ABSTRACT
Dengue fever is the most common arbovirus disease, and presents with a large spectrum of clinical manifestations ranging from asymptomatic disease through to the development of dengue hemorrhagic fever. These extreme cases can lead to dengue shock syndrome, and sometimes death. Spinal cord involvement in dengue virus (DENV) infections is rare. Here, we report a case in which the patient developed acute transverse myelitis (TM) without paraparesis following a DENV infection. This case highlights the importance of physicians' awareness of the possible link between DENV and TM in endemic areas.
Subject(s)
Dengue/complications , Myelitis, Transverse/etiology , Brazil , Humans , Magnetic Resonance Imaging , Male , Myelitis, Transverse/diagnostic imaging , Myelitis, Transverse/virology , Spinal Cord/diagnostic imaging , Spinal Cord/virology , Young AdultABSTRACT
Arboviruses impose a serious threat to public health services. We report a case of a patient returning from a work trip to the Amazon basin with myalgia, arthralgia, fever, and headache. During this travel, the patient visited riverside communities. Both dengue and Chikungunya fevers were first suspected, tested for, and excluded. Mayaro fever was then confirmed by reverse transcription polymerase chain reaction followed by next-generation sequencing and phylogenetic reconstruction. The increased awareness of physicians and consequent detection of Mayaro virus in this case was only possible due a previous surveillance program with specific health personnel training about these neglected arboviruses.
Subject(s)
Alphavirus Infections/diagnosis , Alphavirus/genetics , HIV Infections , Adult , Alphavirus/classification , Alphavirus Infections/virology , Chikungunya Fever/diagnosis , Diagnosis, Differential , Humans , Male , Phylogeny , Reverse Transcriptase Polymerase Chain ReactionABSTRACT
Abstract Arboviruses impose a serious threat to public health services. We report a case of a patient returning from a work trip to the Amazon basin with myalgia, arthralgia, fever, and headache. During this travel, the patient visited riverside communities. Both dengue and Chikungunya fevers were first suspected, tested for, and excluded. Mayaro fever was then confirmed by reverse transcription polymerase chain reaction followed by next-generation sequencing and phylogenetic reconstruction. The increased awareness of physicians and consequent detection of Mayaro virus in this case was only possible due a previous surveillance program with specific health personnel training about these neglected arboviruses.
Subject(s)
Humans , Male , Adult , HIV Infections , Alphavirus Infections/diagnosis , Alphavirus/genetics , Phylogeny , Alphavirus Infections/virology , Alphavirus/classification , Reverse Transcriptase Polymerase Chain Reaction , Diagnosis, Differential , Chikungunya Fever/diagnosisABSTRACT
Several formulae have been developed in an attempt to reduce the toxicity of amphotericin B (AmB), but their high costs preclude widespread use. The aim of this study was to evaluate the efficacy of amphotericin B in a fat emulsion, i.e. Intralipid (AmB-IL), in 37 AIDS patients with cryptococcal meningitis (CM). We retrospectively reviewed data collected in a non-comparative open study between January 1999 and December 2001. The therapeutic cure was defined as complete resolution or improvement of the clinical symptoms or complete absence or improvement of the mycological alterations of the CSF. The outcomes were evaluated at 2 weeks, induction phase (IP), and at the end of treatment or consolidation phase (CP) with the last available CSF. Prior to the diagnosis of CM, 72% of patients had had one or more OI and 67.57% had a concomitant OI. The median CD4-cell count was 32 cells/mm(3), the median leukocyte count in the CSF was 29 cells/mm(3) and the median cumulative dose of AmB-IL was 1,200 mg (300-2,500). The therapeutic cure was 57.14% in the IP and 64.86% in the CP. During IP, 9 patients died (24.32%) and 4 (10.81%) during the CP (p=0.2). Thus, the overall mortality rate was 35.14%. AmB-IL, an inexpensive preparation, might be an alternative to conventional AmB. Some questions remain such as its compatibility, stability and level of toxicity. The benefit is especially important in developing countries, where no drugs other than AmB are available to treat systemic fungal infections.
Subject(s)
AIDS-Related Opportunistic Infections/drug therapy , Amphotericin B/administration & dosage , Antifungal Agents/administration & dosage , Meningitis, Cryptococcal/drug therapy , Adult , Amphotericin B/adverse effects , Antifungal Agents/adverse effects , Fat Emulsions, Intravenous/administration & dosage , Female , Humans , Male , Middle Aged , Retrospective Studies , Treatment OutcomeABSTRACT
Several formulae have been developed in an attempt to reduce the toxicity of amphotericin B (AmB), but their high costs preclude widespread use. The aim of this study was to evaluate the efficacy of amphotericin B in a fat emulsion, i.e. Intralipid (AmB-IL), in 37 AIDS patients with cryptococcal meningitis (CM). We retrospectively reviewed data collected in a non-comparative open study between January 1999 and December 2001. The therapeutic cure was defined as complete resolution or improvement of the clinical symptoms or complete absence or improvement of the mycological alterations of the CSF. The outcomes were evaluated at 2 weeks, induction phase (IP), and at the end of treatment or consolidation phase (CP) with the last available CSF. Prior to the diagnosis of CM, 72 percent of patients had had one or more OI and 67.57 percent had a concomitant OI. The median CD4-cell count was 32 cells/mm³, the median leukocyte count in the CSF was 29 cells/mm³ and the median cumulative dose of AmB-IL was 1,200 mg (300-2,500). The therapeutic cure was 57.14 percent in the IP and 64.86 percent in the CP. During IP, 9 patients died (24.32 percent) and 4 (10.81 percent) during the CP (p=0.2). Thus, the overall mortality rate was 35.14 percent. AmB-IL, an inexpensive preparation, might be an alternative to conventional AmB. Some questions remain such as its compatibility, stability and level of toxicity. The benefit is especially important in developing countries, where no drugs other than AmB are available to treat systemic fungal infections.
Subject(s)
Adult , Female , Humans , Male , Middle Aged , AIDS-Related Opportunistic Infections/drug therapy , Antifungal Agents , Amphotericin B/administration & dosage , Meningitis, Cryptococcal/drug therapy , Antifungal Agents , Amphotericin B/adverse effects , Fat Emulsions, Intravenous/administration & dosage , Retrospective Studies , Treatment OutcomeABSTRACT
a reutilização de materiais médicos-hospitalares pode contribuir para a redução de custos. No Brasil, a legislação não permite o reprocessamento de alguns materiais de uso único, entretanto outro são reutilizados sem uma política padronizada que regulamente os métodos de processamento. Cada hospital dispõe de técnicas a sua maneira, o que deixa em dúvida a qualidade final deste procedimento. Qualquer decisão a ser tomada em relação ao reuso de materiais descartáveis deve seguir orientações fundamentadas em estudos que comprovem a eficácia deste procedimento. É fundamental conhecer o grau de descartabilidade destes materiais que se pretende reutilizar e defenir a viabilidade do reuso. O cateter de monitorização de pressão intracraniana perde suas propriedades originais após o primeiro uso,portanto é inviável o seu reprocessamento
Subject(s)
Catheterization , Intracranial PressureABSTRACT
Pesquisas têm uma associação entre doenças crônicas e transtornos do humor que pode ter um impacto negativo sobre a adesão ao tratamento e enfrentamento da doença. Este estudo tem como objetivo adentificar sintomas de depressão em pacientes portadores de duas doenças crônicas. Foram avaliados 114 pacientes, 59 portadores mellitus [Idade Média (IM) = 48,1; Desvio Padrão (DP) = 1,8], sendo 43 do sexo feminino e 55 portadores de Hepatites virais (IM = 38,0; DP = 1,4), sendo 45 do sexo masculino, atendidos em ambulatórios das respectivas especialidades. O Inventário Beck de Depressão foi aplicado individualmente, sendo excluídos da análise os sintomas orgânicos. Apresentaram sintomas de depressão acima do escore de corte 68,12 por cento dos pacientes portadores de Diabetes e 31,88 por cento dos portadores de Hepatite, indicando haver associação entre doença e depressão (X2 = 18,741 e p < 0,001). A presença de sintomas mostrou-se associada ao sexo feminino (X2 = 9,260 e p = 0,002), à idade mais avançada (t = 4,38 e p < 0,001) e à menor escolaridade (X2 pela Dist6ancia de Hellinger = 0,024). Os dados obtidos são compatíveis com aliteratura e confirmam a necessidade de um atendimento biopsicossocial ao paciente portador das doenças crônicas estudadas, uma vez que sintomas de depressão podem prejudicar ainda mais o funcionamento global do indivíduo
Subject(s)
DepressionABSTRACT
Nos Estados Unidos aproximadamente 50.000 pacientes adquirem infecção da corrente sangüínea, a cada ano, relacionada ao uso de cateteres intravasculares. O objetivo deste estudo foi avaliar, prospectivamente, os aspectos epidemiológicos, evolutivos, microbiológicos e fatores de risco de cateteres intravasculares num hospital geral universitário. A indicação precisa de DV e a prevenção destes morbimortalidade destas infecções
