Jornal de Agentes Antimicrobianos

The COVID-19 global pandemic represents a big challenge for dental practice allover the world. New fears are faced in an already feared profession. The primary moral response is to save lives, subsequently all routine dental care has been suspended and the dental schools has suspended all clinical requirements for dental students. Dental care is only provided for emergency and urgent cases. However, there is a need to re-open the dental practice and to provide necessary services while minimizing risk to patients and dental healthcare personnel. In this talk the following issues will be highlighted

Case Presentation: A 35-year-old woman was admitted with a headache and two episodes of seizures on background of HIV and previous cerebral toxoplasmosis. Collateral history from her husband revealed that she had stopped taking anti-retroviral medications a year ago.On examination her Glasgow Coma Scale was 15/15 but she appeared lethargic and in distress Systemic examination showed left upper limb weakness. There were no other neurological signs.
Investigations: Urgent CT Head showed a vasogenic area in right frontal lobe with mass effect. This lesion was not present when compared to a CT from 10 years ago. Blood tests showed normal inflammatory markers and electrolytes. CD3, CD4 and CD8 counts were 242, 4 and 45 respectively. The cryptococcal antigen test and Cytomegalovirus DNA test were negative. HIV-1 RNA was 66200 copies/ml and HIV-1 viral load detected. Toxoplasma screen was positive.
Further Imaging: MRI head showed 9 ring enhancing lesions in both cerebral hemispheres with significant perilesional edema resulting in 8mm midline shift.
To rule out the possibility of malignancy, CT CAP with contrast was performed which was normal
Management: She was commenced on Pyrimethamine, Clindamycin, Folinic acid, Dexamethasone and Levetiracetam. Her symptoms improved drastically. Neurosurgeons advised that she was not fit for neurosurgery due to spreading nature of lesions in the brain. She was also reviewed by Sexual health and HIV consultant who arranged outpatient follow-up. She was discharged on Co-trimoxazole prophylaxis.
Follow-up: A follow-up MRI head with and without contrast was arranged which showed marked improvement of the extensive neuroinfection diagnosed previously

Case Presentation: A 27 years old patient admitted from ambulatory care due to worsening pain of the left hip since 4 days on the background of intravenous drug abuse.
Examination: Examination revealed restricted movements of the left hip due to pain. However, there was no swelling or overlying skin changes.
Investigations: Laboratory investigations revealed significantly elevated inflammatory markers. The left hip joint radiography revealed decreased joint space. Ultrasonography of the left hip showed a slightly hetergenous anechoic collection in left hip. MRI showed synovial thickening and joint effusion.
Management: An urgent orthopedics opinion was sought who advised open irrigation and joint wash out.
Treatment: An urgent hip joint open irrigation and wash out was done and samples of joint effusion was sent for further investigations. Following procedure, the patient was put on empirical intravenous antibiotic. The synovial fluid analysis revealed significantly elevated white cell count and the culture results showed a mixed growth of staphylococcus aureus and Pseudomonas aeruginosa. The treatment was modified according to the sensitivity results the culture.
Outcome: Following joint wash out, the patient symptoms improved significantly.
Follow-up: A follow-up appointment was arranged at orthopedic clinic.

About all those diseases that attack human’s rabies is an example of the best known. Its exclusive notoriety is unusual when assessed on its influence medially; on the human society. The present study was carried in Srinagar district. Diverse sampling plan / data collection strategy were formulated to fulfill the set of objectives. Epidemiological pattern and occurrence of dog bites was collected from the secondary information. As all such cases are shouldered by the most reputed and super specialist hospital in the Valley i.e. Shri Maharaja Hari Singh hospital, the information recorded for such cases were collected from this institute. Regarding perception of people interview schedule was formulated. As per Srinagar Municipal Corporation (SMC), the city is divided into two divisions; four zones and 34 wards. To exploit the diversity of population response, all the four zones were considered for the present investigation. Further the major factors associated with increased dog population two sources i.e. primary and secondary sources had been utilized for identifying the likely factors responsible for increased dog population. These factors primarily incorporated garbage management, specific control measures for dog population by stakeholders and perception of people. Secondary source includes Srinagar Municipal Corporation, for collecting the relevant information.The Majority, (74.27%) victims were males. Most (26.68%) of them belonged to 30-40 year old group. The majority, (76.11%) of the cases were reported in the same day. Utmost cases were bitten at evening (62.90%) and had also reported (50.83%) at the same time. The majority, (56.60%) had bites on legs.Majority males (78.94%) had bites on face and females (30.93%) had bites on hands, arms and shoulders. Majority (70.16%) had category 3 bites. West zone had recorded (28.95%) the highest number of cases. The summer season had also recorded (29.30%) the highest number of cases. Regarding knowledge of non victimized people it was seen they were aware, but they lacked a complete perception of rabies. The greater parts of respondents had heard of rabies and were awake of its spread through dog bites; however they lacked the information about the other animals transmitting rabies. This faction has enhanced communication and information regarding what is happening in their dwelling, counting dog bites as well. Bite was being mentioned by most of the respondents as a means of transmission but only some of the respondents mentioned scratches and licking as the method of transmission. This could be due to lack of complete acuity of the disease rabies. In our community rabies is well-known as mad dog (halkaer houn) which is allied through aggression. Aggression was thus known by most of the respondents which is in stroke amid the verity that furious form of rabies is widespread in animals. Regarding about the treatment, the majority were aware that the SMHS hospital provides vaccines and the respondents didn’t choose any traditional methods. Some respondents knew about the need of prompt washing of the wound by water and soap. Victims would seek medical attention, potentially due to fear of rabies. The good level of knowledge amongst the non-victims may be due to numerous reports of dog’s bites in Srinagar plus they were more educated. In case of victimized people less had learned of rabies and its transmission showing that rabies information and education is necessary for Srinagar. The maximum menace of rabies is probable to fall on mainly the susceptible sectors of society, particularly poor members with slight or no proper education. Furthermore the attitude of the non victimized and victimized people was positive. Regarding about the major factors associated with increased dog population the respondents, both (Common people and commercial establishment) believed that open garbage dumps are a public health barrier in the area and they commence to stray dog proliferation. Even if the SMC is working meticulously in the field to guarantee incorporated and scientific solid waste management, yet the method needs proper segregation of waste. Till date around 2,000 sterilizations were conducted and also around 2,000 stray dogs were administered the anti-rabies vaccine however this is too less in comparison with the total population of dogs and still the ballot of dogs from the particular zones of Srinagar is deficient.. In termination, the decisions of this study showed that dog bites remain a very important problem in Srinagar area and elimination of stray dogs, as well as educational programs, should be well organized.

INTRODUCTION: The menace and spread of COVID-19 from person to person in communities and around the world has brought to fore, the urgent need for an effective public health surveillance system, especially in resource-limited areas. Advance detection and treatment of diseases represents one major strategy to prevent transmission of diseases. Although, public health surveillance systems have improved the administration and management of diseases, there are still challenges such as adoption of new technologies, standardized cases and validly diagnosed cases and validity. However, the current public health surveillance system is often inconsistent and of poor quality.
AIMS AND OBJECTIVE: Our overall goal in this research study is to develop a robust interactive public health surveillance system using mobile phones and the internet for real-time collection and transmission of adverse events related with administration, surveillance and management of COVID-19 pandemic in the world, especially in rural areas. This public health surveillance system will be useful in the day-to-day monitoring and presumptive management of COVID-19 in rural areas.
METHOD: The System Design: This system is an interactive voice response application for mobile phones in English and French, which is based on a server system from Telecommunications Company. There are five elements that made up this system architecture: (i). Central database and Web server. (ii). Remote access to the database from any Internet-connected computer. (iii). Telephone audio computer-assisted personal interview. (iv.) Voice messages and (v). Short message service (SMS)-based communications to and from the server via cell phones.
RESULT: This system addresses three important ingredients for an effective surveillance system: A) Real-time data collection from health workers reporting an adverse event, or from a doctor reporting a COVID-19 outbreak; B) data is rapidly analysed, prompt decisions and rapid allocation of resources are made; C) prompt communications back to the field for coordinated response.
CONCLUSION: This research showed promise and elucidated that mobile phones can be employed as a surveillance system, and that it is not absolutely necessary to have the latest costly equipment like laptop and personal computer (PC) to create a sophisticated public health surveillance system. The study concluded that with the collaboration of the right technology partner, a surveillance system can be built using mobile phones.

Malaria is a serious and sometimes fatal disease caused by a parasite that commonly infects a certain type of mosquito which feeds on human blood. People who get malaria are typically very sick with high fevers, shaking chills, and flu-like illness. Although malaria can be a deadly disease, illness and death from malaria can usually be prevented through early diagnosis and treatment. Although manual counting is relatively inexpensive to implement, it is tedious and time-consuming. Its adequate sensitivity requires proper training and supervision of technicians. Hence, a blood smear parasite detection system using image processing is used to classify the presence of the malaria parasite in a micrograph of a blood smear image. In this study, we improved parasite mask processing and circle detection by using two different candidate masks, one more selective than the other, to detect the sharp points in an outline formed when two circles overlap. MATLAB has been used in every procedure. The three main steps – pre-processing, individual candidate parasite detection, and cell detection - were taken using image processing techniques such as edge and corner detection, thresholding and segmentation. We aim to obtain more accurate and robust results by implementing this project in the screening of malaria infections in microscope images of thin blood film smears