Diagnosing congenital cytomegalovirus infections using archived dried blood spots: A 15-year observational study, Portugal.

BACKGROUND: Cytomegalovirus (CMV) is a leading cause of congenital infections. Dried blood spots (DBS) collected in the first week of life (Guthrie cards) have been used in the diagnosis of CMV infection outside the three-week window period following birth. The present work summarizes the results of a 15-year observational study in which DBS from 1388 children were used for a late diagnosis of congenital CMV infection. METHODS: Three groups of children were studied: (i) symptomatic (with symptoms at birth or late sequelae) (N = 779); (ii) born to mothers with serological profile of primary CMV infection (N = 75); (iii) without any information (N = 534). A highly sensitive method of DNA extraction (heat-induced) from the DBS was used. CMV DNA was detected by a nested PCR. RESULTS: In total CMV DNA was detected in 7.5% (104/1388) of children. Symptomatic children showed a low rate of CMV DNA detection (6.7%) than children born to mothers with serological profile of primary CMV infection (13.3%) (p = 0.034). Sensorial hearing loss and encephalopathy were the two clinical manifestations with the highest CMV detection rate (18.3% and 11.1%, respectively). Children whose mothers had a confirmed primary infection showed a higher rate of CMV detection (35.3%) when compared with children whose mothers had a not confirmed primary infection (6.9%) (p = 0.007). CONCLUSION: The present work emphasises the importance of testing DBS in symptomatic children even a long time after symptoms onset and in children born to mothers with serologic diagnosis of maternal primary CMV infection when they miss the diagnosis during the three-week window following birth.

On the Identification of Clinically Relevant Bacterial Amino Acid Changes at the Whole Genome Level Using Auto-PSS-Genome.

The identification of clinically relevant bacterial amino acid changes can be performed using different methods aimed at the identification of genes showing positively selected amino acid sites (PSS). Nevertheless, such analyses are time consuming, and the frequency of genes showing evidence for PSS can be low. Therefore, the development of a pipeline that allows the quick and efficient identification of the set of genes that show PSS is of interest. Here, we present Auto-PSS-Genome, a Compi-based pipeline distributed as a Docker image, that automates the process of identifying genes that show PSS using three different methods, namely codeML, FUBAR, and omegaMap. Auto-PSS-Genome accepts as input a set of FASTA files, one per genome, containing all coding sequences, thus minimizing the work needed to conduct positively selected sites analyses. The Auto-PSS-Genome pipeline identifies orthologous gene sets and corrects for multiple possible problems in input FASTA files that may prevent the automated identification of genes showing PSS. A FASTA file containing all coding sequences can also be given as an external global reference, thus easing the comparison of results across species, when gene names are different. In this work, we use Auto-PSS-Genome to analyse Mycobacterium leprae (that causes leprosy), and the closely related species M. haemophilum, that mainly causes ulcerating skin infections and arthritis in persons who are severely immunocompromised, and in children causes cervical and perihilar lymphadenitis. The genes identified in these two species as showing PSS may be those that are partially responsible for virulence and resistance to drugs.

In-vitro mechanical and biological evaluation of novel zirconia reinforced bioglass scaffolds for bone repair.

Bone defects resulting from infections, tumors, or traumas represent a major health care issue. Tissue engineering has been working togehter with medicine to develop techniques to repair bone damage and increase patient's life quality. In that context, scaffolds composed of bioactive ceramics have been explored, although their poor mechanical properties restrain their clinical applications as highly porous structures. As an alternative solution, this study aimed to evaluate the mechanical properties and biological response of novel zirconia reinforced bioactive glass scaffolds (ZRBG) manufactured by the replica method. The microstructure, chemical composition, compressive strength, density, in-vitro bioactivity, and cell viability were analyzed and compared to scaffolds made of monolithic zirconia of similar architecture (45, 60 and 85 ppi). The microstructure of ZRGB scaffolds consisted of a bioactive glass matrix with dispersed zirconia particles (~33% glassy phase) and the compressive strength values (ZRBG scaffolds: 0.33 ± 0.11, 0.41 ± 0.20 and 0.48 ± 0.6 MPa; ZRBG scaffolds with extra BG coating: 0.38 ± 0.13, 0.45 ± 0.11 and 0.50 ± 0.14 MPa for 45, 60 and 80 ppi, respectively) were not statistically different from those of zirconia scaffolds (0.25 ± 0.14 MPa for 45 ppi, 0.32 ± 0.11 MPa for 60 ppi and 0.44 ± 0.07 MPa for 80 ppi). No bioactivity was exhibited by monolithic zirconia scaffolds while significant bioactive response was found for ZRBG scaffolds. The cell viability of ZRBG scaffolds in osteogenic medium was improved up to 171% over zirconia scaffolds. This work provides promosing results for further exploring this technique for implant dentistry.

Avaliação e Reabilitação Neuropsicológica após Lesão Encefálica Adquirida / Evaluación y Rehabilitación Neuropsicológica después de una Lesión Cerebral Adquirida / Neuropsychological Evaluation and Rehabilitation after Acquired Brain Injury

Resumo Sintomas de desconexão inter-hemisférica após lesão cerebral adquirida são pouco usuais na prática clínica atualmente. Os sintomas costumam diminuir espontaneamente e podem incluir anomia táctil, agrafia à esquerda e sinais de competição entre os hemisférios, como o "sinal da mão alienígena". Este trabalho tem por objetivo apresentar um relato de caso clínico de paciente de 33 anos, que evoluiu com sintomas de desconexão inter-hemisférica e alterações de funções executivas, após intervenção cirúrgica para remoção de tumor em região da hipófise, além de avaliar a aplicabilidade de programa de reabilitação neuropsicológica para as queixas cognitivas apresentadas. O paciente foi avaliado com instrumentos neuropsicológicos padronizados antes de iniciar a reabilitação e próximo à alta do tratamento. O estudo de caso foi realizado a partir da análise de dados de intervenção e evolução clínica do paciente em prontuário institucional (resultados de exame de avaliação neuropsicológica e registros de intervenções em sessões de reabilitação). Ao longo de sua evolução, o paciente apresentou melhora dos sintomas cognitivos e demonstrou benefício com os treinos e estratégias utilizados para sua adaptação, bem como para retomar o trabalho e outras atividades prévias. Destaca-se ainda a importância de se realizar mais estudos de intervenções neuropsicológicas para indivíduos com déficits cognitivos.

Resumen Los síntomas de desconexión interhemisférica después de una lesión cerebral adquirida son inusuales en la práctica clínica actual. Los síntomas generalmente disminuyen de forma espontánea y pueden incluir anomia táctil, agrafía izquierda y signos de la competencia entre los hemisférios. Este estudio tiene como objetivo presentar un caso clínico de un paciente de 33 años, que desarrollaron síntomas de desconexión interhemisférica después de la cirugía para la extirpación del tumor en la región pituitaria y alteraciones en la función ejecutiva y evaluar la aplicabilidad del programa de rehabilitación neuropsicológica para las quejas cognitivas. El paciente fue evaluado con instrumentos neuropsicológicas estandarizadas antes de comenzar la rehabilitación y cerca del máximo tratamiento. El estudio de caso se llevó a cabo a partir del análisis de datos de intervención y el desarrollo clínico del paciente registro médico institucional (resultados de los exámenes de evaluación neuropsicológica y las intervenciones en los registros de las sesiones de rehabilitación). A lo largo de su evolución, el paciente mostró una mejoría en los síntomas cognitivos y demostró un beneficio con la formación y las estrategias utilizadas para adaptarse y para reanudar el trabajo y otras actividades anteriores. También pone de relieve la importancia de llevar a cabo más estudios de intervenciones neuropsicológicas para las personas con déficits cognitivos.

Abstract Symptoms of interhemispheric disconnection after acquired brain injury are unusual in the current clinical practice. Symptoms usually diminish spontaneously and may include tactile anomia, agraphia and left signs of competition between the hemispheres, such as "alien hand sign". This work presents a case report of a 33 year old patient who developed symptoms of interhemispheric disconnection and executive function deficits after surgery for removal of a tumor in the pituitary region, as well as the evaluation of the applicability of the neuropsychological rehabilitation program for the cognitive complaints presented. The patient was evaluated with standardized neuropsychological instruments before starting rehabilitation and again close to the discharge from treatment. The case study was conducted by analyzing intervention data and the clinical outcome of the patient in the institutional records (results of neuropsychological evaluation examination and records of interventions in rehabilitation sessions). Throughout his evolution, the patient showed improvement in cognitive symptoms and demonstrated benefits from the training and strategies used for his adaptation and return to work and other previous activities. The study highlights the importance of conducting more studies of neuropsychological interventions for individuals with cognitive deficits.

Prevalence of at-risk drinking among Brazilian truck drivers and its interference on the performance of executive cognitive tasks.

BACKGROUND: Binge drinking (BD) has been associated with an increase in the risk of alcohol-related injuries. Alcohol continues to be the main substance consumed by truck drivers, a population of special concern, since they are often involved in traffic accidents. The aim of this study was to estimate the prevalence of BD and its interference in the executive functioning among truck drivers in Sao Paulo, Brazil. METHODS: A non-probabilistic sample of 684 truck drivers was requested to answer a structured research instrument on their demographic data and alcohol use. They performed cognitive tests to assess their executive functioning and inventories about confounding variables. The participants were then divided according to their involvement in BD. RESULTS: 17.5% of the interviewees have reported being engaged in BD. Binge drinkers showed a better performance on one test, despite having done so at the expense of more mistakes and lower accuracy. More interestingly, binge drinkers took three seconds longer than non-binge drinkers to inhibit an inadequate response, which is worrisome in the context of traffic. Overall, the deleterious effect of BD on performance remained after controlling for the effects of confounding variables in regression logistic models. CONCLUSIONS: As the use of alcohol among truck drivers may be as a way to get by with their work conditions, we believe that a negotiation between their work organization and public authorities would reduce such use, preventing negative interferences on truck drivers' cognitive functioning, which by its turn may also prevent traffic accidents.

Exigências familiares e do trabalho: um equilíbrio necessário para a saúde de trabalhadores e organizações / Family and work requirements: a necessary equilibrium for worker and organization health

O presente artigo objetiva, por meio de um ensaio teórico, promover a reflexão sobre os novos papéis desempenhados pelas pessoas nas famílias, no trabalho e na sociedade em geral. Pautado em artigos e dados da literatura científica, aborda as transformações na sociedade contemporânea atreladas a mudanças no mundo do trabalho e nas relações familiares, com foco no desequilíbrio na relação família-trabalho. Citam-se algumas iniciativas organizacionais atuais como propostas de prevenção e de melhoria da saúde do trabalhador e de suas relações. Considera-se a necessidade de reconstrução de estereótipos ligados a gênero e de redução de desigualdade de oportunidades entre pessoas, como pontos centrais para a mudança de um cenário atual em que predomina a falta de equilíbrio entre exigências que pode gerar consequências negativas tanto para a saúde do indivíduo e de seus familiares como para a organização.(AU)

This article aims, through a theoretical essay, to promote a reflection about the new roles played by people in families, at work and at the society in general. Based on papers and scientific bibliography, it broaches the changes at the contemporary society, linked to changes on world of work and family relationships, focused on the unbalance at family-work relation. Some current organizational initiatives were cited as plans of prevention and improvement of worker health, which affect their relations. It was considered the need of reconstruction of gender stereotypes and reducing the inequality of opportunity between people as focal points for changing a current scenario, which prevails in the lack of balance between requirements that can generate negative consequences both for health the individual and their families and for the organization.(AU)

Exigências familiares e do trabalho: um equilíbrio necessário para a saúde de trabalhadores e organizações / Family and work requirements: a necessary equilibrium for worker and organization health

O presente artigo objetiva, por meio de um ensaio teórico, promover a reflexão sobre os novos papéis desempenhados pelas pessoas nas famílias, no trabalho e na sociedade em geral. Pautado em artigos e dados da literatura científica, aborda as transformações na sociedade contemporânea atreladas a mudanças no mundo do trabalho e nas relações familiares, com foco no desequilíbrio na relação família-trabalho. Citam-se algumas iniciativas organizacionais atuais como propostas de prevenção e de melhoria da saúde do trabalhador e de suas relações. Considera-se a necessidade de reconstrução de estereótipos ligados a gênero e de redução de desigualdade de oportunidades entre pessoas, como pontos centrais para a mudança de um cenário atual em que predomina a falta de equilíbrio entre exigências que pode gerar consequências negativas tanto para a saúde do indivíduo e de seus familiares como para a organização...

This article aims, through a theoretical essay, to promote a reflection about the new roles played by people in families, at work and at the society in general. Based on papers and scientific bibliography, it broaches the changes at the contemporary society, linked to changes on world of work and family relationships, focused on the unbalance at family-work relation. Some current organizational initiatives were cited as plans of prevention and improvement of worker health, which affect their relations. It was considered the need of reconstruction of gender stereotypes and reducing the inequality of opportunity between people as focal points for changing a current scenario, which prevails in the lack of balance between requirements that can generate negative consequences both for health the individual and their families and for the organization...

[Neuroimaging in Human Immunodeficiency Virus infection]. / Neuroimagem na infecção Vírus da Imunodeficiência Humana.

INTRODUCTION: Central Nervous System (CNS) infection by Human Immunodeficiency Virus (HIV) occurs early in the course of the disease and is associated with changes that can reach any level of the neuroaxis. Neuroimaging plays an increasingly important role both in diagnosis and in longitudinal monitoring of these complications, which can be divided into three major categories: injuries directly associated with HIV, opportunistic infections and malignancies. OBJECTIVES: To identify and to describe the neuroradiological changes found in a population of HIV positive patients. METHODS: Retrospective study with analysis of clinical processes and review of neuroimaging studies of HIV positive patients admitted to the Centro Hospitalar de Coimbra - E.P.E. in the period between 1st January 2008 and 31st March 2011. RESULTS: During the study period we identified 337 episodes of hospitalization of patients with HIV infection, accounting for a total of 196 patients. Of these, 88 underwent at least one neuroimaging examination, with a mean age of 47.1 (27-89) years, of which 75% were males. In 12.5% of the examinations we did not find any relevant changes. In 69.3% atrophy was observed, in 31.2% sequelae lesions with different aetiologies (vascular, infectious), and eight cases of HIV encephalitis were identified. In 19.3% of patients it was diagnosed the presence of an opportunistic infection (11 cases of toxoplasmosis, four of progressive multifocal leukoencephalopathy, one case of tuberculosis and one of neurosyphilis). There were also 10 cases with evidence of recent vascular lesions. Although considered in the differential diagnosis in some cases, in our sample we did not identify any case of tumours. CONCLUSIONS: Recognition of CNS changes associated with HIV infection and of their imaging patterns is of critical importance to the establishment of the diagnosis and to the appropriate treatment. Advanced techniques of Magnetic Resonance Imaging may have an important role in this context.

[Glioblastoma multiforme mimicking limbic encephalitis]. / Glioblastoma multiforme mimetizando encefalite límbica.

Selective and bilateral involvement of the limbic system by gliomas is rarely reported. The authors report the case of a 58 years-male complaining of short-term memory loss in the preceding three weeks. The initial MRI revealed areas of hyperintensity on T2 and FLAIR sequences involving both hippocampus, amygdala, parahippocampus gyrus and the fornix, with contrast enhancement in the right mesial temporal region. Limbic encephalitis diagnosis was assumed and steroid therapy was applied. All other evaluation work-up was negative and follow-up imaging was compatible with tumor. The neuropathologic study of the right temporal lesion revealed glioblastoma multiforme. Glioblastoma can crossover through the commissural white matter to the opposite cerebral hemisphere, most often through the corpus callosum. However, selective and bilateral invasion of the limbic system is rare and when it occurs it may mimic limbic encephalitis.

In vitro anti-Candida activity of lidocaine and nitroglycerin: alone and combined.

The aim of this work was to study the anti-Candida activity of lidocaine and nitroglycerin alone and in combination. Ten Candida strains were included, corresponding to 1 collection type strain (ATCC 10231) and 9 clinical isolates: 4 C. albicans, 2 C. glabrata, 1 C. tropicalis, 1 C. krusei, and 1 C. parapsilosis. The CLSI reference M27-A3 micromethod was used to determine the anti-Candida activity of the drugs alone; minimal inhibitory and lethal concentrations were determined. The classic checkboard technique was used to determine the activity of combined drugs. Lidocaine fungicidal effect was dosedependent. Nitroglycerin exhibited a higher effect. The drugs combination resulted in a reduction of the inhibitory concentration, corresponding to an additive effect. In conclusion, both drugs exhibited an interesting anti-Candida activity. The combination of lidocaine with nitroglycerin was shown to have an additive effect against Candida spp., predicting the interest to include, in the future, these drugs in a new delivery system for the treatment of mucocutaneous candidosis.

Reabilitação neuropsicológica em fase aguda e crônica após Traumatismo Crânio-Encefálico (TCE) grave: relato de caso / Neuropsychological rehabilitation during acute and chronicle stages in severe TBI: Case report

Nos últimos anos, é frequente o debate sobre a complexidade da pesquisa na área de ciências humanas. A psicologia clínica possui algumas particularidades e convoca para o debate, para a busca de novos caminhos e de novas possibilidades metodológicas. Neste artigo, pretende-se discutir as particularidades da pesquisa em psicologia clínica e objetiva-se apresentar como a leitura da obra de Winnicott permite a compreensão da pesquisa como um ato criativo. (AU)

In the last few years, there is a frequent discussion about the complexity of research in human sciences. Clinical psychology has some characteristics that motivate the discussion and search of new ways and new methodological possibilities. In this article, we discuss the details of research in clinical psychology and present how the collected works from Winnicott allows the comprehension of research as a creative act. (AU)

Disorders in planning and strategy application in frontal lobe lesion patients.

The aim of this study was to investigate deficits in planning ability using an adapted version of the Modified Six Elements Test, from the Behavioral Assessment of the Dysexecutive Syndrome-BADS [Wilson, B. A., Alderman, N., Burgess, P. W., Emslie, H., & Evans, J. J. (1996). Behavioural Assessment of the Dysexecutive Syndrome (BADS). Bury St Edmunds, U.K.: Thames Valley Test Company. Trans. Ricardo O Souza, Sergio L Schmidt. Rio de Janeiro: Cognição]. Subjects were left- and right-frontal lobe lesion patients. Other measures of executive dysfunctions used were verbal fluency, the Wisconsin Card Sorting Test, and the Trail Making Test. These other instruments were sensitive to detect executive deficits in the left frontal lobe lesion group, except the Wisconsin Card Sorting Test, which showed impairment only for the frontal lobe lesion group as a whole. The Modified Six Elements Test detected planning disorders in left frontal lobe lesion patients. The deficit of these patients was due to a greater likelihood to break the rules of the task, that is, in plan-following processes, rather than in planning the strategic approach to solve it.

Diagnosis of congenital cytomegalovirus infection by detection of viral DNA in urine pools.

Human cytomegalovirus (HCMV) is the most frequent cause of congenital infection. Diagnosis of this infection is important because 5-17% of asymptomatic infected babies will develop late sequelae and should be followed closely. Most of these children will remain undetected, since screening of all newborns by viral culture is too expensive. The aim of this study was to demonstrate that pool testing could be used to detect HCMV congenital infection in newborns. For this purpose, a nested-PCR technique was tested in urine pools. In phase 1, urine specimens were tested alone by nested-PCR and compared with viral culture, followed by cross experiments to test the reliability of detecting one positive specimen in a 20 samples in a urine pool. In phase 2, this pool method was applied to all urine specimens from children received in the virology laboratory of the Centro Hospitalar Cova da Beira for diagnosis of HCMV infection, between January 2002 and March 2003. In phase 1, 74 urine specimens were tested simultaneously by shell-vial culture and nested-PCR; 17 were positive and the remaining 57 negative by both methods. The negative specimens were divided into three pools and each pool was tested alone and crossed with each of the positive specimens by nested-PCR. Although the three pools were negative when tested alone, all 51 crossed results were positive. In phase 2, 15 out of the 180 urine samples tested positive by shell-vial culture and were detected by this pool method. These results suggest that urine pools can be used to detect HCMV positive urines in children, with similar sensitivity and specificity when compared with the standard method, but with a substantial labour reduction. This significant reduction in labour and consequently in cost per test, opens the possibility of applying PCR to urine pools for screening the HCMV congenital infection in newborns.

A enfermeira e a percepção da dor em recém-nascido / Nurse and pain perception by newborn

Com o interesse de descrever se os enfermeiros sabem avaliar a dor do recém-nascido (RN) e também identificar que atitudes tomam frente ao RN com dor, utilizamos um questionário com perguntas abertas e fechadas, aplicado em 12 enfermeiras de neonatologia no município de São Paulo, sendo analisados em frequência e percentual. Verificou-se que 83,33 por cento das entrevistadas afirmam que os RNs sentem dor, sendo ela avaliada por meio de alterações fisiológicas, comportamentais e emocionais. Quando a dor é observada, realizam condutas farmacológicas e não farmacológicas. Entendemos que o estudo permitiu conhecer melhor o fenômeno de dor no RN e, desse modo, contribuiu para melhorar a assistência de enfermagem ao RN.

Metodologia em reabilitacao neuropsicologica de pacientes com lesao cerebral adquirida / Neuropsychological rehabilitation methods for patientes with acquired brain lesions

O objetivo deste trabalho e apresentar a metodologia de reabilitacao neuropsicologica que vem sendo utilizada no Servico de Reabilitacao de Lesao Cerebral do Centro Paulista de Neuropsicologia. O servico destina-se a...

Memória implícita e sua contribuiçao à reabilitaçao de um paciente amnéstico: relato de caso / Contributions of implicit memory strategies to the rehabilitation of an amnesic patient: case report

Mesmo pacientes severamente amnésticos sao capazes de aprender informaçoes novas, apoiados em estratégias de memória implícita. No presente estudo descrevemos uma experiência de reabilitaçao neuropsicológica, em que um paciente amnéstico, portador de lesao cerebral por anóxia, foi submetido a treino para uso de computador, visando sua capacitaçao semi-profissional. O treinamento teve duraçao de 14 semanas, e as técnicas de ensino utilizadas foram a prática repetitiva e a aprendizagem sem erros. O paciente obteve sucesso na realizaçao das tarefas propostas, aprendendo a operar um editor de textos e mantendo o aprendizado após a passagem do tempo. Apesar disso, lembrava-se apenas vagamente da situaçao de aprendizagem. O presente estudo corrobora trabalhos anteriores que observam a interaçao entre mecanismos de memória implícita e resíduos de memória explícita operando na aquisiçao de conhecimentos em pacientes amnésticos. A aprendizagem de conhecimentos específicos vem se mostrando eficiente para a reabilitaçao de pacientes que sofreram lesoes cerebrais

O uso de procedimentos de estruturação de rotina em indivíduos com anóxia cerebral: relato de caso / Procedures to improve daily activities performance in individuals with cerebral anoxia: case report

OBJETIVO: Apresentar um estudo de caso de reabilitação com procedimentos de estruturação de rotina para realização das atividades de vida diária (AVDs). PACIENTE: Quadro de anóxia cerebral, com déficit de memória verbal e visual, desorientação temporal, abulia e bradipsiquismo. MÉTODO: Estruturação de horários fixos na rotina diária; exposição a um calendário 3 vezes ao dia; caminhadas diárias; monitorização do familiar na execução de tarefas de auto cuidado, fornecendo auxílio mediante comandos verbais curtos e pistas específicas. RESULTADOS: Foram observados aumento da iniciativa, maior autonomia nas AVDs, diminuição do período de latência para qualquer resposta, melhora da atenção, orientação temporal e bradipsiquismo. CONCLUSÕES: Estratégias de controle do comportamento trazem ganhos e limitações para pacientes e familiares. Embora obriguem a adaptação a uma rotina pouco flexível, promovem o aprendizado através da automatização de procedimentos que se valem de mecanismos de memória implícita preservados. Estes recursos podem elevar o grau de autonomia do paciente em casa.