Ruolo ed organizzazione della microbiologia clinica di domani

Abstract

INTRODUZIONELe innovazioni tecnologiche, il profilarsi sempre più evidente di quella che diverrà un'emergenza infettiva per le nostre popolazioni, la globalizzazione e l'impatto importante dell'antropizzazione sulla biosfera, stanno cambiando profondamente lo scenario in cui si trovano a lavorare i microbiologi e comportando modifiche tali da porre seriamente il problema di prepararsi ed attrezzar- Another critical point is represented by the possible insurgence of infections due to agents used in bioterrorism.More than ever it is indispensable for our country to define a network of structures able to give an organized response to these relevant problems both in terms of prevention and assistance. It is therefore important to define a protocol for clinical microbiology on a national basis that responds to different levels of activity. Keeping in mind that the fundamental objectives of microbiology are: -diagnosis of infective diseases -determination of resistance to antimicrobic drugs as a valid instrument to allow the clinician to proceed with specific treatment -control of infection spreading in the sanitary structures (hospital infections) -to develop front line defence in new infections and bioterrorism, in collaboration with the department of prevention -to be a reference centre for specific trainingThe principals on which one must base the reorganization are essentially three: 1. to configurate the microbiology service on the basis of real needs of the local population 2. to give qualitatively optimal results in real time 3. supporting "good clinical practice" to assure adequate patient results and acceptable costs for the regionale sanitary system (SSR) The organization of microbiology should therefore foresee a microbiology department, structured on a provincial basis or a vast area including a structured centralized complex with peripheral structures (even simplified). This must integrate actively with the department of prevention in regard to the dynamics of infectious diseases in the territory and with the Division of Infectious Diseases (where this exists). In parallel an active interaction with research structures (IRCCS and University) present in the territory to enable the coordinated implementation of the guidelines of research and its relapse on diagnostic exams. Keeping in mind that the quality of diagnostic performance is closely linked to the professional experience of the operators it is good practice centralizing some diagnostic procedures by identifying a reference centre. In a regional network organized in this way it is important to include a coordinating structure, since it is necessary to activate a complete level of communication, information exchange, activity planning, and complete problem solving.

Promoção Da Saúde Do Binômio Mãe E Feto Para Prevenção Do Tétano Neonatal

“…O TNN é uma patologia causada pela contaminação de uma neurotoxina que leva a hiperexcitabilidade do sistema nervoso central, resultando em contrações e espasmos musculares que podem atingir os neonatos e adultos. Causado por um bacilo gram positivo, esporulado e anaeróbico, Clostridium tetani (Murray, 2006).…”

Environmental and Social Determinants Related to Candidiasis

“…In superficial mycoses, fungi colonize the outermost keratinized layers of the skin, hair, and nails [35]. They are associated with changes in the hydration and pH of the skin, mouth, throat, and other superficial tissues [7].…”

“…Virulence factors include: (a) the expression of surface molecules to achieve attachment of the microorganism to host cells using adhesion proteins; (b) the formation of biofilms is clinically important as their spatial arrangement facilitates the penetration of nutrients, and excretion of waste products [44], they are more resistant to antifungal drugs and provide protection from host's immune defenses [45,46]; therefore, Candida spp. can colonize long-term medical devices, such as intravascular catheters, and the cells can separate and lead to widespread infection [38,47]; (c) secretion of hydrolytic enzymes that promote penetration and destruction of surrounding tissue, thereby releasing nutrients from host cells [48] and toxins such as candidalysin, a cytolytic peptide toxin that is essential for systemic and mucosal infections and enables epithelial damage [49]; (d) the ability to change its morphology (dimorphism), characterized by the morphological transition from blastoconidia to hyphae, and the form of transition between these are pseudohyphae [35]; (e) tigmotropism, a mechanism that allows invasion of invaginations [48]; (f) its metabolic adaptability due to a phenotypic change and response to stress mediated by heat shock proteins (HSP) [38,50].…”

O uso profilático de Palivizumabe em pacientes prematuros com Síndrome de Down na infecção pelo vírus sincicial respiratório reduz a taxa de hospitalização? Uma revisão integrativa

“…A taxa anual global de hospitalização por VSR entre crianças com menos de 5 anos foi de 4,4 por 1.000, e de prematuros de 63,9 por 1.000 casos/ano (Stein et al, 2017). Este fenômeno, decorrente da ação do vírus sincicial respiratório (VSR), desencadeia um processo patológico que inclui necrose das células bronquiolares, ruptura ciliar e infiltração linfocítica peribronquiolar, culminando em obstrução das pequenas vias aéreas e atelectasia (Murray et al, 2014;Piedra & Stark, 2022b;Trabulsi & Alberthum, 2008).…”