Carlos Ferreira

Head-mounted display versus desktop for 3D navigation in virtual reality: a user study

Virtual Reality (VR) has been constantly evolving since its early days, and is now a fundamental technology in different application areas. User evaluation is a crucial step in the design and development of VR systems that do respond to users’ needs, as well as for identifying applications that indeed gain from the use of such technology. Yet, there is not much work reported concerning usability evaluation and validation of VR systems, when compared with the traditional desktop setup. The paper presents a user study performed, as a first step, for the evaluation of a low-cost VR system using a Head-Mounted Display (HMD). That system was compared to a traditional desktop setup through an experiment that assessed user performance, when carrying out navigation tasks in a game scenario for a short period. The results show that, although users were generally satisfied with the VR system, and found the HMD interaction intuitive and natural, most performed better with the desktop setup.

Autoimmune Bullous Dermatoses: A Review

Bullous dermatoses are a variety of autoimmune skin diseases that are characterized by the presence of bullae or blisters. Most of these diseases are associated with substantial morbidity, and a few may result in death. Although most general approaches to the treatment and diagnosis of these entities are similar, the diagnosis of the specific disease is important, because the most appropriate dosage and timing of some commonly used medications vary considerably. The review covers the management of main autoimmune bullous dermatoses, including bullous pemphigoid and pemphigus vulgaris, linear IgA dermatosis, dermatitis herpetiformis, and bullous systemic lupus erythematosus.

User-centered requirements engineering in health information systems

The use of sophisticated information and communication technologies (ICTs) in the health care domain is a way to improve the quality of services. However, there are also hazards associated with the introduction of ICTs in this domain and a great number of projects have failed due to the lack of systematic consideration of human and other non-technology issues throughout the design or implementation process, particularly in the requirements engineering process. This paper presents the methodological approach followed in the design process of a web-based information system (WbIS) for managing the clinical information in hemophilia care, which integrates the values and practices of user-centered design (UCD) activities into the principles of software engineering, particularly in the phase of requirements engineering (RE). This process followed a paradigm that combines a grounded theory for data collection with an evolutionary design based on constant development and refinement of the generic domain model using three well-known methodological approaches: (a) object-oriented system analysis; (b) task analysis; and, (c) prototyping, in a triangulation work. This approach seems to be a good solution for the requirements engineering process in this particular case of the health care domain, since the inherent weaknesses of individual methods are reduced, and emergent requirements are easier to elicit. Moreover, the requirements triangulation matrix gives the opportunity to look across the results of all used methods and decide what requirements are critical for the system success.

Multiple Aseptic Liver Abscesses as the Initial Manifestation of Crohn's Disease: Report of a Case

ABSTRACT: Aseptic liver abscesses preceding the diagnosis of Crohns disease are extremely rare. We report a patient with multiple liver abscesses that yielded negative microbiologic investigation and failed to develop full remission under antibiotic therapy. Diagnosis of Crohns disease of small and large bowel was later established and she was started on sulfasalazine and azathioprine with total regression of the hepatic abscesses. This case illustrates the rare possibility of aseptic liver abscesses as an initial manifestation of Crohns disease, which could be interpreted in the light of recent data on aberrant homing of gut T memory/effector lymphocytes in the liver.

Web-enabled registry of inherited bleeding disorders in Portugal: conditions and perception of the patients

Summary.  Local and national haemophilia registries are powerful instruments to support the healthcare and researchers and improve the communication between Comprehensive Haemophilia Diagnostic and Treatment Centres (HTCs) and patients. Hemo@care is an example of a Local Haemophilia Registry Systems (LHR_Sys) based on the Web, developed in collaboration with a HTC located in Portugal, to support the haemophilia treatments registry, collect and manage the clinical information and provide mechanisms to control the clotting factor concentrates (CFC) stock. To extend this solution (the hemo@care) to other Portuguese HTCs and consequently to meet the preconditions to create a National Haemophilia Registry Systems (NHR_Sys), a study based on a questionnaire was carried out at nationwide. This study aims to assess the conditions and motivations of people with haemophilia (PWH) geographically scattered throughout the country, to use a potential Web‐enabled registry with the purpose of replacing the traditional paper‐diaries, to understand their judgment about a potential NHR_Sys currently non‐existent in Portugal, and at the same time, to characterize demographically and pathologically those people at the nationwide. The results based on the analysis of 168 responses (response rate of 31%) confirmed the high prevalence of the disease in haemophilia A (75%) compared with haemophilia B (11.3%) and a large incidence in the severe levels, or the existence of people with mild severity without diagnosis and treatment. Furthermore, the results also revealed the need, conditions and motivation for using a registry system by PWH; thus it is deemed to justify the extension of the hemo@care to other HTCs in Portugal and consequently to create the NHR_Sys.

Assessment of quality in screening colonoscopy for colorectal cancer

Introduction The effectiveness of screening colonoscopy in decreasing the incidence of colorectal cancer (CRC) is largely dependent on the detection of polyps and the quality of the procedure. Several key quality measures have been proposed to improve the effectiveness of screening colonoscopies. Aim To evaluate quality indicators of screening colonoscopy in a tertiary hospital. Methods All CRC screening colonoscopies performed between 2005 and 2009 in a single tertiary center were reviewed for internationally accepted quality measures. Results Of the 1545 individuals who underwent first-time screening colonoscopy 38% were male and 62% were female. The mean age of the patients was 60.4 years and the mean difference in ages was ± 10.3 years. Cecal intubation rate was 91% (1336), however ileocecal valve photo documentation was performed in only 81% (1248) colonoscopies. The quality of bowel preparation was classified as: good 76% (1171), reasonable 11% (174), and poor 13% (200). Polyp detection rate (PDR) was 33% (503). The prevalence of polyps ≥1 cm in size was 5% (82). PDR was significantly higher in men than in women (44% [260] vs 25% [243], P = 0.0001). Other factors significantly influencing PDR were quality of bowel preparation (odds ratio [OR]: 1.28, 95% confidence interval [CI]: 0.9–1.6) and age over 50 (OR: 1.9, 95% CI: 1.3–2.9). Left colonic polyps were associated with a risk ratio of 2.3 (95% CI: 1.8–2.9) of lesions in the other colonic segments compared to no polyps in the left colon. None of the colonoscopists reported withdrawal time. Conclusion Cecal intubation rate and quality of bowel preparation were suboptimal. The polyp detection rate compares favorably to accepted standards and its main determinants are male sex, age >50 years, quality of bowel preparation, and the presence of left colonic polyps.

Alexithymia in Systemic Lupus Erythematosus Patients

This study aimed to determine the prevalence of alexithymic characteristics in patients with systemic lupus erythematosus (SLE), comparing them with a population of healthy subjects. Fifty‐three SLE patients [American College of Rheumatology (ACR) criteria] and 31 healthy volunteer subjects were administered validated scales for alexithymia (Toronto alexythimia scale‐20), psychopathology (brief symptom inventory; hospital anxiety and depression scale), personality dimensions (NEO five‐factor inventory), and quality of life (short form‐36 health survey). The SLE patients clinical and laboratory evaluations were performed by computerized indicators of activity (SLE disease activity index), of accumulated damage (Systemic Lupus International Collaborating Clinics/American College of Rheumatology damage index), length of disease, and therapy. A high prevalence of alexithymia was found in SLE patients. Alexithymia was associated with psychopathology, personality, and quality of life dimensions. Clinical variables and therapy were not correlated significantly with alexithymia, psychopathology, or quality of life dimensions. Multiple regression analysis showed that openness and depression were the two predictors for alexithymia in SLE patients. The present findings showed that alexithymia may play an important role in SLE patients. The difficulty in the management of emotions may lead to psychological distress and instability affecting the patients quality of life, a relevant finding for the psychological, psychiatric, and clinical intervention and approach.

Rituximab Therapy in Primary Sjögren's Syndrome

Primary Sjögrens syndrome is an autoimmune disease characterized by lymphocytic infiltration of glandular tissues leading to sicca symptoms, namely, dry eyes and dry mouth. In the majority of cases, the disease course is benign, albeit with considerable patient discomfort. Some patients, however, have systemic symptoms with arthritis, cutaneous vasculitis, low complement levels, and cryoglobulinemia. A small but not insignificant percentage of those patients evolve to B cell lymphoma. The increased expression of B cell survival factors, such as B cell activating factor, may promote the perpetuation of a B cell clone and precede the lymphoproliferative disease. Rituximab, a chimeric monoclonal antibody to CD20, leads to B cell depletion and may have a role in Sjögren systemic manifestations as well as in preventing and treating Sjögren‐associated lymphoma.

The relationship between alexithymia and psychological factors in systemic lupus erythematosus

BACKGROUND Alexithymia has been described as an important dimension in several medical diseases. Systemic lupus erythematosus (SLE) is a chronic condition characterized by unpredictable clinical manifestations. Our aim is to reveal which factors (psychological factors and quality of life dimensions) are associated with alexithymia in SLE patients. METHODS Fifty-three sequential SLE patients (ACR criteria) and 41 asthma patients were studied by means of validated scales for alexithymia (Toronto Alexithymia Scale), psychopathology (Brief Symptom Inventory, Hospital Anxiety and Depression Scale), personality dimensions (NEO-FFI), and quality of life (Short Form-36 Health Survey). Systemic lupus erythematosus patients clinical and laboratorial evaluation was performed by indicators of activity (Systemic Lupus Erythematosus Disease Activity Index) of accumulated damage (Systemic Lupus International Collaborating Clinics/ACR Damage Index), length of disease, and therapy. RESULTS An association between alexithymia and psychopathological symptoms, and personality and quality of life dimensions was found. By means of multiple regression analysis, openness and depression were the 2 predictors for alexithymia in SLE patients. We found a high prevalence rate of alexithymia in SLE patients; however, when controlling for depression symptoms (Hospital Anxiety and Depression Scale-Depression, <7), we found a lower percentage of alexithymic traits than that of the total sample of SLE. CONCLUSION Alexithymia was associated with psychological distress and with quality of life impairment. Understanding the role of psychological factors in SLE patients may contribute to a more comprehensive perspective of the disease, its impact on patients daily routine, and how patients adapt emotionally to a chronic disease.

Cardiac noradrenergic denervation in a patient with multiple symmetric lipomatosis.

Introduction: Multiple symmetric lipomatosis (MSL) is a rare disease of unknown etiology characterized by multiple subcutaneous lipomas with a symmetrical distribution. One interesting aspect about MSL is a high incidence of sudden cardiac death despite a low incidence of metabolic syndrome and coronary arterial disease. Autonomic nervous system dysfunction may probably explain this feature of MSL. Case Report: A 74-year-old man was admitted with acute heart failure and atrial fibrillation. He had a morphotype suggestive of MLS. A 123I-metaiodobenzylguanidine myocardial scintigraphy was conducted for evaluation of cardiac autonomic nervous integrity, since atrial fibrillation precluded the classical approach. The heart-to-mediastinum ratio was 1.68 (normal >2.2). Ischemia was not detected in myocardial perfusion scintigraphy. Conclusion: We present the first reported case of MSL autonomic neuropathy detected by 123I- metaiodobenzylguanidine scintigraphy and suggest that this approach could play a role in MSL stratification by risk of sudden cardiac death and in exploring MSL disease mechanisms.