Browsing by Author "Corte-Real, R"
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- Distinguishing Kingella kingae from Pyogenic Acute Septic Arthritis in Young Portuguese ChildrenPublication . Gouveia, C; Subtil, A; Norte, S; Arcangelo, J; Santos, MA; Corte-Real, R; Simões, MJ; Canhão, H; Tavares, DBackground: We aim to identify clinical and laboratorial parameters to distinguish Kingella kingae from pyogenic septic arthritis (SA). (2) Methods: A longitudinal, observational, single-centre study of children < 5 years old with microbiological positive SA admitted to a paediatric hospital from 2013-2020 was performed. Clinical and laboratorial data at admission and at 48 h, as well as on treatment and evolution, were obtained. (3) Results: We found a total of 75 children, 44 with K. kingae and 31 with pyogenic infections (mostly MSSA, S. pneumoniae and S. pyogenes). K. kingae affected younger children with low or absent fever, low inflammatory markers and a favourable prognosis. In the univariate analyses, fever, septic look, CRP and ESR at admission and CRP at 48 h were significantly lower in K. kingae SA. In the multivariate analyses, age > 6 months ≤ 2 years, apyrexy and CRP ≤ 100 mg/L were significative, with an overall predictive positive value of 86.5%, and 88.4% for K. kingae. For this model, ROC curves were capable of differentiating (AUC 0.861, 95% CI 0.767-0.955) K. kingae SA from typical pathogens. (4) Conclusions: Age > 6 months ≤ 2 years, apyrexy and PCR ≤ 100 mg/L were the main predictive factors to distinguish K. kingae from pyogenic SA < 5 years. These data need to be validated in a larger study.
- Implementing an Influenza Vaccine Effectiveness Study in a Hospital Context in Portugal: The EVA Hospital ProjectPublication . Machado, A; Gomez, V; Panarra, A; Poças, J; Corte-Real, R; Peres, MJ; Nunes, BIntroduction: The project ‘Integrated Monitoring of Vaccines in Europe’ aimed to measure seasonal influenza vaccine effectiveness against hospitalised adults, aged 65 years and over, with influenza. We describe the protocol implementation in Portugal. Material and Methods: We implemented a test-negative design, targeting community-dwelling patients aged 65 years old and over hospitalised with severe acute respiratory illness. Patients were reverse transverse-polymerase chain reaction tested for influenza. Cases were those positive for influenza while others were controls. Most variables were collected using hospital medical records. Selection bias was evaluated by comparison with the laboratory influenza test requests database according to demographic characteristics. Crude, season-adjusted influenza vaccine effectiveness was estimated as = 1 – odds ratio, and 95% confidence intervals were obtained by conditional logistical regression, matched with the disease onset month. Results: The recruitment rate was 37.8%. Most participants (n = 368) were female (55.8%) and aged 80 years old and over (55.8%). This was similar to values for potentially eligible severe acute respiratory illness patients (80 years old and over: 56.8%, female: 56.2%). The proportion of missing values was below 2.5% for 20 variables and above 5% (maximum 11.6%) for six variables. Influenza vaccine effectiveness estimates were 62.1% against AH1pdm09 (95% confidence intervals: -28.1 to 88.8), 14.9% against A(H3N2) (95% confidence intervals: -69.6 to 57.3), 43.6% against B/Yam (95% confidence intervals: -66.2 to 80.8). Discussion: Given the non-existence of a coded admission database in either participating hospital the selection of severe acute respiratory illness due to clinical features was the feasible one. These results are only valid for the older adult population residing in the catchment area of the two participating hospitals who were admitted to a public hospital with severe influenza or SARI symptoms. Conclusion: Despite the low participation rate, we observed comparable characteristics of participants and eligible severe acute respiratory illness patients. Data quality was high, and influenza vaccine effectiveness results were in accordance with the results of meta-analyses and European season-specific estimates. The final sample size was low, which inhibited obtaining estimates with good precision.
- Legionella: Novas Abordagens, Novas NecessidadesPublication . Costa Santiago, R; Ramos, S; Corte-Real, R; Manzano, MJ; Infante, JINTRODUÇÃO: O CHLC desenvolve, desde há vários anos, procedimentos contra o crescimento e proliferação da Legionella, monitorizando e auditando as estruturas e as práticas. De acordo com as recentes orientações e normas emanadas pela DGS, surge a necessidade de criar novos instrumentos para a avaliação do risco e dar resposta às necessidades do Centro Hospitalar. OBJETIVO Identificar os fatores de risco que determinam os pontos críticos para a monitorização da Legionella. MATERIAIS E MÉTODOS: Foram construídas listas e grelhas de observação, com os fatores de risco que determinam os pontos críticos, a partir das quais se observaram as estruturas e práticas do CHLC. Os instrumentos utilizados tiveram como base os documentos publicados pela DGS, IPQ, ECDC, o procedimento multissectorial do CHLC - AMB.102 e os relatórios das auditorias. RESULTADOS: Para a avaliação das condições microbiológicas, os pontos críticos deverão ser aqueles, mais suscetíveis da ocorrência da proliferação da Legionella. Destes, a literatura salienta: Pontos distais das redes prediais Zonas de estagnação de água Idade e complexidade das redes e sistemas Sistemas e equipamentos geradores de aerossóis Após a análise dos pontos críticos foram determinados os fatores de risco que estão associados, nomeadamente: Presença de nutrientes e de biofilmes Zonas suscetíveis a fenómenos de corrosão e incrustação Origem do abastecimento de água Zonas de estagnação de água da rede predial e da água dos sistemas e equipamentos geradores de aerossóis Ausência de biocida na rede predial Tipos de materiais utilizados nas redes de canalização CONCLUSÕES A avaliação do risco permitiu reorganizar os pontos críticos definidos anteriormente e atualizar o conhecimento das condições favoráveis ao crescimento da Legionella na nossa instituição, promovendo a melhoria e atualização do programa do CHLC. Assim, torna-se evidente de que a existência de um cadastro completo e atualizado das infraestruturas, redes, sistemas e equipamentos, incluindo peças desenhadas e memórias descritivas das redes de água fria e quente, das redes dos circuitos de água de aquecimento e arrefecimento e uso terapêutico, é essencial para que a avaliação do risco seja mais proficiente.
- Saliva Molecular Testing Bypassing RNA Extraction is Suitable for Monitoring and Diagnosing SARS-CoV-2 Infection in ChildrenPublication . Alenquer, M; Milheiro Silva, T; Akpogheneta, O; Ferreira, F; Vale-Costa, S; Medina-Lopes, M; Batista, F; Garcia, AM; Barreto, VM; Paulino, C; Costa, J; Sobral, J; Diniz-da-Costa, M; Ladeiro, S; Corte-Real, R; Delgado Alves, J; Leite, RB; Demengeot, J; Brito, MJ; Amorim, MJBackground: Adults are being vaccinated against SARS-CoV-2 worldwide, but the longitudinal protection of these vaccines is uncertain, given the ongoing appearance of SARS-CoV-2 variants. Children remain largely unvaccinated and are susceptible to infection, with studies reporting that they actively transmit the virus even when asymptomatic, thus affecting the community. Methods: We investigated if saliva is an effective sample for detecting SARS-CoV-2 RNA and antibodies in children, and associated viral RNA levels to infectivity. For that, we used a saliva-based SARS-CoV-2 RT-qPCR test, preceded or not by RNA extraction, in 85 children aged 10 years and under, admitted to the hospital regardless of COVID-19 symptomatology. Amongst these, 29 (63.0%) presented at least one COVID-19 symptom, 46 (54.1%) were positive for SARS-CoV-2 infection, 28 (32.9%) were under the age of 1, and the mean (SD) age was 3.8 (3.4) years. Saliva samples were collected up to 48 h after a nasopharyngeal swab-RT-qPCR test. Results: In children aged 10 years and under, the sensitivity, specificity, and accuracy of saliva-RT-qPCR tests compared to NP swab-RT-qPCR were, respectively, 84.8% (71.8%-92.4%), 100% (91.0%-100%), and 91.8% (84.0%-96.6%) with RNA extraction, and 81.8% (68.0%-90.5%), 100% (91.0%-100%), and 90.4% (82.1%-95.0%) without RNA extraction. Rescue of infectious particles from saliva was limited to CT values below 26. In addition, we found significant IgM positive responses to SARS-CoV-2 in children positive for SARS-CoV-2 by NP swab and negative by saliva compared to other groups, indicating late infection onset (>7-10 days). Conclusions: Saliva is a suitable sample type for diagnosing children aged 10 years and under, including infants aged <1 year, even bypassing RNA extraction methods. Importantly, the detected viral RNA levels were significantly above the infectivity threshold in several samples. Further investigation is required to correlate SARS-CoV-2 RNA levels to viral transmission.