Diagnosis of Human Leptospirosis in a Clinical Setting: Real-Time PCR High Resolution Melting Analysis for Detection of Leptospira at the Onset of Disease:

Currently, direct detection of Leptospira can be done in clinical laboratories by conventional and by real-time PCR (qRT-PCR). We tested a biobank of paired samples of serum and urine from the same patient (202 patients) presenting at the hospital in an area endemic for leptospirosis using qRT-PCR followed by high resolution melting (HRM) analysis. The results were compared with those obtained by conventional nested PCR and with the serologic gold standard microscopic agglutination test (MAT). Differences were resolved by sequencing. qRT-PCR-HRM was positive for 46 of the 202 patients (22.7%, accuracy 100%) which is consistent with known prevalence of leptospirosis in the Azores. MAT results were positive for 3 of the 46 patients (6.5%). Analysis of paired samples allowed us to identify the illness point at which patients presented at the hospital: onset, dissemination or excretion. The melting curve analysis of Leptospira species revealed that 60.9% (28/46) of patients were infected with L. interrogans and 39.1% (18/46) were infected with L. borgpetersenii, both endemic to the Azores. We validated the use of qRT-PCR-HRM for diagnosis of leptospirosis and for identification of the Leptospira species at the earliest onset of infection in a clinical setting, in less than 2 hours.publishersversionpublishe

Pé diabético na atenção básica: uma revisão de literatura: Diabetic foot in primary care: a literature review

A diabetes se trata de uma patologia decorrente da descompensação da glicose, sendo por reação autoimune que danifica as células de produção de insulina ou por resistência insulínica de tecidos. O descontrole da glicose pode significar um grande perigo ao paciente diabético, elevando o risco de sepse,  neuropatias, dificultando a cicatrização e se agravando para a síndrome do Pé Diabético. No mundo, são mais de 40 milhões de pessoas com a síndrome do Pé Diabético, se tratando de um problema de saúde pública pandêmico. Alguns fatos como falta de conhecimento sobre o assunto, negligência médica, falta de acesso à saúde, não seguimento das orientações passadas pela equipe de saúde da atenção básica por parte do paciente ou não reforçar a importância das orientações contribuem para o surgimento da síndrome. Logo é importante saber os principais tópicos em Pé Diabético para o atendimento na Atenção Básica à Saúde para uma boa orientação para os pacientes.A diabetes se trata de uma patologia decorrente da descompensação da glicose, sendo por reação autoimune que danifica as células de produção de insulina ou por resistência insulínica de tecidos. O descontrole da glicose pode significar um grande perigo ao paciente diabético, elevando o risco de sepse,  neuropatias, dificultando a cicatrização e se agravando para a síndrome do Pé Diabético. No mundo, são mais de 40 milhões de pessoas com a síndrome do Pé Diabético, se tratando de um problema de saúde pública pandêmico. Alguns fatos como falta de conhecimento sobre o assunto, negligência médica, falta de acesso à saúde, não seguimento das orientações passadas pela equipe de saúde da atenção básica por parte do paciente ou não reforçar a importância das orientações contribuem para o surgimento da síndrome. Logo é importante saber os principais tópicos em Pé Diabético para o atendimento na Atenção Básica à Saúde para uma boa orientação para os pacientes

Influenza severe cases in hospitals, between 2014 and 2016 in Portugal

Rede Portuguesa de Laboratórios para o Diagnóstico da GripeBackground: Since 2009, the Portuguese Laboratory Network (PLNID) for Influenza Diagnosis has integrated 15 Laboratories in mainland and Atlantic Islands of Azores and Madeira. This PLNID added an important contribute to the National Influenza Surveillance Program regarding severe and hospitalized influenza cases. The present study aims to describe influenza viruses detected in influenza like illness (ILI) cases: outpatients (Outp), hospitalized (Hosp), and intensive care units (ICU), between 2014 and 2016. Methods: The PLNID performs influenza virus diagnosis by biomolecular methodologies. Weekly reports to the National Influenza Reference Laboratory ILI cases tested for influenza. Reports include data on detecting viruses, hospital assistance, antiviral therapeutics, and information on death outcome. Were reported during two winter seasons 8059 ILI cases,being 3560 cases in 2014/15 (1024 in Outp, 1750 Hosp, and 606 in ICU) and 4499 cases in 2015/2016 (1933 in Outp, 1826 Hosp, and 740 in ICU). Results: The higher percentage of influenza positive cases were detected in Outp in both seasons, 18% during 2014/15 and 20% in 2015/16. In 2014/15,influenza cases were more frequent in individuals older than 65 years old and these required more hospitalizations,even in ICU. In 2015/16,the influenza cases were mainly detected in individuals between 15-64 years old. A higher proportion of influenza positive cases with hospitalization in ICU were observed in adults between 45-64 years old.During the study period,the predominant circulating influenza viruses were different in the two seasons: influenza B and A(H3) co-circulated in 2014/15,and influenza A(H1)pdm09 was predominant during 2015/16. Even when influenza A is notthe dominant virus, A(H3) and A(H1)pdm09 subtypes correlate with higher detection rate in hospitalized cases (Hosp and UCI), with higher frequencies in adults older than 45. Influenza B,detected in higher proportion in outpatients, was frequently relatedwith influenza cases in younger age groups: 0-4 and 5-14 years old. Conclusions: This study highlights the correlation of theinfluenza virus type/subtype that circulates in each season with the possible need for hospitalization and intensive care in special groups of the population. Circulation of influenza A subtypes can cause more frequentdisease in individuals older than 45, with need of hospitalization including intensive care. On the other hand, influenza B is more frequently associated with less severe cases and with infection in children and younger adults. Influenza B circulation might predict lower number of hospitalizations.The identification of influenza type in circulation,byPLNID ineach season, could guide action planning measures in population health care.info:eu-repo/semantics/publishedVersio

Human leptospirosis: seroreactivity and genetic susceptibility in the population of São Miguel Island (Azores, Portugal).

BackgroundLeptospirosis is a worldwide zoonotic and recognized neglected infectious disease. It has been observed that only a proportion of individuals exposed to pathogenic species of Leptospira become infected and develop clinically evident disease. Moreover, little information is available in subsequent reinfections. In the present study, we determine if a first infection with leptospirosis protects against subsequent reinfection, and investigate which of the host genetic factors are involved in the susceptibility and resistance to leptospirosis.Methodology and findingsWe conducted, in 2011, a retrospective hospital-based case-control study in the São Miguel Island population (Azores archipelago). In order to determine the seropositivity against pathogenic Leptospira after the first episode of leptospirosis, we performed a serological evaluation in 97 unrelated participants diagnosed with leptospirosis between 1992 and 2011. The results revealed that 46.4% of the 97 participants have circulating anti-Leptospira antibodies, and from these participants 35.6% maintained the seroprevalence for the same serogroup. Moreover, three of them were reinfected with unrelated Leptospira serovars. The genetic study was carried out by adding a control group composed of 470 unrelated healthy blood donors, also from São Miguel Island. Twenty five SNPs among twelve innate immune genes - IL1α, IL1β, IL6, IL10, IL12RB1, TLR2, TLR4, TLR9, CD14, CISH, LTA and TNF - were genotyped, as well as HLA class I (-A and -B) genes. Association analysis indicates that genotypes -511GG (OR=1.6, 95%CI 1.01-2.56, p=0.04) in IL1β, +1196CG (OR=2.0, 95%CI 1.26-3.27, p=0.003) in IL12RB1, -292TA (OR=1.8, 95% CI 1.06-2.1, p=0.03) and +3415CG (OR=1.8, 95% CI 1.08-3.08, p=0.02), both in CISH confer susceptibility to pathogenic Leptospira.ConclusionThe present study suggests some degree of long-term protection against leptospires with an attenuation of symptoms in case of reinfection. Moreover, our data supports the genetic influence of IL1β, IL12RB1 and CISH genes and the susceptibility to leptospirosis infection

Fitoterapia: uma tecnologia de cuidado proximal comunitária à pessoa idosa e sua família – práticas populares aliadas aos conhecimentos científicos

O objetivo do estudo foi demonstrar a eficácia do uso dos fitoterápicos Carica Papaya e Myracrodruon urundeuva Allemão no cuidado às pessoas idosas com úlceras por pressão, arterial e neuropática de membros inferiores. O cuidado foi provido no domicílio dos idosos por um núcleo de ensino-pesquisa-extensão. Os resultados demonstraram a importância de aliar o saber popular e científico na promoção da saúde, e da ação conjunta entre profissionais de saúde e família na abordagem da Farmácia Viva – SUS – no tratamento de feridas. </p

MAT serological data obtained in 2011, after <i>n</i> years of first confirmed diagnosis.

<p>MAT serological data obtained in 2011, after <i>n</i> years of first confirmed diagnosis.</p

Significative genotype frequencies and susceptibility to leptospirosis.

<p>Bold refers to the significant association.</p><p>Significative genotype frequencies and susceptibility to leptospirosis.</p

Serological evaluation: comparison of Microscopic Agglutination Test (MAT) positive results (retrospective and in 2011).

<p>ND: not determined (borderline reactivity). A unique sample was collected from these individuals; the observed titles were below the cut-off (1∶160), value taken by the reference laboratory (IHMT) to endemic areas.</p><p>NA: not applicable.</p><p>Serological evaluation: comparison of Microscopic Agglutination Test (MAT) positive results (retrospective and in 2011).</p

Demographic, clinical and laboratory characterization of the 97 leptospirosis participants.

a<p>ALT: Alanine transaminase/ASP: Aspartate transaminase.</p>b<p>ALP: Alkaline phosphatase/GGT: Gamma glutamyltransferase.</p>c<p>Kreatinine Kinase.</p><p>Demographic, clinical and laboratory characterization of the 97 leptospirosis participants.</p