Resumo em Inglês:

Respiratory tract infections have an important clinical and economic impact and they are the most common indication for antibiotic use in outpatient practice. This prospective, multicenter non-controlled trial assessed the efficacy and safety of gatifloxacin in the treatment of community-acquired respiratory tract infections. Patients were treated with a daily oral dose of gatifloxacin 400 mg for 7-14 days. The diagnosis of respiratory infection was made based on the clinical condition and/or radiologic findings. A total of 5,044 adult patients with community-acquired respiratory infections was treated with gatifloxacin in different centers in Brazil between March 1, 2001, and October 31, 2001. Among the 5,044 patients treated, 1,501 patients (29.76%) had community-acquired pneumonia, 756 (14.99%) had acute exacerbation of chronic bronchitis and 2,787 (55.25%) had acute sinusitis. Of the total of patients treated, 3,607 (71.51%) were considered cured, 1,261 (25%) progressed with some clinical improvement, 28 (0.56%) presented a relapse, 56 (1.11%) failed to treatment and 92 (1.82%) were unable to be evaluated. Adverse events were described in 634 (12.57%) patients. The most common adverse events were: nausea (2.24%); dyspepsia (1.86%); diarrhea (0.79%); change in taste (0.46%); insomnia and irritability (0.22%); dizziness (0.77%); headache (0.42%); allergic reaction (0.18%); Central Nervous System alterations - insomnia, agitation, anxiety - (0.46%). This study showed that the treatment of respiratory tract infections with gatifloxacin was safe and efficient and had a low incidence of adverse events.

Resumo em Inglês:

OBJECTIVES: Evaluation of the effectiveness, safety and tolerability of gatifloxacin in the treatment of outpatients with community-acquired pneumonia (CAP). STUDY DESIGN: A prospective, multicenter, non-comparative clinical study carried out in Brazil. Voluntary, unpaid physician participation contributed to an unbiased study design. PATIENTS: Adult outpatients with clinical diagnosis of CAP. REGIMEN: Gatifloxacin, 400 mg PO once daily for 7 to 14 days. STUDY PROCEDURES: Initial clinical assessment, at the first day of gatifloxacin therapy; final evaluation after 7 to 14 days of treatment. RESULTS: According to the physicians' assessments 97.3% of patients were cured or improved after gatifloxacin treatment. The incidence of adverse events was low and the most commonly reported events were nausea and dyspepsia. CONCLUSIONS: Gatifloxacin, 400 mg PO once daily for 7 to 14 days, is effective and safe in the treatment of patients with CAP.

Resumo em Inglês:

Factors associated with undetectable viral load (<80 copies/ml) were investigated among non-pregnant adults in antiretroviral treatment in a specialized service for HIV/AIDS in Southern Brazil. Use of antiretrovirals was investigated in two interviews (one month interval). Clinical data were collected from the clinical records; viral load previous to adherence measurement was defined the viral load previous to the first interview; the final viral load, the viral load subsequent to the second interview (interval between measures approximately 6 months). Undetectable final viral load occurred in 48% of the patients and was positively associated with levels of treatment adherence (p<0.001), being 19% for less than 60% of adherence and about 60% for adherence greater than 80%. In the multivariate model, the odds of undetectable final viral load was four times greater for 80-94% and > or = 95% of adherence (CI 95% 1,80-13,28; CI 95% 1,73-9,53), compared with less than 60% adherence; it was greater for less than 6 months in treatment (OR = 3.37; CI 95% 1.09-10.46); and smaller for viral load previous to adherence measurement > or = 5.2 log10 (OR = 0.19; CI95% 0.06-0.58), adjusted for these variables and sex, age, clinical status, current immune status, group of drugs and interval between the two measurements of viral load. The crude odds were lower for age 16-24 years and use of Nucleoside Analog Reverse Transcriptase Inhibitors only, but these effects were not significant in the multivariate model. There was no evidence of effect of sex, clinical status, current immune status, and changes in treatment regimen. Treatment adherence gave the largest effect. Motivational interventions directed at adherence may improve treatment effectiveness.

Resumo em Inglês:

Having a tattoo has been associated with serological evidence of hepatitis B and C viruses, as well as human immunodeficiency virus infections and syphilis; all of these are known to be transmissible by blood transfusion. These associations are of higher magnitude for individuals with nonprofessionally-applied tattoos and with two or more tattoos. Tattoos are common among drug addicts and prisoners, conditions that are also associated with transfusion-transmitted diseases. We examined the implications of these associations for the screening of blood donors in Brazil. Numbers of individuals who would be correctly or unnecessarily deferred from blood donation on the basis of the presence of tattoos, and on their number and type, were calculated for different prevalence situations based on published odds ratios. If having a tattoo was made a deferral criterion, cost savings (due to a reduced need for laboratory testing and subsequent follow-up) would accrue at the expense of the deferral of appropriate donors. Restricting deferral to more `at-risk' sub-groups of tattooed individuals would correctly defer less individuals and would also reduce the numbers of potential donors unnecessarily deferred. Key factors in balancing cost savings and unnecessary deferrals include the magnitude of the pool of blood donors in the population, the prevalence of individuals with tattoos and the `culture' of tattoos in the population. Tattoos can therefore be an efficient criterion for the screening of blood donors in certain settings, a finding that requires corroboration from larger population-based studies.

Resumo em Inglês:

The main strategy to prevent transfusion-associated Chagas' disease is the identification of T. Cruzi-infected blood donors by serological screening tests, however there is no perfect serological gold standard. We evaluated an enzyme immunoassay (EIA), an indirect hemaglutination (IHA), and an indirect immunofluorescence (IIF) test for detecting T. Cruzi antibodies in Brazilian blood donors. The results were submitted to latent class analysis, and a radioimmunopreciptation (RIPA) test was performed on repeatedly positive samples. Among 1951 donors, 11 (0.56%) were positive by EIA, 6 (0.31%) by IHA and 16 (0.82%) by IIF. Six samples were positive with all tests, while 4 reacted with EIA and IIF. The RIPA was positive in 6 (75.0%), 7 (66.6%), and 4 (54.0%) samples reacting by the EIA, IHA and IIF tests, respectively. The latent class model detected a high sensitivity rate (100%) for the EIA and IIF, and a specificity rate of 99.95% and 99.69% for the EIA and IIF tests, respectively. The probability of being case according to the model was 99.92% when both EIA and IIF were positive, and 100% for the association of EIA, IIF, and IHA.

Resumo em Inglês:

A case of Pulmonary Alveolar Proteinosis (PAP), in association with tuberculosis, is described in a 35-year-old diabetic patient. Lung biopsy showed an intra-alveolar accumulation of PAS-positive material, and multifocal granulomas compatible with tuberculosis. The bronchoalveolar culture was positive for Mycobacterium tuberculosis. PAP results from an imbalance of the mechanisms that regulate the homeostasis of the surfactant, where specific proteins are involved, especially SP-A and SP-D, the cytokines, IL-10 and GM-CSF, in addition to alveolar macrophages and type-II pneumocytes. Chemotaxis and phagocytic capacity are reduced. PAP and diabetes share several immunological disfunctions that may increase the risk for tuberculosis. Although there are no controlled studies, the diagnosis of PAP in diabetic patients with tuberculosis must be considered.

Resumo em Inglês:

Vancomycin has been used with increased frequency during the past 15 years and the most common toxicity with this drug is the "red man syndrome". Other adverse effects include neutropenia, fever, phlebitis, nephrotoxicity, ototoxicity, thrombocytopenia, interstitial nephritis, lacrimation, linear IgA bullous dermatosis, necrotizing cutaneous vasculitis and toxic epidermal necrolysis. Only two cases of vancomycin-induced Stevens-Johnson syndrome and one case of pancytopenia have been reported in the medical literature. The treatment for both situations is based on cessation of the vancomycin therapy; in cases of Stevens-Johnson syndrome, antihistamine and/or steroid agents can be used. This article reports a case of pancytopenia and a case of erythema major associated with neutropenia.

Resumo em Inglês:

This report describes a case of Toxoplasma encephalitis during pregnancy of an HIV infected woman who was severely immunosuppressed (CD4: 17 cells/mm3), had a high viral load (RNA PCR:230,000 copies/ml), was treated with sulfadiazine, pyrimethamine and folinic acid for toxoplasmosis and was being treated with highly potent antiretroviral drugs (AZT, 3TC and nelfinavir) for HIV infection. The newborn was born through an elective C-section, received six weeks of AZT according to the 076 protocol and was clinically normal at birth. Subsequently he had two RNA PCR negatives for HIV, seroreverted and had no clinical or laboratory evidence of congenital toxoplasmosis. Despite the concerns of the use of these combined therapies on the foetus during pregnancy, their efficacy illustrates that keeping the mother alive and in good health is an important strategy to protect the unborn child from acquiring these two infections.