HIV-positive patients with oral Kaposi's sarcoma: An overall survival analysis of 31 patients.

OBJECTIVE: The aim of this study was to evaluate the influence of viral load and lymphocyte count on survival of patients who presented with human immunodeficiency virus (HIV)-associated oral Kaposi's sarcoma. STUDY DESIGN: Thirty-one cases (from January 2010 to December 2019) of oral Kaposi's sarcoma in patients with HIV from 2 oral pathology centers in Brazil were reviewed, considering clinical data and correlation of viral load and lymphocyte count with overall survival. Overall survival rates were estimated by a Kaplan-Meier analysis and compared using a log-rank test. The factors introduced stepwise into a Cox proportional hazard model to identify the independent predictors of survival. A P value <.05 was considered significant. RESULTS: Most of the patients were males (90.3%) with a mean age of 32.4 years (range, 19-58). Hard palate, soft palate, and tongue were the most affected sites. Treatment, viral load >999 copies/mL, CD4+ level ≤200 cells/mm3, CD4+/CD8+ level ≤0.39 cells/mm3, and CD4+ nadir level <50 cells/mm3 were related to overall survival. CONCLUSIONS: Survival of patients affected by oral HIV-associated Kaposi's sarcoma is influenced by treatment, viral load, CD4+, CD4+/CD8+, and CD4+ nadir count.

Kaposi's sarcoma in a HIV-positive patient: an exuberant and widespread case report in the Amazon.

A 37-year-old male patient, Fitzpatrick skin phototype IV, a student living in Belem, Amazon region, in 2015 had a confirmed diagnosis of acquired immunodeficiency virus (HIV) infection, but did not initiate antiretroviral treatment at his own option. Three years after the diagnosis, erythematous maculae appeared on the dorsum of the nose with rapid progression to the entire face, with posterior diffuse infiltration and appearance of nodules on the chin and shoulder. In December 2018, the patient presented with exacerbation of the condition with an increase in infiltrated violaceous plaques and disseminated violaceous nodules. A histopathological biopsy of the skin was performed, confirming the diagnosis of angiomatoid proliferation suggestive of Kaposi's sarcoma (KS), with an important dissemination of this disease to the noble organs. In addition, it is important to note that he only started antiretroviral therapy (ART) after the exacerbation of Kaposi (December 2018). In such cases, chemotherapy associated with ART is crucial for the treatment and follow-up of the patient, since Kaposi's sarcoma develops relatively low in patients who do not have immunodeficiency.

Kaposi's sarcoma in persons living with HIV/AIDS: a case series in a tertiary referral hospital.

BACKGROUND: Kaposi's sarcoma (KS) is a rare neoplasm with indolent progression. Since 1981, the Kaposi's sarcoma epidemic has increased as co-infection with HIV. OBJECTIVES: The study aimed to identify the clinical and demographic characteristics and therapeutic approaches in HIV/AIDS patients in a regional referral hospital. METHODS: We analyzed the medical records of 51 patients with histopathological diagnosis of Kaposi's sarcoma hospitalized at Hospital Universitário João de Barros Barreto (HUJBB) from 2004 to 2015. RESULTS: The study sample consisted of individuals 15 to 44 years of age (80.4%), male (80.4%), single (86.3%), and residing in Greater Metropolitan Belém, Pará State, Brazil. The primary skin lesions identified at diagnosis were violaceous macules (45%) and violaceous papules (25%). Visceral involvement was seen in 62.7%, mainly affecting the stomach (75%). The most frequent treatment regimen was 2 NRTI + NNRTI, and 60.8% were referred to chemotherapy. STUDY LIMITATIONS: We assumed that more patients had been admitted to hospital without histopathological confirmation or with pathology reports from other services, so that the current study probably underestimated the number of KS cases. CONCLUSION: Although the cutaneous manifestations in most of these patients were non-exuberant skin lesions like macules and papules, many already showed visceral involvement. Meticulous screening of these patients is thus mandatory, even if the skin lesions are subtle and localized.

Kaposi's sarcoma in persons living with HIV/AIDS: a case series in a tertiary referral hospital

Abstract: Background: Kaposi's sarcoma (KS) is a rare neoplasm with indolent progression. Since 1981, the Kaposi's sarcoma epidemic has increased as co-infection with HIV. Objectives: The study aimed to identify the clinical and demographic characteristics and therapeutic approaches in HIV/AIDS patients in a regional referral hospital. Methods: We analyzed the medical records of 51 patients with histopathological diagnosis of Kaposi's sarcoma hospitalized at Hospital Universitário João de Barros Barreto (HUJBB) from 2004 to 2015. Results: The study sample consisted of individuals 15 to 44 years of age (80.4%), male (80.4%), single (86.3%), and residing in Greater Metropolitan Belém, Pará State, Brazil. The primary skin lesions identified at diagnosis were violaceous macules (45%) and violaceous papules (25%). Visceral involvement was seen in 62.7%, mainly affecting the stomach (75%). The most frequent treatment regimen was 2 NRTI + NNRTI, and 60.8% were referred to chemotherapy. Study limitations: We assumed that more patients had been admitted to hospital without histopathological confirmation or with pathology reports from other services, so that the current study probably underestimated the number of KS cases. Conclusion: Although the cutaneous manifestations in most of these patients were non-exuberant skin lesions like macules and papules, many already showed visceral involvement. Meticulous screening of these patients is thus mandatory, even if the skin lesions are subtle and localized.

Pet-Saúde: O Impacto do Programa na Formação do Profissional Médico / The Educational Program for Health Work: Impact on the Training of Medical Professionals

Introdução: O Programa de Educação pelo Trabalho para a Saúde (PET-Saúde), através do Ministério da Saúde e da Educação, visa qualificar e estimular a formação de profissionais que atendam as necessidades do Sistema Único de Saúde (SUS). A aproximação do estudante de Medicina com a sociedade, pela inserção do mesmo na atenção primária à saúde, através da integralização ensino-serviçocomunidade, é a base do programa, que também estímula a produção científica e a participação em congressos. Objetivo: Avaliar o impacto da vivência no programa PETSaúde durante a graduação para a formação do profissional médico para o SUS. Material e Métodos: Foi realizado estudo observacional, transversal-analítico, com alunos do internato de um curso de graduação em Medicina (N=76), com amostragem por conveniência, utilizando-se questionário socioeducacional e avaliativo sobre o SUS, elaborado para este estudo pelos pesquisadores. Resultados: Houve tendência a maior publicação de artigos científicos pelos participantes do Programa (56,3% vs.31,8%, p=0,0581). A média de acertos nas questões de conhecimentos gerais sobre o SUS dos participantes do PET-Saúde foi maior que a dos não participantes (5,03±2,31 vs. 2,61±2,43, p<0,0001). Também se obteve maior média de acertos dentre aqueles que relataram interesse em trabalhar no SUS. Conclusão: Os alunos participantes do PET-Saúde apresentaram conhecimento superior sobre o SUS em relação aos alunos não participantes.(AU)

Introduction: The Educational Program for Health Work (PETSaúde), which is supported by the Ministry of Health and Education in Brazil, aims to qualify and promote the training of professionals to meet the needs of the Brazilian Healthcare System (SUS). This program brings medical students closer to the community, particularly through primary health care, and promotes service-learning-community integration, in addition to stimulating scientific production and participation in conferences. Objective: To evaluate the impact of participation in the Educational Program for Health Work during medical school towards the training of medical professionals for the healthcare system. Material and Methods: This was an observational, cross-sectional and analytical study with 76 medical students selected by convenience sampling. Participants were interviewed using a questionnaire previously prepared by the researchers for this study. Results: There was a tendency toward greater publication of scientific articles by students participating in the program (56.3% vs. 31.8%, p=0.0581). The success rates in general knowledge questions about the healthcare system (SUS) was higher for students participating in the program than for non-participants (5.03±2.31 vs. 2.61±2.43, p<0.0001). Furthermore, the highest rates were found among those who reported having an interest in working in the healthcare system. Conclusion: Students participating in the Educational Program for Health Work (PET-Saúde) showed greater knowledge about the healthcare system when compared to non-participating students. (AU)

Myocarditis associated with Plasmodium vivax malaria: a case report

Malaria remains a major public health problem in Brazil where Plasmodium vivax is the predominant species, responsible for 82% of registered cases in 2013. Though benign, P. vivax infection may sometimes evolve with complications and a fatal outcome. Here, we report a severe case of P. vivax malaria in a 35-year-old Brazilian man from a malaria endemic area, who presented with reversible myocarditis.

Absence of correlation between IL-28B gene polymorphisms and the clinical presentation of chronic hepatitis B in an Amazon Brazilian population.

OBJECTIVE: The present study investigated the prevalence of the IL-28B polymorphisms rs12979860 and rs8099917 in chronic hepatitis B patients from a case study in Eastern Amazonia. METHODS: In total, 65 chronically infected HBV patients and 97 healthy subjects who were anti-HBc and anti-HBs positive (control group) were evaluated between May 2011 and December 2012. The groups of patients were designated as inactive carriers, chronic hepatitis without cirrhosis, and chronic hepatitis with cirrhosis based on clinical, pathological, biochemical, hematological, and virological variables. The patients were genotyped using quantitative real-time PCR. RESULTS: The frequencies of the rs12979860 polymorphism were similar between the infected group (32.3% CC, 41.5% CT, and 26.2 TT) and the control population (35% CC, 47.4% CT, and 17.6% TT), and the frequencies of the rs8099917 polymorphism (7.7% GG, 35.4% GT, and 56.9% TT versus 7.2% GG, 35.1% GT, and 57.7% TT) were also similar in both groups. The associations between the rs12979860 and rs8099917 polymorphisms and the clinical manifestations were not statistically significant. CONCLUSION: In conclusion, these polymorphisms had a similar distribution between infected and control groups, indicating that they were not associated with susceptibility and the clinical evolution of hepatitis B in the examined population.

SNP rs8099917 in gene IL28B might be associated with risk of chronic infection by HCV but not with response to treatment.

AIM: The aim of this study was to characterize the genetic profile of patients with chronic hepatitis C virus (HCV) infection relative to polymorphisms rs12979860 and rs8099917 in gene IL28B and the association of those polymorphisms with the response to treatment with pegylated interferon and ribavirin, performed at a reference center in Brazilian Amazonia. METHODS: A total of 75 individuals with chronic hepatitis C and 98 healthy individuals from both genders over 18 years old were assessed. DNA samples were collected from leukocytes and subjected to real-time polymerase chain reaction to genotype polymorphisms rs12979860 and rs8099917. RESULTS: Analysis of the allelic and genotypic frequencies of the investigated polymorphisms showed that both groups were in Hardy-Weinberg equilibrium; polymorphism rs12979860 exhibited no significant difference between the groups. For polymorphism rs8099917, allele T was significantly less frequent (P = 0.0195) among the patients (63.3%) than the controls (75.5%), and the patients were 1.7 times as likely to exhibit allele G. No difference in response to treatment was associated with SNP patterns. CONCLUSION: The results suggest a possible association of SNP rs8099917 with higher odds of chronic HCV infection but do not indicate a putative influence of the investigated SNPs on the sustained virologic response.

Myocarditis associated with Plasmodium vivax malaria: a case report.

Malaria remains a major public health problem in Brazil where Plasmodium vivax is the predominant species, responsible for 82% of registered cases in 2013. Though benign, P. vivax infection may sometimes evolve with complications and a fatal outcome. Here, we report a severe case of P. vivax malaria in a 35-year-old Brazilian man from a malaria endemic area, who presented with reversible myocarditis.

Análise dos níveis de satisfação de trabalhadores de saúde mental de um Hospital público de referência psiquiátrica em Belém (PA) / Analysis of levels of satisfaction of mental health workers of a reference Psychiatric public hospital in Belém (PA) / Análisis de los niveles de satisfacción de trabajadores de la salud mental de un hospital público de referencia psiquiátrica en Belém (PA)

A satisfação profissional entre trabalhadores de saúde é cada vez mais reconhecida como uma medida que deve ser incluída na melhoria da qualidade de programas. O objetivo deste artigo é analisar a associação das variáveis sociodemográficas-ocupacionais com o grau de satisfação dos trabalhadores de um serviço de saúde mental.O método empregado foi o estudo observacional, individual, transversal e analítico com 59 profissionais de saúde mental do Serviço de Psiquiatria da Fundação Hospital de Clínicas Gaspar Vianna em Belém (PA). Os instrumentos utilizados na coleta de dados foram: as escalas de avaliação da Satisfação da Equipe em Serviços de Saúde Mental (SATIS-BR), escalas de avaliação do sobrecarga do trabalho (IMPACTO-BR) e questionário sociodemográfico-ocupacional. Para a análise das associações entre variáveis foram empregados os testes de Kruskal-Wallis e Mann-Whitney. Os resultados apontam que os participantes apresentaram média de idade de 38,7 mais ou menos 9,16 anos e tempo médio de serviço de 7,60 mais ou menos 7,68 anos, sendo a maioria do gênero feminino (66,1por cento); o escore médio de satisfação foi 3,29mais ou menos 0,78; não foram observadas associações significativas entre gênero, idade, horas de trabalho semanais e escolaridade com as médias de satisfação; dos profissionais estudados, os psicólogos (6,8por cento ) apresentaram maiores níveis de satisfação 3,81 mais ou menos 0,42 (p igual 0,0062). Conclui-se que a maior parte dos participantes do estudo apresentou nível intermediário de satisfação, havendo influência da renda mensal pessoal, cargo, turnos de trabalho e impacto do trabalho sobre esses níveis.

Job satisfaction among health care workers is increasingly recognized as ameasure that should be included in quality improvement programs. The objective of this paper is to analyze the association of socio-demographic and occupational variables and the level of satisfaction of the workers in a mental health facility. The method used was an observational study, detached, analytical cross-sectional, with 59 mental health professionals of the Department of Psychiatry of the Clinics Hospital Foundation Gaspar Vianna in Belém (PA). The instruments used in data collection were: Mental Health Services? Staff Satisfaction Scale (SATIS-BR), Staff Burden Scale (IMPACT-BR) and Socio-demographic and Occupational questionnaire. For the analysis of associations between variables were used Kruskal-Wallis and Mann-Whitney. The results indicate that participants had the average age of 38.7 more or less 9.16 years old and the average service time was 7.60 more or less 7.68 years, most females (66.1percent ), the average score satisfaction was 3.29 more or less 0.78, there were no significant associations between gender, age, weekly hours of work and education as the means of satisfaction; from the total of professionals analyzed, psychologists (6.8percent) had higher levels of satisfaction 3.81 more or less 0.42 (p equal 0.0062). It is concluded that the majority of the participants of this study had moderate level of satisfaction, with the influence of personal monthly income, job, shift work and impact of work on these levels.

La satisfacción laboral entre los trabajadores de la salud es cada vez másreconocida como una medida que debe incluirse en la mejora de los programas de calidad. El objetivo de este artículo es analizar la asociación de las variables sociodemográficos y ocupacionales con el grado de satisfacción de los trabajadores de un servicio de salud mental. El método utilizado fue el estudio de observación, individual, transversal y analítico, con 59 profesionales de la salud mental del Departamento de Psiquiatría de la Fundación del Hospital de las Clínicas Gaspar Vianna en Belén (PA). Los instrumentos utilizados en la recolección de los datos fueron: las escalas de evaluación de la Satisfacción del equipo em los Servicios de Salud Mental (SATIS-BR), escalas de evaluación de sobrecarga de trabajo (IMPACTO-BR) y un cuestionario sociodemográfico y ocupacional. Para el análisis de lãs asociaciones entre variables se utilizaron los test de Kruskal-Wallis y Mann-Whitney. Los resultados indican que los participantes presentaron una edad media de 38,7 más o menos 9,16 años y el tiempo de servicio promedio de 7,60 más o menos 7,68 años, siendo la mayoría del género femenino (66,1por ciento), la puntuación media de satisfacción fue de 3,29 más o menos 0,78, no fueron observadas asociaciones significativas entre género, edad, horas semanales de trabajo y escolaridad, conlas medias de satisfacción; de los profesionales estudiados, los psicólogos (6,8por ciento) presentaron niveles más altos de satisfacción 3,81 más o menos 0,42 (p igual 0,0062). Se concluye que la mayoría delos participantes del estudio presentaron un nivel intermediario de satisfacción, habiendo influencia de los ingresos personales mensuales, función, turnos de trabajo y el impacto del trabajo bajo eses niveles.