Rapid response of a public health reference laboratory to the COVID-19 pandemic.

Introduction. Brazil was one of the most affected countries by the COVID-19 pandemic. Instituto Adolfo Lutz (IAL) is the reference laboratory for COVID-19 in São Paulo, the most populous state in Brazil. In April 2020, a secondary diagnostic pole named IAL-2 was created to enhance IAL's capacity for COVID-19 diagnosis.Hypothesis/Gap Statement. Public health laboratories must be prepared to rapidly respond to emerging epidemics or pandemics.Aim. To describe the design of IAL-2 and correlate the results of RT-qPCR tests for COVID-19 with secondary data on suspected cases of SARS-CoV-2 infection in the São Paulo state.Methodology. This is a retrospective study based on the analysis of secondary data from patients suspected of infection by SARS-CoV-2 whose clinical samples were submitted to real-time PCR after reverse transcription (RT-qPCR) at IAL-2, between 1 April 2020 and 8 March 2022. RT-qPCR Ct results of the different kits used were also analysed.Results. IAL-2 was implemented in April 2020, just over a month after the detection of the first COVID-19 case in Brazil. The laboratory performed 304,250 RT-qPCR tests during the study period, of which 98 319 (32.3 %) were positive, 205827 (67.7 %) negative, and 104 (0.03 %) inconclusive for SARS-CoV-2. RT-qPCR Ct values≤30 for E/N genes of SARS-CoV-2 were presented by 79.7 % of all the samples included in the study.Conclusion. IAL was able to rapidly implement a new laboratory structure to support the processing of an enormous number of samples for diagnosis of COVID-19, outlining strategies to carry out work with quality, using different RT-qPCR protocols.

Tropical Red Fruit Blend Foam Mat Drying: Effect of Combination of Additives and Drying Temperatures.

Foam mat drying is a widely used technique for liquid products because it has a number of advantages; however, for an efficient process, the choice of additives and temperatures is extremely important. The objective of this study was to evaluate the effect of additives and drying temperatures on the powders obtained from the blend of tropical red fruits, such as acerola, guava, and pitanga. The foam formulations were prepared by mixing the pulps of the three fruits in equal proportions (1:1:1), all added with 6% albumin and 1% stabilizing agent: E1, gum Arabic; E2, guar gum; E3, gelatin. The combinations were subjected to beating, and subsequently, they were dried in an oven with forced air circulation at four temperatures (50 to 80 °C), with a mat thickness of 0.5 cm. The obtained powders showed low levels of water and water activity and high levels of bioactive compounds, colors with a predominance of yellow, intermediate cohesiveness, poor fluidity, and solubility above 50%. The best temperature for obtaining the powders was 60 °C. The formulation that produced the best results for the production of the tropical red fruit blend powder was the combination of albumin and gelatin.

Aborto em Marabá, Pará: fatores e motivos associados / Aborto en Marabá, Pará: factores asociados y razones / Abortion in Marabá, Pará: associated factors and reasons

O bjetivo: i dentificar o perfil sociodemográfico e de abortamento provocado por mulheres residentes em Marabá , Pará e os principais fatores e motivos associados. Método: es tudo quantitativo, do tipo transversal, por meio de questionários coletados de março a dezembro de 2020, envolvendo 394 mulheres residentes em Marabá, alfabetizadas e com idade maior ou igual a 18 anos. Resultados: 37 mulheres que já tiveram algum aborto estavam na faixa etária de 25 a 29 anos, com ensino superior, solteira, com renda familiar de um a dois salários - mínimos, católica e doméstica. Os principais motivos para abortar foram: falta de condições financeiras, não estar preparada para ser mãe e rel ação instável com o parceiro. Conclusão: o aborto provocado é reflexo de um paradigma socioeconômico desigual e sua criminalização traz impedimentos à assistência e reconhecimento do problema.(AU)

Objective: t o identify the sociodemographic and abortion profile of women residing in Marabá , Pará and the main associated factors and reasons. Method: quantitative, cross - sectional study, through questionnaires collected from March to December 2020, involving 394 women residing in Marabá, literate and aged 18 years or older. Results: t he results showed that the 37 women who had already had an abortion w ere aged between 25 and 29 years, with higher education, single, with a family income of one to two minimum wages, catholic and domestic. The main reasons for abortion were lack of financial conditions, not being prepared to be a mother and unstable relati onship with the partner. Conclusion: induced abortion reflects an unequal socioeconomic paradigm, and its criminalization brings obstacles to care and recognition of the problem.(AU)

Objetivo: i dentificar el perfil sociodemográfico y de aborto de las mujeres residentes en Marabá , Pará y los principales factores y motivos asociados. Método: estudio transversal, través de cuestionarios recolectados de marzo a diciembre de 2020, i nvolucrando a 394 mujeres residentes en Marabá, alfabetizadas y con 18 años o más. Resultados: 37 mujeres que ya habían abortado tenían entre 25 y 29 años, con estudios superiores, solteras, con ingreso familiar de uno a dos salarios mínimos, católicas y d omésticas. Los principales motivos del aborto fueron: falta de condiciones económicas, no estar preparada para ser madre y relación inestable en pareja. Conclusión: el aborto inducido es reflejo de un paradigma socioeconómico desigual y su criminalización trae obstáculos para la atención y reconocimiento del problema.(AU)

Knowledge, attitudes and practices of nurses regarding oral hygiene of dependent inpatients.

OBJECTIVE: Assess nurses' knowledge, attitudes and practices towards oral hygiene of dependent inpatients. METHODS: Quantitative, descriptive, and cross-sectional study. Data were collected through a self-administered questionnaire applied to 100 nurses from internal medicine wards of two hospitals in Northern Portugal, which assessed three dimensions: knowledge, attitudes, and practices regarding oral hygiene. Knowledge, attitudes, and practices in oral care were summarized in statistical descriptions including percentages, frequencies, means, and standard deviations using SPSS version 23 for data analysis. RESULTS: The mean total knowledge score was 13.98 out of 22 and the participants' mean score of the attitudes towards oral care was 48.35 out of 60 points. All participants acknowledge the importance of oral care for inpatients, with 96% associating poor oral hygiene with systemic disease. As for practices, 90% of participants assess the need for oral care of inpatients in the first 24 h, and 61% document the result of this assessment. CONCLUSION: The results show that although participants are aware of the importance of oral care, knowledge and practices are not consistent. Concerning oral health practices, it is urgent to narrow the gap between evidence and practice and promote oral care standardization.

RNA-dependent RNA polymerase (RdRp) natural antiviral inhibitors: a review.

Viral diseases are the cause of many global epidemics, leading to deaths, affecting the quality of life of populations, and impairing public health. The limitations in the treatment of viral diseases and the constant resistance to conventional antiviral treatments encourage researchers to discover new compounds. In this perspective, this literature review presents isolated molecules and extracts of natural products capable of inhibiting the activity of the nonstructural protein that acts as the RNA-dependent RNA polymerase. The literature review presented natural compounds with the potential to be tested as alternative medicines or used in the development of synthetic drugs to prevent the replication of RNA viruses, such as COVID-19, hepatitis C, and dengue viruses, among others. Natural products are known to exhibit remarkable activities in mitigation of different viral diseases, in addition, they help to decrease the aggravation of infections. Consequently, reducing hospitalization time and deaths.

Community detection in networks by dynamical optimal transport formulation.

Detecting communities in networks is important in various domains of applications. While a variety of methods exist to perform this task, recent efforts propose Optimal Transport (OT) principles combined with the geometric notion of Ollivier-Ricci curvature to classify nodes into groups by rigorously comparing the information encoded into nodes' neighborhoods. We present an OT-based approach that exploits recent advances in OT theory to allow tuning between different transportation regimes. This allows for better control of the information shared between nodes' neighborhoods. As a result, our model can flexibly capture different types of network structures and thus increase performance accuracy in recovering communities, compared to standard OT-based formulations. We test the performance of our algorithm on both synthetic and real networks, achieving a comparable or better performance than other OT-based methods in the former case, while finding communities that better represent node metadata in real data. This pushes further our understanding of geometric approaches in their ability to capture patterns in complex networks.

Sustainable optimal transport in multilayer networks.

Traffic congestion is one of the major challenges faced by the transportation industry. While this problem carries a high economic and environmental cost, the need for an efficient design of optimal paths for passengers in multilayer network infrastructures is imperative. We consider an approach based on optimal transport theory to route passengers preferably along layers that are more carbon-efficient than the road, e.g., rails. By analyzing the impact of this choice on performance, we find that this approach reduces carbon emissions considerably compared to shortest-path minimization. Similarly, we find that this approach distributes traffic more homogeneously, thus alleviating the risk of traffic congestion. Our results shed light on the impact of distributing traffic flexibly across layers guided by optimal transport theory.

Prevalence and characterization of pertactin deficient Bordetella pertussis strains in Brazil, a whole-cell vaccine country.

Many countries have reported antigenic divergence among circulating Bordetella pertussis strains, mainly in those countries which introduced the acellular pertussis (aP) vaccine. This phenomenon can be seen, for example, with the recent rise of pertactin (Prn)-deficient B. pertussis strains, one of the antigens included in aP vaccine formulas. The whole cell pertussis (wP) vaccine has been used in Brazil since 1977 for the primary pertussis, diphtheria and tetanus immunization series. In 2014, the aP vaccine was recommended for women during pregnancy to protect infants in the first months of life. Our objective was to determine the prevalence of Prn-deficiency in 511 isolates of B. pertussis collected in Brazil during 2010-2016. All isolates were characterized, through PFGE and serotyping, and screened for the loss of Prn by ELISA. Prn-deficiency was confirmed by immunoblotting, and identification of the possible genetic markers was performed with PCR and Sanger sequencing. Results indicate that 110 PFGE profiles are currently circulating, with five profiles representing the majority, and the predominant serotype 3, has been gradually replaced by serotype 2 and serotype 2,3. ELISA screening and immunoblotting identified three Prn-deficient isolates. Genotypic characterization by PCR and sequencing indicated that one isolate had a promoter mutation in prn, while the other two did not have an obvious genetic explanation for their deficiency. While the lack of Prn was identified in a few isolates, this study did not detect a relevant occurrence of Prn-deficiency, until 2016, confirming previous observations that Prn-deficiency is likely aP vaccine-driven.

The role of respiratory virus infection in suspected pertussis: A prospective study.

BACKGROUND: Infections caused by Bordetella pertussis are frequent and responsible for cases of huge severity in unvaccinated young infants. However, clinical manifestations vary and mimic other respiratory diseases as respiratory viruses. METHODS: A prospective cohort study was performed with infants under 1 old, hospitalized with suspected pertussis. All infants were submitted to etiological research to identify Bordetella pertussis (nasopharynx swab for culture and/or PCR) and respiratory viruses (nasopharyngeal aspirate for indirect immunofluorescence). Clinical and demographic data were collected. RESULTS: Among 59 infants, an etiological agent was identified in 37 (62.8%). Respiratory virus was identified in 19 (32%) and Bordetella pertussis in 14 (23.7%) as sole agent. Codetection was found in 4 (7%). Younger age, absence of fever, lack of BP immunization, leukocytosis > 20,000/mm3, lymphocytosis >10,000/mm3 were associated to a greater chance of pertussis. Wheezing and living with siblings were associated with viral infection. After adjustment for confounders, the most important predictors were presence of wheezing for respiratory virus and leukocytosis for pertussis. The severity of infections by RV and BP were similar. CONCLUSION: Respiratory virus infections are frequent in cases of clinical suspicion of pertussis and may actually exceed the prevalence of BP. Clinical/laboratory characteristics may suggest the etiology, but they are not pathognomonic, which stresses the need for respiratory virus and Bordetella pertussis research in this clinical situation.

Network extraction by routing optimization.

Routing optimization is a relevant problem in many contexts. Solving directly this type of optimization problem is often computationally intractable. Recent studies suggest that one can instead turn this problem into one of solving a dynamical system of equations, which can instead be solved efficiently using numerical methods. This results in enabling the acquisition of optimal network topologies from a variety of routing problems. However, the actual extraction of the solution in terms of a final network topology relies on numerical details which can prevent an accurate investigation of their topological properties. In fact, in this context, theoretical results are fully accessible only to an expert audience and ready-to-use implementations for non-experts are rarely available or insufficiently documented. In particular, in this framework, final graph acquisition is a challenging problem in-and-of-itself. Here we introduce a method to extract network topologies from dynamical equations related to routing optimization under various parameters' settings. Our method is made of three steps: first, it extracts an optimal trajectory by solving a dynamical system, then it pre-extracts a network, and finally, it filters out potential redundancies. Remarkably, we propose a principled model to address the filtering in the last step, and give a quantitative interpretation in terms of a transport-related cost function. This principled filtering can be applied to more general problems such as network extraction from images, thus going beyond the scenarios envisioned in the first step. Overall, this novel algorithm allows practitioners to easily extract optimal network topologies by combining basic tools from numerical methods, optimization and network theory. Thus, we provide an alternative to manual graph extraction which allows a grounded extraction from a large variety of optimal topologies. The analysis of these may open up the possibility to gain new insights into the structure and function of optimal networks. We provide an open source implementation of the code online.

Origem da obesidade em adolescentes: impressões dos cuidadores familiares assistidos na atenção primária à saúde / Origin of obesity in adolescents: impressions of family caregivers assisted in primary health care

Objetivo: conhecer as causas da obesidade de adolescentes, atendidos na atenção primária à saúde, na perspectiva de cuidadores familiares. Metodologia: estudo qualitativo realizado no município de Divinópolis/Minas Gerais, Brasil. Foi aprovado em Comitê de Ética CAAE nº 53839316.6.0000.5545. Foram realizadas entrevistas semiestruturadas individuais com 11 familiares cuidadores e o material alcançado foi submetido à Análise de Conteúdo de Bardin. Emergiram-se três categorias analíticas: 1) A Ansiedade do Adolescente; 2) A Família do Adolescente 3) O Papel e A Figura Paterna do Adolescente. Resultados: para os familiares, a obesidade do adolescente tem suas origens no comportamento ansioso e aspectos relacionados à família, principalmente a figura paterna. É fundamental que os profissionais de saúde durante os atendimentos argumentem, reconheçam a realidade e orientem sobre os eventos que precedem ou decorrem da compulsão alimentar. Para elas, o alcoolismo, a agressividade e os desentendimentos paternos causam perturbações psicoemocionais que exigem muita atenção dos profissionais. Conclusão: para melhor adesão ao tratamento são indicadas estratégias como: capacitação dos profissionais sobre manejo dos aspectos psicoemocionais da obesidade no adolescente, discussão do caso em equipe multiprofissional, interconsulta com psicólogo e construção de curvas de IMC atreladas a uma boa anamnese cronológica de eventos marcantes de vida.

Objective: to know the causes of obesity in adolescents, cared for in primary health care, from the perspective of family caregivers. Methodology: qualitative study conducted in the city of Divinópolis/Minas Gerais, Brazil. It was approved by the CAAE Ethics Committee nº 53839316.6.0000.5545. Individual semi-structured interviews with 11 family caregivers were carried out and the material reached was submitted to Bardin Content Analysis. Three analytical categories emerged: 1) The Anxiety of the Adolescent; 2) The Family of the Adolescent 3) The Role and the Father Figure of the Adolescent. Results: for family members, adolescent obesity has its origins in the anxious behavior and aspects related to the family, mainly the father figure. It is fundamental that health professionals during the consultations argue, recognize the reality and guide about the events that precede or result from food compulsion. For them, alcoholism, aggressiveness and paternal disagreements cause psycho-emotional disorders that require much attention from professionals. Conclusion: for better adherence to treatment, strategies are indicated such as: training of professionals in the management of psychoemotional aspects of obesity in adolescents, discussion of the case in a multiprofessional team, inter-consultation with a psychologist and construction of BMI curves linked to a good chronological anamnesis of significant life events.

The effectiveness of maternal pertussis vaccination in protecting newborn infants in Brazil: A case-control study.

INTRODUCTION: In 2014, the Brazilian Ministry of Health (MoH) recommended Tdap to pregnant women in response to a significant increase in the incidence of pertussis among infants. The present study assessed the effectiveness of maternal immunization in preventing pertussis in infants. METHODS: An unmatched case-control study was undertaken in São Paulo State, Brazil from February 2015 to July 2016. Cases were infants aged <8 weeks at onset of pertussis reported to the Surveillance System and confirmed by real-time polymerase chain reaction or culture. Four to six healthy infants were selected as controls per case from birth certificates in the Information System on Live Births database. General characteristics and mother's vaccination status were compared between cases and controls. The vaccine effectiveness (VE) was calculated as 1 - odds ratio (OR). For the adjusted VE, the OR was calculated using logistic regression analysis. RESULTS: Forty-two cases and 248 controls were enrolled in the study. Mothers of 8 cases (19.1%) and 143 controls (57.4%) were vaccinated during pregnancy, resulting in an unadjusted VE of 82.6% (95% confidence interval [CI], 60.8-92.3%). The VE was unchanged after adjusting for maternal age and monthly household income. CONCLUSION: Maternal pertussis vaccination during pregnancy was effective in protecting infants aged <8 weeks from pertussis.

Identificação laboratorial da coqueluche na região do oeste do Estado de São Paulo / Laboratory identification of pertussis in the western region of São Paulo, Brasil

O objetivo deste estudo foi de confirmar laboratorialmente os casos suspeitos de coqueluchena região oeste do Estado de São Paulo, ocorridos entre 2010 a 2015. A cultura foi realizadano Centro de Laboratório Regional - Instituto Adolfo Lutz de Presidente Prudente e a PCR emtempo real (qPCR) foi realizada no Centro de Referência Nacional para Pertussis – Instituto AdolfoLutz em São Paulo, SP. Foram recebidas 189 amostras, sendo 29 (15,3%) confirmadas segundoos critérios laboratoriais (cultura e/ou qPCR). A faixa etária mais acometida foi em criançasmenores de seis meses de idade (82,8%), não vacinados ou com o esquema de vacinação incompleto.Provavelmente, estes resultados representam apenas uma fração do número real de casos decoqueluche que ocorrem no Brasil. O contínuo monitoramento da doença e informações daprevalência por faixa etária são importantes ferramentas para melhorar as estratégias de imunizaçãocomo forma de controlar esta doença reemergente.

The aim of this study was to confirm the suspected cases of pertussis in the Western region ofthe Sao Paulo State from 2010 to 2015. The samples were cultured in the Instituto Adolfo Lutz -Regional Laboratory of Presidente Prudente-SP, and the qPCR was performed at the NationalReference Laboratory for Pertussis – Central Instituto Adolfo Lutz, São Paulo-SP. In this period,189 samples were received, being 29 (15.3%) confirmed by the laboratory criteria (culture and/orqPCR). The most affected group was the children less than six months old (82.8%), not vaccinatedor with the incomplete vaccination. Most likely, these results only represent a fraction of theactual number of pertussis cases occurring in Brazil. The continuous disease monitoring and theprevalence data by age group are fundamental to improve the immunization strategies as a way tocontrol this important re-emerging disease.

Identificação laboratorial da coqueluche na região do oeste do Estado de São Paulo / Laboratory identification of pertussis in the western region of São Paulo State, Brazil

O objetivo deste estudo foi de confirmar laboratorialmente os casos suspeitos de coqueluche na região oeste do Estado de São Paulo, ocorridos entre 2010 a 2015. A cultura foi realizada no Centro de Laboratório Regional - Instituto Adolfo Lutz de Presidente Prudente e a PCR em tempo real (qPCR) foi realizada no Centro de Referência Nacional para Pertussis – Instituto Adolfo Lutz em São Paulo, SP. Foram recebidas 189 amostras, sendo 29 (15,3%) confirmadas segundo os critérios laboratoriais (cultura e/ou qPCR). A faixa etária mais acometida foi em crianças menores de seis meses de idade (82,8%), não vacinados ou com o esquema de vacinação incompleto. Provavelmente, estes resultados representam apenas uma fração do número real de casos de coqueluche que ocorrem no Brasil. O contínuo monitoramento da doença e informações da prevalência por faixa etária são importantes ferramentas para melhorar as estratégias de imunização como forma de controlar esta doença reemergente.

The aim of this study was to confirm the suspected cases of pertussis in the Western region of the Sao Paulo State from 2010 to 2015. The samples were cultured in the Instituto Adolfo Lutz - Regional Laboratory of Presidente Prudente-SP, and the qPCR was performed at the National Reference Laboratory for Pertussis – Central Instituto Adolfo Lutz, São Paulo-SP. In this period, 189 samples were received, being 29 (15.3%) confirmed by the laboratory criteria (culture and/or qPCR). The most affected group was the children less than six months old (82.8%), not vaccinated or with the incomplete vaccination. Most likely, these results only represent a fraction of the actual number of pertussis cases occurring in Brazil. The continuous disease monitoring and the prevalence data by age group are fundamental to improve the immunization strategies as a way to control this important re-emerging disease.

Efeitos de um programa de Enfermagem de Reabilitação na pessoa submetida a cirurgia abdominal programada / Effects of a Rehabilitation Nursing program on the person undergoing scheduled abdominal surgery

Está amplamente descrito na literatura que a cirurgia abdominal é responsável por alterações na função respiratória. Destacam-se, ainda, na literatura os bons resultados obtidos na prevenção ou correção de complicações, nomeadamente na componente respiratória, quando programas de reabilitação são implementados no pré e pós-operatório. Objetivo ­Avaliar a efeito do plano de Enfermagem de Reabilitação sobre variáveis fisiológicas, clínicas e a ansiedade nos doentes submetidos a cirurgia abdominal programada do serviço de cirurgia I da unidade de Vila Real do Centro Hospitalar de Trás-os-Montes e Alto Douro. Métodos ­ Realizou-se um estudo quase-experimental e transversal. A amostra foi constituída por 30 indivíduos, que se submeteram de forma voluntária a um programa de Enfermagem de Reabilitação. A colheita de dados foi efetuada mediante o preenchimento da grelha de avaliação, em dois momentos distintos: pré-operatório e 4º dia de pós-operatório. Foram registadas variáveis de caracterização, variáveis fisiológicas, fluxo expiratório máximo (PEF), dor e ansiedade. A escala utilizada para a avaliação da ansiedade foi a escala Visual analógica VAS-A. Resultados - Na amostra em estudo, 73,3% dos indivíduos eram do sexo masculino. A idade variou entre 30 e 80 anos, com média 66,67 anos. Três dos participantes (10%) dos participantes sofrem de algum tipo de patologia respiratória e relativamente a hábitos tabágicos, estes estão presentes em 2 (6,7%) participantes. Dos principais resultados destacase que o programa de Enfermagem de Reabilitação diminuiu os níveis de ansiedade e aumentou o valor do pico de fluxo expiratório (PFE) mas não teve efeitos estatisticamente significativos nas restantes variáveis Conclusões ­ Os resultados vão no sentido de confirmar a necessidade e utilidade da intervenção especializada em Enfermagem de Reabilitação no doente submetido a cirurgia abdominal programada.

It is widely described in the literature that abdominal surgery is responsible for changes in respiratory function. The literature also shows that good results are obtained in the prevention or correction of complications, particularly in the respiratory component, when rehabilitation programs are implemented in the pre- and postoperative period. Objective - To evaluate the effect of a Rehabilitation Nursing plan on physiological and clinical variables and anxiety in patients undergoing scheduled abdominal surgery at the surgery department of Vila Real unit of Centro Hospitalar de Trás-os-Montes e Alto Douro. Methods - A quasi-experimental and cross-sectional study was carried out. Where included 30 participants, who voluntarily underwent a Rehabilitation Nursing program. Data collection was performed by filling out the evaluation grid at two different times: preoperative and postoperative day 4. Characterization variables, physiological variables, peak expiratory flow (PEF), pain and anxiety were recorded. The Visual Analogue VAS-A scale was used for anxiety assessment. Results - In the study sample, 73.3% of the individuals were male. The age ranged from 30 to 80 years, with a mean of 66.67 years. Three of the participants (10%) suffer from some type of respiratory pathology and in relation to smoking habits, these are present in 2 (6.7%) participants. The main results highlight that the Rehabilitation Nursing program reduced anxiety levels and increased peak expiratory flow (PEF), but did not have statistically significant effects on the other variables Conclusions - The results are aimed at confirming the need and utility of the specialized intervention in Rehabilitation Nursing in patients undergoing scheduled abdominal surgery.

Uso da casuística no processo ensino-aprendizagem de bioética em saúde / Use of casuistry in the process of teaching-learning of bioethics in health / Uso de la casuística en el proceso de enseñanza-aprendizaje de bioética en la salud

Resumo Existem vários modelos em bioética capazes de contribuir para tomada de decisão em saúde. O modelo da casuística trabalha com análise de casos reais para se tomar decisões diante de problemas bioéticos. Trata-se de estudo descritivo, qualitativo, a partir de análise temática, realizado com 16 acadêmicos da área de saúde com o objetivo de identificar suas experiências no processo de ensino-aprendizagem em bioética a partir do método de casos, fundamentado no modelo da casuística. Emergiram duas categorias:"o modelo da casuística como facilitador da formação do posicionamento ético e do processo de tomada de decisão" e "a dificuldade da aplicação prática dos paradigmas e analogias no modelo da casuística". A partir das experiências relatadas, conclui-se que o modelo da casuística contribui significativamente para a tomada de decisão em problemas bioéticos, bem como auxilia o processo de ensino-aprendizagem de bioética durante a graduação na área da saúde.

There are several bioethical models capable of contributing to decision making in health. The casuistic model works with the analysis of real cases for decision making regarding bioethical problems. It is conducted with 16 academic scholars from the health field with the objective of identifying academic experiences in the teaching-learning process of bioethics. It uses the case method, based on the casuistic model. It is a descriptive, qualitative study using thematic analysis, where two categories emerged: "the difficulty of practical application of paradigms and analogies in the casuistic model'' and ''how the casuistic model facilitates the formation of ethical positioning and the decision making process''. From the reported experiences, it is concluded that the casuistic model significantly contributes to decision making in bioethical issues and assists in the teaching--learning process of bioethics during undergraduate study in the health field.

Resumen Hay numerosos modelos de bioética capaces de contribuir a la toma de decisiones en salud. El modelo de la casuística trabaja con el análisis de casos reales para la toma de decisiones frente a las cuestiones de bioética. Este estudio tiene como objetivo identificar las experiencias académicas en el proceso de enseñanza-aprendizaje de bioética a partir del método de casos, con base en el modelo de la casuística. Se trata de estudio descriptivo y cualitativo, a partir del análisis temático, realizado con 16 académicos de la salud. Surgieron dos categorías: "el modelo de la casuística como un facilitador en la formación de la posición ética y el proceso de toma de decisiones" y "la dificultad de la aplicación práctica de los paradigmas y analogías en el modelo de la casuística". A partir de los experimentos relatados, se concluye que el modelo de la muestra contribuye significativamente a la toma de decisiones en cuestiones de bioética y ayuda positivamente en el proceso de la enseñanza-aprendizaje de bioética durante la graduación en salud.

Pertussis characterization in the central-west region of São Paulo state, Brazil / Caracterização da coqueluche na região centro-oeste do Estado de São Paulo, Brasil

Pertussis is a highly contagious respiratory disease caused by Bordetella pertussis. This study aimed at characterizing the B. pertussis laboratory positivity and the isolated strains inmunicipalities of the Central-West Region of São Paulo State, Brazil from 2010 to 2014. A total of 597 nasopharyngeal swabs samples were collected from suspected patients and contacts, andanalyzed by in vitro culture and Real-Time PCR (qPCR). Culture-positive B. pertussis strains were characterized by serotyping and pulsed-field gel electrophoresis. Considering culture and/or qPCR, the positivity rate was of 19.6%. Out of 117 samples with B. pertussis, 23 were detected by both methods, 89 by qPCR only and five by culture only. Strains presenting FIM3 (40%), FIM2,3 (32%) and FIM2 (28%) serotypes were found. Five pulsotypes were detected by PFGE,48% of which identified as BP.Xba.0039, being the predominant type in this study. Among the positive strains, 50% were isolated from <2 months old-children and 17% were isolated from three to six months old patients. Non-vaccinated children or with incomplete vaccination schedule were at the major risk of complications and death, highlighting the importance of a continuous monitoring of this infection for the future control strategies.

A coqueluche é uma doença respiratória altamente contagiosa causada por Bordetella pertussis. Este estudo caracterizou a positividade de B. pertussis e as cepas isoladas em municípios da Região Centro-Oeste do Estado de São Paulo de 2010 a 2014. Foram coletados 597 esfregaços nasofaríngeos de pacientes e contatos suspeitos de coqueluche, e analisados por cultura e Real-Time PCR (qPCR). Os isolados de B. pertussis obtidos de cultura foram caracterizados por sorotipagem e eletroforese em gel de campo pulsado. Considerando-se a cultura e/ou qPCR, verificou-se taxa de positividade de 19,6%. Das 117 amostras positivas para B. pertussis, 23 foram detectadas por ambos os métodos, 89 apenas por qPCR e cinco apenas na cultura. Foram detectadas cepas de sorotipos FIM3 (40%), FIM2,3 (32%) e FIM2 (28%). Cinco pulsotipos foram detectados pela PFGE, e 48% identificados como BP.Xba.0039, o tipo predominante neste estudo. Entre as cepas positivas, 50% foram isoladas de crianças menores de dois meses e 17% isoladas da faixa etária de três a seis meses. Crianças não vacinadas ou com esquema de vacinação incompleta têm maior risco de complicações e óbito, o que ressalta a importância do monitoramento contínuo desta infecção para futuras estratégias de controle.

Pertussis characterization in the central-west region of São Paulo state, Brazil / Caracterização da coqueluche na região centro-oeste do Estado de São Paulo, Brasil

Pertussis is a highly contagious respiratory disease caused by Bordetella pertussis. This study aimed at characterizing the B. pertussis laboratory positivity and the isolated strains in municipalities of the Central-West Region of São Paulo State, Brazil from 2010 to 2014. A total of 597 nasopharyngeal swabs samples were collected from suspected patients and contacts, and analyzed by in vitro culture and Real-Time PCR (qPCR). Culture-positive B. pertussis strains were characterized by serotyping and pulsed-field gel electrophoresis. Considering culture and/or qPCR, the positivity rate was of 19.6%. Out of 117 samples with B. pertussis, 23 were detected by both methods, 89 by qPCR only and five by culture only. Strains presenting FIM3 (40%), FIM2,3 (32%) and FIM2 (28%) serotypes were found. Five pulsotypes were detected by PFGE, 48% of which identified as BP.Xba.0039, being the predominant type in this study. Among the positive strains, 50% were isolated from <2 months old-children and 17% were isolated from three to six months old patients. Non-vaccinated children or with incomplete vaccination schedule were at the major risk of complications and death, highlighting the importance of a continuous monitoring of this infection for the future control strategies.

A coqueluche é uma doença respiratória altamente contagiosa causada por Bordetella pertussis. Este estudo caracterizou a positividade de B. pertussis e as cepas isoladas em municípios da Região Centro-Oeste do Estado de São Paulo de 2010 a 2014. Foram coletados 597 esfregaços nasofaríngeos de pacientes e contatos suspeitos de coqueluche, e analisados por cultura e Real-TimePCR (qPCR). Os isolados de B. pertussis obtidos de cultura foram caracterizados por sorotipagem e eletroforese em gel de campo pulsado. Considerando-se a cultura e/ou qPCR, verificou-se taxa de positividade de 19,6%. Das 117 amostras positivas para B. pertussis, 23 foram detectadas por ambos os métodos, 89 apenas por qPCR e cinco apenas na cultura. Foram detectadas cepas de sorotipos FIM3 (40%), FIM2,3 (32%) e FIM2 (28%). Cinco pulsotipos foram detectados pela PFGE, e 48% identificados como BP.Xba.0039, o tipo predominante neste estudo. Entre as cepas positivas, 50% foram isoladas de crianças menores de dois meses e 17% isoladas da faixa etária de três a seis meses. Crianças não vacinadas ou com esquema de vacinação incompleta têm maior risco de complicações e óbito, o que ressalta a importância do monitoramento contínuo desta infecção para futuras estratégias de controle.

Sources of pertussis infection in young babies from São Paulo State, Brazil.

Household contacts are important sources of Bordetella pertussis in infants. A total of 353 household contacts of 97 index cases were evaluated for pertussis by culture and polymerase chain reaction. Twenty eight contacts were positive (8.0%). The presence of symptoms did not influence the rate of diagnosed bacteriologic pertussis in communicants. We conclude that contacts with an index case can be positive for B. pertussis independently of the presence of symptoms.

Serodiagnosis as adjunct assay for pertussis infection in São Paulo, Brazil.

Pertussis remains an important public health problem in many countries despite extensive immunization. Cultures and real-time PCR (RT-PCR) assays are the recommended pertussis diagnostic tests, but they lack sensitivity at the later stage of the disease. This study introduces the IgG anti-pertussis toxin enzyme-linked immunosorbent assay (PT ELISA) in our routine diagnosis to improve disease burden estimation. Serum samples and nasopharyngeal swabs (n = 503) were collected at the same time from patients presenting with cough illness suspected of being pertussis and tested by the PT ELISA and culture and/or RT-PCR, respectively. Patients were separated into three age groups: group 1, <1 year (n = 260; mean age, 3 months), group 2, 1 to 6 years (n = 81; mean age, 3 years), and group 3, ≥7 years (n = 162; mean age, 26 years). The times (means) from cough onset to specimen collection were 16, 24, and 26 days, respectively. In group 1, 83 (82.2%) of 101 positive cases were positive for pertussis by culture/RT-PCR, while 40 (39.6%) tested positive by PT ELISA. In group 2, 6 (19.4%) of 31 positive cases were culture/RT-PCR positive, and 29 (93.6%) were seropositive. In group 3, 13 (13.8%) of 94 positive cases were positive by culture/RT-PCR and 91 (96.8%) were positive by serology. Culture/RT-PCR detected more cases of pertussis in infants (P < 0.0001), whereas the PT ELISA detected more cases in adolescents and adults (P < 0.0001). The timing between cough onset and specimen collection or recent vaccination may have partially affected our results. Serology is a suitable, cost-effective, and complementary pertussis diagnostic tool, especially among older children, adolescents, and adults during the later disease phase.