Infectious diarrhea in autologous stem cell transplantation: high prevalence of coccidia in a South American center.

BACKGROUND: Diarrhea is frequently seen in autologous stem cell transplantation. Although toxicity related to conditioning is the most common cause, infectious pathogens can play a distinctive role particularly in certain regions and environments. METHODS: The role of enteropathogens was investigated in 47 patients submitted to autologous stem cell transplantation at a Brazilian center between May 2011 and May 2013. All patients who presented with diarrhea consented to stool sample analysis to identify the etiological agents including coccidia, Strongyloides sp., Clostridium difficile and other pathogenic bacteria. RESULTS: Thirty-nine patients (83%) had diarrhea, among whom seven (17.5%) presented with coccidia, three (7.5%) with Candida sp., one (2.5%) with C. difficile, and one (2.5%) with Giardia lamblia. There was a tendency toward a higher incidence of diarrhea in older patients (p-value = 0.09) and those who received conditioning with lomustine, etoposide, cytarabine, and melphalan (p-value = 0.083). Furthermore, the number of days of neutropenia was higher in patients with diarrhea (p-value = 0.06). CONCLUSIONS: The high frequency of diarrhea caused by coccidia shows the importance of investigating and correctly identifying etiological agents and highlights the possible varieties of intestinal infections in patients who undergo autologous stem cell transplantation.

Infectious diarrhea in autologous stem cell transplantation: high prevalence of coccidia in a South American center

ABSTRACT Background: Diarrhea is frequently seen in autologous stem cell transplantation. Although toxicity related to conditioning is the most common cause, infectious pathogens can play a distinctive role particularly in certain regions and environments. Methods: The role of enteropathogens was investigated in 47 patients submitted to autologous stem cell transplantation at a Brazilian center between May 2011 and May 2013. All patients who presented with diarrhea consented to stool sample analysis to identify the etiological agents including coccidia, Strongyloides sp., Clostridium difficile and other pathogenic bacteria. Results: Thirty-nine patients (83%) had diarrhea, among whom seven (17.5%) presented with coccidia, three (7.5%) with Candida sp., one (2.5%) with C. difficile, and one (2.5%) with Giardia lamblia. There was a tendency toward a higher incidence of diarrhea in older patients (p-value = 0.09) and those who received conditioning with lomustine, etoposide, cytarabine, and melphalan (p-value = 0.083). Furthermore, the number of days of neutropenia was higher in patients with diarrhea (p-value = 0.06). Conclusions: The high frequency of diarrhea caused by coccidia shows the importance of investigating and correctly identifying etiological agents and highlights the possible varieties of intestinal infections in patients who undergo autologous stem cell transplantation.

Efficacy and Safety of Ombitasvir/Paritaprevir/Ritonavir and Dasabuvir ± Ribavirin for HCV in Brazilian Adults with Advanced Fibrosis.

INTRODUCTION AND AIM: Approximately 650,000 people in Brazil have chronic hepatitis C virus (HCV) infection. We evaluated the safety and efficacy of ombitasvir (OBV)/paritaprevir (PTV)/ritonavir (r) plus dasabuvir (DSV) with/without ribavirin (RBV) in an openlabel multicenter phase 3b trial in treatment-naive or interferon (IFN) treatment-experienced Brazilian patients with advanced hepatic fibrosis (METAVIR F3/4) and HCV genotype (GT) 1 infection. MATERIAL AND METHODS: All patients received coformulated OBV/PTV/r daily + DSV twice daily (3-DAA). GT1a-infected patients received 3-DAA plus RBV for 12 weeks, except for prior pegIFN/RBV nonresponders with cirrhosis who were treated for 24 weeks. GT1b-infected patients received 3-DAA alone (F3) or in combination with RBV (F4) for 12 weeks. The primary endpoint was sustained virologic response (HCV RNA < 15 IU/mL) at post-treatment Week 12 (SVR12). RESULTS: The study enrolled 222 patients, 214 achieved an SVR12 (96.4%; 95% CI, 93.1-98.2%), one GT1a-infected patient experienced virologic breakthrough, six (5 GT1a) relapsed, and one was lost to follow-up. SVR12 was achieved in 111/ 112 (99.1%) GT1b-infected patients, including 42/43 (97.7%) noncirrhotic, and 69/69 (100%) cirrhotic patients; and in 103/110 (93.6%) GT1a-infected patients, including 44/46 (95.7%) noncirrhotic and 59/64 (92.2%) cirrhotic patients. Overall there was a low rate of serious adverse events (n = 6, 2.7%). One patient experienced a treatment-related serious adverse event and one patient discontinued treatment because of an adverse event. DISCUSSION: The results confirm that the 3-DAA regimen with/without RBV is well tolerated and had a favorable safety profile and is efficacious in GT1-infected patients with advanced fibrosis (METAVIR F3/4).

Structural features and assessment of zymosan-induced arthritis in rat temporomandibular joint model using sulfated polysaccharide / Características estruturais e ensaio de artrite induzida por zimosam em modelo de articulação temporomandibular de ratos usando polissacarídeo sulfatado

The green seaweed Caulerpa cupressoides var. lycopodium contains three SPs fractions (Cc-SP1, Cc-SP2 and Cc-SP3). Cc-SP1andCc-SP2 had anticoagulant (in vitro), pro- and antithrombotic, antinociceptive and/or anti-inflammatory (in vivo) effects. This study analyzed structural features and the antinociceptive and anti-inflammatory effects of Cc-SP1 on zymosan-induced acute arthritis of the rat temporomandibular joint (TMJ). Cc-SP1 was investigated by infrared technique. Male Wistar rats (200-240 g) received subcutaneously (s.c.) Cc-SP1 1h prior to intra-articular (i.art.) injection of zymosan (2 mg joint-1) or saline (0.9%) into the left TMJ. Mechanical hypernociception was measured by the electronic Von Frey method in the basal and 4h after zymosan injection. Animals were euthanized 6h after zymosan injection and the TMJ cavity was removed for total leukocyte counts from the synovial fluid and myeloperoxidase (MPO) activity assessment. Cc-SP1 (1, 3 or 9 mg kg-1) containing sulfate ester, galactose-6-sulfate, uronic acid and glycosidic linkages reduced zymosan-induced hypernociception (78.12, 81.13 and 87.43%, respectively, p 0.01), and inhibited the total leukocyte influx (85, 88.14 and 89.95%, respectively, p 0.01), being confirmed by MPO activity (p 0.05). Therefore, Cc-SP1 reveals a pharmacological tool for treating inflammatory arthropathies.(AU)

A alga marinha verde Caulerpa cupressoides var. lycopodium contém três frações de PSs (Cc-PS1; Cc-PS2 e Cc-PS3). Cc-PS1 e Cc-PS2 apresentaram efeitos anticoagulante (in vitro), pró- e antitrombótico, antinociceptivo e/ou anti-inflammatório (in vivo). Analisaram-se as características estruturais e os efeitos antinociceptivo e anti-inflamatório de Cc-PS1 sobre artrite aguda induzida por zimosam na articulação temporomandibular (ATM) de ratos. Foi investigada a Cc-PS1 por técnica de infravermelho. Ratos machos Wistar (200-240 g) receberam subcutaneamente (s.c.) Cc-PS1 1h antes de injeção intra-articular (i.art.) de zimosam (2 mg articulação-1) ou salina (0,9%) na ATM esquerda. A hipernocicepção mecânica foi mensurada por método Von Frey elétrico em zero e 4h após injeção de zimosam. Os animais foram entanasiados após 6h de injeção de zimosam e a cavidade da ATM foi removida para contagem de leucócitos totais do fluído sinovial e ensaio da atividade de mieloperoxidase (MPO). A Cc-PS1 (1; 3 ou 9 mg kg-1) contendo éster sulfato, galactose-6-sulfato, ácido urônico e ligações glicosídicas reduziu a hipernocicepção induzida por zimosam (78,12; 81,13 e 87,4%, respectivamente; p 0,01), além de inibir o influxo de leucócitos totais (85; 88,14 e 89,95%, respectivamente; p 0,01), sendo, ainda, confirmado pela atividade de MPO (p 0,05). Portanto, a Cc-PS1 revela como uma ferramenta farmacológica para tratar de artropatias inflamatórias.(AU)

Miopia aguda e hipertensão intraocular após uso de topiramato / Acute miopia and intraocular hypertension after topiramate use

A migrânea acomete cerca de 6% a 7% dos homens e 18% a 20% das mulheres, principalmente entre 25 e 55 anos de idade, e é responsável por enorme impacto na atividade produtiva. O topirama-to é um das drogas antiepilépticas aprovadas pela Food and Drug Administration (FDA), sendo usado para a prevenção da migrânea. É uma droga segura, mas não isenta de efeitos adversos. Embora alterações oftalmológicas causadas pelo uso dessa medicação não sejam comuns, aqui é relatado um caso de uma paciente que, ao procurar profilaxia para as crises de migrânea, apresentou efeito adverso ocular, o qual, se não fosse reconhecido em tempo hábil, causaria efeitos maiores e mais danosos à paciente.

Migraine affects approximately 6% and 7% of men and 18% and 20% of women mainly between 25 and 55 years old, responsible for its enormous impact on productive activity. Topiramate is one of the Food and Drug Administration (FDA) approved antiepileptic drugs used for migraine prevention. It is a safe drug but not without side effects. Although ophthalmologic changes caused by this medication are not common, here is reported a case of a patient looking for pro-phylaxis of migraine attacks exhibited an ocular adverse effect, and if not recognized in due time, larger and more harmful effects could be inflicted to the patient.

Structural features and assessment of zymosan-induced arthritis in rat temporomandibular joint model using sulfated polysaccharide / Características estruturais e ensaio de artrite induzida por zimosam em modelo de articulação temporomandibular de ratos usando polissacarídeo sulfatado

The green seaweed Caulerpa cupressoides var. lycopodium contains three SPs fractions (Cc-SP1, Cc-SP2 and Cc-SP3). Cc-SP1 and Cc-SP2 had anticoagulant (in vitro), pro- and antithrombotic, antinociceptive and/or anti-inflammatory (in vivo ) effects. This study analyzed structural features and the antinociceptive and anti-inflammatory effects of Cc-SP1 on zymosan-induced acute arthritis of the rat temporomandibular joint (TMJ). Cc -SP1 was investigated by infrared technique. Male Wistar rats (200-240 g) received subcutaneously (s.c.) Cc-SP1 1h prior to intra-articular (i.art.) injection of zymosan (2 mg joint -1) or saline (0.9%) into the left TMJ. Mechanical hypernociception was measured by the electronic Von Frey method in the basal and 4h after zymosan injection. Animals were euthanized 6h after zymosan injection and the TMJ cavity was removed for total leukocyte counts from the synovial fluid and myeloperoxidase (MPO) activity assessment. Cc-SP1 (1, 3 or 9 mg kg-1) containing sulfate ester, galactose-6-sulfate, uronic acid and glycosidic linkages reduced zymosan-induced hypernociception (78.12, 81.13 and 87.43%, respectively, p < 0.01), and inhibited the total leukocyte influx (85, 88.14 and 89.95%, respectively, p < 0.01), being confirmed by MPO activity (p < 0.05). Therefore, Cc-SP1 reveals a pharmacological tool for treating inflammatory arthropathies.

A alga marinha verde Caulerpa cupressoides var. lycopodium contém três frações de PSs (Cc-PS1; Cc-PS2 e Cc-PS3). Cc-PS1 e Cc-PS2 apresentaram efeitos anticoagulante (in vitro), pró- e antitrombótico, antinociceptivo e/ou anti-inflammatório (in vivo). Analisaram-se as características estruturais e os efeitos antinociceptivo e anti-inflamatório de Cc-PS1 sobre artrite aguda induzida por zimosam na articulação temporomandibular (ATM) de ratos. Foi investigada a Cc-PS1 por técnica de infravermelho. Ratos machos Wistar (200-240 g) receberam subcutaneamente (s.c.) Cc-PS1 1h antes de injeção intra-articular (i.art.) de zimosam (2 mg articulação-1) ou salina (0,9%) na ATM esquerda. A hipernocicepção mecânica foi mensurada por método Von Frey elétrico em zero e 4h após injeção de zimosam. Os animais foram entanasiados após 6h de injeção de zimosam e a cavidade da ATM foi removida para contagem de leucócitos totais do fluído sinovial e ensaio da atividade de mieloperoxidase (MPO). A Cc-PS1 (1; 3 ou 9 mg kg-1) contendo éster sulfato, galactose-6-sulfato, ácido urônico e ligações glicosídicas reduziu a hipernocicepção induzida por zimosam (78,12; 81,13 e 87,4%, respectivamente; p < 0,01), além de inibir o influxo de leucócitos totais (85; 88,14 e 89,95%, respectivamente; p < 0,01), sendo, ainda, confirmado pela atividade de MPO (p < 0,05). Portanto, a Cc-PS1 revela como uma ferramenta farmacológica para tratar de artropatias inflamatórias.

Influência do tabagismo na força muscular respiratória em idosos / Influence of smoking on respiratory muscle strength in elderly

Este estudo consistiu em avaliar a influência do tabagismo na força muscular respiratória (pressões inspiratória máxima e expiratória máxima) em idosos fisicamente independentes, comparando-os àqueles não fumantes. Foram selecionados 120 idosos com idades iguais ou acima de 60 anos de ambos os sexos e divididos em dois grupos de acordo com os critérios da Organização Mundial de Saúde: Grupo Tabagistas, com 14, e Grupo Não tabagistas, com 106 indivíduos. Foi aplicado um questionário estruturado para coleta de dados demográficos. Para avaliação da força muscular respiratória, utilizou-se o manovacuômetro analógico da marca Gerar®, com intervalo de -300 a +300 cmH2O. Foram utilizados o teste t de Student para avaliar a diferença entre as médias encontradas e o coeficiente de correlação de Pearson (r2) para analisar as associações. O Grupo Tabagistas apresentou menor pressão inspiratória máxima com diferença significante (p<0,0001). Não houve diferença significativa na pressão expiratória máxima. Observou-se que o índice de massa corpórea também foi significantemente inferior nos fumantes (p<0,0001), porém não foi identificada correlação positiva com força muscular inspiratória. Esses resultados sugerem que o tabagismo está relacionado com a redução da força da musculatura inspiratória e que, apesar de não apresentar correlação positiva com esta diminuição de força muscular, o índice de massa corpórea também foi menor em tais indivíduos.

This study evaluated the influence of smoking on respiratory muscle strength (maximal inspiratory and maximal expiratory pressures) in physically independent elderly compared to nonsmokers. We selected 120 aged people equal or above 60 years-old divided into two groups, according to the World Health Organization criteria: Smokers Group, including 106 individuals, and Nonsmokers Group, with 14. A structured questionnaire was applied to collect demographic data. For respiratory muscle strength evaluation, a GERAR® analog manovacuometer with a range of -300 to +300 cmH2O was used. Student's t-test was used to evaluate the difference between means, and Pearson's correlation coefficient (r2) to analyze associations. The Smokers Group presented lower maximum inspiratory pressure with a significant difference (p<0.0001). There was no significant difference in the maximum expiratory pressure. It was observed that the body mass index was also significantly lower in smokers (p<0.0001), however no positive correlation with inspiratory muscle strength was found. These results suggest that smoking is related with reduction of the inspiratory muscle strength, and that although it does not present a positive correlation with such decreased muscle strength, body mass index was also reduced in such individuals.

Relato e reflexões sobre o desenvolvimento do pet-saúde da Faculdade de Medicina de Marília / Report and reflections on the development of the health work educational program at Marília Medical School

O presente relato tem como objetivo apresentar a implementaçãodas oito propostas do Projeto PET-Saúdeda Faculdade de Medicina de Marília em parceria com aSecretaria Municipal de Saúde da Família, descrevendo atrajetória e refletindo sobre as potencialidades e fragilidadesencontradas nesse primeiro ano das atividades. Nodesenvolvimento das propostas, observa-se a consolidaçãodos grupos tutoriais, compreensão dos procedimentos depesquisa científica, busca de compreensão de referenciaisque subsidiam a atenção à saúde no contexto da atençãoprimária, assim como dos princípios e diretrizes do SistemaÚnico de Saúde e de integração com a comunidade.

Perfil do desenvolvimento motor do prematuro atendido pela Fisioterapia / Profile of motor development of premature attended in Physiotherapy

JUSTIFICATIVA E OBJETIVOS: Nos últimos anos tem crescido o interesse de profissionais e pesquisadores que atuam na área da Saúde em favorecer as condições de vida da criança, procurando garantir sua boa adaptação no decorrer de seu desenvolvimento. O objetivo deste estudo foi analisar o perfil do desenvolvimento motor do prematuro atendido na clínica de Fisioterapia da UNOPAR. Foi pesquisado o desenvolvimento motor de crianças prematuras com e sem doenças associadas, correlacionando com a intervenção fisioterapêutica. MÉTODO: Trata-se de um estudo de coorte retrospectiva a partir de revisão dos prontuários anexados na clínica de fisioterapia pediátrica da Universidade Norte do Paraná (UNOPAR). A pesquisa se fundamentou na análise de 50 prontuários. Foi realizada a divisão de dois grupos, o grupo A com 16 crianças prematuras sem doenças e o grupo B com 34 crianças prematuras com doenças associadas. Realizou-se dentro de cada grupo a planilha com a idade gestacional, análise das etapas do desenvolvimento motor e a intervenção fisioterapêutica aplicada a estas crianças. Com base nestes dados, desenvolveu-se este estudo a fim de observar e relatar as diferenças das aquisições motoras entre crianças prematuras sem doenças associadas antes da intervenção da fisioterapia e entre os grupos A e B após a intervenção. Ainda foi possível observar nestes grupos a influênciada idade gestacional através das variáveis avaliadas (p < 0,05). RESULTADOS: Houve relevância significativa em relação à intervenção fisioterapêutica e expondo que quanto menor a idade gestacional maior a probabilidade dos bebês nascerem com distúrbios. CONCLUSÃO: Os grupos estudados obtiveram evolução motora satisfatória, reforçando que a fisioterapia auxilia no desenvolvimento motor do prematuro e participa efetivamente na orientação aos familiares quanto ao valor das etapas motoras.

Spatial analysis of hospitalizations for pneumonia in the Vale do Paraíba region of Brazil.

OBJECTIVE: To identify spatial patterns in hospitalizations for pneumonia in infants under one year of age in the Vale do Paraíba region of Brazil. METHODS: This was an ecological exploratory study using a georeferencing technique based on data from the Information Technology Department of the Brazilian Unified Health Care System on the number of hospitalizations for pneumonia among infants under one year of age in the Vale do Paraíba region between 2004 and 2005. Based on the distribution of the rates of hospitalizations for pneumonia per 1,000 live births, thematic maps were created. Moran's spatial autocorrelation coefficient was estimated, and the cities with the highest rates were identified using box maps. RESULTS: During the study period, 2,227 infants under one year of age were hospitalized for pneumonia. Moran's coefficient was 0.37 (p = 0.02), demonstrating a spatial autocorrelation for these hospitalizations. Eight cities deserving special attention for future interventions were identified. CONCLUSIONS: The spatial analysis was successful in determining the spatial autocorrelation, as well as in identifying the cities in which an intervention is necessary regarding the number of hospitalizations for pneumonia in infants under one year of age.

Análise espacial das internações por pneumonia na região do Vale do Paraíba (SP) / Spatial analysis of hospitalizations for pneumonia in the Vale do Paraíba region of Brazil

OBJETIVO: Identificar padrões espaciais nas internações por pneumonia em menores de um ano de idade e identificar os municípios com prioridade para intervenção no Vale do Paraíba (SP). MÉTODOS: Estudo ecológico e exploratório utilizando-se de técnica de geoprocessamento com dados do Departamento de Informática do Sistema Único de Saúde sobre o número de internações por pneumonia em menores de um ano de idade no Vale do Paraíba paulista nos anos 2004 e 2005. Foram obtidas taxas por 1.000 nascidos vivos e, a partir das distribuições dessas, foram criados mapas temáticos. Estimou-se o coeficiente de autocorrelação espacial de Moran e identificaram-se os municípios com altas taxas através de box map. RESULTADOS: No período do estudo, 2.227 crianças com menos de um ano de idade foram internadas por pneumonia. O coeficiente de Moran foi de 0,37 (p = 0,02), o que demonstrou a existência de uma autocorrelação espacial para essas internações. Foram identificados oito municípios que merecem uma atenção especial para possíveis intervenções. CONCLUSÕES: A análise espacial foi utilizada com sucesso para determinar a autocorrelação espacial e para identificar os municípios onde é necessária uma intervenção em relação ao número de internações por pneumonia em menores de um ano de idade.

OBJECTIVE: To identify spatial patterns in hospitalizations for pneumonia in infants under one year of age in the Vale do Paraíba region of Brazil. METHODS: This was an ecological exploratory study using a georeferencing technique based on data from the Information Technology Department of the Brazilian Unified Health Care System on the number of hospitalizations for pneumonia among infants under one year of age in the Vale do Paraíba region between 2004 and 2005. Based on the distribution of the rates of hospitalizations for pneumonia per 1,000 live births, thematic maps were created. Moran's spatial autocorrelation coefficient was estimated, and the cities with the highest rates were identified using box maps. RESULTS: During the study period, 2,227 infants under one year of age were hospitalized for pneumonia. Moran's coefficient was 0.37 (p = 0.02), demonstrating a spatial autocorrelation for these hospitalizations. Eight cities deserving special attention for future interventions were identified. CONCLUSIONS: The spatial analysis was successful in determining the spatial autocorrelation, as well as in identifying the cities in which an intervention is necessary regarding the number of hospitalizations for pneumonia in infants under one year of age.

High levels of primary antiretroviral resistance genotypic mutations and B/F recombinants in Santos, Brazil.

This study characterized HIV-1 among antiretroviral-naïve populations presenting recent infection (RI) or long-standing infection (LSI). Sera collected from January 1999 to December 2001 at an anonymous HIV testing site in Santos, Brazil, were submitted to serologic testing algorithm for recent HIV seroconversion (STARHS). The STARHS methodology uses a combination of a sensitive and a less sensitive version of an anti-HIV enzyme immunoassay (EIA), and specimens found to be positive on the sensitive EIA and negative on the less sensitive EIA are considered to represent RI. HIV-1 V3 and pol regions of those with RI and LSI were compared. Antiretroviral resistance was defined solely by genotypic analysis. Ninety samples were evaluated representing those taken from an original cohort of 345 individuals, for whom adequate samples were available. Of 90 HIV-positive individuals, 25 presented RI. Cumulatively, 36.8% of those with RI and 25% of those with LSI presented resistance to at least one antiretroviral class. In the pol and V3 regions, 47% and 53% of those with RI presented clade B viruses and B/F recombinant viruses, respectively, whereas 56.2%, 41.7%, and 2.1% of those with LSI harbored clades B, B/F, and clade C viruses, respectively. Primary resistance and the prevalence of B/F recombinants was high in this population. Monitoring HIV-1 genetic diversity is important for developing vaccines and treatment strategies.

[Nursing auxiliaries and technicians and hospital infection control in surgical centers: myths and truths]. / Auxillares e Técnicos de Enfermagem e controle de infecção hospitalar em centro cirúrgico: mitos e verdades.

This analytical and descriptive study is aimed at detecting concepts that translate myths and truths on hospital infection among nursing auxiliaries and technicians at the surgical centers of three hospitals. The data collection instrument consisted of 28 affirmative statements (15 true and 13 false) encompassing factors related to the patient, the surgical team, the environment, and procedures. The statements contain a three-point scale (I agree, I am in doubt, I disagree). We received 72% of adequate answers and 28% of non-adequate, which indicates that perioperative nursing professionals have satisfactory knowledge of hospital infection control. In the items use of safety footwear, rings and other objects, hair as a pathogen, hand scrubbing, use of humid gown and surgical area, infected surgery and cleaning routine, occupational diseases, hospital infection, surgical site infection and surgery time we were able to detect myths and rituals about infection control, which are mainly related to the culture of those who practice them, thus perpetuating resistance to change.

Auxiliares e Técnicos de Enfermagem e controle de infecção hospitalar em centro cirúrgico: mitos e verdades / Nursing auxiliaries and technicians and hospital infection control in surgical centers: myths and truths

Este estudo analítico descritivo objetivou detectar conceitos que traduzem mitos e verdades relativos à infecção hospitalar entre auxiliares e técnicos de enfermagem no centro cirúrgico de três hospitais. O instrumento para coleta de dados possui 28 afirmações (15 verdadeiras e 13 falsas) contemplando fatores relacionados ao paciente, equipe cirúrgica, ambiente, procedimentos. As afirmações contêm escala em três pontos (concordo, tenho dúvida, discordo). Obtivemos respostas adequadas em 72% e não adequadas em 28%, indicando o satisfatório conhecimento da enfermagem perioperatória relacionadas ao controle infecção hospitalar . Nos itens uso de propé, alianças e outros objetos, pêlo como patógeno, escovação das mãos, uso de avental e campo cirúrgico umedecidos, cirurgia infectada e rotina de limpeza, doenças ocupacionais, infecção hospitalar, infecção sítio cirúrgico e tempo operatório, pudemos detectar mitos e rituais referentes ao controle de infecção, que estão relacionados sobretudo à cultura de quem os praticam, perpetuando resistência a mudanças.

This analytical and descriptive study is aimed at detecting concepts that translate myths and truths on hospital infection among nursing auxiliaries and technicians at the surgical centers of three hospitals. The data collection instrument consisted of 28 affirmativestatements (15 true and 13 false)encompassing factors related to the patient, the surgical team, the environment, and procedures. The statements contain a three-point scale (I agree, I am in doubt, I disagree). We received 72% of adequate answers and28% of non-adequate, which indicates that perioperative nursing professionals have satisfactory knowledge of hospitalinfection control. In the items use of safety footwear, rings and other objects, hair as a pathogen, hand scrubbing, use of humid gown and surgical area, infected surgery and cleaning routine, occupational diseases, hospital infection,surgical site infection and surgery time we were able to detect myths and rituals about infection control, which are mainly related to the culture of those who ractice them, thus perpetuating resistance to change.

Este estudio analítico descriptivo tuvo como objetivo detectar conceptos que traduzcan mitos y verdades relativas a la infección hospitalaria entre auxiliares y técnicos de enfermería en el centro quirúrgico de tres hospitales. El instrumento de recolección de datos contenía 28 afirmaciones (15 verdaderas y 13 falsas) que contemplaba factores relacionados al paciente, equipo quirúrgico, ambiente,procedimientos. Las afirmaciones contienen escala en tres puntos concuerdo, tengo duda, desacuerdo). Obtuvimos respuestas adecuadas en el 72% y no adecuadas en el 28%, indicando el conocimiento satisfactorio de la enfermería perioperatoria relacionadas al control de la infección hospitalaria. En los items uso de botas quirúrgicas, anillos y otros objetos, pelo como patógeno, cepillado de las manos,uso del mandil y campo quirúrgico humedecidos, cirugía infectada y rutina de limpieza, enfermedades ocupacionales, infección hospitalaria, infección del área quirúrgica y tiempo operatorio, pudimos detectar mitos y rituales referentes al control de infección, que están relacionados sobre todo a la cultura de quienes los practican, perpetuando resistencia a los cambios.

Risk factors for incident HIV infection among anonymous HIV testing site clients in Santos, Brazil: 1996-1999.

OBJECTIVES: To determine temporal trends in HIV infection and risk factors among persons seeking anonymous HIV testing in Santos, Brazil. METHODS: Data and sera from persons testing for HIV from 1996 to 1999 were used. Exposures were abstracted from HIV testing risk assessments. Stored HIV-positive sera were tested to identify recently acquired HIV infection using a serologic testing algorithm for detecting recent HIV seroconversion (STARHS). Independent associations between exposures and recently acquired HIV infection were determined using multivariate analyses. RESULTS: Overall, estimated HIV incidence was 2.0% (95% CI: 1.1-3.5) for the 4-year period: 1.2% (95% CI: 0.5-2.6) in women and 2.7% (95% CI: 1.3-5.0) in men. Incidence increased among women but remained stable among men. Exposures independently associated with incident infection included a history of sex work (OR= 5.4, 95% CI: 1.5-18.7), concurrent syphilis infection (OR =4.1, 95% CI: 1.4-11.9), anal sex (OR = 3.0, 95% CI: 1.3-7.1), and having an HIV-positive sexual partner (OR= 1.4, 95% CI: 1.1-1.9). CONCLUSIONS: This study further demonstrates the public health utility of using the STARHS for the assessment of emerging trends in the HIV epidemic. Results from this study will help to target appropriate prevention strategies directed toward at-risk populations in Santos.

Differences in histoplasmosis in patients with acquired immunodeficiency syndrome in the United States and Brazil.

Demographic and clinical parameters among patients with acquired immunodeficiency syndrome and histoplasmosis in Brazil and United States were compared. The Brazilian isolates were typed by restriction-fragment length polymorphism analysis and were DNA fingerprinted by random amplification of polymorphic DNA (RAPD)-polymerase chain reaction (PCR). Skin lesions occurred in 66% of Brazilian case patients, compared with 1%-7% of US case patients. Of 21 treated case patients, 4 (19%) died, a rate similar to that of the US case patients (5%-13%). By nuclear gene typing, the Brazilian isolates were equally divided between South American classes 5 and 6, and RAPD-PCR showed 18 distinct genetic fingerprints in 20 isolates. Skin lesions are more common in infection with class 5 or 6 organisms than with class 2 Histoplasma capsulatum. The role of genetic differences in the organism as a cause for the clinical differences requires investigation.