Um tango com Gardel

Dissertação submetida à Escola Superior de Teatro e Cinema para cumprimento dos requisitos necessários à obtenção do grau de Mestre em Teatro - especialização em Artes Performativas – vertente Teatro-Música.

Genetic relationships of Corynebacterium diphtheriae strains isolated from a diphtheria case and carriers by restriction fragment length polymorphism of rRNA genes

In the present study we report the results of an analysis, based on ribotyping of Corynebacterium diphtheriae intermedius strains isolated from a 9 years old child with clinical diphtheria and his 5 contacts. Quantitative analysis of RFLPs of rRNA was used to determine relatedness of these 7 C.diphtheriae strains providing support data in the diphtheria epidemiology. We have also tested those strains for toxigenicity in vitro by using the Elek's gel diffusion method and in vivo by using cell culture method on cultured monkey kidney cell (VERO cells). The hybridization results revealed that the 5 C.diphtheriae strains isolated from contacts and one isolated from the clinical case (nose case strain) had identical RFLP patterns with all 4 restriction endonucleases used, ribotype B. The genetic distance from this ribotype and ribotype A (throat case strain), that we initially assumed to be responsible for the illness of the patient, was of 0.450 showing poor genetic correlation among these two ribotypes. We found no significant differences concerned to the toxin production by using the cell culture method. In conclusion, the use of RFLPs of rRNA gene was successful in detecting minor differences in closely related toxigenic C.diphtheriae intermedius strains and providing information about genetic relationships among them.

Estudo da exposição profissional a formaldeído em laboratórios hospitalares de anatomia patológica

RESUMO - A exposição a formaldeído é reconhecidamente um dos mais importantes factores de risco presente nos laboratórios hospitalares de anatomia patológica. Neste contexto ocupacional, o formaldeído é utilizado em solução, designada comummente por formol. Trata-se de uma solução comercial de formaldeído, normalmente diluída a 10%, sendo pouco onerosa e, por esse motivo, a eleita para os trabalhos de rotina em anatomia patológica. A solução é utilizada como fixador e conservante do material biológico, pelo que as peças anatómicas a serem processadas são previamente impregnadas. No que concerne aos efeitos para a saúde do formaldeído, os efeitos locais parecem apresentar um papel mais importante comparativamente com os efeitos sistémicos, devido à sua reactividade e rápido metabolismo nas células da pele, tracto gastrointestinal e pulmões. Da mesma forma, a localização das lesões correspondem principalmente às zonas expostas às doses mais elevadas deste agente químico, ou seja, o desenvolvimento dos efeitos tóxicos dependerá mais da intensidade da dose externa do que da duração da exposição. O efeito do formaldeído no organismo humano mais facilmente detectável é a acção irritante, transitória e reversível sobre as mucosas dos olhos e aparelho respiratório superior (naso e orofaringe), o que acontece em geral para exposições frequentes e superiores a 1 ppm. Doses elevadas são citotóxicas e podem conduzir a degenerescência e necrose das mucosas e epitélios. No que concerne aos efeitos cancerígenos, a primeira avaliação efectuada pela International Agency for Research on Cancer data de 1981, actualizada em 1982, 1987, 1995 e 2004, considerando-o como um agente cancerígeno do grupo 2A (provavelmente carcinogénico). No entanto, a mais recente avaliação, em 2006, considera o formaldeído no Grupo 1 (agente carcinogénico) com base na evidência de que a exposição a este agente é susceptível de causar cancro nasofaríngeo em humanos. Constituiu objectivo principal deste estudo caracterizar a exposição profissional a formaldeído nos laboratórios hospitalares de anatomia patológica Portugueses. Pretendeu-se, ainda, descrever os fenómenos ambientais da contaminação ambiental por formaldeído e explorar eventuais associações entre variáveis. Considerou-se uma amostra de 10 laboratórios hospitalares de anatomia patológica, avaliada a exposição dos três grupos profissionais por comparação com os dois referenciais de exposição e, ainda, conhecidos os valores de concentração máxima em 83 actividades. Foram aplicados simultaneamente dois métodos distintos de avaliação ambiental: um dos métodos (Método 1) fez uso de um equipamento de leitura directa com o princípio de medição por Photo Ionization Detection, com uma lâmpada de 11,7 eV e, simultaneamente, realizou-se o registo da actividade. Este método disponibilizou dados para o referencial de exposição da concentração máxima; o outro método (Método 2) traduziu-se na aplicação do método NIOSH 2541, implicando o uso de bombas de amostragem eléctricas de baixo caudal e posterior processamento analítico das amostras por cromatografia gasosa. Este método, por sua vez, facultou dados para o referencial de exposição da concentração média ponderada. As estratégias de medição de cada um dos métodos e a definição dos grupos de exposição existentes neste contexto ocupacional, designadamente os Técnicos de Anatomia Patológica, os Médicos Anatomo-Patologistas e os Auxiliares, foram possíveis através da informação disponibilizada pelas técnicas de observação da actividade da análise (ergonómica) do trabalho. Estudaram-se diversas variáveis independentes, nomeadamente a temperatura ambiente e a humidade relativa, a solução de formaldeído utilizada, as condições de ventilação existentes e o número médio de peças processadas por dia em cada laboratório. Para a recolha de informação sobre estas variáveis foi preenchida, durante a permanência nos laboratórios estudados, uma Grelha de Observação e Registo. Como variáveis dependentes seleccionaram-se três indicadores de contaminação ambiental, designadamente o valor médio das concentrações superiores a 0,3 ppm em cada laboratório, a Concentração Média Ponderada obtida para cada grupo de exposição e o Índice do Tempo de Regeneração de cada laboratório. Os indicadores foram calculados e definidos através dos dados obtidos pelos dois métodos de avaliação ambiental aplicados. Baseada no delineado pela Universidade de Queensland, foi ainda aplicada uma metodologia de avaliação do risco de cancro nasofaríngeo nas 83 actividades estudadas de modo a definir níveis semi-quantitativos de estimação do risco. Para o nível de Gravidade considerou-se a informação disponível em literatura científica que define eventos biológicos adversos, relacionados com o modo de acção do agente químico e os associa com concentrações ambientais de formaldeído. Para o nível da Probabilidade utilizou-se a informação disponibilizada pela análise (ergonómica) de trabalho que permitiu conhecer a frequência de realização de cada uma das actividades estudadas. A aplicação simultânea dos dois métodos de avaliação ambiental resultou na obtenção de resultados distintos, mas não contraditórios, no que concerne à avaliação da exposição profissional a formaldeído. Para as actividades estudadas (n=83) verificou-se que cerca de 93% dos valores são superiores ao valor limite de exposição definido para a concentração máxima (VLE-CM=0,3 ppm). O “exame macroscópico” foi a actividade mais estudada e onde se verificou a maior prevalência de resultados superiores ao valor limite (92,8%). O valor médio mais elevado da concentração máxima (2,04 ppm) verificou-se no grupo de exposição dos Técnicos de Anatomia Patológica. No entanto, a maior amplitude de resultados observou-se no grupo dos Médicos Anatomo-Patologistas (0,21 ppm a 5,02 ppm). No que respeita ao referencial da Concentração Média Ponderada, todos os valores obtidos nos 10 laboratórios estudados para os três grupos de exposição foram inferiores ao valor limite de exposição definido pela Occupational Safety and Health Administration (TLV-TWA=0,75 ppm). Verificou-se associação estatisticamente significativa entre o número médio de peças processadas por laboratório e dois dos três indicadores de contaminação ambiental utilizados, designadamente o valor médio das concentrações superiores a 0,3 ppm (p=0,009) e o Índice do Tempo de Regeneração (p=0,001). Relativamente à temperatura ambiente não se observou associação estatisticamente significativa com nenhum dos indicadores de contaminação ambiental utilizados. A humidade relativa apresentou uma associação estatisticamente significativa apenas com o indicador de contaminação ambiental da Concentração Média Ponderada de dois grupos de exposição, nomeadamente com os Médicos Anatomo-Patologistas (p=0,02) e os Técnicos de Anatomia Patológica (p=0,04). A aplicação da metodologia de avaliação do risco nas 83 actividades estudadas permitiu verificar que, em cerca de dois terços (35%), o risco foi classificado como (pelo menos) elevado e, ainda, constatar que 70% dos laboratórios apresentou pelo menos 1 actividade com a classificação de risco elevado. Da aplicação dos dois métodos de avaliação ambiental e das informações obtidas para os dois referenciais de exposição pode concluir-se que o referencial mais adequado é a Concentração Máxima por estar associado ao modo de actuação do agente químico. Acresce, ainda, que um método de avaliação ambiental, como o Método 1, que permite o estudo das concentrações de formaldeído e simultaneamente a realização do registo da actividade, disponibiliza informações pertinentes para a intervenção preventiva da exposição por permitir identificar as actividades com a exposição mais elevada, bem como as variáveis que a condicionam. As peças anatómicas apresentaram-se como a principal fonte de contaminação ambiental por formaldeído neste contexto ocupacional. Aspecto de particular interesse, na medida que a actividade desenvolvida neste contexto ocupacional e, em particular na sala de entradas, é centrada no processamento das peças anatómicas. Dado não se perspectivar a curto prazo a eliminação do formaldeído, devido ao grande número de actividades que envolvem ainda a utilização da sua solução comercial (formol), pode concluir-se que a exposição a este agente neste contexto ocupacional específico é preocupante, carecendo de uma intervenção rápida com o objectivo de minimizar a exposição e prevenir os potenciais efeitos para a saúde dos trabalhadores expostos. ---------------- ABSTRACT - Exposure to formaldehyde is recognized as one of the most important risk factors present in anatomy and pathology laboratories from hospital settings. In this occupational setting, formaldehyde is used in solution, typically diluted to 10%, and is an inexpensive product. Because of that, is used in routine work in anatomy and pathology laboratories. The solution is applied as a fixative and preservative of biological material. Regarding formaldehyde health effects, local effects appear to have a more important role compared with systemic effects, due to his reactivity and rapid metabolism in skin, gastrointestinal tract and lungs cells. Likewise, lesions location correspond mainly to areas exposed to higher doses and toxic effects development depend more on external dose intensity than exposure duration. Human body formaldehyde effect more easily detectable is the irritating action, transient and reversible on eyes and upper respiratory tract (nasal and throat) membranes, which happen in general for frequent exposure to concentrations higher than 1 ppm. High doses are cytotoxic and can lead to degeneration, and also to mucous membranes and epithelia necrosis. With regard to carcinogenic effects, first assessment performed by International Agency for Research on Cancer in 1981, updated in 1982, 1987, 1995 and 2004, classified formaldehyde in Group 2A (probably carcinogenic). However, most recent evaluation in 2006, classifies formaldehyde carcinogenic (Group 1), based on evidence that exposure to this agent is likely to cause nasopharyngeal cancer in humans. This study principal objective was to characterize occupational exposure to formaldehyde in anatomy and pathology hospital laboratories, as well to describe formaldehyde environmental contamination phenomena and explore possible associations between variables. It was considered a sample of 10 hospital pathology laboratories, assessed exposure of three professional groups for comparison with two exposure metrics, and also knows ceiling concentrations in 83 activities. Were applied, simultaneously, two different environmental assessment methods: one method (Method 1) using direct reading equipment that perform measure by Photo Ionization Detection, with 11,7 eV lamps and, simultaneously, make activity description and film. This method provided data for ceiling concentrations for each activity study (TLV-C). In the other applied method (Method 2), air sampling and formaldehyde analysis were performed according to NIOSH method (2541). This method provided data average exposure concentration (TLV-TWA). Measuring and sampling strategies of each methods and exposure groups definition (Technicians, Pathologists and Assistants) was possible by information provided by activities (ergonomic) analysis. Several independent variables were studied, including temperature and relative humidity, formaldehyde solution used, ventilation conditions, and also anatomic pieces mean value processed per day in each laboratory. To register information about these variables was completed an Observation and Registration Grid. Three environmental contamination indicators were selected has dependent variables namely: mean value from concentrations exceeding 0,3 ppm in each laboratory, weighted average concentration obtained for each exposure group, as well each laboratory Time Regeneration Index. These indicators were calculated and determined through data obtained by the two environmental assessment methods. Based on Queensland University proposal, was also applied a methodology for assessing nasopharyngeal cancer risk in 83 activities studied in order to obtain risk levels (semi-quantitative estimation). For Severity level was considered available information in scientific literature that defines biological adverse events related to the chemical agent action mode, and associated with environment formaldehyde concentrations. For Probability level was used information provided by (ergonomic) work analysis that helped identifies activity frequency. Environmental assessment methods provide different results, but not contradictory, regarding formaldehyde occupational exposure evaluation. In the studied activities (n=83), about 93% of the values were above exposure limit value set for ceiling concentration in Portugal (VLE-CM = 0,3 ppm). "Macroscopic exam" was the most studied activity, and obtained the higher prevalence of results superior than 0,3 ppm (92,8%). The highest ceiling concentration mean value (2,04 ppm) was obtain in Technicians exposure group, but a result wider range was observed in Pathologists group (0,21 ppm to 5,02 ppm). Concerning Method 2, results from the three exposure groups, were all lower than limit value set by Occupational Safety and Health Administration (TLV-TWA=0,75ppm). There was a statistically significant association between anatomic pieces mean value processed by each laboratory per day, and two of the three environmental contamination indicators used, namely average concentrations exceeding 0,3 ppm (p=0,009) and Time Regeneration Index (p=0,001). Temperature was not statistically associated with any environmental contamination used indicators. Relative humidity had a statistically significant association only with one environmental contamination indicator, namely weighted average concentration, particularly with Pathologists group (p=0,02) and Technicians group (p=0,04). Risk assessment performed in the 83 studied activities showed that around two thirds (35%) were classified as (at least) high, and also noted that 70% of laboratories had at least 1 activity with high risk rating. The two environmental assessment methods application, as well information obtained from two exposure metrics, allowed to conclude that most appropriate exposure metric is ceiling concentration, because is associated with formaldehyde action mode. Moreover, an environmental method, like Method 1, which allows study formaldehyde concentrations and relates them with activity, provides relevant information for preventive information, since identifies the activity with higher exposure, as well variables that promote exposure. Anatomic pieces represent formaldehyde contamination main source in this occupational setting, and this is of particular interest because all activities are focused on anatomic pieces processing. Since there is no prospect, in short term, for formaldehyde use elimination due to large number of activities that still involve solution use, it can be concluded that exposure to this agent, in this particular occupational setting, is preoccupant, requiring an rapid intervention in order to minimize exposure and prevent potential health effects in exposed workers.

Nosocomial infection in long-term care facilities. A survey in a Brazilian psychiatric hospital

Nosocomial infection among male patients in a public psychiatric hospital was studied and the definitions for use in long-term care facilities were employed for diagnosis. The overall nosocomial infection rate was 6.7 per 1,000 day inpatients; 55.6% of these infections were identified in the respiratory tract, 50% of them being respiratory viral diseases; 38.9% of the nosocomial infections involved the eyes, ears, nose, throat and mouth, and 5.6% involved the skin and soft tissues. The epidemiological characteristics and the main clinical alterations of these inpatients were also identified.

Evolution of genotypes of Group A streptococci from colonization and infection

Dissertação para obtenção do Grau de Doutor em Biologia

Renal involvement in human rabies: clinical manifestations and autopsy findings of nine cases from northeast of Brazil

A retrospective study was conducted in nine patients with rabies admitted to a hospital of Fortaleza, Brazil. Autopsy was performed in all cases. The ages ranged from three to 81 years and six were males. They all were bitten by dogs. The time between the accident and the hospital admission ranged from 20 to 120 days (mean 45 ± 34 days). The time until death ranged from one to nine days (mean 3.3 ± 5.5 days). The signs and symptoms presented were fever, hydrophobia, aerophobia, agitation, disorientation, dyspnea, sialorrhea, vomiting, oliguria, sore throat, pain and hypoesthesia in the site of the bite, headache, syncope, cough, hematemesis, mydriasis, hematuria, constipation, cervical pain and priapism. In three out of six patients, there was evidence of acute renal failure, defined as serum creatinine > 1.4 mg/dL. The post-mortem findings in the kidneys were mild to moderate glomerular congestion and mild to intense peritubular capillary congestion. Acute tubular necrosis was seen in only two cases. This study shows some evidence of renal involvement in rabies. Histopathologic findings are nonspecific, so hemodynamic instability, caused by autonomic dysfunction, hydrophobia and dehydration must be responsible for acute renal failure in rabies.

Fexofenadine is Efficacious and Safe in Children (Aged 6-11 Years) with Seasonal Allergic Rhinitis

Background: This is the first prospective, randomized, doubleblind, placebo-controlled study showing statistical improvement of an H1-antihistamine in children with seasonal allergic rhinitis in all symptoms throughout the entire treatment period. Objective: This randomized, placebo-controlled, parallelgroup,double-blind study was performed to assess the efficacy and safety of fexofenadine in children with seasonal allergic rhinitis. Methods: This study was conducted at 148 centers in 15 countries. Nine hundred thirty-five children (aged 6-11 years) were randomized and treated with either fexofenadine HCl 30 mg (n = 464) or placebo (n = 471) tablets twice a day for 14 days. Individual symptoms (sneezing; rhinorrhea; itchy nose, mouth, throat, and/or ears; itchy, watery, and/or red eyes; and nasal congestion) were assessed at baseline and then daily at 7:00 AM and 7:00 PM (±1 hour) during the double-blind treatment period. Each total symptom score was the sum of all symptoms, excluding nasal congestion. The primary efficacy variable was the change from baseline in the average of the daily 12-hour evening reflective total symptom scores throughout the double-blind treatment. Safety was evaluated from adverse-event reporting, vital signs, physical examinations, and clinical laboratory data at screening and study end point.

Dor à Palpação da Tiróide

A 37-years-old woman, complaining of fever, malaise, myalgia, sore throat and dysphagia lasting for 15 days, had been taking antibiotics and paracetamol for 7 days, without symptoms' improvement. The clinical examination revealed hyperaemic oropharynx and enlarged, painful thyroid. Further exams showed increased analytic inflammatory serum parameters as well as thyrotoxicosis. The thyroid gland had heterogeneous echostructure, with markedly hypoechoic areas and significant capsular oedema as well as decreased radionuclide uptake in the scintigraphy. Both symptoms and imaging improved with paracetamol and ibuprofen. Thyroid gland function normalized in two months. The patient remains in follow-up. This case reports the clinical features of subacute or De Quervain's thyroiditis. The differential medical approach to the patient with painful thyroid palpation is discussed. The diagnosis is essentially clinic, highlighting the importance of a rigorous physical exam. These patients' follow-up is required, considering the clinical and analytic progression.

Streptococcal acute pharyngitis

Acute pharyngitis/tonsillitis, which is characterized by inflammation of the posterior pharynx and tonsils, is a common disease. Several viruses and bacteria can cause acute pharyngitis; however, Streptococcus pyogenes (also known as Lancefield group A β-hemolytic streptococci) is the only agent that requires an etiologic diagnosis and specific treatment. S. pyogenes is of major clinical importance because it can trigger post-infection systemic complications, acute rheumatic fever, and post-streptococcal glomerulonephritis. Symptom onset in streptococcal infection is usually abrupt and includes intense sore throat, fever, chills, malaise, headache, tender enlarged anterior cervical lymph nodes, and pharyngeal or tonsillar exudate. Cough, coryza, conjunctivitis, and diarrhea are uncommon, and their presence suggests a viral cause. A diagnosis of pharyngitis is supported by the patient's history and by the physical examination. Throat culture is the gold standard for diagnosing streptococcus pharyngitis. However, it has been underused in public health services because of its low availability and because of the 1- to 2-day delay in obtaining results. Rapid antigen detection tests have been used to detect S. pyogenes directly from throat swabs within minutes. Clinical scoring systems have been developed to predict the risk of S. pyogenes infection. The most commonly used scoring system is the modified Centor score. Acute S. pyogenes pharyngitis is often a self-limiting disease. Penicillins are the first-choice treatment. For patients with penicillin allergy, cephalosporins can be an acceptable alternative, although primary hypersensitivity to cephalosporins can occur. Another drug option is the macrolides. Future perspectives to prevent streptococcal pharyngitis and post-infection systemic complications include the development of an anti-Streptococcus pyogenes vaccine.

Anfíbios Anuros da coleção Adolpho Lutz: III - Hyla claresignata Lutz & B. Lutz, 1939

Hyla claresignata Lutz & Lutz, 1939, is a large species apparently not closely allied to the other known Brazilian hylas. It is characterized by the very small tympanum; the head is short and the snout rounded; the legs are long, the hands and feet unusually large, the latter extensively webbbed. The specific name is derived from the insular, irregular, or roughly triangular, dark spots, with a light halo, found mostly in the dorso-lateral region and on the legs. It belongs to the rain-forest fauna of the Marítime Range. The adult is a bromeliad-dweller and the tadpole rhyacophilous. DESCRIPTION. Vomerine teeth in two separate, oblique, groups, behind the large choanae, parallel to the posterior half of their inner border. Tongue entire, short, very broad and hardly free behind. Snout short, rounded, with distinct canthus rostralis and gradually sloping loreal region. Eye very large and prominent, its horizontal diameter almost equal to the distance between its anterior corner and the tip of the snout. Tympanum very small, less than one third of the diameter of the eye, but distinct, partly covered by a short, heavy ridge. Lateral fingers less than one third webbed; fourth finger slightly longer than the second, just reaching the base of the disk of the third; subarticular tubercles well developed; an angular pollex rudiment, more noticeable in the males. Toes almost completely webbed, the edge of the web inserted at the base of the disk on the third and the fifth; an inner metatarsal tubercle. Skin smooth above, granular beneath, on the throat minutely so. No dermal appendage on the hell. Habit robust, head broader than long, body rather heavy, slightly narrowed in the postaxillary region. Legs long, the tibiotarsal articulation reaching beyond the tip of the snout when adpressed. Type (female): 61 mm. (Fig. 1.) DIAGNOSIS of TADPOLE (by G. Orton). "A large specialized, mountain-stream tadpole, with wide head an elongated, flattened snout, greatly enlarged lips and high tooth formula. Eyes dorsal. Spiracle sinistral, projecting, situated far back on side. Anus dextral. Tooth formula 8/12 to 9/14 in fully grown larvae. Tail with a prominent, vertical dark band across musculature and fins; a second concentration of dark pigment near tip of tail, may or may not form a similar but narrower band. Maximum known total length: 60mm.; head and body length 25mm. (Figs. 6 e 7). For further details see Lutz & Lutz, 1939 and Lutz B. & Orton G. 1946.

Allergic asthma to thaumatin : case report

Background: Thaumatin is a protein originally isolated from an African fruit (the "katemfe"), but various thaumatin-like proteins have been found in apples, grapes, kiwis and olives, etc. Thaumatin has natural sweetening properties and is about 2000 to 3000 times more potent than sucrose. It is therefore used in the food industry, particularly in the processing of low-calories sweeteners. Recently, thaumatin-like proteins have been described as a new family of allergens. Methods: We report the case of a 44-year-old woman occupationally exposed to thaumatin, who developed an allergy to it. The first symptom was an urticaria, which she presented two years after the factory she was working in (a sweeteners manufacturer), started to use thaumatin. Later on, she perceived an acute episode of a sensation of lump in the throat, persisting mild dyspnea, dysphonia and cough. Despite normal peak flow values and a normal chest examination, her general practitioner treated her with local corticoids and systemic antihistaminic drugs, which improved the symptoms. As occupational physicians, we were asked about the likelihood of an occupational disease. We visited her working place, and assessed the exposure to thaumatin. We concluded that the probability for a delayed asthma related to a thaumatin exposure was high, despite the lack of an exposure test. Results: The case was submitted to the insurance company as an occupational disease, and was accepted as such. It was therefore decided not to perform the exposure test, given the absence of true benefit for the patient, who was advised to switch job, and to avoid any exposure to thaumatin in the future. A few months later, the symptoms had completely disappeared. Conclusion: Some molecules only used in specific industry sectors, can cause health problems, such as allergy, but also toxic impairments, etc. The occupational physician, trained to find out which products and identify which molecules are involved, can contribute to the diagnosis, and help make possible a safe return to work for the patient.

PHA urges parents to get 'at risk' children vaccinated against seasonal flu

The Public Health Agency is urging Northern Ireland parents to make sure children in 'at risk' groups get their flu vaccine early.The message has been issued to parents and carers of children as the PHA's seasonal flu vaccination programme gets underway for 2011/12.It is very important that children with any condition that puts them more at risk of the complications of flu get the vaccine.These 'at risk' conditions include:chronic lung conditions such as asthma;chest infections that have required hospital admission;chronic heart conditions;chronic liver disease;chronic kidney disease;diabetes;lowered immunity due to disease or treatment such as steroids or cancer therapy;chronic neurological conditions such as stroke, multiple sclerosis or a condition that affects the nervous system, such as cerebral palsy;hereditary and degenerative diseases of the central nervous system or muscles.Children who attend special schools for severe learning or physical disabilities are considered to be particularly at risk, as well as those with other complex health needs.The PHA has written to principals of local special schools, as well as parents of children at these schools, to raise awareness of the importance of getting vaccinated early.Dr Richard Smithson, PHA Flu Vaccination Lead, said: "For many people, flu is a short, unpleasant illness, but it does not usually cause any serious problems. However, for others, it can have very serious complications including, in rare cases, being fatal."We have been particularly reminded over the last two winters that children with chronic neurological problems and other complex health needs are very vulnerable to these complications. We have seen children become very seriously ill and, tragically, there have even been a few deaths in children who attend special schools."For this reason, we recommend that all children who attend special schools for severe learning disability, and special schools for physical disability, are offered the flu vaccine early in the autumn, before the flu viruses start circulating."The vaccine is now available from GP surgeries and the PHA recommends that parents check arrangements with their own GP's surgery so that their child can get the jab.The earlier you get vaccinated the better, as it takes the body about 10-14 days after the jab to develop antibodies. These will then protect you against the same or similar viruses if the body is exposed to them. The vaccine contains three strains of the flu virus, which are considered the most likely to be circulating this winter, including the H1N1 (swine flu) virus."Your child needs to get the flu jab every year - the protection it gives only lasts for one winter, so even if they got it last year, they still need to get it this year," added Dr Smithson."Also, if your child has been diagnosed with flu or swine flu in the past couple of years, they will still need the jab this year as there are different types of flu that the jab will protect against. Getting the flu jab is the best way to protect your child against flu and we would strongly recommend that you arrange for them to have it."Although the vaccine gives good protection, no vaccine gives total protection, so if your child develops flu-like symptoms (such as fever, cough, aches and pains, and sore throat) you should contact your GP for advice. If your child has any of these symptoms, they should be kept at home until they feel better."For more information on seasonal flu, go to www.fluawareni.info and follow us on Facebook and Twitter.

Smoking causes mouth cancer, PHA warns

Mouth cancer awareness week begins on the 13 - 20 November. With this in mind the Public Health Agency is urging everyone to be aware of the signs and symptoms of mouth cancer and is encouraging all smokers thinking about stopping smoking to make the decision to stop today.In Northern Ireland 195 people were diagnosed with mouth cancer in 2009. The disease causes one death every five hours in the UK and yet it is one of the least well-known cancers. Smoking and excess alcohol consumption is associated with an increased risk of developing mouth cancer, which can occur in or on any part of the mouth, tongue, lips, neck and throat. In its very early stages, mouth cancer can be easy to ignore. Most people with mouth cancer have no early symptoms at all, but others may have:an ulcer in the mouth or on the lip that won't heal; constant pain or soreness; red or white patches in the mouth;a lump on the lip, tongue or in the neck; bad breath; unexplained bleeding in the mouth; numbness in the mouth; loose teeth.The earlier the disease is caught, the better. Survival rates rise to 90 per cent if the cancer is treated before it has spread. Gerry Bleakney, Head of Health and Social Wellbeing Improvement, PHA, said: "Certain lifestyle choices can increase an individual's risk of developing mouth cancer. Tobacco is considered to be the main cause of mouth cancer, with three in four cases being linked to smoking. Excess alcohol consumption is also a known factor, with those who both smoke and drink excessively being up 30 times more likely to be at risk. "Mouth cancer and the treatment required can be traumatic for the patient as this may affect functions such as speech, chewing and swallowing. The positive news is that stopping smoking is associated with a rapid reduction in the risk of oral cancers. Regular trips to the dentist are also a must because half of all mouth cancer cases are detected by dentists."I would encourage everyone who is thinking about quitting to log on to our Want 2 Stop website www.want2stop.info and order a 'Quit Kit' free of charge. Alternatively contact the Smokers' Helpline on 0808 812 8008. "Health Minister Edwin Poots said: "Smoking is the single greatest cause of preventable illness and premature death in Northern Ireland.It is a major risk factor for oral cancer, as well as coronary heart disease, strokes and other diseases of the circulatory system. Approximately 2,300 people die each year in Northern Ireland from smoking related illnesses. Quitting smoking is the single most effective step people can take to improve their long term health."A key objective of the Department's new ten-year tobacco control strategy, due to be published next month,is to prevent people from starting to smoke. Funding provided by the Department for smoking cessation services has resulted in around 650 such services being made available in Northern Ireland in a range of settings, including pharmacies, GP surgeries and community centres. These services have helped almost 80,000 smokers to set a quit date between 2008/09 and 2010/11."The Minister added: "It is also important for people to look after their oral health by regularly attending the dentist for check-ups, as any problems can be picked up and treated at an early stage."

Patterns of phenotypic variation reveal substantial differentiation in sexual dimorphism of three Psammodromus (Squamata, Lacertidae) species

The Spanish sand racer (Psammodromus hispanicus) has been recently split into three distinct species: P. hispanicus, P. edwardsianus, and P. occidentalis. Some morphological differences have been reported but there is as yet no description allowing unambiguous identification of the three species. Here, we describe differentiation in body measurements, scalation traits, and colour traits as well as in the degree of sexual dimorphism. Our results show that P. edwardsianus can be easily distinguished by the presence of a supralabial scale below the subocular scale, which is absent in the other two species. Psammodromus hispanicus and P. occidentalis can be distinguished by the number of femoral pores, throat scales and ocelli, and the relative width of the anal scale. The degree of sexual size dimorphism and sexual colour dimorphism substantially differs among species, suggesting that different scenarios of sexual and natural selection may exist for each species. Moreover, sexually selected traits (nuptial colouration, ocelli, and femoral pores) significantly differ among species, suggesting that visual and chemical communication may also differ among species. Such differences could prevent reproduction and gene flow at secondary contact zones, potentially reinforcing isolation and speciation within this group of lizards.

Rapid detection of MRSA in screening specimens during a hospital outbreak.

Objectives: To compare the results of rapid PCR screening for MRSA using the GeneXpert system with those of cultures in an outbreak setting. Methods: GeneXpert was used for screening MRSA in nose, throat, groin, and other clinical samples during a 6-month period. Samples were performed using a double-swab transystem. When >1 sample was found positive in a screening set, all second swabs of the set were analysed by culture. Results: From June to October 2009, 7568 rapid tests were performed, among which 432 (5.7%) were positive (nose: 149/2090, 7.1%; throat: 98/2078, 4.7%; groin: 152/2080, 7.3%; urine: 14/1090, 1.3%; wounds: 18/150, 12%; and others:1/27, 3.7%), and 84 (1.1%) were invalid. A total of 1517 samples were analyzed by both rapid PCR and culture. Rapid tests had a sensitivity of 0.896 compared to cultures, a specificity of 0.769, a PPV of 0.763, and a NPV of 0.899. The rapid test was found to be less sensitive in throat samples (0.81) than in nose or inguinal samples (0.93 for both). In 32/192 (16%) patients a positive rapid PCR result was not confirmed by culture, despite several subsequent screening samples in some patients. Cycle threshold (Ct) for SCCmec of these PCR positive reactions were all >30. Conclusions: GeneXpert MRSA was found to be suitable for the rapid detection in nose, inguinal, and throat samples, however with a lower sensitivity in the later. Negative cultures in 16% of our PCR-positive patients raised the question of false positivity or higher sensitivity of GeneXpert. Further work is needed to investigate these cases.