Disseminated histoplasmosis in AIDS patients: an urban disease. Experience in a metropolis in the middle east of Brasil.

Histoplasmosis is a fungal disease commonly observed as an opportunistic disease in AIDS patients. It is a neglected disease in many countries, particularly Latin America, including Brazil. It is related with environmental factors, even in urban areas, where the incidence has increased. Implementing a descriptive ecological study, we performed a retrospective chart review for data collected between January 2003 and July 2014 for AIDS patients with histoplasmosis who lived in Goiania. The selected cases were georeferenced to analyse the incidence of histoplasmosis in AIDS patients in the metropolitan area of Goiania. In all, 166 patients (130 men) met the criteria for AIDS and histoplasmosis coinfection. Almost half of the patients (41%) had simultaneous histoplasmosis and AIDS diagnoses. The general mortality was 53% (88 patients). The main symptoms involved the respiratory, gastrointestinal, and cutaneous systems. The distribution of cases included almost all regions of the urban areas, with some predominance in the eastern and western regions close to areas of environmental degradation, contaminated water sources and unplanned urbanisation. In conclusion, coinfection with HIV and disseminated histoplasmosis is common and associated with high mortality rates in our referral hospital for infectious diseases. Despite being considered as having a predominantly rural epidemiology, many patients reported living in urban areas such as Goiânia and Aparecida de Goiânia. Our findings suggest the need for environmental studies to evaluate environmental contamination and possible local risk factors for H. capsulatum infection in addition to serological surveys to determine the prevalence of this infection in the studied cities.

Neurosurgery Simulators Developed for Neurosurgical Training in Brazil: A Systematic Review

Introduction Simulation in neurosurgery is a growing trend in medical residency programs around the world due to the concerns there are about patient safety and the advancement of surgical technology. Simulation training can improve motor skills in a safe environment before the actual setting is initiated in the operating room. The aim of this review is to identify articles that describe Brazilian simulators, their validation status and the level of evidence (LoE). Methodology This study was conducted using the Preferred Reported Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. A search was performed in the Medline, Scielo, and Cochrane Library databases. The studies were evaluated according to the Medical Education Research Quality Instrument (MERSQI), and the LoE of the study was established according to the classification system of the Oxford Centre for Evidence-Based Medicine (OCEBM), which has been adapted by the European Association of Endoscopic Surgery. Results Of all the studies included in this review, seven referred to validated simulators. These 7 studies were assigned an average MERSQI score of 8.57 from 18 possible points. None of the studies was randomized or conducted in a high-fidelity environment. The best evidence was provided by the studies with the human placenta model, which received a score of 2b and a degree of recommendation of 3. Conclusion Brazilian simulators can be reproduced in the different laboratories that are available in the country. The average MERSQI score of Brazilian studies is similar to the international average score. New studies should be undertaken to seek greater validation of the simulators and carry out randomized controlled trials.