Thoracic actinomycosis simulating neoplastic disease in Pediatrics

OBJECTIVE: To describe a pulmonary actinomycosis case in a pediatric patient. CASE DESCRIPTION: A ten-year-old healthy girl was admitted with a history of chest pain for the past three months. During the last two months, she evolved with bulging of the left anterior chest wall. Physical examination showed a mass with 8.0cm diameter in the left inframamilar region, without signs of inflammation. Chest tomography showed an expansion process in the left anterior chest wall. Biopsy and culture of the material identified Actinomyces israelli. She was treated with crystalline penicillin and amoxicillin, leading to the disappearance of the thoracic mass. COMMENTS: Actinomycosis is a rare, indolent and invasive bacterial infection, and is often not considered in children as a cause of chest masses. Early diagnosis is uncommon.OBJETIVO: Descrever um caso de actinomicose pulmonar em paciente pediátrico. DESCRIÇÃO DO CASO: Menina de dez anos, saudável, com história de dor torácica há três meses, evoluindo há dois meses com abaulamento em parede torácica anterior esquerda. Ao exame físico, apresentava massa de 8,0cm de diâmetro em região inframamilar esquerda, sem sinais flogísticos. A tomografia do tórax mostrou processo expansivo em parede torácica anterior esquerda. Realizou-se biópsia e a cultura do material identificou Actinomyces israelli. Foi tratada com penicilina cristalina e amoxicilina, com desaparecimento da massa torácica. COMENTÁRIOS: A actinomicose é uma doença bacteriana rara, indolente, invasiva e, frequentemente, não considerada em crianças como causa provável de massas torácicas, sendo incomum o diagnóstico precoce.OBJETIVO: Describir un caso de actinomicosis pulmonar en paciente pediátrico. DESCRIPCIÓN DEL CASO: Muchacha de diez años, saludable, con historia de dolor torácico hace tres meses, evolucionando, hace dos meses, con abombamiento en pared torácica anterior izquierda. Al examen físico, presentaba masa de 8,0 cm de diámetro en región inframamilar izquierda, sin señales flogísticas. La tomografía del tórax mostró proceso expansivo en pared torácica anterior izquierda. Se realizó biopsia y la cultura del material identificó Actinomyces israelli. Se trató con penicilina cristalina y amoxicilina, con desaparición de la masa torácica. COMENTARIOS: La actinomicosis es una enfermedad bacteriana rara, indolente, invasiva y, frecuentemente, no considerada en niños como causa probable de masas torácicas, siendo poco común el diagnóstico temprano.45045

Impacto da anosognosia relacionada à demência de Alzheimer na qualidade de vida de cuidadores

Dissertação (mestrado)—Universidade de Brasília, Instituto de Psicologia, Departamento de Processos Psicológicos Básicos, Pós-Graduação em Ciências do Comportamento, 2014.A demência de Alzheimer (DA) apresenta como um de seus sintomas a anosognosia, definida como um prejuízo da capacidade de o indivíduo julgar as alterações decorrentes da doença. Esse prejuízo é relacionado a diversos comprometimentos cognitivos e comportamentais e se relaciona a dificuldade na tomada de decisões sobre o tratamento, a adesão ao uso de medicamentos e pode limitar o engajamento a atividades de reabilitação. É apontada como tendo significativo impacto sobre a qualidade de vida dos cuidadores. O presente estudo avaliou o impacto da anosognosia relacionada à DA sobre a qualidade de vida (QV) de cuidadores, utilizando o método da detecção da anosognosia por meio da avaliação da discrepância entre as avaliações de pacientes e cuidadores. Foram avaliados 50 pares paciente-cuidador através do Exame Cognitivo de Addenbrooke, Questionário de Demência Ampliado e Escala de Qualidade de vida na DA (versão do cuidador), sendo observado que cuidadores de pacientes com sinais de anosognosia apresentavam menores escores na avaliação de qualidade de vida (p<0,01) e estes pacientes apresentavam pior quadro cognitivo (p<0,05). Escores de anosognosia e QV apresentaram correlação de -,849 (p<0,01), enquanto QV e quadro cognitivo apresentou correlação de ,613 (p<0,01). Tentando-se controlar o quadro cognitivo, observamos que a anosognosia apresenta maior impacto na QV em indivíduos com quadro cognitivo mais grave, mas esse impacto é observado em todos os grupos. Intervenções que visem diminuir o impacto da anosognosia poderiam influenciar positivamente a qualidade de vida de cuidadores, independente do quadro cognitivo em que o paciente se encontra. ______________________________________________________________________________ ABSTRACTAlzheimer's disease (AD) has anosognosia as one of its symptoms, it is defined as a change in the individual's ability to judge their difficulties. It is related to several cognitive and behavioral impairments and it is linked to difficulty in making decisions regarding treatment, adherence to medication use and can limit rehabilitation activities engagement. It is observed as having a significant impact on quality of life of caregivers. The present study evaluated the impact of anosognosia related to AD in quality of life (QoL) of caregivers, using the detection of anosognosia method of evaluating the discrepancy between assessments of patients and caregivers. 50 patient - caregiver pairs were evaluated through the Addenbrooke's Cognitive Examination, Dementia Questionnaire - expanded and scale of quality of life in AD (caregiver version). It was observed that caregivers of patients with signs of anosognosia had lower scores on the QoL assessment (p < 0.01) and these patients had a worse cognitive potential (p < 0.05). Anosognosia and QoL scores were negatively correlated (-,849, p < 0.01 ) , while QoL and cognitive functioning presented correlation of ,613 ( p < .01 ) . Trying to control the cognitive functioning we observed that anosognosia has greater impact on QoL in individuals with more severe cognitive impairments but this impact appears in all groups. Interventions aimed at reducing the impact of anosognosia could influence the quality of life of caregivers, regardless of cognitive functioning of the patient

Intervenção em alexitimia na Doença de Parkinson e impacto no reconhecimento de emoções faciais

Tese (doutorado)—Universidade de Brasília, Instituto de Psicologia, Departamento de Processos Psicológicos Básicos, Programa de Pós-Graduação em Ciências do Comportamento, 2018.A doença de Parkinson (DP) apresenta entre seus sintomas não motores a alexitimia, caracterizada como a dificuldade na identificação de emoções, distinção de emoções e sensação corporal de excitação emocional, dificuldade na descrição de sentimentos para outras pessoas e redução em processos imaginativos, evidenciada por vida fantasiosa pobre. Apresenta correlação com a dificuldade no reconhecimento de emoções faciais, presença de sintomas depressivos e alterações na expressividade facial decorrente da bradicinesia associada a DP. Este trabalho comparou programas de intervenção para a alexitimia em um grupo de indivíduos com diagnóstico de DP, especificamente se intervenções formuladas considerando características da DP teriam melhores resultados. Foi observada melhora quanto a redução em sintomas depressivos, em ambos os grupos, mas o grupo submetido à intervenção especificamente pensada para os sintomas da DP apresentou significativamente menores escores quanto a alexitimia e reconhecimento de emoções faciais. Os resultados obtidos confirmam a relação entre a alexitimia e o reconhecimento de emoções faciais e justifica o uso de intervenções levando-se em consideração características específicas da doença.Parkinson's disease (PD) has alexithymia as one of its non-motor symptoms, characterized as the difficulty in identifying emotions and distinguishing emotions and bodily sensation of emotional arousal, difficulty describing feelings to other people and reduction in imaginative processes. It correlates with the difficulty in recognizing facial emotions, depressive symptoms and changes in facial expression due to bradykinesia associated with PD. This study compared intervention programs for alexithymia in a group of individuals diagnosed with PD, specifically if designed interventions considering characteristics of PD would have better results. We observed reduction of depressive symptoms in both groups, but the intervention group specifically designed for PD symptoms presented significantly lower scores regarding alexithymia and recognition of facial emotions. The results confirm the relationship between alexithymia and the recognition of facial emotions and justifies the use of interventions considering specific characteristics of the disease

Clouder: a flexible large scale decentralized object store - architecture overview

The current exponential growth of data calls for massive scale capabilities of storage and processing. Such large volumes of data tend to disallow their centralized storage and processing making extensive and flexible data partitioning unavoidable. This is being acknowledged by several major Internet players embracing the Cloud computing model and offering first generation remote storage services with simple processing capabilities. In this position paper we present preliminary ideas for the architecture of a flexible, efficient and dependable fully decentralized object store able to manage very large sets of variable size objects and to coordinate in place processing. Our target are local area large computing facilities composed of tens of thousands of nodes under the same administrative domain. The system should be capable of leveraging massive replication of data to balance read scalability and fault tolerance.(undefined

Maximum drawdown: models and applications

Financial series may possess fractal dimensions which would induce cycles of many different durations. This inherent characteristic would explain the turbulent cascades in stock markets when strong local dependence is observed. A drawdown is defined as the percentual accumulated loss due to a sequence of drops in the price of an investment. It is collected over non-fixed time intervals and its duration is also a random variable. The maximum drawdown occuring during a fixed investment horizon is a flexible measure that may provide a different perception of the risk and price flow of an investment. In this paper we propose statistical models from the extreme value theory for the severity and duration of the maximum drawdown. Our empirical results indicate that there may exist a relation between the pattern of the GARCH volatility of an investment and the fluctuations of the severity of the maximum drawdown and that, typically, extreme (but not outlying) maximum drawdowns occur during stress periods of high volatility. We suggest applications for the maximum drawdown, including the computation of the Maximum Drawdown-at-Risk with exceedance probability α, and the classification of investments according to their performance when controlling losses via the maximum drawdown.Indisponível

Adrenal function in 23 children with paracoccidioidomycosis

Adrenal involvement by Paracoccidioides brasiliensis was described at necropsies and in many clinical studies, but only in adults. Therefore, the aim of this study was to evaluate adrenal function in children with paracoccidioidomycosis. Twenty-three children with the systemic form of paracoccidioidomycosis were evaluated and divided in two Groups: Group A (n = 8) included children before treatment and Group B (n = 15) children after the end of treatment. Plasma cortisol (basal and after ACTH test), ACTH, renin activity, aldosterone, sodium and potassium were measured. They were within normal range in all cases, except for renin activity and aldosterone, which were elevated in some cases. Group A patients showed basal and post-ACTH cortisol levels significantly greater than Group B patients. The results showed that adrenal function was not compromised in these children with paracoccidioidomycosis.O acometimento adrenal pelo Paracoccidioides brasiliensis é descrito em necropsias e em estudos clínicos, mas apenas em adultos. Portanto, o objetivo deste estudo foi avaliar a função adrenal em crianças com paracoccidioidomicose. Vinte e três crianças com forma sistêmica de paracoccidioidomicose foram avaliadas e divididas em dois grupos: Grupo A (n = 8) pacientes antes de iniciar o tratamento e Grupo B (n = 15) pacientes após o termino do tratamento. Dosagens plasmáticas de cortisol (basal e após teste com ACTH), ACTH, atividade de renina, aldosterona, sódio e potássio foram realizadas. Estas dosagens foram normais em todos os casos, com exceção da atividade da renina e da aldosterona que foram elevadas em alguns casos. Os pacientes do Grupo A mostraram valores de cortisol basal e após-ACTH significativamente maiores que os do Grupo B. Os resultados demonstraram que a função adrenal não foi comprometida neste grupo de crianças com paracoccidioidomicose

Using robust portfolios techniques in emerging markets

Financial data are heavy tailed containing some proportion of extreme observations. We propose to use a robust covariance estimator to define the center and orientation of the data. We provide an illustration of the usefulness of the proposed procedure to efficiently allocate among emerging stock markets. We show that the resulting robust portfolios may yield higher cumulative returns and have more stable weights. We strongly recommend that a robust covariance matrix is used to solve emerging stock markets allocation problems. We believe that our technique has a key advantage. Because all we change is the covariance matrix, we can use any commercially available optimizer to obtain robust portfolio weights.Indisponível

A correlation-aware data placement strategy for key-value stores

Key-value stores hold the unprecedented bulk of the data produced by applications such as social networks. Their scalability and availability requirements often outweigh sacri cing richer data and pro- cessing models, and even elementary data consistency. Moreover, existing key-value stores have only random or order based placement strategies. In this paper we exploit arbitrary data relations easily expressed by the application to foster data locality and improve the performance of com- plex queries common in social network read-intensive workloads. We present a novel data placement strategy, supporting dynamic tags, based on multidimensional locality-preserving mappings. We compare our data placement strategy with the ones used in existing key-value stores under the workload of a typical social network appli- cation and show that the proposed correlation-aware data placement strategy o ers a major improvement on the system's overall response time and network requirements

Preparation and characterisation of novel multifuncional chitosan-based membranes to modulate cell-material interactions

Tese de Doutoramento - Ramo de Ciência e Tecnologia de Materiais - Área de BiomateriaisA critical scarcity of donors and the high risk of graft rejection are the two major obstacles to the wide spreading of organ transplantation as an universal therapy for the substitution of organ, which underwent disease caused failure or irreversible accidental damaging. In order to overcome some of the limitations of the current therapies, several regenerative medicine concepts have emerged in the last few decades. One of those concepts, denominated guided bone regeneration (GBR), consists on the use of barrier membranes that prevent the in-growth of connective tissue, which in critical size defects inhibits the formation of new bone through the natural healing process. The first objective of this thesis was to develop biodegradable membranes based on chitosan and soybean protein exhibiting a biphasic structure, which would originate in situ porous formation, through a two step degradation mechanism. This application features some limitations and new approaches were designed seeking to widen the impact that the developed work could have in the regenerative medicine field. The tissue engineering field is likely to be the most paradigmatic example within the several regenerative medicine strategies born in the past decades. However, tissues and organs reconstruction have been often limited by these approaches, since tissue engineered constructs are very sensitive to a range of variables, which correlation is frequently not well understood or easily controllable. In order to overcome some of the limitations imposed by the use of supporting biodegradable materials, a new ingenious approach known as “cell sheet engineering” proved to succeed on recreating in vitro tissues with high therapeutic potential. Despite of the still relatively low number of the papers found in the literature about this issue, “cell sheet engineering” products are already reaching the clinical stage. This technology makes use of culture dishes grafted with thermo-responsive poly(Nisopropylacrylamide) (PNIPAAm) that undergo a transition at the lower critical solution temperature (LCST) from hydrophobic (above that value) to hydrophilic. At the culture temperature, grafted surfaces are slightly hydrophobic and cell adhesion and proliferation proceed as in conventional culture surfaces. Cultured confluent cell sheets spontaneously detach by merely reducing the temperature. In fact, the slightly hydrophobic surfaces are suitable for cell adhesion, while the more hydrated hydrophilic surfaces are not. The method is minimally invasive to the extracellular matrix (ECM), cell-to-cell and cell-to-ECM interactions, in opposition to the conventional enzymatic methods, which are deleterious to important biological structures such as ECM and cell membrane proteins. Despite of the great advances that have been already done on culturing and harvesting cell sheets from varied phenotypes, much less endeavour has been devoted to the creation of multifunctional novel thermo-responsive surfaces. In this thesis, several studies have been performed towards this goal, which are described in detail in Chapters 5, 6 and 7. First, we prepared chitosan membranes and studied the influence of crosslinking these membranes with glutaraldehyde in a range of different properties. We performed measurements of the mechanical properties with the samples immersed in an aqueous environment at 37ºC, in order to simulate physiological and cell culture conditions. Chitosan absorbs high amounts of water in aqueous solutions forming hydrogels. In this kind of systems, the determination of the mechanical properties in dry conditions has no practical meaning. Second, a preliminary cytotoxicity screening was performed in order to check if the materials would be suitable as implantable biomaterials, as well as for cell culture purposes. The tested membranes showed to be suitable for biomedical applications. Third, the transport properties of small molecules have been studied, showing that the membranes possess permeation properties that can be useful for the controlled delivery of bioactive agents, but also in combined strategies of growth and differentiation factors delivery and cell sheet engineering. Finally, PNIPAAm was grafted onto chitosan membranes to render surface with thermoresponsive properties. Those modified membranes showed to be suitable for cell culture, which can reach confluence and be thermally harvested by means of lowering the temperature. Single cell sheets can be layered in order to recreate thicker tissue-like constructs. However, the number of cell sheets that can be kept in culture is limited, because of restrictions on the delivery of nutrients and accumulation of metabolic wastes. It should be noticed that PNIPAAm grafted tissue culture polystyrene (TCPS) substrates commonly used to culture single cell sheets are impermeable. The use of chitosan membranes, which we found to be permeable to small molecules, would increase the mass transfer area for nutrients and metabolic wastes, hopefully supporting the culture of thicker layered cell sheet constructs. Furthermore, fully hydrated chitosan membranes should be easily adaptable to several anatomical shapes, owing to its flexible mechanical properties, facilitating the transfer of either single cell sheets or layered cell sheet constructs directly to the host site with minimal manipulation.O elevado défice de doadores e o risco de rejeição impedem a banalização do transplante de órgãos como abordagem terapêutica. Nas últimas décadas têm sido propostas várias estratégias de investigação no campo da medicina regenerativa para tentar resolver estas limitações. A regeneração guiada de osso (GBR) é uma dessas estratégias e consiste no uso de membranas que proporcionam uma barreira à penetração de tecido conectivo no defeito ósseo, o que em lesões acima de uma determinada dimensão, impede o processo natural de regeneração. O primeiro objectivo desta tese foi desenvolver membranas biodegradáveis para este tipo de aplicações, combinando quitosano com proteína de soja, de forma a obter uma estrutura com duas fases. A diferente taxa de degradação de cada uma dessas fases originaria a formação de poros in situ. Ainda que bastante interessantes, estas aplicações possuem potencialidades de inovação algo limitadas, pelo que, outras estratégias foram implementadas ao longo do trabalho para alargar seu o impacto no campo da medicina regenerativa. A engenharia de tecidos humanos é provavelmente uma das estratégias mais paradigmáticas e representativas das revoluções recentes no campo da medicina regenerativa. Contudo, a reconstrução de tecidos e órgãos é muitas vezes limitada, uma vez que os implantes produzidos por engenharia de tecidos são muito sensíveis a um conjunto de variáveis cuja correlação é frequentemente obscura ou dificilmente controlável. Mais recentemente, uma estratégia inovadora, denominada em inglês “cell sheet engineering”, têm permitido recriar tecidos in vitro com elevado potencial terapêutico, evitando o uso de materiais de suporte biodegradáveis. De facto, embora seja relativamente recente, alguns produtos já foram testados clinicamente com sucesso. Esta tecnologia baseia-se no uso de superfícies modificadas com poli(N-isopropilacrilamida) (PNIPAAm). Este polímero possuí uma temperatura de transição em solução (LCST), conferindo à superfície carácter hidrofóbico acima da LCST e hidrofílico abaixo desse valor. Assim, superfícies modificadas com este polímero têm um carácter hidrofóbico nas condições de cultura celular, permitindo uma correcta adesão e proliferação. No entanto, diminuindo a temperatura abaixo da LCST o carácter da superfície passa a ser hidrofílico, induzindo o destacamento das células. Quando cultivadas até atingirem a confluência, ocorre uma separação espontânea de uma película de células contíguas ou “cell sheet”, conjuntamente com a matriz extracelular entretanto produzida por essas mesmas células. Este método permite a recuperação de estruturas biológicas importantes para o correcto funcionamento dos tecidos, em oposição aos métodos enzimáticos mais convencionais, que são bastante destrutivos. As grandes potencialidades deste método, já demonstradas para células de diversas origens e fenótipos, tornam bastante atractivo o desenvolvimento de superfícies que respondem à temperatura com outras funcionalidades inovadoras. Os diversos estudos desenvolvidos no âmbito desta tese com este objectivo estão detalhados nos capítulos 5, 6 e 7. Em primeiro lugar, prepararam-se membranas de quitosano e estudou-se a influência da reticulação dessas membranas com glutaraldeído em várias propriedades. As propriedades mecânicas destas membranas foram estudadas submergindo as amostras em soluções aquosas a 37ºC, de forma a simular as condições fisiológicas. O quitosano absorve quantidades consideráveis de água, sendo os materiais resultantes hidrogéis. Neste tipo de sistemas, a determinação das propriedades mecânicas com as amostras secas perderia o significado prático. Numa segunda fase foi feita uma avaliação preliminar da citotoxicidade dos materiais, o que demonstrou a sua potencial aplicabilidade como biomateriais e em culturas celulares. No passo seguinte estudaram-se as propriedades de transporte de pequenas moléculas, demonstrando-se que as membranas possuem valores de permeabilidade que podem ser úteis para aplicações de libertação controlada de agentes bioactivos, assim como, em estratégias que combinem a libertação controlada de factores de crescimento e diferenciação com as técnicas de “cell sheet engineering”. Por último, a PNIPAAm foi originalmente imobilizada à superfície das membranas de quitosano, de forma a que a superfície responda a alterações de temperatura. Estas membranas demonstraram ser adequadas para a cultura de células que, uma vez atingida a confluência, puderam ser separadas da superfície apenas reduzindo a temperatura. As “cell sheets” podem ser sobrepostas de forma a criar estruturas biológicas com maior espessura. No entanto, o número de “cell sheets” sobrepostas que se podem manter em cultura está limitado por restrições no fornecimento de nutrientes e pela acumulação de produtos metabólicos de excreção. As superfícies tipicamente usadas em “cell sheet engineering” consistem em PNIPAAm covalentemente imobilizado na superfície de placas de poliestireno de cultura celular. No entanto, estes materiais são impermeáveis. O uso de membranas de quitosano, permeáveis a moléculas de pequenas dimensões, aumentaria a eficiência na troca de nutrientes e produtos de excreção, permitindo eventualmente o aumento do número de “cell sheets” que se poderia sobrepor em cultura. Adicionalmente, as membranas de quitosano hidratadas poderão ser facilmente adaptáveis a formas anatómicas diversas, devido à sua elasticidade, facilitando a manipulação e a transferência directa de “cell sheets” individuais ou sobrepostas para o paciente

Bread with stoned table olives – the union of two traditional products of excellence of Trás-os-Montes region, Portugal: preliminary results

The aim of the present work was to conduct a preliminary study on characterization of wheat bread with stoned green table olives, also called “alcaparras”, in order to obtain a produce that join two traditional products of excellence from Trás-os-Montes region, Northeast of Portugal. ”Alcaparras” are processed from healthy green or yellow-green olives, which are broken using a wooden hammer separating the pulp of the core. The pulp is sliced into two approximately equal parts perpendicularly to the major axis of the fruit and placed on water, which is changed three to four times during a week. This treatment has the purpose of removing olive bitterness. Afterwards the product is stored in brine until consumption. Wheat breads were prepared with different percentages of ”alcaparras”: 0, 3, 5 and 7% and stored at 25 °C for 4 days, being analysed every two days, regarding pH, ash, fat and salt contents, as well as mesophiles, moulds and yeasts. The physicochemical determinations were only made at 0 and 2 days because after the fourth day the bread had developed moulds. The breads presented pH values between 5.85-5.96, salt 0.51- 1.01% (d.w.–dry weight), ash 2.13-2.77% (d.w.) and fat 2.00-3.78% (d.w.) contents. The breads with the highest ”alcaparras” percentage presented the lowest pH value and the highest salt and ash contents. As expected the breads with the lowest fat content were those without ”alcaparras”. The mesophiles varied between 1.3-7.4 log UFC/g (f.w.), and moulds and yeasts between <1 to 5 log UFC/g (f.w.), being the highest values obtained at the end of storage. In conclusion, bread with ”alcaparras” is a promising product to be sold in gourmet shops; however, more studies are needed to increase its shelf-life. The inclusion of ”alcaparras” in traditional breads is also an innovative strategy to valorise two different food products at once.This work was performed in collaboration with the TRADEIT project which has received funding from the European Union’s Seventh Framework Programme for research, technological development and demonstration under grant agreement n° 613776.info:eu-repo/semantics/publishedVersio