Infección congénita por citomegalovirus: evaluación de diagnóstico y desafíos en la detección temprana / Congenital cytomegalovirus infection: diagnosis assessment and challenges in early detection / Infecção congênita por citomegalovírus: avaliação do diagnóstico e desafios na detecção precoce

Resumen La detección temprana de la infección congénita por citomegalovirus (cCMV) en pacientes pediátricos permite la implementación de un tratamiento apropiado con el fin de reducir la gravedad de las secuelas asociadas a esta infección, lo cual impacta directamente en la calidad de vida del paciente. El objetivo de este estudio fue determinar la tasa de positividad de infección por CMV en niños con sospecha clínica de infección congénita y analizar las estrategias utilizadas en la confirmación diagnóstica de laboratorio. Para ello se realizó un análisis retrospectivo de muestras de niños con sospecha clínica de cCMV, las cuales fueron evaluadas en el laboratorio de Virología de la institución mediante una reacción en cadena de la polimerasa en tiempo real (qPCR) específica para citomegalovirus (CMV). Fue incluido un total de 698 pacientes y se analizaron 125 muestras de sangre de tarjetas de screening neonatal (TSN) y 659 muestras de orina en el período comprendido entre el 1 de enero de 2016 y el 31 de diciembre de 2022. El diagnóstico de cCMV fue confirmado en 24 pacientes mediante la presencia del virus en muestras de orina o TSN según la edad del paciente, lo que correspondió al 3,4% (24/698) del total de los pacientes estudiados.

Abstract Early detection of congenital cytomegalovirus (cCMV) infection in pediatric patients enables the implementation of appropriate treatment to reduce the severity of associated sequelae, directly impacting the child's quality of life. The aim of this study was to determine the CMV positivity rate in children clinical suspected of congenital infection and to analyse the strategies used in laboratory diagnostic confirmation. A retrospective analysis of samples from children with clinical suspected cCMV was evaluated by the Virology Laboratory of this institution using real-time polymerase chain reaction (qPCR) specific for cytomegalovirus (CMV). A total of 698 patients were included, analysing 125 samples from neonatal screening cards (NSC) and 659 urine samples in the period between January 1, 2016 and December 31, 2022. The diagnosis of congenital CMV (cCMV) was confirmed in 24 patients through the presence of the virus in urine or NSC samples, corresponding to 3.4% (24/698) of the total patients studied.

Resumo A detecção precoce da infecção congênita pelo citomegalovírus (cCMV) em pacientes pediátricos permite a implementação de um tratamento adequado com o objetivo de reduzir a gravidade das sequelas associadas a esta infecção, o que impacta diretamente na qualidade de vida da criança. O objetivo deste estudo foi determinar a taxa de positividade de infecção por CMV em crianças com suspeita de infecção congênita e analisar as estratégias utilizadas na confirmação diagnóstica laboratorial. Para isso, foi realizado uma análise retrospectiva de amostras de crianças com suspeita de cCMV, as quais foram estudiadas pelo laboratório de Virologia da instituição por meio de reação em cadeia da polimerase em tempo real (qPCR) específica para citomegalovírus (CMV). Um total de 698 pacientes foram incluídos, sendo analisadas 125 amostras de sangue de cartões de triagem neonatal (TSN) e 659 amostras de urina no período entre 1º de janeiro de 2016 e 31 de dezembro de 2022. O diagnóstico de cCMV foi confirmado em 24 pacientes pela presença do vírus em amostras de urina ou TSN, de acordo com a idade do paciente, correspondendo a 3,4% (24/698) do total de pacientes estudados.

Adapting lean management to prevent healthcare-associated infections: a low-cost strategy involving Kamishibai cards to sustain bundles' compliance.

Lean healthcare visual management has been successfully integrated into infection control programs, leading to lower healthcare-associated infection (HAI) rates and greater provider compliance with evidence-based prevention practices; however, its implementation during quality improvement (QI) initiatives in limited-resource settings has not yet been well exploited. We aimed to describe a low-cost strategy involving Kamishibai cards to sustain bundles' adherence to prevent HAIs in a middle-income country. This descriptive case study evaluated the implementation of a lean healthcare visual management tool-Kamishibai board (K-board)-during a nationwide QI collaborative preventing three critical HAIs in 189 adult and pediatric/neonatal intensive care units (ICUs) from September 2021 to January 2023. Considering a limited-resource setting, our team adapted a K-board using simple, cheap, and easy-to-handle materials for routine monitoring of QI procedures, including safety bundles' compliance. After test prototypes, the final K-board version was implemented. The chart materials and assembly cost BRL 80.00 (USD 15.48). Before launching, expert working group meetings were held to shape the contents, refine technical issues, and prepare the ICU teams for implementation. After starting, plan-do-study-act cycles were conducted according to the Breakthrough Series model. Participating ICU teams, including leaders and front-line health workers, performed bedside audits following a weekly chronogram. Two indicators were calculated: the percentage of ICUs in which K-boards were being implemented and whether bundles' compliance was addressed in the K-board. Audit data were recorded in 'SimpleQI'. After 17 months of this initiative, 177 (93.7%) participating ICUs had included this visual management tool in their daily care routines. When more than 94 (>50%) ICUs posted K-board data, the mean compliance for the bundles for each HAI was sustained above 85%. A lean healthcare visual management tool can be adapted to local settings, including healthcare facilities with limited resources. K-board seems to be a feasible method for auditing evidence-based practices in medical care, including safety bundles to simultaneously prevent three types of HAIs.

A network-based analysis to assess COVID-19 disruptions in the Bogotá BRT system.

The global COVID-19 crisis has severely affected mass transit in the cities of the global south. Fear of widespread propagation in public spaces and the dramatic decrease in human mobility due to lockdowns have resulted in a significant reduction of public transport options. We analyze the case of TransMilenio in Bogotá, a massive Bus Rapid Transit system that is the main mode of transport for an urban area of roughly 10 million inhabitants. Concerns over social distancing and new health regulations reduced the number of trips to under 20% of its historical values during extended periods of time during the lockdowns. This has sparked a renewed interest in developing innovative data-driven responses to COVID-19 resulting in large corpora of TransMilenio data being made available to the public. In this paper we use a database updated daily with individual passenger card swipe validation microdata including entry time, entry station, and a hash of the card's ID. The opportunity of having daily detailed minute-to-minute ridership information and the challenge of extracting useful insights from the massive amount of raw data (∼1,000,000 daily records) require the development of tailored data analysis approaches. Our objective is to use the natural representation of urban mobility offered by networks to make pairwise quantitative similarity measurements between daily commuting patterns and then use clustering techniques to reveal behavioral disruptions as well as the most affected geographical areas due to the different pandemic stages. This method proved to be efficient for the analysis of large amount of data and may be used in the future to make temporal analysis of similarly large datasets in urban contexts.

Effects of vaccine registration on disease prophylaxis: a systematic review.

BACKGROUND: The impact of the pandemic caused by the coronavirus (SARS-CoV-2), causing the disease COVID-19, has brought losses to the world in terms of deaths, economic and health problems. The expected return of the public to activities adapted to the new health situation led to discussions about the use of vaccination and its effects. However, the demand for proof of vaccination showed how inconsistent, unregistered, and uncontrolled this health process is with current technologies. Despite the proven effectiveness of vaccines in reducing infection rates, mortality, and morbidity, there are still doubts about their use in preventing certain infections and injuries, as well as the use of digital medical records for identification at public events and disease prevention. Therefore, this review aims to analyze the use of digital immunization cards in disease prevention in general. METHODS: A systematic review of Science, PubMed/MEDLINE, LILACS /BSV, CINALH, and IEEE and Xplore was performed using PRISMA guidelines. The authors summarized the studies conducted over the last decade on the impacts of prophylaxis by control through immunization cards. Studies were selected using the following terms: Vaccination; Mobile Applications; Health Smarts Cards; Immunization Programs; Vaccination Coverage. For data analysis, we used Mendeley, Excel, RStudio, and Bibliometrix software among others. RESULTS: A total of 1828 publications were found. After applying eligibility criteria (Articles published in Portuguese, Spanish or English in the last 10 years). Studies that only dealt with paper or physical records were excluded, as well as studies that were not linked to their country's health Department, as a possibility of bias exists with these types of information). After removing duplicates and applying filters 1 and 2, we included 18 studies in this review. This resulted in 18 papers that met our priori inclusion criteria; it was found that the most relevant sources were from the databases of the Institute of Electrical and Electronics Engineers (IEEE). CONCLUSIONS: Considering the selected studies, we found that scientific evidence and epidemiological surveillance are essential tools to characterize the efficiency and effectiveness of immunization passport protection intervention and to ethically justify them. Technological development of digital vaccine passports can assist in vaccination programs and positively impact disease prophylaxis.

Baralho para avaliação, intervenção e posvenção do comportamento suicida / Deck of cards for assessement, intervention and prevention and postvention of suicidal behavior / Baraja de cartas para evaluación, intervención y posvención de la conducta suicida

A pesquisa teve como objetivo construir um baralho para avaliação, intervenção e posvenção do comportamento suicida em adultos que tivesse evidência de validade de conteúdo. Para buscar a evidência de validade de conteúdo das cartas realizou-se a análise quantitativa por meio da porcentagem de concordância entre os juízes, índice de validade de conteúdo (IVC) e coeficiente de Kappa, assim como a análise semântica do conteúdo das cartas. 134 cartas apresentaram IVC dentro dos parâmetros psicométricos recomendáveis, e o Kappa geral e por dimensões demonstrou concordância moderada entre os juízes. Na análise semântica, 27 cartas foram modificadas e 16excluídas. Estima-se que o baralho auxiliará na instrumentalização dos psicólogos frente ao comportamento suicida, na prevenção do risco ao suicídio, assim como dará suporte a pessoa com ideação, plano e tentativa suicida e a sobreviventes enlutados (AU).

This research aimed to build a deck of cards for assessment, intervention and postvention of suicidal behavior in adults that evidenced content validation. To search for evidence of card content validation, a quantitative analysis was performed through the percentage of agreement among the judges, Content Validity Index (CVI) and Cohen's Kappa Coefficient, as well as the semantic analysis of the content of the cards. 134 cards presented the recommended psychometric parameters, furthermore the general Kappa had moderate level of agreement among the judges. In the semantic analysis, 27 cards were modified and 16were excluded. It is estimated that this deck of cards will help psychologists provide tools for suicidal behavior, prevent the risk of suicide, as well as support people who struggle with suicidal ideation, plan and attempt, as well as survivors of suicide (AU).

Esta investigación tuvo como objetivo construir una baraja de cartas para la evaluación, intervención y posvención de la conducta suicida en adultos que evidenciara validación de contenido. Para buscar evidencia de validación del contenido de la tarjeta, se realizó un análisis cuantitativo a través del porcentaje de acuerdo entre los jueces, Índice de Validez de Contenido (CVI) y Coeficiente Kappa de Cohen, así como el análisis semántico del contenido de las tarjetas. 134 tarjetas presentaron los parámetros psicométricos recomendados, además el Kappa general tuvo un nivel moderado de acuerdo entre los jueces. En el análisis semántico, se modificaron 27 cartas y se excluyeron 16. Se estima que esta baraja de cartas ayudará a los psicólogos a proporcionar herramientas para el comportamiento suicida, prevenir el riesgo de suicidio, así como apoyar a las personas que luchan con la ideación, el plan y el intento suicida, así como a los sobrevivientes del suicidio (AU).

Parents Influence Responsible Credit Use in Young Adults: Empirical Evidence from the United States, France, and Brazil.

From the start of adulthood, consumers are frequently faced with complex financial decisions, and the consequences of these decisions may be reflected throughout the rest of their lives. As access to credit has expanded among college students around the world, it is critical that we understand both universal and culture-specific processes. Although some work has examined credit card use in two cultures simultaneously, there is, to our knowledge, no research examining such use in three cultures on three continents and across both genders. This study analyzes credit card use behavior among 1458 young adults living either in Brazil, the United States, or France. A structural equations model is used to incorporate relationships between the latent variables. The model, which was validated by the study, examines how financial well-being is affected by the way in which the individual uses credit cards, which in its turn is affected by social comparison and by financial self-confidence, the latter being also impacted by the financial education received from the parents. In the comparison between groups we found evidence that men are more dependent on parental education than women.

Current Scenario and Future Direction of Newborn Screening and Management Program for Phenylketonuria in Bangladesh

Abstract Phenylketonuria (PKU) is a correctable inborn error of metabolism which causes lethal intellectual delay and neurobehavioral anomalies. A screening package, especially for early recognition can support to regulate the PKU process of most patients. New-born screening program in any country focuses at the earliest detection of inheritance deficiency disorders in order to avoid the most severe repercussion by appropriate medication. This screening program needs a concomitant diagnosis and involves additional clinical research. Strategies from developed countries recommend that new-born screening should be done as soon as possible after birth before hospital/clinic discharge because if detected later, it conveys to significantly increase in disability as well as morbidity. Although exact protocol differs among different countries, testing procedures for PKU should be followed universally recognized in the developed world. Unfortunately, new-born screening program in Bangladesh is in lying-in room or possibly in pilot study in particular hospital, because the health-care system is classically targeted mortality (like childbirth complications) and transmittable morbidities (such as COVID-19) but not inborn frailties. Although policies and management of childbirth complications have been successfully lowered infant and mother mortality rates, the number of disabled babies increased tremendously. The study aims to investigate the current status of new-born screening (NBS) program of PKU in the Rajshahi Division Bangladesh, and focus on future plans to manage with life-long treatment. The primary challenges such as financial support for newborn screening, publicity, should be identified and implemented for national PKU-NBS policy as a role model of Bangladesh for developing countries.

Jogo de cartas como estratégia para o ensino de doenças autoimunes na graduação médica / Card game as strategy for the teaching of autoimmune diseases in medical graduation / Juego de cartas como estrategia para la enseñanza de enfermedades autoinmunes en la graduación médica

A experiência relatada neste artigo envolveu a elaboração e aplicação do ImunoDAI, um jogo de cartas desenvolvido por alunos e professores do curso de Medicina para abordar o conteúdo técnico de vinte Doenças Autoimunes (DAI). As DAI compreendem numerosas doenças com diferentes apresentações clínicas que compartilham uma etiologia complexa, porém comum, representada pela resposta imunológica contra autoantígenos. O ImunoDAI trata-se de um jogo produzido coletivamente que, enquanto recurso pedagógico, possibilitou o trabalho com as DAI por meio da elaboração de quatro cartas contendo informações sobre as principais causas da doença; imunopatogênese; sinais e sintomas; diagnóstico e tratamento. A utilização do jogo facilitou a fixação dos conteúdos e favoreceu o processo de ensino-aprendizagem ao permitir múltiplas interações, promover a aprendizagem dos conteúdos, desenvolver autonomia, criatividade, cooperação mútua, discussões e tomadas de decisões, habilidades indispensáveis aos futuros médicos.

The experience reported in this article involved the development and application of ImmunoDAI, a card game developed by students and professors of the medical course to address the technical content of twenty autoimmune diseases (DAI). The DAI comprise numerous diseases with different clinical presentations that share a complex but common etiology represented by the immune response against autoantigens. The ImunoDAI is a collectively produced game that, as a pedagogical resource, made possible the work with the DAI through the elaboration of four letters containing information about the main causes of the disease; immunopathogenesis; signals and symptoms; diagnosis and treatment. The use of the game facilitated the fixing of contents and favored the teaching-learning process by allowing multiple interactions, promoting content learning, developing autonomy, creativity, cooperation, discussions and decision making, skills that are indispensable for future doctors.

A experiencia relatada en este artículo involucró la elaboración y aplicación del ImunoDAI, un juego de cartas desarrollado por alumnos y profesores del curso de Medicina para abordar el contenido técnico de veinte Enfermedades autoinmunes (DAI). Las DAI comprenden numerosas enfermedades con diferentes presentaciones clínicas que comparten una etiología compleja, pero común, representada por la respuesta inmunológica contra autoantígenos. El ImunoDAI es un juego producido colectivamente que, en cuanto recurso pedagógico, posibilitó el trabajo con las DAI por medio de la elaboración de cuatro cartas conteniendo informaciones sobre las principales causas de la enfermedad; inmunopatogenia; signos y síntomas; diagnóstico y tratamiento. La utilización del juego facilitó la fijación de los contenidos y favoreció el proceso de enseñanza-aprendizaje al permitir múltiples interacciones, promover el aprendizaje de los contenidos, desarrollar autonomía, creatividad, cooperación, discusiones y tomas de decisiones, habilidades indispensables para los futuros médicos.

Preconception Micronutrient Supplementation Reduced Circulating Branched Chain Amino Acids at 12 Weeks Gestation in an Open Trial of Guatemalan Women Who Are Overweight or Obese.

Elevated branched chain amino acids (BCAAs: valine, leucine, and isoleucine) are well-established biomarkers of obesity-associated insulin resistance (IR). Mounting evidence suggests that low- and middle-income countries are suffering from a "double burden" of both undernutrition (growth stunting) and overnutrition (obesity) as these countries undergo a "nutrition transition". The purpose of this study was to examine if pre-pregnancy body mass index (BMI, kg/m²) and a daily lipid-based micronutrient supplement (LNS, Nutriset) would lead to cross-sectional differences in circulating levels of branched chain amino acids (BCAAs) in Guatemalan women experiencing short stature during early pregnancy. Using data from an ongoing randomized controlled trial, Women First, we studied women who were normal weight (NW, BMI range for this cohort = 20.1⁻24.1 kg/m²) or overweight/obese (OW/OB, BMI range for this cohort = 25.6⁻31.9 kg/m²), and divided into two groups: those who received daily LNS ≥ 3 months prior to conception through 12 weeks gestation (+LNS), or no LNS (-LNS) (n = 9⁻10/group). BCAAs levels were obtained from dried blood spot card samples (DBS) assessed at 12 weeks gestation. DBS cards provide a stable, efficient, and reliable means of collecting, transporting, and storing blood samples in low resource or field settings. Circulating maternal leptin, adiponectin, and insulin were determined by immunoassays from serum samples collected at 12 weeks gestation. We found maternal pre-pregnancy body mass index (ppBMI) was associated with higher circulating BCAAs (r² = 0.433, p = 0.002) and higher leptin/adiponectin ratio (r = 0.466, p = 0.044) in -LNS mothers at 12 weeks gestation. +LNS mothers demonstrated no correlations between BCAAs or leptin/adiponectin ratio across ppBMI suggesting LNS may be effective at improving metabolic status in OW/OB mothers during early pregnancy.

Assessment of FTA card employment for Pasteurella multocida DNA transport and detection of virulence-associated genes in strains isolated from fowl cholera in the United States / Avaliação do emprego de cartões FTA para o transporte do DNA de Pasteurella multocida e pesquisa de genes associados à virulência em cepas isoladas de cólera aviária nos Estados Unidos

Fowl Cholera (FC) is a disease caused by Pasteurella multocida. The severity of this disease is partly caused by virulence factors. Genes encoding fimbriae, capsule, sialidases and proteins for iron metabolism may be related to P. multocida's ability to infect the host. Besides to examining DNA for the presence of virulence genes, DNA is essential for the diagnostic and FTA cards are an alternative for genetic material transport. The study aims to evaluate the viability of P. multocida DNA transport using the cards and to detect 14 virulence genes in 27 strains isolated from FC cases in the United States by multiplex-PCR. No growth was observed in any of the FTA cards, which was essential to assess the security. Furthermore, DNA detection was possible in 100% of the samples, independent of the storage period (7 to 35 days) and temperature (4°C and 37°C). ptfA, exbd-tonB, hgbA, nanB, oma87, hyaD-hyaC, sodC, hgbB, sodA, nanH and pfhA genes were detected in more than 80% of the samples. FTA cards have proven to be a viable and safe tool for DNA transport of P. multocida. A majority of genes showed a high frequency, which was similar to strains isolated from FC cases.(AU)

Cólera aviária (CA) é uma doença causada pela bactéria Pasteurella multocida e a severidade dos casos é em parte justificada por fatores de virulência. Genes codificando fímbrias, cápsulas, sialidases, dismutases e proteínas do metabolismo férrico podem ser relacionados à capacidade do agente em infectar o hospedeiro. Além da obtenção do DNA para pesquisa de genes de virulência, o material genético é fundamental para o diagnóstico, e os cartões FTA seriam uma alternativa no transporte de microrganismos. Os objetivos da presente pesquisa foram avaliar a viabilidade do transporte de DNA de P. multocida através dos cartões e detectar 14 genes de virulência em 27 cepas isoladas de CA nos Estados Unidos, por meio de multiplex-PCR. Nenhuma das amostras para análise microbiológica da segurança dos cartões apresentou crescimento. Foi possível a detecção do DNA em 100% das amostras, independentemente do tempo de estocagem (sete a 35 dias) e das temperaturas (4°C e 37°C) avaliadas. Genes ptfA, exbd-tonB, hgbA, nanB, oma87, hyaD-hyaC, sodC, hgbB, sodA, nanH e pfhA foram detectados em mais de 80% das amostras. Os cartões FTA demonstraram ser uma ferramenta viável e segura para o transporte do DNA de P. multocida. A maioria dos genes apresentou uma alta frequência, compatível com isolados de CA.(AU)

Assessment of FTA card employment for Pasteurella multocida DNA transport and detection of virulence-associated genes in strains isolated from fowl cholera in the United States / Avaliação do emprego de cartões FTA para o transporte do DNA de Pasteurella multocida e pesquisa de genes associados à virulência em cepas isoladas de cólera aviária nos Estados Unidos

Fowl Cholera (FC) is a disease caused by Pasteurella multocida. The severity of this disease is partly caused by virulence factors. Genes encoding fimbriae, capsule, sialidases and proteins for iron metabolism may be related to P. multocida's ability to infect the host. Besides to examining DNA for the presence of virulence genes, DNA is essential for the diagnostic and FTA cards are an alternative for genetic material transport. The study aims to evaluate the viability of P. multocida DNA transport using the cards and to detect 14 virulence genes in 27 strains isolated from FC cases in the United States by multiplex-PCR. No growth was observed in any of the FTA cards, which was essential to assess the security. Furthermore, DNA detection was possible in 100% of the samples, independent of the storage period (7 to 35 days) and temperature (4°C and 37°C). ptfA, exbd-tonB, hgbA, nanB, oma87, hyaD-hyaC, sodC, hgbB, sodA, nanH and pfhA genes were detected in more than 80% of the samples. FTA cards have proven to be a viable and safe tool for DNA transport of P. multocida. A majority of genes showed a high frequency, which was similar to strains isolated from FC cases.(AU)

Cólera aviária (CA) é uma doença causada pela bactéria Pasteurella multocida e a severidade dos casos é em parte justificada por fatores de virulência. Genes codificando fímbrias, cápsulas, sialidases, dismutases e proteínas do metabolismo férrico podem ser relacionados à capacidade do agente em infectar o hospedeiro. Além da obtenção do DNA para pesquisa de genes de virulência, o material genético é fundamental para o diagnóstico, e os cartões FTA seriam uma alternativa no transporte de microrganismos. Os objetivos da presente pesquisa foram avaliar a viabilidade do transporte de DNA de P. multocida através dos cartões e detectar 14 genes de virulência em 27 cepas isoladas de CA nos Estados Unidos, por meio de multiplex-PCR. Nenhuma das amostras para análise microbiológica da segurança dos cartões apresentou crescimento. Foi possível a detecção do DNA em 100% das amostras, independentemente do tempo de estocagem (sete a 35 dias) e das temperaturas (4°C e 37°C) avaliadas. Genes ptfA, exbd-tonB, hgbA, nanB, oma87, hyaD-hyaC, sodC, hgbB, sodA, nanH e pfhA foram detectados em mais de 80% das amostras. Os cartões FTA demonstraram ser uma ferramenta viável e segura para o transporte do DNA de P. multocida. A maioria dos genes apresentou uma alta frequência, compatível com isolados de CA.(AU)

Is Anyone Paying Attention to Physician Report Cards? The Impact of Increased Availability on Consumers' Awareness and Use of Physician Quality Information.

OBJECTIVE: To determine if the release of health care report cards focused on physician practice quality measures leads to changes in consumers' awareness and use of this information. PRIMARY DATA SOURCES: Data from two rounds of a survey of the chronically ill adult population conducted in 14 regions across the United States, combined with longitudinal information from a public reporting tracking database. Both data were collected as part of the evaluation for Aligning Forces for Quality, a nationwide quality improvement initiative funded by the Robert Wood Johnson Foundation. STUDY DESIGN: Using a longitudinal design and an individual-level fixed effects modeling approach, we estimated the impact of community public reporting efforts, measured by the availability and applicability of physician quality reports, on consumers' awareness and use of physician quality information (PQI). PRINCIPAL FINDINGS: The baseline level of awareness was 12.6 percent in our study sample, drawn from the general population of chronically ill adults. Among those who were not aware of PQI at the baseline, when PQI became available in their communities for the first time, along with quality measures that are applicable to their specific chronic conditions, the likelihood of PQI awareness increased by 3.8 percentage points. For the same group, we also find similar increases in the uses of PQI linked to newly available physician report cards, although the magnitudes are smaller, between 2 and 3 percentage points. CONCLUSIONS: Specific contents of physician report cards can be an important factor in consumers' awareness and use of PQI. Policies to improve awareness and use of PQI may consider how to customize quality report cards and target specific groups of consumers in dissemination.

Optimización de un método de PCR en tiempo real para el diagnóstico de infecciones por Mycoplasma pneumoniae / Optimization of a real-time PCR method for the diagnosis of Mycoplasma pneumoniae infections

A Mycoplasma pneumoniae se lo ha descrito como causante de diversas patologías, pero la más frecuente es la neumonía de la comunidad, en la que puede asociarse a otros patógenos. Afecta pincipalmente a niños de edad escolar y adultos jóvenes, aunque en las últimas décadas es frecuente hallarlo también en niños menores de 5 años. El daño celular ocurre sobre el epitelio de bronquios y bronquiolos por acumulación de peróxido de hidrógeno y radicales superóxido producidos durante su metabolismo celular. Recientemente se ha reportado que en estos eventos patogénicos también participa una citotoxina conocida como CARDS toxin (community-acquired respiratory distress syndrome) que la bacteria expresa como factor de virulencia, ya que induce una importante respuesta inflamatoria celular. Los métodos moleculares son más sensibles y rápidos que los métodos de diagnóstico tradicionales y se consideran de elección. No obstante, para lograr un diagnóstico óptimo, se aconseja la combinación de estos métodos junto con los serológicos. En el presente estudio se optimiza un método de PCR en tiempo real con iniciadores dirigidos a la región del gen que codifica la CARDS toxin. El método demostró ser muy sensible y rápido para el diagnóstico clínico de M. pneumoniae, con una concordancia қ: 0,95 con el método convencional de PCR anidada que emplea como target al gen que codifica para la citoadhesina P1. A su vez es mucho menos laborioso e implica un menor riesgo de contaminación, lo que permite el manejo de un alto número de muestras clínicas (AU)

Mycoplasma pneumoniae has been described as the cause of different infections, the most common of which is communityacquired pneumonia, possibly associated with other pathogens. Community-acquired pneumonia mainly affects school-age children and young adults, although over the past decades the disease has also been found in children under 5 years of age. Cell damage occurs on the epithelium of the bronchi and bronchioles due to accumulation of hydrogenous peroxide and superoxide radicals produced during cell metabolism. Recently, it has been reported that in these pathogenic events a cytotoxin known as CARDS toxin (community-acquired respiratory distress syndrome) participates, expressed by the bacteria as a factor of virulence, as it induces an important inflammatory cell response. The molecular methods are more sensitive and faster than the traditional diagnostic methods, and are considered the methods of choice; however, for an optimal diagnosis, a combination of these methods together with serological studies is recommended. In the current study, a real-time PCR method with markers targeted to the region of the gene encoding the CARDS toxin was optimized. The method showed to be very sensitive and fast for the clinical diagnosis of M. pneumoniae, with a қ agreement of 0.95 with the conventional nested PCR method that uses the gene encoding cytoadhesin P1 as a target. Additionally, the new method is much easier with a lower risk of contamination, which allows management of a large number of clinical samples (AU)

The use of FTA cards for transport and detection of gyrA mutation of Campylobacter jejuni from poultry.

The purpose of the present study was to evaluate a technique involving the use of commercially available FTA classic card (Whatman) for transporting and detection of DNA to use in PCR analysis and genetic sequencing of Campylobacter jejuni of poultry origin. Fifty isolates of Campylobacter jejuni were obtained from broiler carcasses in Rio Grande do Sul, Brazil. Antimicrobial susceptibility testing to ciprofloxacin revealed that all 50 isolates were resistant to ciprofloxacin. Each isolate was transferred to Brucella broth tubes and incubated overnight at 41.5°C. Cell cultures were diluted to match a McFarland Turbidity Standard 0.5, and 110 µL of the cell suspension were applied to one circle on Whatman FTA classic cards. The samples were then covered and allowed to dry at room temperature. Cards were identified and stored at room temperature until further use (3 mo after collection). FTA cards were shipped for analysis to the Department of Poultry Science, University of Arkansas. Amplification of the Campylobacter gyrA gene was successful and demonstrated strong bands for a large amplicon for all 50 samples preserved on FTA cards. Mutations present in each gene were confirmed by DNA sequencing. Then, 7 samples were chosen for the sequencing. The detection of a mutation regarding ciprofloxacin-resistant isolates revealed that 7 samples had a mutation in the gyrA gene. In conclusion, the characteristics of the profiles suggest that the DNA has maintained its integrity after 3 mo of storage at room temperature and is a suitable template for PCR and sequencing from Campylobacter samples. The application of this technology has potential in numerous methodologies, especially when working in remote areas and in developing countries where access to laboratory facilities and equipment is limited.

Impact of outpatient non-myeloablative haematopoietic stem cell transplantation in quality of life vs. conventional therapy.

The role of outpatient hematopoietic stem cell transplantation (HSCT) as a therapeutic tool has been strengthened significantly because of the increasing number of patients undergoing this treatment. Due the very nature of this procedure, one of the aspects that should not be overlooked is the quality of life (QOL) of patients undergoing HSCT. Thus, one must consider not only health status after treatment, but also, the psychosocial implications for the patient. This is an observational, longitudinal, and prospective study to assess QOL in patients undergoing outpatient HSCT vs. similar patients receiving medical treatment (MxTx). By applying the COOP/WONKA charts on five occasions (pre-HSCT/initial, post-HSCT/first month, and at 3, 6, and 9 months), thirty-eight patients were analysed, 19 with HSCT and 19 with MxTx with no differences in age, gender or diagnosis. The initial survey found significant differences only in pain perception, which was higher in the HSCT group (p = .08); at the first month, there was a greater tendency for feelings of depression or anxiety in the HSCT group (p = .016), with more limitations in social (p = .003) and daily (p = .044) activities. From 3 months post-HSCT, the results were very similar. The differences persisted only in the area of social activities. Four patients developed graft-versus-host disease with no significant difference in the scores obtained compared to other transplant patients at 3, 6, and 9 months (p = .26) of follow-up.

Carteira de vacinação virtual / Virtual vaccination card

Apesar do constante crescimento do uso da tecnologia nas diversas áreas, ainda existem processos não informatizados, dependendo exclusivamente do uso da caneta e do papel, exemplo disso é a carteira de vacinação no Brasil. Em vários postos de saúde, os processos de registro da vacinação, desde o registro de quantas vacinas chegaram ao posto até o controle de quantas vacinas foram aplicadas diária e mensalmente são realizados através de fichas preenchidas manualmente pelos colaboradores destes postos. Esses procedimentos geram: inconsistência e perda de informações, difícil acesso a informações, dentre outros. Este artigo propõe um protótipo de carteira de vacinação virtual com o objetivo de propiciar o acesso ágil às informações registradas, armazenar informações de forma centralizada e organizada, permitindo a consistência e integridade de dados. Para isso, utiliza-se um cartão inteligente combinado a um ambiente web proporcionando acesso imediato e integral ao registro do histórico de vacinação de todo cidadão.

Despite the steady growth in the use of technology in different areas, there are still not computerized procedures, depending exclusively the use of pen and paper, example is the vaccination card in Brazil. In several health centers, all of vaccination registration processes, since the registration of all vaccines reached the post until track ofhow many vaccines were applied daily and monthly are performed through bookmarks manually filled by employees of these stations. These procedures create: inconsistency and loss of information, difficult access to information, among others. This paper purposes a prototype a virtual vaccination card in order to provide an agile access to recorded information, store information in a centralized and organized manner, allowing consistency and data integrity. For this,we use a combined smart card to web environment providing immediate and full access to the record of the vaccination history of all citizens.

Interpatient distributions of bloodspot area per fixed volume of application: comparison between filter paper and non-cellulose dried matrix spotting cards.

BACKGROUND: Non-cellulose dried matrix spotting (DMS) cards are an alternative to filter paper (FP) for bloodspots. We compared the interpatient distributions of bloodspot areas between DMS and FP for a fixed volume of application of whole blood, and examined correlations of areas with hematocrit. METHODS: EDTA-whole blood adult patient samples (n=49; 25 males, 24 females) were utilized after routine measurement of hemoglobin and hematocrit. Replicate (4×) bloodspots were produced by bolus drop application of 50µL whole blood via a fixed-volume pipettor to either FP or DMS. Dried bloodspot areas were determined by image analysis. RESULTS: Hematocrits (HCT) were normally distributed (HCT=30.9±5.3%). For both FP and DMS, bloodspot areas (a, cm(2)) across patients were normally distributed: for FP, a=1.11±0.056cm(2) (±5.0%); for DMS, a=0.378±0.037cm(2) (±9.9%). Relative bloodspot area differences across the population range were >20% for both DMS and FP. Correlation of bloodspot areas to hematocrit was negative for FP (r=-0.80) but positive for DMS (r=+0.78). CONCLUSIONS: Interpatient variation in blood volume per area is a preanalytical variable for both DMS and FP bloodspots. Hematocrit is but one interpatient variable, as correlations of fixed-volume bloodspot areas with hematocrit across patients were substantially inexact (r(2)<0.65).

Uso dos cartões FTA para o transporte de amostras de DNA de Salmonella spp. isoladas de produtos avícolas do Sul do Brasil / Use of FTA cards for the transport of DNA samples of Salmonella spp. from poultry products from Southern Brazil

Background: The contamination of products with Salmonella is a major threat to the poultry industry because the possible transmission to humans and animals can produce a huge negative impact. The diversity of Salmonella enterica serotypes complicates the diagnostic systems and the transport of live cultures to the diagnostic labs may represent a biohazard. Current methods for serotyping using antibodies do not work well for many Salmonella serotypes and reagents are not often available. For these reasons, methods that assign serotype by the analysis of DNA are preferred. One step that is currently in development is streamlining methods for DNA submission to the laboratories for sequencing. For this purpose, we investigated fi lter papers commercially available (Flinders Technology Associates - FTA) to ship DNA samples. Filter papers are impregnated with a chemical formulation that lyses cells, immobilizes DNA, and protects it from degradation. The objective of this study was to assess the feasibility of the FTA cards for transporting Salmonella DNA samples in order to reduce biohazards and if they would yield enough DNA in quantity and quality for molecular analyses. Material, Methods & Results: In this study 156 samples of Salmonella enterica serotypes Enteritidis, Heidelberg, Hadar, Gallinarum, Typhimurium, Agona and Pullorum were isolated from poultry products and environments in southern Brazil. Samples were stored in the Avian Diagnostic and Research Center of the Federal University of Rio Grande do Sul. Following instructions for spotting cards with cell cultures at a density that visually matched a McFarland Turbidity Standard 0,5; they were shipped to the Agriculture Research Service of the United States Department of Agriculture (USDA-ARS, Athens, GA-USA), using FTA cards. Upon the reception of the cards, safety testing was performed by transferring one disk from each sample into 10 mL of brain heart infusion (BHI) tubes and incubated at 37°C for 24 h. The BHI tube that showed turbidity after incubation was transferred to brilliant green (BG) agar and incubated at 37°C for 24 h to 48 h. If colonies were obtained in BG, biochemical analyses were performed by using the Enterotube method. Only one sample (S. Enteritidis) showed turbidity in BHI, but any bacterial growth was observed in the BG agar. The average DNA concentration, as measured by spectrophotometry, was 42,32 (± 9,84) ng/µL and the average 280/260 ratio was 1,9 (± 0,09). All the analyzed samples were negative for live cultures of Salmonella and the DNA obtained was suitable for molecular testing. Discussion: FTA cards can be used to transport DNA samples from pathogenic bacteria, reducing biohazards associated with shipping live cultures. The possibility of shipping DNA, in an economic and safe way, for testing samples at the laboratories facilitates the identification of Salmonella enterica serotypes that are circulating in the environment of poultry. Turbidity in BHI tubes that did not result in colonies on agar media may be caused by the presence of other contaminants such as environmental saprophytic microorganisms that may occurred during the process of handling the cards. DNA samples of Salmonella enterica shipped from Brazil to the United States for this set of isolates did not show bacterial growth. Thus the FTA cards provided safe and effective inactivation of the pathogen, and the DNA obtained from the cards were adequate for downstream analyses.

Use of FTA cards for the transport of DNA samples of Salmonella spp. from poultry products from southern Brazil / Uso dos cartões FTA para o transporte de amostras de DNA de Salmonella spp. isoladas de produtos avícolas do Sul do Brasil

Background: The contamination of products with Salmonella is a major threat to the poultry industry because the possible transmission to humans and animals can produce a huge negative impact. The diversity of Salmonella enterica serotypes complicates the diagnostic systems and the transport of live cultures to the diagnostic labs may represent a biohazard. Current methods for serotyping using antibodies do not work well for many Salmonella serotypes and reagents are not often available. For these reasons, methods that assign serotype by the analysis of DNA are preferred. One step that is currently in development is streamlining methods for DNA submission to the laboratories for sequencing. For this purpose, we investigated fi lter papers commercially available (Flinders Technology Associates - FTA) to ship DNA samples. Filter papers are impregnated with a chemical formulation that lyses cells, immobilizes DNA, and protects it from degradation. The objective of this study was to assess the feasibility of the FTA cards for transporting Salmonella DNA samples in order to reduce biohazards and if they would yield enough DNA in quantity and quality for molecular analyses.Material, Methods & Results: In this study 156 samples of Salmonella enterica serotypes Enteritidis, Heidelberg, Hadar, Gallinarum, Typhimurium, Agona and Pullorum were isolated from poultry products and environ

Background: The contamination of products with Salmonella is a major threat to the poultry industry because the possible transmission to humans and animals can produce a huge negative impact. The diversity of Salmonella enterica serotypes complicates the diagnostic systems and the transport of live cultures to the diagnostic labs may represent a biohazard. Current methods for serotyping using antibodies do not work well for many Salmonella serotypes and reagents are not often available. For these reasons, methods that assign serotype by the analysis of DNA are preferred. One step that is currently in development is streamlining methods for DNA submission to the laboratories for sequencing. For this purpose, we investigated fi lter papers commercially available (Flinders Technology Associates - FTA) to ship DNA samples. Filter papers are impregnated with a chemical formulation that lyses cells, immobilizes DNA, and protects it from degradation. The objective of this study was to assess the feasibility of the FTA cards for transporting Salmonella DNA samples in order to reduce biohazards and if they would yield enough DNA in quantity and quality for molecular analyses.Material, Methods & Results: In this study 156 samples of Salmonella enterica serotypes Enteritidis, Heidelberg, Hadar, Gallinarum, Typhimurium, Agona and Pullorum were isolated from poultry products and environ

Use of FTA cards for the transport of DNA samples of Salmonella spp. from poultry products from southern Brazil / Uso dos cartões FTA para o transporte de amostras de DNA de Salmonella spp. isoladas de produtos avícolas do Sul do Brasil

Background: The contamination of products with Salmonella is a major threat to the poultry industry because the possible transmission to humans and animals can produce a huge negative impact. The diversity of Salmonella enterica serotypes complicates the diagnostic systems and the transport of live cultures to the diagnostic labs may represent a biohazard. Current methods for serotyping using antibodies do not work well for many Salmonella serotypes and reagents are not often available. For these reasons, methods that assign serotype by the analysis of DNA are preferred. One step that is currently in development is streamlining methods for DNA submission to the laboratories for sequencing. For this purpose, we investigated fi lter papers commercially available (Flinders Technology Associates - FTA) to ship DNA samples. Filter papers are impregnated with a chemical formulation that lyses cells, immobilizes DNA, and protects it from degradation. The objective of this study was to assess the feasibility of the FTA cards for transporting Salmonella DNA samples in order to reduce biohazards and if they would yield enough DNA in quantity and quality for molecular analyses.Material, Methods & Results: In this study 156 samples of Salmonella enterica serotypes Enteritidis, Heidelberg, Hadar, Gallinarum, Typhimurium, Agona and Pullorum were isolated from poultry products and environ

Background: The contamination of products with Salmonella is a major threat to the poultry industry because the possible transmission to humans and animals can produce a huge negative impact. The diversity of Salmonella enterica serotypes complicates the diagnostic systems and the transport of live cultures to the diagnostic labs may represent a biohazard. Current methods for serotyping using antibodies do not work well for many Salmonella serotypes and reagents are not often available. For these reasons, methods that assign serotype by the analysis of DNA are preferred. One step that is currently in development is streamlining methods for DNA submission to the laboratories for sequencing. For this purpose, we investigated fi lter papers commercially available (Flinders Technology Associates - FTA) to ship DNA samples. Filter papers are impregnated with a chemical formulation that lyses cells, immobilizes DNA, and protects it from degradation. The objective of this study was to assess the feasibility of the FTA cards for transporting Salmonella DNA samples in order to reduce biohazards and if they would yield enough DNA in quantity and quality for molecular analyses.Material, Methods & Results: In this study 156 samples of Salmonella enterica serotypes Enteritidis, Heidelberg, Hadar, Gallinarum, Typhimurium, Agona and Pullorum were isolated from poultry products and environ