Randomized, double-blind trial comparing indinavir alone, zidovudine alone and indinavir plus zidovudine in antiretroviral therapy-naive HIV-infected individuals with CD4 cell counts between 50 and 250/mm3.

Treatment with indinavir has been shown to result in marked decreases in viral load and increases in CD4 cell counts in HIV-infected individuals. A randomized double-blind study to evaluate the efficacy of indinavir alone (800 mg q8h), zidovidine alone (200 mg q8h) or the combination was performed to evaluate progression to AIDS. 996 antiretroviral therapy-naive patients with CD4 cell counts of 50-250/mm3 were allocated to treatment. During the trial the protocol was amended to add lamivudine to the zidovudine-containing arms. The primary endpoint was time to development of an AIDS-defining illness or death. The study was terminated after a protocol-defined interim analysis demonstrated highly significant reductions in progression to a clinical event in the indinavir-containing arms, compared to the zidovudine arm (p<0. 0001). Over a median follow-up of 52 weeks (up to 99 weeks), percent reductions in hazards for the indinavir plus zidovudine and indinavir groups compared to the zidovudine group were 70% and 61%, respectively. Significant reductions in HIV RNA and increases in CD4 cell counts were also seen in the indinavir-containing groups compared to the zidovudine group. Improvement in both CD4 cell count and HIV RNA were associated with reduced risk of disease progression. All three regimens were generally well tolerated.

Human lagochilascariasis treated successfully with ivermectin: a case report.

A 15 year old male patient was diagnosed as being infected with the nematode Lagochilascaris minor, presenting as abscesses over the left mastoid region, and invading the temporal bone, mastoid sinuses and possibly the CNS. Surgical drainage and administration of cambendazole and levamisole led to improvement, followed by an early relapse and poor tolerance to the antihelminthic drugs. Repeated doses of ivermectin (an animal preparation) were used for the first time to treat this condition and resulted in complete remission of signs of infection, maintained for 15 months after the end of drug therapy, indicating cure of the disease.

[Patterns of antimicrobial resistance in gram-negative bacilli isolated from patients in intensive care units]. / Padrões de resistência a antimicrobianos em bacilos gram-negativos isolados de pacientes em unidade de terapia intensiva.

Minimal inhibitory concentration test with 16 antibiotics was performed for 435 stains of Gram negative bacilli, isolated from patients in intensive care units of five large hospitals. The results were analysed as to provide in vitro sensitivity patterns, as well as cross resistance between the tested drugs. The most frequent species were Pseudomonas aeruginosa, E. coli, Klebsiella spp., Enterobacter ssp., and Acinetobacter calcoaceticu, accounting for more than 80% of all isolates. Best figures were seen with ciprofloxacin and imipenem, with 805 of sensitive strains or more; third generation cephalosporins, aminoglycosides and aztreonam had overall sensitivity rates ranging from 58 to 73%. There was marked cross resistance between ceftazidime and other beta-lactam antibiotics, except for imipenem. These results bear implications regarding the establishment of empirical therapy in critical patients.

[Postoperative tetanus: report of a case and prophylaxis]. / Tétano pós-cirúrgico: descrição de caso e profilaxia.

We describe a case of a patient presenting tetanus after mastectomy with postoperative complications. Risk factors and prophylaxis of this disease after surgery are discussed, emphasizing the need for vaccine protection and evaluation of all patients before any kind of surgical procedure.

Contaminacao bacteriana em dialise peritoneal, com sistema de drenagem aberto e fechado. / On bacterial contamination during peritoneal dialysis with open and closed drainage technics

Foram estudadas 20 sessoes de dialise peritoneal em nove pacientes que usavem protese de Deane; dez foram realizadas de forma convencional, isto e, com a extremidade distal de drenagem da solucao dialitica colocada em frasco de vidro aberto e outras dez de forma fechada, em que o liquido drenado do peritonio foi coletado.Foram feitas culturas sistematicas dos liquidos efluentes do peritonio dos cateteres peritoneais e das proteses de Deane, alem de controles hematologicos, citologicos e bioquimicos, los liquidos de banhos de dialise. Observaram-se, nas sessoes realizadas pelo sistema aberto, 18(62,1%) culturas positivas, entre as 29 amostras de liquidos examinados; no sistema fechado apenas sete (23,3%) foram positivas. A diferenca e significante ao nivel de 5%.Houve um epidosio clinico de peritonite. As demais provas laboratoriais nao tiveram valor na diferenciacao de amostras de liquidos contaminados e estereis. Os resultados encontrados permitem sugerir que a introducao de sistema de coleta fechado, em pacientes submetidos a dialise peritoneal cronica, pode diminuir o numero de contaminacoes e, potencialmente, de complicacoes infecciosas desses pacientes.plicacoes infecciosas desses pacientes