Phylogenomics of Dengue Virus Isolates Causing Dengue Outbreak, São Tomé and Príncipe, 2022.

We determined that the dengue outbreak in São Tomé and Príncipe during 2022 was caused by dengue virus serotype 3 genotype III. Phylogenomic analyses showed that the outbreak strain was closely related to the newly identified GIII-American-II lineage and that the virus probably was introduced from the Americas.

Carotid Paraganglioma - Classical Surgical Technique.

INTRODUCTION: A carotid body tumor is a rare neoplasm, generally benign, that predominantly affects people between their fourth and fith decades of life. It manifests as a pulsatile and generally painless cervical mass with firm consistency, located below the angle of the jaw. Clinically it can cause localized pain, dysphagia, hiccups, hoarseness and hypersensitive carotid body syndrome. Surgery is the treatment of choice, bearing in mind the possibility of malignant transformation, peritumoral invasion and metastasis. The most widely-used technique is surgical resection, with or without concomitant preoperative endovascular embolisation. Overall complication rates, stroke rates between 0 and 8% and cranial nerve palsy less than 1% to 49%. Mortality rates vary from 0 to 3%. METHODS: Clinical case of a 69 years old male patient diagnosed with a carotid body tumor in a routine ultrasound exam. The patient was asyntomatic. Complementary exams were then conducted - CT scan and MRI supported the diagnosis. Neck CT scan: Well defined, nodular formation, enhanced after intravenous contrast, localized on the jugular-carotid region, with an aproximate diameter of 36 mm. Neck MRI: Expansive heterogenous solid lesion, localized on carotid bulb, well defined, enhanced after intravenous contrast, compatible with carotid paraganglioma - Shamblin's II. RESULTS: Patient was submited to a complete surgical classic ressection of the tumor, without any previously procedure. Proximal dissection was made with a help of a nose and ear surgeon. No post-surgery complications, except wound infection at week 3. No nerve damage. CONCLUSION: Follow up to 1 year without any complain and no lesions. In an era of multiple techniques there should always be a place for classic, well planned surgeries.

Traumatic Carotid-Jugular Av Fistula in a Child.

INTRODUCTION: Traumatic Arteriovenous fistulae of the neck vessels are a rare condition, comprising less than 4% of traumatic fistulae found anywhere else in the body. METHODS: The authors propose to report a clinical case of such a condition in a 10-year-old boy who sustained a gunshot wound in the left side of the neck. RESULTS: Shortly after the event, the patient was admitted to paediatric ICU and intubated for airway protection. A palpable thrill in the left side of the neck was noticed, giving rise to the need of imaging study. A communication between the left common carotid artery and the internal jugular vein was confimed by AngioCT. No signs of cerebral hypoperfusion or cardiac overload were present. The surgical correction was performed by direct suture repair of both vessels involved. No complications on the postoperative period. During follow up, antiagregation with acetilsalicilic acid for 1 month was prescribed and no complications occured. CONCLUSION: The patient lives a normal life with no limitations.

Popliteal artery aneurysm surgical repair: Retrospective unicenter analysis.

BACKGROUND: Popliteal artery aneurysm (PAA) thromboembolic complications may result in limb loss. We review our experience reporting outcomes in terms of complications and early and long-term patency rates. METHODS: From 2004 to 2013, 116 PAA required surgical repair at Coimbra Hospital and Universitary Centre, Portugal. Outcomes were analyzed using Kaplan-Meier method with log-rank tests, X2, and Cox proportional hazards models. RESULTS: A total of 116 PAAs with a mean diameter of 3.3 cm (1.5 to 10 cm) were followed. 40% limbs were asymptomatic and 27% presented with acute ischemia. 97% underwent medial bypass procedure (venous in 66%). Early mortality was 0.9% (1/116). 30-day and five-year cumulative limb salvage was 94.0% and 87%, respectively. There was no limb loss in asymptomatic patients and 1-3 Rutherford chronic ischemia. 62% early amputations were performed in acute ischemia, half of them with functioning bypass. 30-day primary and secondary patency rates were 91% and 97% respectively, higher with GSVs (96% and 99%) than PTFE (58% and 95%, P < .05; Fig 1). The 5-year primary and secondary patency rates were 68.1% and 73,5%, respectively, higher with GSVs (83% and 87%) than PTFE (37% and 43%, P < .05). Two recurrent PAAs (1,7%) required reintervention. Predictors for both amputation and loss of primary patency were PTFE bypass (p =0,002), and emergent surgery (p = 0,005). Acute ischemia was also predictor for amputation (p = 0,026), but not for loss of primary patency. CONCLUSIONS: Results of surgery on asymptomatic PAAs are good - significantly better than those from symptomatic PAAs. The results are similarly good in claudicants. The risks of early and late amputation were higher with prosthetic grafts and in an emergent settings.

Wastewater-based surveillance for Hepatitis A virus, Enterovirus, Poliovirus, and SARS-CoV-2 in São Tomé and Príncipe: A pilot study.

BACKGROUND: Wastewater-based surveillance is a valuable tool for monitoring pathogen transmission in communities, especially in regions where formal surveillance systems are limited. AIM: The aim of this study was to implement and evaluate a wastewater-based monitoring system for viral pathogens in São Tomé and Príncipe. METHODS: A total of 122 water samples were collected bi-weekly from June 2022 to July 2023 at six locations in São Tomé city and analysed for molecular detection of Hepatitis A Virus (HAV), Enterovirus (EV), Poliovirus (PV), SARS-CoV-2, as well as JC-Polyomavirus (JCPyV) and pepper mild mottle virus (PMMoV) as indicators of human contamination. Prevalence was analysed per pathogen and across sampling locations. Results for SARS-CoV-2 were assessed together with notifications from national COVID-19 surveillance. Further, we estimated resources needed to establish a wastewater-based approach to assess community-level transmission of viral pathogens. RESULTS: All 122 and 117 samples were found positive for PMMoV and JCPyV, respectively, demonstrating a high level of human contamination at all sampling locations. The prevalence of HAV and EV ranged from 0 % to 59 % and 56 % respectively. Consistent with national surveillance data the highest proportion of SARS-CoV-2 positive water samples coincides with the highest number of COVID-19 cases reported during the study, demonstrating the potential of wastewater-based surveillance to identify signals. In addition, for SARS-CoV-2 this approach provided evidence of continuous circulation of the virus in the community, most importantly during weeks when no COVID-19 cases were reported. CONCLUSION: Our findings provide evidence of high transmission of HAV and EV in communities in São Tomé and continuous circulation of SARS-CoV-2, even in weeks without COVID-19 case notifications. This study demonstrates that monitoring of viral pathogens in humanly impacted open water streams and sewage tanks is a valuable tool to complement clinical surveillance in resource-limited settings.

VENOUS GANGRENE: REMINDING A VASCULAR CATASTROPHE.

A 85 year-old, female patient, with an active colon neoplasm, was diagnosed with extensive ilio-femoro-popliteal deep vein thrombosis. She presented with severe oedema of the left lower limb and a cyanotic foot. Pedal pulses were palpable. Despite immediate anticoagulation, the patient expired at 72h.

Toxicity in vitro and in Zebrafish Embryonic Development of Gold Nanoparticles Biosynthesized Using Cystoseira Macroalgae Extracts.

INTRODUCTION: Research on gold nanoparticles (AuNPs) occupies a prominent place in the field of biomedicine nowadays, being their putative toxicity and bioactivity areas of major concern. The green synthesis of metallic nanoparticles using extracts from marine organisms allows the avoidance of hazardous production steps while maintaining features of interest, thus enabling the exploitation of their promising bioactivity. OBJECTIVE: To synthesize and characterize AuNPs using, for the first time, macroalga Cystoseira tamariscifolia aqueous extract (Au@CT). METHODS: Algal aqueous extracts were used for the synthesis of AuNPs, which were characterized using a wide panel of physicochemical techniques and biological assays. RESULTS: The characterization by UV-Vis spectroscopy, transmission electron microscopy, Z-potential and infrared spectroscopy confirmed that Au@CT were stable, spherical and polycrystalline, with a mean diameter of 7.6 ± 2.2 nm. The antioxidant capacity of the extract, prior to and after synthesis, was analyzed in vitro, showing that the high antioxidant potential was not lost during the synthesis. Subsequently, in vitro and in vivo toxicity was screened, by comparing two species of the genus Cystoseira (C. tamariscifolia and C. baccata) and the corresponding biosynthesized gold nanoparticles (Au@CT and Au@CB). Cytotoxicity was tested in mouse (L929) and human (BJ5ta) fibroblast cell lines. In both cases, only the highest (nominal) test concentration of both extracts (31.25 mg/mL) or Au@CB (12.5 mM) significantly affected cell viability, as measured by the MTT assay. These results were corroborated by a Fish Embryo Acute Toxicity (FET) test. Briefly, it was shown that, at the highest (nominal) tested concentration (31.25 mg/mL), CT extract induced significantly higher cytotoxicity and embryotoxicity than CB extract. However, it was demonstrated that Au@CT, but not Au@CB, were generally non-toxic. At sub-lethal (nominal) test concentrations (1.25 and 2.5 mM), Au@CT affected zebrafish embryonic development to a much lesser extent than Au@CB. In vitro wound healing assays also revealed that, while other experimental conditions did not impact cell migration, CT and Au@CT displayed a moderate positive effect. CONCLUSION: Au@CT and Au@CB display promising features, desirable for biomedical applications, as wound healing.

Abdominal Aortic Aneurysms and Q Fever: An Odd Connection to Keep in Mind.

Abdominal aortic aneurysms (AAAs) secondary to Coxiella burnetii infections are rare but carry important implications. The diagnosis is difficult due to unspecific symptoms. To the authors' knowledge, this is the first AAA caused by chronic Q fever treated with an endoprosthesis.

Design of polymeric core-shell carriers for combination therapies.

Particle engineering for co-delivery of drugs has the potential to combine multiple drugs with different pharmaceutical mechanisms within the same carrier, increasing the therapeutic efficiency while improving patient compliance. This work proposes a novel approach for producing polymer-polymer core-shell microparticles by multi-step processing of emulsion and spray drying. The particle core was obtained by an oil-in-water emulsion of poly(ε-caprolactone) (PCL) loaded with curcumin (CM), followed by the resuspension in poly(vinyl alcohol) (PVA) containing ciprofloxacin (CPx) forming the shell layer by spray-drying. The obtained core-shell particles showed an average size of 3.8 ± 1.2 µm, which is a suitable size for inhalation therapies. The spatial distribution of the drugs was studied using synchrotron-based macro attenuated total reflection Fourier transform infrared (macro ATR-FTIR) microspectroscopy to map the chemical distribution of the components within the particles and supported the presence of CM and CPx in the core and shell layers, respectively. The formation of the core-shell structure was further supported by the differences in the release profile of CM from these particles, when compared to the release profile observed for the single particle structure (PCL-CM). Both empty and drug-loaded carriers (up to 100 µg.mL-1) showed no cytotoxic effects on A549 cells while exhibiting the antibacterial activity of CPx against Gram-positive and Gram-negative bacteria. These polymer core-shell microparticles provide a promising route for the combination and sequential drug release therapies, with the potential to be used in inhalation therapies.

Lipid-based Nanocarriers for siRNA Delivery: Challenges, Strategies and the Lessons Learned from the DODAX: MO Liposomal System.

The possibility of using the RNA interference (RNAi) mechanisms in gene therapy was one of the scientific breakthroughs of the last century. Despite the extraordinary therapeutic potential of this approach, the need for an efficient gene carrier is hampering the translation of the RNAi technology to the clinical setting. Although a diversity of nanocarriers has been described, liposomes continue to be one of the most attractive siRNA vehicles due to their relatively low toxicity, facilitated siRNA complexation, high transfection efficiency and enhanced pharmacokinetic properties. This review focuses on RNAi as a therapeutic approach, the challenges to its application, namely the nucleic acids' delivery process, and current strategies to improve therapeutic efficacy. Additionally, lipid-based nanocarriers are described, and lessons learned from the relation between biophysical properties and biological performance of the dioctadecyldimethylammonium:monoolein (DODAX: MO) system are explored. Liposomes show great potential as siRNA delivery systems, being safe nanocarriers to protect nucleic acids in circulation, extend their half-life time, target specific cells and reduce off-target effects. Nevertheless, several issues related to delivery must be overcome before RNAi therapies reach their full potential, namely target-cell specificity and endosomal escape. Understanding the relationship between biophysical properties and biological performance is an essential step in the gene therapy field.

Declínio funcional dos idosos e o envelhecimento ativo / Functional decline in the elderly and active aging

À medida que a idade avança a resposta do organismo às agressões a que está sujeito ao longo da vida, nomeadamente físicas, psíquicas, e sociais vai sendo cada vez menos eficaz, devido ao envelhecimento das células e dos sistemas. É fundamental compreender quais as alterações biológicas, moleculares, celulares e morfológicas que levam às doenças associadas ao envelhecimento. Existem vários estudos e teorias que explicam este complexo fenómeno. O conhecimento dessas alterações poderá no futuro levar a alterações genéticas e farmacológicas que previnam o declínio funcional, e promovam um envelhecimento ativo e saudável. O tema da pessoa idosa é pertinente, o aumento da esperança média de vida, revela um avanço cientifico na civilização humana, no entanto não deixa de ser um problema das civilizações modernas, pelo impacto socioeconómico e pela necessidade de viver condignamente; importa viver mais anos, mas, com qualidade de vida. De modo a solucionar esta problemática que afeta toda a humanidade e no seguimento destes prossupostos, os objetivos desta investigação são Estudar de que forma os domínios da atividade física, psicológica, espiritual, e social se interligam com a autonomia da pessoa Idosa; Contribuir para uma maior e mais abrangente compreensão da pessoa Idosa; Verificar se existe associação significativa entre as variáveis sociodemográficas (idade, sexo, estado civil, habilitações literárias, profissão, viver sozinho, manter se ativo) e a (in)dependência funcional dos idosos domiciliados especificamente no Concelho de Manteigas. Pretende-se igualmente conhecer os contributos do Enfermeiro de Reabilitação nesta problemática. A metodologia usada foi quantitativa. Após a colheita de dados, estes foram devidamente tratados com recurso a programa informático, foram analisados, compreendidos, discutidos e direcionados para a solução desta problemática, a resolução poderá passar por recorrer ao auxilio de profissionais de saúde diferenciados, da qual fazem parte os Enfermeiros de Reabilitação. Para concluir, a dependência leva a uma maior vulnerabilidade, obrigando a sociedade a uma preparação adequada, ao nível da prevenção de doenças e reabilitação. O aumento da atividade suscita o aumento da capacidade de desempenho das tarefas do dia a dia e sugere mais independência para o idoso e consequentemente mais autoestima.