Influenza vaccination in older adults and patients with chronic disorders: A position paper from the Portuguese Society of Pulmonology, the Portuguese Society of Diabetology, the Portuguese Society of Cardiology, the Portuguese Society of Geriatrics and Gerontology, the Study Group of Geriatrics of the Portuguese Society of Internal Medicine, and the Portuguese Society of Infectious Diseases and Clinical Microbiology

Influenza affects millions of people worldwide each year and can lead to severe complications, hospitalizations, and even death, especially among vulnerable populations such as older adults and those with chronic medical conditions. Annual vaccination is considered the most effective measure for preventing influenza and its complications. Despite the widespread availability of influenza vaccines, however, vaccination coverage rates remain suboptimal in several countries. Based on the latest scientific evidence and expert opinions on influenza vaccination in older people and patients with chronic disease, the Portuguese Society of Pulmonology (SPP), the Portuguese Society of Diabetology (SPD), the Portuguese Society of Cardiology (SPC), the Portuguese Society of Geriatrics and Gerontology (SPGG), the Study Group of Geriatrics of the Portuguese Society of Internal Medicine (NEGERMI-SPMI), and the Portuguese Society of Infectious Diseases and Clinical Microbiology (SPDIMC) discussed best practices for promoting vaccination uptake and coverage and drew up several recommendations to mitigate the impact of influenza. These recommendations focus on the efficacy and safety of available vaccines; the impact of influenza vaccination on older adults; patients with chronic medical conditions, namely cardiac and respiratory conditions, diabetes, and immunosuppressive diseases; and health care professionals, optimal vaccination timing, and strategies to increase vaccination uptake and coverage. The resulting position paper highlights the critical role that vaccinations play in promoting public health, raising awareness, and encouraging more people to get vaccinated.

[Grey platelet disease]

Grey Platelet disease is a rare disease characterized by morphologic changes in platelets alpha-granules. These proteins are essential for the homeostasis, so the patients with this blood defect present hemorrhagic disturbs. The blood discrasia is usually mild, however some patients could present more serious manifestations, usually after a severe trauma. The authors present the following clinical report about a patient that was admitted in a Medical Department with a severe bleeding and mild thrombocytopenia. The patient was submitted to an extensive study to determine the etiology (autoimmunity serology, myelogram, coagulation study) that were all normal. The diagnosis of Idiopathic Thrombocytopenic Purpura was considered. Six months after a worsening of the hemorrhagic discrasia and thrombocytopenia the patient was assisted. Corticotherapy was initiated without improvement. The morphology of the platelets was revised and the blood smear with Wright coloration revealed the presence of large, pale and grey platelets. The electronic microscopy confirmed the diagnosis of Grey Platelet disease. The family of the patient was studied and we found that two direct relatives were affected with the same disease. In these family these syndrome probably has autossomic dominant inherence.

Delayed-type hypersensitivity to amide local anesthetics

We present a 54-year-old woman who suffered eczematous eruptions on her face after the administration of lidocaine and mepivacaine for dental surgeries. Patch tests showed delayed-type-hypersensitivity to the amide local anesthetics lidocaine and mepivacaine with cross reaction to other amynoacylderivatives (prilocaine,bupivacaine) but not articaine.

Liver abscess caused by Ascaris lumbricoides: case report

A case is reported of a woman who lived in a rural area with a chronic illness that consisted of weight loss and abdominal pain in the epigastrium and upper right quadrant. The initial diagnosis was a mass in the liver, which was later, demonstrated, both by direct and histological examination, to be an abscess caused by Ascaris lumbricoides. Eggs of Ascaris lumbricoides and abundant Charcot-Leyden Crystals were found.

Expression of cytokine genes in Aotus monkeys immunized with synthetic and recombinant Plasmodium vivax and P. falciparum antigens

Cytokine responses in human host-protective immunity to malaria have yet to be completely elucidated. No data appear to exist on the cytokine patterns in non-human primate models immunized with malarial antigens. Expression of mRNA transcripts of 10 cytokines, the adhesion molecule ICAM-1 and inducible nitric oxide synthase (iNOS) in peripheral-blood mononuclear cells (PBMC) from nine Aotus monkeys was analysed by reverse-transcriptase PCR. Five of the monkeys had been immunized with multiple-antigen peptides (MAP) of the Plasmodium vivax circumsporozoite protein and two with constructs of the P. falciparum merozoite surface protein-1 (MSP-1). The other two monkeys served as non-immunized controls. PBMC were cultured for 24 h after stimulation with phytohaemagglutinin mitogen, MAP and MSP-1 antigens. Elevated expression of interleukin-6 (IL-6), IL-10, IL-12, tumour necrosis factor-alpha (TNF-alpha), TNF-beta and iNOS was seen in response to the MAP. Monkeys immunized with either P. falciparum MSP r190L or synthetic 190L peptides expressed predominantly the type-1 cytokines (IL-1 beta, IL-12, interferon-gamma, TNF-alpha, TNF-beta) characteristic of splenic, cell-mediated activity with macrophage activation and nitric oxide production.

Current status of onchocerciasis in Colombia

To assess the current epidemiologic status of onchocerciasis in Colombia two surveys were undertaken in 1995 in a suspected new focus on the border between Colombia and Ecuador and in the known focus located on the Micay River. No new focus was found along the Colombia-Ecuador border. In the known focus, communities along the upper Micay River and its tributaries were surveyed; 655 adults underwent physical examinations and skin biopsies. Infected individuals were found almost exclusively in the community of Naiciona, where prevalence of infection was 40% (36 of 91). Polymerase chain reaction detection of onchocercal DNA in skin snips correlated with the skin-snip biopsy results. The prevalence of punctate keratitis, the only ocular manifestation found, was 33%. A rapid entomologic assessment demonstrated Simulium exiguum infected with Onchocerca volvulus. This is the first finding in Colombia of naturally infected black flies and confirms S. exiguum as a vector species. These data will be used for implementing a control program using periodic ivermectin distribution.

Stevens-Johnson syndrome from tetrazepam

We present a case of a patient showing a cutaneous and systemic affectation compatible with the Stevens-Johnson syndrome due to the intake of tetrazepam as a muscular relaxant. The symptoms remitted after the suspension of the involved medicines and after treatment with systemic corticoids. Months later, a study with patch tests, with the standard battery and the medicines that she took (indapamide, tetrazepam, acetyl salicylic acid, botriozolam and levomepromazine) was carried out. She presented positivity to tetrazepam at 48 and 96 hours. The oral provocations with the other medicines, which she consumed, were negative. The study of cross reactivity with other benzodiazepines was negative. In the medical literature, different cutaneous affectations regarding benzodiazepine use (generalised drug eruptions, contact dermatitis, erythema multiforme, ...) have been described byt non Stevens-Johnson syndrome. The patch tests are useful in the diagnosis of this type of cutaneous reactions, avoiding in this way the achievement of oral provocations, with the potential risk for the patient that they imply. The absence of cross-reactions with other substances of the same group has to be pointed out, even with those with which keeps great structural similarity as the diazepam. In spite of the absence of cross reactions with the rest of benzodiazepines, faced with the seriousness of the case presented, it is advised to the patient to avoid this type of medicines.

[Complete atrioventricular block and rupture of the interventricular septum in a child following closed thoracic traumatism. The usefulness of Doppler color echocardiography]

We report a case of a 6-year-old child with a third-degree atrioventricular heart block, ventricular septal rupture, tricuspid regurgitation and pericardial effusion after closed chest trauma. The role of the two dimensional echocardiography and color Doppler flow study in the early and reliable detection of cardiac lesions due to blunt chest traumas pointed out.

Standardization and evaluation of ELISA for the serodiagnosis of amoebic liver abscess

An ELISA test for the serological diagnosis of amoebic liver abscess (ALA) was standardized and evaluated in sera from three groups of patients: (1) three patients with diagnosis confirmed by isolation of the parasite, (2) thirty seven patients with diagnosis established by clinical findings and ultrasound studies and (3) seven patients whose diagnosis were established by clinical findings and a positive double immunodifusion test. Ninety one serum samples from healthy subjects and 22 from patients with other liver or parasitic diseases were also included in the study. The optimum concentration of Entamoeba histolytica antigen was 1.25 micrograms/ml and optimum dilutions of serum and anti-human IgG -alkaline phosphatase conjugate were 1:400 and 1:4000 respectively. The cut-off point of the ELISA test in this study was an absorbance value of 0.34. The test parameters were: sensitivity = 95.7%, specificity = 100%, positive predictive value = 100% and negative predictive value = 98.2%. The ELISA test was found to be of great use as a diagnostic tool for the establishment of amoebic etiology in patients with clinical supposition of ALA. The test could also be used for seroepidemiological surveys of the prevalence of invasive amoebiasis in a given population, since it allows the processing of a greater number of samples at a lower cost than other serological tests.

Distribution and etiology of leishmaniasis in Colombia

A total of 340 Leishmania strains, isolated from humans, animals, and sand flies from various regions of Colombia, were examined by isozyme electrophoresis. Seven different Leishmania species were identified. Leishmania panamensis and L. braziliensis were the most common, representing 53.8% and 30.3% of the total, respectively. Isolation rates of the other species were as follows: L. chagasi, 9.4%; L. guyanensis, 2.6%; L. amazonensis, 1.8%; L. mexicana, 0.8%; and a new species requiring additional study, 1.2%. Statistical analyses of representative L. panamensis and L. braziliensis isolates indicated that the populations of these 2 species are genetically very similar. L. panamensis may have a continuous distribution in Colombia west of the eastern Andes Mountains and L. braziliensis may have a continuous distribution east of the western Andes Mountains. Information is given on disease manifestations of the parasites in human hosts and on isolation records from sand flies and animals.