Comparing the cost-effectiveness of two screening strategies for latent tuberculosis infection in Portugal.

INTRODUCTION AND OBJECTIVES: Screening for latent tuberculosis infection (LTBI) in close contacts of infectious TB cases might include Tuberculin Skin Test (TST) and Interferon-Gamma Release Assays (IGRA), in combination or as single-tests. In Portugal, the screening strategy changed from TST followed by IGRA to IGRA-only testing in 2016. Our objective was to compare the cost-effectiveness of two-step TST/IGRA with the current IGRA-only screening strategy in immunocompetent individuals exposed to individuals with respiratory TB. MATERIALS AND METHODS: We reviewed clinical records of individuals exposed to infectious TB cases diagnosed in 2015 and 2016, in two TB outpatient centers in the district of Porto. We estimated medical, non-medical and indirect costs for each screening strategy, taking into account costs of tests and health care personnel, travel distance from place of residence to screening site and employment status. We calculated the incremental cost-effectiveness ratio (ICER) as the cost difference between the two screening strategies with the difference number of LTBI diagnosis as a measure of cost-effectiveness, assuming that treating LTBI is a cost-effective intervention. We also calculated adjusted odds-ratios to test the association between diagnosis of LTBI and screening strategy and estimated the total cost for averting a potential TB case. RESULTS: We compared 499 contacts TST/IGRA screened with 547 IGRA-only. IGRA-only strategy yielded a higher screening effectiveness for diagnosing latent tuberculosis infection (aOR 2.12, 95%CI: 1.53 - 2.94). ICER was €106 per LTBI diagnosis, representing increased effectiveness with a slightly increased cost of IGRA-only screening strategy. CONCLUSIONS: Our data suggests that in Portugal LTBI screening with IGRA-only is more cost-effective than the two-step TST/IGRA testing strategy, preventing a higher number of cases of TB cases.

Lung abscess due to Neisseria meningitidis serogroup X-unexpected virulence of a commensal resulting from putative serogroup B capsular switching.

To report the first case of a lung abscess caused by Neisseria meningitidis (Nm) and to genetically characterize the rare underlying capsule switching event. The strain (PT NmX) was subjected to whole genome sequencing, and a comparative gene-by-gene analysis was performed based on 1605 N. meningitidis core loci that constitute the MLST core-genome scheme (cgMLST) V1.0. All ~ 9,600 genomes available on Neisseria PubMLST (until 30th November 2019) from all serogroups were used to better identify the genome make-up of the PT NmX strain. This strain was found to be highly divergent from other NmX reported worldwide and to belong to a new sequence type (ST-14273), with the finetype X: P1.19,15-1:F5-2. Moreover, it revealed a closer genetic proximity to strains from serogroup B than to other serogroups, suggesting a genome backbone associated with serogroup B, while it presents a capsule synthesis region derived from a NmX strain. We describe a new hybrid NmB/X isolate from a noninvasive meningococcal infection, causing lung abscess. Despite capsular switching events involving serogroup X are rare, it may lead to the emergence of pathogenic potential. Studies should continue to better understand the molecular basis underlying Neisseria strains' ability to spread to body compartments other than the tissues for which their tropism is already known.

Antifungal compounds with anticancer potential from Trichoderma sp. P8BDA1F1, an endophytic fungus from Begonia venosa.

Fungi in the genus Trichoderma are notorious producers of secondary metabolites with diverse applications, such as antibacterial, antifungal, and plant growth-promoting properties. Peptaibols are linear peptides produced by such fungi, with more than 440 compounds described to date, including tricholongins, longibrachins, trichobrachins, and trichovirins. Peptaibols are synthesized by non-ribosomal peptide synthetases and they have several biological activities. Our research group isolated four peptaibols (6DP2, 6DP3, 6DP4, and 6DP5) with antifungal activity against the plant pathogen Colletotrichum gloeosporioides and the proteasome (a cancer chemotherapy target) from Trichoderma sp. P8BDA1F1, an endophytic fungus from Begonia venosa. The ethyl acetate extract of this endophyte showed activity of 6.01% and 75% against C. gloeosporioides and the proteasome, respectively. The isolated compounds were identified by MS/MS and compared to literature data, suggesting the presence of trilongins BI, BII, BIII, and BIV, which are peptaibols containing 20 amino acid residues. The minimum inhibitory concentration against C. gloeosporioides was 40 µM for trilongin BI, 320 µM for trilongin BII, 160 µM for trilongin BIII, and 310 µM for trilongin BIV. BI-BIV trilongins inhibited proteasome ChTL activity, with IC50 values of 6.5 ± 2.7; 4.7 ± 1.8; 6.3 ± 2.2; and 2.7 ± 0.5 µM, respectively. The compounds were tested ex vivo against the intracellular amastigotes of Leishmania (L.) infantum but showed no selectivity. It is the first report of trilongins BI-BIV with antifungal activity against C. gloeosporioides and the proteasome target.

Secondary metabolites produced by endophytic fungi: novel antifungal activity of fumiquinone B

Fungi are present in the most diverse environments including the interior of plant tissues, living as endophytes without causing apparent damage. These endophytes are producers of secondary metabolites, also known as natural products, such as fungicides. Here, we evaluated the ethyl acetate fractions obtained from endophytic fungiisolated from plants in the genus Begonia. The fractions were submitted to inhibitorytest against the plant pathogens Diaporthe phaseolorum and Colletotrichum gloeosporioides. From the 88 ethyl acetate fractions evaluated, 14.7 % inhibited C. gloeosporioidesand 11.3 %inhibited D. phaseolorum. One fungal isolate displaying an active fraction was selected for chemical investigation. The fungus identified as Neopestalotiopsissp., produced a compound that was active against D. phaseolorum, with a MIC of 312 μg mL-1(1,695.3 μM). The compound was identified by mass spectrometry and 1H NMR as the known compound fumiquinone B. The results highlight that the endophytes are capable of producing compounds that may be used to control plant pathogens. The compound fumiquinone B is reported for the first time as an antifungal agent against D. phaseolorum, a relevant plant pathogen worldwide. This is also the first report of the production of fumiquinone B by the genus Neopestalotiopsis.

Coimbra's response to the 1918-1919 influenza epidemic, seen from the viewpoint of a local newspaper. / A resposta em Coimbra à epidemia de pneumónica de 1918-1919 sob o olhar de um periódico local.

This article investigates the 1918-1919 influenza epidemic in Coimbra using information found in the pages of a local newspaper. Rigorous and systematic analysis of the Gazeta de Coimbra reveals the urban bourgeoisie's perception of this health disaster, considered the most severe in the twentieth century. Guided by the newspaper's editor though an unofficial view of the facts, the reader can glimpse reactions to the first news of the epidemic, particularly the population's fears related to this information, but also the response from authorities and civil society. The newspaper is critical in many aspects, openly censuring inaction by several institutions of the city such as the city council, the medical school at the University of Coimbra, and the Misericórdia charitable institution.

Neste artigo pretende-se compreender a epidemia de gripe pneumónica de 1918-1919 em Coimbra, a partir das informações contidas nas páginas de um periódico local. Por meio da análise rigorosa e sistemática da Gazeta de Coimbra consegue-se inferir a perceção que uma burguesia urbana teve desta catástrofe sanitária, considerada a maior do século XX. Guiados pelo editor do jornal, numa perspetiva não oficial dos fatos, é possível vislumbrar as reações às primeiras notícias da epidemia, nomeadamente os temores da população frente à informação veiculada, mas também a resposta das autoridades e da sociedade civil. Crítico em muitos aspetos, censura abertamente a inércia de várias instituições da cidade, como a Câmara Municipal, a Faculdade de Medicina da Universidade e a Misericórdia.

A resposta em Coimbra à epidemia de pneumónica de 1918-1919 sob o olhar de um periódico local / Coimbra's response to the 1918-1919 influenza epidemic, seen from the viewpoint of a local newspaper

Resumo Neste artigo pretende-se compreender a epidemia de gripe pneumónica de 1918-1919 em Coimbra, a partir das informações contidas nas páginas de um periódico local. Por meio da análise rigorosa e sistemática da Gazeta de Coimbra consegue-se inferir a perceção que uma burguesia urbana teve desta catástrofe sanitária, considerada a maior do século XX. Guiados pelo editor do jornal, numa perspetiva não oficial dos fatos, é possível vislumbrar as reações às primeiras notícias da epidemia, nomeadamente os temores da população frente à informação veiculada, mas também a resposta das autoridades e da sociedade civil. Crítico em muitos aspetos, censura abertamente a inércia de várias instituições da cidade, como a Câmara Municipal, a Faculdade de Medicina da Universidade e a Misericórdia.

Abstract This article investigates the 1918-1919 influenza epidemic in Coimbra using information found in the pages of a local newspaper. Rigorous and systematic analysis of the Gazeta de Coimbra reveals the urban bourgeoisie's perception of this health disaster, considered the most severe in the twentieth century. Guided by the newspaper's editor though an unofficial view of the facts, the reader can glimpse reactions to the first news of the epidemic, particularly the population's fears related to this information, but also the response from authorities and civil society. The newspaper is critical in many aspects, openly censuring inaction by several institutions of the city such as the city council, the medical school at the University of Coimbra, and the Misericórdia charitable institution.

ERS/ECDC Statement: European Union standards for tuberculosis care, 2017 update.

The International Standards for Tuberculosis Care define the essential level of care for managing patients who have or are presumed to have tuberculosis, or are at increased risk of developing the disease. The resources and capacity in the European Union (EU) and the European Economic Area permit higher standards of care to secure quality and timely TB diagnosis, prevention and treatment. On this basis, the European Union Standards for Tuberculosis Care (ESTC) were published in 2012 as standards specifically tailored to the EU setting. Since the publication of the ESTC, new scientific evidence has become available and, therefore, the standards were reviewed and updated.A panel of international experts, led by a writing group from the European Respiratory Society (ERS) and the European Centre for Disease Prevention and Control (ECDC), updated the ESTC on the basis of new published evidence. The underlying principles of these patient-centred standards remain unchanged. The second edition of the ESTC includes 21 standards in the areas of diagnosis, treatment, HIV and comorbidities, and public health and prevention.The ESTC target clinicians and public health workers, provide an easy-to-use resource and act as a guide through all the required activities to ensure optimal diagnosis, treatment and prevention of TB.

Tuberculosis en los portugueses residentes en el extranjero / Tuberculosis Among Portuguese Living Abroad

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O Fazer Psicológico na Ditadura Civil Militar / The Psychological practice during the Military Civilian Dictatorship / El Quehacer Psicológico de la Dictadura Civil Militar

Resumo: O presente artigo apresenta discussão sobre o fazer psi na época da ditadura civil militar, objetivando responder ao seguinte questionamento: a Psicologia brasileira esteve a serviço da ditadura civil militar ou da sociedade?. Considerando que a regulamentação da profissão de psicólogo em 1962 coincidiu com o período ditatorial vivenciado no Brasil entre os anos de 1964 a 1985, objetivamos discutir sobre o desenvolvimento da Psicologia como ciência e profissão neste contexto turbulento para a sociedade brasileira. Para alcançar esse objetivo, utilizou-se como metodologia a pesquisa bibliográfica. Nesse sentido, referenciamo-nos na discussão sobre o papel do psicólogo, na perspectiva de Martín-Baró, para discutir o compromisso do profissional com o processo de conscientização das pessoas. Conforme as discussões empreendidas, foi possível descortinar os movimentos de atuação que corroboravam com a manutenção do sistema, ou seja, que compactuavam com práticas repressivas, mas também, os movimentos que buscavam promover a conscientização, ou mesmo dispor a Psicologia a serviço dos menos favorecidos, mesmo que de modo clandestino....(AU)

Abstract: This article presents a discussion about the psychological practice in the era of the military civilian dictatorship, in order to answer the following question: Has Brazilian Psychology been at the service of the civilian military dictatorship or of society? Considering that the regulation of the profession of the psychologist in 1962 coincided with the dictatorial period experienced in Brazil between 1964 and 1985, we aimed to discuss the development of Psychology as a science and profession in this turbulent context for Brazilian society. To reach this objective, the bibliographic research methodology was used as methodology. In this sense, we refer to the discussion about the role of the psychologist in the perspective of Martín-Baró to discuss the commitment of the professional with the process of awareness of the people. According to the discussions, it was possible to reveal the psychological practices that supported the maintenance of the system, that is, that compacted with repressive actions, but also, the practices that sought to promote awareness, or even used psychology at the service of the less favored, even if clandestinely....(AU)

Resumen: El presente artículo presenta una discusión sobre el quehacer psicológico en la época de la dictadura civil militar, con el objetivo de responder al siguiente cuestionamiento: ¿La Psicología brasileña estuvo al servicio de la dictadura civil militar o de la sociedad?. Considerando que la reglamentación de la profesión de psicólogo en 1962 coincidió con el período dictatorial vivido en Brasil entre los años 1964 a 1985, tenemos el objetivo de discutir sobre el desarrollo de la Psicología como ciencia y profesión en este contexto turbulento para la sociedad brasileña. Para alcanzar ese objetivo, se utilizó como metodología la investigación bibliográfica. En ese sentido, nos referimos a la discusión sobre el papel del psicólogo, en la perspectiva de Martín-Baró para discutir el compromiso del profesional con el proceso de concientización de las personas. Conforme a las discusiones emprendidas, fue posible desvendar las prácticas que apoyaban el mantenimiento del sistema, o sea, que eran complacientes con prácticas represivas, y también, los movimientos que buscaban promover la concientización, o incluso poner la psicología al servicio de los menos favorecidos aunque de forma clandestina....(AU)

[Pertussis hospitalisations: Northern Region of Portugal, 2000-2006]. / Internamentos por tosse convulsa: Região Norte 2000-2006.

Pertussis is an acute bacterial disease involving the respiratory tract. The causal agent is Bordetella pertussis. Among all age groups, infants (aged < 12 months) have had the highest incidence of pertussis in the vaccine era. The majority of hospitalisations, complications and deaths occurred in that age group. The aim of this study was to describe and characterize the epidemiological pattern of hospitalized pertussis cases during the period of 2000-2006 in the hospitals of Northern Portugal. We conducted a retrospective observational study based on hospitalisations in the Northern region of Portugal between 2000 and 2006. Descriptive summary statistics for all variables were calculated at region, district and municipality levels. The average rates of hospitalisation were calculated per 100,000 population for the region, district and municipality, according to sex and age group. The severity of disease was evaluated on the basis of the average length of hospitalisation, the proportion of patients treated in intensive care units, and the case fatality rate. Three hundred and twenty two cases were identified between 2000 and 2006 in the Northern region of Portugal. Viana do Castelo and Braga districts were those who had the highest hospitalisations rate. In the district of Bragança there were no cases of hospitalisation with the diagnosis of pertussis. Fifty six per cent of the cases were male. The proportion of infants hospitalized under one year was 91.0 %. Cases among infants younger than two months accounted for 43.5 % of all cases. The mean annual hospitalisation incidence rate for infants under one year was 114 per 100,000. The mean length of hospital stay was eight days. The proportion of patients treated in intensive care units was 11.0 %, and case fatality rate was 0.3 %. This hospital-based study indicates that pertussis continues to be an important cause of morbidity and mortality in infants. Pertussis incidence remains high among infants, most of whom are under one year of age. Immunization strategies in the adult population must be reviewed and updated in order to attain higher protection of the more vulnerable paediatric population.