Alcohol Withdrawal Syndrome as a Precipitating Factor of Takotsubo Cardiomyopathy on a Background of Wernicke's Encephalopathy.

Takotsubo cardiomyopathy (TC) is a rare entity defined by a temporary, reversible left ventricular systolic abnormality similar to myocardial infarction in the absence of coronary artery disease. Alcohol withdrawal syndrome (AWS) can result from a marked decrease or sudden cessation of alcohol consumption and seems to be related to excess catecholamines that induce a cardiomyotoxic effect. Wernicke's encephalopathy (WE), mostly associated with alcoholism, is caused by a deficiency in vitamin B1 (thiamine) and is severe if not supplemented in a timely manner. We present a complex case of a patient with the simultaneous presentation of two rare conditions, takotsubo cardiomyopathy, and Wernicke's encephalopathy, precipitated by an alcohol withdrawal syndrome.

Corynebacterium striatum cardiac device-related endocarditis: A case report.

Corynebacterium striatum is an emerging Gram-positive bacillus associated with invasive infection in both immunocompetent and immunocompromised patients, especially associated with medical devices. Its ability to form biofilms has been demonstrated and it has been occasionally associated with cardiac device-related infective endocarditis with few cases described in literature. We report a case of C. striatum cardiac device-related infective endocarditis of complex management.

Pantoprazole: An Unusual Suspect in a Patient with Fever.

Drugs can cause fever of unknown origin. Drug fever is a diagnosis of exclusion and can lead to unnecessary investigations and prolonged hospitalization. Any drug can be responsible. Here, we describe the case of a woman admitted because of acute hepatitis. Pantoprazole was started for stress ulcer prophylaxis when she was admitted to the ICU. Fever developed a few days later and an extensive diagnostic work-up was negative. Fever remitted after pantoprazole discontinuation and the diagnosis of drug fever was established. LEARNING POINTS: Despite extensive diagnostic work-up, the aetiology of acute liver failure remains unclear in a large proportion of cases.Drug fever is a diagnosis of exclusion and must be considered in every patient with unexplained fever; any drug should be seen as a possible offending agent.Pantoprazole, a commonly prescribed drug, can be a rare cause of fever.

Perfil vacinal dos profissionais de enfermagem em hospital referência para doenças infecciosas de Fortaleza - Ceará / Professional profile of vaccine in a hospital nursing reference in infectious diseases in Fortaleza - Ceará / Perfil de vacunas de los profesionales de enfermeria en un hospital de referencia de enfermedades infecciosas en la Fortaleza - Ceará

Objetivou-se traçar o perfil vacinal dos trabalhadores de enfermagem de hospital terciário de médio porte especializado em doenças infecciosas, em Fortaleza-Ceará. Pesquisa transversal, na qual os dados foram secundários, disponibilizados pelo Núcleo Hospitalar de Epidemiologia, contendo informações do esquema vacinal contra hepatite B, tétano, febre amarela, sarampo, varicela e tuberculose, de uma amostra de 223 profissionais. Os resultados mostraram que a maioria dos profissionais pertence ao sexo feminino, trabalhando em setores assistenciais. O esquema vacinal contra varicela foi o mais frequente, seguido do sarampo, hepatite B, tétano, febre amarela e tuberculose. Com base no resultado, sugere-se a realização de programas de educação permanente voltados à disponibilidade perene de vacinas para os trabalhadores de saúde. Também é fundamental a continuidade da análise do perfil vacinal desses profissionais, incluindo outras doenças imunopreveníveis, cujas vacinas encontram-se disponibilizadas no País, tais como a da Influenza, da hepatite A e da Meningite.

This study aimed to define the profile vaccination of the components of professional nursing tertiary hospital midsize specialized in infectious diseases, in Fortaleza, Ceará. Cross-sectional survey, in which data were secondary, provided by the Center Hospital Epidemiology, containing information of a vaccination against hepatitis B, tetanus, yellow fever, measles, chicken pox and tuberculosis of a sample of 223 professionals. The results showed that most professionals are female, working in health care sectors. The varicella vaccine schedule was the most frequent, followed by measles, hepatitis B, tetanus, yellow fever and tuberculosis. Based on the results we suggest conducting continuing education programs focused on perennial availability of vaccines for health workers. Also, it is essential to continue the analysis of the vaccine profile of these professionals, including other preventable diseases, which vaccines are available in the country, such as Influenza, Hepatitis A and meningitis.

Este estudio tuvo como objetivo definir el perfil de la vacunación de los trabajadores de enfermería de un hospital de tercer nivel de tamaño mediano especializado en enfermedades infecciosas, en Fortaleza, Ceará. Investigación transversal, cuyos datos eran secundarios, provistos por el Núcleo Hospitalario de Epidemiología, conteniendo informaciones del esquema de vacunas contra hepatitis B, tétanos, fiebre amarilla, sarampión, varicela y tuberculosis, de una muestra de 223 profesionales. Los resultados mostraron que la mayoría de los profesionales pertenece al sexo femenino, que trabaja en los sectores asistenciales. El esquema de vacunas contra la varicela fue el más frecuente, seguido por el sarampión, la hepatitis B, el tétanos, la fiebre amarilla y la tuberculosis. Con base en el resultado, se sugiere la realización de programas de educación permanente dirigida a la disponibilidad perenne de vacunas para los trabajadores de salud. También es fundamental la continuidad del análisis del perfil de vacuna de estos profesionales, incluyendo otras enfermedades inmunoprevenibles, cuyas vacunas están disponibles en el País, tales como la de la Influenza, hepatitis A y Meningitis.

A cluster of Listeria monocytogenes infections in hospitalized adults.

BACKGROUND: Listeriosis occurs mainly in persons at extremes of age and with immunocompromising conditions. It is believed that most cases of listeriosis are acquired in the community. A cluster of listeriosis in hospitalized patients prompted the present investigation. METHODS: We conducted a case series study of listeriosis from August 21, 2006, to June 1, 2007, in a hospital in the city of Rio de Janeiro, Brazil. RESULTS: Six patients with Listeria monocytogenes infection were identified: 5 during hospitalization and 1 at a day clinic. By the time the infection was diagnosed, 5 patients had been in the hospital for a mean of 9 days. All patients were elderly (median age, 80 years) and had immunocompromising conditions. Five (83%) patients died. Four patients developed bloodstream infections, 3 caused by serotype 1/2b. Two patients had peritonitis: one caused by serotype 3b and another by serotype 1/2b. Four L monocytogenes isolates belonged to a single pulse-field gel electrophoresis genotype, suggesting a common source. An epidemiologic investigation pointed to the hospital kitchen as the possible contamination. CONCLUSION: Data suggest a health care-associated outbreak of listeriosis and highlight the importance of developing guidelines for prevention and treatment of health care-associated foodborne diseases, especially in hospitals with immunocompromised adult patients.

Conhecimento dos pacientes a serem submetidos ao implante de marcapasso cardíaco definitivo sobre os principais cuidados domiciliares / Main home care awareness for patients undergoing permanent cardiac pacemaker implants / Conocimiento de los pacientes que se someterán al implante de marcapasos cardiaco definitivo sobre los principales cuidados domiciliarios

O coração exerce a função de bombear o sangue para todo o corpo. Além disso, esse órgão é dotado de um sistema elétrico capaz de manter a contração sinusal do músculo cardíaco. Quando esse processo é lesado, o implante de marcapasso cardíaco definitivo poderá ser indicado para obter a atividade elétrica cardíaca a mais fisiológica possível. Uma vez implantado o marcapasso, o paciente deverá ter conhecimento sobre as possíveis interferências que o ambiente domiciliar poderá proporcionar. Desta forma, acredita-se que o enfermeiro exerce um papel fundamental na educação desses pacientes, orientando-os sobre os principais cuidados no domicílio e esclarecendo suas principais dúvidas, visando à prevenção de possíveis interferências eletromagnéticas decorrentes do implante do marcapasso e uma melhor reabilitação. O objetivo deste trabalho foi avaliar o conhecimento dos pacientes a serem submetidos ao implante de marcapasso cardíaco definitivo sobre os principais cuidados domiciliares relacionados a possíveis fontes de interferências eletromagnéticas e cuidados no período de reabilitação e de mudança do estilo de vida.

The heart’s job is to pump blood throughout the body. In addition to that, it has an electrical system capable of maintaining the cardiac muscle sinus contraction. Whenever this processis injured, the implant of a permanent cardiac pacemaker will be indicated in order to achieve an electrical cardiac activity that is as physiological as possible. Once the pacemaker has been implanted, the patient should be aware of all possible interferences around the house. Therefore, we believe thatthe nurse plays an important role while teaching the patients about the main cautions around the home and answering their questions, thus preventing them from electromagnetic interferences as a result of their pacemaker implant as well as enabling them to accomplish a better rehabilitation. The objective of this paper was to assess the knowledge of patients undergoing permanent cardiac pacemaker regarding the main cautions related to possible sources of electromagnetic interference, and the care to be taken in the rehabilitation period and the changes in life style.

El corazón ejerce la función de bombear la sangre para todo el cuerpo. Además, ese órgano está dotado de un sistema eléctrico capaz de mantener la contracción sinusal del músculocardiaco. Cuando se lesiona ese proceso, se podrá indicar el implante de marcapasos cardiaco definitivo a fin de lograr la actividad eléctrica cardiaca más fisiológica posible. Una vez implantado el marcapasos, el paciente deberá tener conocimiento acerca de las posibles interferencias que elambiente domiciliario podrá proporcionarle. De esa manera, se cree que el enfermero ejerce un papelfundamental en la educación de esos pacientes, orientándoles sobre los principales cuidados en el domicilio y aclarándoles sus principales dudas, con vistas a la prevención de posibles interferencias electromagnéticas consecuentes del implante del marcapasos y una mejor rehabilitación. El objetivo de este trabajo ha sido el de evaluar el conocimiento de los pacientes que se someterán al implantede marcapasos cardiaco definitivo acerca de los principales cuidados domiciliarios relacionados con las posibles fuentes de interferencias electromagnéticas y cuidados en el período de rehabilitación y cambio del estilo de vida.

Análise sensorial do leite humano ordenhado e sua carga microbiana / Sensorial analysis of expressed human milk and its microbial load

OBJETIVO: Verificar a existência de relação entre a presença de off-flavor e a carga de microrganismos em amostras de leite humano ordenhado rejeitadas pelo controle de qualidade de um banco de leite humano. MÉTODOS: Testou-se em 30 amostras de leite humano ordenhado com presença de off-flavor a ocorrência dos seguintes microrganismos: aeróbios mesófilos, psicrotróficos, proteolíticos, proteolíticos-psicrotróficos, termodúricos, termodúricos-psicrotróficos, bactérias lácticas, lipolíticos, bolores e leveduras e Staphylococcus aureus, coliformes totais e coliformes termotolerantes, de acordo com métodos oficiais. RESULTADOS: A ocorrência percentual dos microrganismos foi a seguinte: aeróbios mesófilos = 80 por cento; psicrotróficos = 36,7 por cento; proteolíticos = 46,7 por cento; proteolíticos-psicrotróficos = 16,7 por cento; termodúricos = 6,7 por cento; termodúricos-psicrotróficos = 0 por cento; bactérias lácticas = 50 por cento; lipolíticos = 10 por cento; bolores e leveduras = 6,7 por cento; S. aureus = 30 por cento; coliformes totais = 53,3 por cento; e coliformes termotolerantes = 16,7 por cento. CONCLUSÃO: Observou-se relação consistente entre a presença de off-flavor e elevadas contagens dos microrganismos nas amostras analisadas, o que reforça a importância da pesquisa de off-flavor na seleção e no controle da qualidade dos bancos de leite humano.

OBJECTIVE: To verify the existence of a relationship between presence of off-flavor and microorganism load in quality control rejected samples of expressed human milk from a donor milk bank. METHODS: A total of 30 samples of expressed human milk with off-flavor were tested for the occurrence of the following microorganisms: aerobic mesophilic, psycrotrophic, proteolytic, psycrotrophic proteolytic, thermoduric, psycrotrophic thermoduric, lactate and lipolytic bacteria, molds and yeasts and Staphylococcus aureus, total coliforms and thermophilic coliforms, in accordance with official methods. RESULTS: Percentage occurrence of microorganisms was as follows: aerobic mesophilic = 80 percent; psycrotrophic = 36.7 percent; proteolytic = 46.7 percent; psycrotrophic proteolytic = 16.7 percent; thermoduric = 6.7 percent; psycrotrophic thermoduric = 0 percent; lactate bacteria = 50 percent; lipolytic = 10 percent; molds and yeasts = 6.7 percent; S. aureus = 30 percent; total coliforms = 53.3 percent; and thermophilic coliforms = 16.7 percent. CONCLUSION: A consistent relationship between presence of off-flavor and elevated microorganism counting was observed in the analyzed samples. This correlation highlights the importance of off-flavor research during selection and quality control processes in human milk banks.

Sensorial analysis of expressed human milk and its microbial load.

OBJECTIVE: To verify the existence of a relationship between presence of off-flavor and microorganism load in quality control rejected samples of expressed human milk from a donor milk bank. METHODS: A total of 30 samples of expressed human milk with off-flavor were tested for the occurrence of the following microorganisms: aerobic mesophilic, psycrotrophic, proteolytic, psycrotrophic proteolytic, thermoduric, psycrotrophic thermoduric, lactate and lipolytic bacteria, molds and yeasts and Staphylococcus aureus, total coliforms and thermophilic coliforms, in accordance with official methods. RESULTS: Percentage occurrence of microorganisms was as follows: aerobic mesophilic = 80%; psycrotrophic = 36.7%; proteolytic = 46.7%; psycrotrophic proteolytic = 16.7%; thermoduric = 6.7%; psycrotrophic thermoduric = 0%; lactate bacteria = 50%; lipolytic = 10%; molds and yeasts = 6.7%; S. aureus = 30%; total coliforms = 53.3%; and thermophilic coliforms = 16.7%. CONCLUSION: A consistent relationship between presence of off-flavor and elevated microorganism counting was observed in the analyzed samples. This correlation highlights the importance of off-flavor research during selection and quality control processes in human milk banks.

[Lung-kidney syndrome]. / Sindrome pulmão-rim.

The lung-kidney syndrome is characterized by the coexistence of glomerulonephritis and pulmonary hemorrhage. However these manifestations can define different pathologies. The association of diffuse pulmonary hemorrhage, glomerulonephritis and circulating anti-glomerular basement membrane antibodies define Goodpasture syndrome. We report a case of Goodpasture syndrome with review of the literature.