Corrigendum: Antibiotic susceptibility pattern of Portuguese environmental Legionella isolates.

[This corrects the article DOI: 10.3389/fcimb.2023.1141115.].

Pooling Saliva Sample as an Effective Strategy for the Systematic CMV Screening of Newborns-A Multicentric Prospective Study.

BACKGROUND: Cytomegalovirus is the most common cause of congenital infections worldwide. Screening all newborns in the first 2 weeks of life is the only way to detect all cases of congenital infection, allowing the monitoring of children with asymptomatic infection at birth and early intervention. AIM: In this multicenter study, we aimed to evaluate the feasibility of using a saliva pool strategy for mass screening in 7 Portuguese hospitals, and to estimate the current prevalence of this congenital infection in these hospitals. METHODS: A total of 7033 newborns were screened between June 2020 and June 2022, and 704 pools of 10 saliva samples were analyzed by polymerase chain reaction (PCR). RESULTS: Of the 704 pools analyzed, 685 were negative and 19 had positive PCR results for cytomegalovirus. After individual PCR testing, 26 newborns had positive saliva results, of which 15 were confirmed by urine testing. Thus, this study's prevalence of congenital infection was 0.21% (95% confidence interval: 0.12%-0.35%). CONCLUSIONS: In this study, the pooling strategy proved to be effective for the systematic screening of newborns, although this low prevalence raises questions regarding the cost-effectiveness of implementing universal screening. However, this prevalence is probably the result of the control measures taken during the pandemic; therefore, the rates are expected to return to prepandemic values, but only a new study after the pandemic will be able to confirm this.

Antibiotic susceptibility pattern of Portuguese environmental Legionella isolates.

Introduction: Legionnaires' Disease is a pneumonia caused by Legionella spp., currently treated empirically with fluoroquinolones and macrolides. In this study, we aim to describe the antibiotic susceptibility pattern of environmental Legionella recovered in the south of Portugal. Methods: Minimal inhibitory concentration (MIC) determination of 57 Legionella isolates (10 Lp sg 1, 32, Lp sg 2-14 15 L. spp) was achieved by broth microdilution, as described by EUCAST, for azithromycin, clarithromycin, ciprofloxacin, levofloxacin, and doxycycline. Results: Fluoroquinolones were the most active antibiotic, displaying the lowest MIC values in contrast to doxycycline which had the highest. MIC90 and epidemiological cut-off (ECOFF) values were, respectively, 0.5/1 mg/L for azithromycin, 0.125/0.25 mg/L for clarithromycin, 0.064/0.125 mg/L for ciprofloxacin, 0.125/0.125 mg/L for levofloxacin and 16/32 mg/L for doxycycline. Discussion: MIC distributions were higher than reported by EUCAST for all antibiotics. Interestingly, two phenotypically resistant isolates with high-level quinolone resistance were identified. This is the first time that MIC distributions, lpeAB and tet56 genes have been investigated in Portuguese environmental isolates of Legionella.

Salty freshwater macrophytes: the effects of salinization in freshwaters upon non-halophyte aquatic plants.

Salinization is a threat that affects aquatic ecosystems worldwide. As primary producers, freshwater macrophytes are of paramount importance in these ecosystems, however, information regarding the potential impacts of salinization upon these organisms is still scarce. In this review we provide a comprehensive and updated discussion of how freshwater macrophytes deal with salinity increase in freshwaters. We reviewed the salinity tolerance of widespread non-halophyte macrophytes through an overview of salinity tolerance mechanisms, their tolerance classification, and salinity effects at different levels of organization: from individuals to ecosystems. Thus, we demonstrated that widespread macrophytes that inhabit freshwaters display efficient salinity tolerance to salinity levels between 5 and 10 g L-1, and only a few species display tolerance to salinities higher than 10 g L-1. Widespread macrophytes demonstrated salinity tolerance of approximately 5 g L-1. Widespread macrophytes demonstrated salinity tolerance of approximately 5 g L-1. Emergent, floating and submerged species showed no significant difference in salinity tolerance. Salinity stress symptoms in freshwater macrophytes are somewhat similar to those of terrestrial plants and can show up even at slight salinity increases. Salinities higher than 1 g L-1 can negatively affect both physiology and diversity of non-halophyte macrophytes and cause long-term - and not well understood - changes in freshwater ecosystems. Salinization of freshwater ecosystems, among others threats, in combination with climate change, raise concerns about the future ecological status of freshwater ecosystems and the services they can provide.

Energy recovery by anaerobic digestion of algal biomass from integrated microalgae/constructed wetland wastewater treatment.

The present study evaluated the potential for biogas generation from microalgae (MA) biomass and macrophytes used in vertical flow constructed wetlands (VFCW). The samples were obtained by separation and collection of MA after a hydraulic retention time of 14 days, frozen and taken to the laboratory, while the macrophytes of VFCW were obtained, by pruning, every 6 months. The obtained results presented reductions of 63.22% and 61.18% for COD and BOD5, respectively, and removal efficiencies of 53.91% for TP and 99.98% de N-NH3. Average biogas generation was 2322.51 NmL-gSV-1 with 54.61% CH4 (winter/2019), 4491.47 Nml-gSV-1 with 57.17% CH4 (spring/2019), 680.78 NmL-gSV-1 with 16.04% CH4 (summer/2020), and 681.0 NmL-gSV-1 with 19.86% CH4 (autumn/2020) for MA biomass and generation of biogas of 3826.70 NmL-gSV-1 with 44.26% CH4 for VFCW biomass in winter and spring/2019 and of 829.68 NmL-gSV-1 with 17.06% CH4 in summer and autumn/2020. Regarding electricity generation, the present work obtained 1.50 kWh/m3, therefore reaching similar values to other studies that used more traditional biomass sources.

Wastewater treatment using bamboos in constructed wetlands: experiences and future perspectives.

Wastewater treatment using constructed wetlands (CWs) based on natural wetlands constitute a viable alternative with excellent cost and benefit, presenting themselves as efficient technologies in the secondary and tertiary treatment of wastewaters with low implementation, operation, and maintenance costs. The present study aims to evaluate the use of bamboo species, as an alternative to macrophytes, frequently used in CWs, through bibliometric analysis, besides to a review based on case studies. The maps generated by the VOSviewer software and by the analyses of the Web of Science and Scopus databases allowed for a review of typical concepts of CWs, in addition to revealing potential benefits of using bamboos in CWs, such as their hyperaccumulation capacity and bioproduct generation. Other promising aspects were identified, for example the use of bamboo charcoal as a substrate used in subsurface wetlands and the application of ornamental bamboo species for landscape improvements, among other observations. The efficiencies found in six case studies showed values between 89-99.7%, 47.6-99.7%, 58.3-99.9%, and 85.5-99.8% for BOD5, COD, total nitrogen (TN), and total phosphorus (TP), respectively. Despite the promising results, the lack of studies using bamboos in CWs for the treatment of wastewaters limits an assertive statement about the use of this technology, requiring further research, focusing on the morphological functions of bamboos in this treatment with landscape integration and resources recovery.

Hybrid constructed wetlands integrated with microbial fuel cells and reactive bed filter for wastewater treatment and bioelectricity generation.

The present study aimed to develop a pilot-scale integrated system composed of anaerobic biofilter (AF), a floating treatment wetland (FTW) unit, and a vertical flow constructed wetland coupled with a microbial fuel cell (CW-MFC) and a reactive bed filter (RBF) for simultaneously decentralized urban wastewater treatment and bioelectricity generation. The first treatment stage (AF) had 1450 L and two compartments: a settler and a second one filled with plastic conduits. The two CWs (1000 L each) were vegetated with mixed plant species, the first supported in a buoyant expanded polyethylene foam and the second (CW-MFC) filled with pebbles and gravel, whereas the RBF unit was filled with P adsorbent material (light expanded clay aggregate, or LECA) and sand. In the CW-MFC units, 4 pairs of electrode chambers were placed in different spacing. First, both cathode and anode electrodes were composed of graphite sticks and monitored as open circuit. Later, the cathode electrodes were replaced by granular activated carbon (GAC) and monitored as open and closed circuits. The combined system efficiently reduced COD (> 64.65%), BOD5 (81.95%), N-NH3 (93.17%), TP (86.93%), turbidity (94.3%), and total coliforms (removal of three log units). Concerning bioenergy, highest voltage values were obtained with GAC electrodes, reaching up to 557 mV (open circuit) and considerably lower voltage outputs with closed circuit (23.1 mV). Maximum power densities were obtained with 20 cm (0.325 mW/m2) and 30 cm (0.251 mW/m2). Besides the electrode superficial areas, the HRT and the water level may have influenced the voltage values, impacting DO and COD concentrations in the wastewater.

Combined system for wastewater treatment: ozonization and coagulation via tannin-based agent for harvesting microalgae by dissolved air flotation.

This study evaluated the performance of urban wastewater treatment in pilot-plant by an integrated system consisting of anaerobic reactor, microalgae cultivation, Venturi tube ozone recirculation, coagulation/flocculation with tannin-based agent natural coagulant, and dissolved air flotation (DAF). Ozone concentrations (without ozone, 0.13 and 0.25 mg O3/mg of biomass) and tannin dosages (65, 85 and 105 mg/L) were evaluated regarding microalgae separation and their influences on wastewater treatment performance. During the experiments, it was verified that the treatment efficiency increased when ozone was applied and with higher tannin dosages. The best results were found with 0.13 mg O3/mg of biomass and 105 mg/L of tannin, obtaining excellent removal of turbidity removal (99.4%), apparent colour at 420 nm (94.5%), TN (83.2%), N-NH3 (100%), TOC (86.8%), BOD5 (86.5%) and COD (100%), 47.6% reduction in electric conductivity, 46.1% in TDS, 66.4% TP removal for the integrated system and 84% microalgae biomass recovery were obtained. Our results showed that the system proved to be a viable alternative for the treatment of urban wastewater and the recovery of microalgae through the insertion of ozone via Venturi tube combined with tannin-based agent.

Lower prevalence of congenital cytomegalovirus infection in Portugal: possible impact of COVID-19 lockdown?

Cytomegalovirus (CMV) is the most frequent cause of congenital infection all over the world. Its prevalence ranges from 0.2 to 2.2%. Transmission from children to their pregnant mothers is a well-known risk factor, particularly if they attend a childcare centre. This study aims to compare the prevalence of CMV congenital infection (CMV_CI) in Portugal (Lisbon) between two studies, performed respectively in 2019 and 2020. In the 2019 study, performed in two hospitals, we found a 0.67% CMV_CI prevalence, using a pool strategy previously tested with saliva samples. In the 2020 study, using the same pool approach in four hospitals (the previous and two additional), and based on 1277 samples, the prevalence was 0.078%.Conclusion: The close temporal coincidence with COVID-19 lockdown suggests that these measures may have had a significant impact on this reduction, although other explanations cannot be ruled-out. What is Known: • Cytomegalovirus is the leading cause of congenital infection. • Behavioural measures decrease cytomegalovirus seroconversion in pregnant women. What is New: • From 2019 to 2020 there was a significant reduction in the prevalence of congenital CMV infection.

Sodium found in processed cow milk and estimated intake by infants

Abstract Objective: To determine the sodium concentration in cow milk available for sale and to estimate its consumption by infants up to 6 months of age. Methods: Sodium level was determined by flame emission spectrophotometry in eight different lots of five brands of liquid ultra-high temperature milk and three brands of powdered milk. To estimate sodium consumption via cow milk, orientations for exceptional situations when neither breastfeeding nor infant formula is possible were considered. Inferential statistics were performed and results were compared with critical parameters at a 5% significance level. Results: The mean sodium content per portion found in liquid milk (162.5 ± 16.2) mg/200 mL was higher than that in powdered milk (116.8 ± 3.0) mg/26 g. Estimated sodium consumption by infants through powdered milk varied from 149.8 to 224.7% of adequate intake, and via liquid milk can be more than 500% of the adequate intake, reaching 812.4% of it if dilution is not applied. Seven of the eight brands of milk studied had declared, on their labels, that the sodium content was 13-30% lower than that found in chemical analysis. Conclusion: Liquid and powdered whole cow milk have high sodium content, and the content per portion is higher in liquid milk than in powdered milk. The estimated consumption of sodium through these products can far exceed the adequate intake for infants from 0 to 6 months old, even when the recommended dilution and maximum daily volumes are followed.

Meteorological drivers and ENSO influence on phytoplankton biomass dynamics in a shallow subtropical lake.

Meteorological features influence the dynamics of aquatic ecosystems and consequently their biotas. This study aimed to identify the meteorological drivers of phytoplankton biomass (chlorophyll a), sampled seasonally over a period of 12 years (2001-2013) in Lake Mangueira, a large shallow subtropical lake in southern Brazil. The lake is 90 km long and 3-10 km wide with a mean depth of 3 m and is oligo-mesotrophic and highly affected by wind action. In general, non-parametric multiplicative regression analysis identified wind direction, radiation, and the Oceanic Niño Index as the main drivers of variation in chlorophyll a. Notably, ENSO periods caused changes in physical, chemical, and meteorological parameters, including conductivity, total suspended solids, total and dissolved nitrogen, alkalinity, soluble reactive silica, wind speed, and precipitation. Phytoplankton biomass showed significant differences between ENSO periods and the periods without events, occurring in the highest values during La Niña years. This study showed that meteorological variables can significantly influence productivity patterns, indicating the importance of including them in limnological studies.

Sodium found in processed cow milk and estimated intake by infants.

OBJECTIVE: To determine the sodium concentration in cow milk available for sale and to estimate its consumption by infants up to 6 months of age. METHODS: Sodium level was determined by flame emission spectrophotometry in eight different lots of five brands of liquid ultra-high temperature milk and three brands of powdered milk. To estimate sodium consumption via cow milk, orientations for exceptional situations when neither breastfeeding nor infant formula is possible were considered. Inferential statistics were performed and results were compared with critical parameters at a 5% significance level. RESULTS: The mean sodium content per portion found in liquid milk (162.5±16.2) mg/200mL was higher than that in powdered milk (116.8±3.0) mg/26g. Estimated sodium consumption by infants through powdered milk varied from 149.8 to 224.7% of adequate intake, and via liquid milk can be more than 500% of the adequate intake, reaching 812.4% of it if dilution is not applied. Seven of the eight brands of milk studied had declared, on their labels, that the sodium content was 13-30% lower than that found in chemical analysis. CONCLUSION: Liquid and powdered whole cow milk have high sodium content, and the content per portion is higher in liquid milk than in powdered milk. The estimated consumption of sodium through these products can far exceed the adequate intake for infants from 0 to 6 months old, even when the recommended dilution and maximum daily volumes are followed.

Floating treatment wetlands in domestic wastewater treatment as a decentralized sanitation alternative.

Floating treatment wetlands (FTW) are technologies that have stood out for their efficiency, ease of installation and maintenance. They consist of macrophytes emerging in a floating structure that keep the plant roots in direct contact with the effluent regardless of the water flow variation over time, allowing the removal of pollutants by various processes. The application of FTWs for the treatment of domestic wastewater has the advantage of low costs in terms of removing nutrients and at the same time reducing the cost of maintenance and energy consumption when compared to the conventional centralized treatment of effluent. The lack of wastewater treatment in areas distant from urban centers is even more limited, mainly due to the high cost of tubing and pumps for the effluent to reach the treatment plants. Therefore, the objective of this study was to research FTW systems applied to the decentralized treatment of domestic wastewater. First, a bibliometric analysis was conducted comparing the main issues involving FTW, and the challenges regarding the integration of FTW and domestic wastewater treatment systems. The feasibility of the floating system as a decentralized treatment approach were discussed, as well as the removal of nutrients in domestic wastewater, which was the most covered topic by researchers who developed studies in the area. In addition, other technologies are being integrated into the phytoremediation systems seeking to improve the quality of the treated effluent and assessing the potential reuse in the homes where they are generated and treated, determining the costs and space requirements for the entire process. There is a large research gap regarding the treatment of domestic wastewater by FTW in decentralized systems, mainly in terms of operation, cost assessment and reuse Therefore, further investigations in order to better understand the performance of the process and the reactions that occur with physical, chemical and microbiological removal mechanisms are still necessary.

Root growth and nutrient removal of Typha domingensis and Schoenoplectus californicus over the period of plant establishment in a constructed floating wetland.

Constructed floating wetlands have been employed worldwide to treat effluents and to ameliorate water quality of water resources. However, the period of macrophyte establishment into the hydroponic functioning has not been specifically addressed. This paper reports root growth and nutrient removal of Typha domingensis and Schoenoplectus californicus in a floating structure without growth substrates over the period of 11 weeks of macrophyte establishment. The experiment was conducted in mesocosm with two replicas of each specie. Weekly batches were applied with three different concentrations of a synthetic effluent. Root growth was measured to evaluate the macrophyte adaptation. Physicochemical parameters were weekly monitored, and total nitrogen, nitrate, total phosphorus, and orthophosphate were quantified to assess nutrient removal. Both species have adapted to the floating structure, but T. domingensis presented superior root growth in relation to S. californicus. No significant differences were found during the application of first two synthetic solutions. As to solution 3, significant differences between input and output values were found to total phosphorus (F = 9.948, df = 1, p = 0.008), nitrate (F = 5.990, df = 1, p = 0.031), and total nitrogen (F = 40.212, df = 1, p < 0.0001). Removal efficiency of T. domingensis ranged from 4 to 31% for total nitrogen and from 8 to 15% for total phosphorus. S. californicus, on the other hand, varied its removal efficiency from - 6 to 5% and 2 to 12% for total nitrogen and total phosphorus, respectively. Time period of macrophyte establishment varied between species, and it was an important factor that contributed to the increase of nutrient removal rates and root growth.

Floating treatment wetlands integrated with microbial fuel cell for the treatment of urban wastewaters and bioenergy generation.

The objective of the present study was to develop a combined system composed of anaerobic biofilter (AF) and floating treatment wetlands (FTW) coupled with microbial fuel cells (MFC) in the buoyant support for treating wastewater from a university campus and generate bioelectricity. The raw wastewater was pumped to a 1450 L tank, operated in batch flow and filled with plastic conduits. The second treatment stage was composed of a 1000 L FTW box with a 200 L plastic drum inside (acting as settler in the entrance) and vegetated with mixed ornamental plants species floating in a polyurethane support fed once a week with 700 L of wastewater. In the plant roots, graphite rods were placed to act as cathodes, while on the bottom of the box 40 graphite sticks inside a plastic hose with a stainless-steel cable acting as the anode chamber. Open circuit voltages were daily measured for 6 weeks, and later as closed circuit with the connection of 1000 Ω resistors. Plant harvestings were conducted, in which biomass production and plant uptake from each of the species were measured. On average, system was efficient in reducing BOD5 (55.1%), COD (71.4%), turbidity (90.9%) and total coliforms (99.9%), but presented low efficiencies regarding total N (8.4%) and total P (11.4%). Concerning bioenergy generation, voltage peaks and maximum power density were observed on the feeding day, reaching 225 mV and 0.93 mW/m2, respectively, and in general decaying over the 7 days. In addition, plant species with larger root development presented higher voltage values than plants with the smaller root systems, possible because of oxygen release. Therefore, the combined system presented potential of treating wastewater and generating energy by integrating FTW and MFC, but further studies should investigate the FTW-MFC combination in order to improve its treatment performance and maximize energy generation.

Bureaucracy and the balanced scorecard in health care settings.

PURPOSE: We explore the relationship between the balanced scorecard (BSC) and neo-bureaucracy by investigating whether the operationalization of the BSC incorporates "neo-bureaucratic" ideas and whether the BSC implemented in a Portuguese Local Health Unit (LHU) demonstrates a neo-bureaucratic approach. DESIGN/METHODOLOGY/APPROACH: We conduct semi-structured interviews with LHU staff and analyse documents to assess whether features of bureaucratic organization were evident in the use of a BSC by the LHU. FINDINGS: We found nine bureaucratic features evident in the LHU's BSC. These were systematization, rationality, authority, jurisdiction, professional qualification, knowledge, discipline, transparency and accountability. The BSC used at the LHU demonstrated a neo-bureaucratic approach. ORIGINALITY/VALUE: Our study helps to demystify bureaucracy and overcome prevailing prejudices regarding some of its principles. Health care managers should recognize and endorse neo-bureaucratic principles in developing a BSC. They should recognize the BSC as involving a neo-bureaucratic approach. The BSC is a valuable management tool that hospital managers should find useful in fostering flexibility, collaboration, innovation and adaptation - all of which should help lead to improved healthcare outcomes.

Biomonitoring of urban wastewaters treated by an integrated system combining microalgae and constructed wetlands.

The objectives of the present study were to apply different, toxicological assays for monitoring the toxicity of treated and untreated urban effluents produced at a university campus. The research was conducted at the wastewater treatment plant of the University of Santa Cruz do Sul, (UNISC), from october 2018 to april 2019. An integrated system with, anaerobic reactor (AR), microalgae (MA) and constructed wetlands (CWs) was, proposed for detoxification of the wastewaters produced at the university campus with a hydraulic detention time of 17 days. Daphnia, magna (ecotoxicity) and Allium cepa (phytotoxicity, cytotoxicity, and, genotoxicity) were used as tools to monitor the efficiency of the integrated system. Obtained results showed that the integrated system (MA, + CWs) presented good COD and BOD5 reductions, besides removal rates of, almost 98% for N-NH3, being much more efficient than the UNISC wastewater, treatment plant (UWTTP). The results of ecotoxicity presented the raw wastewaters (RW) as slightly toxic and an absence of ecotoxicity in all the treatments steps. Regarding phytotoxicity, the results showed no significant differences between the treatments. The cytogenetic assays indicated a significant increase in mitotic index (MI) (p < 0.001) after treatment by CWs compared to the final treatment UWTTP while the results, regarding binucleated cells (BNC) did not present significant differences, among the treatments. Micronucleus (MN) indexes were significantly different between the UWWPT and the integrated system (p < 0.01). In relation to chromosome aberrations (CA) the results indicate a significant difference between the CWs and UWWTP treatments (p < 0.01) and, RW and CWs (p < 0.001), confirming the detoxifying potential of the integrated system when compared to UWWPT. Thus, the results of the present research highlight the relevance in the proposition of the integrated system as an alternative of cleaner technology to the detriment of conventional technologies applied in wastewater treatment.

Fatores Associados à Escolha da Especialidade de Medicina de Família e Comunidade / Factors Associated with the Choice of Specializing in Family Medicine

Resumo: Introdução: A Medicina de Família e Comunidade (MFC) é considerada a especialidade mais relacionada com os princípios de longitudinalidade, integralidade e coordenação do cuidado da atenção primária à saúde (APS). A escolha da especialidade de MFC pode ser considerada por aspectos pessoais, profissionais e do currículo médico. O objetivo deste estudo foi analisar o perfil dos médicos residentes e egressos dos programas de residência de MFC de Pernambuco e os fatores associados à escolha da especialidade. Método: Realizou-se um estudo de corte transversal envolvendo 129 médicos ingressantes nas residências de MFC de Pernambuco, de 2012 a 2017. A coleta de dados foi feita com a aplicação de questionário eletrônico do LimeSurvey em escala tipo Likert de cinco pontos, com perguntas sobre fatores que contribuíram para a escolha da especialidade. Fizeram-se análises descritivas das variáveis do estudo no Epi Info 7.0, apresentadas em distribuição de frequência e medidas de tendência central e dispersão. Avaliou-se a consistência interna dos dados pelo alfa de Cronbach. O estudo foi aprovado pelo Comitê de Ética em Pesquisa da Faculdade Pernambucana de Saúde. Resultados: Responderam ao questionário 104 médicos, com média de idade de 31 + 6,1 anos. Do total de participantes, 58,6% eram mulheres, 70% eram egressos de faculdades públicas e 66,3% escolheram a MFC após a conclusão da faculdade. Os aspectos pessoais analisados como influenciadores na escolha da especialidade de MFC foram: compromisso social, aptidão e afinidade com a especialidade, e circunstâncias da vida pessoal. Em relação às características da residência, a duração e a disponibilidade de vagas favoreceram a escolha. A maior parte dos aspectos relacionados com as caraterísticas próprias da especialidade exerceu influência positiva na escolha dos participantes. Os fatores do currículo da graduação que favoreceram a escolha da especialidade foram: influência de preceptores modelos e atividades práticas no contexto da MFC. O coeficiente alfa de Cronbach foi de 0,847. Conclusões: Entre os fatores referidos pelos residentes como influenciadores na escolha da especialidade de MFC, incluem-se os aspectos pessoais e as características do programa de residência e da especialidade. Por sua vez, os aspectos do currículo da graduação, de forma geral, não contribuíram para a essa escolha, entretanto houve concordância de que a vivência em cenário de prática de MFC e o exemplo de preceptores modelos influenciaram na decisão.

Abstract: Introduction: Family Medicine (FM) is considered the specialty which is most closely related to the primary health care (PHC) principles of longitudinality, comprehensiveness and coordination. The choice to specialize in FM can be related to personal, professional and curricular aspects. Objective: To analyze the profile of family medicine residents in Pernambuco and the factors associated with the choice of this specialty. Method: Cross-sectional study, involving 129 physicians entering FM residency in Pernambuco from 2012 to 2017. Data collection was performed by applying an electronic LimeSurvey questionnaire using a five-point Likert scale with questions about factors that may have contributed to their choice of the specialty. Descriptive analyses of the study variables were performed in EpiInfo® 7.0, presented in frequency distribution and measures of central tendency and dispersion. The internal consistency of the data was assessed using Alpha Cronbach. The study was approved by the Research Ethics Committee of the Faculdade Pernambucana de Saúde. Results: 104 physicians answered the questionnaire, with a mean age of 31 + 6.1 years, 58.6% women, 70% were graduates from public universities and 66.3% of the medics decided to specialize in FM after graduating. Personal aspects analysed in relation to influence on the physician's choice to specialize in FM are social commitment, aptitude, affinity with the specialty and personal life circumstances. In terms of the characteristics of medical residency, both the duration and the availability of places in the state's FM programs played a part in the choice. Most aspects related to the choice of following a career in FM were classed as a positive influence on that choice. Factors related to the undergraduate curriculum included model preceptors and practical activities in the family medicine setting. Cronbach's alpha coefficient was 0.847. Conclusion: The factors cited by residents as influencing their choice to specialize in FM include personal aspects, characteristics of the residency program as well as characteristics of the specialty itself. On the other hand, aspects related to the undergraduate curriculum in general did not contribute to this choice. There was, however, agreement that practical experience in a FM setting and the example of model tutors influenced the decision.

Milk types and their contribution to daily sodium and calcium intake. / Tipos de leite e sua contribuição na ingestão diária de sódio e cálcio.

Low calcium consumption and high sodium intake among adolescents is a serious public health problem. Thehigh content and bioavailability of calcium in milk makes it the best choice for meeting the Dietary Reference Intakes (DRIs) for calcium. Since milk also contributes to sodium intake, programs promoting milk consumption should be preceded by initiatives to reduce its sodium content. Knowing the calcium and sodium content of processed milk is essential for establishing the adequate consumption of milk. The aim of this study was to estimate the calcium and sodium content of different brands of powdered and ultra heat treated (UHT) milk sold in supermarkets in Rio de Janeiro and calculate the amount of these milks that should be consumed by adolescents to meet daily calcium needs and the impact of this consumption on sodium intake. Volumetric analysis was used to measure calcium content and sodium content was determined using flame photometry. The mean calcium and sodium concentrations of powdered (mg/26g) and UHT milk (mg/200ml) were 262.5 ± 5.1 mg and 116.8 ± 3.1 mg and 246.0 ± 10.3 mg and 162.5 ± 16.3 mg, respectively. Milk intake sufficient to meet the DRI for calcium among adolescents would result in a sodium intake of 584 mg (39% of the AI) from the consumption of powdered milk and 812.5 mg (54% of the AI) from the consumption of UHT milk.

O baixo consumo de cálcio e elevado de sódio por adolescentes configura um sério problema de saúde pública. A biodisponibilidade e o teor de cálcio contido no leite fazem dele a melhor opção no atendimento a Ingestão Dietética Recomendada (IDR) desse nutriente. Como o leite pode contribuir para a ingestão de sódio, a realização de programas que visem aumentar o seu consumo deve ser precedida de ações para diminuir o teor de sódio nele presente. O conhecimento dos teores de cálcio e sódio presentes nos leites industrializados é fundamental para que se estabeleça a quantidade adequada a ser consumida. O estudo realizado visou quantificar o cálcio e o sódio de leites em pó e ultrapasteurizados comercializados em supermercados da cidade do Rio de Janeiro e estimar a quantidade a ser consumida para atingir as necessidades diárias de cálcio e o impacto sobre a ingestão de sódio. O cálcio foi quantificado por volumetria e o sódio por fotometria de chama. Os teores médios de cálcio e sódio do leite em pó (mg/26g) foram, respectivamente, 262,5 ± 5,1mg e 116,8 ± 3,1mg, e do leite ultrapasteurizado (mg/200mL) foram, respectivamente, 246,0 ± 10,3mg e 162,5 ± 16,3mg. Para atingir a IDR do cálcio, pelo consumo de leite, os adolescentes consumiriam 584mg de sódio pelo leite em pó (39% da IDR) e 812,5mg pelo ultrapasteurizado (54% da IDR).

Tocilizumab in refractory juvenile idiopathic arthritis with associated uveitis: a case report.

INTRODUCTION: We report a 9-year follow-up of a child with refractory juvenile idiopathic arthritis (JIA) with associated uveitis in which tocilizumab proved to be effective in achieving disease control. CASE REPORT: A 16-month child was diagnosed with JIA and at the age of 3 developed bilateral non-granulomatous anterior uveitis. Throughout the follow-up, the patient presented frequent joint and ocular flares. Refractory anterior uveitis and topical corticosteroid therapy resulted in the development of bilateral cataract and high intraocular pressure (IOP). The patient underwent multiple ocular surgeries along with corticosteroids, immunosuppressive therapy with Methotrexate and Adalimumab failing to reach disease control. Only after the introduction of Tocilizumab a lower disease activity was achieved. DISCUSSION: Management of JIA-associated uveitis is challenging and requires a close collaboration between paediatric rheumatologists and ophthalmologists. Clinical remission can be difficult to achieve. However, one should always pursuit JIA inactivity with IOP and inflammation control. This report supports Tocilizumab as a useful therapeutic option for JIA-associated uveitis.