.4%) 80% of the walls had crevices. One hundred forty seven specimens of Triatoma infestans were captured, of which 104 (70.7%) were domestic, and 1 peridomestic Triatoma sordida. Precipitin host identification: birds, 67.5%; humans, 27.8%; rodents, 11.9%; dogs, 8.7%; cats, 1.6%. House infestation and density indices were 53.3 and 493.0 respectively. We found 21 (14.3%) specimens of T. infestans infected with trypanosomes, 18 (85.7%) of which in domestic environments. DISCUSSION: The elements for the vector transmission of Chagas disease are present in Avaroa/Primer de Mayo and the ancient custom of keeping guinea pigs indoors adds to the risk of human infection. In neighboring Cochabamba, due to substandard quality control, contaminated blood transfusions are not infrequent, which further aggravates the spread of Chagas disease. Prompt action to check the transmission of this infection, involving additionally the congenital and transfusional modes of acquisition, is required.

Plataforma de gestão de incidentes

Mestrado em Engenharia Electrotécnica e de Computadores. Área de Especialização de Telecomunicações.

Gestão do risco em mercados de energia eléctrica recorrendo ao VaR por simulação de Monte Carlo

Mestrado em Engenharia Electrotécnica – Sistemas Eléctricos de Energia.

Climatização passiva em edifício de serviços

Dissertação Final de Mestrado para obtenção do grau de Mestre em Engenharia Civil no Ramo de Edificações

The contribution of multitemporal information from multispectral satellite images for automatic land cover classification at the national scale

Thesis submitted to the Instituto Superior de Estatística e Gestão de Informação da Universidade Nova de Lisboa in partial fulfillment of the requirements for the Degree of Doctor of Philosophy in Information Management – Geographic Information Systems

Specific circulating immune complexes in acute chagas' disease

The presence of circulating immune complexes formed by IgM and IgG (CIC-IgM and CIC-IgG) was investigated, using antigen-specific enzyme-immunoassays (ELISA), in 30 patients with acute Chagas' disease who showed parasitemia and inoculation chagoma. Control population consisted of patients with chronic T. cruzi infection (30), acute toxoplasmosis 10), leishmaniasis (8), rheumatoid arthritis (3) and healthy individuals with negative serology for Chagas* disease (30). Acute chagasic patients were 100% CIC-IgG and 96.66% CIC-IgM positive whereas immunofluorescence tests yielded 90% and 86.66% of positivity for specific IgG and IgM antibodies, respectively. Chronic patients were 68% CIC-IgG and 0% CIC-IgM positive. The 30 negative and the 21 cross-reaction controls proved negative for ELISA (CIC-IgM and CIC-IgG). The high sensitivity of ELISA assays would allow early immunologic diagnosis, as well as prompt treatment, of acute T. cruzi infection, thus eliminating the problem of the false-positive and false-negative results which affects traditional methods for detection of circulating antibodies.

Seizures and Praziquantel. A case report

A 27 year Old male developed seizures after receiving a single 20 mg/kg dose of praziquantel for the treatment of an intestinal Hymenolepis nana infection. On further clinical and laboratorial evaluations, he was found to suffer from an until then asymptomatic parenchymal brain cysticercosis. Praziquantel must be used with caution in those areas where cysticercosis represents a mayor public health problem. The occurrence of unexpected seizures in an individual being treated with the compound, must prompt clinicians to rule out cysticercosis of the CNS.

Neuroartropatia de Charcot do pé diabético: identificação, tratamento conservador e prevenção das suas complicações

Mestrado em Gestão e Avaliação de Tecnologias em Saúde

Phenylketonuria: Protein content and amino acids profile of dishes for phenylketonuric patients. The relevance of phenylalanine

Phenylketonuria is an inborn error of metabolism, involving, in most cases, a deficient activity of phenylalanine hydroxylase. Neonatal diagnosis and a prompt special diet (low phenylalanine and natural-protein restricted diets) are essential to the treatment. The lack of data concerning phenylalanine contents of processed foodstuffs is an additional limitation for an already very restrictive diet. Our goals were to quantify protein (Kjeldahl method) and amino acid (18) content (HPLC/fluorescence) in 16 dishes specifically conceived for phenylketonuric patients, and compare the most relevant results with those of several international food composition databases. As might be expected, all the meals contained low protein levels (0.67–3.15 g/100 g) with the highest ones occurring in boiled rice and potatoes. These foods also contained the highest amounts of phenylalanine (158.51 and 62.65 mg/100 g, respectively). In contrast to the other amino acids, it was possible to predict phenylalanine content based on protein alone. Slight deviations were observed when comparing results with the different food composition databases.

Targeting specific nutrient deficiencies in proteinrestricted diets: some practical facts in PKU dietary management

Among aminoacidopathies, phenylketonuria (PKU) is the most prevalent one. Early diagnosis in the neonatal period with a prompt nutritional therapy (low natural-protein and phenylalanine diet, supplemented with phenylalanine-free amino acid mixtures and special low-protein foods) remains the mainstay of the treatment. Data considering nutrient contents of cooked dishes is lacking. In this study, fourteen dishes specifically prepared for PKU individuals were analysed, regarding the lipid profile and iron and zinc contents. These dishes are poor sources of essential nutrients like Fe, Zn or n-3 fatty acids, reinforcing the need for adequate supplementation to cover individual patients’ needs. This study can contribute to a more accurate adjustment of PKU diets and supplementation in order to prevent eventual nutritional deficiencies. This study contributes to a better understanding of nutrient intake from PKU patients’ meals, showing the need for dietary supplementation.

Adesão ao regime terapêutico na pessoa com enfarte agudo do miócardio: contributo dos enfermeiros no internamento hospita

RESUMO: O Enfarte Agudo do Miocárdio (EAM) representa um dos principais problemas de saúde pública em Portugal. A rápida intervenção nos factores de risco determinantes da saúde cardíaca pode ter um impacto positivo em vários indicadores de saúde. O objectivo final dessa intervenção passa por capacitar a pessoa, para que, autonomamente, adopte um conjunto de comportamentos de saúde, baseados em estilos de vida protectores da saúde cardíaca, que favorecem positivamente o processo de reabilitação. Esta procura e aquisição do comportamento de saúde, adesão ao regime terapêutico, deve ser desenvolvido em parceria com os profissionais de saúde. O hospital representa a porta de entrada da pessoa com EAM no sistema de saúde. É neste contacto que se inicia uma intervenção de sensibilização e promoção da adesão ao regime terapêutico. Sendo os enfermeiros um grupo profissional que estabelece uma relação continua com a pessoa, importa conhecer um conjunto de dimensões do desempenho dos enfermeiros na promoção da adesão ao regime terapêutico. Breve referência ao desenho de estudo. Foram incluídas no estudo 143 enfermeiros de 9 serviços hospitalares da Região de Saúde de Lisboa e Vale do Tejo. Os dados foram obtidos através de um questionário auto-preenchido. Os dados mostraram que a população de enfermeiros é jovem (M= 30,5: dp= 8,0), 49% têm uma idade £ 26 anos e apresenta pouca experiência profissional (M=7,7; dp= 7,6), 48,2% exerce a profissão há menos de 3 anos. A antiguidade no serviço actual é reduzida (M= 4,7; dp= 4,6), 48,9% estão no serviço há menos de 2 anos. Os enfermeiros acreditam que deviam intervir com mais frequência nos factores de risco fisiológicos e comportamentais que nos factores psicossociais e ambientais; a confiança que têm nas capacidades para intervir nos factores de risco fisiológicos e comportamentais é maior que nos factores psicossociais e ambientais e no último ano, intervieram mais frequentemente nos factores de risco fisiológicos e comportamentais que nos psicossociais e ambientais. O “ensaio” da validação da escala de Will scale de Anderson et al (2004), sobre a capacidade de intervenção na saúde cardíaca, mostrou que o teste de Esfericidade de Bartlett e Medida de adequação da amostragem de Kaiser-Meyer- Olkin (KMO) permitiram a realização da análise factorial em componentes principais (AFCP). Da AFCP emergiram 16 factores, os mesmos que no estudo original de Anderson et al (2004), que revelaram boa consistência interna, com valores de alpha de Cronbach que variaram entre 0,71 a 0,98. Os resultados revelam a necessidade de sensibilizar os enfermeiros para valorizar a intervenção no âmbito dos factores de risco psicossociais e ambientais para promover a adesão ao regime terapêutico. Sugerem ainda que a intervenção baseada na evidência pode ser potenciada de forma a melhorar as práticas de cuidados dos enfermeiros. ABSTRACT: Myocardial infarction (MI) is one of the most important problems in public health in Portugal. A prompt intervention in cardiac health determinants means a positive impact in health outcomes, individually and collectively. The main purpose of this intervention lays on patient’s empowerment so he or she becomes able to choose healthy behaviours, based on heart health protective life styles, and therefore to manage his/hers therapeutic regime. This search and acquisition of health behaviours leading to therapeutic regime adherence may positively have an influence on the whole rehabilitation process and it must be developed in partnership with health workers. MI patients’ first contact with the Health System usually happens at the Hospital. Here the first steps are taken to start an intervention in order to promote therapeutic regime adherence. Nurses are a group of health workers who establish a unique and continuous relation with patients, so it matters to have knowledge of their performance skills that can actually promote a healthy behaviours and increase therapeutic regime adherence. Short Study design The study sample includes 143 nurses working on 9 different hospital wards, belonging to the Lisboa and Tejo’s Valley Health Region, in the district of Lisbon. Data were collected trough a self-administered questionnaire. It revealed that the nurses sample is a young population (M=30,5; dp=8,0), 49% of whom are aged less than 26 years old and has little professional experience (M=7,7; dp= 7,6); 48,2% work has nurses for less than 3 years. There’s a low percentage of seniority (M=4,7; dp=4,6), 48,9% of nurses work in these wards for less than 2 years. Nurses believe they should have intervene more frequently in physiological and behaviour risk factors than in psychological, social and environmental factors; they have greater confidence in their ability to intervene in physiological and behaviour risk factors than to intervene in psychological, social and environmental factors. In last year they took interventions more frequently in physiological and behaviour risk factors than in the other health determinants. The Scale Validation “essay” on Will Scale (Anderson et al, 2004), about heart health intervention capacity, revealed that the Bartlett’s test sphericity and the Kaiser-Meyer- Olkin’s (KMO) appropriate sample measure allowed the factorial analysis on main components (FAMC). From FAMC emerged 16 factors, the same number found on Anderson’s et al (2004) study, revealing good internal consistence, with Cronbach’s alpha values that varied between 0,71 and 0,98. The results point a need for nurses to attribute bigger value to other health determinants intervention - such as psychological, social and environmental determinants - so they’ll take part in promoting therapeutic regime adherence. The results also suggest t

Cochineal, a precious source of red: cochineal dyes characterization by high performance liquid chromatography with diode array detection and principal component analysis

Presented at Faculdade de Ciências e Tecnologias, Universidade de Lisboa, to obtain the Master Degree in Conservation and Restoration of Textiles

Stability of the Transthyretin Molecule as a Key Factor in

Transthyretin (TTR) protects against A-Beta toxicity by binding the peptide thus inhibiting its aggregation. Previous work showed different TTR mutations interact differently with A-Beta, with increasing affinities correlating with decreasing amyloidogenecity of the TTR mutant; this did not impact on the levels of inhibition of A-Beta aggregation, as assessed by transmission electron microscopy. Our work aimed at probing differences in binding to A-Beta by WT, T119M and L55P TTR using quantitative assays, and at identifying factors affecting this interaction. We addressed the impact of such factors in TTR ability to degrade A-Beta. Using a dot blot approach with the anti-oligomeric antibody A11, we showed that A-Beta formed oligomers transiently, indicating aggregation and fibril formation, whereas in the presence of WT and T119M TTR the oligomers persisted longer, indicative that these variants avoided further aggregation into fibrils. In contrast, L55PTTR was not able to inhibit oligomerization or to prevent evolution to aggregates and fibrils. Furthermore, apoptosis assessment showed WT and T119M TTR were able to protect against A-Beta toxicity. Because the amyloidogenic potential of TTR is inversely correlated with its stability, the use of drugs able to stabilize TTR tetrameric fold could result in increased TTR/ABeta binding. Here we showed that iododiflunisal, 3-dinitrophenol, resveratrol, [2-(3,5-dichlorophenyl)amino] (DCPA) and [4- (3,5-difluorophenyl)] (DFPB) were able to increase TTR binding to A-Beta; however only DCPA and DFPB improved TTR proteolytic activity. Thyroxine, a TTR ligand, did not influence TTR/A-Beta interaction and A-Beta degradation by TTR, whereas RBP, another TTR ligand, not only obstructed the interaction but also inhibited TTR proteolytic activity. Our results showed differences between WT and T119M TTR, and L55PTTR mutant regarding their interaction with A-Beta and prompt the stability of TTR as a key factor in this interaction, which may be relevant in AD pathogenesis and for the design of therapeutic TTR-based therapies.

PARACOCCIDIOIDOMYCOSIS AND AIDS: REPORT OF THE FIRST TWO COLOMBIAN CASES

The records of the first two Colombian patients with AIDS and paracoccidioidomycosis are presented. Both patients were males and had no known risk factors for HIV although in the past they had worked in the field where they could have been infected with the fungus. They exhibited the juvenile type of disease with multiple organ system involvement and symptoms of short duration. They were deeply immunodepressed as indicated by less than 100 CD4 T lymphocytes per mL; however, serologic tests revealed circulating anti-Paracoccidioides brasiliensis antibodies and in one patient the first diagnostic clue came from such tests. In one case, the mycosis preceded the AIDS diagnosis while in the other, both pathologies were discovered simultaneously. Antimycotic therapy with itraconazole was administered for over 10 months, with an initial dose of 200 mg/day followed by 100 mg/day; marked improvement of the mycotic signs and symptoms was soon noticed an there have been no signs of relapse. The patients´ improvement was also due to the combined retroviral treatment that was instituted. In spite of the rarity of the AIDS-paracoccidioidomycosis association, physicians practicing in endemic areas should consider the presence of the mycosis in immunosuppressed patients, since a prompt diagnosis and institution of combined antimycotic-anti-retroviral treatments would result in patient improvement and survival. It appears possible that the longer survival time of today's AIDS patients would give the quiescent fungus the opportunity to revive, multiply and cause overt disease.