The anticorruption compliance programs and the Brazilian regulatory reality today

2021 ◽  
Author(s):  
IURY GABRIEL AMAZONAS TUSSOLINI ◽  
GABRIELLE RODRIGUES TUSSOLINI ◽  
GABRIELLA FONSECA DE JESUS MESQUITA ◽  
DAYENE BUENO CRUVINEL DE LIMA ◽  
HIAGO BRUNO CARDOSO COSTA FONSECA ◽  
...  
Keyword(s):  
Causative Agent ◽  
Clinical Laboratory ◽  
Final Diagnosis ◽  
Reference Laboratory ◽  
Eosinophilic Meningitis ◽  
Central Laboratory ◽  
Serological Tests ◽  
Neck Stiffness ◽  
Csf Analysis ◽  
Compliance Programs

March 2021, a 12-month-old infant was brought to the HPS East Zone Little Jonh, in the capital of the State of Amazonas, Brazil, where she was admitted with fever, vomiting, intense prostration, little acceptance of breast milk, difficulty in walking, associated with left-facing strabismus and neck stiffness. At admission, the main author performed a lumbar puncture, and serological tests on the CSF to identify the causative agent were referred to a reference laboratory, which suggested that they be referred to the Central Laboratory - LACEN for suspecting the presence of agent Angionsytrongylis Canyonensis. Although, the identification of the causative agent is difficult to be detected and confirmed, this case report shows us the importance of the clinical laboratory in the identification of Eosinophilic Meningitis. The sub-detection of eosinophils in the CSF helps to underestimate the prevalence of eosinophilic meningitis. Thus, CSF analysis, slide preparation, sediment staining, as well as knowledge about the importance of adequate leukocyte differentiation in CSF are extremely important, to properly conduct the final diagnosis of the disease and prevent possible endemicity. The knowledge of this condition and early detection allows an effective therapy and improvement of public health actions. ? ?,

A RARE CASE OF EOSINOPHYLIC MENINGITIS BY PROBABLE ANGIOSTRONGYLUS CANTONENSIS, IN AN INFANT IN THE CITY OF MANAUS, IN THE AMAZON REGION OF BRAZIL

2021 ◽  
Author(s):  
IURY GABRIEL AMAZONAS TUSSOLINI ◽  
GABRIELLE RODRIGUES TUSSOLINI ◽  
GABRIELLA FONSECA DE JESUS MESQUITA ◽  
DAYENE BUENO CRUVINEL DE LIMA ◽  
HIAGO BRUNO CARDOSO COSTA FONSECA ◽  
...  
Keyword(s):  
Causative Agent ◽  
Clinical Laboratory ◽  
Final Diagnosis ◽  
Reference Laboratory ◽  
Eosinophilic Meningitis ◽  
Central Laboratory ◽  
Serological Tests ◽  
Neck Stiffness ◽  
Csf Analysis ◽  
The City

March 2021, a 12-month-old infant was brought to the HPS East Zone Little Jonh, in the capital of the State of Amazonas, Brazil, where she was admitted with fever, vomiting, intense prostration, little acceptance of breast milk, difficulty in walking, associated with left-facing strabismus and neck stiffness. At admission, the main author performed a lumbar puncture, and serological tests on the CSF to identify the causative agent were referred to a reference laboratory, which suggested that they be referred to the Central Laboratory - LACEN for suspecting the presence of agent Angionsytrongylis Canyonensis. Although, the identification of the causative agent is difficult to be detected and confirmed, this case report shows us the importance of the clinical laboratory in the identification of Eosinophilic Meningitis. The sub-detection of eosinophils in the CSF helps to underestimate the prevalence of eosinophilic meningitis. Thus, CSF analysis, slide preparation, sediment staining, as well as knowledge about the importance of adequate leukocyte differentiation in CSF are extremely important, to properly conduct the final diagnosis of the disease and prevent possible endemicity. The knowledge of this condition and early detection allows an effective therapy and improvement of public health actions. ? ?,

A RARE CASE OF EOSINOPHYLIC MENINGITIS BY PROBABLE ANGIOSTRONGYLUS CANTONENSIS, IN AN INFANT IN THE CITY OF MANAUS, IN THE AMAZON REGION OF BRAZIL

2021 ◽  
Author(s):  
IURY GABRIEL AMAZONAS TUSSOLINI ◽  
GABRIELLE RODRIGUES TUSSOLINI ◽  
GABRIELLA FONSECA DE JESUS MESQUITA ◽  
DAYENE BUENO CRUVINEL DE LIMA ◽  
HIAGO BRUNO CARDOSO COSTA FONSECA ◽  
...  
Keyword(s):  
Causative Agent ◽  
Clinical Laboratory ◽  
Final Diagnosis ◽  
Reference Laboratory ◽  
Eosinophilic Meningitis ◽  
Central Laboratory ◽  
Serological Tests ◽  
Neck Stiffness ◽  
Csf Analysis ◽  
The City

March 2021, a 12-month-old infant was brought to the HPS East Zone Little Jonh, in the capital of the State of Amazonas, Brazil, where she was admitted with fever, vomiting, intense prostration, little acceptance of breast milk, difficulty in walking, associated with left-facing strabismus and neck stiffness. At admission, the main author performed a lumbar puncture, and serological tests on the CSF to identify the causative agent were referred to a reference laboratory, which suggested that they be referred to the Central Laboratory - LACEN for suspecting the presence of agent Angionsytrongylis Canyonensis. Although, the identification of the causative agent is difficult to be detected and confirmed, this case report shows us the importance of the clinical laboratory in the identification of Eosinophilic Meningitis. The sub-detection of eosinophils in the CSF helps to underestimate the prevalence of eosinophilic meningitis. Thus, CSF analysis, slide preparation, sediment staining, as well as knowledge about the importance of adequate leukocyte differentiation in CSF are extremely important, to properly conduct the final diagnosis of the disease and prevent possible endemicity. The knowledge of this condition and early detection allows an effective therapy and improvement of public health actions. ? ?,

scholarly journals Moraxella lacunata infection accompanied by acute glomerulonephritis

Open Medicine ◽  
2020 ◽  
Vol 15 (1) ◽  
pp. 962-967
Author(s):  
Nami Sawada ◽  
Tamaki Morohashi ◽  
Tomokazu Mutoh ◽  
Tsukasa Kuwana ◽  
Junko Yamaguchi ◽  
...  
Keyword(s):  
Clinical Laboratory ◽  
Case Reports ◽  
Laboratory Data ◽  
Inflammatory Cells ◽  
Final Diagnosis ◽  
Renal Tissue ◽  
Acute Glomerulonephritis ◽  
Pathological Findings ◽  
Complement Activity ◽  
Moraxella Lacunata

AbstractMoraxella lacunata (M. lacunata) is a Gram-negative bacterium, which rarely causes serious infection. This is a rare case report of acute glomerulonephritis diagnosed by pathological findings in a child accompanied by M. lacunata infection. The patient showed hematuria, proteinuria and hyperkalemia requiring emergency hemodialysis. After hospitalization, M. lacunata bacteremia became apparent. Pathological findings showed an increase in glomerulus inflammatory cells and glomerular C3 deposition was observed in the renal tissue biopsy. Final diagnosis was endocapillary proliferative glomerulonephritis. Clinical reports of M. lacunata infection requiring emergency hemodialysis in children are rare. Previous reports have suggested that lowered immune competency with chronic kidney disease may be a risk factor associated with serious invasive cases of M. lacunata infection. However, detailed clinical laboratory data and pathological findings have not been identified in previous case reports. Our case directly indicated complement activity and acute glomerulonephritis with M. lacunata infection. Although there are various causes for acute glomerulonephritis, infection-related glomerulonephritis (IRGN) is an important concept. M. lacunata infection might have a potential risk for IRGN with dysregulation of complement activity leading to serious and invasive clinical conditions than previously considered.

Primary leptomeningeal lymphoma masquerading as infectious tubercular meningitis

2021 ◽  
Vol 14 (9) ◽  
pp. e243574
Author(s):  
Salini Sumangala ◽  
Thidar Htwe ◽  
Yousuf Ansari ◽  
Lidia Martinez- Alvarez
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Correct Diagnosis ◽  
Central Nervous System Lymphoma ◽  
Final Diagnosis ◽  
Csf Analysis ◽  
Antitubercular Treatment ◽  
Lymphoma Treatment ◽  
Work Up ◽  
Timely Treatment

Primary central nervous system lymphoma (PCNSL) is infrequent and often poses diagnostic conundrums due to its protean manifestations. We present the case of a South Asian young man presenting with raised intracranial pressure and a lymphocytic cerebrospinal fluid (CSF) with pronounced hypoglycorrhachia. Progression of the neuro-ophthalmic signs while on early stages of antitubercular treatment led to additional investigations that produced a final diagnosis of primary leptomeningeal lymphoma. Treatment with chemoimmunotherapy (methotrexate, cytarabine, thiotepa and rituximab (MATRix)) achieved full radiological remission followed by successful autologous transplant. This case highlights the difficulties and diagnostic dilemmas when PCNSL presents as a chronic meningeal infiltrative process. While contextually this CSF is most often indicative of central nervous system tuberculosis and justifies empirical treatment initiation alone, it is essential to include differential diagnoses in the investigation work-up, which also carry poor prognosis without timely treatment. High suspicion, multidisciplinary collaboration and appropriate CSF analysis were the key for a correct diagnosis.

scholarly journals The first outbreak of brucellosis in the region of Sabac

2010 ◽  
Vol 67 (8) ◽  
pp. 634-637 ◽  
Author(s):  
Ljiljana Markovic-Denic ◽  
Vesna Skodric-Trifunovic ◽  
Vladimir Zugic ◽  
Dragana Radojcic ◽  
Goran Stevanovic
Keyword(s):  
Confidence Interval ◽  
Animal Species ◽  
Epidemiological Methods ◽  
Human Brucellosis ◽  
Reference Laboratory ◽  
Serological Tests ◽  
Military Medical Academy ◽  
Medical Academy ◽  
Laboratory Confirmation ◽  
The Military

Background/Aim. In Serbia brucellosis is a primary disease of the animals in the southern parts of the country. The aim of this study was to describe the first outbreak of human and animal brucellosis in the region of Sabac, Serbia. Methods. An epidemiological investigation was conducted to identify a source of outbreak and the ways of transmission of brucellosis infection in human population. A descriptive and analytical epidemiological methods (cohort study) were used. Additional data included monthly reports of the infectious diseases from the Institutes of Public Health and data from the Veterinary Specialistic Institute in Sabac. The serological tests for human brucellosis cases were performed in the Laboratory of the Military Medical Academy; laboratory confirmation of animal brucellosis cases was obtained from the reference laboratory of the Faculty of Veterinary Medicine, Belgrade. Results. Twelve cases of brucellosis were recorded from February 9 to September 1, 2004. Total attack rate was 8.1% (7.5% of males, 14.2% of females). Relative risk (RR) of milk consumption was 8.9 (95% confidence interval: 1.63-13.38), and RR for direct contact with animals was 14 (95% confidence interval: 3.5-55.6). The prevalence of seropositive animals in 33 villages of the Macva region accounted for 0.8%. Regarding animal species, sheep were predominant - 264 (95.7%). Out of a total number of seropositive animals, ELISA results were positive in 228 (88.7%) of them. Conclusion. As contact epidemics generally last longer, it is probable that the implemented measures of outbreak control did reduce the length of their duration.

scholarly journals Necrotizing sarcoid granulomatosis with clinical presentations of recurrent acute abdomen. Case report and literature review

2017 ◽  
Vol 89 (11) ◽  
pp. 60-68 ◽  
Author(s):  
V I Vasilyev ◽  
S G Palshina ◽  
B D Chaltsev ◽  
S G Radenska-Lopovok ◽  
T N Safonova
Keyword(s):  
Acute Abdomen ◽  
Clinical Laboratory ◽  
Morphological Changes ◽  
Abdominal Cavity ◽  
High Dose ◽  
Drug Induced ◽  
Serological Tests ◽  
Surgical Interventions ◽  
First Case ◽  
Clinical Presentations

The authors have described the world’s first case of necrotizing sarcoid granulomatosis (NSG) in a 22-year-old woman with the clinical presentations of acute abdomen, which are associated with abdominal lymph nodal infiltration and necrosis, obvious constitutional disturbances (fever, nocturnal sweats, and significant weight loss), high inflammatory activity (anemia, leukocytosis, high erythrocyte sedimentation rates and C-reactive protein levels), the gradual appearance of splenic and hepatic necrotic foci, and infiltration into the lung and lacrimal glands with the development of unilateral uveitis. The patient underwent five surgical interventions, several needle biopsies for recurrent abdominal syndrome, and long-term antibiotic treatment for presumed sepsis, which had caused drug-induced hepatitis. Bacteriological examination of blood, puncture samples, and removed abdominal cavity tissues, serological tests, and immunomorphogical study of biopsy samples and removed tissues yielded negative results for the presence of bacterial, fungal, and tuberculosis infections. NSG was diagnosed on the basis of the systemic nature of the lesion, the presence of granulomas with severe abdominal lymph nodal necrosis and necrotizing granulomatous/lymphocytic vasculitis in the mesentery and removed spleen, as well as the absence of granulomas in the spleen, appendix, and biopsy materials of the liver, colonic mucosa, and parotid gland. Fludarabine therapy was first used in world practice due to the inefficient treatment with high-dose glucocorticoids and cyclophosphamide and to a disease relapse when reducing their doses. The paper gives a detailed review of the literature on the clinical, laboratory, radiological, and morphological manifestations of the disease, which allow the differential diagnosis of NSG with different variants of granulomatous lesions. Based on the 5-year follow-up of the patient and on the analysis of clinical, laboratory, radiological, and morphological changes, the authors uphold the concept that the disease is an independent nosological entity: necrotizing angiitis with sarcoid reactions, rather than the entity of nodular or classic sarcoidosis.

scholarly journals Model Proficiency Testing Scheme for Serological Diagnosis of Brucellosis: Interlaboratory Study

2004 ◽  
Vol 87 (4) ◽  
pp. 965-971 ◽  
Author(s):  
Donatella Nannini ◽  
Manuela Tittarelli ◽  
Lucilla Ricci ◽  
Annamaria Conte ◽  
Bernardo Di Emidio ◽  
...  
Keyword(s):  
Complement Fixation Test ◽  
Complement Fixation ◽  
Fixation Test ◽  
Reference Laboratory ◽  
Correct Result ◽  
The European Union ◽  
Serological Tests ◽  
Testing Scheme ◽  
Z Scores ◽  
Qualitative Test

Abstract A model interlaboratory testing scheme was developed by the Italian National Reference Laboratory for Brucellosis. This scheme was planned for both qualitative (Rose Bengal Plate Test; RBPT) and quantitative (Complement Fixation Test; CFT) serological tests and involved a total of 42 laboratories. In the preparation of this scheme, reference was made to general protocols and guidelines and to methods reported in the literature, which were applicable to analytical chemistry laboratories. Six field sera from naturally infected animals, one positive serum at a titer below the European Union (EU) positivity threshold, and 5 sera positive at titers between 20 and 851 International Units of Complement Fixation Test (IUCFT)/mL plus one negative serum were used to produce a panel of test sera. To evaluate laboratory performances in the quantitative test for each tested sample examined, z-scores based on robust summary statistics (the median and normalized interquartile range) were used. To evaluate overall laboratory performance, 2 types of combined z-scores were used: Rescaled Sum of Scores and Sum of Squared Scores. In the case of the qualitative test (RBPT), results were analyzed by a Bayesian approach. A Beta distribution, based on the result of each laboratory, was calculated and used to estimate the probability of each laboratory giving a correct result and its uncertainty.

scholarly journals A balanced scorecard for assessing a strategic plan in a clinical laboratory

2019 ◽  
Vol 29 (2) ◽  
pp. 284-291
Author(s):  
Luisa Alvarez ◽  
Anna Soler ◽  
Leonor Guiñón ◽  
Aurea Mira
Keyword(s):  
Balanced Scorecard ◽  
Clinical Laboratory ◽  
Theoretical Perspective ◽  
Strategic Plan ◽  
Reference Laboratory ◽  
Healthcare Organizations ◽  
Public And Private ◽  
The Balanced Scorecard ◽  
Definition Of ◽  
Public And Private Sector

The Balanced Scorecard (BSC) is a tool for strategic management that is used in many companies and organizations worldwide, both in the public and private sector. With this purpose it has also been used in healthcare organizations and institutions but there are not many studies on the implementation of BSC methodology in the day-to-day clinical laboratory. This review shows the strategy for the development of a BSC, which includes theoretical perspective objectives, as well as some indicators and goals with which the monitoring and quantitative measurement of the achievements of a strategic plan in a clinical laboratory can be done. Moreover, the results of the indicators allow the prioritization of the initiatives to be implemented each year. The methodology for the development of the proposed BSC includes the following steps: definition of theoretical objectives of each of the perspectives most used in the management of a clinical laboratory (customers, financial, internal processes and learning) taking into account the vision and the organizational model of the laboratory; creation of a strategic map of perspective objectives; definition of the relevant indicators to follow up on the objectives in a quantitative manner and establishment of the goals. Whether or not the laboratory is a reference laboratory, in which specific and infrequent analysis and health population programs are performed, is another fact to take into account. In this review a BSC for a reference clinical laboratory of the Spanish public sector is shown.

scholarly journals Sífilis: Prevalência num Hospital de Lisboa

2016 ◽  
Vol 29 (1) ◽  
pp. 52 ◽  
Author(s):  
Leonor Lopes ◽  
Rita Ferro-Rodrigues ◽  
Samuel Llobet ◽  
Luís Lito ◽  
João Borges-Costa
Keyword(s):  
Clinical Laboratory ◽  
Transmitted Disease ◽  
Public Health Problem ◽  
Secondary Syphilis ◽  
Disease Classification ◽  
Serological Tests ◽  
Important Public Health Problem ◽  
Early Syphilis ◽  
Latent Syphilis

<p><strong>Introduction:</strong> Syphilis is a sexual and vertical transmitted disease. Its incidence is increasing in Europe, particularly, in Portugal.<br /><strong>Material and Methods:</strong> A descriptive, retrospective study was performed based on positive treponemal tests from January to December 2013, at the Santa Maria Hospital, Lisbon. In-patients and out-patients evaluated in medical appointments and at the emergency department were included. We proceeded to epidemiological characterization, disease classification and definition of risk factors.<br /><strong>Results:</strong> We obtained a sample of 580 patients, of whom 51 with no clinical data and 45 with false positive serologies were excluded. There was a predominance of male patients (75%) and a mean age of 47 years. Most (59%) had syphilis successfully treated in the past and 3.7% were in follow-up. We recorded 13 primaries syphilis, 71 cases of secondary syphilis, 40 cases of early latent syphilis, 49 unknown duration syphilis and five cases of late latent syphilis. In the early syphilis group, 42% (n = 124) were HIV-positive and, in 8% both diagnosis were done simultaneously.<br /><strong>Discussion:</strong> We emphasize the high prevalence of syphilis/HIV co-infection in patients with early syphilis, reinforcing the importance of promoting the use of preventive measures. We obtained 11% of patients with late clinical forms, which are notifiable since June 2014, in Portugal. All serological tests for the diagnosis of syphilis have limitations which emphasizes the importance of clinical-laboratory correlation.<br /><strong>Conclusion:</strong> Syphilis remains an important public health problem. It is necessary to establish education programs, screening and follow-up strategies to reduce their prevalence and to perform more efficient screening of the partners.</p>

A Team-Based Approach to Autopsy Education: Integrating Anatomic and Clinical Pathology at the Rotation Level

2014 ◽  
Vol 138 (3) ◽  
pp. 322-327 ◽  
Author(s):  
Tiffany Michele Hébert ◽  
Sara Maleki ◽  
Ljiljana V. Vasovic ◽  
Jeffrey L. Arnold ◽  
Jacob J. Steinberg ◽  
...  
Keyword(s):  
New York ◽  
Clinical Laboratory ◽  
Medical Center ◽  
Clinical Pathology ◽  
Holistic Approach ◽  
Final Diagnosis ◽  
Perceived Usefulness ◽  
Final Report ◽  
Laboratory Findings ◽  
Depth Analysis

Context.—Pathology residency training programs should aim to teach residents to think beyond the compartmentalized data of specific rotations and synthesize data in order to understand the whole clinical picture when interacting with clinicians. Objective.—To test a collaborative autopsy procedure at Montefiore Medical Center (Bronx, New York), linking residents and attending physicians from anatomic and clinical pathology in the autopsy process from the initial chart review to the final report. Residents consult with clinical pathology colleagues regarding key clinical laboratory findings during the autopsy. This new procedure serves multiple functions: creating a team-based, mutually beneficial educational experience; actively teaching consultative skills; and facilitating more in-depth analysis of the clinical laboratory findings in autopsies. Design.—An initial trial of the team-based autopsy system was done from November 2010 to December 2012. Residents were then surveyed via questionnaire to evaluate the frequency and perceived usefulness of clinical pathology autopsy consultations. Results.—Senior residents were the most frequent users of clinical pathology autopsy consultation. The most frequently consulted services were microbiology and chemistry. Eighty-nine percent of the residents found the clinical pathology consultation to be useful in arriving at a final diagnosis and clinicopathologic correlation. Conclusion.—The team-based autopsy is a novel approach to integration of anatomic and clinical pathology curricula at the rotation level. Residents using this approach develop a more holistic approach to pathology, better preparing them for meaningful consultative interaction with clinicians. This paradigm shift in training positions us to better serve in our increasing role as arbiters of outcomes measures in accountable care organizations.

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