Subject(s)
Hantavirus Infections/epidemiology , Leptospirosis/epidemiology , Urban Health , Animals , Brazil/epidemiology , Dengue/epidemiology , Diagnosis, Differential , Disease Outbreaks , Orthohantavirus/classification , Hemorrhagic Fever with Renal Syndrome/epidemiology , Humans , Male , Muridae , RatsABSTRACT
The management of 50 AIDS patients by traditional hospital admission (25 cases) and outpatient clinics (25 cases) was studied between August and November 1995 in the Department of Infectious and Parasitic Diseases of the Federal University Hospital. The most costly items of expenditure were hospital services and consumable materials. Comparison of costs was complicated by differences in clinical status of the patients in the two groups. The choice of treatment was much more dependent on clinical status than on sociodemographic factors. Traditional hospital admission tended to be associated with the poorest patients. The rationalization of care based on cost-benefit analysis requires much future work.
Subject(s)
Acquired Immunodeficiency Syndrome/therapy , Acquired Immunodeficiency Syndrome/diagnosis , Acquired Immunodeficiency Syndrome/economics , Adolescent , Adult , Ambulatory Care Facilities , Cost-Benefit Analysis , Costs and Cost Analysis , Female , Hospitalization , Humans , Karnofsky Performance Status , Male , Middle AgedABSTRACT
Foram estudados 25 pacientes com Aids do grupo IV da classificação do Centers for Disease Control (CDC)(12), admitidos no Serviço de Doenças Infecciosas e Parasitárias (DIP) do Hospital das Clínicas da Universidade Federal de Pernambuco (HU-UFPE), que fizeram uso do regime de hospital-dia no período de janeiro a dezembro de 1995. Vinte pacientes 80(por cento) eram do sexo masculino e cinco 20(por cento) do sexo feminino. A média de permanência foi de 3,1 dias. Herpes simplex e neurotoxoplasmose ocorreram em sete casos 28(por cento) e pneumonia por Pneumocystis carinil em seis pacientes 24(por cento). As medicações mais usadas foram dipirona e metoclopramida em todos os pacientes, 100(por cento), sulfametoxazol-trimetropim 18 casos, 72(por cento) e zidovudina 13 casos, 52(por cento)
Subject(s)
Day Care, Medical , Patients , Acquired Immunodeficiency SyndromeABSTRACT
Foram estudados prospectivamente 18 pacientes com Aids, admitidos no Programa de Assistência Domiciliar Terapêutica (PADT) do Hospital das Clínicas da Universidade Federal de Pernambuco, no período de agosto de 1995 a março de 1996. Seis doentes 33,3(por cento) permaneceram no programa por um período menor que 50 dias e um 5,5(por cento) por mais de 200 dias. Houve um total de nove óbitos 50(por cento), dos quais um 5,5(por cento) ocorreu em casa. Dez pacientes 55,5(por cento) necessitaram também de internamento tradicional e cinco 27,7(por cento) utilizaram o regime de hospital dia
Subject(s)
HIV , Home Care Services, Hospital-Based , Acquired Immunodeficiency Syndrome , Sexually Transmitted Diseases , Residential TreatmentABSTRACT
Fifty AIDS patients were studied. All patients had anti-HIV antibodies (ELISA) present and met OPAS/Caracas punctuation criteria for AIDS cases in adults. Cerebrospinal fluid (CSF) analysis included pressure, cytology (number of cytomorphological aspects), total protein and electrophoresis, glucose and chloride concentration. Bacteriological and mycological investigations were performed as well as agglutination tests for Cryptococcus. Complement fixation, indirect immunoflorescence, passive hemagglutination and/or ELISA tests were performed for syphilis, toxoplasmosis, viral and fungal infections. All CSF analysis were made in the same laboratory following the same methodology. CSF was altered in 45 cases (90.0%) of the 50 patients studied. The most important alterations observed were: gammaglobulin (55.5%) and total protein (51.1%) increase, hypercytosis (48.9%) and decrease of chloride concentration (40.0%). HIV antibodies were detected in 42 patients (93.3%). Toxomoplamosis, isolated or associated to other agents, was the most frequent opportunistic infection (57.7%). Cerebrospinal fluid should always be examined in AIDS patients with or without neurological symptoms.
Subject(s)
Acquired Immunodeficiency Syndrome/cerebrospinal fluid , Opportunistic Infections/cerebrospinal fluid , Adult , Female , Humans , Male , Middle Aged , Reference ValuesABSTRACT
Although it has not been definitely proven that the severity of malaria is associated to human immunodeficiency virus (HIV) we know that infection through Plasmodium falciparum can favor a rapid evolution of the HIV infection. Besides, association of malaria with HIV/AIDS from a clinical point of view can be clinically severe in the face of the occurrence of other microorganisms or neoplasias, which worsens the evolution and prognosis of the affected patients. The concurrence of HIV with Plasmodium in malaria endemic zones is a possibility which should always be taken into consideration, since transmission is related to risk factors caused by people's behavior which are not always promptly revealed and/or identified. The authors report one case of brain malaria infection by Plasmodium vivax and Plasmodium falciparum in a patient with AIDS. They describe the clinical evolution and therapy.
Subject(s)
Acquired Immunodeficiency Syndrome/complications , Malaria, Cerebral/complications , Acquired Immunodeficiency Syndrome/diagnosis , Adult , Enzyme-Linked Immunosorbent Assay , Humans , Malaria, Cerebral/diagnosis , Malaria, Cerebral/drug therapy , MaleABSTRACT
Foram estudados 50 pacientes com AIDS, todos estes pacientes apresentavam anticorpos ant-HIV1 (ELISA) e preenchiam os critérios de pontuaçao OPAS/Caracas de definiçao de casos de AIDS em adultos. A análise do liquido cefalorraqueano (LCR) incluiu: pressao; citologia (número de células e aspectos citomorfológicos); proteína total e eletroforese; concentraçoes de glicose, cloretos e testes imunológicos para sífilis, toxoplasmose e infecçoes virais (citomegalovírus, varicela-zoster, Herpes simplex, e HIV1). Investigaçoes bacteriológicas e micológicas (pesquisa direta e cultura), além de teste de aglutinaçao (látex) paracryptococcus foram também realizados. Os testes imunológicos usados foram fixaçao do complemento, imunofluorescência indireta, hemaglutinaçao passiva e/ou ELISA. Todos os LCR foram analisados no mesmo laboratório seguindo sempre a mesma metodologia. O LCR esteve alterado em 45 pacientes (90,0 por cento) dos 50 pacientes estudados. As principais alteraçoes encontradas no LCR foram: aumento de gamaglobulina em 25 casos (55,5 por cento); aumento da proteína total em 23 (51,1 por cento); hipercitose em 22 (48,9 por cento) e diminuiçao dos cloretos em 18(40,0 por cento). A detecçao de anticorpos anti- HIV1 estiveram presentes em 42 pacientes (93,3 por cento). Toxoplasmose isolada ou associada a outros agentes foi a infecçao oportunista mais frequente, detectada em 26 casos (57,7 por cento). O LCR deverá ser sempre analisado em todos os pacientes com AIDS, com ou sem sintomas neurológicos.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Opportunistic Infections/cerebrospinal fluid , Acquired Immunodeficiency Syndrome/cerebrospinal fluid , Reference ValuesABSTRACT
Embora nao esteja definitivamente comprovada que a severidade da malária esteja associada com o vírus da imunodeficiência humana (HIV), sabe-se que a infecçao pelo Plasmodium falciparum pode favorece uma rápida evoluçao da infecçao pelo HIV. Além disso a associaçao da malária com HIV/AIDS, do ponto de vista clínico, pode ser extremamente grave face a ocorrência de outros microorganismos e/ou neoplasias, o que piora a evoluçao e prognóstico dos pacientes. A concomitância do vírus HIV com o Plasmodium em zonas endêmicas de malária, é uma possibilidade que deve ser sempre pensada, visto que a sua transmissao está relacionada a fatores de risco ligados aos comportamentos das pessoas, que nem sempre sao logo revelados e/ou identificados. Os autores descrevem um caso de malária cerebral Plasmodium vivax e Plasmodium falciparum em um paciente com AIDS. Descrevem sua evoluçao clínica e terapêutica.
Subject(s)
Humans , Male , Adult , Malaria, Cerebral/complications , Acquired Immunodeficiency Syndrome/complications , Enzyme-Linked Immunosorbent Assay , Malaria, Cerebral/diagnosis , Malaria, Cerebral/drug therapy , Acquired Immunodeficiency Syndrome/diagnosisABSTRACT
This article reports results of a World AIDS Foundation-funded training programme in North-Eastern Brazil. Training objectives were: (1) to increase the effectiveness of existing medical and behavioural HIV-related services; (2) to prepare professionals to implement and evaluate social skills-based AIDS prevention programmes incorporating metacontingency systems; (3) to prepare professionals to disseminate training content in North-Eastern Brazil; and (4) to promote local involvement in regional AIDS programme planning. Fifty-eight health and behavioural sciences leaders from 5 North-Eastern Brazilian states represented a variety of institutions actually or potentially involved in AIDS prevention. Training activities focused on programme planning and evaluation and social skills training. Written pre- and post-test data indicate that all participants had a basic understanding of AIDS transmission at baseline. Significant knowledge increases (p < 0.01) resulted in all domains trained except for programme evaluation. For the two social skills evaluated (Condom Use Negotiation and Social Skills Trainer), significant improvements (p < 0.01) resulted in verbal and non-verbal content, assertiveness and anxiety, with the exception of near-significant levels (p < 0.10) achieved for assertiveness and anxiety on the 'Trainer' skill. Participants cofacilitated follow-up trainings in their respective states. These trainings demonstrated a successful model for technology transfer. More focused training is needed in programme design and evaluation methods.
Subject(s)
Acquired Immunodeficiency Syndrome/prevention & control , Health Education , Health Occupations/education , Regional Medical Programs/organization & administration , Adolescent , Adult , Brazil , Clinical Competence , Curriculum , Educational Measurement , Female , Health Planning , Humans , Male , Middle Aged , Program Development , Program EvaluationABSTRACT
From January 1st up to September 30th 1990, 77 patients with leptospirosis confirmed by laboratory studies were admitted at the Infectious and Parasitic Diseases Service of the Hospital das Clínicas of the Universidade Federal de Pernambuco. Clinical manifestations had sudden onset with presence of fever, headache, chills and muscle pains. Plurisystemic involvement was observed both in the icteric and in the non-icteric patients. The neurological exam was abnormal in 70 of the patients (90.91%). Neurological findings were essentially variable. Though in a transitory form, they allowed the observation of the following clinical forms: meningoencephalitis and polyneuritis in association, meningoencephalitis, polyneuritis, and subarachnoid hemorrhage.
Subject(s)
Central Nervous System Diseases/etiology , Leptospirosis/complications , Central Nervous System Diseases/diagnosis , Humans , Neurologic ExaminationABSTRACT
From January 1st up to September 30th 1990, 77 patients with leptospirosis diagnosis confirmed by laboratory studies were admitted at the Infectious and Parasitic Disease Service of the Hospital das Clínicas of the Universidade Federal de Pernambuco. The neurological exam was abnormal in 70 of the patients (90.91%). The cerebrospinal fluid (CSF) examination was carried out on 67 (87%) of the patients; it was abnormal in 64 (95.52%) yielding hypercytosis in the majority of cases. There was no difference in the CSF behavior in report to the several neurological forms nor in relation to the icteric or non-icteric forms of the disease. Significant were the results for the microscopic agglutination tests for leptospirosis in the CSF.
Subject(s)
Central Nervous System Diseases/cerebrospinal fluid , Leptospirosis/cerebrospinal fluid , HumansABSTRACT
From January 1st up to September 30th 1990, 77 patients with leptospirosis were admitted at the Infectious and Parasitic Diseases Service of the Hospital das Clínicas of the Universidade Federal de Pernambuco. The majority (64) were male patients, and average age was 28 years old. Serovars icterohaemorrhagic and canicola were the most frequent. CSF examination was performed in 67 (87.0%) patients and it was abnormal in 64 (95.52%). Micro-agglutination test for leptospirosis with live antigens was performed in CSF, as well as immunological tests for syphilis, cysticercosis and schistosomiasis for differential diagnosis. Concerning the serovar identification, results of microagglutination test for leptospirosis in CSF were significant considering the similitude of responses when compared to those found for blood samples.
Subject(s)
Central Nervous System Diseases/diagnosis , Leptospirosis/diagnosis , Adolescent , Adult , Aged , Agglutination Tests , Antigens, Bacterial/analysis , Antigens, Bacterial/cerebrospinal fluid , Central Nervous System Diseases/cerebrospinal fluid , Diagnosis, Differential , Female , Humans , Leptospira/immunology , Leptospirosis/cerebrospinal fluid , Male , Middle AgedABSTRACT
Entre 1-janeiro e 30-setembro-1990 foram estudados 77 pacientes com diagnóstico de leptospirose confirmada, laboratorialmente. Apresentaram início súbito dos sintomas 69 (89,61 por cento) pacientes, com febre, cefaléia, calafrios e mialgias. Observou-se envolvimento plurissistêmico quer nos pacientes ictéricos, quer nos anictéricos. O exame neurológico foi anormal em 70(90,91 por cento) pacientes, com achados variáveis e que, embora de caráter transitório, permitiram caracterizar as formas clínicas seguintes: meningoencefalite e polineurite associadas, meningoencefalite, polineurite e hemorragia subaracnóidea
Subject(s)
Humans , Central Nervous System Diseases/etiology , Leptospirosis/complications , Central Nervous System Diseases/diagnosis , Neurologic ExaminationABSTRACT
Entre 1-janeiro e 30-setembro-1990 foram estudados 77 pacientes com diagnóstico de leptospirose, admitidos no SDIP/UFPE. O exame neurológico foi anormal em 70 (90,91 por cento) dos pacientes. O exame do LCR, foi realizado em 67 (87 por cento) dos pacientes, foi anormal em 64 (95,52 por cento), tendo como achado mais frequente a pleocitose. Näo houve diferença significativa no comportamento do LCR nas diversas formas clínicas neurológicas observadas, nem quando comparadas as formas ictéricas com as näo ictéricas. Bastante significativos foram os resultados da reaçäo de microaglutinaçäo para leptospirose no LCR
Subject(s)
Humans , Central Nervous System Diseases/cerebrospinal fluid , Leptospirosis/cerebrospinal fluidABSTRACT
Entre 1-janeiro e 30-setembro-1990 foram estudados 77 pacientes com diagnóstico de leptospirose: 64 (83,11 por cento) eram do sexo masculino e a média de idade, 28 anos. Os sorovars icterohemorrhagiae e canicola foram os mais frequentes. O exame do LCR, realizado em 67 (87,0 por cento) dos pacientes, foi anormal em 64 (95,52//). A reaçäo de microaglutinaçäo para leptospirose com antígenos vivos foi realizada no LCR, bem como reaçöes imunológicas para sífilis, cisticercose e esquistossomose para diagnóstico diferencial. Bastante signficativa foram os resultados da reaçäo de microaglutinaçäo para leptospirose no LCR, pela semelhança das respostas àquelas encontradas no sangue quanto à identificaçäo do sorovar
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Central Nervous System Diseases/diagnosis , Leptospirosis/diagnosis , Agglutination Tests , Antigens, Bacterial/analysis , Antigens, Bacterial/cerebrospinal fluid , Central Nervous System Diseases/cerebrospinal fluid , Leptospira/immunology , Leptospirosis/cerebrospinal fluidABSTRACT
Rat-bite fever results from an infection with the organism Spirillum minus. The authors report a symptomatic patient with fever, malaise, and ulcer in forehead after a rodent exposure. The organism was identified in darkfield examination of the ulcer exudate. Penicillin was the drug used with clinical improvement of symptoms.