Números racionais não negativos - tarefas para o 5.º ano

Este livro contém um conjunto de tarefas matemáticas, e a sua exploração, para apoio ao novo programa de Matemática do ensino básico.Direcção Geral de Inovação e Desenvolvimento Curricular - Ministério da Educaçã

Atas do XXVIII Seminário de Investigação em Educação Matemática

Em 2017, realiza-se em Viseu, pela terceira vez, o Seminário de Investigação em Educação Matemática (SIEM), dinamizado pelo Grupo de Trabalho de Investigação (GTI) da Associação de Professores de Matemática (APM). Estes seminários aconteceram em 1992 e em 2002. Em 1992 realizou-se na Escola Superior de Educação de Viseu o III SIEM. Foi neste seminário que surgiu, de forma mais visível, o Grupo de Trabalho de Investigação, com a aprovação dos seus objetivos e linhas orientadoras. A ideia de constituir, no seio da Associação de Professores de Matemática, um grupo de trabalho dedicado à Investigação em Educação Matemática vinha de trás, do Encontro de Professores de Matemática (ProfMat) de 1989, em Viana do Castelo, por iniciativa de João Pedro da Ponte. Em 1992, Viseu sucedia, assim, ao SIEM das Caldas da Rainha, em 1990, e ao SIEM do Porto, no ano seguinte. A revista Quadrante, publicada pelo GTI, tem tantos anos quantos decorreram desde esse primeiro SIEM em Viseu, 25 anos. Pode dizer-se que a Quadrante nasceu em Viseu, na medida em que no seu número inaugural, que saiu nesse ano de 1992, publicou textos baseados em comunicações realizadas no III SIEM.info:eu-repo/semantics/publishedVersio

Factors associated with clinical, immunological and virological responses in protease-inhibitor-experienced brazilian children receiving highly active antiretroviral therapy containing Lopinavir-Ritonavir

This study evaluates clinical, virological and immunological responses to antiretroviral (ARV) therapy based on Lopinavir/ritonovir (LPV/r) in previously protease -inhibitor-experienced children. The study included 29 Brazilian children (median age = 5.91 years) who had failed previous ARV therapy and had begun a regimen based on LPV/r. At 12 months follow-up, a good virological response to LPV/r therapy was defined as achieving an undetectable viral load or as a decrease in plasma HIV RNA levels to > 1 log. A good immunological response was defined as an increase in CD4+ cell count from baseline sufficient to attain a better CDC immune stage classification. The number of infectious episodes 12 months before and 12 months after beginning LPV/r was assessed. Sixteen (55.2%) and 19 (65.5%) of 29 patients exhibited good virological and immunological responses, respectively. Baseline CD4+ values (>500) predicted both virological and immunological responses (p<0.05). Older children were less likely to develop an immunological response (p<0.001) than younger children. Nine children receiving 3 ARV drugs plus LPV/r showed an immunological response (100%) compared to 10/20 (50%) children receiving 2 drugs plus LPV/r (p=0.01). A lower number (n<5) of infectious episodes was noted after 12 months follow-up in children using the LPV/r regimen (p=0.006). There was a positive correlation between children whose baseline CD4+ values were greater than 500 cells/mm³ and virological responses. Although virological responses to therapy were seen in about half the children (55.2%), the use of HAART containing LPV/r provided clinical and immmunological benefits.Federal University of São PauloSão Paulo University Faculty of Public HealthUSP FM Institute of Tropical MedicineUNIFESP, EPMSciEL

Patient-physician discordance in assessment of adherence to inhaled controller medication: a cross-sectional analysis of two cohorts

We aimed to compare patient's and physician's ratings of inhaled medication adherence and to identify predictors of patient-physician discordance.(SFRH/BPD/115169/2016) funded by Fundação para a Ciência e Tecnologia (FCT); ERDF (European Regional Development Fund) through the operations: POCI-01-0145-FEDER-029130 ('mINSPIRERS—mHealth to measure and improve adherence to medication in chronic obstructive respiratory diseases—generalisation and evaluation of gamification, peer support and advanced image processing technologies') cofunded by the COMPETE2020 (Programa Operacional Competitividade e Internacionalização), Portugal 2020 and by Portuguese Funds through FCT (Fundação para a Ciência e a Tecnologia).info:eu-repo/semantics/publishedVersio

Depressão em idosos: fatores associados e manejo terapêutico / Depression in the elderly: associated factors and therapeutic management

A depressão é um problema de saúde pública que afeta cerca de 154 milhões de pessoas em todo o mundo, com incidência crescente nos últimos anos. Diante dessa problemática, os idosos apresentam uma prevalência de 15% de sintomas de depressão, o que requer cuidados e intervenções preventivas. O objetivo deste artigo foi compreender o perfil da depressão em idosos, assim como o processo de prevenção e tratamento de sinais e sintomas. A metodologia utilizada foi o estudo bibliográfico, que se refere a um estudo integrativo desenvolvido a partir de materiais publicados em revistas cientificas, livros, manuais, boletins e sites oficiais de especialidades médicas. Os resultados mostraram idosos afetados por depressão, tipos de tratamento, dados sobre acesso a cuidados de saúde e coexistência de comorbidades. O estudo também destacou a importância de promover o autocuidado, ativando e engajando esse público e seus e familiares nas atividades educativas, além da valorização da educação profissional em saúde e ampliação da rede de cuidado a esses usuários. Concluiu-se que os profissionais de saúde que lidam com idosos devem estar atentos aos sinais e sintomas da depressão, além de realizar treinamento constante para fornecer uma assistência eficiente e eficaz, bem como indicar as melhores opções terapêuticas disponíveis

Dermatomiosite juvenil, manifestações clínicas e condutas médicas: relato de caso / Juvenile dermatomyositis, clinical manifestations and medical management: case report

O presente artigo visou relatar o caso clínico de uma paciente, sabidamente portadora do anticorpo anti-Ro e de alterações enzimáticas musculares, que foi encaminhada por uma Unidade de Pronto Atendimento (UPA) a um hospital público devido à refratariedade à terapêutica instituída na unidade. Posteriormente, procedeu-se a internação desta em enfermaria de reumatologia. Trata-se, portanto, de um estudo descritivo, do tipo relato de caso, que visou discorrer sobre as principais observações constatadas durante a permanência da paciente no centro terciário de atenção à saúde. Para tanto, foram analisados os documentos sobre suas evoluções diárias, bem como os resultados de exames laboratoriais e de imagens realizados por ela. A paciente evoluiu com características clínicas típicas e, por vezes, patognomônicas de dermatomiosite juvenil (DMJ), como fraqueza muscular proximal e simétrica, heliotrópio, pápulas de Gottron, sinal do “V” do decote e vasculites, além de intercorrências como manifestações gastrointestinais. A abordagem farmacológica, ajustada às alterações diárias em seu quadro clínico, permitiram melhor prognóstico e estabilização da agudização da doença. 

Identification of clusters of asthma control: A preliminary analysis of the inspirers studies

This work was funded by ERDF (European Regional Development Fund) through the operations: POCI- -01-0145-FEDER-029130 (“mINSPIRERS—mHealth to measure and improve adherence to medication in chronic obstructive respiratory diseases - generalisation and evaluation of gamification, peer support and advanced image processing technologies”) co-funded by the COMPETE2020 (Programa Operacional Competitividade e Internacionalização), Portugal 2020 and by Portuguese Funds through FCT (Fundação para a Ciência e a Tecnologia).© 2020, Sociedade Portuguesa de Alergologia e Imunologia Clinica. All rights reserved. Aims: To identify distinct asthma control clusters based on Control of Allergic Rhinitis and Asthma Test (CARAT) and to compare patients’ characteristics among these clusters. Methods: Adults and adolescents (≥13 years) with persistent asthma were recruited at 29 Portuguese hospital outpatient clinics, in the context of two observational studies of the INSPIRERS project. Demographic and clinical characteristics, adherence to inhaled medication, beliefs about inhaled medication, anxiety and depression, quality of life, and asthma control (CARAT, >24 good control) were collected. Hierarchical cluster analysis was performed using CARAT total score (CARAT-T). Results: 410 patients (68% adults), with a median (percentile 25–percentile 75) age of 28 (16-46) years, were analysed. Three clusters were identified [mean CARAT-T (min-max)]: cluster 1 [27(24-30)], cluster 2 [19(14-23)] and cluster 3 [10(2-13)]. Patients in cluster 1 (34%) were characterised by better asthma control, better quality of life, higher inhaler adherence and use of a single inhaler. Patients in clusters 2 (50%) and 3 (16%) had uncontrolled asthma, lower inhaler adherence, more symptoms of anxiety and depression and more than half had at least one exacerbation in the previous year. Further-more, patients in cluster 3 were predominantly female, had more unscheduled medical visits and more anxiety symp-toms, perceived a higher necessity of their prescribed inhalers but also higher levels of concern about taking these inhalers. There were no differences in age, body mass index, lung function, smoking status, hospital admissions or specialist physician follow-up time among the three clusters. Conclusion: An unsupervised method based on CARAT--T, identified 3 clusters of patients with distinct, clinically meaningful characteristics. The cluster with better asthma control had a cut-off similar to the established in the validation study of CARAT and an additional cut-off seems to distinguish more severe disease. Further research is necessary to validate the asthma control clusters identified.publishersversionpublishe

In vivo antileishmanial efficacy of a naphthoquinone derivate incorporated into a Pluronic? F127-based polymeric micelle system against Leishmania amazonensis infection.

New therapeutic strategies against leishmaniasis are desirable, since the treatment against disease presents problems, such as the toxicity, high cost and/or parasite resistance. As consequence, new antileishmanial compounds are necessary to be identified, as presenting high activity against Leishmania parasites, but low toxicity in mammalian hosts. Flau-A is a naphthoquinone derivative recently showed to presents an in vitro effective action against Leishmania amazonensis and L. infantum species. In the present work, the in vivo efficacy of Flau-A, which was incorporated into a Poloxamer 407-based micelle system, was evaluated in a murine model against L. amazonensis infection. Amphotericin B (AmB) and Ambisome? were used as controls. The animals were infected and later treated with the compounds. Thirty days after the treatment, parasitological and immunological parameters were evaluated. Results showed that AmB, Ambisome? , Flau-A or Flau-A/M-treated animals presented significantly lower average lesion diameter and parasite burden in tissue and organs evaluated, when compared to the control (saline and micelle) groups. Flau-A or Flau-A/M-treated mice were those presenting the most significant reductions in the parasite burden, when compared to the others. These animals developed also a more polarized antileishmanial Th1 immune response, which was based on significantly higher levels of IFN-?, IL-12, TNF-?, GM-CSF, and parasite-specific IgG2a isotype; associated with low levels of IL-4, IL10, and IgG1 antibody. The absence of toxicity was found in these animals, although mice receiving AmB have showed high levels of renal and hepatic damage markers. In conclusion, results suggested that the Flau-A/M compound may be considered as a possible therapeutic target to be evaluated against human leishmaniasis

Genomic Surveillance of Yellow Fever Virus Epizootic in São Paulo, Brazil, 2016 – 2018

São Paulo, a densely inhabited state in southeast Brazil that contains the fourth most populated city in the world, recently experienced its largest yellow fever virus (YFV) outbreak in decades. YFV does not normally circulate extensively in São Paulo, so most people were unvaccinated when the outbreak began. Surveillance in non-human primates (NHPs) is important for determining the magnitude and geographic extent of an epizootic, thereby helping to evaluate the risk of YFV spillover to humans. Data from infected NHPs can give more accurate insights into YFV spread than when using data from human cases alone. To contextualise human cases, identify epizootic foci and uncover the rate and direction of YFV spread in São Paulo, we generated and analysed virus genomic data and epizootic case data from NHPs in São Paulo. We report the occurrence of three spatiotemporally distinct phases of the outbreak in São Paulo prior to February 2018. We generated 51 new virus genomes from YFV positive cases identified in 23 different municipalities in São Paulo, mostly sampled from NHPs between October 2016 and January 2018. Although we observe substantial heterogeneity in lineage dispersal velocities between phylogenetic branches, continuous phylogeographic analyses of generated YFV genomes suggest that YFV lineages spread in São Paulo at a mean rate of approximately 1km per day during all phases of the outbreak. Viral lineages from the first epizootic phase in northern São Paulo subsequently dispersed towards the south of the state to cause the second and third epizootic phases there. This alters our understanding of how YFV was introduced into the densely populated south of São Paulo state. Our results shed light on the sylvatic transmission of YFV in highly fragmented forested regions in São Paulo state and highlight the importance of continued surveillance of zoonotic pathogens in sentinel species