Doença Meningocócica Invasiva: Aplicação do Base Excess and Platelets Score numa Unidade de Cuidados Intensivos Pediátricos Portuguesa

INTRODUCTION: Meningococcal infection has a high mortality and morbidity. Recently a new prognostic scoring system was developed for paediatric invasive meningococcal disease, based on platelet count and base excess â base excess and platelets score. The main objective of this study was to evaluate the accuracy of base excess and platelets score to predict mortality in children admitted to intensive care due to invasive meningococcal disease. MATERIAL AND METHODS: Observational study, with retrospective data collection, during a 13.5 years period (01/2000 to 06/2013). Mortality by invasive meningococcal disease and related factors (organ dysfunction and multi-organ failure) were analysed. The base excess and platelets score was calculated retrospectively, to evaluate its accuracy in predicting mortality and compared with Paediatric Risk of Mortality and Paediatric Index of Mortality2. RESULTS: Were admitted 76 children with invasive meningococcal disease. The most frequent type of dysfunction was cardiovascular (92%), followed by hematologic (55%). Of the total, 47 patients (62%) had criteria for multi-organ failure. The global mortality was 16%. Neurologic and renal dysfunction showed the strongest association with mortality, adjusted odds ratio 315 (26 - 3 804) and 155 (20 - 1 299). After application of receiver operating characteristic curves, Base Excess and Platelets score had an area under curve of 0.81, Paediatric Index of Mortality2 of 0.91 and Paediatric Risk of Mortality of 0.96. DISCUSSION: The Base Excess and Platelets score showed good accuracy, although not as high as Paediatric Risk of Mortality or Paediatric Index of Mortality 2. CONCLUSIONS: The Base Excess and Platelets score may be useful tool in invasive meningococcal disease because is highly sensitive and specific and is objectively measurable and readily available at presentation

MILIARY TUBERCULOSIS IN THE XXI CENTURY – A CASE REPORT

Introdução: Atualmente, a tuberculose ainda representa um sério problema de saúde pública. A idade precoce e a infeção VIH constituem importantes fatores de risco para doença grave ou disseminada. Caso clínico: Apresentamos o caso de uma menina de três anos de idade observada por febre prolongada sem foco infecioso evidente ao exame físico. O estudo analítico inicial foi sugestivo de infeção urinária, pelo que iniciou antibioticoterapia empírica. A urocultura confirmou esse diagnóstico, mas a febre persistiu. Na investigação complementar, a radiografia torácica revelou um infiltrado pulmonar com padrão miliar. O Mycobacterium tuberculosis foi isolado no aspirado gástrico, líquor e urina. Iniciou tratamento com antituberculosos e corticóide, com melhoria clínica significativa. Conclusões: Nesta era de tecnologia médica avançada, a tuberculose ainda é um desafio diagnóstico, especialmente quando a apresentação clínica é atípica e extrapulmonar. Um elevado índice de suspeição clínica é fundamental, pois a instituição precoce do tratamento é decisiva para o prognóstico

Thermodynamics of adiabatic feedback control

We study adaptive control of classical ergodic Hamiltonian systems, where the controlling parameter varies slowly in time and is influenced by system's state (feedback). An effective adiabatic description is obtained for slow variables of the system. A general limit on the feedback induced negative entropy production is uncovered. It relates the quickest negentropy production to fluctuations of the control Hamiltonian. The method deals efficiently with the entropy-information trade off.Comment: 6 pages, 1 figur

Tyrosine and phenylalanine supplementation on Diplodus sargus larvae: effect on growth and quality

27 páginas, 3 figuras, 5 tablas. The definitive version is available at www.blackwell-synergy.comPhenylalanine is the precursor of tyrosine, which is involved in the synthesis of several molecules with key roles in the regulation of metabolism and growth, stress response and pigmentation. In this study, three experimental diets were tested: an amino acid (AA) balanced diet supplemented with phenylalanine, another supplemented with phenylalanine and tyrosine and a non-supplemented AA balanced diet. Rotifers were enriched with liposomes encapsulating free AA in order to obtain a balanced AA profile. The experimental diets resulted in similar larval survival, growth, enzyme activities of AA catabolism and nitrogen excretion in all treatments. High levels of skeletal deformities were registered and significant differences were found between the control and the phenylalanine treatment for the percentage of vertebral compressions in the trunk region of the vertebral column (30% in the control and 5% in the phenylalanine group). A significantly higher survival to a temperature stress test was found for larvae fed the diet supplemented with phenylalanine and tyrosine. The results suggest that supplementation of phenylalanine/tyrosine in fish diets may be useful in order to reduce skeletal deformities and mortalities caused by stress. The present study confirms that AA requirements may be sufficient for covering growth and survival but insufficient to cover other metabolic processes.This work was supported by the project POCI/MAR/61623/2004 – SAARGO, financed by the programme POCI 2010 (FCT, Portugal), which is co-financed by FEDER. FEDER and PN Project AGL2004-06669-C02-01 (Ministry of Education and Science, Spain) are co-financed by FEDER and project –‘Tecnologias de Produção Aquícola’– (22-05-01-FBR-00014 – QCA IIII).Peer reviewe

Euclid space mission: a cosmological challenge for the next 15 years

Euclid is the next ESA mission devoted to cosmology. It aims at observing most of the extragalactic sky, studying both gravitational lensing and clustering over $\sim$15,000 square degrees. The mission is expected to be launched in year 2020 and to last six years. The sheer amount of data of different kinds, the variety of (un)known systematic effects and the complexity of measures require efforts both in sophisticated simulations and techniques of data analysis. We review the mission main characteristics, some aspects of the the survey and highlight some of the areas of interest to this meetingComment: to appear in Proceedings IAU Symposium No. 306, 2014, "Statistical Challenges in 21st Century Cosmology", A.F. Heavens, J.-L. Starck & A. Krone-Martins, ed

Improving resource efficiency and minimize environmental footprint: a case study preliminary results

Panasqueira Mine (Portugal) has been mainly exploited for wolframite, cassiterite and chalcopyrite (W, Sn, Cu). Through the detailed and careful characterization of tailings with different mineralogy, new invaluable insights into the weathering characteristics of many different minerals will be received, making possible proper risk assessments, and predict which type of tailings might pose severe future environmental risk namely to the Zêzere river. The Zêzere River is an important river and is under the Cabeço do Pião tailings influence. The knowledge and methods acquired will lead to a conceptual model working as guidance to a more sustainable mining in the hereafter.This work of the project Remine was funded with public national funds from FCT under the programme for International Cooperation ERA-NET, supported by ERA-MIN (2011-2015) funded under the EU 7th Framework Programme FP7-NMP having also for partners the Technical University of Luleå (Sweden) and the National Institute for Metals and Radioactive Resources (INCDMRR), Romania.info:eu-repo/semantics/publishedVersio

Long-term survey of sea turtles (Caretta caretta) reveals correlations between parasite infection, feeding ecology, reproductive success and population dynamics.

Long-term monitoring of host-parasite interactions is important for understanding the consequences of infection on host fitness and population dynamics. In an eight-year survey of the loggerhead sea turtle (Caretta caretta) population nesting in Cabo Verde, we determined the spatiotemporal variation of Ozobranchus margoi, a sanguivorous leech best known as a vector for sea turtle fibropapilloma virus. We quantified O. margoi association with turtles' δ15N and δ13C stable isotopes to identify where infection occurs. We then measured the influence of infection on reproduction and offspring fitness. We found that parasite prevalence has increased from 10% of the population in 2010, to 33% in 2017. Stable isotope analysis of host skin samples suggests transmission occurs within the host's feeding grounds. Interestingly, we found a significant interaction between individual size and infection on the reproductive success of turtles. Specifically, small, infected females produced fewer offspring of poorer condition, while in contrast, large, infected turtles produced greater clutch sizes and larger offspring. We interpret this interaction as evidence, upon infection, for a size-dependent shift in reproductive strategy from bet hedging to terminal investment, altering population dynamics. This link between infection and reproduction underscores the importance of using long-term monitoring to quantify the impact of disease dynamics over time

A multicenter validation of an endoscopic classification with narrow band imaging for gastric precancerous and cancerous lesions

BACKGROUND AND STUDY AIM: The reliability and external validity of narrow band imaging (NBI) in the stomach have not been described consistently. The aim of the current study was to describe and estimate the accuracy and reliability of a simplified classification system for NBI in the diagnosis of gastric lesions. METHODS: Consecutive patients undergoing NBI endoscopy at two reference centers (n=85, 33% with dysplasia) were included in two studies. In total, 224 different areas were biopsied and recorded onto video. In the derivation study, previously described NBI features were analyzed in order to develop a simplified classification. In the validation study the accuracy and reliability of this classification were estimated among three groups of endoscopists with different levels of expertise in NBI. .RESULTS: The reliability/accuracy results from the derivation study allowed the creation of a simplified NBI classification. In the validation study, "regular vessels with circular mucosa" (pattern A) was associated with normal histology (accuracy 83%; 95% confidence interval [CI] 75?%-90%); "tubulo-villous mucosa" (pattern B) was associated with intestinal metaplasia (accuracy 84%; 95CI 77%-91%; positive likelihood ratio [LR+]=4.75); and "irregular vessels and mucosa" (pattern C) was associated with dysplasia (accuracy 95%; 95CI 90%-99%; LR+=44.33). The reproducibility of these patterns was high (k=0.62). "Light-blue crest" was moderately reliable (k=0.49) but specific (87%) for intestinal metaplasia. A variable vascular density (additional pattern+) was the best feature for Helicobacter pylori gastritis (accuracy 70%; 95CI 59%-80%) but showed only fair reliability (k=0.38). Non-experienced endoscopists presented lower agreement (k=0.6 vs. k=0.75) and accuracy (74% vs. 86%) than international experts/experienced endoscopists. CONCLUSION: A simplified NBI classification is accurate and reliable for the diagnosis of intestinal metaplasia and dysplasia. The classification should be further assessed and validated on a per-patient assessment of NBI, and by comparing NBI with other imaging technologies.This study was supported by a grant for medical investigation from the Portuguese Digestive Endoscopy Society (SPED 2009 Investigation Grant)

Distribution of genetic diversity reveals colonization patterns and philopatry of the loggerhead sea turtles across geographic scales.

Understanding the processes that underlie the current distribution of genetic diversity in endangered species is a goal of modern conservation biology. Specifically, the role of colonization and dispersal events throughout a species' evolutionary history often remains elusive. The loggerhead sea turtle (Caretta caretta) faces multiple conservation challenges due to its migratory nature and philopatric behaviour. Here, using 4207 mtDNA sequences, we analysed the colonisation patterns and distribution of genetic diversity within a major ocean basin (the Atlantic), a regional rookery (Cabo Verde Archipelago) and a local island (Island of Boa Vista, Cabo Verde). Data analysis using hypothesis-driven population genetic models suggests the colonization of the Atlantic has occurred in two distinct waves, each corresponding to a major mtDNA lineage. We propose the oldest lineage entered the basin via the isthmus of Panama and sequentially established aggregations in Brazil, Cabo Verde and in the area of USA and Mexico. The second lineage entered the Atlantic via the Cape of Good Hope, establishing colonies in the Mediterranean Sea, and from then on, re-colonized the already existing rookeries of the Atlantic. At the Cabo Verde level, we reveal an asymmetric gene flow maintaining links across island-specific nesting groups, despite significant genetic structure. This structure stems from female philopatric behaviours, which could further be detected by weak but significant differentiation amongst beaches separated by only a few kilometres on the island of Boa Vista. Exploring biogeographic processes at diverse geographic scales improves our understanding of the complex evolutionary history of highly migratory philopatric species. Unveiling the past facilitates the design of conservation programmes targeting the right management scale to maintain a species' evolutionary potential

Livestock monitoring prototype implementation and validation

Abstract: This paper presents the proposal, implementation and validation of a low cost fault-tolerant functional prototype for livestock monitoring. This prototype uses IoT devices, ESP8266 and ESP32, creating a mesh network, managed by the painlessMesh library, with WiFi and LoRa technologies. It allows, for instance, the collection of vital signs from animals. In comparison with the traditional method of livestock examination, this cost-efficient approach reduces manual labor and saves working time. It also improves animal health, increases profits and decreases the environmental footprint.info:eu-repo/semantics/publishedVersio