Clinical profile and microbiological aetiology diagnosis in adult patients hospitalized with community-acquired pneumonia.

Early introduction of appropriate antibiotherapy is one of the major prognostic-modifying factors in community acquired pneumonia (CAP). Despite established guidelines for empirical therapy, several factors may influence etiology and, consequently, antibiotic choices. The aims of this study were to analyze the etiology of CAP in adults admitted to a northern Portugal University Hospital and evaluate the yield of the different methods used to reach an etiological diagnosis, as well as analyze of the impact of patient demographic and clinical features on CAP etiology. We retrospectively analyzed 1901 cases of CAP with hospitalization. The diagnostic performance increased significantly when blood and sputum cultures were combined with urinary antigen tests. The most frequent etiological agent was Streptococcus pneumoniae (45.7%), except in August, when it was overtaken by gram-negative bacilli (GNB) and Legionella pneumophila infections. Viral infections were almost exclusive to winter and spring. A negative microbiological result was associated with increasing age, non-smoking and lack of both blood/sputum cultures. Younger age was a predictor for S. pneumoniae, Influenza and L. pneumophila infections. Active smoking without any previously known respiratory disease was a risk factor for legionellosis. COPD was associated with Haemophilus influenzae cases, while dementia was typical in GNB and S. aureus patients. Diabetes mellitus (DM) and heart disease were negative predictors of S. pneumoniae and H. influenzae, respectively. P. aeruginosa was an independent risk factor for mortality (OR 13.02, 95% CI 2.94-57.7). This study highlights the importance of a comprehensive microbiological diagnostic workup and provides clues to predicting the most probable CAP causative agents, based on a patient's clinical profile. These may be taken into account when establishing first line antibiotherapy.

Thrombotic events and COVID-19 vaccines.

COVID-19 vaccines are considered promising agents in the control of the pandemic. Although their safety was assessed in randomised clinical trials, severe adverse events (AEs) have been reported after large-scale administration. This study aims to evaluate thromboembolic AEs reported after vaccination in a real-world context and how they led to the interruption of vaccination campaigns. We also review the benefits and risks of the vaccines approved in the European Union and provide recommendations. A review of the literature was performed using Medline/PubMed electronic database as well as institutional and pharmacovigilance official reports. Our findings show that vaccine-induced prothrombotic immune thrombocytopenia has been suggested as a very rare AE associated with viral vector vaccines. Unusual thrombotic events combined with moderate-to-severe thrombocytopenia were reported mainly in women under 60 years of age. As safety signals emerged, Vaxzevria and Janssen´s COVID-19 vaccine campaigns have been paused while investigations proceed. On the other hand, the number of deep vein thrombosis and pulmonary embolism reports have not increased. Post-marketing surveillance indicated that mRNA vaccines are safe and should continue to be used. The thrombotic events report rate is not increased in people over 60 years. As they are at greater risk for COVID-19 complications and death, no vaccine restrictions are recommended in this group. Risk factors for vaccine-induced prothrombotic immune thrombocytopenia should be established so that evidence-based decisions can be made. Systematic monitoring of COVID-19 vaccine safety is essential to ensure that the benefits of vaccination outweigh the risks.

Different disease, same challenges: Social determinants of tuberculosis and COVID-19.

Infectious diseases, such as tuberculosis (TB) and the novel coronavirus (COVID-19) relate to environmental factors, understanding of which is essential to inform policy and practice and tackle them effectively. The review follows the conceptual framework offered by the World Health Organization Commission on Social Determinants of Health (defined as "all those material, psychological and behavioural circumstances linked to health and generically indicated as risk factors' in the conventional epidemiological language"). It describes the social factors behind TB and COVID-19, the commonalities between the two diseases, and what can be learned so far from the published best practices. The social determinants sustaining TB and COVID-19 underline the importance of prioritising health and allocating adequate financial and human resources to achieve universal health coverage and health-related social protection while addressing the needs of vulnerable populations. Rapid and effective measures against poverty and other major social determinants and sources of inequality are urgently needed to develop better health in the post-COVID-19 world.

Seemingly Harmless Differentiated Thyroid Carcinoma Presenting as Bone Metastasis.

Thyroid carcinoma is the most common endocrine neoplasia. Differentiated thyroid carcinomas (DTCs) represent the majority of cases, which usually follow an indolent clinical course with low mortality rates. The authors describe two cases of well DTC without classic histological poor prognosis features, presenting as extensive and unresectable osteolytic bone metastases. DTCs are considered harmless tumours, due to their benign and silent behaviour. The authors want to underline the importance of clinical awareness during follow-up in cases of DTC, which can be aggressive in presentation and behaviour. Timely identification and diagnosis of these tumours are essential for prompt treatment initiation and improvement of overall survival.

Pterygosomatidae and Trombiculidae mites infesting Tropidurus hispidus (Spix, 1825) (Tropiduridae) lizards in northeastern Brazil.

Parasitism of the lizard Tropidurus hispidus by Geckobiella sp. and by larvae of Eutrombicula alfreddugesi was examined in a mountainous area in Chapada do Araripe (07° 16' S and 39° 26' W), southern Ceará State, Brazil. Of the 56 lizards collected (26 females, 27 males, and 3 juveniles), 40 (total prevalence of 71.42%) were infested by mites. Mite-pockets were the sites most heavily infested by E. alfreddugesi larvae, while Geckobiella sp. was found uniformly distributed under scales over the host's entire body. The female specimens of T. hispidus parasitised by E. alfreddugesi had an average infestation rate of 8.57 ± 3.62, 1-27, while the males had an average infestation rate of 11.90 ± 2.63, 1-25. The female specimens parasitised by Geckobiella sp. had an average infestation rate of 5.91 ± 2.28, 1-25, while the males had an average infestation rate of 5.43 ± 1.52, 1-23. Seven specimens were also infested by eggs and immature forms of unidentified mites (average 2.28 ± 0.89, 1-7). There were no significant differences between the total prevalence of mites on adult male (70.4%) and adult female (65.4%) lizards. The body sizes of the hosts did not influence their infestation rates. The average infestation intensity by E. alfreddugesi (10.2 ± 8.7) was significantly greater than the average infestation intensity by Geckobiella sp. (5.9 ± 6.8). T. hispidus is the new host record to Geckobiella mites.

Hospital resource utilization and treatment cost of skeletal-related events in patients with metastatic breast or prostate cancer: estimation for the Portuguese National Health System.

BACKGROUND: Skeletal-related events (SREs) occur frequently in patients with bone metastases as a result of breast (BC) and prostate (PC) cancers. They increase both morbidity and mortality and lead to extensive health-care resource utilization. METHODS: Health care resource utilization by BC/PC patients with at least one SRE during the preceding 12 months was assessed through retrospective chart review. SRE-treatment costs were estimated using the Portuguese Ministry of Health cost database and analyzed using generalized linear models. RESULTS: This study included 152 patients from nine hospitals. The mean (SD) annual SRE-treatment cost per patient was €5963 (€3646) and €5711 (€4347), for BC (n=121) and PC (n=31) patients, respectively. Mean cost per single episode ranged between €1485 (radiotherapy) and €13,203 (spinal cord compression). Early onset of bone metastasis (P = 0.03) and diagnosis of bone metastases at or after the occurrence of the first SRE (P < 0.001) were associated with higher SRE-treatment costs. CONCLUSION: These results reveal the high hospital SRE-treatment costs, highlighting the need for early diagnosis and treatment, and identify key factors determining the economic value of therapies for patients with skeletal metastases.

Periplasmically located α-santonin binding factor in Sphingomonas paucimobilis strain S ATCC 43388.

A marked reduction in uptake of α-santonin, accompanied by loss of ability of cells to transform the substrate, is observed on shocking Sphingomonas paucimobilis strain S ATCC 43388 cells by freeze - thaw method. The shock fluid shows a 26% quench in fluorescence at 350nm on incubation with the substrate. Addition of shock fluid to the freeze thawed cells restores both uptake as well as transformation of α-santonin to near normal.

Expression of carotenoid pigments of haloarchaeal cultures exposed to aniline.

The effects of exposure to aniline on growth and pigmentation in three haloarchaeal isolates from the Indian subcontinent--GUSF (MTCC 3265), from the estuarine saltpans of Goa, India; and GURFT-1 and GURFP-1, both from continental shelf sediments of the west coast of India--were studied. In nutrient-rich tryptone yeast extract medium containing 25% NaCl/crude salt, the growth of GUSF, measured as absorbance at 600 nm, was not affected significantly at all concentrations of aniline used [0.005%-0.04% (v/v)], whereas the growth phases of GURFT-1 and GURFP-1 were affected at concentrations > 0.005%; the total yield, however, was nearly equal to the yield of cultures growing in the absence of aniline. GURFT-1 reached approximately 40% of total yield on the 7th day in the presence of 0.04% aniline, which declined thereafter. The pigmentation observed visually was completely abolished at concentrations of aniline greater than 0.01%. Spectral scans of acetone extracts of the pigment of each of the cultures exposed to concentrations of aniline > 0.01% showed that (i) the bacterioruberin component of the pigments (absorbance in the range 390-500 nm) was completely abolished and (ii) the pigment component(s) shifted toward squalene and phytofluene derivatives (320-360 nm). This is the first report examining the effect of an aromatic pollutant such as aniline on the growth and pigmentation of haloarchaeal cultures.

[Multicenter open study with docetaxel. Treatment of patients with locally advanced or metastatic breast carcinoma]. / Estudo aberto multicêntrico com docetaxel. Tratamento de doentes com carcinoma da mama localmente avançado ou metastático.

The efficacy and safety of docetaxel were evaluated in an open, multicentric, non comparative study involving 24 patients with locally advanced or metastatic breast cancer, eligible for second line or subsequent anticancer chemotherapy; the results confirm a global response around 50%, suggesting some advantages when compared to the usual treatments in this set of patients; the median duration of response, the median time to progression and the median time of survival were respectively, 309, 219 and 345 days; the main iatrogenic event was haematological, mainly in the white and red blood cells.

[Clinical diagnosis in dentistry. Apropos of a case of lymphoma]. / O diagnostico clinico em estomatologia. A proposito de um caso de linfoma.

Taking into account this clinical case, the authors made a research into lymphomas. They made point of proving how important the clinical history, the knowledge o the oral pathology and the multidisciplinary investigation by the different medical specialties are, as well as of emphasizing the importance of the Stomatologist to the valuation and solution of medical problems.

[Craniofacial polyostotic fibro-osseous dysplasia. (1) A clinical case]. / Displasia fibro-óssea poliostótica crãnio-facial. (1) Um caso clínico.

Taking the opportunity of a richness of clinical and radiological manifestations from an uncommon pathology, the authors present a case on polyostotic bony--fibrous displasia with a large envelopment of the facial-skull massif, and outstand the role of the stomatologist as member of a multidisciplinary medical team and the successful therapheutical result achieved through the surgical intervention performed.