A Propósito de um Caso de Diabetes Insípida Central Provavelmente Familiar e Gravidez

Os autores apresentam um caso de Diabetes Insípida Central provavelmente Familiar cujo diagnóstico foi feito durante a gravidez. Não houve complicações no decurso desta, tendo a doente respondido eficazmente à 1-deamino-8-d-arginina-vasopressina (DDAVP) por via nasal; o parto e a amamentação decorreram sem problemas.

Função Tiroideia em Doentes com Trissomia 21 – Casuística de Duas Consultas num Hospital Pediátrico Central

Em crianças e adolescentes com síndrome de trissomia 21 observa-se uma prevalência aumentada de alterações da função tiroideia. A mais frequentemente encontrada é o hipotiroidismo subclínico, seguida do hipotiroidismo clínico e, mais raramente, doença de Graves. O diagnóstico de hipotiroidismo é, por vezes, tardio pois os sintomas são confundidos com as manifestações características da trissomia 21, sendo portanto fundamental rastrear sistematicamente a função tiroideia nestas crianças. A velocidade de crescimento é um elemento clínico que pode contribuir quer para a valorização do diagnóstico quer da terapêutica apesar de esta não ser totalmente consensual. Descreve-se a casuística de um Hospital Central Pediátrico em foram seguidas quarenta e cinco crianças e adolescentes com trissomia 21, entre Janeiro de 2000 e Maio de 2008. Neste grupo de crianças, foram detectadas alterações da função tiroideia em dezanove; a alteração mais frequente foi o hipotiroidismo subclínico (treze) seguida do hipotiroidismo clínico (cinco); houve apenas um caso de hipertiroidismo. As alterações da função tiroideia aumentaram com a idade dos doentes, foram mais frequentes no sexo feminino e tiveram uma clínica inespecífica.

NATURAL INFECTION BY Trypanosoma cruzi IN ONE DOG IN CENTRAL WESTERN BRAZIL: A CASE REPORT

SUMMARY It is estimated that about 10 million people are infected with Trypanosoma cruzi worldwide, mostly in Latin America and more than 25 million are at risk of acquiring this infection in endemic areas. Dogs are an important reservoir for this pathogen and thus, considered a risk factor for human populations. This report describes one case of Chagas disease in a dog from Cuiabá, Mato Grosso State, Brazil. The diagnosis was obtained by direct examination of trypomastigote forms in blood smears. Amastigotes forms were visualized in microscopy of the bone marrow, lymph nodes, kidneys, liver and brain. The T. cruzi (ZIII) infection was confirmed by Polymerase Chain Reaction, and sequencing. The animal presented multisystemic failure and died. Although acute Chagas disease in humans is not reported in Cuiabá, this is the first report of a canine case in this region. This case represents a warning, to health professionals and authorities, to the possibility of transmission of this zoonosis in Cuiabá.

POLYCLONAL OUTBREAK OF BLOODSTREAM INFECTIONS CAUSED BY Burkholderia cepacia COMPLEX IN HEMATOLOGY AND BONE MARROW TRANSPLANT OUTPATIENT UNITS

Aim: The objective was to describe an outbreak of bloodstream infections by Burkholderia cepacia complex (Bcc) in bone marrow transplant and hematology outpatients.Methods: On February 15, 2008 a Bcc outbreak was suspected. 24 cases were identified. Demographic and clinical data were evaluated. Environment and healthcare workers' (HCW) hands were cultured. Species were determined and typed. Reinforcement of hand hygiene, central venous catheter (CVC) care, infusion therapy, and maintenance of laminar flow cabinet were undertaken. 16 different HCWs had cared for the CVCs. Multi-dose heparin and saline were prepared on counter common to both units.Findings: 14 patients had B. multivorans(one patient had also B. cenopacia), six non-multivorans Bcc and one did not belong to Bcc. Clone A B. multivorans occurred in 12 patients (from Hematology); in 10 their CVC had been used on February 11/12. Environmental and HCW cultures were negative. All patients were treated with meropenem, and ceftazidime lock-therapy. Eight patients (30%) were hospitalized. No deaths occurred. After control measures (multidose vial for single patient; CVC lock with ceftazidime; cleaning of laminar flow cabinet; hand hygiene improvement; use of cabinet to store prepared medication), no new cases occurred.Conclusions: This polyclonal outbreak may be explained by a common source containing multiple species of Bcc, maybe the laminar flow cabinet common to both units. There may have been contamination by B. multivorans (clone A) of multi-dose vials.

Estudo de viabilidade técnico-económica da instalação de caldeiras a biomassa para o aquecimento central do ISEP

Neste projeto pretende-se utilizar uma fonte energética renovável (nomeadamente a biomassa), no âmbito da produção de água quente para aquecimento central das instalações do Instituto Superior de Engenharia do Porto (ISEP). O objetivo principal remete para a avaliação técnico-económica da substituição das quinze caldeiras existentes, alimentadas a gás natural, por seis caldeiras alimentadas a biomassa, nomeadamente a pellets. Desta forma, permite-se apostar na biomassa como uma alternativa para reduzir a dependência dos combustíveis fósseis. Neste trabalho apresenta-se uma comparação realista do sistema de aquecimento existente face ao novo a implementar, alimentado por um combustível renovável utilizando caldeiras a pellets de 85% de rendimento. Para realizar esta comparação, usou-se as faturas energéticas de gás natural do ISEP, o custo da quantidade equivalente necessária de pellets, os custos de manutenção dos dois tipos de caldeiras e, os custos do consumo de energia elétrica por parte de ambas as caldeiras. Com este estudo, estimou-se uma poupança anual de 84.100,76 €/ano. Determinaram-se experimentalmente, em laboratório, os parâmetros essenciais de uma amostra de pellets, que foram usados para calcular as necessidades energéticas em biomassa no ISEP, bem como a produção de cinzas gerada por parte das caldeiras. Foi proposto um destino ambientalmente adequado para os 788,5 kg/ano de cinzas obtidas – a utilização na compostagem, após tratamento e aprovação de ensaios ecotoxicológicos realizados pela empresa que fará a sua recolha. As caldeiras a pellets terão um consumo mínimo teórico de 16,47 kgpellets/h, consumindo previsivelmente 197,13 tpellets/ano. Para este efeito, serão usadas caldeiras Quioto de 150 kW da marca Zantia. Para comparar distintas possibilidades de investimento para o projeto, avaliaram-se dois cenários: um foi escolhido de forma a cobrir o somatório da potência instalada das caldeiras atuais e o outro de forma a responder aos consumos energéticos em aquecimento atuais. Além disso, avaliaram-se cenários de financiamento do investimento distintos: um dos cenários corresponde ao pagamento do investimento total do projeto no momento da aquisição das caldeiras, enquanto o outro cenário, mais provável de ser escolhido, refere-se ao pedido de um empréstimo ao banco, no valor de 75% do investimento total. Para o cenário mais provável de investimento, obteve-se um VAL de 291.364,93 €/ano, com taxa interna de rentabilidade (TIR) de 17 %, um índice de rentabilidade (IR) de 1,85 e um período de retorno (PBP) de 5 anos. Todos os cenários avaliados registam rentabilidade do projeto de investimento, sem risco para o projeto.

Acquired-Transient Factor X Deficiency in a Teenager with Extensive Burns

Acquired factor X deficiency is an extremely rare situation. It has shown to be associated with systemic amyloidosis, respiratory mycoplasma infection, factor X inhibitors, antiphospholipid antibodies, vitamin K defi ciency/liver disease as well as the use of certain medications (meropenem, valproic acid). The pathogenesis and transient nature of this deficit remain poorly understood. The authors describe the case of a teenager hospitalised for extensive burns that developed active bleeding after removal of central venous catheter. He was diagnosed with transient factor X deficiency. Normalisation of coagulation status and factor X levels occurred spontaneously 10 days after the bleeding episode.

ASSESSMENT OF THE PRESENCE OF Toxocara EGGS IN SOILS OF AN ARID AREA IN CENTRAL-WESTERN ARGENTINA

With the aim of studying the contamination of soils with eggs of Toxocara spp. in an arid area in the central-western region of Argentina, 76 soil samples were collected from 18 towns belonging to six provinces of central-western Argentina. They were processed by the centrifugal flotation method. No eggs of Toxocara spp. were found. It can be concluded that the negative results are directly related to the characteristics of the environment and climate present in the studied area. The finding of eggs in soils depends on several factors: the presence of canine or feline feces, the hygienic behavior of pet owners, the presence of stray animals without veterinary supervision, the weather and environmental conditions, and laboratory techniques used; and all these circumstances must be considered when comparing the results found in different geographical regions. In order to accurately define the importance of public spaces in the transmission of infection to humans, it is important to consider the role of backyards or green spaces around housing in small towns, where the population is not used to walking pets in public spaces, and in such cases a significant fraction of the population may acquire the infection within households.

SAINT LOUIS ENCEPHALITIS VIRUS IN MATO GROSSO, CENTRAL-WESTERN BRAZIL

The dengue virus (DENV), which is frequently involved in large epidemics, and the yellow fever virus (YFV), which is responsible for sporadic sylvatic outbreaks, are considered the most important flaviviruses circulating in Brazil. Because of that, laboratorial diagnosis of acute undifferentiated febrile illness during epidemic periods is frequently directed towards these viruses, which may eventually hinder the detection of other circulating flaviviruses, including the Saint Louis encephalitis virus (SLEV), which is widely dispersed across the Americas. The aim of this study was to conduct a molecular investigation of 11 flaviviruses using 604 serum samples obtained from patients during a large dengue fever outbreak in the state of Mato Grosso (MT) between 2011 and 2012. Simultaneously, 3,433 female Culex spp. collected with Nasci aspirators in the city of Cuiabá, MT, in 2013, and allocated to 409 pools containing 1-10 mosquitoes, were also tested by multiplex semi-nested reverse transcription PCR for the same flaviviruses. SLEV was detected in three patients co-infected with DENV-4 from the cities of Cuiabá and Várzea Grande. One of them was a triple co-infection with DENV-1. None of them mentioned recent travel or access to sylvatic/rural regions, indicating that transmission might have occurred within the metropolitan area. Regarding mosquito samples, one pool containing one Culex quinquefasciatus female was positive for SLEV, with a minimum infection rate (MIR) of 0.29 per 1000 specimens of this species. Phylogenetic analysis indicates both human and mosquito SLEV cluster, with isolates from genotype V-A obtained from animals in the Amazon region, in the state of Pará. This is the first report of SLEV molecular identification in MT.

PHLEBOTOMINE FAUNA (DIPTERA: PSYCHODIDAE) IN AN AREA OF FISHING TOURISM IN CENTRAL-WESTERN BRAZIL

The aim of this study was to identify behavioral aspects of the sandfly fauna of a fishing tourism area in the municipality of Bonito (MS). Monthly captures were undertaken from December 2009 to November 2010, using automatic CDC type light traps, from 18h00 to 06h00, in a forested area, a savannah area, peridomiciles and animal shelters near peridomiciliary areas. Nyssomyia whitmani was the most frequent out of a total of 6,699 specimens collected, belonging to 16 species, followed by Psathyromyia bigeniculata and Lutzomyia longipalpis, found in all the environments investigated, though in their greatest numbers in the animal shelters. Ny. whitmani exhibited its highest frequencies during the dry months, coincident with the fishing season, when the risk of transmission of cutaneous leishmaniasis for tourists and inhabitants increases. Noteworthy was the finding of two species naturally infected by flagellates: Ny. whitmani and Pa. bigeniculata. The local population and visiting tourists should be warned of the threat posed by leishmaniasis and the health authorities alerted to the need for adopting environmental sanitary measures, especially regarding such animal shelters as they seem to provide favorable conditions to the proliferation, maintenance and breeding opportunities of phlebotomines.

Understanding the relationship between central metabolism and virulence in the human pathogen Streptococcus pneumoniae

Dissertation presented to obtain the Ph.D. degree in Biochemistry

Investigation and Control of a Large Outbreak of Multi-Drug Resistant Tuberculosis at a Central Lisbon Hospital

An increase in the number of new cases of tuberculosis (TB) combined with poor clinical outcome was identified among HIV-infected injecting drug users attending a large HIV unit in central Lisbon. A retrospective epidemiological and laboratory study was conducted to review all newly diagnosed cases of TB from 1995 to 1996 in the HIV unit. Results showed that from 1995 to 1996, 63% (109/173) of the Mycobacterium tuberculosis isolates from HIV-infected patients were resistant to one or more anti-tuberculosis drugs; 89% (95) of these were multidrug-resistant, i.e., resistant to at least isoniazid and rifampicin. Eighty percent of the multidrug-resistant strains (MDR) available for restriction fragment length polymorphism (RFLP) DNA fingerprinting clustered into one of two large clusters. Epidemiological data support the conclusion that the transmission of MDR-TB occurred among HIV-infected injecting drug users exposed to infectious TB cases on open wards in the HIV unit. Improved infection control measures on the HIV unit and the use of empirical therapy with six drugs once patients were suspected to have TB, reduced the incidence of MDR-TB from 42% of TB cases in 1996 to 11% in 1999.

Linfoma Primitivo do Sistema Nervoso Central em Doente com Sida

O aumento da incidência do linfoma cerebral primitivo parece ser real em pessoas imunologicamente normais. Contudo, os linfomas do sistema nervoso central têm uma muito maior incidência em doentes imunodeprimidos tais como os submetidos a transplantes cardíacos ou renais, doentes com deficiência de IgA ou síndrome de Wiskott-Aldrich. Assim, não é surpreendente o aumento da predisposição dos doentes com a síndrome de imunodeficiência adquirida para os linfomas do sistema nervoso central, sendo esta a segunda causa mais frequente de lesão ocupando espaço intracerebral nesta população. Os autores descrevem o caso de uma mulher de 36 anos com síndrome de imunodeficiência adquirida e uma lesão ocupando espaço intracerebral que demonstraram tratar-se de um linfoma cerebral.

Queratite por Acantamoeba - Revisão de 6 Casos Clínicos. Centro Hospitalar Lisboa Central

Objectivo: Determinar os factores de risco, características clínicas e desfecho da queratite por acantamoeba. Métodos: Os autores revêem os casos de queratite por acantamoeba em 6 doentes (3 do sexo masculino e 3 do sexo feminino) com idades compreendidas entre os 18 e os 41 anos, vigiados no Departamento de Córnea do nosso Hospital. As suas características e curso clínicos foram estudados retrospectivamente. Resultados: Todos os doentes eram portadores de lentes de contacto. Quatro dos 6 casos tiveram início do quadro entre final de Maio e Julho. A suspeita inicial de queratite bacteriana, fúngica ou viral precedeu o diagnóstico final de queratite por acantamoeba em todos os doentes. O diagnóstico foi feito através de observação clínica, PCR (polymerase chain reaction) ou microscopia confocal. Em todos os casos a terapêutica dirigida foi iniciada com propamidina, com adição de clorohexidina em um doente. Em 3 doentes verificou-se necessidade de realização de queratoplastia penetrante: um caso por incapacidade de controlo da infecção e por sequelas noutros dois. Conclusão: É necessário um grande nível de suspeita de infecção por acantamoeba em indivíduos utilizadores de lente de contacto e falência inicial à terapêutica antimicrobiana ou antiviral. A microscopia confocal é um auxiliar importante no diagnóstico da queratite por este microrganismo.