Resumo em Inglês:

Linezolid, an oxazolidinone-class antimicrobial agent, is a new drug; its use has frequently been questioned due to its high price. However, recent trials have demonstrated that the use of linezolid in mechanical ventilation-associated nosocomial pneumonia caused by methicillin-resistant Staphylococcus aureus (VAP-MRSA) may be justified due to its improved efficacy compared to vancomycin. Price and cost have different magnitudes, and clinical efficacy should always be considered in the decision-making process. Our objective was to determine whether linezolid treatment was more cost-effective than vancomycin for treating VAP-MRSA. METHODOLOGY: Elaboration of an economic model from a metanalysis of previous clinical trials comparing both drugs, through a cost-effectiveness analysis. Costs of the treatments were calculated using Brazilian parameters and were compared to the results obtained in the metanalysis. In order to compare the results with real life conditions, costs were calculated for both name brand and for generic vancomycin. RESULTS: The cost (May/2004) per unit (vial, ampoule or bag) was R$ 47.73 for the name-brand vancomycin, R$ 14.45 for generic vancomycin and R$ 214.04 for linezolid. Linezolid's efficacy in VAP-MRSA according to the metanalysis was 62.2% and vancomycin's efficacy was 21.2%. The total cost per cured patient was R$ 13,231.65 for the name-brand vancomycin, R$ 11,277.59 for generic vancomycin and R$ 7,764.72 for linezolid. CONCLUSION: Despite the higher price per unit, linezolid was more cost-effective than vancomycin.

Resumo em Inglês:

Pain is frequently reported by patients infected with Acquired Immunodeficiency Virus (HIV), and its causes and specific treatment should be appropriately investigated. We evaluated 197 hospitalized HIV-positive patients with serial interviews and analysis of prescriptions and clinical evolution charts. The main characteristics of pain reported by these patients were: high intensity (60.7%), high frequency (72.0%) and well-known causes (88.8%). Fifty-two per cent of the patients reported persistent or frequent pain during the two weeks before hospital admission. Parameters such as gender, educational level and Karnofsky Index showed no direct relation to the presence or absence of pain. The most commonly affected sites were the head (28.0%) and the abdomen (26.2%). The frequency of indications of pain in the clinical evolution charts (46.2%) was considerably lower than the frequency of complaints reported by patients during the interviews (76.3%). Pain was undertreated in 83.2% of patients, both due to poor efficacy of the prescribed medications and to the excessive and inefficient use of standing order ("if necessary") regimens. We observed that pain was better managed during the hospitalization period, although this cannot be explained by improvement of the analgesic treatment; it might be due to successful treatment of the underlying disease. We concluded that pain reported by hospitalized HIV-positive patients is often underestimated and inadequately treated by assisting doctors, in spite of its severity and frequency.

Resumo em Inglês:

We examined the characteristics of AIDS mortality in Rio de Janeiro city from 1995 to 2003. During this period, highly active antiretroviral therapy with protease inhibitors was made available, and it changed the pattern of the epidemics. There was a 47.5% reduction in the number of AIDS deaths within the period, with an increase in the proportion of women among the deceased; their schooling was lower than that of the men, similar to the trends of the national-level epidemics. The main place of death changed from university hospitals to emergency rooms. The proportion of cases reported to the National Diseases Surveillance System (SINAN) reported only through the death certificate remained high. Although there is free distribution of antiretrovirals by the public health system, many patients still lack access to diagnosis and treatment. We need to give priority to access to anti-HIV testing and treatment, to increase the quality of care and to look into the issue of adherence in order to further reduce AIDS mortality.

Resumo em Inglês:

Establish the susceptibility pattern of Gram-negative bacteria causing infections in ICU patients, MYSTIC Program Brazil 2003. Gram-negative bacteria (n = 1,550) causing nosocomial infections were collected at 20 Brazilian centers. The central laboratory confirmed the identification and performed the susceptibility tests by Etest methodology (AB Biodisk, Solna, Sweden) for meropenem, imipenem, ciprofloxacin, ceftazidime, cefepime, cefotaxime, piperacillin/tazobactam, gentamicin, and tobramycin. Interpretation criteria used were according to National Committee for Clinical Laboratory Standards (NCCLS). Pseudomonas aeruginosa (30.3%) was the most frequent isolate, followed by E. coli (18.6%), Klebsiella pneumoniae (16.9%), Acitenobacter baumannii (8.8%), and Enterobacter cloacae (7.1%). Pseudomonas aeruginosa (n=470) isolates presented susceptibility rates of 64% to meropenem, 63.8% to piperacillin/tazobactam, 63.4% to amikacin, 58.7% to imipenem. Acitenobacter baumannii presented susceptibility rates to meropenem of 97.1%, and 73% to tobramycin. E. coli and K. pneumoniae were highly susceptible to both carbapenems.Carbapenem resistance among the Enterobacteriaceae is still rare in the region. Acitenobacter baumannii and P. aeruginosa presented elevated resistance rates to all antimicrobials. Since they play an important role in nosocomial infections in this environment, the use of empirical combination therapy to treat these pathogens may be justified.

Resumo em Inglês:

We made a retrospective cohort study of a primary bloodstream infection outbreak in patients of a cancer unit in a general hospital, evaluated the impact of intervention measures and investigated the predisposing factors. The targeted predisposing factors were selected based on the medical literature. The data were treated with univariate analysis to calculate the relative risk, and statistical significance was set at p<0.05. The presence of a long-term totally-implanted central venous catheter appears to be a predisposing factor, while a peripheral venous catheter appears to have offered protection from infection. This is reinforced by fact that intervention measures controlled the outbreak, suggesting cross-contamination from a common source. These findings corroborate the fundamental role of the hospital infection control service in early intervention and reinforce the need for continued training of health professionals that perform this type of care.

Resumo em Inglês:

We determined the frequency of Streptococcus pneumoniae, Haemophilus influenzae, Staphylococcus aureus, and Gram-negative enteric bacteria (GNEB) in pneumonia patients, determined the antibiograms of these pathogens, and investigated the relationship between pneumonia and selected risk factors. Sputum and demographic data were collected from 124 pneumonia patients. Sputum was cultured for S. aureus, GNEB, H. influenzae and S. pneumoniae. The disc diffusion method was used to determine resistance to eight antimicrobial agents. Among the 124 sputum samples, eight (6.5%) were positive for S. aureus, 15 (12.1%) for GNEB, two (1.6%) for S. pneumoniae and one (0.8%) for H. influenzae. Hospitals, gender, ethnicity, co-morbidities and symptoms did not significantly (p > 0.05; chi2) affect the prevalence of these bacteria. GNEB infection was most prevalent (47%) in patients over 70 years old. Gentamicin and levofloxacin were the most effective against these bacteria.

Resumo em Inglês:

Sexually transmitted diseases (STDs) have long been known, but they have only recently been recognized as causes of significant long-term morbidity, mainly as a result of increased knowledge concerning viral STDs. The relationship of these diseases with conditions such as anogenital cancer and acquired immunodeficiency syndrome (AIDS) has made viral STDs an important issue in the healthcare of women and infants, and in reproductive health. The evolution of the AIDS pandemic is now characterized by growing differences between rich and poor nations. New diagnostic tools include rapid tests of blood, urine and saliva samples. New techniques, such as computerized cytology, have been developed for the diagnosis of human papillomavirus (HPV). Women infected with HIV are at a greater risk of being co-infected with HPV, and they are also more prone to the progression and persistence of HPV lesions. The herpes simplex virus presents high rates of co-infection with HIV, and it plays a particularly important role in increasing transmission rates of this virus.

Resumo em Inglês:

In this case report, which includes a statement related by the patient himself, the authors also discuss the importance of a good doctor-patient relationship in treating HIV patients and in assuring the patient's adherence to his treatment. Related issues, such as the importance of treating psychiatric comorbidities, of preserving the patient's hope and motivation, and of giving him an adequate amount of information regarding the disease and its treatment, are also discussed.

Resumo em Inglês:

Dengue fever is the most important arboviral infection in the world, with an estimated 100 million cases per year and 2.5 billion people at risk. Encephalopathy is a rare complication of dengue virus infection and may occur as a consequence of intracranial hemorrhage, cerebral edema, hyponatremia, cerebral anoxia, fulminant hepatic failure with portosystemic encephalopathy, microcapillary hemorrhage or release of toxic products. We report a rare case of hemorrhagic encephalopathy in dengue shock syndrome caused by type 3 dengue virus.

Resumo em Inglês:

We report two cases of varicella pneumonia in immunocompetent patients, with emphasis on high-resolution computer tomography manifestations. The predominant findings consisted of multiple bilateral nodules, ranging from 1-10 mm in diameter, with or without a surrounding halo of ground-glass attenuation. Other findings include ground-glass opacities, focal areas of consolidation and small pleural effusions.

Resumo em Inglês:

Entamoeba histolytica can infect any organ of the body, but only one case of renal involvement has been reported till now in the literature. We report a rare case of amoebic renal cyst in a 78-yearshowing favorable outcome with metronidazole treatment and therapeutic drainage.