Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 20 de 119
Rev. Soc. Bras. Med. Trop ; 54: e0169, 2021. tab
Article in English | LILACS-Express | LILACS | ID: biblio-1340829


Abstract INTRODUCTION: The clinical manifestations of cryptococcosis are usually associated with the infecting agents Cryptococcus neoformans (CN) and C. gattii (CG) species complexes and the host. In this study, non-HIV-infected patients, at a university hospital in southeastern Brazil, had epidemiological and clinical data associated with cryptococcal disease and isolated Cryptococcus species: CN - 24 patients and CG - 12 patients. METHODS: The comparison was comprised of demographic data, predisposing factors, clinical and laboratory manifestations, and outcomes of cryptococcosis patients treated between 2000 and 2016. Immunocompetent and immunosuppressed patients were also compared, irrespective of the infecting species. Cryptococcus spp. were genotyped by PCR-RFLP analysis of the URA5 gene. RESULTS: Infections by the CN species complex (100% VNI genotype) were associated with drug immunosuppression and fungemia, and patients infected with the CG species complex (83% VG II and 17% VGI genotypes) had more evident environmental exposure and higher humoral response. CN and CG affected patients with or without comorbidities. CONCLUSIONS: Diabetes mellitus, other chronic non-infectious diseases, and alcoholism were likely predisposing factors for infection by both CN and CG species. Immunocompetent patients, independent of the infecting Cryptococcus species complexes, showed a higher occurrence of meningitis and a trend toward less fungal dissemination and longer survival than immunosuppressed hosts.

Rev. Soc. Bras. Med. Trop ; 54: e0090, 2021. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1288081


Abstract INTRODUCTION: Antimicrobial resistance has worsened since the onset of COVID-19. METHODS: This study involved patients admitted to the adult intensive care unit (ICU) of a tertiary hospital. Pre- and post-COVID-19 data were analyzed. The healthcare-related infections (HCRIs) reported between January 2018 and January 2020 and during the pandemic between February and July 2020 were compared. RESULTS: Antimicrobial resistance increased during the pandemic, especially for Klebsiella pneumoniae isolates, with a rate increase from 5% to 50% for Polymyxin B. CONCLUSIONS: The susceptibilities of the main pathogens associated with HCRIs in the ICU changed and should be considered in managing severe COVID-19.

Medicina (B.Aires) ; 80(supl.3): 37-41, June 2020. tab
Article in Spanish | LILACS | ID: biblio-1135189


Para contener la pandemia de COVID-19 se han adoptado medidas nacionales estrictas de aislamiento social y se han reorganizado los sistemas de salud. En este período, se observaron cambios en la atención de enfermedades no infecciosas. El objetivo de este trabajo fue describir las consecuencias de la pandemia de COVID-19 sobre la atención de enfermedades no transmisibles. Se realizó una encuesta estructurada retrospectiva a 31 centros asistenciales de la Asociación de Clínicas, Sanatorios y Hospitales Privados de la República Argentina y Cámara de Entidades de Diagnóstico y Tratamiento. Se compararon indicadores de abril de 2019 versus abril 2020. Se recolectaron datos sobre consultas de emergencia, ingresos hospitalarios, procedimientos invasivos, tratamiento y ocupación de áreas de internación. En ese periodo las consultas a emergencias y las hospitalizaciones disminuyeron en 75% y 48% respectivamente; los ingresos por angina de pecho y síndrome coronario agudo en 62% y los debidos a accidentes cerebrovascular e isquémico transitorio en 46%. Se encontró una disminución de las angioplastias coronarias (59%) e intervenciones percutáneas totales (65%), y un descenso tanto de las cirugías generales (73%) como de las cardíacas centrales (58%). Si bien el aislamiento social obligatorio es una estrategia clave de salud pública para aplanar la curva de propagación de la infección, la marcada disminución porcentual de consultas e intervenciones podría influir negativamente sobre la morbimortalidad cardiovascular, cerebrovascular y oncológica. Se requiere un esfuerzo conjunto para evitar una posible expansión del daño colateral del COVID-19.

To contain the coronavirus pandemic (COVID-19), a strict nationwide lockdown has been enforced and the health systems have been reorganized to deal with this entity. During this period, changes in the care of non-infectious diseases have been observed. Our aim was to describe the impact of the COVID-19 pandemic in the care of non-communicable diseases. A structured retrospective survey was carried out in 31 healthcare centers affiliated with the Asociación de Clínicas, Sanatorios y Hospitales Privados de la República Argentina y Cámara de Entidades de Diagnóstico y Tratamiento. We compared data for April 2019 versus April 2020 regarding emergency room consultations, hospital admissions, invasive procedures and treatments, and bed occupancy. In April 2020, we observed a decrease in emergency room visits (75%) and hospitalizations (48%). A 62% decrease in admissions was noted for angina pectoris and acute coronary syndromes and a 46% decrease in admissions for stroke and transient ischemic attack. A meaningful decrease was found in coronary angioplasties (59%) and total percutaneous interventions (65%), and also a decrease in general surgeries (73%), and cardiac surgeries (58%). Although social distancing measures are a key public health strategy to flatten the infection curve, the observed decrease in medical visits and interventions may impact negatively on cardiovascular, cerebrovascular and cancer related morbidity and mortality. A collective effort is required to avoid the unintended consequences and collateral damage of the COVID-19 pandemic.

Humans , Pneumonia, Viral , Patient Acceptance of Health Care , Coronavirus Infections , Delivery of Health Care/organization & administration , Pandemics , Noncommunicable Diseases/therapy , Argentina , Social Isolation , Hospitals, Private , Cost of Illness , Betacoronavirus , SARS-CoV-2 , COVID-19
Rev. Soc. Bras. Med. Trop ; 53: e20180463, 2020. tab, graf
Article in English | LILACS | ID: biblio-1057304


Abstract INTRODUCTION: The therapeutic efficacy of daily amphotericin B infusion is related to its maximum concentration in blood; however, trough levels may be useful in intermittent regimens of this antifungal drug. METHODS : High performance liquid chromatography (HPLC) was used to determine the minimum concentration (Cmin) of amphotericin B in the serum of patients receiving deoxycholate (D-Amph) or liposomal amphotericin B (L-AmB) for the treatment of cryptococcal meningitis (n=28), histoplasmosis (n=8), paracoccidioidomycosis (n=1), and leishmaniasis (n=1). RESULTS: Daily use of D-Amph 30 to 50 mg or L-AmB 50 mg resulted in a similar Cmin, but a significant increase ocurred with L-AmB 100 mg/day. The geometric mean Cmin tended to decrease with a reduction in the dose and frequency of intermittent L-AmB infusions: 357 ng/mL (100 mg 4 to 5 times/week) > 263 ng/mL (50 mg 4 to 5 times/week) > 227 ng/mL (50 mg 1 to 3 times/week). The impact on Cmin was variable in patients whose dose or therapeutic scheme was changed, especially when administered the intermittent infusion of amphotericin B. The mean Cmin for each L-AmB schedule of intermittent therapy was equal or higher than the minimum inhibitory concentration of amphotericin B against Cryptococcus isolates from 10/12 patients. The Cmin of amphotericin B in patients with cryptococcal meningitis was comparable between those that survived or died. CONCLUSIONS: By evaluating the Cmin of amphotericin B, we demonstrated the therapeutic potential of its intermittent use including in the consolidation phase of neurocryptococcosis treatment, despite the great variability in serum levels among patients.

Humans , Amphotericin B/blood , Deoxycholic Acid/blood , Antifungal Agents/blood , Paracoccidioidomycosis/drug therapy , Leishmaniasis/drug therapy , Amphotericin B/administration & dosage , Amphotericin B/pharmacokinetics , Chromatography, High Pressure Liquid , Meningitis, Cryptococcal/drug therapy , Deoxycholic Acid/administration & dosage , Deoxycholic Acid/pharmacokinetics , Histoplasmosis/drug therapy , Antifungal Agents/administration & dosage , Antifungal Agents/pharmacokinetics
Rev. Soc. Bras. Med. Trop ; 52: e20180461, 2019. tab, graf
Article in English | LILACS | ID: biblio-1003123


Abstract Dirofilariasis is a little-known zoonosis, with dogs and cats as definitive hosts. It is caused by nematodes and transmitted by mosquito bites. We report the case of a 67-year-old man with a consumptive syndrome with two subpleural pulmonary opacities. A transthoracic lung biopsy revealed a Dirofilaria worm. Myocardial nuclear magnetic resonance (NMR) demonstrated dilated cardiomyopathy after myocarditis related to dirofilariasis. Human infection is rare and occurs accidentally. The most common radiological alteration is a mainly subpleural coin lesion. Dirofilariasis is a neglected emergent disease and knowledge about it is important for differential diagnoses from neoplastic pulmonary nodules.

Humans , Male , Aged , Dirofilariasis/complications , Lung Diseases, Parasitic/complications , Myocarditis/etiology , Dirofilariasis/diagnosis , Lung Diseases, Parasitic/diagnosis , Myocarditis/diagnosis
Braz. j. infect. dis ; 22(5): 371-376, Sept.-Oct. 2018. tab, graf
Article in English | LILACS | ID: biblio-974237


ABSTRACT Background: Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) is spreading worldwide, but little is known about the epidemiology of this pathogen in Brazil. Objective: To evaluate clinical and microbiological features of children with S. aureus infections admitted to a university hospital. Methods: This was a cross-sectional study evaluating the potential risk factors for CA-MRSA, and a retrospective cohort evaluating in-hospital clinical outcomes. To include patients with both community and hospital-associated infections, we screened the results of the microbiological laboratory tests from January 1, 2012, to December 31, 2016. According to the phenotype, we classified the isolates in Methicillin-Susceptible S. aureus (MSSA), Hospital-Associated Methicillin-Resistant S. aureus (HA-MRSA), and CA-MRSA. Clinical data were collected from the patients' medical records. Results: We identified 279 cases of S. aureus infections (MSSA = 163, CA-MRSA = 69, HA-MRSA = 41). Overall, the incidence density of CA-MRSA and MSSA infections increased while the HA-MRSA incidence density decreased over the study period. CA-MRSA infected patients were more likely to present with skin and soft tissue infections (OR: 2.83, 95%CI: 1.54-5.33, p < 0.001) and osteomyelitis (OR: 4.76; 95%CI: 1.16-22.71, p = 0.014) when compared to MSSA and HA-MRSA infections. Unadjusted case fatality rates were similar between MSSA-infected patients (3.14%, 5/159) and CA-MRSA infected patients (3.80%, 3/79, p = 0.792), while HA-MRSA infected patients were more likely to die in the hospital (12.20%, 5/41, p = 0.013). Conclusions: CA-MRSA is an emergent pediatric pathogen in Brazil. Our results highlight the relevance of choosing an appropriate initial antimicrobial drug for treating children with severe S. aureus infections.

Humans , Male , Female , Infant , Child, Preschool , Child , Staphylococcal Infections/microbiology , Staphylococcal Infections/epidemiology , Methicillin-Resistant Staphylococcus aureus/isolation & purification , Phenotype , Reference Values , Staphylococcal Infections/drug therapy , Time Factors , Brazil/epidemiology , Incidence , Cross-Sectional Studies , Retrospective Studies , Risk Factors , Community-Acquired Infections/microbiology , Community-Acquired Infections/drug therapy , Community-Acquired Infections/epidemiology , Statistics, Nonparametric , Anti-Bacterial Agents/therapeutic use
Biosci. j. (Online) ; 34(5): 1219-1224, sept./oct. 2018.
Article in English | LILACS | ID: biblio-967309


Among the agricultural production factors, the water deficit is one of the main reasons that limits soy production in Brazil. In order to mitigate losses due to water stress in the plants, hydrogels appear as soil water conditioners. They are polymers capable of absorbing large amounts of water and are being used as a viable alternative to improve the storage of water in areas of scarcity. Hydrogen concentrations between 14 and 18 kg ha-1 resulted in higher plant height, number of pods, one hundred grain mass and grain yield.

Dentre os fatores de produção agrícola, o déficit hídrico é um dos principais motivos que mais limita a produção de soja no Brasil. A fim de amenizar os prejuízos por estresse hídrico nas plantas, os hidrogéis surgem como condicionadores de água no solo, já são polímeros capazes de absorver grande quantidade de água e estão sendo utilizados como alternativa viável para melhorar o armazenamento de água em áreas de escassez. Objetivou-se com este trabalho avaliar a eficiência da utilização do hidrogel na retenção e disponibilização de água para o desenvolvimento e produção da cultura da soja quando submetido a estresse hídrico. As concentrações de hidrogéis entre 14 e 18 kg ha-1 resultaram em maior altura de plantas, número de vagens, massa de cem grãos e produtividades de grãos.

Soybeans , Grassland , Dehydration , Droughts , Crop Production
Rev. odontol. mex ; 22(3): 154-159, jul.-sep. 2018. tab, graf
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1014414


RESUMEN El labio y paladar hendido es una de las patologías congénitas con mayor prevalencia en el mundo. En el presente trabajo se hace un análisis de 12 PNU localizados en las secuencias genómicas de ABCA4, BMP4, MSX1, SUMO1, VAX1 y IRF6, bajo una perspectiva epidemiológica, de genética molecular, genómica y de genética de poblaciones; todo lo anterior aplicado a una población de Querétaro, México, de origen genético mixto. Material y métodos: Se realizó un estudio observacional, analítico y descriptivo a partir de muestras de 93 tríadas (sujetos de estudio y sus padres). Al seleccionar PNU que puedan ser diferenciados por medio de RFLP esperamos distinguir entre marcadores genéticos que: 1) cumplan con la ecuación de equilibrio de Hardy-Weinberg y 2) validarlos como potenciales marcadores genéticos para ser empleados en estudios de asociación en poblaciones cerradas de origen genético mixto con labio y paladar hendido (Amealco, Querétaro, México). De ser así, posteriormente se plantea probar las frecuencias obtenidas con una población seleccionada genéticamente cerrada de Amealco, Querétaro. Resultados: Después de realizar el análisis RFLP de 12 PNU localizados en la secuencia de genes ABCA4, BMP4, MSX1, SUMO1, VAX1 y IRF6, hallamos el mismo alelo para PNU analizado, el cual se encuentra en el 100% de la población. Conclusión: De los 12 PNU analizados, en este reporte, por primera vez se menciona la frecuencia de cinco de ellos. Los restantes siete presentaron la misma frecuencia reportada en la literatura. Aunque los PNU seleccionados no fueron de utilidad como marcadores genéticos debido a que el mismo alelo está presente en el 100% de la población general. El hecho de haberlos encontrado en el mismo genotipo de todas las muestras indica que la población de la ciudad de Querétaro es genéticamente cerrada y con base en esto extremadamente útil para futuras validaciones de otros PNU como posibles marcadores genéticos.

ABSTRACT The cleft lip and palate is one of the congenital pathologies with greater prevalence in the world. In the present work, there is an analysis of 12 SNP's located in genomic sequences of ABCA4, BMP4, MSX1, SUMO1, VAX1 andIRF6, under an epidemiological perspective, molecular genetics, genomics and population genetics. All of the above applied to a population of Queretaro, Mexico, of mixed genetic origin. Material and methods: A study was conducted of observation, analytic and descriptive study with samples from 93 triads (study subjects and their parents). When you select SNP's that can be differentiated by RFLP (Restriction Fragment Length Polymorphism)we hope to distinguish between genetic markers that: 1)comply with the equation of balance of Hardy-Weiner and 2) Validate them as potential genetic markers to be used in studies of association in closed populations of genetic origin mixed with cleft lip and palate in Amealco, Queretaro, Mexico. If so subsequently raises test the frequencies obtained with a selected population genetically closed in Amealco, Queretaro. Results: After performing the RFLP analysis of 12 SNP's located in the sequence of genes ABCA4, BMP4, MSX1, SUMO1, VAX1 and IRF6, we find the same allele for SNP analyzed which is located in the 100% of the population. Conclusion: Of the 12 SNP's analyzed in this report, for the fi rst time 5 of them are mentioned their frequency. The rest of them had the same frequency reported in the literature. Although the SNP's selected were not useful as a genetic markers due to the same allele is present in 100% of the general population. The fact of having found in the same genotype of all samples indicates that the population of the city of Queretaro is genetically closed and on the basis of this extremely useful for future validations of other SNP's as potential genetic markers.

Oncol. (Guayaquil) ; 28(2): 150-162, Ago. 30, 2018.
Article in Spanish | LILACS | ID: biblio-1000122


Introducción: El cáncer de ovario es una causa común de muerte entre las mujeres que desarrollan neoplasias ginecológicas. La supervivencia depende de factores clínicos y del tipo de cirugía. El objetivo del presente estudio es describir la supervivencia de un grupo de pacientes con diagnóstico de cáncer de ovario tomando en cuenta varios factores. Métodos: El presente estudio longitudinal retrospectivo se realizó en mujeres con cáncer de ovario tratadas en el Instituto Nacional de Oncología y Radiobiología, La Habana-Cuba entre el 1 de enero y el 31 de diciembre de 2005, con seguimiento de por lo menos 5 años. Las variables fueron edad, tipo histológico del tumor, etapa clínica de la FIGO, grado de diferenciación celular, valores del biomarcador CA-125, tipo de cirugía realizada, respuesta a la quimioterapia utilizada, supervivencia, recurrencias. El paquete estadístico utilizado fue SPSS 11.0 para Windows. Se aplicaron pruebas estadísticas como la prueba no paramétrica de Kruskal-Wallis, la prueba no paramétrica de MannWhitney y la prueba de Chi-cuadrado de Pearson. Resultados: Se registraron 29 casos de mujeres con cáncer de ovario. Once casos (37.9 %) fueron en menores de 45 años. En Etapa clínica III, 18 casos (62.1 %). De grado indiferenciado en 17 casos (58.6 %). 16 casos (55.2 %) fueron del tipo histológico seroso. El valor del CA-125 fue >35 U/mL en 13 casos (61.9 %). Las mujeres con etapa clínica I, tuvieron un Intervalo Libre de la Enfermedad (ILE) de 46 meses versus 27 meses en mujeres con etapa III y 12 meses en etapa IV (P>0.05). El grado de diferenciación celular Bien diferenciado determinó estadísticamente el mejor ILE: 55 meses versus 27 meses en el grado moderadamente diferenciado y de 21 meses en el grado indiferenciado (P=0.025). El tipo histológico así como los niveles de CA-125 no determinaron diferencias estadísticas de ILE, así como en Supervivencia Global Media (SGM). Según el tipo de tratamiento no existieron diferencias estadísticas significativas en el ILE, SGM. Sin embargo las cirugías clasificadas como "óptimas" por parte del equipo quirúrgico tuvieron mayor ILE (Delta 17 meses) P=0.038. Conclusión: En esta serie de casos presentada, las pacientes con cáncer de ovario en Etapa clínica I tuvieron una mejor supervivencia que las pacientes con Etapa clínica III. Así mismo las cirugías clasificadas como óptimas tuvieron mayor intervalo libre enfermedad y mayor supervivencia libre de enfermedad.

Introduction: Ovarian cancer is a common cause of death among women who develop gynecological neoplasms. Survival depends on clinical factors and the type of surgery. The objective of the present study is to describe the survival of a group of patients diagnosed with ovarian cancer taking into account several factors. Methods: The present retrospective longitudinal study was conducted in women with ovarian cancer treated at the National Institute of Oncology and Radiobiology, Havana-Cuba between January 1 and December 31, 2005, with follow-up of at least 5 years . The variables were age, histological type of the tumor, clinical stage of the FIGO, degree of cellular differentiation, values of the CA-125 biomarker, type of surgery performed, response to the chemotherapy used, survival, recurrences. The statistical package used was SPSS 11.0 for Windows. Statistical tests were applied, such as the non-parametric Kruskal-Wallis test, the nonparametric Mann-Whitney test and the Pearson Chi-square test. Results: There were 29 cases of women with ovarian cancer. Eleven cases (37.9%) were in children under 45 years of age. In Clinical Stage III, 18 cases (62.1%). Of undifferentiated degree in 17 cases (58.6%). 16 cases (55.2%) were of the serous histological type. The value of CA-125 was> 35 U/ mL in 13 cases (61.9%). Women with clinical stage I had a Disease Free Interval (DFI) of 46 months versus 27 months in women with stage III and 12 months in stage IV (P> 0.05). The degree of differentiated cellular differentiation statistically determined the best DFI: 55 months versus 27 months in the moderately differentiated degree and 21 months in the undifferentiated degree (P = 0.025). The histological type as well as CA-125 levels did not determine statistical differences of DFI, as well as in Average Global Survival (AGS). According to the type of treatment, there were no significant statistical differences in the FID and AGS. However, surgeries classified as "optimal" by the surgical team had a greater DFI (Delta 17 months) P = 0.038. Conclusion: In this case series presented, patients with ovarian cancer in clinical stage I had a better survival than patients with clinical stage III. Likewise, surgeries classified as optimal had greater free disease interval and greater disease-free survival.

Female , Adult , Middle Aged , Ovarian Neoplasms , Ovary , Survivorship , Women , CA-125 Antigen , Neoplasms
Braz. j. infect. dis ; 22(1): 11-15, Jan.-feb. 2018. tab, graf
Article in English | LILACS | ID: biblio-951617


ABSTRACT Fluconazole is extensively used for the treatment of candidiasis and cryptococcosis. Among other factors, successful treatment is related to appropriate fluconazole levels in blood and cerebrospinal fluid. In the present study, fluconazole levels were determined in 15 patients, 14 of whom had AIDS and 13 had neurocryptococcosis. The only selection criterion was treatment with fluconazole, which was performed with a generic or similar form of the drug. Fluconazole level was determined by high performance liquid chromatography and the susceptibility profile of Cryptococcus spp. isolated from the patients was assessed by broth microdilution. Blood and cerebrospinal fluid fluconazole levels were found to be related to the fluconazole daily dose, and exceeded the minimum inhibitory concentration of this antifungal for the Cryptococcus spp. isolates. A good correlation was observed between serum and cerebrospinal fluid drug concentration. In conclusion, treatment with non-original fluconazole under usual medical practice conditions results in appropriate blood and cerebrospinal fluid levels of the drug for inhibiting Cryptococcus spp. susceptible to this antifungal drug. The relatively common failures of neurocryptococcosis treatment appear not to be due to insufficient fluconazole levels in the cerebrospinal fluid, especially with the use of daily doses of 400-800 mg.

Humans , Adult , Middle Aged , Fluconazole/cerebrospinal fluid , Fluconazole/blood , Cryptococcosis/drug therapy , Antifungal Agents/cerebrospinal fluid , Antifungal Agents/blood , Reference Values , Candidiasis/cerebrospinal fluid , Candidiasis/drug therapy , Candidiasis/blood , Microbial Sensitivity Tests , Fluconazole/administration & dosage , Chromatography, High Pressure Liquid , Treatment Outcome , AIDS-Related Opportunistic Infections/drug therapy , Statistics, Nonparametric , Cryptococcosis/cerebrospinal fluid , Cryptococcosis/blood , Cryptococcus/isolation & purification , Cryptococcus/drug effects , Dose-Response Relationship, Drug , Histoplasmosis/cerebrospinal fluid , Histoplasmosis/drug therapy , Histoplasmosis/blood , Antifungal Agents/administration & dosage
Rev. Soc. Bras. Med. Trop ; 49(5): 559-566, Sept.-Oct. 2016. tab, graf
Article in English | LILACS | ID: lil-798126


Abstract INTRODUCTION: We aimed to evaluate the effectiveness of a symbiotic product to decolonize the intestinal tract of patients harboring multidrug-resistant (MDR) Gram-negative bacilli and to prevent nosocomial infections. METHODS: This was a randomized, double blind, placebo-controlled clinical trial, conducted in a tertiary-care university hospital. All adult hospitalized patients with a positive clinical culture and a positive rectal swab for any MDR Gram-negative bacilli were potentially eligible. Exclusion criteria were pregnancy, immunosuppression, and bowel obstruction/perforation. The intervention consisted of administering a symbiotic product (Lactobacillus bulgaricus, Lactobacillus rhamnosus, and fructo-oligosaccharides) twice a day for seven days via the oral/enteral route. RESULTS: Between August 1, 2012 and December 22, 2013, 116 of 275 eligible patients were allocated to treatment (n=57) and placebo (n=59). Overall, 101 patients received at least four doses of the study products and were included in the modified intention-to-treat analysis. The primary study outcome, a negative rectal swab for MDR Gram-negative bacilli after treatment, was identified in 16.7% (8/48) and 20.7% (11/53) of patients in the experimental and placebo group, respectively (p=0.60). The secondary outcome, the combined incidence of nosocomial respiratory and urinary tract infections, was 37.5% (18/48) in the experimental group versus 22.6% (12/53) in the control group (adjusted odds ratio: 1.95, 95% confidence interval: 0.69-5.50, p=0.21). Length of stay after the beginning of the intervention, incidence of adverse events, and in-hospital mortality rates were similar in both study groups. CONCLUSIONS: Under the present study conditions, symbiotic administration was not effective for decolonizing hospitalized patients harboring MDR Gram-negative bacilli.

Humans , Male , Female , Adult , Aged , Cross Infection/prevention & control , Gram-Negative Bacterial Infections/prevention & control , Probiotics/therapeutic use , Drug Resistance, Multiple, Bacterial/drug effects , Gram-Negative Bacteria/drug effects , Double-Blind Method , Middle Aged
Rev. Soc. Bras. Med. Trop ; 49(2): 177-182, Mar.-Apr. 2016. tab, graf
Article in English | LILACS | ID: lil-782100


Abstract: INTRODUCTION Klebsiella pneumoniae has become an increasingly important etiologic agent of nosocomial infections in recent years. This is mainly due to the expression of virulence factors and development of resistance to several antimicrobial drugs. METHODS This retrospective study examines data obtained from the microbiology laboratory of a Brazilian tertiary-care hospital. To assess temporal trends in prevalence and antimicrobial susceptibility, K. pneumoniae isolates were analyzed from 2000 to 2013. The relative frequencies of K. pneumoniae isolation were calculated among all Gram-negative bacilli isolated in each period analyzed. Susceptibility tests were performed using automated systems. RESULTS: From 2000-2006, K. pneumonia isolates comprised 10.7% of isolated Gram-negative bacilli (455/4260). From 2007-2013, this percentage was 18.1% (965/5331). Strictly considering isolates from bloodstream infections, the relative annual prevalence of K. pneumoniae increased from 14-17% to 27-32% during the same periods. A progressive decrease in K. pneumoniae susceptibility to all antimicrobial agents assessed was detected. Partial resistance was also observed to antimicrobial drugs that have been used more recently, such as colistin and tigecycline. CONCLUSIONS Our study indicates that K. pneumoniae has become a major pathogen among hospitalized patients and confirms its recent trend of increasing antimicrobial resistance.

Humans , Klebsiella Infections/microbiology , Klebsiella pneumoniae/drug effects , Anti-Bacterial Agents/pharmacology , Brazil , Microbial Sensitivity Tests , Prevalence , Retrospective Studies , Drug Resistance, Bacterial/drug effects , Tertiary Care Centers/statistics & numerical data , Klebsiella pneumoniae/isolation & purification
Salud pública Méx ; 58(2): 302-308, Mar.-Apr. 2016. graf
Article in English | LILACS | ID: lil-792993


Abstract The epithelial ovarian cancer (EOC) has been underdiagnosed because it does not have a specific clinical presentation, and the signs and symptoms are similar to the irritable bowel syndrome and pelvic inflammatory disease. EOC is less common than breast and cervical cancer, but it is more lethal. On the whole, EOC has an early dissemination to peritoneal cavity, which delays a timely diagnosis and increases the rate of advanced diagnosed disease. The diagnosis usually surprises the women and the primary care physician. Therefore, it is necessary to count on prevention and early diagnosis programs. EOC has 80% response to surgical treatment, but nearly 70% of the patients may relapse in five years. The objectives of this document are presenting a summary of the EOC epidemiology and comment about advancements in prevention, diagnosis, and treatment of this cancer. That will raise awareness about the importance of this disease.

Resumen El cáncer ovárico epitelial (COE) ha sido subdiagnosticado debido a que no tiene presentación clínica específica y a que los signos y síntomas son similares al síndrome de colon irritable y a la enfermedad inflamatoria pélvica. Es menos común que el cáncer de mama o el cervicouterino, pero es más letal. En general, tiene diseminación temprana a cavidad peritoneal, lo cual retrasa un pronóstico oportuno e incrementa la tasa de diagnóstico de enfermedad avanzada. Usualmente, el diagnóstico sorprende a la mujer y al médico de primer contacto. Entonces, es necesario contar con programas de prevención y diagnóstico temprano. El COE tiene 80% de respuesta quirúrgica, pero cerca de 70% de las pacientes puede recaer en cinco años. Los objetivos de este documento son presentar un resumen de la epidemiología del COE y comentar los avances en prevención, diagnóstico y tratamiento de este cáncer. Esto despertará la conciencia acerca de la importancia de esta enfermedad.

Humans , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Ovarian Neoplasms/epidemiology , Carcinoma/epidemiology , Ovarian Neoplasms/therapy , Peritoneal Neoplasms/secondary , Carcinoma/diagnosis , Carcinoma/therapy , Ovariectomy , Combined Modality Therapy , Early Detection of Cancer , Immunotherapy , Mexico/epidemiology , Neoplasm Staging
Rev. Soc. Bras. Med. Trop ; 49(1): 51-56, Jan.-Feb. 2016. graf
Article in English | LILACS | ID: lil-776534


Abstract INTRODUCTION: Methicillin-resistant Staphylococcus aureus (MRSA) is a nosocomial pathogen in community settings. MRSA colonized individuals may contribute to its dissemination; the risk of MRSA infection is increased in human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) patients, although the prevalence of colonization in this group is not well established. The present study addressed this issue by characterizing MRSA isolates from HIV/AIDS patients and their healthcare providers (HCPs) to determine whether transmission occurred between these two populations. METHODS: A total of 24 MRSA isolates from HIV-infected patients and five from HCPs were collected between August 2011 and May 2013. Susceptibility to currently available antimicrobials was determined. Epidemiological typing was carried out by pulsed-field gel electrophoresis, multilocus sequence typing, and Staphylococcus cassette chromosome (SCCmec) typing. The presence of heterogeneous vancomycin-intermediate Staphylococcus aureus (hVISA) and heterogeneous daptomycin-resistant Staphylococcus aureus (hDRSA) was confirmed by population analysis profile. Isolates characterized in this study were also compared to isolates from 2009 obtained from patients at the same hospital. RESULTS: A variety of lineages were found among patients, including ST5-SCCmecII and ST30-SCCmecIV. Two isolates were Panton-Valentine leukocidin-positive, and hVISA and hDRSA were detected. MRSA isolates from two HCPs were not related to those from HIV/AIDS patients, but clustered with archived MRSA from 2009 with no known relationship to the current study population. CONCLUSIONS: ST105-SCCmecII clones that colonized professionals in 2011 and 2012 were already circulating among patients in 2009, but there is no evidence that these clones spread to or between HIV/AIDS patients up to the 7th day of their hospitalization.

Humans , Staphylococcal Infections , HIV Infections/microbiology , Cross Infection/transmission , Infectious Disease Transmission, Professional-to-Patient/statistics & numerical data , Methicillin-Resistant Staphylococcus aureus/genetics , Anti-Bacterial Agents/pharmacology , Staphylococcal Infections/microbiology , Microbial Sensitivity Tests , Cross Infection/microbiology , Bacterial Typing Techniques , Electrophoresis, Gel, Pulsed-Field , Molecular Epidemiology , Methicillin-Resistant Staphylococcus aureus/isolation & purification , Multilocus Sequence Typing , Tertiary Care Centers
Rev. Inst. Med. Trop. Säo Paulo ; 57(supl.19): 11-20, Sept. 2015. tab
Article in English | LILACS | ID: lil-762049


SUMMARYThe epidemiological characteristics of paracoccidioidomycosis were reviewed and updated. The new endemic areas in Brazil were discussed in the section regarding the geographic distribution of the mycosis. Subclinical infection with Paracoccidioides brasiliensis was discussed on the basis of skin test surveys with antigens of the fungus, seroepidemiological studies, and disease cases outside Latin America. Large case series permitted a comparison of the prevalence of the mycosis in different regions, its estimated incidence and risk factors for the development of the disease. Aspects modulating the expression of the clinical forms of paracoccidioidomycosis are also presented. This review also deals with diseases associated with the mycosis, opportunistic paracoccidioidomycosis, lethality, mortality and infection and disease in animals.

RESUMOAs características epidemiológicas da paracoccidioidomicose foram revistas e atualizadas. Novas áreas endêmicas brasileiras foram discutidas na seção de distribuição geográfica da micose. A infecção subclínica por Paracoccidioides brasiliensis foi discutida com base em pesquisas realizadas com testes cutâneos com antígenos do fungo, estudos soroepidemiológicos e em casos de doença, fora da América Latina. Grandes séries de casos permitiram a comparação da prevalência da micose em diferentes regiões, sua incidência estimada e fatores de risco para o desenvolvimento da doença. Aspectos modulando a expressão de formas subclínicas da paracoccidioidomicose foram igualmente apresentados. Esta revisão também trata de doenças associadas à micose, paracoccidioidomicose oportunista, letalidade, mortalidade e infecção e doença em animais.

Humans , Animals , Paracoccidioidomycosis/epidemiology , Incidence , Latin America/epidemiology , Paracoccidioidomycosis/veterinary , Prevalence , Risk Factors
Rev. Soc. Bras. Med. Trop ; 48(4): 483-487, July-Aug. 2015. tab, ilus
Article in English | LILACS | ID: lil-755967



Polymyxins are antimicrobial agents capable of controlling carbapenemase-producing Klebsiella pneumoniae infection.


We report a cluster of four patients colonized or infected by polymyxin-resistant and Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae.


Three patients were hospitalized in adjacent wards, and two were admitted to the intensive care unit. The index case maintained prolonged intestinal colonization by KPC-producing K. pneumoniae. Three patients received polymyxin B before the isolation of polymyxin-resistant K. pneumoniae.


Colonization by KPC-producing K. pneumoniae and previous use of polymyxin B may be causally related to the development of polymyxin-resistant microorganisms.


Adult , Aged , Female , Humans , Male , Middle Aged , Anti-Bacterial Agents/pharmacology , Cross Infection/microbiology , Klebsiella Infections/microbiology , Klebsiella pneumoniae/drug effects , Polymyxins/pharmacology , Carbapenems/pharmacology , Drug Resistance, Bacterial , Klebsiella pneumoniae/isolation & purification , Microbial Sensitivity Tests
Biosci. j. (Online) ; 31(3): 780-790, may./jun. 2015.
Article in English | LILACS | ID: biblio-963883


Common bean was originated from the Americas and has shown enormous socioeconomic importance as the main source of feeding in many countries. Due to adoption of technologies such as irrigation, the bean has been cultivated at different times throughout the year, however, the lack of cultivars adapted to the climatic conditions of the Cerrado of Tocantins has limited obtaining best yields at the time of the season. Thus, the aim of this work was to evaluate the performance of common bean genotypes in three cropping years in Cerrado soils. The experiments were conducted in the field at the Experimental Station of the Federal University of Tocantins in the dry season of the years 2010, 2011 and 2012. The experimental design was a randomized block with four replications in a 8 x 3 factorial, consisting of eight genotypes and three years. The evaluated characteristics were plant height, the first pod height, number of pods per plant, number of seeds per pod, weight of hundred grains and grain yield. The Princesa genotype stood out with yields above 3,000 kg ha-1 in more than a year of cultivation, demonstrating its potential for cropping systems in the State of Tocantins. The genotype BRS-Esplendor was the only genotype that showed stable behavior for all traits.

Originário das Américas o feijão comum tem apresentado enorme importância socioeconômica como principal fonte de alimento em diversos países. Devido à adoção de tecnologias como a irrigação, o feijoeiro tem sido cultivado em diferentes épocas ao longo do ano, porém, a falta de cultivares adaptadas as condições edafoclimáticas do Cerrado do Tocantins tem limitado a obtenção de melhores produtividades na época da entressafra. Desta forma, objetivou-se com este trabalho avaliar o desempenho produtivo de genótipos de feijão comum em três anos de cultivo em solo de Cerrado. Os experimentos foram conduzidos em campo na Estação Experimental da Universidade Federal do Tocantins nas entressafras dos anos 2010, 2011 e 2012. O delineamento utilizado foi o de blocos ao acaso com quatro repetições, num esquema fatorial 8x3, constituído por oito genótipos e três anos. As características avaliadas foram altura de plantas, altura de inserção da primeira vagem, número de vagens por planta, número de grãos por vagem, massa de cem grãos e produtividade de grãos. O genótipo Princesa se destacou por apresentar produtividades acima de 3.000 kg ha-1 em mais de um ano de cultivo, demonstrando desta forma potencial para o cultivo na entressafra no Estado do Tocantins. O genótipo BRS-Esplendor foi o único genótipo que demonstrou comportamento estável para todas as características avaliadas.

Soil , Grassland , Phaseolus , Food Supply , Genotype , Fabaceae , Efficiency
Radiol. bras ; 48(1): 1-6, Jan-Feb/2015. tab, graf
Article in English | LILACS-Express | LILACS | ID: lil-741703


Objective: To evaluate musculoskeletal involvement in paracoccidioidomycosis at computed tomography. Materials and Methods: Development of a retrospective study based on a review of radiologic and pathologic reports in the institution database. Patients with histopathologically confirmed musculoskeletal paracoccidioidomycosis and submitted to computed tomography were included in the present study. The imaging findings were consensually described by two radiologists. In order to avoid bias in the analysis, one patient with uncountable bone lesions was excluded from the study. Results: A total of seven patients were included in the present study. A total of 18 bone lesions were counted. The study group consisted of 7 patients. A total number of 18 bone lesions were counted. Osteoarticular lesions were the first manifestation of the disease in four patients (57.14%). Bone lesions were multiple in 42.85% of patients. Appendicular and axial skeleton were affected in 85.71% and 42.85% of cases, respectively. Bone involvement was characterized by well-demarcated osteolytic lesions. Marginal osteosclerosis was identified in 72.22% of the lesions, while lamellar periosteal reaction and soft tissue component were present in 5.55% of them. One patient showed multiple small lesions with bone sequestra. Conclusion: Paracoccidioidomycosis can be included in the differential diagnosis of either single or multiple osteolytic lesions in young patients even in the absence of a previous diagnosis of pulmonary or visceral paracoccidioidomycosis .

Objetivo: Avaliar o acometimento musculoesquelético da paracoccidioidomicose nas imagens de tomografia computadorizada. Materiais e Métodos: Estudo retrospectivo desenvolvido a partir de revisão de laudos radiológicos e patológicos do banco de dados da instituição. Foram selecionados pacientes com paracoccidioidomicose osteoarticular submetidos a tomografia computadorizada. Todos os casos considerados tiveram confirmação histopatológica da doença. Os achados de imagem foram descritos em consenso por dois radiologistas. Um paciente com incontáveis lesões ósseas foi excluído da contabilização das anormalidades com a finalidade de evitar viés. Resultados: Foram incluídos 7 pacientes no presente estudo. Um total de 18 lesões ósseas foi contabilizado. Em quatro casos (57,14%) a lesão osteoarticular foi a primeira manifestação da doença. As lesões ósseas eram múltiplas em 42,85%. Os esqueletos apendicular e axial foram afetados em 85,71% e 42,85% dos pacientes, respectivamente. O envolvimento ósseo caracterizou-se por lesões osteolíticas bem delimitadas. Identificou-se osteoesclerose marginal em 72,22% das lesões contabilizadas. Reação periosteal lamelar e componente de partes moles estiveram presentes em 5,55% das anormalidades. Um paciente exibiu múltiplas lesões com sequestros ósseos. Conclusão: A paracoccidioidomicose pode ser incluída no diagnóstico diferencial de lesões osteolíticas, únicas ou múltiplas, em pacientes jovens, mesmo sem diagnóstico prévio de paracoccidioidomicose pulmonar ou visceral. .

Rev. Soc. Bras. Med. Trop ; 48(1): 77-82, jan-feb/2015. tab, graf
Article in English | LILACS | ID: lil-742967


INTRODUCTION: To evaluate predictive indices for candidemia in an adult intensive care unit (ICU) and to propose a new index. METHODS: A prospective cohort study was conducted between January 2011 and December 2012. This study was performed in an ICU in a tertiary care hospital at a public university and included 114 patients staying in the adult ICU for at least 48 hours. The association of patient variables with candidemia was analyzed. RESULTS: There were 18 (15.8%) proven cases of candidemia and 96 (84.2%) cases without candidemia. Univariate analysis revealed the following risk factors: parenteral nutrition, severe sepsis, surgical procedure, dialysis, pancreatitis, acute renal failure, and an APACHE II score higher than 20. For the Candida score index, the odds ratio was 8.50 (95% CI, 2.57 to 28.09); the sensitivity, specificity, positive predictive value, and negative predictive value were 0.78, 0.71, 0.33, and 0.94, respectively. With respect to the clinical predictor index, the odds ratio was 9.45 (95%CI, 2.06 to 43.39); the sensitivity, specificity, positive predictive value, and negative predictive value were 0.89, 0.54, 0.27, and 0.96, respectively. The proposed candidemia index cutoff was 8.5; the sensitivity, specificity, positive predictive value, and negative predictive value were 0.77, 0.70, 0.33, and 0.94, respectively. CONCLUSIONS: The Candida score and clinical predictor index excluded candidemia satisfactorily. The effectiveness of the candidemia index was comparable to that of the Candida score. .

Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Alcohol Drinking/mortality , Cause of Death , Liver Diseases, Alcoholic/mortality , Marital Status , Social Isolation , Age Factors , Alcohol Drinking/economics , Cohort Studies , Commerce , Finland/epidemiology , Liver Diseases, Alcoholic/economics , Risk Factors
Rev. mex. cardiol ; 25(2): 121-125, abr.-jun. 2014. ilus
Article in Spanish | LILACS-Express | LILACS | ID: lil-723012


Se presenta el caso de un hombre de 44 años de edad sin factores de riesgo coronario; éste, después de un entrenamiento de artes marciales en el que recibió múltiples traumatismos con golpe a mano cerrada y puntapié en la cara anterior del tórax durante enfrentamiento corporal, presentó dolor opresivo intenso en región retroesternal y acudió con dos médicos, quienes le prescribieron analgésicos y antiinflamatorios. Por la persistencia de la sintomatología sin mejoría, acudió con un tercer facultativo quien realizó un electrocardiograma (ECG), el cual documentó lesión subepicárdica inferior; fue trasladado para realizar coronariografía, la cual mostró oclusión trombótica funcional del segmento proximal de la coronaria derecha, misma que fue tratada exitosamente con intervención coronaria percutánea primaria e implante de stent medicado. Este caso muestra que el infarto agudo del miocardio asociado con trauma cerrado de tórax es una patología de difícil diagnóstico.

This is a case of the 44 year old male patient without history or risk factors for coronary disease, with blunt chest trauma in the anterior region after training of an Israeli martial art, right after he had typical retroesternal chest pain, he went to different doctors who prescribed different antiinflamatory drugs, because the persistence of the pain he decided to check with a third doctor who took an EKG and found an inferior epicardial lesion. Coronary angiography showed functional thrombotic occlusion of proximal segment of the right coronary. Successful primary angioplasty and stenting was done. The case shows that myocardial infarction after blunt chest trauma is challenging in terms of diagnosis and treatment.