Potencialidades e fragilidades da rede de cuidado da pessoa com HIV/Aids / Potencialidades y fragilidades de la red de cuidado de las personas con VIH/SIDA / Potentialities and weaknesses in the care network of people with HIV/AIDS

RESUMOObjetivo:compreender as potencialidades e fragilidades da rede de cuidado da pessoa com HIV/Aids em um serviço de referência do Estado de Santa Catarina-SC.Método:participaram oito sujeitos e sua rede de cuidado, totalizando 18 participantes. Os dados foram coletados através de entrevistas e examinados por análise de conteúdo, sustentados teoricamente pelo interacionismo simbólico.Resultado:a análise resultou nas categorias: A rede ofertando o cuidado à pessoa com síndrome da imunodeficiência adquirida e Enfrentando Barreiras no cuidar, que refletem as potencialidades e fragilidades, na rede de cuidado. A primeira retrata a oferta de cuidado afetivo e humanizado e a segunda, uma rede pouco ampliada, constituída por profissionais de saúde e algum membro familiar.Conclusão:a rede de cuidado profissional é importante, mesmo diante do aumento dos atendimentos numa estrutura física e número de profissionais que já não comportam a crescente demanda.

RESUMENObjetivo:comprender las fortalezas y debilidades de la red de atención de la persona con VIH/SIDA en un centro de referencia en el estado de Santa Catarina-SC.Metodo:ocho participantes sujetos y su red de atención, por un total de 18 participantes. Los datos fueron recolectados a través de entrevistas y se examinaron mediante análisis de contenido, en teoría, con el apoyo de la interacción simbólica.Resultados:el análisis resultó en las siguientes categorías: La red de ofrecer atención a las personas con síndrome de inmunodefi ciencia adquirida y tropezando con obstáculos a la atención, que refl ejan las fortalezas y debilidades en la red de atención. El primero representa la prestación de atención emocional y humano y la segunda un poco más amplia, incluyendo la red de profesionales de la salud y un miembro de la familia.Conclusión:la red de atención profesional es importante, a pesar del aumento de las llamadas en una estructura física y el número de profesionales que ya no se comportan de la creciente demanda.

ABSTRACTObjective:to understand the strengths and weaknesses in the care network of people with HIV/AIDS in a referral center in the state of Santa Catarina-SC.Method:participants were eight subjects and their care network, totaling 18 participants. Data were collected through interviews and examined by content analysis, theoretically supported by symbolic interaction.Results:the analysis resulted in the following categories: The network offering care to people with acquired immunodefi ciency syndrome, and Facing Barriers in care, which refl ect the strengths and weaknesses in the care network. The fi rst depicts the provision of emotional and humanized care, and the second a restricted network formed by health professionals and a family member.Conclusion:the professional care network is important, despite the increased number of assistances in a physical structure and amount of professionals who no longer meet the growing demand.

A eritromicina utilizada como tratamento da encefalopatia hepática em portadores de cirrose: estudo prospectivo, randomizado, duplo-cego e controlado / Erythromycin used as treatment of hepatic encephalopathy in patients with cirrhosis: prospective study, randomized, double-blind and controlled

A encefalopatia hepática (EH) é uma complicação da cirrose considerada como sinal de mau prognóstico na doença hepática avançada. As conseqüências da EH não são completamente reversíveis, por isso o tratamento deve ter rápido início de ação e ser altamente eficaz. Atualmente os antibióticos são os medicamentos mais eficazes na EH aguda, porém no tratamento da EH são utilizados apenas os de baixa absorção, que em geral demandam certo tempo para apresentar resultados. Além disso, esses antibióticos não são isentos de efeitos adversos. Análise comparativa da eficácia da eritromicina (ERY), usada pela primeira vez no tratamento da EH em portadores de cirrose. Ensaio clínico prospectivo, randomizado e duplo cego de pacientes adultos portadores de cirrose, internados por EH no período de agosto/2008 a outubro/2010 no Hospital das Clínicas da Faculdade de Medicina de Botucatu - UNESP. Após a admissão, os indivíduos receberam tratamento com ERY 250 mg ou neomicina (NEO) 1 grama. As medicações foram utilizadas por via oral e administradas de 6/6 horas até a alta hospitalar, prescrição de outro antibiótico ou óbito. Todos os pacientes foram avaliados diariamente por meio do índice de encefalopatia hepática (IEH). Foram realizadas dosagens diárias de amônia sérica e proteína C reativa (PCR), bem como exames de bioquímica hepática e renal. A análise estatística foi realizada por meio de testes de comparação entre os grupos (testes t de Student e Mann-Whitney), medidas de distribuição central e análise descritiva. 30 casos de EH foram avaliados (15 tratados com ERY e 15 com NEO). Os grupos foram homogêneos em relação a idade, IEH, grau de EH à admissão hospitalar, escala de coma de Glasgow, escore Meld e classificação de Child-Pugh modificada.(...)

Hepatic encephalopathy (HE) is one of the major complications in patients with hepatic cirrhosis, and is considered a sign of bad prognosis in this setting. The consequences of HE are not totally reversible, thus the treatment must to be effective in a short time to attain HE regression. Actually, antibiotics are the best options in acute HE treatment. However, the antibiotics used in HE are drugs of low absorption, which often spend a long time to obtain its effect. Nevertheless, these antibiotics are not free of adverse effects. Comparative analysis of efficacy of erythromycin (ERY) used by the first time as a treatment of HE. Randomized controlled trial of adult patients with HE and hepatic cirrhosis admitted from August 2008 to October 2010 in the hospital of the Botucatu Medical School - UNESP. After randomization, the patients received either ERY 250 mg or neomycin (NEO) 1 g. The drugs were administered orally q.i.d. until hospital discharge, prescription of another antibiotic or death. All subjects were evaluated diary and the hepatic encephalopathy index (HEI) was calculated every day. Serum ammonia, C reactive protein (CRP) and biochemical profile (hepatic and renal exams) were obtained diary of each patient. Statistical analysis was performed using tests for comparison between the groups (Student t test and Mann-Whitney test), Spearman’s rank correlation, central distribution measures and descriptive analysis. 30 cases of HE were evaluated (15 treated with each drug). In the moment of admission, the groups were homogeneous with respect to age, HEI, HE grade, Glasgow coma scale, Meld score and Child-Pugh modified classification. The subjects that received ERY had a short time of hospitalization (p = 0.032) and a great degree in the alanine aminotransferase (ALT) levels (p = 0.026).(...)

efficacy of topical solution of 0.3% ciprofloxacin in treatment of mild to moderate acne vulgaris

Acne vulgaris is a very common disorder affecting virtually every adolescent at some point in time. Topical treatment of acne involves the use of retinoids and antimicrobials. Antimicrobials reduce P. acne population and are effective for treatment of inflammatory lesions. We evaluated the efficacy and safety of topical ciprofloxacin solution and compared it with topical erythromycin solution. The study was a prospective single-blind clinical trial. One hundred patients with mild to moderate acne were enrolled. The patients were randomly treated with topical application of 0.3% ciprofloxacin or 4% erythromycin solutions. For a six week period, they were visited every two weeks. Acne severity index [ASI] was calculated in each visit and recorded. Ninety-three patients completed the study, 50 patients in the ciprofloxacin and 43 in the erythromycin groups. Irritation was generally mild for both treatments and no discontinuation was reported because of adverse effects. There was no statistically significant difference between the two treatment groups in reduction of comedons or papules but reduction of pustules was greater in ciprofloxacin treatment group after 4 weeks. ASI was reduced in the two groups but in ciprofloxacin treated patients, this reduction was more significant at all follow up visits. The results of this study indicate that topical solutions of erythromycin and ciprofloxacin were effective in treating mild to moderate acne vulgaris and both were well-tolerated by the patients. Ciprofloxacin solution produced greater reduction in pustule counts and ASI, during the six week period of twice-daily application. This novel modality may have an important potential role in rotational topical therapy of inflammatory acne lesions

Determining the efficacy of erythromycin ointment 0.5% in protection of conjunctivitis in neonates under phototherapy with eye patches

Ophthalmia neonatorum is a form of conjunctivitis that occurs in infants younger than 4 weeks of age. It is the most common eye disease in newborns. It presents as the inflammation of mucous membrane lining posterior layer of eyelids and bulbar part of eyeball except cornea. It's complications are corneal ulcer, corneal perforation and blindness. The aim of this randomised clinical trial was to investigate the effect of erythromycin ointment 0.5% to prevent the incidence of conjunctivitis in icteric neonates who were under phototherapy with eye patches. A total of 200 cases of icteric newborns in Javaheri hospital who admitted for phototherapy were considered. Neonatal conjunctivitis was not correlated with gestational age, duration of admission, type of delivery, and weight. It was not associated with erythromycin use, however, there was a significant association between conjunctivitis and age of newborn. Results showed that erythromycin ointment is not useful for protecting conjunctivitis in neonates under phototherapy with eye patches

Incidencia, diagnóstico, manejo y evolución de las neumonías atípicas en el Hospital Militar Cap. (Av) Guillermo Hernández Jacobsen: enero 1999-mayo 2006 / Incidence, diagnosis, management and development of atypical pneumonia at the Military Hospital Cap. (Av)Guillermo Hernández Jacobsen: january 1999-may 2006

Se realiazó un estudio descriptivo, retrospectivo y observacional mediante la revisión de 35 historias médicas de pacientes hospitalizados con Neumonía Atípica entre enero de 1999 y mayo de 2006. El grupo etáreo más afectado fue el de 15 a 39 años de edad, que representa el 54.2 por ciento. Los síntomas más frecuentes fueron de origen respiratorio, como son tos (32.5 por ciento) y disnea (26.25 por ciento). El 22.8 por ciento resultó positivo para Mycoplasma y el 20 por ciento para Chlamydia. Al momento del ingreso, se manejó con amtibioticoterapia basada en Levofloxacina en un 29.7 por ciento. Claritromicina en un 16.2 por ciento. Se observo evolución satisfactoria en el 82.8 por ciento de los casos en estudio.

Terapêutica medicamentosa na isquemia e reperfusão mesentérica: revisão da literatura / Medicamentous therapeutical in the ischemia and mesenteric reperfusion: review of literature

Até pouco tempo atrás se acreditava que na isquemia mesentérica todas as alterações orgânicas desta afecção eram devidas à obstrução total ou parcial do fluxo arterial intestinal. Recentes descobertas quanto à fisiopatologia do processo de isquemia e reperfusão mesentérica demonstraram que os radicais livres, principalmente, atuam durante a reperfusão, levando à lesão tecidual muito mais importante do que as lesões que ocorrem na fase de isquemia isoladamente. Assim, surge uma nova possibilidade terapêutica além do tratamento cirúrgico, em que uma determinada substância poderia atuar de modo a inibir ou minimizar a cascata de alterações no nível celular que culminam na lesão e morte celular. Realizamos uma ampla revisão da literatura médica atual pelos bancos de dados LILACS e MEDLINE, visando verificar quais os fármacos estudados para este fim e os resultados obtidos nas pesquisas. Constatamos que inúmeras substâncias têm sido avaliadas em estudos experimentais, em sua maioria utilizando ratos e a maioria não apresentou resultados satisfatórios a ponto de permitirem seu emprego na prática clínica; algumas, entretanto, apresentaram resultados promissores, necessitando ainda de novos estudos a fim de se descobrir uma substância que possa ser empregada em seres humanos em situações de isquemia e reperfusão mesentérica, a fim de se evitar tratamentos intervencionistas com altos índices de morbi-mortalidade.

Nutrición enteral en UCI: ¿qué hay de nuevo? / Enteral nutrition in ICU: what's new?

This review analysis various controlled randomized studies and systematic reviews in which tolerance, complications, drawback factors, immunonutrition and other advances where evaluated in relationships to enteric nutrition in critical patients.

Oral erythromycin for treatment of feeding intolerance in preterm infants: a preliminary report.

Feeding intolerance is a common problem in preterm infants resulting in a prolonged hyperalimentation which is associated with an increased risk of serious and sometimes even life threatening complications, including cholestasis jaundice, liver impairment, nutritional deficiency, biochemical rickets and catheter-related septicaemia. Erythromycin, a commonly used macrolide antibiotic, has been reported as having potent prokinetic properties and enhancing gastrointestinal motor activity. The authors, therefore, conducted a preliminary study of oral erythromycin for the treatment of feeding intolerance in preterm infants to evaluate the safety and efficacy of this drug. AIM: To evaluate the safety and efficacy of oral erythromycin as a prokinetic agent in promoting enteral feeding in preterm infants with feeding intolerance. METHOD: Preterm infants, gestational age (GA) < or = 36 wk, who met the feeding intolerance criteria, were enrolled in the study. Inclusion criteria included infants who received enteral feeding less than half of full feeding or less than 75 ml/kg/day by day 14 post-natal age or gastric residual > or = 50 per cent of a given amount of feeding, more than 2 consecutive feeds by day 7 post-natal age. All patients received oral erythromycin ethylsuccinate 12 mg/kg every six hours for 2 days, then 3 mg/kg every six hours for 5 days. The times taken to establish full enteral feeding after the drug treatment and time to stop hyperalimentation were recorded. Potential adverse effects of erythromycin were assessed. Response to treatment was defined as decreased gastric residual < 30 per cent of a similar amount of the previous feed and was able to continue to full feeding. RESULTS: Ten preterm infants were enrolled in this study with a mean GA of 30.8 weeks (26-35), mean birth weight of 1,489 g (range 900-2,560 g) and mean age at entry of 9.2 days (range 7-12 days). Nine of 10 infants responded to treatment within 24 hours. The average time to establish full enteral feeding after the drug treatment was 6.6 days (range 4-10 days). None of the infants developed adverse effects such as vomiting, diarrhea, or pyloric stenosis. CONCLUSION: The preliminary data indicates that oral erythromycin is effective and safe in facilitating enteral feeding in preterm infants with feeding intolerance. Infants can achieve full feeding within a week after treatment, and this may shorten the course of hyperalimentaiton. Further randomized controlled trials are warranted.

Clinical use of erythromycin in children with gastrointestinal dysmotility.

Intolerant feeding is a common symptom in gastrointestinal disorders which is commonly found in systemic diseases. Prokinetic drugs play a role in management. A low dose of erythromycin has an effect on improvement of antroduodenal motility and gastric emptying in children and adults. The objective of this study was to evaluate the efficacy of intravenous erythromycin in the treatment of GI dysmotility in children. Retrospective studies were performed in the Department of Pediatrics, Siriraj Hospital, Mahidol University between 1996 and 2000 in 22 patients with intolerance of feeding due to GI dysmotility. Their ages ranged from 11 days to 12 years (42.1 +/- 48.1 months). The patients were divided into 2 groups: 12 critically ill and 10 non-critically ill patients. Dosages of intravenous erythromycin were 1-3 mg/kg/dose every 6 hours. The result of treatment was evaluated as: good (tolerant feeding), fair (tolerant feeding but needing erythromycin for longer than 1 month) and failed (intolerant feeding). All non-critically ill patients had improved symptoms with 9 +/- 4.3 days duration of treatment. In the other group, 8 patients had good results with 10.9 +/- 6 days of treatment. Two patients needed the drug for longer than 1 month and the other 2 patients did not respond and died due to severe infection. Low dose intravenous erythromycin had good efficacy in the treatment of intolerant feeding related to GI dysmotility in children.

Angiomatosis bacilar / Bacillary angiomatosis

La angiomatosis bacilar (AB) es un proceso patológico caracterizado por la prolifración vascular secundaria a microorganismos del género Bartonella. Se ha asociado comúnmente con pacientes HIV positivos, pero también ha sido reportado en otros pacientes inmunodeprimidos y en un pequeño grupo de pacientes sin inmuno-supresión demostrada. Se caracteriza por lesiones cutáneas vasculares que pueden diseminarse sistémicamente. La angiomatosis bacilar es tratable y puede ser curada con tratamiento antibiótico

The changing face of antihistamines and cardiac adverse drug reactions: a clinical perspective.

Recent times have witnessed a qualitative shift in the recognition and management of adverse drug effects. Many of them occur in organs that are unconnected to the primary target of pharmacological action. Out of these, cardiac side-effects have drawn particular attention because of their potential to cause death. Starting with the early observations on antibiotics such as macrolides, followed by fluoroquinolones and others, the focus has now shifted to the antihistamine class of drugs which are used extensively by patients all over the world, thanks to the ever increasing levels of environmental pollution. The occurrence of prolonged QTc interval following treatment with terfenadine leading to ventricular tachycardia of torsades de points variety with a potentially fatal outcome has forced many regulatory authorities of the world to clamp a ban the use of this drug. Alerted by these developments, studies on a new member, followed by fluoroquinolones and others, the focus has now shifted to the antihistamine class of drugs which are used extensively by patients all over the world, thanks to the ever incresing levels of envrionmental pollution. The occurrence of prolonged QTc interval following treatment with terfenadine leading to ventricular tachycardia of torsades de points variety with a potentially fatal outcome has forced many regulatory authorities of the world to clamp a ban use of this drug. Alerted by these developments, studies on a new member of non-sedating antihistamine class viz, fexofenadine, have been reviewed especially because of the structural similarity between terfenadine and fexofenadine. It is now clear that despite the closeness of its chemical structure to terfenadine fexofenadine behaves in a different manner and does not affect the electrophysiology of the heart muscle tissue, as proved by data from extensive clinical trials as well as membrane models in vitro. Interestingly, the solitary false alarm that was sounded on the drug by a group of workers in the Netherlands was later rectified by the same group. Clinically speaking, the cardiovascular safety of fexofenadine has been convincingly demonstrated at various dose levels and various time intervals, alone and together with other drugs of potential toxigenicity. All things put together, it appears reasonable to conclude that fexofenadine is free from cardiovascular ADRs of clinical significance. It could also be concluded that cardiac side-effects of antihistamines is not a class effect.

En coqueluche: ¿es posible? / In pertussis: is it possible?

Existen esquemas alternativos a los recomendados por la Academia Americana de Pediatría para el tratamiento antimicrobiano de la coqueluche. Estudios controlados apoyan la posibilidad de reducir el plazo de tratamiento a 7 días empleando eritromicina. Desde cuidarse en especial la dosficación de eritromicina (para etilsuccinato debe ser de 50 a 60 mg/kg/ día y administrarse siempre inmediatamente después de las comidas). El empleo de nuevos macrólidos requiere mayor base experimental para establecer dosis diaria, duración y eficacia bacteriológica. Es conveniente implementar el cultivo en centros centros centinelas para vigilar la susceptibilidad in vitro de bordetella pertussis y ratificar la eficacia bacteriológica de los esquemas abreviados de terapia específica. Los pasos abreviados de tratamiento de la infección establecida por bordetella pertussis parecen ser extrapolables a los esquemas recomendados para la profilaxis en los contactos

Antibioticoterapia nas infecçöes odontogênicas / Antibiotic therapy in odontogenic infections

Os autores fazem uma revisäo a respeito dos princípios fundamentais da antibioticoterapia, procurando orientar o cirurgiäo-dentista na utilizaçäo racional dos antibióticos, que säo importantes coadjuvantes no tratamento das infecçöes odontogênicas. Além disso, säo apresentados esquemas antibióticos para serem utilizados em infecçöes leves, moderadas ou severas, visando o uso destes medicamentos de acordo com suas características individuais

Estudio ORACLE: protocolo y estado actual de la investigación en la Argentina / ORACLE study: protocol and present status of the investigation in Argentine

ORACLE es una investigación aleatorizada factorial pragmática multicéntrica, dirigida desde la Universidad de Leicester (Reino Unido), cuyo objetivo es verificar el rol de la antibióticoterapia (eritromicina y/o augmentina y/o placebo) en la amenaza de parto prematuro (APP), con o sin rotura prematura de membranas (RPM). Los puntos finales principales son mortalidad perinatal y morbilidad neonatal severa. El tamaño muestral propuesto es de 10.000 casos. Participan 164 maternidades de 16 países y se llevan incluidos 7.364 pacientes. Argentina, que inició su gestión en agosto de 1997, a marzo de 1999 lleva incluidos 762 pacientes, reclutados entre las 9 maternidades participantes, sitas en Buenos Aires, provincia de Buenos Aires y Salta. Dos de ellas, figuran 2º y 3º en la lista de hospitales con mayor índice de reclutamiento en el mundo. El 88 por ciento de las ingresadas presentó APP y el 12 por ciento, RPM. Ambas situaciones se combinaron en el 8 por ciento de ellas. La mediana de la edad gestacional al ingreso es 32 semanas (cuartilos: 29 y 34). El 82,6 por ciento ya finalizó su participación y sólo hay un 2 por ciento de pérdidas de seguimiento. El 58 por ciento de los nacimientos ocurrió al término. La mediana de peso al nacer es 2.870 g (cuartilos 2.250 y 3.250). El 27 por ciento requirió UTI y la mortalidad perinatal es 3,6 por ciento. No se han registrado efectos adversos fetoneonatales atribuibles a las medicaciones del estudio. Los efectos adversos maternos suman 14 casos y han sido los habituales ante el consumo de antibióticos.

Valoración en niños de la aceptabilidad de antibióticos resistentes a beta-lactamasas / Assessment of the palatability of beta-lactamase-resistant antibiotics in children

Se evaluó la aceptabilidad de tres antibióticos conocidos por su resistencia a beta-lactamasas en una muestra integrada por niños. Los resultados fueron comparados con los obtenidos en adultos. La aceptabilidad al sabor de los antibióticos en suspensión fue calificada con base en una escala analógica de 10 cm. Tanto en niños como en adultos, se asignó la calificación más alta a la azitromicina. Las significativas diferencias entre los sabores sugieren que este factor debe ser tomado en cuenta en todo estudio de aceptabilidad

Sífilis congénita: experiencia de cinco años en control serológico (VDRL) del embarazo, casos clínicos y estudio de factores facilitadores / Congenital syphilis: 5 years experience in serological control (VDRL) of pregnancy, clinical cases and study of risk factors

Este artículo presenta el seguimiento serológico de pacientes embarazadas VDRL positivas, casos de sífilis congénita y factores facilitadores de esta patología en el Centro de Control de ETS del Servicio de Salud Metropolitano Sur Oriente, durante el periodo 1991-1995. Se realizaron 141.234 pruebas VDRL en embarazadas; de éstas 1.696 resultaron positivas (1,2 por ciento) y fueron sometidas a pruebas treponémicas (FTA-ABS o MHA TP). El 78,1 por ciento correspondió a serología residual o inespecífica, mientras que el 20,7 por ciento correspondió a sífilis. De un total de 68.966 recién nacidos vivos, se realizó VDRL en sangre de cordón umbilical a 67.516 (97,9 por ciento), de los cuales 431 (0,64 por ciento) resultaron positivos. De ellos, 38 (8,8 por ciento) presentaron sífilis congénita y 372 (86,3 por ciento) mostraron serología reactiva. Hubo 43 casos de sífilis congénita: 38 en neonatos y cinco en lactantes. Treinta casos fueron de sífilis congénita latente y 13 de sífilis congénita precoz: neurolúes (nueve casos) y hepatitis luética (cuatro casos, dos de los cuales tuvieron además neurolúes), un síndrome nefrótico relacionado con neurolúes y dos casos de osteoartritis. El control prenatal eficiente es eficaz en la prevención de sífilis congénita. Los casos de enfermedad se debieron a: 1) embarazo no controlado, 2) infección sifilítica de la madre dentro de las cuatro semanas previas al parto, 3) control prenatal en otros servicios públicos o privados y 4) deficiencias del equipo de salud. Se destaca el valor de VDRL (+) de cordón umbilical: en el 95 por ciento de los casos, esta prueba influyó para establecer el diagnóstico correcto. Se propone la identificación de embarazadas con alto riesgo de transmisión de sífilis para control serológico más frecuente y mayor educación sobre ETS, sobre todo de sífilis y sus consecuencias para feto y neonato

Formulation and evaluation of controlled release erythromycin tablets and capsules

Various formulations of erythromycin base were designed to be controlled release forms. Tablets were prepared using Avicel as a diluent and both of stearic acid and magnesium stearate as hydrophobic materials to control the release. In addition, a control was prepared by direct compression of erythromycin base powder into tablets. On the other h and, microcapsules [MC] and solid dispersions [SD] of erythromycin base, which were prepared in a previous study, were either directly compressed into tablets or filled into hard gelatin capsules. Then, the formulated products were evaluated for hardness, disintegration time, penetration and dissolution rate testing. Also, the bioavailabilities of these products were investigated on humans. It was found that capsules containing MC or SD revealed higher release rate profiles compared to the corresponding tablets. On the other h and, products containing magnesium stearate were found to depict a reduction in drug release upon increasing magnesium stearate. However, the presence of stearic acid in the product resulted in a reverse effect