Implantação da rede laboratorial para realização do ensaio de liberação de interferon-gama (IGRA) para detecção de tuberculose latente no Estado de São Paulo: primeiros passos e desafios / Implementation of the laboratory network to carry out the interferon-gamma release assay (IGRA) to detect latent tuberculosis in the State of Sao Paulo: first steps and challenges

A tuberculose (TB) continua sendo um grande desafio para a saúde pública mundial e, para um controle eficiente, também é essencial identificar pessoas com tuberculose latente (ILTB). O ensaio de liberação de interferon-gama (IGRA), incorporado pelo SUS em 2021, permitirá ampliar o diagnóstico de ILTB, em complemento à prova tuberculínica. Para essa implantação, as coordenações do Programa Estadual e da Rede de Laboratórios de TB/SP iniciaram a identificação de executores do IGRA a partir da rede de laboratórios de TB e/ou CD4, para verificar possíveis barreiras para implantação do teste. Foram avaliados os insumos e os profissionais para execução do ensaio, a infraestrutura laboratorial e a disponibilidade de equipamentos. Dez laboratórios avaliaram amostras de sangue total com o kit QuantiFERON®-TB Gold Plus e relataram sua experiência quanto à logística de amostras, execução do ensaio e liberação de laudos. Para otimizar o exame, a coleta ocorreu em tubos heparinizados (sódio ou lítio). Foi sugerida a logística da rede de laboratórios de CD4, que foi utilizada por 20% dos laboratórios participantes, enquanto 50% optaram pelo agendamento. Não foram reportadas dificuldades na liberação de laudo. Dois laboratórios avaliaram o número de células T CD4+ prévio e no momento do IGRA, observando diferença em 10% dos pacientes, fator que pode ser relevante na análise do resultado. Ao todo, foram analisadas 383 amostras, 81 (21,1%) reagentes, 297 (77,5%) não reagentes e cinco (1,3%) indeterminados. Foi observada grande variação de positividade (3,6-50,0%) entre os laboratórios, provavelmente devido à população atendida. Apesar dos desafios encontrados, consideramos que a taxa média de positividade (~20%) sugere que a oferta do IGRA na rede pública possibilitará o aumento do diagnóstico de ILTB e melhor controle da TB.

A prospective, multicentre, cohort study to assess the incidence of dengue illness in households from selected communities in Brazil (2014-2018).

OBJECTIVES: To estimate the incidence of dengue infection across geographically distinct areas of Brazil. METHODS: This prospective, household-based, cohort study enrolled participants in five areas and followed them up for up to 4 years (2014-2018). Dengue seroprevalence was assessed at each scheduled visit. Suspected dengue cases were identified through enhanced passive and active surveillance. Acute symptomatic dengue infection was confirmed through reverse-transcriptase quantitative polymerase chain reaction in combination with an antigenic assay (non-structural protein 1) and serology. RESULTS: Among 3300 participants enrolled, baseline seroprevalence was 76.2%, although only 23.3% of participants reported a history of dengue. Of 1284 suspected symptomatic dengue cases detected, 50 (3.9%) were laboratory-confirmed. Based on 8166.5 person-years (PY) of follow-up, the incidence of laboratory-confirmed symptomatic infection (primary endpoint) was 6.1 per 1000 PY (95% confidence interval [CI]: 4.5, 8.1). Incidence varied substantially in different years (1.8-7.4 per 1000 PY). The incidence of inapparent primary dengue infection was substantially higher: 41.7 per 1000 PY (95% CI: 31.1, 54.6). CONCLUSIONS: Our findings, highlighting that the incidence of dengue infection is underestimated in Brazil, will inform the design and implementation of future dengue vaccine trials. CLINICAL TRIAL REGISTRATION: NCT01751139.

Knowledge and compliance as factors associated with needlestick injuries contaminated with biological material: Brazil and Colombia. / Conhecimento e adesão como fatores associados a acidentes com agulhas contaminadas com material biológico: Brasil e Colômbia.

This was a cross-sectional study to start a cohort in two University Hospitals of two countries - Brazil and Colombia - for assessing the prevalence of needlestick and sharps injuries (NSI), the level of compliance with standard precautions (SPs), and knowledge on blood borne pathogens and associated factors among health students and professionals, within the framework of the implementation of the NR-32 standard. We created compliance scales based on 12 and 10 questions, for assessing knowledge. We used the Multinomial Poisson-Tweedie Regression to evaluate the relationship between knowledge and compliance with SPs within NSI. We evaluated 965 individuals (348 students and 614 professionals). The mean score points for level of knowledge was 10.98, with a median of 11 (10; 12) and α-Cr of 0,625. Compliance with SP had a mean of 30.74 and median of 31 (28; 34), with a α-Cr coefficient of 0.745, associated with country, group (student) and risk perception. Among the factors associated with the report of NSI, we singled out knowledge and compliance, country of origin, and full vaccination scheme against the Hepatitis B virus. We concluded that the level of knowledge and compliance were adequate among participants, but better among Brazilian participants, and it was associated with NSI reporting.

Fizemos estudo transversal para iniciar coorte em dois Hospitais Universitários de dois países - Brasil e Colômbia - para avaliar a prevalência de acidentes com material biológico (AT-MB), o nível de adesão às Precauções Padrão (PP) e o conhecimento sobre patógenos transmissíveis pelo sangue e fatores associados entre trabalhadores e estudantes da saúde, no marco da implementação da norma NR-32. Criamos escalas para estimar conhecimento e adesão baseadas em 12 e 11 perguntas respectivamente. Utilizamos Regressão de Poisson-Tweedie para avaliar a associação do conhecimento e da adesão às PP com sofrer AT-MB. Avaliamos 965 indivíduos (348 estudantes e 617 profissionais). O conhecimento teve média de 10,98 com mediana de 11 (10, 12) e α-Cr de 0,625. A média de adesão foi de 30,74 com mediana de 31 (28, 34) e α-Cr de 0,745, associando-se a País, grupo (estudantes) e percepção de risco. Entre os fatores associadas ao relato de AT-MB encontraram-se o conhecimento, a adesão às PP, País de origem e ter tomado o esquema completo de vacinação contra Hepatites B. Concluímos que o nível de conhecimento e adesão foram adequados, ainda melhores entre os participantes do Brasil e associaram-se ao relato AT-MB.

Hicimos estudio transversal como punto de partida de estudio de cohorte en dos Hospitales Universitarios en dos países - Brasil y Colombia - para evaluar la prevalencia de accidentes con material biológico (AT-MB), el nivel de adhesión a las Precauciones Estándares (PUs) y el conocimiento sobre patógenos transmisibles y factores asociados entre trabajadores y estudiantes de la Salud en el marco de la implementación de la norma NR-32. Creamos escalas para evaluar el conocimiento y la adhesión con base en 12 e 11 preguntas respectivamente. Utilizamos Regresión de Poisson-Tweedie para evaluar asociación entre el conocimiento y la adhesión a las PUs con sufrir AT-MB. Evaluamos 965 individuos (348 estudiantes e 617 profesionales). El puntaje medio de conocimiento fue 10,98 con mediana de 11 (10, 12) y α-Cr de 0,625. La media de adhesión fue de 30,74 con mediana de 31 (28, 34) e α-Cr de 0,745, asociándose a país, grupo (estudiantes) e percepción de riesgo. Entre los factores asociados al relato de AT-MB encontramos conocimiento, adhesión a las PUs, país de origen y tener el esquema completo de vacunación contra Virus da Hepatitis B. Concluimos que el nivel de conocimiento y adhesión fueron adecuados, aunque mejores entre los participantes del Brasil y se asociaron a los AT-MB.

Conhecimento e adesão como fatores associados a acidentes com agulhas contaminadas com material biológico: Brasil e Colômbia / Knowledge and compliance as factors associated with needlestick injuries contaminated with biological material: Brazil and Colombia / Conocimiento y adhesión como factores asociados a los accidentes con agujas contaminadas con material biológico: Brasil y Colombia

Resumo Fizemos estudo transversal para iniciar coorte em dois Hospitais Universitários de dois países - Brasil e Colômbia - para avaliar a prevalência de acidentes com material biológico (AT-MB), o nível de adesão às Precauções Padrão (PP) e o conhecimento sobre patógenos transmissíveis pelo sangue e fatores associados entre trabalhadores e estudantes da saúde, no marco da implementação da norma NR-32. Criamos escalas para estimar conhecimento e adesão baseadas em 12 e 11 perguntas respectivamente. Utilizamos Regressão de Poisson-Tweedie para avaliar a associação do conhecimento e da adesão às PP com sofrer AT-MB. Avaliamos 965 indivíduos (348 estudantes e 617 profissionais). O conhecimento teve média de 10,98 com mediana de 11 (10, 12) e α-Cr de 0,625. A média de adesão foi de 30,74 com mediana de 31 (28, 34) e α-Cr de 0,745, associando-se a País, grupo (estudantes) e percepção de risco. Entre os fatores associadas ao relato de AT-MB encontraram-se o conhecimento, a adesão às PP, País de origem e ter tomado o esquema completo de vacinação contra Hepatites B. Concluímos que o nível de conhecimento e adesão foram adequados, ainda melhores entre os participantes do Brasil e associaram-se ao relato AT-MB.

Abstract This was a cross-sectional study to start a cohort in two University Hospitals of two countries - Brazil and Colombia - for assessing the prevalence of needlestick and sharps injuries (NSI), the level of compliance with standard precautions (SPs), and knowledge on blood borne pathogens and associated factors among health students and professionals, within the framework of the implementation of the NR-32 standard. We created compliance scales based on 12 and 10 questions, for assessing knowledge. We used the Multinomial Poisson-Tweedie Regression to evaluate the relationship between knowledge and compliance with SPs within NSI. We evaluated 965 individuals (348 students and 614 professionals). The mean score points for level of knowledge was 10.98, with a median of 11 (10; 12) and α-Cr of 0,625. Compliance with SP had a mean of 30.74 and median of 31 (28; 34), with a α-Cr coefficient of 0.745, associated with country, group (student) and risk perception. Among the factors associated with the report of NSI, we singled out knowledge and compliance, country of origin, and full vaccination scheme against the Hepatitis B virus. We concluded that the level of knowledge and compliance were adequate among participants, but better among Brazilian participants, and it was associated with NSI reporting.

Resumen Hicimos estudio transversal como punto de partida de estudio de cohorte en dos Hospitales Universitarios en dos países - Brasil y Colombia - para evaluar la prevalencia de accidentes con material biológico (AT-MB), el nivel de adhesión a las Precauciones Estándares (PUs) y el conocimiento sobre patógenos transmisibles y factores asociados entre trabajadores y estudiantes de la Salud en el marco de la implementación de la norma NR-32. Creamos escalas para evaluar el conocimiento y la adhesión con base en 12 e 11 preguntas respectivamente. Utilizamos Regresión de Poisson-Tweedie para evaluar asociación entre el conocimiento y la adhesión a las PUs con sufrir AT-MB. Evaluamos 965 individuos (348 estudiantes e 617 profesionales). El puntaje medio de conocimiento fue 10,98 con mediana de 11 (10, 12) y α-Cr de 0,625. La media de adhesión fue de 30,74 con mediana de 31 (28, 34) e α-Cr de 0,745, asociándose a país, grupo (estudiantes) e percepción de riesgo. Entre los factores asociados al relato de AT-MB encontramos conocimiento, adhesión a las PUs, país de origen y tener el esquema completo de vacunación contra Virus da Hepatitis B. Concluimos que el nivel de conocimiento y adhesión fueron adecuados, aunque mejores entre los participantes del Brasil y se asociaron a los AT-MB.

Bartonella henselae bacteremia diagnosed post-mortem in a myelodysplastic syndrome patient.

This study involves a 49-year-old male, who for three years suffered with a myelodysplastic syndrome and who needed frequent blood transfusions. One day following a transfusion, he presented fever and abdominal pain. The fever became persistent and only improved temporarily with two cycles of intravenous ciprofloxacin. Nearly 120 days after beginning the second cycle of treatment, he had experienced a weight loss of 16 kg and recurring fever. Screening for fever of unknown origin was conducted, including Bartonella infection. No etiology could be found. The patient improved with an antimicrobial regimen composed of oral doxycycline and intravenous ciprofloxacin. After 15 days afebrile, the patient was discharged with a four-month oral prescription of doxycycline and ciprofloxacin. Eight months following the antibiotic treatment, the patient received an allogeneic bone marrow transplant. Five days following the transplant, the patient initiated a febrile neutropenia and died. From a blood sample collected and stored at the time of hospitalization, a microbiological and molecular study was performed again. Blood- and liquid culture-PCRs from the same blood sample were all negative, but an isolate from solid subculture was found. The molecular reactions from this isolate were all positive and the sequence was 100% homologous to Bartonella henselae . The present report points to the limitations of laboratory techniques currently available for investigation of possible cases of bartonellosis in clinical practice, and the potential risk of Bartonella spp. transmission through blood transfusions.

Occupational Exposure to Potentially Infectious Biological Material Among Physicians, Dentists, and Nurses at a University.

OBJECTIVE: The objective of this study was to evaluate the prevalence and incidence of accidents with biological material, the level of knowledge, and compliance to standard precautions (SPs) among dentists, physicians, nurses, and dental and medical students. METHODS: A closed cohort study with a prospective and retrospective component was conducted between August 2014 and September 2015. The participants were contacted in two moments during the follow-up period, during which a structured questionnaire divided into six sections was used; the interviews were conducted during the follow-up period (Month 6) and at the end of the observation period (Month 12). RESULTS: The global prevalence of accidents in the previous 12 months was 10.2%, with a difference between professionals and students (13.0% vs. 5.1%, respectively; p < 0.003). The incidence rate was 6.49 per 100 person/year, with difference between the groups (6.09 per 100 person/year in professionals and 7.26 per 100 person/year in students), type of specialization (hazard ratio, 3.27), and hours worked per week (hazard ratio, 2.27). The mean of compliance to SP was 31.99 (±3.85) points, with a median of 33 (30, 35) points against the expected 27.75 points. Adherence to SP was associated with the accident report (p < 0.020). CONCLUSION: We conclude that the proportion/incidence rate of accidents with biological material was high in relation to that in the literature, being higher in professionals and especially among physicians. The levels of knowledge and adherence to SP were good, with the best found in dentists and dental students.

Cost-utility analysis of outpatient parenteral antimicrobial therapy (OPAT) in the Brazilian national health system.

BACKGROUND: Outpatient parenteral antimicrobial therapy (OPAT) has been used for decades in different countries to reduce hospitalization rates, with favorable clinical and economic outcomes. This study assesses the cost-utility of OPAT compared to inpatient parenteral antimicrobial therapy (IPAT) from the perspective of a public university hospital and the Brazilian National Health System (Unified Health System -SUS). METHODS: Prospective study with adult patients undergoing OPAT at an infusion center, compared to IPAT. Clinical outcomes and quality-adjusted life year (QALY) were assessed, as well as a micro-costing. Cost-utility analysis from the hospital and SUS perspectives were conducted by means of a decision tree, within a 30-day horizon time. RESULTS: Forty cases of OPAT (1112 days) were included and monitored, with a favorable outcome in 97.50%. OPAT compared to IPAT generated overall savings of 31.86% from the hospital perspective and 26.53% from the SUS perspective. The intervention reduced costs, with an incremental cost-utility ratio of -44,395.68/QALY for the hospital and -48,466.70/QALY for the SUS, with better cost-utility for treatment times greater than 14 days. Sensitivity analysis confirmed the stability of the model. CONCLUSION: Our economic assessment demonstrated that, in the Brazilian context, OPAT is a cost-saving strategy both for hospitals and for the SUS.

Nomeação e institucionalização da saúde do trabalhador: um campo em disputa / Naming and institutionalization of the health of the worker: a disputed field / Designación e institucionalización de la salud del trabajador: un campo en disputa

Resumo Considerando a dispersão de sentidos que constitui a nomeação da área 'Saúde do Trabalhador', buscou-se compreender o que está em jogo nas constantes mudanças da nomenclatura nesse campo. Essas alterações ocorrem em uma linha do tempo, mas concomitantemente. Seu marco inaugural foi encontrado na estabilidade do nome 'medicina do trabalho', nome institucionalizado pela Organização Internacional do Trabalho, no início da segunda metade do século XX. Desse primeiro gesto de nomeação, seguem outros, estabelecidos em relações tensas e contraditórias de substituição, recobrimento e concorrência como: saúde ocupacional, saúde e segurança no trabalho, e, mais contemporaneamente, em meio a estas variações, encontrou-se o acréscimo do termo 'Saúde do Trabalhador'. O penúltimo nome é o mais estável e acionado pelas instâncias internacionais e empresariais.

Abstract Based on the dispersal of meanings that constitutes the naming of the 'Health of the Worker' field, we sought to comprehend what is at stake in the constant changes in nomenclature in this field. These changes occur within a timeline, but they happen concomitantly. Its inaugural landmark was found in the stability of the name 'occupational medicine,' a name institutionalized by the International Labour Organization in the beginning of the second half of the 20th century. This first gesture of naming was followed by other gestures, established in tense and contradictory relationships of replacement, recovering and concurrence, such as: occupational health, health and safety at work, and, more recently, among these variations, we found the addition of the term 'Health of the Worker.' The second-to-last name is the most stable one, and it is used by international and entrepreneurial organizations.

Resumen Partiendo de la dispersión de sentidos que constituye la designación del área 'Salud del Trabajador', se buscó comprender lo que está en juego en los constantes cambios de la nomenclatura en este campo. Estos cambios se producen en una línea de tiempo, pero de forma concomitante. Su marco inaugural se encuentra en la estabilidad del nombre 'medicina del trabajo', institucionalizado por la Organización Internacional del Trabajo a comienzos de la segunda mitad del siglo XX. A este primer gesto de designación le siguen otros, establecidos en relaciones tensas y contradictorias de sustitución, enmascaramiento y competencia, tales como: salud ocupacional, salud y seguridad en el trabajo, y más recientemente, en medio de estas variaciones, se encontró el agregado del término 'Salud del Trabajador'. El penúltimo nombre es el más estable y utilizado por las instancias internacionales y empresariales.

Análise do discurso da 'segurança' na área da saúde: uma crítica ao trabalhador como vigilante de si / Analysis of the 'safety' discourse in the field of health: a critique of the worker as watchman of oneself / Análisis del discurso de la 'seguridad' en el área de la salud: una crítica al trabajador como cuidador de sí mismo

Resumo A Norma Regulamentadora NR 32 objetiva reduzir acidentes e doenças entre os trabalhadores da saúde. Filiando-nos à perspectiva da análise do discurso proposta por Michel Pêcheux, nesta pesquisa tivemos como objetivo compreender o processo de significação em torno de segurança e saúde no trabalho na NR 32 e apreender como este processo significa nas políticas públicas no Brasil. Mostramos que, embora a norma seja um meio de assegurar a segurança e a saúde ao trabalhador, sua discursividade formula a segurança como um mito fundamentado em alegações externas ao processo de regulação das condições de trabalho e alheio às exigências coletivas e culturais de produção. Nesse processo, produz-se a responsabilização do trabalhador convertido em vigilante de si próprio e responsabilizado por isso de maneira individualizada. Pudemos, finalmente, observar um efeito de sentido que indica uma conexão que, na prática, resulta em apoio econômico às empresas que produzem e/ou comercializam os dispositivos de segurança para os materiais perfurocortantes.

Abstract Regulation NR 32 has the goal of reducing accidents and disease among health workers. Adopting the perspective of the discourse analysis proposed by Michel Pêcheux, in this research we had the goal of understanding the process of signification regarding safety and health at work within the NR 32, and learn how this process signifies in the public policies in Brazil. We show that, even though the regulation is a means of guaranteeing the safety and health of the worker, its discursiveness formulates safety as a myth based on claims that are not part of the process of regulation of labor conditions and are unconnected to the collective and cultural requirements for production. In this process, the responsibilization of the worker is produced, and the workers become watchmen of themselves, and are held accountable for that in an individualized manner. Finally, we could observe an effect of meaning that points to a connection that, in practice, results in financial support to the companies that make and/or sell the safety devices for sharps.

Resumen El objetivo de la Norma Reguladora NR 32 es reducir accidentes y enfermedades entre los trabajadores de la salud. Tomando como base la perspectiva del análisis del discurso propuesto por Michel Pêcheux, el objetivo en esta investigación fue comprender el proceso de significación en torno a la seguridad y la salud en el trabajo en la NR 32 y entender lo que significa este proceso en las políticas públicas de Brasil. Se muestra que más allá de la norma ser un medio de asegurar la seguridad y la salud al trabajador, su discurso formula a la seguridad como un mito fundamentado en alegaciones externas al proceso de regulación de las condiciones de trabajo y ajeno a las exigencias colectivas y culturales de producción. En este proceso, se responsabiliza al trabajador convirtiéndolo en cuidador de sí mismo y a cargo por dicha responsabilidad de manera individual. Por último, pudimos observar un efecto de sentido que indica una conexión, la cual en la práctica se traduce como apoyo económico a las empresas que producen y/o comercializan los dispositivos de seguridad para los materiales punzantes.

Development of a Multiplex PCR Test with Automated Genotyping Targeting E7 for Detection of Six High-Risk Human Papillomaviruses.

Cervical cancer is caused by high-risk human papillomaviruses (HPV) and viral detection tests aid in the diagnosis of precursor lesions. In the present study, a molecular test for detection of high-risk HPV DNA, called E7-HPV, was standardized and assessed in samples from women with pre-cancerous lesions. The development of the E7-HPV test for detection and genotyping of six high-risk HPV (types 16, 18, 31, 33, 45 and 52), consisted of evaluating primer quality and adjusting the multiplex PCR conditions. Primer design was based on the E7 region of each HPV, and the fluorochrome 6-FAM was added to PCR primers. Viral detection was performed by capillary electrophoresis in automated sequencer in samples obtained from 60 women (55 with ASC-H/HSIL cytology) from August to September 2013. A non-inferiority analysis was conducted with the cobas HPV test as a reference and following international guidelines for the development of new tests. The two tests had a high concordance rate in HPV16 detection (kappa=0.972), with only one discordant case (cervical intraepithelial neoplasia grade 3, negative with cobas and positive for HPV16 by E7-HPV) and complete agreement in HPV18 detection. When comparing detection of all high-risk HPV, three cases were positive with cobas but negative with E7-HPV, and another three cases were negative with cobas but positive with E7-HPV (HPV16, 31 and 52). When we evaluate the cases initially suspected by cytology, the two tests had the same sensitivity in detection CIN2 or worse. In conclusion, the E7-HPV test has satisfactory initial results, and its development can be continued.

Conhecimento e adesão às precauções padrão: estudantes diante dos riscos biológicos no Brasil e na Colômbia / Knowledge of and compliance with universal precautions: students dealing with biological risk in Brazil and Colombia / Conocimiento y adhesión a las precauciones universales: estudiantes frente a los virus, en Brasil y en Colombia

Objetivo Avaliar as escalas de adesão às precauções padrão (PPs) e conhecimento sobre meios de transmissão entre estudantes da saúde no Brasil e na Colômbia. Métodos Trata-se de um estudo piloto para validar o questionário que iniciou estudo de coorte. Selecionamos intencionalmente 26 estudantes na Colômbia e 25 no Brasil, comparáveis em número e características sociodemográficas, que cursavam profissões da saúde (medicina, enfermagem e odontologia). Utilizamos o programa SPSS versão 18.0 para criar o banco de dados e a análise estatística. Resultados : Avaliamos 51 estudantes, com média ± Desvio Padrão de idade de 21,78 ± 2,33, dos quais 84,3 % eram mulheres, 66,7 % de cor de pele branca, , 47,1 % de medicina, e 70,6 % do 70 semestre. Responderam sobre hábitos sexuais afirmando que 45,1 % tiveram no último ano só um parceiro, 23,5 % não usaram proteção, e dos que se protegeram, 45,1 % utilizaram o preservativo. A média de con0hecimento foi 10,88 (±0,952) pontos, para valor esperado de 9 pontos; com Alpha de Cronbach's (α) de 0,823. A média de adesão às precauções padrão (PPs) foi 33,69 (±3,36) pontos, para 30,75 esperados. O α foi de 0,741. Encontramos diferença significativa no conhecimento (p<0,007) entre os dois países, e na adesão as PPs segundo o curso (p<0,001). Conclusões O conhecimento sobre meios de transmissão foi bom. A adesão às precauções padrão em geral foi aceitável, mas foi baixa para algumas precauções avaliadas como o uso de óculos, máscara e o descarte de perfurocortantes. Estudantes de odontologia tiveram melhor adesão.(AU)

Objective To assess scales of adherence to universal precautions and means of knowledge transmission among healthcare students in Brazil and Colombia. Methods We conducted a pilot study to validate the questionnaire that started a cohort study. Twenty-six students in Colombia and 25 in Brazil were intentionally selected. The participants were comparable in number and sociodemographic characteristics in both countries and studied the health professions (medicine, nursing and dentistry). The program SPSS version 18.0 was used to create the database and to carry out statistical analysis. Results We evaluated a total of 51 students. They had a a mean (SD) age of 21.78 (2.33), 84.3 % were women, 66.7 % had white skin, 47.1 % were medical students, and 70,6 % were in their 4th year. They answered about sexual habits reporting that 45.1 had only one partner% in the last year, 23.5 % did not use protection, and, of those who were protected, 45.1 % used a condom. The mean knowledge was 10.88 (±0.952) points to an expected 9 points; Cronbach's Alpha (α) was 0.823. The mean adherence to universal precautions (UPs) was 33.69 (±3.36) points to an expected 30.75; α was 0.741. We found a significant difference in knowledge levels (p<0.007) between the two countries and in the adherence to PUs by year of study (p<0.001). Conclusions Knowledge about means of transmission was good. Adherence to universal precautions was acceptable, but low in terms of the use of glasses, face masks, and discarding sharp objects. Dentistry students showed the best adherence.(AU)

Objetivo Evaluar escalas de adhesión a las precauciones universales y de conocimiento sobre medios de transmisión entre estudiantes de la salud, en Brasil y Colombia. Métodos Realizamos estudio piloto para validar cuestionario utilizado en el inicio del estudio de cohorte. Seleccionamos intencionalmente 26 estudiantes en Colombia y 25 en Brasil, comparables en número y características socio-demográficas, de profesiones de la salud (medicina, enfermería y odontología). Se utilizó el programa SPSS versión 18.0 para crear el banco de datos y realizar el análisis estadístico. Resultados Evaluamos 51 estudiantes, con media (SD) de edad de 21,78 años (2,33), 84,3 % eran mujeres, 66,7 % de tez blanca, 47,1 % de medicina, y 70,6 % del 70 período. Ellos contestaran sobre sus hábitos sexuales reportando que 45,1 % tuvieron en el último año sólo un compañero, 23,5 % no usaron protección, y de los que se protegieron, 45,1 % utilizaron el preservativo. La media de conocimiento fue 10,88 (±0,952) puntos, para una esperada de 9 puntos; con Alpha de Cronbach's (α) de 0,823. La media de adhesión a las Precauciones Universales (PUs) fue 33,69 (±3,36) puntos, con una expectativa de 30,75; α fue de 0,741. Se encontró diferencia significativa en el conocimiento (p<0,007) entre los dos países, y en la adhesión de las PUs según el curso (p<0,001). Conclusiones El conocimiento sobre medios de transmisión era bueno. La adhesión a las precauciones universales era aceptable, pero baja para el uso de gafas, tapabocas y el descarte de elementos cortantes y perforantes. Estudiantes de odontología tuvieron mejor adhesión.(AU)

[Knowledge of and compliance with universal precautions: students dealing with biohazards in Brazil and Colombia]. / Conhecimento e adesão às precauções padrão: Estudantes diante dos riscos biológicos no Brasil e na Colômbia.

Objective To assess scales of adherence to universal precautions and means of knowledge transmission among healthcare students in Brazil and Colombia. Methods We conducted a pilot study to validate the questionnaire that started a cohort study. Twenty-six students in Colombia and 25 in Brazil were intentionally selected. The participants were comparable in number and sociodemographic characteristics in both countries and studied the health professions (medicine, nursing and dentistry). The program SPSS version 18.0 was used to create the database and to carry out statistical analysis. Results We evaluated a total of 51 students. They had a a mean (SD) age of 21.78 (2.33), 84.3 % were women, 66.7 % had white skin, 47.1 % were medical students, and 70,6 % were in their 4th year. They answered about sexual habits reporting that 45.1 had only one partner% in the last year, 23.5 % did not use protection, and, of those who were protected, 45.1 % used a condom. The mean knowledge was 10.88 (±0.952) points to an expected 9 points; Cronbach's Alpha (α) was 0.823. The mean adherence to universal precautions (UPs) was 33.69 (±3.36) points to an expected 30.75; α was 0.741. We found a significant difference in knowledge levels (p<0.007) between the two countries and in the adherence to PUs by year of study (p<0.001). Conclusions Knowledge about means of transmission was good. Adherence to universal precautions was acceptable, but low in terms of the use of glasses, face masks, and discarding sharp objects. Dentistry students showed the best adherence.

[Fatal evolution of Chagas'disease/Aids co-infection: diagnostic difficulties between myocarditis reactivation and chronic chagasic myocardiopathy]. / Evolução fatal da co-infecção doença de Chagas/Aids: dificuldades diagnósticas entre a reagudização da miocardite e a miocardiopatia chagásica crônica.

Chagas disease is a type of parasitosis caused by the protozoan Trypanosoma cruzi, and it is transmitted by triatomine insects. This disease is found between the southern United States to Argentina and approximately 14 million people in Latin America are believed to be infected, predominantly with the chronic form of the disease. Reactivation of Chagas disease can occur among immunosuppressed patients, as has been observed among AIDS patients. In one such case, we observed cardiac decompensation with severe ventricular dysfunction and arrhythmias. This case was thought to be reactivation of Chagas disease in the myocardium, since the xenodiagnosis was positive. Specific treatment for Trypanosoma cruzi was administered, consisting of benznidazole, but the course of treatment was not completed because the patient died due to cardiopathic complications. The necropsy showed the usual stigmas of chronic Chagas cardiopathy, such as fibrosing myocarditis and a decreased number of neurons in the digestive system. There were no amastigote forms of Trypanosoma cruzi in any of the tissue samples studied. Therefore, reactivation of Chagas disease was not demonstrated but, rather, the natural evolution of chronic Chagas cardiopathy was demonstrated.

Evolução fatal da co-infecção doença de Chagas/Aids: dificuldades diagnósticas entre a reagudização da miocardite e a miocardiopatia chagásica crônica / Fatal evolution of Chagas'disease/Aids co-infection: diagnostic difficulties between myocarditis reactivation and chronic chagasic myocardiopathy

A doença de Chagas é uma parasitose causada pelo protozoário Trypanosoma cruzi, transmitido por insetos triatomíneos. A doença ocorre desde o sul dos Estados Unidos da América do Norte até a Argentina, sendo que, aproximadamente, 14 milhões de pessoas devam estar infectados na América Latina, predominantemente na forma crônica da doença. A reagudização da doença de Chagas pode ocorrer em imunossuprimidos, como tem sido observado em pacientes com aids. Verificou-se descompensação cardíaca em um destes casos, com grave disfunção ventricular e arritmias sendo considerada a possibilidade de reagudização da doença de Chagas no miocárdio, uma vez que o xenodiagnóstico foi positivo. Face a gravidade foi tratado especificamente para o Trypanosoma cruzi com benznidazol, porém sem completar o tempo estipulado para este fim, vindo a falecer em conseqüência de complicações da cardiopatia. A necropsia apresentou os estigmas habituais da cardiopatia chagásica crônica como miocardite fibrosante e redução do número de neurônios no tubo digestório, não sendo encontradas formas amastigotas do Trypanosoma cruzi em nenhum dos tecidos examinados. Assim, não ficou demonstrada a reagudização da doença de Chagas, mas sim evolução natural da cardiopatia chagásica crônica.

Chagas disease is a type of parasitosis caused by the protozoan Trypanosoma cruzi, and it is transmitted by triatomine insects. This disease is found between the southern United States to Argentina and approximately 14 million people in Latin America are believed to be infected, predominantly with the chronic form of the disease. Reactivation of Chagas disease can occur among immunosuppressed patients, as has been observed among AIDS patients. In one such case, we observed cardiac decompensation with severe ventricular dysfunction and arrhythmias. This case was thought to be reactivation of Chagas disease in the myocardium, since the xenodiagnosis was positive. Specific treatment for Trypanosoma cruzi was administered, consisting of benznidazole, but the course of treatment was not completed because the patient died due to cardiopathic complications. The necropsy showed the usual stigmas of chronic Chagas cardiopathy, such as fibrosing myocarditis and a decreased number of neurons in the digestive system. There were no amastigote forms of Trypanosoma cruzi in any of the tissue samples studied. Therefore, reactivation of Chagas disease was not demonstrated but, rather, the natural evolution of chronic Chagas cardiopathy was demonstrated.

Viral hepatitis in patients infected with human immunodeficiency virus.

From 1992 to 1995 we studied 232 (69% male, 87% Caucasian) anti-human immunodeficiency virus (anti-HIV) positive Brazilian patients, through a questionnaire; HIV had been acquired sexually by 50%, from blood by 32%, sexually and/or from blood by 16.4% and by an unknown route by 1.7%. Intravenous drug use was reported by 29%; it was the most important risk factor for HIV transmission. The alanine aminotransferase quotient (qALT) was >1 for 40% of the patients, 93.6% had anti-hepatitis A virus antibody, 5.3% presented hepatitis B surface antigen, 44% were anti-hepatitis B core antigen positive and 53.8% were anti-hepatitis C virus (anti-HCV) positive. The anti-HCV test showed a significant association with qALT>1. Patients for whom the probable HIV transmission route was blood had a 10.8 times greater risk of being anti-HCV positive than patients infected by other routes. Among 30 patients submitted to liver biopsy, 18 presented chronic hepatitis.

Viral hepatitis in patients infected with human immunodeficiency virus

From 1992 to 1995 we studied 232 (69 percent male, 87 percent Caucasian) anti-human immunodeficiency virus (anti-HIV) positive Brazilian patients, through a questionnaire; HIV had been acquired sexually by 50 percent, from blood by 32 percent, sexually and/or from blood by 16.4 percent and by an unknown route by 1.7 percent. Intravenous drug use was reported by 29 percent; it was the most important risk factor for HIV transmission. The alanine aminotransferase quotient (qALT) was >1 for 40 percent of the patients, 93.6 percent had anti-hepatitis A virus antibody, 5.3 percent presented hepatitis B surface antigen, 44 percent were anti-hepatitis B core antigen positive and 53.8 percent were anti-hepatitis C virus (anti-HCV) positive. The anti-HCV test showed a significant association with qALT>1. Patients for whom the probable HIV transmission route was blood had a 10.8 times greater risk of being anti-HCV positive than patients infected by other routes. Among 30 patients submitted to liver biopsy, 18 presented chronic hepatitis

Identificaçäo de sequências como indicadores (primers) específicos para a caracterizaçäo em cultura dos sorotipos A e B de Cryptococcus neoformans pela Reaçäo em Cadeia da Polimerase (PCR) / Sequences identification as specific indicators (primers) for the characterization in culture of Cryptococcus neoformans serotypes A and B by the Polimerase Chain Reaction (PCR)

A Criptococose, doença cosmopolita, causada pelo Cryptococcus neoformans, é conhecida há cerca de um século. A imunossupressäo que decorre, tanto de tratamentos com asteróides e outros tipos de drogas, quanto de doenças degenerativas e infecciosas, facilita multiplicaçäo e o desenvolvimento desse agente tornando a doença importante, particularmente nesses casos. O aparecimento da Síndrome da Imunodeficiência Adquirida (AIDS) ao final da década de 70 fez proliferar a criptococose, já que um dos efeitos daquela síndrome é o comprometimento acentuado das defeses dos pacientes. Neste trabalho foram estudadas trinta e três cepas de Cryptococcus neoformans isoladas de vinte e quatro pacientes atendidos no Hospital das Clínicas da Universidade Estadual de Campinas. Estes isolamentos foram obtidos de líquor, sangue e biópsia de pele.