Introdução: A incidência de infeções nosocomiais aumenta gradualmente acima dos 65 anos. O objetivo primário deste trabalho foi avaliar o impacto da redução ou perda de autonomia dos doentes idosos na aquisição de infeção nosocomial. Material e Métodos: Análise prospetiva dos doentes internados entre março 2017 e fevereiro 2018, no Serviço de Medicina Interna do Hospital de Vila Real, com avaliação do grau de dependência, através da escala de Katz, e aquisição de infeção nosocomial. Outras variáveis foram analisadas: sistemas acometidos e fatores de risco nas infeções nosocomiais, duração média de internamento, mortalidade e reinternamento. Resultados: Foram analisados 1311 doentes, com uma idade média de 83,2 anos. Da amostra de doentes, 33,6% eram autónomos, 32,6% parcialmente dependentes e 33,7% totalmente dependentes. Infeção nosocomial observou-se em 10,6% dos doentes. Verificou-se uma associação estatisticamente significativa entre o grau de dependência e o desenvolvimento de infeções nosocomiais, assim como entre a presença de infeção nosocomial e a mortalidade, e o reinternamento aos 30 dias. O grau de dependência também se associou de forma significativa com o número de dias de internamento, com a mortalidade e com o reinternamento. Discussão e Conclusão: Este estudo revelou que o desenvolvimento de infeção nosocomial foi superior nos doentes com um maior grau de dependência assim como a mortalidade, que também foi superior neste subgrupo de doentes. Desta forma, a perda de autonomia deve ser encarada como um potencial predisponente para a aquisição de infeção

Introduction: Incidence of nosocomial infections gradually increase over the age of 65. The primary objective of this paper was to assess the impact of the reduction or loss of autonomy of the elderly patients in the nosocomial infection acquisition. Material and Methods: Prospective analysis of hospitalized patients from March 2017 to February 2018 at the Department of Internal Medicine of Vila Real Hospital, with an evaluation of the dependence level through the Katz scale and nosocomial infection acquisition. Other variables were analyzed: compromised systems and risk factors in nosocomial infections, mean duration of hospitalization, mortality and readmission. Results: A total of 1311 patients were analyzed, with a mean age of 83.2. Of the patients’ sample, 33.6% were autonomous, 32.6% were partially dependent and 33.7% were totally dependent. Nosocomial infection was observed in 10.6% of patients. There was a statistically significant association between the dependence level and the nosocomial infections acquisition, as well as between the presence of nosocomial infection and mortality, and readmission after 30 days. The dependence level was also significantly associated with days of hospitalization, with mortality and with readmission. Discussion and Conclusion: This study revealed that nosocomial infection development was superior in patients with a greater dependence level as well as the mortality, which was also higher in this subgroup of patients. In this way, the loss of autonomy should be considered as a predisposing potential for acquisition of infection.

The sequence of tasks is vital to the development of any project. The order of tasks is influenced by the information flow among them. The dependency structure matrix (DSM) can be used to model information flow. However, the information used by the DSM, including task duration, time required for communication, and task overlap, can have uncertain values. The aim of this paper is to analyze the effect of uncertainty on the scheduling of tasks using the DSM. Monte Carlo Simulation is applied to represent uncertainty in time estimates for projects using DSM. Conventional project duration, normal project duration with communication times, and normal project duration containing natural overlapping were considered for project time estimations. Several distribution functions were used to represent the uncertainty. It is concluded that project duration has normal distribution behavior that is independent of the type of input parameter distribution functions; that mean values of the input parameters give a good estimation of mean project duration; that interval and inner interval arithmetic give overestimation and underestimation of project duration times respectively.

La secuencia de actividades es vital para el desarrollo de cualquier proyecto. El orden de las actividades está influenciado por el flujo de información entre ellas. La matriz de la estructura de dependencias (DSM) se puede utilizar para modelar el flujo de información. Sin embargo, la información utilizada por la DSM puede tener valores inciertos. El objetivo de este trabajo es analizar el efecto de la incertidumbre sobre la programación de actividades utilizando la DSM. La simulación de Monte Carlo se aplica para representar la incertidumbre en las estimaciones de tiempo para proyectos que utilizan DSM. Para las estimaciones de duración de proyecto se consideraron la duración convencional del proyecto, la duración normal de proyecto con tiempos de comunicación, y la duración normal de proyecto con superposición natural. Las incertidumbres se representaron con varias funciones de distribución. Se concluye que la duración de proyecto presenta distribución normal que es independiente del tipo de funciones de distribución de los parámetros de entrada; valores medios de los parámetros de entrada dan una buena estimación de la duración media del proyecto; las aritméticas de intervalo e intervalos interior dan una sobreestimación y subestimación de los tiempos de duración de proyecto respectivamente.

A Tuberculose mantém-se como um problema de saúde pública. O envolvimento extra-pulmonar e sistémico constitui uma forma de apresentação rara. Descreve-se o caso de uma doente de 77 anos observada por distensão abdominal, febre e sudorese nocturna. Apresentava hepatoesplenomegalia e ascite de pequeno volume. Na avaliação complementar tinha leucocitose (142700/mm³) com predomínio de neutrófilos e precursores mielóides, proteína c-reactiva baixa e gradiente albumina soro-ascite=1,1. Assumida provável Leucemia Mielóide Crónica, iniciou citorredução com hidroxicarbamida e efectuou estudo genético e molecular que não confirmou o diagnóstico. Posteriormente, foi isolado no líquido ascítico e nas hemoculturas Mycobacterium Tuberculosis. Admitiu-se reacção leucemóide a Tuberculose Disseminada, suspendeu o citostático e iniciou antibacilares com subsequente melhoria clínica e analítica. A dificuldade diagnóstica desta reacção leucemóide a infecção sistémica por Mycobacterium Tuberculosis particulariza este caso pela sua invulgaridade.

Tuberculosis remains as a public health problem. The systemic extra-pulmonary involvement is rare and constitutes a clinical presentation subtype. Female patient, 77 years old, observed with abdominal distension, fever and night sweats. she had hepatosplenomegaly, small volume ascites, leukocytosis (142700/mm³), with neutrophils and myeloid precursors predominance, insignificant c-reactive protein and serum-ascites albumin gradient = 1.1. Assumed probable Chronic Myelogenous Leukemia, cytoreduction with hydroxyurea was started and was performed genetic and molecular study that did not confirm the diagnosis. it was later isolated in ascitic fluid and blood cultures Mycobacterium Tuberculosis. it was assumed leukemoid reaction secondary to Disseminated Tuberculosis, cytostatic was suspended and it was started anti-tuberculosis therapy with clinical and analytic improvement. The difficult and uncommon diagnosis of this leukemoid reaction to Mycobacterium Tuberculosis highlights this clinical case.

Satoyoshi  syndrome is a rare multisystemic disease of presumed autoimmune etiology characterized by progressive painful intermittent muscle spasms, diarrhea frequently associated with malabsorption, alopecia, skeletal abnormalities and endocrine disorders with a poor long-term prognosis due to early crippling. We report a 14-year-old Chilean girl with clinical and radiological features of the syndrome who has been successfully treated with prednisone and carbamazepine. She remarkably recovered from muscle spasms, alopecia and diarrhea. At follow up, 24 months later, she persists asymptomatic with considerable improvement in her quality of life.