Clinical and epidemiology evaluation of Aids-infected patients hospitalized between 2011 and 2016 in the Santos region of Brazil

Abstract INTRODUCTION: We assessed the clinical-epidemiological profile of acquired immune deficiency syndrome (AIDS) patients in the Santos region (São Paulo state) with the highest AIDS prevalence in Brazil. METHODS Information was extracted from records of 409 AIDS-infected patients hospitalized between 2011 and 2016. RESULTS: Human immunodeficiency virus (HIV) was diagnosed in 24.7% of patients during admission, and 39.6% of already diagnosed patients received highly active antiretroviral therapy (HAART) irregularly. The mortality rate was 19.1%, and the main secondary manifestations were neurotoxoplasmosis and tuberculosis. CONCLUSIONS: AIDS patients in the Santos region had high rates of late diagnosis and low treatment adherence.

Survey of hepatitis B and C infection control: procedures at manicure and pedicure facilities in São Paulo, Brazil

Bleeding due to the habit of removing the cuticles of the finger and toes nails, without appropriate sterilization of instruments can be an important factor of contamination by hepatitis B and C viruses. The objectives of this study were to verify the use of standards on biosafety in the routine work of manicurists and/or pedicurists located in São Paulo, Brazil; know the level of information they have about ways of transmission and prevention of hepatitis B and C; evaluate the degree of risk perception for accidental exposure to infectious agents; and to estimate the prevalence of serological markers of hepatitis B and C among them. This was descriptive, cross-sectional study that included a random sample of 100 manicurists and/or pedicurists working in beauty salons. We administered a questionnaire to obtain personal information about the characteristics of the participants, collected blood for hepatitis B and C serology and assessed the working environment. Adherence to the professional standards on biosafety has been inadequate, and we noted that only 5 percent used disposable gloves, none washed their hands, 93 percent did not previously cleaned their working material and only 7 percent used disposable materials. A low level of knowledge about the routes of transmission, prevention, standards of biosafety, and risk perception of the infectious agents in their professional activity was observed. One out of ten interviewed manicurist and/or pedicurist had serological markers of hepatitis B or C, with 8 percent of hepatitis B and 2 percent of hepatitis C.

Kikuchi-Fujimoto disease: an unusual association with acute renal failure

Kikuchi-Fujimoto disease, also known as histiocytic necrotizing lymphadenitis of unknown etiopathogenesis, is a self-limited disease which frequently appears as feverish lymphadenomegaly, thus creating the need for differential diagnosis with lymphoma, systemic lupus erythematosus (SLE), infectious mononucleosis, cat-scratch disease, and toxoplasmosis with lymphonodal impairment. However, there are cases in which it may evolve with complications such as aseptic meningitis, cerebellar ataxia, and aseptic myocarditis. We are presenting a case of a 24-year-old man who had an initial picture of arthralgia, evening fever and adenomegaly. Kikuchi disease was diagnosed through lymph node biopsy with immunohistochemistry and evolves with severe systemic manifestations, such as pericarditis with cardiac tamponade, pneumonitis, hepatitis, and acute kidney failure - the latter has not been reported in literature yet. There was significant improvement of the clinical picture with prednisone.

Histological response study of chronic viral hepatitis C patients treated with interferon alone or combined with ribavirin

Chronic hepatitis C is often a progressive, fibrotic disease that can lead to cirrhosis and other complications. The recommended therapy is a combination of interferon and ribavirin. Besides its antiviral action, interferon is considered to have antifibrotic activity. We examined the outcome of hepatic fibrosis and inflammation in chronic hepatitis C patients who were non-responders to interferon. We made a case series, retrospective study, based on revision of medical records and reassessment of liver biopsies. For inclusion, patients should have been treated with interferon alone or combined with ribavirin, with no virological response (non responders and relapsers) and had a liver biopsy before and after treatment. Histological evaluation included: i-outcome of fibrosis and necroinflammation; ii-annual fibrosis progression rate evaluation, before and after treatment. Seventy-five patients were included. Fifty-seven patients (76 percent) did not show progression of fibrosis after treatment, compared to six (8 percent) before treatment (p < 0.001). The mean annual fibrosis progression rate was significantly reduced after treatment (p = 0.036). Inflammatory activity improved in 19 patients (25.3 percent). The results support the hypothesis of an antifibrotic effect of interferon-based therapy, in non-responder patients. There was evidence of anti-inflammatory effects of treatment in some patients.

Weight-based combination therapy with peginterferon alpha-2b and ribavirin for Naïve, relapser and non-responder patients with chronic hepatitis C

Combination therapy with pegylated interferon and ribavirin is considered the new standard therapy for naïve patients with chronic hepatitis C. We evaluated the efficacy and safety of treatment with weight-based peginterferon alpha-2b (1.5 mg/kg per week) plus ribavirin (800-1,200 mg/day) for 48 weeks in naïve, relapser and non-responder (to previous treatment with interferon plus ribavirin) patients with chronic hepatitis C. Sixty-seven naïve, 26 relapser and 40 non-responder patients were enrolled. The overall sustained virological response (SVR) for the intention-to-treat population was 54 percent for naïve, 62 percent for relapser and 38 percent for non-responder patients. In the naïve subgroup, SVR was significantly higher in patients with the non-1 genotype (67 percent) compared to those with genotype 1 (45 percent). In relapsers and non-responders, SVR was, respectively, 69 percent and 24 percent in patients with genotype 1 and 43 percent and 73 percent in those with genotype non-1. There were no significant differences in SVR rates among the three body weight ranges (< 65 kg, 65-85 kg and > 85 kg) in any of the subgroups. Early virological response (EVR) was reached by 78 percent, 81 percent and 58 percent of naïve, relapser and non-responder patients, respectively, and among those with EVR, 63 percent, 67 percent and 61 percent, respectively, subsequently achieved SVR. All of the non-responder patients who did not have EVR reached SVR. Treatment was discontinued in 13 percent of the patients, due to loss to follow-up, hematological abnormalities or depression.

Estimated prevalence of immunity to poliomyelitis in the city of Säo Paulo, Brazil: a population-based survey

OBJECTIVES: Estimate the prevalence of immunity to poliomyelitis (anti-polio antibodies) in the city of Säo Paulo/Brazil through a population-based survey. METHODS: A quantitative and inductive method was used to draw a representative sample of the population. Randomization and stratification (based on sex, age and residence region) was done, and 1,059 individuals were studied on a home-visit basis (structured questionnaires and blood samples). A microneutralization test was performed to detect anti-polio antibodies against serotypes 1, 2 and 3. RESULTS: The estimated prevalence of immunity to poliomyelitis was high, with 94.6 percent prevalence of anti-polio 1 antibodies, 98.8 percent anti-polio 2 and 91.9 percent anti-polio 3. Despite this high prevalence, there were significantly lower prevalence levels in some groups, specially among age and residence region groups. DISCUSSION: Routine child immunization and NIDs with OPV have provided excellent levels of serological immunity to poliomyelitis in the population of the city of Säo Paulo, Brazil. However, there may be specific groups with a lower prevalence of immunity. Estimations of the prevalence of immunity to poliomyelitis were made in a population-based survey, which could be used as an auxiliary tool for supporting the polio eradication program

Genotype distribution of the GB virus C in citizens of Säo Paulo City, Brazil

There has been several studies worldwide on phylogenetics and genotype distribution of the GB-virus C / Hepatitis G virus (GBV-C/HGV). However, in their great majority, those investigations were based on some epidemiologically linked group, rather than on a representative sampling of the general population. The present is a continuation of the first study in Brazil with such a population; it addresses the GBV-C/HGV phylogenetics and genotype distribution based on samples identified among more than 1,000 individuals of the city of Säo Paulo. For this purpose, a 728 bp fragment of the 5 non-coding region (5 NCR) of the viral genome, from 24 isolates, was sequenced and subjected to phylogenetic analysis. Genotypes 1, 2a and 2b were found at 8.3 percent (2/24), 50 percent (12/24) and 41.7 percent (10/24), respectively. In conclusion Säo Paulo displays a genotype distribution similar to the published data for other States and Regions of Brazil, endorsing the notion that types 1 and 2 would have entered the country with African and European people, respectively, since its earliest formation

New prevalence estimate of TT virus (TTV) infection in low- and high-risk population from Säo Paulo, Brazil

The prevalence of TT virus (TTV) infection was investigated by Polymerase Chain Reaction (PCR) in low- (blood donors and healthy children/adolescents) and high-risk (hemophiliacs) groups from Säo Paulo, Brazil. Primers based on the untranslated region (UTR) of the viral genome proved to be much more ubiquitous, leading to much higher frequencies for both groups ( > or = 81 percent) than the earlier N22-PCR directed to the open reading frame 1 (blood donors, 5.5 percent, and hemophiliacs, 42.3 percent). The UTR-PCR also revealed an interesting profile for healthy children/adolescents: very high prevalence at the early years and significant decrease in male teenagers. The N22-PCR, in turn, demonstrated higher frequency in hemophiliacs treated with fresh blood products (58 percent), than in those treated with virus-inactivated clotting factors (9.4 percent) and blood donors (5.5 percent)

Co-infecções Aids e Hepatite B e C / Co-infections Aids and Hepatitis B and C

Esta edição , que anuncia a Mesa Redonda sobre Co-infecçoes AIDS e Hepatite B e C, não só nos convida a fazer uma série de reflexões, como acabou transformando-se em uma verdadeira aula sobre a situação atual em nosso País, com propostas para a ação individual e coletiva do Setor Saúde como um todo. O local nao poderia ser mais feliz, o recem-inaugurado Centro de Pesquisa em Saúde, o CEPES, da Faculdade de Medicina do ABC. Os Drs. David Uip, Hoel Sette Jr., Roberto Focaccia e Maria Cassia Mendes Correa, além do altissimo nível dos debates, mantiveram durante toda a reunião uma atitude ousada, provocativa, questionando os seus próprios conhecimentos cientifícos com a sua vivência, do seu dia a dia na linha de frente da luta contra a AIDS e a hepatite. Podemos afirmar que ao término da reunião, todos os presentes sentiam que não se encerrava um debate, mas sim que algo novo começava a ser criado. Os debatedores não se limitaram a fazer as suas conclusões finais, mas plantaram idéias fundamentais que, sem duvida, vão nortear as açoes futuras que se fazem necessarias para colocar o nosso País, mais uma vez, em posição de destaque no campo da Medicina

Revisäo sobre o emprego clínico do cefadroxil: fundamentos para uso a cada 12 horas / Review of the clinical use of cefadroxil: basis for its use each 12 hour

Sä discutidas as propriedades microbiológicas, a farmacocinética, os usos clínicos e a toxicologia do cefadroxil, uma cefalosporina para uso oral. Säo destacados os níveis séricos prolongados após administraçäo oral, permitindo tratamento em duas tomadas ao dia. Säo revistas avaliaçöes clínicas, recentes, em várias doenças infecciosas

AIDS: infecçöes respiratórias associadas / AIDS: respiratory tract infections associated

The lungs are the principal target organ of the infectious complications of human immunodeficiency virus infection, probably because their immunologic capabilities may be more suppressed than other organs. Opportunistic pulmonary infections are the most frequent cause of pulmonary disorders and death during the course of HIV-infection. This report gives our diagnostic and therapeutic current procedures applied in the major pulmonary infections complications of human immunodeficiency virus infection

Imunizaçäo contra hepatite A e B / Immunization against hepatitis A and B

Os autores fazem revisäo da literatura médica a respeito da imunizaçäo ativa e passiva contra hepatite A e B, com destaque aos aspectos práticos pertinentes à eficácia, inocuidade, via de administraçäo, populaçäo-alvo, esquemas posológicos, riscos e indicaçöes clínicas dos vários tipos de agentes vacinais disponíveis

Hepatite viral fulminante: medidas terapeuticas / Fulminant viral hepatitis: treatment

Os autores analisam as medidas terapeuticas modernamente intriduzidas no tratamento das hepatites virais fulminantes. Sao discutidos procedimentos de suporte de vida, novas drogas(N-acetyl-L-cisteina, interferon, prostaglandinas) procedimentos hemodialiticos e transplante hepatico. Destacam a importancia da reducao do edema cerebral, controles metabolicos e antiinfecciosos.

Residência médica em doenças infecciosas e parasitárias no Hospital das Clínicas da Faculdades de Medicina da Universidade de Säo Paulo / Residency in infections and parasitic diseases at the Hospital das Clínicas da Faculdade de Medicina da Universidade de Säo Paulo

Os autores realizaram, através de inquérito, estudo sobre a Residência Médica na Clínica de Doenças Infecciosas e Parasitárias do H.C./F.M.U.S.P., entre 1952 e 1984, visando conhecer: a) caracterizaçäo geral dos estagiários; b) condiçöes econômicas dos mesmos durante a realizaçäo da Residência; c) fixaçäo do ex-Residente na área e desenvolvimento de atividade acadêmico-científicas após a conclusäo do Programa; d) condiçöes atuais do exercício profissional. As informaçöes coletadas mostram que: 1) apenas 44% dos médicos egressos da Residência estavam exercendo a especialidade e, dentre estes, 81% exerciam trabalhos profissionais em outras áreas para complementar rendimentos. O H. C. e a F.M.U.S.P. absorverem 91% dos que exercem a especialidade. Dos médicos egressos do Programa cerca de 50% exerceram atividades científicas, 59% cursam (ou cursaram) pós-graduaçäo em diversas áreas, e 47% estavam exercendo atividades didáticas. Cerca de 75% consideraram bom o nível da Residência e 91% dos que exercem a especialidade julgaram que a Residência foi decisiva para integrá-los profissionalmente na área de Infectologia

Patogênesi da AIDS: possível papel dos co-fatores na reativaçäo do HIV / Pathogenesis of AIDS: possible role of the co-factors on HIV reactivation

Um dos aspectos mais intrigantes da patogênese da AIDS é o da longa permanência do HIV em células humanas sem causas lhes efeito citopático durante vários anos, em alguns portadores assintomáticos, e causando destruiçäo celular, e doença, a curto prazo, em outros. Foram descritos vários agentes e os mecanismos por eles utilizados para reativar o HIV latente, "in vitro" e "in vivo" (culturas de tecidos), assim como a observaçäo epidemiológica da frequente presença de tais agentes no individuo com AIDS doença, reforçando a hipótese de atuarem os mesmos como reativadores do provírus latente. Foram feitas, nesse contexto, consideraçöes especiais para os vírus da hepatite B, herpesvírus HHV-1, 2 e 6, citomegalovírus, vírus EB, retrovírus HTLV-1 e 2, arbovírus do grupo B (vírus Maguary), malária e outras doenças endêmicas que acometem milhöes de brasileiros. Reconhecendo-se a importância da atuaçäo de tais fatores sobre os gens reguladores da expressäo viral na prevençäo indireta da eclosäo da AIDS-doença

Risco de contágio pelo vírus da hepatite B em funcionários hospitalares e imunidade naturalmente adquirida / Risk of infection by hepatitis B virus in hospital personnel and immunity naturally acquired

Através de inquéritos soroepidemiológicos em 620 funcionários hospitalares, verificou-se que a prevalência de marcadores séricos do vírus da hepatite B é 2,9 vezes maior nos funcionários que manipulam materiais orgânicos do que em um grupo controle (X2obs=16,3835; p < 0,001). Näo houve predomínio entre sexos (0,10 < p < 0,20) ou nível sócio-econômico (0,70 < p < 0,080). Os dois fatores mais interferentes na soropositividade foram: contato freqüente com materiais orgânicos e tempo decorrido de atividade hospitalar. O anti-HBc foi o marcador epidemiológico mais sensível. A soroprevalência de infecçäo atual ou progressa no grupo exposto foi sempre acima de 20%, sendo que os maiores índices foram encontrados no banco de sangue (39,28%), unidade de transplante renal (38,46%), hemodinâmica (31,82%) e unidades de terapia intensiva (26,92%). Em 76,81% dos indivíduos imunes ocorreu soroconversäo subclínica. O grupo de maior risco apresentou 6,46% de casos de hepatite clínica após ter iniciado suas funçöes hospitalares contra 0,80% do grupo controle (0,01 < p < 0,02). Os achados sugerem que a exposiçäo ocupacional a materiais orgânicos contaminados promove ampla imunizaçäo natural pelo vírus da hepatite B de funcionários hospitalares que trabalham em nosocômios situados em áreas de média ou alta endemicidade comunitária dessa infecçäo