Phylogeography of hepatitis B virus: The role of Portugal in the early dissemination of HBV worldwide.

In Portugal, the genetic diversity, origin of HBV and the Portuguese role in the dissemination of HBV worldwide were never investigated. In this work, we studied the epidemic history and transmission dynamics of HBV genotypes that are endemic in Portugal. HBV pol gene was sequenced from 130 patients followed in Lisbon. HBV genotype A was the most prevalent (n = 54, 41.5%), followed by D (n = 44, 33.8%), and E (n = 32, 24.6%). Spatio-temporal evolutionary dynamics was reconstructed in BEAST using a Bayesian Markov Chain Monte Carlo method, with a GTR nucleotide substitution model, an uncorrelated lognormal relaxed molecular clock model, a Bayesian skyline plot, and a continuous diffusion model. HBV subgenotype D4 was the first to be introduced in Portugal around 1857 (HPD 95% 1699-1931) followed by D3 and A2 a few decades later. HBV genotype E and subgenotype A1 were introduced in Portugal later, almost simultaneously. Our results indicate a very important role of Portugal in the exportation of subgenotypes D4 and A2 to Brazil and Cape Verde, respectively, in the beginning of the XX century. This work clarifies the epidemiological history of HBV in Portugal and provides new insights in the early and global epidemic history of this virus.

Screening a Targeted Panel of Genes by Next-Generation Sequencing Improves Risk Stratification in Real World Patients with Acute Myeloid Leukemia.

Although mutation profiling of defined genes is recommended for classification of acute myeloid leukemia (AML) patients, screening of targeted gene panels using next-generation sequencing (NGS) is not always routinely used as standard of care. The objective of this study was to prospectively assess whether extended molecular monitoring using NGS adds clinical value for risk assessment in real-world AML patients. We analyzed a cohort of 268 newly diagnosed AML patients. We compared the prognostic stratification of our study population according to the European LeukemiaNet recommendations, before and after the incorporation of the extended mutational profile information obtained by NGS. Without access to NGS data, 63 patients (23%) failed to be stratified into risk groups. After NGS data, only 27 patients (10%) failed risk stratification. Another 33 patients were re-classified as adverse-risk patients once the NGS data was incorporated. In total, access to NGS data refined risk assessment for 62 patients (23%). We further compared clinical outcomes with prognostic stratification, and observed unexpected outcomes associated with FLT3 mutations. In conclusion, this study demonstrates the prognostic utility of screening AML patients for multiple gene mutations by NGS and underscores the need for further studies to refine the current risk classification criteria.

Cultural probes for environmental education: Designing learning materials to engage children and teenagers with local biodiversity.

Direct contact with nature is paramount in deepening children's and teenagers' interest in biodiversity. Learning materials chosen to convey information and engage participants during outings in nature-rich environments are varied and can support rich learning experiences. For this purpose, learning materials can be acquired "off-the-shelf" or developed for site-specific locations or projects. However, there is little guidance on potential techniques for those wishing to generate contextually relevant materials. With the view of responding to this challenge, we propose the cultural probes technique. We demonstrate that the technique, commonly used in qualitative research to generate novel insights in conversation with participants, can instigate innovative and thoughtful approaches to materials designed for children and teenagers to explore nature. We present a toolkit that draws on the literature on cultural probes, inquiry-based learning, and the value of sensory, emotional, and aesthetic experiences in environmental education for structuring interactions with participants. To test our approach, we applied a descriptive research design and mixed-methods approach for collecting questions from youths between the ages of 10 and 18, inspired by a nature walk and a set of exploratory tasks executed through the toolkit. Specifically, we tested our toolkit along a trail in the Nature Park of Terceira, situated in the Azores, a Portuguese volcanic archipelago in the North Atlantic. Here, we present and reflect on the data collected during one visit organized over two days with two groups of participants and one post-trail activity directed at both groups. Results demonstrate that the open-ended and playful nature of cultural probes offers a novel way to engage youths with nature-rich environments through questioning. This contribution further highlights the potential of cultural probes for instigating encounters that tap into the value of sensory, emotional, and aesthetic experience in nature, with positive outcomes for participants.

Influence of Face Masks on the Use of Contact Lenses.

BACKGROUND: The COVID-19 epidemic is largely controlled by the use of face masks. The use of a face mask has been indicated as a strong cause of dry eye, although it is not yet described in the literature. This study aims to compare the impact of the use of masks on the visual quality of patients. The symptoms in the human eye intensified during the pandemic versus the symptoms before the pandemic, in a Portuguese population. METHODS: A fifteen-question questionnaire was conducted to find out what changes occurred in the use of soft contact lenses during the pandemic in relation to the use of masks. Statistical analysis was performed with SPSS 27.0 software (SPSS Inc., Chicago, IL, USA). RESULTS: The use of contact lenses decreased compared with before the pandemic (p < 0.001). The number of hours of wear decreased significantly compared with before the pandemic (p < 0.001). The sensation of dry eyes was found to be worse in those using monthly replacement contact lenses (p = 0.034), and the need to remove contact lenses was more frequent in women (p = 0.026) after using a mask. CONCLUSIONS: Mask use increases dry eye symptoms in contact lens wearers, negatively impacting visual quality.

Air pollution, sociodemographic and health conditions effects on COVID-19 mortality in Colombia: An ecological study.

OBJECTIVE: The present study aimed to determine the association between chronic exposure to fine particulate matter (PM2.5), sociodemographic aspects, and health conditions with COVID-19 mortality in Colombia. METHODS: We performed an ecological study using data at the municipality level. We used COVID-19 data obtained from government public reports up to and including July 17th, 2020. We defined PM2.5 long-term exposure as the 2014-2018 average of the estimated concentrations at municipalities obtained from the Copernicus Atmospheric Monitoring Service Reanalysis (CAMSRA) model. We fitted a logit-negative binomial hurdle model for the mortality rate adjusting for sociodemographic and health conditions. RESULTS: Estimated mortality rate ratios (MRR) for long-term average PM2.5 were not statistically significant in either of the two components of the hurdle model (i.e., the likelihood of reporting at least one death or the count of fatal cases). We found that having 10% or more of the population over 65 years of age (MRR = 3.91 95%CI 2.24-6.81), the poverty index (MRR = 1.03 95%CI 1.01-1.05), and the prevalence of hypertension over 6% (MRR = 1.32 95%CI1.03-1.68) are the main factors associated with death rate at the municipality level. Having higher hospital beds capacity is inversely correlated to mortality. CONCLUSIONS: There was no evidence of an association between long-term exposure to PM2.5 and COVID-19 mortality rate at the municipality level in Colombia. Demographics, health system capacity, and social conditions did have evidence of an ecological effect on COVID-19 mortality. The use of model-based estimations of long-term PM2.5 exposure includes an undetermined level of uncertainty in the results, and therefore they should be interpreted as preliminary evidence.

Concomitant myeloproliferative and lymphoproliferative neoplasms, distinct progenitors: A case report and review of the literature.

Patients with a Philadelphia chromosome-negative myeloproliferative neoplasm may develop a lymphoproliferative disorder; however, the clinical and molecular determinants and the chronological onset of the two events remain unknown. We herein report the case of a 64-year-old man with concomitant diagnosis of high-risk essential thrombocythemia with evidence of a thrombotic event and high-count monoclonal B-cell lymphocytosis (high-count MBL). The patient harbored a JAK2V617F mutation and one of the most common genetic alterations found in chronic lymphocytic leukemia (CLL) (del 13q), which may represent a sign of disease progression. He was initiated on cytoreductive therapy with hydroxyurea 500 mg 3 times per week and hypocoagulation treatment, and is currently under regular surveillance of MBL without CLL criteria.

Concomitant presence of JAK2V617F mutation and BCR­ABL translocation in two patients: A new entity or a variant of myeloproliferative neoplasms (Case report).

Myeloproliferative neoplasms (MPNs) are classically divided into BCR RhoGEF and GTPase activating protein (BCR)-ABL proto­oncogene 1 non­receptor tyrosine kinase (ABL) positive chronic myeloid leukemia (CML) and BCR­ABL negative MPNs, including essential thrombocythemia (ET). One of the major diagnostic criteria for ET is the absence of the philadelphia chromosome, thus when present it is almost indicative of CML. ET and CML are considered to be mutually exclusive; however, there are rare situations in which patients with ET present positive BCR­ABL without the features of CML. Although from the literature review, the frequency of JAK2V617F mutation and BCR­ABL translocation coexistence in MPNs is low, it may be higher than expected. The current study reported cases of two patients with an initial diagnosis of ET in the presence of JAK2V617F mutation and BCR­ABL translocation by fluorescent in situ hybridization. Both patients presented with a heterozygous BCR­ABL translocation, and absence of p190 and p210 transcripts, seemingly a der(9) in the background of an ET JAK2V617F mutation.

Characterization of contaminants from a sanitized milk processing plant.

Milk processing lines offer a wide variety of microenvironments where a diversity of microorganisms can proliferate. We sampled crevices and junctions where, due to deficient reach by typical sanitizing procedures, bacteria can survive and establish biofilms. The sampling sites were the holding cell, cold storage tank, pasteurizer and storage tank--transfer pump junction. The culturable bacteria that were isolated after the sanitation procedure were predominantly Pseudomonas spp., Serratia spp, Staphylococcus sciuri and Stenotrophomonas maltophilia. We assayed several phenotypic characteristics such as the ability to secrete enzymes and siderophores, as well as the capacity of the strains to form biofilms that might contribute to their survival in a mixed species environment. The Pseudomonas spp. isolates were found to either produce proteases or lecithinases at high levels. Interestingly, protease production showed an inverse correlation with siderophore production. Furthermore, all of the Serratia spp. isolates were strong biofilm formers and spoilage enzymes producers. The organisms identified were not mere contaminants, but also producers of proteins with the potential to lower the quality and shelf-life of milk. In addition, we found that a considerable number of the Serratia and Pseudomonas spp. isolated from the pasteurizer were capable of secreting compounds with antimicrobial properties.

A WNK4 gene variant relates to osteoporosis and not to hypertension in the Portuguese population.

Germline mutations in the WNK4 gene originate Gordon syndrome or pseudohypoaldosteronism type II, a familial form of hypertension with hyperkalemia and hypercalciuria. In order to elucidate the contribution of WNK4 genetic variants to hypertension and/or osteoporosis, we analyzed 271 control individuals and a cohort of 448 hypertensive and 372 osteoporosis patients from the Portuguese population. Ten genetic variants were detected in 4.3% of the population under study, none of which revealed any significant association to the hypertension phenotype. In contrast, a rare missense alteration within exon 17 in a highly conserved arginine residue showed a possible tendency for association to the osteoporosis group. Our data suggest that WNK4 polymorphism rs56116165 is a rare allelic variant in a candidate gene with a biological function in renal calcium homeostasis that may contribute to a genetic predisposition to osteoporosis.

[Reliability of cause of death due to violence from information systems in Belo Horizonte, Southern Brazil]. / Confiabilidade da informação sobre mortalidade por violência em Belo Horizonte, MG.

OBJECTIVE: To determine reliability of data encoding for death due to violence; to assess the agreement between cause of death in the Mortality Information System and cause selected from the Forensic Medicine Institute database; and to assess the impact of adding information of non-specified injuries and undetermined death events subsequently obtained from Forensic Medicine Institute in the mortality statistics due to violence. METHODS: A random sample of 411 death certificates due to violence was obtained in Belo Horizonte, Southeastern Brazil, between 1998 and 2000. Based on data from death certificates and Forensic Medicine Institute database, causes of death were coded and the agreement between this information and that from Mortality Information System was assessed. Also, in all certificates including "non-specified injury" and "undetermined death events," the impact of adding information from Forensic Medicine Institute was assessed in the classification of cause of death. RESULTS: Coding agreement was significant (Kappa=0.782; 95% CI: 0.744; 0.819) and of the underlying cause was moderate to significant (Kappa=0.602; 95% CI: 0.563; 0.641). There were 12.9% and 5.7% misclassification of suicides and murders, respectively, for those causes classified as "non-specified injury" and "undetermined death events," which were overall reduced to 47.3% and 59.8% respectively. CONCLUSIONS: There is a need for further improving the process of underlying cause coding and selection. Also medical examiners need to provide more complete death certificates and medical and police information provided with bodies for Forensic Medicine Institute autopsy should be more complete, especially in those cases of road traffic injuries and falls.

Confiabilidade da informação sobre mortalidade por violência em Belo Horizonte, MG / Reliability of cause of death due to violence from information systems in Belo Horizonte, Southern Brazil

OBJETIVO: Determinar a confiabilidade da codificação e seleção da causa básica dos óbitos por violência; verificar a concordância entre causa registrada no Sistema de Informação sobre Mortalidade e causa selecionada após investigação no Instituto Médico Legal; avaliar o impacto de incorporar informações pós-investigação dos acidentes não especificados e eventos de intenção indeterminada nas estatísticas de mortalidade. MÉTODOS: Selecionou-se amostra aleatória de 411 declarações de óbito de residentes em Belo Horizonte, MG, de 1998 a 2000. Com base nas informações dessas declarações e do Instituto Médico Legal, procedeu-se à codificação da causa e à determinação da concordância entre esta codificação e aquela registrada no Sistema de Informação sobre Mortalidade. Ainda, para todas as declarações classificadas como "acidentes não especificados" e "eventos de intenção indeterminada", avaliou-se o impacto da agregação das informações do Instituto Médico Legal sobre a classificação dos diversos tipos de violência. RESULTADOS: A concordância da codificação foi substancial (Kappa=0,782; IC 95 por cento: 0,744; 0,819) e, da causa básica entre moderada e substancial (Kappa=0,602; IC 95 por cento: 0,563; 0,641). Identificou-se 12,9 por cento mais suicídios e 5,7 por cento mais homicídios entre os acidentes não especificados e eventos de intenção indeterminada, estes reduzidos em 47,3 por cento e 59,8 por cento, respectivamente. CONCLUSÕES: Verificou-se necessidade de aprimoramento da codificação e seleção da causa básica; de melhoria no preenchimento da declaração de óbito pelos legistas e das informações médicas e policiais nos documentos de encaminhamento de corpos para necropsia, em especial nos acidentes de transporte e quedas.

OBJECTIVE: To determine reliability of data encoding for death due to violence; to assess the agreement between cause of death in the Mortality Information System and cause selected from the Forensic Medicine Institute database; and to assess the impact of adding information of non-specified injuries and undetermined death events subsequently obtained from Forensic Medicine Institute in the mortality statistics due to violence. METHODS: A random sample of 411 death certificates due to violence was obtained in Belo Horizonte, Southeastern Brazil, between 1998 and 2000. Based on data from death certificates and Forensic Medicine Institute database, causes of death were coded and the agreement between this information and that from Mortality Information System was assessed. Also, in all certificates including "non-specified injury" and "undetermined death events," the impact of adding information from Forensic Medicine Institute was assessed in the classification of cause of death. RESULTS: Coding agreement was significant (Kappa=0.782; 95 percent CI: 0.744; 0.819) and of the underlying cause was moderate to significant (Kappa=0.602; 95 percent CI: 0.563; 0.641). There were 12.9 percent and 5.7 percent misclassification of suicides and murders, respectively, for those causes classified as "non-specified injury" and "undetermined death events," which were overall reduced to 47.3 percent and 59.8 percent respectively. CONCLUSIONS: There is a need for further improving the process of underlying cause coding and selection. Also medical examiners need to provide more complete death certificates and medical and police information provided with bodies for Forensic Medicine Institute autopsy should be more complete, especially in those cases of road traffic injuries and falls.

Agenda de prioridades da vigilância e prevenção de acidentes e violências aprovada no I Seminário Nacional de Doenças e Agravos não Transmissíveis e Promoção da Saúde / Agenda of priorities for the surveillance and prevention of accidents and violence approved by the I National Seminar on Noncommunicable Diseases and Conditions and Health Promotion

As taxas de mortalidade por causas externas – acidentes e violências – apresentam-se altas e crescentes desde a década de 80, disseminando-se, em algumas regiões do Brasil, à semelhança de doenças transmissíveis. O Ministério da Saúde tem se mobilizado para o enfrentamento do problema e, por intermédio da Coordenação-Geral de Doenças e Agravos Não Transmissíveis da Secretaria de Vigilância em Saúde, promoveu, em setembro de 2005, o I Seminário Nacional de Doenças e Agravos Não Transmissíveis e Promoção da Saúde. No evento, aprovou-se a Agenda de Vigilância, Prevenção e Controle dos Acidentes e Violências. O documento define quatro eixos principais de atuação, cujos elementos são detalhados no presente artigo: I – Implantação da Vigilância e do Sistema de Informação de Acidentes e Violências; II – Gestão; III – Intervenção; e IV – Avaliação e apoio à pesquisa...

A proposta da rede de serviços sentinela como estratégia da vigilância de violências e acidentes / The injury surveillance system based on sentinel health services

No Brasil, as bases de dados oficiais permitem o monitoramento da mortalidade e internações no SUS, decorrentes dos acidentes e violências. É preciso conhecer a magnitude e o perfil dessas causas que demandam os serviços de emergência, bem como identificar alguns problemas ocultos tais como as violências doméstica e sexual. O propósito deste artigo é apresentar a proposta do Ministério da Saúde de implantação da Rede de Serviços Sentinela de Vigilância de Violências e Acidentes - Rede VIVA, iniciada em 2006, que visa complementar o sistema de informações existente para a vigilância dessas causas. Para obter um quadro mais completo do problema e atender à legislação vigente no País, foram estabelecidos dois componentes: 1) Vigilância de acidentes e violências em emergências hospitalares selecionadas: coleta em um mês a cada ano, através de uma amostra; 2) Vigilância das violências sexual, doméstica e/ou outras violências interpessoais em serviços de referência: coleta universal e contínua. O estabelecimento da Rede VIVA foi realizado pelo Ministério da Saúde em parceria com as Secretarias Estaduais e Municipais de Saúde a partir de critérios previamente estabelecidos. A adesão ao projeto foi acima das expectativas, todas as regiões do Brasil foram representadas.

In Brazil, the official data sets allow monitoring the impact of injury deaths and injury hospitalization in the public health system. But it is necessary to gather more information about the magnitude and the characteristics of injuries at Emergency Departments (ED), as well as to identify some hidden problems, such as domestic and sexual violence. The purpose of this article is to present the new Injury Surveillance System based on Sentinel Health Services, carried out by the Ministry of Health in order to broaden the knowledge of these causes.To have a more accurate picture of injuries and to enforce the law which made mandatory the information about violence against women in the country, the measures to be taken were twofold: 1) injury surveillance in ED, carried out in chosen services, collecting one-month data yearly, through a sample; 2) domestic, sexual and interpersonal violence surveillance carried out in violence reference services, through universal and continuous data collection, involving a larger number of services. The implementation of that Health Sentinel Services Network has been conducted by the Ministry of Health in partnership with the State and Municipal Health Departments based on pre-established criteria. The adherence to the project has been taken place all over Brazil.

The urban environment from the health perspective: the case of Belo Horizonte, Minas Gerais, Brazil

O objetivo desse estudo foi conhecer a distribuição de eventos em saúde em ambiente urbano. Foram georrefenciados ao endereço de residência casos de homicídios, gravidez na adolescência, internações por asma em crianças, dengue e leishmaniose visceral. A análise incluiu, para cada evento, cálculo de indicadores anuais médios, construção de mapas temáticos usando o índice comparativo de morbidade, além da criação de escores do padrão de ocorrência simultânea dos eventos por unidade espacial. Taxas elevadas de homicídio, de mães adolescentes e de internação por asma foram observadas em áreas de grandes desigualdades sociais do município. Para as doenças vetoriais, foram encontradas aglomerações de altos índices dos eventos em regiões desfavorecidas em contraponto com baixos índices em regiões favorecidas, além da relativamente pouca coexistência dos dois agravos nas mesmas regiões do município. O estudo sugeriu a coexistência espacial de agravos consagrados como resultantes das desigualdades sociais, em áreas caracterizadas pela miséria e pobreza, com grupos sociais desfavorecidos, representados pelas camadas mais pobres da população. Sugeriu também uma possível participação de fatores ambientais na modulação dos eventos de origem vetorial.

The urban environment from the health perspective: the case of Belo Horizonte, Minas Gerais, Brazil.

This study aims to determine spatial patterns of mortality and morbidity for five health problems in an urban environment: homicides, adolescent pregnancy, asthma hospitalization, and two vector-borne diseases, dengue and visceral leishmaniasis. All events were obtained through the city health database and geoprocessed using residential addresses and 80 planning units consisting of census tracts. We used thematic maps, proportionate mortality/morbidity ratios by planning unit, and the overlapped rank of the 20th worse planning unit rates for each event. A spatial pattern of high rates of homicides, proportion of young mothers, and hospitalization due to asthma overlapped in socially and economically disadvantaged areas. For the two vector-borne diseases, high rates with great dispersion were found in underprivileged areas, in contrast with very low rates among higher income areas. The results indicated the coexistence of heavier disease burden for residents of urban areas where poverty and lack of effective public health policies may be modulating social health problems. For the two vector-borne diseases, an environmental intervention in one mosquito-borne disease might be playing a role in the other's incidence.

Utilización de cuidados intensivos pediátricos por cirugia maxilofacial entre 1986 y 1999 / Usefulness of pediatric intensive care unit by maxilofacial surgery. 1986 - 1999

Se realiza un estudio retrospectivo en el servicio de Cirugía Maxilofacial del Hospital Provincial Pediátrico Docente "Hermanos Cordové" de Manzanillo, entre octubre de 1986 y octubre de 1999, para conocer los índices de utilización de la Unidad de Cuidados Intensivos por la especialidad en esos trece años de trabajo. En el período se registró un total de 1342 ingresos, de los cuales sólo 39 (2,9 por ciento) requirieron cuidados intensivos. El sexo masculino y el grupo de edad entre 5 y 9 años resultaron predominantes. La celulitis facial grave y el trauma facial complicado fueron los diagnósticos que generaron mayor número de ingresos a dicha unidad(AU)

La accesibilidad a los sevicios de salud: la experiencia de Belo Horizonte.

Estratégias para universalização do acesso aos serviços de saúde em Belo Horizonte.