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Considering the growing volume of information and services available on the Web, it has become essential to provide Web sites and applications with tools, such as recommender systems, capable of helping their users to obtain the information and services appropriate to their interests. Due to the complexity of Web adaptation and the ability of multi-agent systems to deal with complex problems, the multi-agent systems technology have been increasing. In this paper, we present a thorough survey of the use of multi-agent-based recommender systems. The results show that the use of multi-agent systems in recommender systems is increasing. The review shows the diversity of applications of multi-agent systems in recommender systems, namely on what concerns to the diversity of domains, different types of approaches, contributing to improving the performance of the recommendation systems. info:eu-repo/semantics/publishedVersion

Guiding the building occupants under fire emergency to a safe place is an open research problem, and finding solutions to address the problem requires a perfect knowledge of the fire building evacuation domain. The use of ontologies to model knowledge of a domain allows a common and shared understanding of that domain, between people and heterogeneous systems. This paper presents an ontology that aims to build a knowledge model to understand the referred domain better and help develop more capable building evacuation solutions and systems. The herein proposed ontology considers the different variables and actors involved in the fire building evacuation process. We followed the Methontology methodology for its developing, and we present all the development steps, from the specification to its implementation with the Protégé tool. info:eu-repo/semantics/publishedVersion

The herein proposed research project brings together the area of the multi-agent recommender systems and the IoT and aims to study the extent to which a context-based multi-agent recommender system can contribute to improving efficiency in the evacuation of buildings under a fire emergency, recommending the most adequate and efficient evacuation routes in real time. info:eu-repo/semantics/publishedVersion

Patient EAC, female, 33, with previous history of hypertension, presented dyspnea, palpitations, and edema of the lower limbs for about 15 years, with worsening for approximately 10 months and evolving to dyspnea at rest and paroxysmal nocturnal dyspnea in recent days. Cardiac auscultation was irregular heart rhythm with holosystolic murmur (5 +/6 +) continues along the right sternal border.

The present study reports a case of a young male patient, 22 years old, with a previous diagnosis of Hodgkin’s lymphoma who presented for two weeks with dyspnea complaints with minimum efforts, a continuous chest pain on pressure, dysphagia, sporadic palpitations, and dry cough with fever episodes not measured. Physical exam revealed presence of fever, bibasal pulmonary crackles in respiratory auscultation, increased jugular venous pulse, and hypotension associated with paradoxical pulse, and hypotension associated with paradoxical pulse were found. No more pathological finding was noticed.

Tuberculous pericarditis is a rare condition, with significant severity, in patients infected with Mycobacterium tuberculosis or in a state of relapse of the disease. An initial diagnosis of symptoms is fundamentally important for the proper treatment of the patient. The clinical case presents a 37-year-old male patient, who complained of dyspnea and progressive chest pain for 20 days. Patient had undergone pulmonary tuberculosis treatment and surgical procedure 5 months ago due to complication of the disease. According to clinic and patient’s previous history, tuberculous pericarditis was suspected. In this condition, the pericardium can be affected by Koch’s bacillus through hematogenous dissemination during the course of endogenous reactivation of pulmonary focus or by direct extension of the disease in the lung, pleura, and tracheobronchial lymph nodes into the pericardial cavity. Proof of diagnosis is performed by demonstration of tubercle bacilli in pericardial material, through pericardial culture or pericardial fluid biopsy. The echocardiogram is the most effective diagnostic test for the disease. Pericardial tuberculosis has a variable presentation that makes it difficult to diagnose and may delay the start of adequate treatment. Rapid institution of the clinical suspicion and accomplishment of the diagnostic tests are definitive for a better prognosis of the patient.

Este estudo teve por objetivo identificar o perfil dos pacientes com insuficiência cardíaca (IC) descompensada internados em hospital terciário da região norte do Ceará. A amostra consistiu em casos de internação por descompensação de IC no período entre 1° de abril e 31 de dezembro de 2017. As informações foram coletadas a partir de entrevistas com os pacientes e dos prontuários médicos. Dos 148 pacientes selecionados, 63,5% eram indivíduos do sexo masculino, 60,1% tinham acima de 65 anos, 50,7% cursaram até o Ensino Fundamental e 93,2% se autodeclararam de cor branca. A classe funcional IV (CF IV) foi a mais prevalente (50,0%), seguida pela CF III (39,1%). Observou-se significância estatística nos preditores de mortalidade: história de cirurgia de revascularização do miocárdio; anemia; diabetes mellitus (DM); perfil hemodinâmico frio/congesto no momento da admissão hospitalar; etiologia isquêmica; creatinina > 1,4 mg/dL; e glicemia > 180 mg/dL. Constatou-se a necessidade de intervenções voltadas ao controle clínico da IC para diminuir a incidência de descompensação em programas de promoção e educação continuada em saúde e para avaliar a adesão ao tratamento e o adequado manejo terapêutico da IC nos serviços públicos de saúde.

In our research work we plan to develop a Multi-agent based Recommender System to help e-learning systems recommend the more appropriate learning resources to students. In our approach we will explore the multi-agent technology potentialities to build a solution where multiple collaborative and content filtering algorithms, working together, leads to a higher performance solution than that obtained with individual algorithms.

O hemangioma colorretal (HCR) é uma lesão vascular benigna rara, com manifestação clínica geralmente entre 5 e 25 anos de idade. Faz parte do diagnóstico diferencial das causas de hemorragia digestiva baixa, sendo confundido, na maioria das vezes, com entidades mais comuns, como hemorróidas e doenças inflamatórias intestinais. O retardo do diagnóstico ocorre freqüentemente devido ao desconhecimento da doença, com taxas de mortalidade alcançando 40 a 50% na presença de sangramento importante. O caso relatado é de uma paciente de 17 anos de idade, admitida no Serviço de Colo-proctologia do Hospital Universitário - HUUFMA, em setembro de 2005, com anemia e sangramento retal, desde a infância, de forma intermitente e não dolorosa. Apresentado sua história clínica e propedêutica diagnóstica, realizada por meio de exames laboratoriais, endoscopia digestiva alta, colonoscopia e arteriografia de mesentéricas e ilíacas internas. O tratamento cirúrgico realizado foi retossigmoidectomia convencional com anastomose colorretal baixa, com boa evolução pós-operatória, tendo o exame histopatológico da peça cirúrgica ressecada, confirmado o diagnostico.The colon and rectum hemangioma is a rare benign vascular lesion, with clinical features usually between 5 and 25 years of age. It is included in the differential diagnose of the lower digestive bleeding causes, and has been frequently misdiagnosed with other more common entities, like hemorrhoids and bowel inflammatory disease. The late diagnose occurs usually because of the rarity of the disease, with mortality rates reaching 40 to 50% in presence of severe bleeding. We report a case of a 17 years old girl who was admitted at the Coloproctology Service of the Academic Hospital - HUUFMA, in September 2005, with anemia and intermittent rectal bleeding since childhood. Laboratorial findings included laboratorial exams, GI endoscopy, colonoscopy and arteriography of mesenteric and internal iliacs arteries. Conventional rectosigmoidectomy with low colorectal anastomosis was done, with good postoperative evolution and histopathologic examination of the resected specimen.

Resumo Introdução: A prevenção da nefropatia induzida por contraste (NIC) é difícil nas situações de emergência, tornando essenciais estudos sobre NIC em pacientes submetidos à angioplastia de urgência. Objetivo: Determinar a incidência e fatores associados à NIC em pacientes com infarto agudo do miocárdio (IAM) submetidos à angioplastia nas primeiras 12 horas após início dos sintomas. Métodos: Foram estudados 201 casos consecutivos de IAM com supradesnivelamento do segmento ST com menos de 12 horas de evolução. Todos os pacientes foram submetidos ao mesmo protocolo de angioplastia. A NIC foi definida como elevação absoluta da creatinina de pelo menos 0,5 mg/dL e/ou aumento relativo da creatinina de 25% em relação ao valor basal no período entre 48 e 72 horas após a administração do contraste. As variáveis que diferiram entre os pacientes com e sem NIC na análise univariada foram analisadas por regressão logística. Resultados: A amostra foi formada por 135 (67,2%) homens e 66 (32,8%) mulheres com idade média de 66,6 ± 11,7 anos. A incidência de NIC foi de 23,8%. Na análise univariada os pacientes com NIC eram mais idosos e com maior frequência de fração de ejeção do ventrículo esquerdo ≤ 40% e da classificação Killip ≥ 2. Na análise multivariada não foram encontrados preditores independentes de NIC. Conclusão: A NIC acomete ¼ dos pacientes com IAM submetidos à angioplastia sem variáveis preditoras. Esse resultado ressalta a necessidade de medidas preventivas para NIC após uso de contraste em angioplastia de urgência. Abstract Introduction: The prevention of contrast-induced nephropathy (CIN) is difficult in emergency situations, making it essential to study CIN in patients submitted to urgent angioplasty. Objective: To determine the incidence and associated factors to CIN in patients with myocardial infarction (MI) submitted to primary angioplasty in the first 12 hours after onset of symptoms. Methods: We studied 201 consecutive cases of MI with ST-segment elevation with less than 12 hours of evolution. All patients were submitted to the same angioplasty protocol. CIN was defined as an absolute increase of creatinine of at least 0.5 mg/dL and/or a relative increase of creatinine of 25% in relation to baseline in a period between 48 and 72 hours after contrast administration. The variables that differed between patients with and without CIN in univariate analysis were analyzed by logistic regression. Results: The sample was formed by 135 (67.2%) men and 66 (32.8%) women, with mean age of 66.6 ± 11.7 years. The incidence of CIN was 23.8%. In univariate analysis the patients with CIN were older and had higher frequency of left ventricular ejection fraction ≤ 40% and Killip classification ≥ 2. In multivariate analysis, we did not find independent predictors of CIN. Conclusion: CIN occurred in ¼ of the patients with MI submitted to angioplasty without predictor variables. This finding highlights the need for CIN preventive measures after contrast use in emergency angioplasty.

O câncer colorretal (CCR) é a quarta neoplasia maligna mais incidente no Brasil. Seu diagnóstico em pacientes jovens é geralmente subestimado pelos médicos por ser frequentemente considerada como condição clínica de pacientes idosos. O presente trabalho tem como objetivo avaliar variáveis clínico-patológicas em pacientes com menos de 40 anos, no que diz respeito a idade, sexo e raça do paciente, história familiar, tabagismo, sinais e sintomas, tempo entre início dos sintomas e o diagnóstico, e localização da lesão primária, através de estudo retrospectivo de 11 casos de CCR atendidos no Hospital Universitário - HUUFMA no período de 1995 a 2005. Os pacientes incluídos representaram 11 (3,27%) dos casos, sendo mais freqüente o sexo feminino (54,5%). A idade média ao diagnóstico foi de 30,5 anos. Os sinais e sintomas mais prevalentes foram dor abdominal, alteração do hábito intestinal, perda ponderal, dor retal e hematoquezia. O tempo médio entre o início da sintomatologia e o aparecimento dos sintomas foi de 9,09 meses. A maioria das lesões encontrava-se no retossigmóide e reto (81,8%). Cerca de 80% dos pacientes apresentaram carcinoma estágios C e D da classificação de Dukes Astler-Coller. Pacientes jovens portadores de CCR apresentam, geralmente, sintomatologia rica, com doença avançada ao diagnóstico, portanto, com menor possibilidade de cura e prognóstico mais reservado.The colorectal cancer (CRC) is the fourth incident malignant neoplasm in Brazil. Its diagnosis in young patients is usually underestimated by being frequently considered as elderly patients' clinical condition. This research has the objective to evaluate clinical-pathological variables in patients below 40 years, according to age, gender, ethnic, family history, smoking, signs and symptoms, time from the beginning of the symptoms to the diagnosis, and location of the primary lesion through retrospective study of 11 cases of CRC assisted at the Academical Hospital - HUUFMA in the period from 1995 to 2005. The included patients represented 11 (3,27%) of the cases which are more frequent in women (54,5%). The average age to the diagnosis was 30,5 years. The signs and symptoms more prevalent were abdominal pain, intestinal habit alterations, weight loss, rectal pain and hematoquezy. The average time from the beginning of the sintomatology to the emergence of the symptoms was of 9,09 months. Most of the lesions were founded in the recto-sigmoid and rectum (81,8%). Around 80% of the patients presented carcinoma in stages C and D of Dukes Astler-Coller's classification. Young patients with CRC have usually vast symptomatology with advanced disease at the diagnosis, therefore with smaller cure possibility and worse prognosis.

Due to the large amount of pages in Websites it is important to collect knowledge about users’ previous visits in order to provide patterns that allow the customization of the Website. In previous work we proposed a multi-agent approach using agents with two different algorithms (associative rules and collaborative filtering) and showed the results of the offline tests. Both algorithms are incremental and work with binary data. In this paper we present the results of experiments held online. Results show that this multi-agent approach combining different algorithms is capable of improving user’s satisfaction. info:eu-repo/semantics/publishedVersion

Apesar dos avancos na cirurgia de Fontan, obstrucoes nos condutos extracardiacos podem ocorrer e causar deterioracao clinica. Relatamos dois casos em que foram realizados implante de stent para correcao de estenose na cirurgia de Fontan. Ascite era o sinal clinico comum; um paciente tinha enteropatia perdedora de proteinas.Todos os procedimentos obtiveram sucesso angiografico e clinico.

O espasmo de artérias coronárias no perioperatório de cirurgia de revascularização do miocárdio é uma complicação grave, com elevada mortalidade. Paciente de 51 anos submetido à cirurgia de revascularização do miocárdio sem circulação extracorpórea. Apresentou no 1ºdia de pós-operatório (PO) alteração enzimática e supradesnivelamento do segmento ST, evoluindo, em seguida, em fibrilação ventricular, com reanimação cardiopulmonar com sucesso. Cateterismo cardíaco demonstrou espasmo importante de todas as artérias coronárias e da anastomose entre artéria torácica interna esquerda com artéria interventricular anterior. Utilizados vasodilatadores intracoronarianos e intra-enxerto, com restabelecimento de seus calibres usuais, imediata melhora clínica e estabilidade hemodinâmica. Com evolução satisfatória, o paciente recebeu alta hospitalar no 13º PO. Coronary artery spasm in perioperative of coronary artery bypass graft surgery is a serious complication, with high rate mortality. Patient 51 years-old submitted to coronary artery bypass graft surgery without Extracorporeal Circulation. The patient evolved in 1st post operative (PO) day with enzymatic alteration and ST-elevation, developing soon afterwards in ventricular fibrillation, defibrillation with success. Cardiac catheterization showed important spasm of all coronary arteries and anastomosis between the left internal thoracic artery and the left anterior interventricular artery. Intracoronary Vasodilators and intra-graft, with re-establishment of their usual and immediate calibers to improve clinic and Hemodynamic stability was used. Satisfactory evolution, discharged at 13rd PO day.

Despite advances in Fontan surgery, obstruction in extracardiac ducts may occur and cause clinical deterioration. We report two cases of stent implantation for correction of stenosis in the Fontan surgery. Ascites was a common clinical sign; a patient was protein losing enteropathy. All procedures were angiographically and clinically successful.

INTRODUCAO: A realizacao do cateterismo cardiaco diagnostico e da intervencao coronaria percutânea (ICP) no mesmo procedimento (ICP ad hoc) tem sido uma pratica crescente. Estudos tem apontado como vantagens dessa estrategia a reducao dos custos hospitalares, a maior comodidade para o paciente e a diminuicao das complicacoes vasculares. METODO: Neste estudo, 651 pacientes com angina estavel foram randomizados para ICP ad hoc ou ICP estagiada. O desfecho primario foi a composicao de: morte cardiaca, infarto agudo do miocardio (IAM), cirurgia cardiaca de urgencia, acidente vascular cerebral (AVC) ou complicacoes hemorragicas. RESULTADOS: O desfecho primario ocorreu em 2,9% na ICP ad hoc vs. 4,4% na ICP estagiada (P = 0,406). A analise isolada dos eventos clinicos nao evidencia diferencas significativas entre os grupos: morte por causa cardiaca ocorreu em 1% na ICP ad hoc vs. 0,3% na ICP estagiada (P = 0,354); IAM ocorreu em 1,3% na ICP ad hoc vs. 1,2% na ICP estagiada (P > 0,99) e AVC ocorreu em 0,3% na ICP ad hoc vs. 0,3% na ICP estagiada (P > 0,99). A taxa de complicacoes hemorragicas foi significativamente maior na ICP estagiada (1% vs. 3,5%; P = 0,035). Os preditores independentes do desfecho primario foram: IAM previo (odds ratio [OR] = 6,287; intervalo de confianca de 95% [IC 95%] 1,62-24,36; P = 0,008), vasculopatia periferica (OR = 16,97; IC 95% 6,39-45,01; P = 0,0001) e doenca coronaria multiarterial (OR = 13,97; IC 95% 3,65-53,50; P = 0,0001). CONCLUSAO: O estudo demonstrou que a ICP ad hoc e tao segura e eficaz quanto a ICP estagiada em pacientes com angina estavel, e esta associada a taxa significativamente menor de complicacoes hemorragicas relacionadas ao acesso vascular.

O hemangioma colorretal (HCR) é uma lesão vascular benigna rara, com manifestação clínica geralmente entre 5 e 25 anos de idade. Faz parte do diagnóstico diferencial das causas de hemorragia digestiva baixa, sendo confundido, na maioria das vezes, com entidades mais comuns, como hemorróidas e doenças inflamatórias intestinais. O retardo do diagnóstico ocorre freqüentemente devido ao desconhecimento da doença, com taxas de mortalidade alcançando 40 a 50% na presença de sangramento importante. O caso relatado é de uma paciente de 17 anos de idade, admitida no Serviço de Colo-proctologia do Hospital Universitário - HUUFMA, em setembro de 2005, com anemia e sangramento retal, desde a infância, de forma intermitente e não dolorosa. Apresentado sua história clínica e propedêutica diagnóstica, realizada por meio de exames laboratoriais, endoscopia digestiva alta, colonoscopia e arteriografia de mesentéricas e ilíacas internas. O tratamento cirúrgico realizado foi retossigmoidectomia convencional com anastomose colorretal baixa, com boa evolução pós-operatória, tendo o exame histopatológico da peça cirúrgica ressecada, confirmado o diagnostico. The colon and rectum hemangioma is a rare benign vascular lesion, with clinical features usually between 5 and 25 years of age. It is included in the differential diagnose of the lower digestive bleeding causes, and has been frequently misdiagnosed with other more common entities, like hemorrhoids and bowel inflammatory disease. The late diagnose occurs usually because of the rarity of the disease, with mortality rates reaching 40 to 50% in presence of severe bleeding. We report a case of a 17 years old girl who was admitted at the Coloproctology Service of the Academic Hospital - HUUFMA, in September 2005, with anemia and intermittent rectal bleeding since childhood. Laboratorial findings included laboratorial exams, GI endoscopy, colonoscopy and arteriography of mesenteric and internal iliacs arteries. Conventional rectosigmoidectomy with low colorectal anastomosis was done, with good postoperative evolution and histopathologic examination of the resected specimen.

O câncer colorretal (CCR) é a quarta neoplasia maligna mais incidente no Brasil. Seu diagnóstico em pacientes jovens é geralmente subestimado pelos médicos por ser frequentemente considerada como condição clínica de pacientes idosos. O presente trabalho tem como objetivo avaliar variáveis clínico-patológicas em pacientes com menos de 40 anos, no que diz respeito a idade, sexo e raça do paciente, história familiar, tabagismo, sinais e sintomas, tempo entre início dos sintomas e o diagnóstico, e localização da lesão primária, através de estudo retrospectivo de 11 casos de CCR atendidos no Hospital Universitário - HUUFMA no período de 1995 a 2005. Os pacientes incluídos representaram 11 (3,27%) dos casos, sendo mais freqüente o sexo feminino (54,5%). A idade média ao diagnóstico foi de 30,5 anos. Os sinais e sintomas mais prevalentes foram dor abdominal, alteração do hábito intestinal, perda ponderal, dor retal e hematoquezia. O tempo médio entre o início da sintomatologia e o aparecimento dos sintomas foi de 9,09 meses. A maioria das lesões encontrava-se no retossigmóide e reto (81,8%). Cerca de 80% dos pacientes apresentaram carcinoma estágios C e D da classificação de Dukes Astler-Coller. Pacientes jovens portadores de CCR apresentam, geralmente, sintomatologia rica, com doença avançada ao diagnóstico, portanto, com menor possibilidade de cura e prognóstico mais reservado. The colorectal cancer (CRC) is the fourth incident malignant neoplasm in Brazil. Its diagnosis in young patients is usually underestimated by being frequently considered as elderly patients' clinical condition. This research has the objective to evaluate clinical-pathological variables in patients below 40 years, according to age, gender, ethnic, family history, smoking, signs and symptoms, time from the beginning of the symptoms to the diagnosis, and location of the primary lesion through retrospective study of 11 cases of CRC assisted at the Academical Hospital - HUUFMA in the period from 1995 to 2005. The included patients represented 11 (3,27%) of the cases which are more frequent in women (54,5%). The average age to the diagnosis was 30,5 years. The signs and symptoms more prevalent were abdominal pain, intestinal habit alterations, weight loss, rectal pain and hematoquezy. The average time from the beginning of the sintomatology to the emergence of the symptoms was of 9,09 months. Most of the lesions were founded in the recto-sigmoid and rectum (81,8%). Around 80% of the patients presented carcinoma in stages C and D of Dukes Astler-Coller's classification. Young patients with CRC have usually vast symptomatology with advanced disease at the diagnosis, therefore with smaller cure possibility and worse prognosis.