The impact of remote work on worker's health.

Remote work was brought to the forefront with the arrival of the COVID-19 public health emergency. Although there is no evidence of a direct cause-and-effect relationship between venous disease and work, the current medical consensus is that work can severely intensify its progression. Here, we report the case of a worker at a financial institution, who had been working remotely for around one year and had stopped exercising regularly for the same period. In January 2021, he presented intense pain and marked edema in the soleus area of the right lower limb, which prompted a visit to the emergency department. Laboratory analyses showed slight increases in d-dimer (720 ng/mL) and C-reactive protein (5 mg/dL) levels. A venous Doppler ultrasound of the lower limbs revealed the presence of an occlusive thrombus in the right soleus veins, reaching the right popliteal vein with associated venous dilation. The diagnosis of right, popliteal-distal acute deep vein thrombosis was thus reached. It is clearly impossible to change some of the risk factors of chronic venous insufficiency; however, other aspects such as obesity and working conditions can be the object of preventive actions that generate changes. We thus highlight the importance and possibility of a multidisciplinary approach to this theme, which could evolve into the establishment of a protocol for the prevention and treatment of venous diseases according to each job position.

O home office ganhou um papel de destaque com a chegada da emergência de saúde pública relativa à COVID-19. Embora não haja evidência da relação direta de causa e efeito de doença venosa com o trabalho, existe consenso atual, na opinião médica, de que o trabalho pode agravar seriamente o seu desenvolvimento. É relatado o caso de um profissional de instituição bancária, em teletrabalho há cerca de 1 ano, momento em que suspendeu também a prática de exercício físico. Em janeiro de 2021, iniciou quadro de dor intensa e edema acentuado na região solear do membro inferior direito, motivo pelo qual recorreu ao Serviço de Urgência. No estudo analítico, foram destacadas ligeiras elevações dos D-dímeros (720 ng/mL) e proteína C-reativa (5 mg/dL). A ecografia com estudo de Doppler venoso dos membros inferiores revelou presença de trombo oclusivo nas veias soleares direitas com extensão à veia poplítea direita com dilatação venosa associada. Admitiu-se, então, o diagnóstico de trombose venosa profunda poplíteo-distal direita de características agudas. É evidente que é impossível modificar alguns dos fatores de risco para a insuficiência venosa crônica; porém, outros fatores como obesidade e condições de trabalho podem ser alvo de ações preventivas que gerem modificações. Assim, ressaltam-se a importância e a possibilidade da abordagem multidisciplinar ao tema, o que poderia evoluir para o estabelecimento de um protocolo de prevenção e tratamento de doenças venosas em função do posto de trabalho executado.

Tuberculosis, an unusual source - a case report.

Tuberculosis is an infectious disease caused by bacteria in the Mycobacterium tuberculosis complex. It can affect any organ, but the pulmonary form is the most common manifestation. Not only humans can be affected by tuberculosis, and animals are also commonly infected. This disease can be transmitted to humans usually by inhalation of aerosols or by ingestion of unpasteurized milk or dairy products. We report the case of a zoo worker. He reported an epidemiological context of contact with sea lions and dolphins, of which he takes care, with tuberculosis in the last 4 months. He sought permanent medical care for a 3-week history of cough, fever, sweating, and weight loss. Bronchial lavage was positive for acid-alcohol resistant bacilli. Lavage cultures were positive for the M. tuberculosis complex. The patient was referred for treatment with antituberculosis drugs. Tuberculosis is a major public health problem worldwide. In the occupational setting, tuberculosis remains a matter of great concern and attention, most often in the hospital environment or among health care professionals. However, the case reported here shows another, less usual occupational setting in which this type of contact can also occur. It is expected that the warning of this case can be used by occupational health teams, namely those who are responsible for periodic surveillance of workers' health in the animal sector.

A tuberculose é uma doença infecciosa causada por bactérias do Mycobacterium tuberculosis complex. Pode atingir qualquer órgão, sendo a forma pulmonar a mais frequente. Não só os humanos podem ser atingidos pela tuberculose, sendo também muito comum a existência de infecção de animais. Essa patologia pode espalhar-se para os humanos, normalmente pela inalação de aerossóis ou pela ingestão de leite ou derivados não pasteurizados. Trata-se do caso de um trabalhador de zoológico, com contexto epidemiológico de contato com leões-marinhos com tuberculose nos últimos 4 meses. Recorreu a atendimento permanente por história de 3 semanas de tosse, febre, sudorese e perda ponderal. A pesquisa de bacilos resistentes a álcool-ácido no lavado brônquico revelou-se positiva. Quanto ao exame cultural do lavado, concluiu-se positivo para M. tuberculosis complex. Foi, então, realizado o devido encaminhamento, e o paciente iniciou tratamento com antibacilares. A tuberculose constitui um importante problema de saúde pública em nível global. No contexto ocupacional, mantém-se como um motivo de grande preocupação e atenção, mais frequentemente em meio hospitalar ou entre os profissionais de saúde. No entanto, este caso mostra outro contexto ocupacional, menos óbvio, em que este tipo de contato também pode acontecer. Espera-se que o alerta do presente caso possa ser utilizado pelas equipas de saúde ocupacional, nomeadamente as que realizam vigilância periódica a trabalhadores do setor animal.

Expression of annexin-A1 in blood and tissue leukocytes of leprosy patients.

INTRODUCTION: In leprosy, immune system mediators that regulate the infectious process act in a complex manner and can lead to several clinical outcomes. To understand the behavior of these mediators we quantified the expression of annexin-A1 (ANXA1) in the peripheral blood and plasma as well as tissue leukocytes in all clinical forms of leprosy and compared with healthy controls. METHODS: Seventy healthy controls and 70 patients with leprosy, tuberculoid (TT) (n = 13), borderline tuberculoid (BT) (n = 15), borderline borderline (BB) (n = 13), borderline lepromatous (BL) (n = 15), and lepromatous leprosy (LL) (n = 14), were selected. Phenotyping of the lymphocyte cells and the intracellular expression of ANXA1 in leukocytes was performed by immunofluorescence. Plasma protein levels were determined by enzyme-linked immunosorbent assay. RESULTS: Histiocytes and CD4+ and CD8+ T cells in the skin of BL and LL patients had higher ANXA1 expression. ANXA1 expression was also high in circulating polymorphonuclear, monocytes, and CD4+ and CD8+ T cells in the blood of LL patients compared to those of TT, BT, BB, and BL patients, and these levels were similar to those in healthy controls. Plasma ANXA1 levels indicate an increase in paracrine release in patients with LL. CONCLUSIONS: The data indicate that ANXA1 expression is enhanced in the leukocytes and plasma of patients with LL, and may contribute to the inhibition of leukocyte action, leading to inadequate functioning of the immune system and thus contributing to the spread of M. leprae infection.

Expression of annexin-A1 in blood and tissue leukocytes of leprosy patients

Abstract INTRODUCTION In leprosy, immune system mediators that regulate the infectious process act in a complex manner and can lead to several clinical outcomes. To understand the behavior of these mediators we quantified the expression of annexin-A1 (ANXA1) in the peripheral blood and plasma as well as tissue leukocytes in all clinical forms of leprosy and compared with healthy controls. METHODS Seventy healthy controls and 70 patients with leprosy, tuberculoid (TT) (n = 13), borderline tuberculoid (BT) (n = 15), borderline borderline (BB) (n = 13), borderline lepromatous (BL) (n = 15), and lepromatous leprosy (LL) (n = 14), were selected. Phenotyping of the lymphocyte cells and the intracellular expression of ANXA1 in leukocytes was performed by immunofluorescence. Plasma protein levels were determined by enzyme-linked immunosorbent assay. RESULTS Histiocytes and CD4+ and CD8+ T cells in the skin of BL and LL patients had higher ANXA1 expression. ANXA1 expression was also high in circulating polymorphonuclear, monocytes, and CD4+ and CD8+ T cells in the blood of LL patients compared to those of TT, BT, BB, and BL patients, and these levels were similar to those in healthy controls. Plasma ANXA1 levels indicate an increase in paracrine release in patients with LL. CONCLUSIONS The data indicate that ANXA1 expression is enhanced in the leukocytes and plasma of patients with LL, and may contribute to the inhibition of leukocyte action, leading to inadequate functioning of the immune system and thus contributing to the spread of M. leprae infection.