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Introducción: La crisis hipertensiva es un problema de salud pública que afecta física y psicológicamente la salud de los pacientes, quienes enfrentan una serie de condiciones clínicas que ponen en riesgo su vida. Objetivo: Analizar los principales factores protectores de crisis hipertensiva en pacientes que acudieron a emergencia al Hospital Básico del Instituto Ecuatoriano de Seguridad Social-Esmeraldas durante el periodo noviembre-diciembre 2021. Materiales y métodos: Estudio con enfoque cuantitativo de tipo descripto con corte transversal y un diseño no experimental, con una población total de 115 pacientes de 30 años de edad en adelante, diagnosticados con hipertensión y crisis hipertensiva y 25 médicos que atienden casos de I10 en el área de emergencia del hospital. Como técnica para la recopilación de información se utilizó la encuesta y como instrumento dos cuestionarios estructurados. Las variables estudiadas fueron características sociodemográficas, hábitos y estilo de vida, tratamiento, comorbilidades, factores asociados y factores protectores. Resultados: Se evidenció que la crisis hipertensiva prevalece en las mujeres con el 51,30% y en los hombres con el 47,83%. Además, la población adulta mayor está en mayor riesgo con el 49,57%. En otras consideraciones, el 53, 04% de los pacientes realiza actividad física raramente; el 48% en algo cumple con el tratamiento médico y el 60% tiene poco conocimiento sobre la enfermedad y su prevención. Conclusiones: Es fundamental el cambio de los hábitos y estilo de vida de los pacientes, así como un mayor grado de concienciación sobre este problema de salud y la seriedad de sus complicaciones.

(1) Background: The nutritional status of women during pregnancy can have a considerable effect on maternal and fetal health, and on the perinatal outcome. Aim: to assess the changes occurring in dietary iodine intake, potassium iodide supplementation, and smoking habit, and the impact of these changes on the urinary iodine concentration (UIC) during pregnancy in a population of women in Catalonia (Spain). (2) Methods: Between 2009–2011, an observational study included a cohort of women whose pregnancies were monitored in the public health system in the Central and North Metropolitan areas of Catalonia. Women received individual educational counseling, a dietary questionnaire was completed, and a urine sample was collected for iodine determination at each trimester visit. (3) Results: 633 (67.9%) women answered the questionnaire at all 3 visits. The percentage of women with a desirable UIC (≥150 μg/L) increased from the first to the second trimester and remained stable in the third (57.3%, 68.9%, 68%, p &lt, 0.001). Analysis of the relationship between UIC≥150 μg/L and the women’s dietary habits showed that the percentage with UIC ≥150 μg/L increased with greater consumption of milk in the first trimester, and the same was true for iodized salt use in all three trimesters and iodine supplementation in all three. (4) Conclusion: During pregnancy, increased intake of milk, iodized salt, and iodine supplements were associated with an increase in the UIC.

Few economic evaluations have assessed laparoscopy for colon cancer. This study aimed to compare the cost-effectiveness of laparoscopic and open surgery for the treatment of colon cancer. A cost-effectiveness analysis was performed comparing two groups of patients treated according to standard clinical practice (REDISSEC-CARESS/CCR cohort) by laparoscopic or open surgery. Data were collected from health records on clinical characteristics and resource use over 2 years after surgery. To calculate the incremental cost-effectiveness ratio, costs and quality-adjusted life years (QALYs) were obtained for each patient. Clinical heterogeneity was addressed using propensity score and joint multivariable analysis (seemingly unrelated regression) that included interactions between TNM stage, age, and surgical procedure to perform subgroup analysis. The sample was composed of 1591 patients, 963 who underwent laparoscopy and 628 open surgery. Using propensity score and regression analysis, we found that laparoscopy was associated with more QALYs and less resource use than open surgery (0.0163 QALYs, 95% CI 0.0114–0.0212; and − €3461, 95% CI − 3337 to − 3586). Costs were lower for laparoscopy in all subgroups. In the subgroups younger than 80 years old, utility was higher in patients who underwent laparoscopy. Nevertheless, open surgery had better outcomes in older patients in stages I–II (0.0618 QALYs) and IV (0.5090 QALYs). Overall, laparoscopy appears to be dominant, resulting in more QALYs and lower costs. Nevertheless, while laparoscopy required fewer resources in all subgroups, outcomes may be negatively affected in elderly patients, representing an opportunity for shared decision making between surgeons and patients. ClinicalTrials.gov Identifier: NCT02488161

To assess the impact of readmission and reoperation on colon or rectal cancer patients in clinical and patient-reported outcome measures (PROMs) and to identify predictors of these events up to 1 year after surgery. Prospective cohort study of patients diagnosed with colon or rectal cancer who underwent surgery at 1 of 22 hospitals. Medical history, clinical parameters, and PROMs were evaluated as possible predictors. Multivariable multilevel logistic regression and survival models were used in the analyses to create the clinical prediction rules. Models were developed in a derivation sample and validated in a different sample. Readmission and reoperation were related to clinical outcomes and changes in some PROMs. Predictors of readmission in colon cancer were ASA class (odds ratio (OR) 4.5), TNM (OR for TNM III 3.24, TNM IV 4.55), evidence of residual tumor (R2) (OR 3.96), and medical (OR 1.96) and infectious (OR 2.01) complications within 30 days after surgery, while for rectal cancer, the predictors identified were age (OR 1.03), R2 (OR 6.48), infectious complications within 30 days (OR 2.29), hemoglobin (OR 3.26), lymph node ratio (OR 2.35), and surgical complications within 1 month (OR 3.04). Predictors of reoperation were TNM IV (OR 5.06), surgical complications within 30 days (OR 1.98), and type and site of tumor (OR 1.72) in colon cancer and being male (OR 1.52), age (OR 1.80), stoma (OR 1.87), and surgical complications within 1 month (OR 1.95) in rectal cancer. Our clinical prediction rule models are easy to use and could help to develop and implement interventions to reduce preventable readmissions and reoperations. https://clinicaltrials.gov/ct2/show/NCT02488161 Identifier: NCT02488161

Background Lupus nephritis (LN) affects up to 50% of patients with SLE and is a major cause of morbidity, despite modern therapeutic approaches [1,2]. To date, renal biopsy is still the gold standard for diagnosing and classifying the degree of renal inflammation and scarring, but its invasiveness makes it unsuitable for serial monitoring. A novel biomarker to predict the evolution of renal inflammatory injury is still needed. Neuropilin-1 (NRP-1) has important functions in adult tissues, being involved in axonal guidance, vascular endothelial sprouting, regeneration and organ repair and immunosupression [3]. Objectives Evaluate the protein and expression levels of NRP-1 at the time of the renal flare in patients with lupus nephritis and determine whether they could predict the disease progression. Methods Urine and serum of 70 patients with LN with nephrotic proteinuria, 25 patients with chronic non-lupus related nephopathy, and 25 healthy controls were analyzed by qPCR-RT and ELISA to determinate the levels of mRNA/protein of NRP-1. Immunohistochemistry of protein levels were done in renal biopsy (N=5). Urine and serum from 39 other patients with LN with nephrotic proteinuria were collected prospectively during two years. Results Increases in mRNA expression and protein concentration of NRP-1 were identified in urine samples of LN patients in flare compared with the different control groups. However, significant NRP-1 levels were found in LN patients that gone into remission compared with patients in non-remission after one year of treatment (p Conclusions For first time, we demonstrate that urinary levels of NRP-1 might reflect the evolution of renal inflammatory injury and could be used as novel biomarker to predict the recovery of LN. References Cervera R, Khamashta MA, Font J, et al. Morbidity and mortality in systemic lupus erythematosus during a 10-year period: a comparison of early and late manifestations in a cohort of 1,000 patients. Medicine (Baltimore) 2003;82:299–308. Baker KP, Edwards BM, Main SH, et al. Generation and characterization of LymphoStat-B, a human monoclonal antibody that antagonizes the bioactivities of B lymphocyte stimulator. Arthritis Rheum.2003;48:3253–65. Gagnon ML, Bielenberg DR, Grechtman Z, et al. Identification of a natural soluble neuropilin-1 that binds vascular endothelial growth factor: in vivo expression and antitumor activity. Proc Natl Acad Sci USA2000;97:2573–2578. Disclosure of Interest None declared

Resumen basado en el de la publicación Título, resumen y palabras clave también en inglés Se recoge la entrevista realizada por Mª Dolores Soto-González a Teresa Torres de Eça, presidenta de APECV (Associação de Professores de Expressão e Comunicação Visual) e InSEA (International Society For Education Throught Art) en el Museo da Quinta da Cruz de Viseu sede de APECV el sábado 30 de Marzo de 2017. Teresa Torres de Eça, amante de las artes y de la educación, explica su labor llevada a cabo desde esta institución así como el modo en que se puede articular la necesaria relación entre museo, escuela y universidad. ESP

Relatório final do estágio profissionalizante do 6.º ano

Summary Background Although thalidomide has been shown to be effective in patients with refractory cutaneous lupus erythematosus (CLE), its use is still hampered by its potential severe side-effects and the current restricted availability. Objectives To evaluate prospectively the clinical efficacy and safety of low-dose thalidomide in an observational study and to establish prognostic factors of clinical outcome. Methods Sixty consecutive patients with refractory CLE were treated with thalidomide (100 mg daily). Clinical response was assessed by the CLE Disease Area and Severity Index (CLASI). Clinical and immunological parameters were evaluated during treatment. Results Patients were followed for up to 8 years (range 2–18). One patient discontinued treatment because of side-effects. Of the 59 remaining patients, 58 (98%) achieved clinical response, already noticeable at 2 weeks following treatment. Complete response occurred in 50 patients (85%). Clinical relapse was frequent (70%) and usually occurred 5 months after withdrawal or reduction of thalidomide. Subacute CLE (SCLE) was the predicting factor of long-term remission after therapy discontinuation [odds ratio (OR) 30, 95% confidence interval (CI) 5·82–154·63], whereas discoid lupus erythematosus (DLE) was predictive of relapse (OR 5·71, 95% CI 1·36–24·06). Eleven patients (18%) reported paraesthesia; in five of the 11, nerve conduction studies confirmed a sensory polyneuropathy. Neurological symptoms resolved in 12 months (range 6–18) after thalidomide withdrawal. Two patients, heavy smokers and without antiphospholipid antibodies, had a cerebral ischaemic event. Conclusions Low-dose thalidomide is an effective treatment for refractory CLE, but its benefits need to be balanced against the potential adverse effects. Whereas DLE forms tended to relapse and required a long-term maintenance dose of thalidomide, SCLE forms showed a sustained remission after withdrawal.

The electric power market is changing-it has passed from a regulated market, where the government of each country had the control of prices, to a deregulated market economy. Each company competes in order to get more cli.e.nts and maximize its profits. This market is represented by a Stackelberg game with two firms, leader and follower, and the leader anticipates the reaction of the follower. The problem is formulated as a Mathematical Program with Complementarity Constraints (MPCC). It is shown that the constraint qualifications usually assumed to prove convergence of standard algorithms fail to hold for MPCC. To circumvent this, a reformulation for a nonlinear problem (NLP) is proposed. Numerical tests using the NEOS server platform are presented.

The REDISSEC CARESS-CCR (Results and Health Services Research in Colorectal Cancer)- group: Jose María Quintana, Marisa Baré, Maximino Redondo, Eduardo Briones, Nerea Fernández de Larrea, Cristina Sarasqueta, Antonio Escobar, Francisco Rivas, Maria M. Morales-Suárez, Juan Antonio Blasco, Isabel del Cura, Inmaculada Arostegui, Amaia Bilbao, Nerea González, Susana García-Gutiérrez, Iratxe Lafuente, Urko Aguirre, Miren Orive, Josune Martin, Ane Antón-Ladislao, Núria Torà, Marina Pont, María Purificación Martínez del Prado, Alberto Loizate, Ignacio Zabalza, José Errasti, Antonio Z Gimeno, Santiago Lázaro, Mercè Comas, Jose María Enríquez, Carlos Placer, Amaia Perales, Iñaki Urkidi, Jose María Erro, Enrique Cormenzana, Adelaida Lacasta, Pep Piera Pibernat, Elena Campano, Ana Isabel Sotelo, Segundo Gómez-Abril, F. Medina-Cano, Julia Alcaide, Arturo Del Rey-Moreno, Manuel Jesús Alcántara, Rafael Campo, Alex Casalots, Carles Pericay, Maria José Gil, Miquel Pera, Pablo Collera, Josep Alfons Espinàs, Mercedes Martínez, Mireia Espallargues, Caridad Almazán, Paula Dujovne Lindenbaum, José María Fernández-Cebrián, Rocío Anula Fernández, Julio Ángel Mayol, Ramón Cantero, Héctor Guadalajara, María Heras, Damián García, Mariel Morey, Javier Mar., [Background] Colorectal cancers are one of the most common forms of malignancy worldwide. But two significant areas of research less studied deserve attention: health services use and development of patient stratification risk tools for these patients., [Methods] Design: a prospective multicenter cohort study with a follow up period of up to 5 years after surgical intervention. Participant centers: 22 hospitals representing six autonomous communities of Spain. Participants/Study population: Patients diagnosed with colorectal cancer that have undergone surgical intervention and have consented to participate in the study between June 2010 and December 2012. Variables collected include pre-intervention background, sociodemographic parameters, hospital admission records, biological and clinical parameters, treatment information, and outcomes up to 5 years after surgical intervention. Patients completed the following questionnaires prior to surgery and in the follow up period: EuroQol-5D, EORTC QLQ-C30 (The European Organization for Research and Treatment of Cancer quality of life questionnaire) and QLQ-CR29 (module for colorectal cancer), the Duke Functional Social Support Questionnaire, the Hospital Anxiety and Depression Scale, and the Barthel Index. The main endpoints of the study are mortality, tumor recurrence, major complications, readmissions, and changes in health-related quality of life at 30 days and at 1, 2, 3 and 5 years after surgical intervention. Statistical analysis: In relation to the different endpoints, predictive models will be used by means of multivariate logistic models, Cox or linear mixed-effects regression models. Simulation models for the prediction of discrete events in the long term will also be used, and an economic evaluation of different treatment strategies will be performed through the use of generalized linear models., [Discussion] The identification of potential risk factors for adverse events may help clinicians in the clinical decision making process. Also, the follow up by 5 years of this large cohort of patients may provide useful information to answer different health services research questions., [Trial registration] ClinicalTrials.gov Identifier: NCT02488161. Registration date: June 16, 2015., This work was supported in part by grants from the Fondo de Investigación Sanitaria (PS09/00314, PS09/00910, PS09/00746, PS09/00805, PI09/90460, PI09/90490, PI09/90397, PI09/90453, PI09/90441); Department of Health of the Basque Country (2010111098); KRONIKGUNE –Centro de Investigación en Cronicidad (KRONIK 11/006); and the European Regional Development Fund (ERDF).

Background. One of the challenges of treating patients with lupus nephritis (LN) is to accurately assess disease activity and predict its outcome. Since renal-biopsy cannot be performed routinely, new surrogate biomarkers are needed. Methods. We evaluated neutrophil gelatinase-associated lipocalin (NGAL), to predict renal outcome in LN. Serum and urinary NGAL levels, measured by the enzyme-linked immunosorbent assay, and the fractional excretion (FE) of NGAL relative to the FE of proteins (FE NGAL/FE protein ratio) were determined in a cross-sectional (n = 199) and longitudinal (n = 45) cohort of systemic lupus erythematosus (SLE) patients. Global and renal disease activity was assessed by the SLE disease activity indices, SLEDAI and rSLEDAI, respectively. Correlations between traditional biomarkers were established. Sensitivity, specificity and predictive values of NGAL for renal flare, response to therapy and progression to chronic kidney disease were calculated. Results. The FE NGAL/FE protein ratio exhibited the best sensitivity and specificity to discriminate patients with active LN from those with non-renal flare and inactive SLE. In the prospective study, this biomarker was found to be the best candidate to predict proteinuric flares with an 87% sensitivity and 62% specificity for ratios >14.56 and complete response with a 61% sensitivity and 78% specificity for ratios >26.54 in the presence of a simultaneous worsening or improving rSLEDAIs, respectively. In both conditions, the FE NGAL/FE protein ratio outperformed the anti-dsDNA antibody titres and C3 predictive value. Progression to chronic kidney disease was best predicted by estimated glomerular filtration rate levels, but persistently high levels of serum NGAL (>444.4 ng/mL, P = 0.0001 by Kaplan–Meier) predicted a faster progression. Conclusions. The FE NGAL/FE protein ratio is a reliable marker of disease activity in patients with SLE and could be used as an indicator of response to therapy, although further studies are required to confirm these results.

Mestrado em Psicologia Forense A externalização é uma dimensão da personalidade que envolve um espectro de comportamentos antissociais e violentos. Na sua conceção relaciona comportamentos antissociais, traços de personalidade associados à desinibição e à agressão, e dependência de substâncias. Considerando que tanto as dimensões da personalidade como as variáveis associadas à expressão e regulação da ira poderão ser um antecedente das tendências externalizantes, este estudo pretendeu avaliar de que forma os domínios de personalidade incluídos no Modelo dos Cinco Fatores, as estratégias de regulação emocional e a ira predizem a externalização, comparando um grupo de reclusos com um grupo de não reclusos. A amostra incluiu 60 reclusos do Estabelecimento Prisional do Porto e 25 participantes não reclusos do sexo masculino, avaliados com o Inventário de Externalização – versão reduzida (IE), o Inventário de Personalidade dos Cinco Fatores (NEO-FFI), o Questionário de Regulação Emocional (QRE) e o Inventário da Expressão da Ira Estado-Traço (STAXI-2). Concluiu-se que a população reclusa em comparação com a população não reclusa apresenta maiores níveis de externalização, maiores dificuldades ao nível da regulação emocional e maior expressão da ira. Para o grupo de reclusos verificou-se que o neuroticismo prediz de forma significativa a desinibição geral, com a reavaliação cognitiva como preditor adicional. A ira-estado foi o único preditor significativo da agressão insensível. Para o grupo de não reclusos, a conscienciosidade foi preditor significativo da agressão insensível, sendo a ira-traço um preditor adicional deste fator e do fator de desinibição geral. A supressão expressiva foi o único preditor significativo do uso de substâncias. Estes resultados contribuem para uma melhor compreensão da externalização, bem como dos fatores que podem tornar a sua expressão distinta em grupos normativos e grupos de reclusos. Podendo sugerir-se que os indivíduos com níveis mais elevados de externalização apresentam características de baixa tolerância à frustração, níveis elevados de hostilidade e impulsividade. As dificuldades ao nível da regulação emocional estão intimamente ligadas à forma como posteriormente estes indivíduos processam as emoções, podendo contribuir para o modo como se comportam socialmente. Externalizing is a personality dimension that involves a spectrum of antisocial and violent behavior. It relates antisocial behaviors, personality traits associated with disinhibition and aggression, and substance abuse. Considering that both personality dimensions and variables associated with the expression and regulation of anger may be antecedents of externalizing behaviors, the aim of this study was to evaluated the predictive role of personality (according to the Five Factor Model), as well as the role of emotion regulation strategies and anger in externalizing behaviors by comparing a group of inmates with a group of non-inmates. The sample included 60 male inmates of the Porto Prison and 25 male participants not inmates, assessed using the Externalizing Spectrum Inventory – brief form (ESI) , the NEO Five Factor Inventory (NEO - FFI) , the Emotion Regulation Questionnaire (ERQ) and the State-Trait Anger Expression Inventory (STAXI - 2). Results show that the inmates compared with the non-inmates had higher levels of externalizing behaviors, greater difficulties in emotion regulation and greater expression of anger. For the group of inmates it was found that neuroticism significantly predicts the general disinhition, and cognitive reappraisal was an additional predictor. State anger was the only significant predictor of callous-aggression. For the group of non-inmates, conscientiousness was a significant predictor of callous-aggression, and trait anger was an additional predictor of this factor and of the general disinhibition factor. Expressive suppression was the only significant predictor of substance abuse. These results contribute to a better understanding of externalizing, and of the factors that may make its expression different in normative versus inmate groups. May be suggested that individuals with higher levels of externalizing exhibit characteristics of low frustration tolerance, high levels of hostility and impulsivity. The difficulties in emotion regulation are closely linked to how these individuals subsequently process the emotions and can contribute on way they behave.

Neste texto faço uma análise sumária da educação artística em Portugal entre a década de 1990 e os primeiros sete anos do século XXI. Enfoco aspectos da educação formal e não formal, bem como algumas tendências e questões emergentes. Faço uma abordagem mais ampla da educação artística visual, que tem tido uma grande presença no ensino formal. Destaco no ensino não formal atividades na área da educação artística integrada, que me parecem muito positivas e têm causado algum impacto no grande público. Finalmente, focalizo a necessidade da educação artística como meio de transformação social, com exemplos de pequenos grupos ligados à educação, à comunidade e ao teatro social.

It is known that CD48 regulates T-cell activation. We evaluated the transcriptional expression of CD48 in CD4 + T cells from 30 SLE patients and 30 healthy controls. CD48 mRNA levels were considerably higher in the patients group: 1.80 ± 1.41 versus 1.10 ± 0.50 ( p = 0.023). An inverse correlation was obtained with respect to CD48 mRNA levels and age in the control group ( r = −0.478, p = 0.007). None association was found between CD48 mRNA expression and levels of anti-dsDNA, complement, or lymphocyte counts. Alternatively, a statistically significant positive correlation was observed between CD48 transcript levels and SLEDAI values ( r = 0.372, p = 0.042). The higher CD48 mRNA levels observed in CD4 + T cells from SLE patients and the positive correlation found with SLEDAI lead us to infer that an overexpression of the protein coded by this gene may have important consequences on the development of SLE.

Background Although mycophenolate mofetil (MMF) is being increasingly used to manage lupus nephritis (LN), long-term experience is limited. Despite treatment, a significant proportion of patients will be refractory to this regime. Methods We report, in this observational study, our long-term experience treating 70 patients with biopsy-proven LN, with MMF as continuous induction-maintenance therapy, who were followed up prospectively over a 5-year period. As rescue therapy for MMF-resistant cases, tacrolimus (0.075 mg/kg/day) was added. The study primary end point was complete response (CR). Secondary end points included partial response (PR), treatment failure, relapse and side effects. Predictor factors associated to renal outcome were analysed by Cox regression analysis. Results Thirty-six MMF-treated patients (51%) remained in CR, and 23 (33%) failed treatment at last follow-up. Time to treatment failure was associated with persistent hypoalbuminaemia (hazard ratio (HR) = 0.87; 95%CI, 0.81-0.95; P = 0.001), higher proteinuria (HR = 1.29; 95%CI, 1.03-1.62; P = 0.030) and fewer early responses (HR 0.28; 95%CI, 0.10-0.77; P = 0.014). Renal relapse occurred in 24 (34%) patients. Time to flare was associated with persistent anti-dsDNA titres (HR = 1.001; 95%CI, 1.001-1.003; P = 0.005) and younger age at inclusion (HR = 0.36; 95%CI, 0.14-0.90; P = 0.029). Tacrolimus was added to 17 (24%) patients. A significant reduction of proteinuria was already observed at 3 months (P = 0.002). After 2 years follow-up, 12 (70%) of them achieved clinical response (six CR and six PR). Conclusions. MMF is an effective treatment for LN. Combination therapy with tacrolimus is an effective and safe alternative for MMF-resistant patients.

Objectives1) To assess the impact of multi-drug leprosy therapy on the development of nasal deformities and nasal airway patency. 2) Evaluate the nasal morphology and nasal patency in leprosy patients treated with the multidrug therapy in comparison with patients treated with 1 drug therapy and a group of healthy volunteers.MethodsIn an overall group of 84 patients studied, 38 were treated with a therapy based on a single drug, and 22 were treated with multi-drug therapy, while 24 subjects formed a control group. We used anterior rhinoscopy to analised the morphology of the nose. We meassured the nasal inspiratory and expiratory resistance of the right and left nostrils and total nasal inspiratory and expiratory resistance at a transnasal pressure of 150 Pa. by using active anterior rhinomanometry. The statistical analysis was carried out using the Varianza analisys.ResultsThe nasal structures in the 1-drug therapy group underwent bone and cartilaginous resorption with an increase in nasal resistances. We...

“El objetivo de esta investigación es rescatar, a través de las madres amas de casa de las cruces, los afanes cotidianos de las mujeres de sectores populares, y hacer evidente la participación activa, aunque generalmente silenciosa, del género femenino en la configuración de su ámbito inmediato doméstico, laboral, comunal y político así como en la construcción de la ciudad y su historia”.

RESUMEN Se estudiaron clinicamente y mediante exame-nes de laboratorio 42 nifios infectados por Toxo-cara sp. La edad promedio de los casos fue de 4 12afios 2 meses ± 3 afios 5 meses. Habia geofagia en97,6%, grades variables de compromise pulmonaren 64,3% y hepatomegalia en 59,5% de lospacientes. El Fondo de ojos tem'a alteraciones en 14 4,8% de los pacientes. En el Hemograma laconcentration de Hemoglobina promedio fue deil,0g/dl, el recuento de leucocitos promedio 1S 19.213 x mm 3 y el de eosinofilos 8.918,9 xmm 3 . 84,86% de los nifios presentaron niveles de 16isohemaglutininas > l.:64 y 95,2% titulos deELISA para Toxocara superiores a esta dilution.El tratamiento con Tiabendazol fue bien toleradoen 83,3% y efectivo en 70,8% de los nifios. En29,2% se observ6 mejoria parcial, clinica y delaboratorio.AGRADECMENTOS A "Parasitology Division of the Center for DiseaseControl, Atlanta, Georgia", por la realization del diag-nostico serologico de Toxocariasis.Al personal del Banco de Sangre del Hospital LuisCalvo Mackenna Sras. Maria Agurto, Monica Arizmendi,Irene Ruiz y Sr. Miguel Manosalva, por la titulacion deisohemaglutininas.

Background Sufficient iodine intake is needed during pregnancy to ensure proper fetal development. The iodine levels of women in their first trimester of pregnancy in Catalonia are currently unknown. This data would help to determine whether our public health services should establish recommendations or interventions in this line. The aim of this study was to investigate the iodine nutritional status, prevalence of urinary iodine 2 glasses, OR = 0.593 95% CI (0.37–0.95); iodized salt consumption, OR = 0.678 95% CI (0.51–0. 90); and use of iodine supplementation, OR = 0.410 95% CI (0.31–0.54), protected against the risk of UIC

Doutoramento em Matemática A relação entre a epidemiologia, a modelação matemática e as ferramentas computacionais permite construir e testar teorias sobre o desenvolvimento e combate de uma doença. Esta tese tem como motivação o estudo de modelos epidemiológicos aplicados a doenças infeciosas numa perspetiva de Controlo Ótimo, dando particular relevância ao Dengue. Sendo uma doença tropical e subtropical transmitida por mosquitos, afecta cerca de 100 milhões de pessoas por ano, e é considerada pela Organização Mundial de Saúde como uma grande preocupação para a saúde pública. Os modelos matemáticos desenvolvidos e testados neste trabalho, baseiam-se em equações diferenciais ordinárias que descrevem a dinâmica subjacente à doença nomeadamente a interação entre humanos e mosquitos. É feito um estudo analítico dos mesmos relativamente aos pontos de equilíbrio, sua estabilidade e número básico de reprodução. A propagação do Dengue pode ser atenuada através de medidas de controlo do vetor transmissor, tais como o uso de inseticidas específicos e campanhas educacionais. Como o desenvolvimento de uma potencial vacina tem sido uma aposta mundial recente, são propostos modelos baseados na simulação de um hipotético processo de vacinação numa população. Tendo por base a teoria de Controlo Ótimo, são analisadas as estratégias ótimas para o uso destes controlos e respetivas repercussões na redução/erradicação da doença aquando de um surto na população, considerando uma abordagem bioeconómica. Os problemas formulados são resolvidos numericamente usando métodos diretos e indiretos. Os primeiros discretizam o problema reformulando-o num problema de optimização não linear. Os métodos indiretos usam o Princípio do Máximo de Pontryagin como condição necessária para encontrar a curva ótima para o respetivo controlo. Nestas duas estratégias utilizam-se vários pacotes de software numérico. Ao longo deste trabalho, houve sempre um compromisso entre o realismo dos modelos epidemiológicos e a sua tratabilidade em termos matemáticos. The relationship between epidemiology, mathematical modeling and computational tools allows to build and test theories on the development and fighting of a disease. This thesis is motivated by the study of epidemiological models applied to infectious diseases in an Optimal Control perspective, giving particular relevance to Dengue. It is a subtropical and tropical disease transmitted by mosquitoes, that affects about 100 million people per year and is considered by the World Health Organization as a major concern for public health. The mathematical models developed and tested in this work, are based on ordinary differential equations that describe the dynamics underlying the disease, including the interaction between humans and mosquitoes. An analytical study is made related to equilibrium points, their stability and basic reproduction number. The spreading of Dengue can be attenuated through measures to control the transmission vector, such as the use of specific insecticides and educational campaigns. Since the development of a potential vaccine has been a recent global bet, models based on the simulation of a hypothetical vaccination process in a population are proposed. Based on the Optimal Control theory, we have analyzed the optimal strategies for using these controls and respective impact on the reduction / eradication of the disease during an outbreak in the population considering a bioeconomic approach. The formulated problems are numerically solved using direct and indirect methods. The first discretize the problem turning it into a nonlinear optimization problem. Indirect methods use the Pontryagin Maximum Principle as a necessary condition to find the optimal curve for the respective control. In these two strategies several numerical software packages are used. Throughout this study, there was a compromise between the realism of epidemiological models and their mathematical tractability.

Doutoramento em Matemática Submitted by Nuno Cruz (nuno@ua.pt) on 2013-02-18T12:53:22Z No. of bitstreams: 1 tese.pdf: 3486905 bytes, checksum: 12527e65db8475516eff83e0ebd44ab5 (MD5) Made available in DSpace on 2013-02-18T12:53:22Z (GMT). No. of bitstreams: 1 tese.pdf: 3486905 bytes, checksum: 12527e65db8475516eff83e0ebd44ab5 (MD5) Previous issue date: 2012