Molecular and serological diagnosis of toxoplasmosis: a systematic review and meta-analysis

ABSTRACT Toxoplasmosis is an infection of vast worldwide distribution whose etiologic agent is Toxoplasma gondii. This disease can cause problems ranging from mild symptoms to serious conditions, such as encephalitis, miscarriage and blindness. Therefore, it is of utmost importance to perform a diagnosis with reproducible techniques in order to obtain a good prognosis. The aim of this review was to analyze the efficiency of toxoplasmosis diagnostic techniques based on sensitivity and specificity results. Five research platforms in English language were used (Eric, Elsevier, Google Scholar, PubMed and SciELO), which contained data on the diagnosis of toxoplasmosis. The search and selection were performed for studies published prior to June 2021. The search resulted in the inclusion of 13 articles published from 2005 to 2020. The data revealed the use of different samples in the standardization of techniques such as serum, total blood, colostrum and amniotic fluid. The flow cytometry, lateral flow immunoassay and qPCR techniques showed 100% sensitivity, whereas the ELISA, western blotting, qPCR and RE-LAMP techniques achieved 100% specificity. Significantly, the qPCR and LAMP techniques were more accurate when the likelihood ratio was assessed. The meta-analysis identified that ISAGA and western blotting have low sensitivity values and LIASON, ELFA and ELISA, using a silica bioconjugate, also have low specificity values. It was noted that a wide range of methods have high values of sensitivity and specificity. Therefore, the choice of the method will be based on the conditions and its financial viability.

Occurrence of potentially highly pathogenic free-living amoebae in ready made salads from restaurants in Jatai, Goias, Brazil

Free-living amoebae (FLA) are part of a group of protozoa found worldwide and in the most diverse environments. They resist various temperatures and disinfection methods, and are a risk to human health. Pathogenic strains grow at high temperatures and under hyperosmolarity conditions. Some FLA genera are mainly related to primary amoebic meningoencephalitis (PAM), skin ulcerations, corneal lesions, kidney and lung infections and keratitis. Therefore, studies that assess the pathogenic potential of FLA are public health issues of great concern. We aimed to evaluate the pathogenic potential of FLA isolated in salads from restaurants in vitro, using osmotolerance and thermotolerance tests. Forty-five isolates were used from ready-made salads purchased in restaurants in Jatai, Goias. Twelve isolates subjected to the osmotolerance test (26.6%) showed growth in 0.5 M mannitol, 18 (40.0%) in 1.0 M mannitol and 16 (35.5%) in 1.5 M mannitol, 13 (28.8%) isolates did not show growth. Four isolates that underwent the thermotolerance test (8.9%) showed growth at 25°C, 8 (17.8%) showed growth at 30°C, 3 (6.7%) showed growth at 37°C and 30 (66.7%) did not show growth. With the indices obtained in the present study, we concluded that 15.6% of the isolates were osmotolerant and thermotolerant. Our findings highlight a public health problem once these FLA are associated with harboring or being harbored by microorganisms responsible for diseases such as diarrhea and meningitis. Measures are required to improve food hygiene and so avoid FLA-related health problems.

Interprofissionalidade na atenção primária: intencionalidades das equipes versus realidade do processo de trabalho / La colaboración interprofesional en la atención primaria: la intencionalidad de los equipos versus la realidad del proceso de trabajo / Interprofessional collaboration in primary health care: the team's intentions versus the reality of work processes

Resumo Objetivo comparar atitudes relacionadas à colaboração interprofissional autorrelatadas por diferentes equipes da atenção primária com a realidade observada de seus processos de trabalho. Método abordagem qualitativa e quantitativa implementada em duas etapas de coleta de dados, entre dezembro de 2019 e outubro de 2020. Na qualitativa, empregou-se a observação sistemática dos atendimentos em unidades de saúde. Utilizou-se roteiro de observação baseado no Referencial para Competências em Interprofissionalidade e no Fluxograma Analisador do processo de trabalho centrado no usuário. As observações foram registradas em diário de campo. Na etapa quantitativa, aplicou-se a Escala de Atitudes Relacionadas à Colaboração Interprofissional. Resultados noventa e um profissionais da atenção básica responderam a escala. Obteve-se uma média de 120 de pontuação, que significa valorização do trabalho colaborativo por respondentes de todas as equipes. Apesar disso, foram observadas divergências entre o falado e o vivido, pois o processo de trabalho estruturado parece limitar atitudes colaborativas. Conclusões e implicações para a prática valorização de atividades programadas para o trabalho interprofissional da equipe de saúde e de enfermagem na atenção primária, como espaços na agenda para reuniões. Necessidade de promoção da educação interprofissional com trabalhadores, bem como de políticas públicas que garantam mecanismos para o trabalho colaborativo na atenção básica.

Resumen Objetivo comparar las actitudes relacionadas con la colaboración interprofesional autoinformada por diferentes equipos de la atención primaria con la realidad observada en sus procesos de trabajo. Método investigación cualitativa y cuantitativa. La recolección de datos ocurrió entre diciembre de 2019 y octubre de 2020. En la etapa cualitativa se utilizó la observación sistemática de la atención en las unidades de salud, con un guión de observación basado en el Referencial de Competencias Interprofesionales y el Diagrama Analizador del Flujo del proceso de trabajo centrado en el usuario. Registramos las observaciones en el diario de campo. En la etapa cuantitativa se aplicó la Escala de Actitudes Relacionadas con la Colaboración Interprofesional. Resultados 91 profesionales respondieron la escala. Se obtuvo una media de 120 puntos, lo que supone valorización del trabajo colaborativo por profesionales de todos los equipos evaluados. Sin embargo, verificamos diferencias entre lo relatado y lo vivido, ya que el proceso de trabajo estructurado parece limitar las actitudes para el trabajo colaborativo. Conclusiones e implicaciones para la práctica valorización de actividades programadas para el trabajo interprofesional de los equipos de salud y de enfermería, como reuniones programadas. Necesidad de promoción de la educación interprofesional, así como de políticas públicas que garanticen mecanismos de trabajo colaborativo.

Abstract Objective to compare self-reported interprofessional attitudes according to the teams from different primary health care services with the actual context of work processes. Method Quantitative and qualitative study in which data were collected in two stages between December of 2019 and October of 2020. Systematic observation was the strategy used to collect data from primary health care centers. A script based on the Canadian Interprofessional Health Collaborative framework and the Analyzer Flowchart was used to observe the patient-centered work process. Observations were recorded in a Field Diary, and the Brazilian version of the Jefferson Scale of Attitudes Toward Interprofessional Collaboration was used. Results 91 primary health workers completed the scale. The median score was 120, meaning all the health teams value collaborative work. Nonetheless, differences were found between what the participants say and what they do, considering that the structured work process limits collaborative practice. Conclusions and Implications to Practice the services need to value programmed activities to promote interprofessional collaboration among health and nursing teams working in primary health care, and reserve time, and give opportunities for meetings to occur. Additionally, training addressing interprofessional collaboration needs to be provided to workers in addition to public policies to ensure mechanisms that promote collaborative practices.

Occurrence of parasites in salads in restaurants in Aparecida de Goiânia, Goiás, Brazil

Parasitoses are the most widespread diseases in the world. They are transmited via contaminated water or food. Considering that the daily consumption of vegetables is estimated at 142g per person, the purpose of this study was to evaluate the occurrence of parasites in salads available for consumption in restaurants in Aparecida de Goiânia, Goiás State. Salad samples were collected from the restaurants and parasitological analysis was performed using the Willis, Hoffman, Faust and Ziehl Neelsen techniques as well as cultures for the isolation of free-living amoebae. 51 samples were analyzed, 16 (31.4%) were positive. The parasites detected were: Acanthamoeba spp. in 12 (23.5%); free-living larvae, Schistosoma mansoni and Entamoeba coli in 1 (2.0%); Endolimax nana in 2 (3.9%). The PCR technique determined that 17.6% of the samples presented Toxoplasma gondii DNA. These techniques evidenced that the salad samples presented parasite contamination not only in the restaurants with the lowest price per Kg, but also in the most expensive ones. Therefore, in addition to effective sanitary surveillance, prophylactic measures are necessary regarding suppliers, handlers and restaurant owners to prevent the spread of these and other parasites.