Fisiopatologia da emese - proposta de construção de um objecto de aprendizagem

Introdução: Os Objetos de Aprendizagem (OA) têm sido alvo de discussão devido ao seu interesse pedagógico nomeadamente nas ciências da saúde, pois permite uma dimensão maior em relação à educação e ao acesso a informação credível, certificada e interativa à distancia. Os OA podem tem como base de estudo, um caso clinico, um jogo ou até mesmo servir de apoio a outras actividades, que levem o estudante a interagir com outras ferramentas aumentando assim a sua capacidade de síntese, planeamento e critica. Com este trabalho pretende-se traçar os passos iniciais necessários para o desenvolvimento do OA. Métodos: O trabalho iniciou-se com uma revisão bibliográfica sobre a fisiopatologia e tratamento emese sustentados em manuais de referência, artigos científicos e guidelines de forma a estabelecer uma base teórica. Para a construção do OA seguiu-se a proposta de Jesus, Gomes e Cruz (2012). Apresentação de Resultados e Discussão: Obteve-se um referencial teórico baseado na evidência que caracteriza 4 tipos de emese: associada ao movimento; associada à gravidez; associada a medicamentos antineoplásicos e a contexto pós-operatório. O desenvolvimento do OA, foi constituído por fases, ou seja, fase de análise que teve em consideração o contexto em que se processa a instrução, as características gerais dos estudantes, as necessidades de instrução, e-conteúdos e informação base para a construção do OA. Seguiu-se a fase de desenho instrucional do OA, que utilizou os resultados obtidos na fase anterior para planear e desenvolver as atividades. Esta fase tem em consideração a estrutura hierárquica de sequenciação dos conteúdos, estratégias de instrução e metodologias de avaliação. Finalmente, para a construção do protótipo foi utilizada a ferramenta de autor XERTE. Considerações Finais e Perspectivas Futuras: A construção deste OA representa mais um passo para a investigação alargada para a produção e implementação de OA no ensino da Farmacologia e da Terapêutica. Pretende-se agora que o OA seja sujeito a testes de compatibilidade com diferentes LMS e também seja alvo de um processo de avaliação por profissionais e alunos.

O papel da terapia de suporte no tratamento do cancro

Os enormes avanços que ocorreram no tratamento de neoplasias nos últimos anos, pelo surgimento de novos fármacos, ao nível da radioterapia ou dos transplantes de medula óssea, fazem-se acompanhar por uma série de efeitos colaterais, que comprometem quase todas as funções orgânicas. A própria neoplasia pode estar na génese destas complicações clinicas. A toxicidade hematológica seja neutropénia, anemia ou trombocitopenia, constitui um efeito grave que necessita de intervenção imediata pelo risco que acarreta para os doentes oncológicos. As náuseas e vómitos são um transtorno frequente da quimioterapia que é particularmente desagradável e assustador para os doentes. A sua severidade pode levar mesmo à interrupção prematura do tratamento. É portanto pertinente prover uma adequada terapia antiemética baseada no potencial emetogénico da quimioterapia, fatores de risco individuais e diferentes fases da emese. A diarreia é uma complicação séria da quimioterapia, que pode surgir em resultado de processos imunológicos, infeciosos ou decorrentes do próprio cancro. Esta deverá ser bem gerida por forma a prevenir desequilíbrios eletrolíticos e desidratação que poderão comprometer o tratamento. A obstipação surge por diversas causas, frequentemente como efeito adverso resultante do controlo da dor com opiáceos. A inflamação das mucosas, ou mucosite, é outra patologia gastrointestinal que pode ser observada em vários locais, podendo ser muito debilitante e reduzir a qualidade de vida dos doentes. É uma das responsabilidades do farmacêutico dar recomendações aos doentes quanto à profilaxia da mucosite e seu tratamento. Ao nível da doença óssea, esta surge frequentemente nalguns tipos de cancro e tratamentos, pelo que a administração de moduladores da formação óssea poderá contribuir para um aumento da sobrevida. A maioria dos doentes com tumores também apresenta dor durante o curso da doença, muitas vezes pela compressão de raízes nervosas. A causa, tipo e a intensidade de dor pode ser diferente. É importante e necessário um diagnóstico e intervenção precoce.Com a presente revisão bibliográfica pretendeu-se compilar a informação relevante existente na literatura científica por forma a compreender melhor o papel do farmacêutico na terapêutica de suporte do cancro e como este profissional poderá contribuir para uma melhor qualidade de vida do doente oncológico. Para isso é necessário que este aprofunde os seus conhecimentos ao nível da fisiopatologia, prevenção e tratamento dos frequentes efeitos colaterais.

Futures basis, inventory and commodity price volatility: an empirical analysis

We employ a large dataset of physical inventory data on 21 different commodities for the period 1993–2011 to empirically analyze the behavior of commodity prices and their volatility as predicted by the theory of storage. We examine two main issues. First, we analyze the relationship between inventory and the shape of the forward curve. Low (high) inventory is associated with forward curves in backwardation (contango), as the theory of storage predicts. Second, we show that price volatility is a decreasing function of inventory for the majority of commodities in our sample. This effect is more pronounced in backwardated markets. Our findings are robust with respect to alternative inventory measures and over the recent commodity price boom.

Forecasting VaR using analytic higher moments for GARCH processes

It is widely accepted that some of the most accurate Value-at-Risk (VaR) estimates are based on an appropriately specified GARCH process. But when the forecast horizon is greater than the frequency of the GARCH model, such predictions have typically required time-consuming simulations of the aggregated returns distributions. This paper shows that fast, quasi-analytic GARCH VaR calculations can be based on new formulae for the first four moments of aggregated GARCH returns. Our extensive empirical study compares the Cornish–Fisher expansion with the Johnson SU distribution for fitting distributions to analytic moments of normal and Student t, symmetric and asymmetric (GJR) GARCH processes to returns data on different financial assets, for the purpose of deriving accurate GARCH VaR forecasts over multiple horizons and significance levels.

Price discovery of credit spreads in tranquil and crisis periods

In this paper we investigate the price discovery process in single-name credit spreads obtained from bond, credit default swap (CDS), equity and equity option prices. We analyse short term price discovery by modelling daily changes in credit spreads in the four markets with a vector autoregressive model (VAR). We also look at price discovery in the long run with a vector error correction model (VECM). We find that in the short term the option market clearly leads the other markets in the sub-prime crisis (2007-2009). During the less severe sovereign debt crisis (2009-2012) and the pre-crisis period, options are still important but CDSs become more prominent. In the long run, deviations from the equilibrium relationship with the option market still lead to adjustments in the credit spreads observed or implied from other markets. However, options no longer dominate price discovery in any of the periods considered. Our findings have implications for traders, credit risk managers and financial regulators.

Time varying price discovery

We show how multivariate GARCH models can be used to generate a time-varying “information share” (Hasbrouck, 1995) to represent the changing patterns of price discovery in closely related securities. We find that time-varying information shares can improve credit spread predictions.

Toxic acute hepatitis associated to the administration of prostaglandin in a dog

A prostaglandina F2a pode ser usada em caes para aumentar o volume do ejaculado em casos de inseminação artificial, criopreservação seminal ou biotecnologias de reprodução. Os efeitos colaterais após a administração da PGF2a, como taquicardia, salivação, emese, diarréia e convulsões geralmente são relacionadas com a dose utilizada. Esse trabalho objetiva relatar a ocorrência de hepatite tóxica aguda após a administração de PGF2a em um cão, e discutir a importância de se utilizar essa droga com cautela nessa espécie.

Efeito da arnica 6D e 30D administradas por via transmucosa oral e subcutânea no controle da dor pós-operatória de gatas submetidas à ovariossalpingohisterectomia

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

A phase IIa randomized controlled pilot study evaluating the safety and clinical outcomes following the use of rhGDF-5/β-TCP in regenerative periodontal therapy

To present the safety profile, the early healing phase and the clinical outcomes at 24 weeks following treatment of human intrabony defects with open flap debridement (OFD) alone or with OFD and rhGDF-5 adsorbed onto a particulate β-tricalcium phosphate (β-TCP) carrier. Twenty chronic periodontitis patients, each with at least one tooth exhibiting a probing depth ≥6 mm and an associated intrabony defect ≥4 mm entered the study. Ten subjects (one defect/patient) were randomized to receive OFD alone (control) and ten subjects OFD combined with rhGDF-5/β-TCP. Blood samples were collected at screening, and at weeks 2 and 24 to evaluate routine hematology and clinical chemistry, rhGDF-5 plasma levels, and antirhGDF-5 antibody formation. Plaque and gingival indices, bleeding on probing, probing depth, clinical attachment level, and radiographs were recorded pre- and 24 weeks postsurgery. Comparable safety profiles were found in the two treatment groups. Neither antirhGDF-5 antibody formation nor relevant rhGDF-5 plasma levels were detected in any patient. At 6 months, treatment with OFD + rhGDF-5/β-TCP resulted in higher but statistically not significant PD reduction (3.7 ± 1.2 vs. 3.1 ± 1.8 mm; p = 0.26) and CAL gain (3.2 ± 1.7 vs. 1.7 ± 2.2 mm; p = 0.14) compared to OFD alone. In the tested concentration, the use of rhGDF-5/β-TCP appeared to be safe and the material possesses a sound biological rationale. Thus, further adequately powered, randomized controlled clinical trials are warranted to confirm the clinical relevance of this new approach in regenerative periodontal therapy. rhGDF-5/β-TCP may represent a promising new techology in regenerative periodontal therapy.

Non-invasive diagnosis of coronary artery disease using cardiogoniometry performed at rest

PRINCIPLES: Cardiogoniometry is a non-invasive technique for quantitative three-dimensional vectorial analysis of myocardial depolarization and repolarization. We describe a method of surface electrophysiological cardiac assessment using cardiogoniometry performed at rest to detect variables helpful in identifying coronary artery disease. METHODS: Cardiogoniometry was performed in 793 patients prior to diagnostic coronary angiography. Using 13 variables in men and 10 in women, values from 461 patients were retrospectively analyzed to obtain a diagnostic score that would identify patients having coronary artery disease. This score was then prospectively validated on 332 patients. RESULTS: Cardiogoniometry showed a prospective diagnostic sensitivity of 64%, and a specificity of 82%. ECG diagnostic sensitivity was significantly lower, with 53% and a similar specificity of 75%. CONCLUSIONS: Cardiogoniometry is a new, noninvasive, quantitative electrodiagnostic technique which is helpful in identifying patients with coronary artery disease. It can easily be performed at rest and delivers an accurate, automated diagnostic score.

Psychotic symptoms are associated with physical health problems independently of a mental disorder diagnosis:results from the WHO World Health Survey

This study explored whether physical health problems are related to psychotic symptoms independently of a mental disorder diagnosis. A total of 224,254 subjects recruited for the World Health Organization World Health Survey were subdivided into those with both a lifetime diagnosis of psychosis and at least one psychotic symptom in the 12 months prior to the evaluation, those with at least one psychotic symptom in the past 12 months but no lifetime diagnosis of psychosis, and those without psychotic symptoms in the past 12 months and without a lifetime diagnosis of psychosis. The three groups were compared for the presence of medical conditions, health problems, and access to health care. Medical conditions and health problems (angina, asthma, arthritis, tuberculosis, vision or hearing problems, mouth/teeth problems, alcohol consumption, smoking, and accidents), medication consumption, and hospital admissions (but not regular health care visits) were more frequent in individuals with psychotic symptoms but no psychosis diagnosis, compared to those with no symptoms and no diagnosis. The number of medical conditions increased with the number of psychotic symptoms. Given the sample analyzed, this trend seems to be independent from the socio-economic development of the country or the specific health care system.

The continuum of psychotic symptoms in the general population:a cross-national study

OBJECTIVE: To identify the cross-national prevalence of psychotic symptoms in the general population and to analyze their impact on health status. METHOD: The sample was composed of 256,445 subjects (55.9% women), from nationally representative samples of 52 countries worldwide participating in the World Health Organization's World Health Survey. Standardized and weighted prevalence of psychotic symptoms were calculated in addition to the impact on health status as assessed by functioning in multiple domains. RESULTS: Overall prevalences for specific symptoms ranged from 4.80% (SE = 0.14) for delusions of control to 8.37% (SE = 0.20) for delusions of reference and persecution. Prevalence figures varied greatly across countries. All symptoms of psychosis produced a significant decline in health status after controlling for potential confounders. There was a clear change in health impact between subjects not reporting any symptom and those reporting at least one symptom (effect size of 0.55). CONCLUSIONS: The prevalence of the presence of at least one psychotic symptom has a wide range worldwide varying as much as from 0.8% to 31.4%. Psychotic symptoms signal a problem of potential public health concern, independent of the presence of a full diagnosis of psychosis, as they are common and are related to a significant decrement in health status. The presence of at least one psychotic symptom is related to a significant poorer health status, with a regular linear decrement in health depending on the number of symptoms.