Performance of a local reference curve for predicting small for gestational age fetuses in pregnant women with HIV/AIDS.

PURPOSE: To compare the performance of a local estimated fetal weight curve with curves established for other populations to predict small for gestational age (SGA) fetuses. METHODS: A retrospective and cross-sectional study involving 231 fetuses in which the performance of a local curve (proposed model) was compared with the Hadlock and Intergrowth-21st curves in the prediction of SGA fetuses, by applying them to a population of high-risk pregnant woman with HIV/AIDS. For each model, a receiver operating characteristic curve was adjusted, considering the SGA classification by the neonatal Intergrowth method as the gold standard, and the area under the curve (AUC) was calculated. RESULTS: The models presented linear correlations with each other. The agreement of the proposed model with Hadlock was very good (kappa = 0.83), whereas the proposed model and Intergrowth-21st had moderate agreement (kappa = 0.44). The SGA fetus detection sensitivities of the proposed model and Hadlock were 61.9% and 57.1%, with specificity of 84.1% and 86.2% and accuracy of 80.1% and 81%, respectively, without statistical difference. The sensitivity of the Intergrowth-21st model was 33.3%, while the accuracy was 85.7% and the specificity was 97.4%. The AUC estimated values for the Hadlock, proposed, and Intergrowth-21st models were 0.834, 0.832, and 0.835, respectively. CONCLUSION: The proposed model and Hadlock were interchangeable in the prediction of SGA fetuses and superior to the Intergrowth-21st model.

Diagnostic importance of eosinophilic meningitis in HIV-positive and HIV-negative patients.

The presence of eosinophils in the cerebrospinal fluid (CSF) should always be considered abnormal. This study aimed to evaluate the causes of eosinophils in the CSF of patients who are HIV positive and HIV negative. This is the first study of eosinophils in the CSF of patients who are HIV-positive. This was a retrospective study of CSF reports from 1996 to 2005, patients were selected based on the presence of eosinophils in the CSF. We analyzed 20,008 CSF reports; eosinophils were present in 5%. The median and interquartile range (IQR) of eosinophils was 2% (1%, 4%). Eosinophilic meningitis (CSF eosinophils ≥ 10%) was present in 12% of the samples. The main etiologies were infectious diseases as follows: neurocysticercosis, Cryptococcus sp. meningitis, and acute bacterial meningitis. In HIV-positive cases, all causes were by infectious disease, the main pathogen being Cryptococcus sp. The probability of neurocysticercosis in a patient from an endemic region who is HIV-negative and has CSF eosinophils more than 10% was five times higher compared to a person without eosinophilic meningitis. There was a weak positive correlation between CSF eosinophils and increased serum eosinophils. Among the HIV-negative cases, the most frequent non-infectious causes were cerebrovascular syndromes, of these hemorrhage (91.5%). In the HIV-positive group, there were no cases of non-infectious cerebral disease. CSF eosinophils are suggestive of disease. The causes must be investigated, considering the most prevalent infectious diseases in the region.

Inquérito entre pacientes e médicos sobre as estratégias aplicadas na prevençäo e tratamento da retinopatia diabética / Survey among patients and physicians over the strategies applied in diabetic retinopathy treatment

O objetivo do presente estudo foi o de analisar as atitudes de manejo adotadas por médicos e pacientes na prevenção e tratamento da retinopatia diabética em nosso Estado. Quarenta e sete pacientes, de clínicas privadas e serviços previdenciários de saúde, e quarenta e cinco clínicos e endocrinologistas foram entrevistados de forma protocolada, Os resultados mostraram que apenas 29,7 por cento dos pacientes procuraram aos oftalmologistas orientados por seus médicos especialistas, 80, 8 por cento dosando a glicemia ocasionalmente, e apenas 10 por cento seguindo um esquema intensificado de tratamento. Entre os médicos, apenas 22 por cento faziam fundoscopia de rotina, e somente 44 por cento indicavam adequadamente os exames oftalmológicos. Os resultados desta amostragem mostram uma expressiva distância entre o que é recomendado e aquilo que é realizado no manejo da retinopatia diabética em nosso meio.

Criptococose: uma micose em expansäo / Cryptococcosis: the mycosis in expansion

Os autores fazem consideraçoes clínico-epidemiológicas sobre 19 pacientes com criptococose observados de 1989 a 1992. Enfatizam o aumento da incidência da micose, a predominância de formas encefalíticas, a importância da pesquisa direta do fungo em liquor, as dificuldades terapêuticas e a alta letalidade, especialmente em sidéticos. Salientam a necessidade de pesquisar esta micose em imunodeprimidos com alteraçoes neurológicas subjetivas ou objetivas.