Electrocardiographic changes during low-dose, short-term therapy of cutaneous leishmaniasis with the pentavalent antimonial meglumine

The pentavalent antimonial (Sb5+) meglumine is the drug of choice for the treatment of cutaneous leishmaniasis (CL) in Brazil. Although the cardiotoxicity of high-dose, long-term Sb5+ therapy is well known, the use of low-dose, short-term meglumine has been considered to be safe and relatively free from significant cardiac effects. In order to investigate the cardiotoxicity of low-dose, short-term therapy with meglumine in cutaneous leishmaniasis, 62 CL patients treated with meglumine were studied. A standard ECG was obtained before and immediately after the first cycle of treatment (15 mg Sb5+ kg-1 day-1). The electrocardiographic interpretation was carried out blindly by two investigators using the Minnesota Code. There were no significant differences in qualitative ECG variables before and after meglumine treatment. However, the corrected QT interval was clearly prolonged after antimonial therapy (420.0 vs 429.3 ms, P<10-6). QTc augmentation exceeded 40 ms in 12 patients, 7 of whom developed marked QTc interval enlargement (500 ms) after meglumine therapy. This previously unrecognized cardiac toxicity induced by short-term, low-dose antimonial therapy has potentially important clinical implications. Since sudden death has been related to QTc prolongation over 500 ms induced by high-dose antimonial therapy, routine electrocardiographic monitoring is probably indicated even in CL patients treated with short-term, low-dose meglumine schedules. Until further studies are conducted to establish the interactions between pentavalent antimonials and other drugs, special care is recommended when using meglumine in combination with other medications, in particular with drugs that also increase the QTc interval

Seroprevalence of retrovirus infection in a population of Tanzania bordering HIV-1 epidemic areas

A seroepidemiological survey in the Mara Region of Tanzania investigated a randomly selected population between the ages of 15 and 49 in rual and urban areas; as well as a group including high-risk individuals. Reports on 1272 individuals confirm HIV-1 seropositivity in the rural area at under 3 percent; HLTV-1 is present. Preliminary results in the other two groups suggest a higher seroprevelance

Seroprevalence of retrovirus infection in a population of Tanzania bordering HIV-1 epidemic areas

A seroepidemiological survey in the Mara Region of Tanzania investigated a randomly selected population between the ages of 15 and 49 in rural and urban areas; as well as a group including high-risk individuals. Reports on 1272 individuals confirm HIV-1 seropositivity in the rural area at under 3 percent; HLTV-1 is present. Preliminary results in the other two groups suggest a higher seroprevelance

Sistema médico de emergência: princípios básicos / Emergency medical care system: basic principles

Cada vez säo mais freqüentes os acidentes que ocorrem em nosso meio. A visäo fatalista com que säo encaradas tais ocorrências determina atitudes de omissäo ou mesmo de recusa em relaçäo ao planejamento global da questäo. O Sistema Médico de Emergência deve-se centrar em dois objetivos fundamentais: meios de comunicaçäo eficientes e terapêutica precoce. As falhas principais da assistência de emergência em nosso país säo: inexistência de eficiente sistema de comunicaçöes; deficiência de atendimento médico imediato; inadequaçäo dos meios de transporte; ausência ou descontinuidade do treinamento das equipes de emergência; e falta de orientaçäo educacional, dirigida à comunidade