Coagulase-negative staphylococci (CoNS) may be considered contaminants when isolated from clinical specimens but may also be a cause of true infection. This study aimed to compare the clonality and SCCmec type of a collection of CoNS isolated from blood cultures of inpatients, nasal swabs of healthy individuals, and patients with chronic wounds, all from the same community, using SCCmec typing, pulsed-field gel electrophoresis (PFGE), and MLST. Staphylococcus epidermidis, exhibited high clonal diversity, but hospital and community clusters were observed. Nosocomial S. epidermidis clones belonged to sequence types ST2, ST6, and ST23. Some Staphylococcus haemolyticus clones were found to circulate in the hospital and community, while Staphylococcus saprophyticus exhibited very high clonal diversity. Staphylococcus lugdunensis, Staphylococcus warneri, and Staphylococcus capitis revealed several isolates belonging to the same clone in the hospital and community. The detection of different SCCmec types within the same cluster indicated high diversity. S. epidermidis was associated with SCCmec I and III, S. haemolyticus with I and II, S. capitis with type V, Staphylococcus hominis with mec complex type A and ccr1, and S. warneri and S. saprophyticus with SCCmec I. The generation of elements and new combinations of cassette genes were highly associated with CoNS isolates, suggesting that SCCmec may not be a good marker of clonality in these bacteria.

IntroductionThe Japanese Saito coined the term “hikikomori” to define an extreme form of social withdrawal, particularly present in Japan (1998). In the West there is an increasing frequency of adolescents hikikomori.Objectives and AimsThe UFSMIA Arezzo has received a number of requests to take care of adolescents bearing strong similarities to hikikomori teenagers or “on the way of the social withdrawal”. These admissions have led to an epidemiological study in order to quantify these behaviors among very young teenagers in a Italian town.MethodsThe research used a questionnaire addressed to the coordinator teachers of the middle schools of Arezzo (2694 students). The questionnaire collected information on the single student absent from school for more than 40 days asking reasons for the absence.ResultsAbsents from school for more than 40 days not for an illness were 27. The average age was 14,5 years, 59,3% males, 40,7% females. The 66,6% of the students repeated one or more times a year of school. The teachers do not know the reasons for the absences for 29,6% of students but for 51,9% they indicate psychological problems as the main reason of the absences. The 40,7% of students showed difficulty waking up, leaving home, coming to school, difficulty in relating to others and low self-esteem. These signs could bring to identify hikikomori subjects.ConclusionsThe research shows that the school is not able to recognize a student hikikomori, but it can provide valuable informations to identify a teenager with social withdrawal.

Introduction"Hikikomori” is known since the 80s and was described by Saito in 1998 as a different clinical picture from any current diagnostic category, being social withdrawal the most important aspect. Young hikikomoris, more than a million in Japan (Teo2010), withdraw in their room for at least six months, interrupting communication with the outside world. This picture was described by many international scholars (Watts 2002; Zielenzinger 2008; Teo 2010; Piotti et al.2014). Part of international literature, after DSMIV-TR, defined hikikomori as a culture-bound syndrome (Agugliaetal.,2010). However, recently similar cases were described in different contexts, both in Asia and Western world (Kato et al.,2012), highlighting peculiar clinical signs influenced by the context, although maintaining a common matrix referred to Saito framework.AimsThis literature review aims to gather descriptions of hikikomori in different cultures, to identify cross-cultural variables on which the phenomenon is based and to analyse any differences in clinical manifestations.MethodsEighty-two articles which contained ‘hikikomori” in the title or abstract were reviewed and searched using online databases (PsycINFO, PubMed, googleschoolar)ResultsThe scientific literature was divided by year of publication and by three phases:1. The articles are mostly Japanese2. Western articles, referring to Japanese contexts3. The Hikikomoriconcept isclosely related tosocial withdrawal (sources from many countries).ConclusionThe literature shows a tendency to consider hikikomori a phenomenon which exceeds cultural context (although influenced by it), rather than a culturally characterized syndrome.

RESUMO Objetivo: descrever a assistência pré-natal e perfil das gestantes confirmadas para zika vírus na atenção primária à saúde de Palmas, Tocantins no ano de 2016. Métodos: Trata-se de um estudo descritivo, com dados obtidos do SINAN, SISPRENATAL e SINASC. Foram confirmadas 63 gestantes com a infecção por Zika vírus por exame laboratorial. Resultados: A média de idade das gestantes foi de 26 anos. Os casos confirmados foram notificados predominantemente nas unidades de pronto atendimento (41,27%) e no hospital materno de referência (47,62%). Houve predomínio de gestantes pardas (61,90%), sem ensino médio completo (73,02%), em união estável (47,62%) e jovens (58,73%), que foram atendidas em quase totalidade nos serviços públicos de atenção secundária e terciária. Conclusão: Os resultados deste estudo mostraram a necessidade de melhoria para a assistência pré-natal às gestantes positivas na atenção primária e trouxe evidências do caráter da vulnerabilidade social da infecção pelo Zika vírus na capital do Tocantins.   Palavras-chave: Cuidado Pré-Natal; Epidemiologia; Zika vírus; Atenção Primária à Saúde. ABSTRACT Objective: describe the prenatal care and profile of confirmed pregnant women for zika virus in the primary health care of Palmas city, Tocantins, in the year 2016. Methods: This is a descriptive study, with data obtained from SINAN, SISPRENATAL and SINASC. Sixty-three pregnant women with Zika virus infection were confirmed by laboratory examination. Results: The mean age of pregnant women was 26 years. The confirmed cases were predominantly reported in the emergency care units (41.27%) and in the maternal reference hospital (47.62%). There was a predominance of brown pregnant women (61.90%), without complete secondary education (73.02%), in a stable union (47.62%) and young women (58.73%), who were attended almost entirely in public services of secondary and tertiary care. Conclusion: The results of this study showed the need for improvement for prenatal care to positive pregnant women in primary care and brought evidence of the social vulnerability of the Zika virus infection in the capital of Tocantins. Keywords: Prenatal care; Epidemiology; Zika virus; Primary Health Care.

As projeções por demanda hospitalar do Covid 19 em relação às medidas de distanciamento social no estado do Tocantins foram realizadas por meio da modelagem SEIR. O estado ficará sem UTIs COVID-19 em 09/05/2020. No auge da demanda, serão necessárias 549 novas UTIs. Esta demanda corresponde a 62,01 vezes o número de leitos de UTI dedicados ao COVID-19 e 3,85 vezes o número total de UTIs instaladas na região. Este cenário prevê que 0,15% da população geral morreria num surto de COVID-19. Este número corresponde a 1,43% de todos que ficaram doentes. O modelo também indica que 76,28% da população será infectada pelo vírus, mas apenas 14% destes desenvolverão sintomas visíveis.