Prevalence, capsular types, antimicrobial resistance and risk factors associated with pneumococcal carriage among children after long-term 10-valent pneumococcal conjugate vaccine use in Brazil.

BACKGROUND: The 10-valent pneumococcal conjugate vaccine (PCV10) was introduced for childhood vaccination in Brazil's National Immunization Program in 2010. After nine years of PCV10 use, we investigated the carriage prevalence, capsular types, antimicrobial resistance and risk factors among children living in Niterói city, RJ, Brazil. METHODS: Between September and December 2019, we conducted a cross-sectional study and recruited children under 6 years of age. Antimicrobial susceptibility was evaluated by the disk-diffusion method and MICs to beta-lactams and macrolides were determined by E-test®. Capsular types were deduced by multiplex PCR. Logistic regression was used to predict risk factors for pneumococcal carriage. RESULTS: Seventy-five (17.4%) of the 430 children were pneumococcal carriers. The most frequent capsular types were 6C/D (14.7%), 11A/D (13.3%), and 23B (9.3%). PCV10 serotypes represented 5.3%. All isolates were susceptible to levofloxacin, linezolid, rifampicin, and vancomycin. Penicillin non-susceptible pneumococci (PNSP) made up 37.3%, with penicillin and ceftriaxone MICs ranging from 0.12 to 4.0 µg/ml and 0.064-4.0 µg/ml, respectively. Of the 19 (25.3%) erythromycin-resistant (ERY-R) isolates (macrolide MICs of 6 to >256 µg/ml), most had the cMLSB phenotype (84.2%) and carried the erm(B) gene (73.7%). We detected 17 (22.6%) multidrug-resistant (MDR) isolates, strongly associated with serotype 6C/D. Presence of any symptoms, chronic diseases, childcare center attendance, living with young siblings, slum residence, and unstable income were predictors of pneumococcal carriage. CONCLUSIONS: Long-term universal childhood use of PCV10 has nearly eliminated carriage with PCV10 serotypes, but the high frequency of MDR isolates, especially associated with serotype 6C/D, remains a concern. Replacing PCV10 with PCV13 should reduce the proportion of ERY-R isolates and PNSP by at least 14% and 18%, respectively.

Development of Capacitive-Type Sensors by Electrochemical Anodization: Humidity and Touch Sensing Applications.

This work describes the development of a capacitive-type sensor created from nanoporous anodic aluminium oxide (NP-AAO) prepared by the one-step anodization method conducted in potentiostatic mode and performed in a low-cost homemade system. A series of samples were prepared via an anodization campaign carried out on different acid electrolytes, in which the anodization parameters were adjusted to investigate the effect of pore size and porosity on the capacitive sensing performance. Two sensor test cases are investigated. The first case explores the use of highly uniform NP-AAO structures for humidity sensing applications while the second analyses the use of NP-AAO as a capacitive touch sensor for biological applications, namely, to detect the presence of small "objects" such as bacterial colonies of Escherichia Coli. A mathematical model based on equivalent electrical circuits was developed to evaluate the effect of humidity condensation (inside the pores) on the sensor capacitance and also to estimate the capacitance change of the sensor due to pore blocking by the presence of a certain number of bacterial microorganisms. Regarding the humidity sensing test cases, it was found that the sensitivity of the sensor fabricated in a phosphoric acid solution reaches up to 39 (pF/RH%), which is almost three times higher than the sensor fabricated in oxalic acid and about eight times higher than the sensor fabricated in sulfuric acid. Its improved sensitivity is explained in terms of the pore size effect on the mean free path and the loss of Brownian energy of the water vapour molecules. Concerning the touch sensing test case, it is demonstrated that the NP-AAO structures can be used as capacitive touch sensors because the magnitude of the capacitance change directly depends on the number of bacteria that cover the nanopores; the fraction of the electrode area activated by bacterial pore blocking is about 4.4% and 30.2% for B1 (E. Coli OD600nm = 0.1) and B2 (E. Coli OD600nm = 1) sensors, respectively.

Narcissistic Equilibrium in Paranoid Schizophrenia.

Several studies have stressed the relevance of family environment in the course of schizophrenia and the perception of the pathology by both the subjects and family members. The objective of the current qualitative study consisted in the development of a grounded theory (GT) regarding narcissism and the family dynamics of subjects diagnosed with paranoid schizophrenia. Semistructured interviews were conducted with five subjects in a state psychiatric hospital in the urban catchment area of Lisbon and their respective families. A diagnosis of paranoid schizophrenia had previously been established according to DSM-IV-TR and ICD-10 criteria. The interviews were transcribed and analyzed using the GT methodology, in order to identify the latent processes. A basic social process of narcissistic equilibrium was identified as a way to protect personal and familial identity, where three main processes were found: splitting, detachment and projective identification. These processes were developed as a tentative solution for the existing narcissistic impairments in the self and/or family, occurring both in an intrapsychic dimension and on a transactional dimension within family relationships.

Regenerative capacity and histomorphometric changes in rat sciatic nerve following experimental neurotmesis / Capacidad regenerativa y cambios histomorfométricos en el nervio ciático de ratas luego de una neurotmesis experimental

Through a wide range of cellular and molecular events, the peripheral nervous system is endowed with great regenerative capacity, responding immediately to injuries that occur along the length of the nerve. The aim of this study was to histomorphometrically assess the degree of maturity of the nervous tissue and possible microscopic changes in newly formed nerve segments 60 days after experimental neurotmesis of the sciatic nerve in rats. Control Group (CG) and an Injury Group (IG) were used. IG underwent neurotmesis of the sciatic nerve of the right foot, with immediate surgical repair using the tubulization technique. 60 days following experimental surgery, animals from both groups had their sciatic nerves collected for histomorphometric analysis. Statistical analysis was performed, using the Student t-test for independent samples, expressed as mean ± standard deviation, with 5% significance. In the event of injury, peripheral nerve tissue is mobilized in an intrinsic self-healing process. 60 days following of nerve regeneration in neurotmesis injury, the peripheral nerve presents a segment joining the newly formed neural stump. The new stump has a number of regenerated axons compatible with an intact nerve, but which still show great immaturity in the axonal structural layers of the nerve.

Mediante diversos procesos celulares y moleculares, el sistema nervioso periférico tiene una gran capacidad regenerativa, respondiendo inmediatamente a las lesiones ocurridas a lo largo de su extensión. El objetivo de este estudio fue evaluar histomorfométricamente el grado de madurez del tejido nervioso y los posibles cambios microscópicos en los segmentos nerviosos recién formados 60 días después de la neurotmesis experimental en el nervio ciático de ratas. Se utilizaron 9 ratas (Wistar) separadas en grupo control (GC, n= 4) y Grupo lesión (GL, n= 5). A los 60 días de vida, el grupo GL fue sometido a neurotmesis del nervio ciático de la miembro posterior derecho, con inmediata corección quirúrgica con la técnica de tubolización. Completados 60 días luego de la cirugía experimental, los animales de ambos grupos fueron anestesiados y sus nervios ciáticos seccionados para el análisis histomorfométrico. Se realizó un análisis estadístico utilizando la prueba t de Student para muestras independientes, expresado como media ± desviación estándar, con un 5% de significancia. A los 60 días de la lesión por neurotmesis, el nervio ciático del GL presentó alteraciones histomorfométricas significativas para las variables: número de vasa nevorum, densidad de fibras mielínicas, diámetro axonal y de fibras mielínicas, espesor de la vaina de mielina y razón G, con similitud solamente para los números absolutos de fibras mielínicas regeneradas. El nervio periférico durante su proceso regenerativo, pasa por grandes alteraciones estructurales, siguiendo una secuencia coordinada de acciones, que dependiendo de las condiciones del microambiente donde ocurre esta regeneración, podrá ser clave para el nivel de regenerecion nerviosa periférica.

General practitioners' procedures for sexual history taking and treating sexual dysfunction in primary care.

INTRODUCTION: Good history-taking skills are the first step towards achieving a correct diagnosis of sexual dysfunction (SD). However, studies show most general practitioners (GPs) do not take the initiative to ask the patient about SD, and when diagnosing a condition, they tend to give preference to their own criteria over clinical guidelines. AIM: The aim of this study is to characterize GPs' attitudes towards taking sexual history, identifying its frequency and focus, and to describe GPs' diagnostics and therapeutic approaches including the use of clinical guidelines, exploring patients' and doctor-related differences. METHODS: Cross-sectional study using confidential self-administrated questionnaires applied to GPs working in primary healthcare units in the Lisbon region. MAIN OUTCOME MEASURES: Data concerning GPs' consultation of guidelines, active exploration of SD in male and in female patients, and focus on sexual history taking was collected. RESULTS: Of the 50 participants (73.5% response rate), 15.5% actively ask their patients about SD. The main reasons for asking patients about their sexuality are diabetes (84.0%), prescription of medication with adverse effects on sexuality (78.0%), and family planning (72.0%), the latter being a significantly more frequent reason for GPs with 20 or less years of practice. Routine sexual history taking (22.0%) appears as one of the least mentioned motives. The percentage of appointments with active exploration of SD was positively associated with guidelines' consultation, as well as considering the specialty as a good source of information and having longer appointments when SD is mentioned. However, 76.0% report not having consulted any guidelines in the previous year. Lack of time (31.6%) and low accessibility (25.0%) were referred to as the main reasons for not consulting guidelines. CONCLUSIONS: Routine sexual history taking and consultation of guidelines about SD are not yet a generalized practice in primary care. Data should be interpreted with caution as they are self-reported. Further objective measurement such as direct observation or clinical files consultation should be implemented.

General practitioners' knowledge, attitudes, beliefs, and practices in the management of sexual dysfunction-results of the Portuguese SEXOS study.

INTRODUCTION: Evidence shows that sexual dysfunctions (SDs) are very prevalent in both sexes and that they share risk factors with many other conditions. It is known that only a minority of people experiencing sexual problems seek treatment, but the role of the general practitioner (GP) in SD diagnosis and treatment is relatively unexplored. No study has been conducted in Portugal in order to identify GPs' knowledge, attitudes, beliefs, and practices regarding SD and only a small amount of similar studies from other countries have been published. AIM: To characterize GPs' knowledge, attitudes, and beliefs concerning SD; practices of SD management in daily practice; self-perceived competence in discussing and treating SD; and need for training. METHODS: Cross-sectional study using confidential self-administered questionnaires applied to GPs working in Primary Health Care Units in the Lisbon region. MAIN OUTCOME MEASURES: The questionnaire collected information concerning GPs' knowledge and perceptions regarding SD, training and practice in sexual health, criteria for initiating discussion and treatment, and the adoption of guidelines. RESULTS: A total of 50 questionnaires (30 females) were obtained (73.5% response rate). On average, the 50 participants were 52±8.6 years old, had 21±8.2 years of family practice, and followed 1,613±364 patients. The degree in medicine was never considered as an extremely adequate source of information both for male and female SD. Lack of time to obtain relevant information for clinical practice and to deal with sexual health issues were perceived as important barriers in initiating a discussion with the patient, as well as lack of academic training and experience in this area. CONCLUSIONS: GPs expressed a high need for continuous training in this area and more than half considered that their degree was not an adequate source of training. These results indicate that there is a need for both pregraduate and postgraduate training in this area.

Angiotensin-(3-4) counteracts the Angiotensin II inhibitory action on renal Ca2+-ATPase through a cAMP/PKA pathway.

We recently demonstrated that Angiotensin-(3-4) [Ang-(3-4)], an Ang II-derived dipeptide, overcomes inhibition of plasma membrane Ca(2+)-ATPase promoted by nanomolar concentrations of Ang II in basolateral membranes of renal proximal tubule cells, with involvement of a so far unknown AT(2)R-dependent and NO-independent mechanism. The present study investigates the signaling pathway triggered by Ang-(3-4) that is responsible for counteracting the inhibitory effect of Ang II, and attempts to elucidate the functional interaction of the dipeptide with Ang II at the level of AT(2)R. Stimulation by cholera toxin of G(s)α protein structurally linked to AT(2)R--as revealed by their co-immunoprecipitation--mimicked the effect of Ang-(3-4) on Ca(2+)-ATPase activity. Furthermore, addition of dibutyril-cAMP (db-cAMP) mimicked Ang-(3-4), whereas the specific PKA inhibitor, PKAi(5-24) peptide, suppressed the counter-regulatory effect of Ang-(3-4) and the AT(2)R agonist, CGP42112A. Membrane-associated PKA activity was stimulated by Ang-(3-4) or CGP42112A to comparable levels as db-cAMP, and the Ang-(3-4) effect was abrogated by the AT(2)R antagonist PD123319, whereas the AT(1)R antagonist Losartan had no effect. Ang-(3-4) stimulated PKA-mediated phosphorylation of Ca(2+)-ATPase and activated PKA to comparable levels. Binding assays demonstrated that Ang-(3-4) could not displace (3)H-Ang II from HEK 293T cells expressing AT(2)R, but 10(-10) mol/L Ang-(3-4) resulted in the appearance of a probable higher-affinity site (picomolar range) for Ang II. The results presented herein demonstrate that Ang-(3-4), acting as an allosteric enhancer, suppresses Ang II-mediated inhibition of Ca(2+)-ATPase through an AT(2)R/cAMP/PKA pathway, after inducing conformational changes in AT(2)R that results in generation of higher-affinity sites for Ang II.

A scrutiny of the biochemical pathways from Ang II to Ang-(3-4) in renal basolateral membranes.

In a previous paper we demonstrated that Ang-(3-4) counteracts inhibition of the Ca(2+)-ATPase by Ang II in the basolateral membranes of kidney proximal tubules cells (BLM). We have now investigated the enzymatic routs by which Ang II is converted to Ang-(3-4). Membrane-bound angiotensin converting enzyme, aminopeptidases and neprilysin were identified using fluorescent substrates. HPLC showed that Plummer's inhibitor but not Z-pro-prolinal blocks Ang II metabolism, suggesting that carboxypeptidase N catalyzes the conversion Ang II--> Ang-(1-7). Different combinations of bestatin, thiorphan, Plummer's inhibitor, Ang II and Ang-(1-5), and use of short proteolysis times, indicate that Ang-(1-7)--> Ang-(1-5)--> Ang-(1-4)--> Ang-(3-4) is a major route. When Ang III was combined with the same inhibitors, the following pathway was demonstrated: Ang III--> Ang IV--> Ang-(3-4). Ca(2+)-ATPase assays with different Ang II concentrations and different peptidase inhibitors confirm the existence of these pathways in BLM and show that a prolyl-carboxypeptidase may be an alternative catalyst for converting Ang II to Ang-(1-7). Overall, we demonstrated that BLM have all the peptidase machinery required to produce Ang-(3-4) in the vicinity of the Ca(2+)-ATPase, enabling a local RAS axis to effect rapid modulation of active Ca(2+) fluxes.

Ang-(3-4) suppresses inhibition of renal plasma membrane calcium pump by Ang II.

We previously demonstrated that Ang II inhibits the renal plasma membrane Ca(2+)-ATPase. In the present work we have studied the effect of Ang II, at concentrations similar to those found in the renal interstitium, on the Ca(2+)-ATPase from proximal tubule cells. High Ang II concentration (5 x 10(-7) mol/L) led to the recovery of Ca(2+)-ATPase activity previously inhibited by 50% at low Ang II concentration (10(-10) mol/L). Reactivation occurred in parallel with: (i) formation of only two dead-end metabolites [Ang-(3-4) and Tyr] after incubation of isolated membranes with micromolar Ang II; and (ii) dissociation of constitutive AT(1)R/AT(2)R heterodimers, which are preserved with 10(-10) mol/L Ang II. When the membranes were incubated with 10(-14) mol/L Ang-(3-4), inhibition by 10(-10) mol/L Ang II was no longer observed. The counteracting effect of Ang-(3-4) was abolished by PD123319, an antagonist of AT(2)R, and mimicked by CGP42112A, an agonist of AT(2)R. Ang-(1-7) is an intermediate in the formation of Ang-(3-4) via a pathway involving angiotensin-converting enzyme (ACE), and complete dipeptide breakdown to Tyr and Val is impaired by low Ang II. We conclude that Ang-(3-4) may be a physiological regulator of active Ca(2+) fluxes in renal proximal cells by acting within the renin-angiotensin axis.