Healthcare-associated infections: a threat to the survival of patients with COVID-19 in intensive care units.

BACKGROUND: Wide variation in mortality rates among critically ill patients with coronavirus disease 2019 (COVID-19) has been reported. This study evaluated whether healthcare-associated infections (HAI) are a risk factor for death among patients with severe COVID-19 in the intensive care unit (ICU). METHODS: This retrospective cohort study included patients with severe COVID-19 hospitalized in the ICU of four hospitals in the city of Curitiba, Brazil. Patients with COVID-19 who died during ICU hospitalization were compared with those who were discharged. A second analysis compared patients who developed HAI in the ICU with those who did not. Multiple logistic regression models were used to control for confounders. RESULTS: In total, 400 patients were included, and 123 (31%) patients developed HAI. The most common HAI was lower respiratory tract infection (67%). Independent risk factors for death were: age [odds ratio (OR) 1.75, 95% confidence interval (CI) 1.43-2.15; P<0.0001]; clinical severity score (OR 2.21, 95% CI 1.70-2.87; P<0.0001); renal replacement therapy (OR 12.8, 95% CI 5.78-28.6; P<0.0001); and HAI (OR 5.9, 95% CI 3.31-10.5; P<0.0001). A longer interval between symptom onset and hospital admission was protective against death (OR 0.93, 95% CI 0.88-0.98; P=0.017). The only independent factors associated with HAI were high C-reactive protein and low PaO2/FiO2 ratio. CONCLUSIONS: No factors that could point to a high-risk group for HAI acquisition were identified. However, age, dialysis and HAI increased the risk of death in ICU patients with severe COVID-19; of these, HAI is the only preventable risk factor.

Criopreservação do plasma rico em plaquetas de equinos / Equine platelet-rich plasma cryopreservation

Avaliou-se o congelamento do plasma rico em plaquetas (PRP) de equinos, a -196ºC em nitrogênio líquido, utilizando-se como crioprotetor o DMSO em duas concentrações (3% e 6%), e, como ponto final, a avaliação da morfologia e da agregometria plaquetária. Foram utilizadas 12 amostras de PRP em duas repetições. Previamente ao congelamento, as amostras foram submetidas a um resfriamento lento (-0,07ºC/minuto) até a temperatura final de 4-5ºC. A criopreservação do PRP equino, incluindo um resfriamento lento a 4-5ºC, previamente ao congelamento a -197ºC em nitrogênio líquido, foi similar para as concentrações do crioprotetor DMSO a 3% ou 6%, quando avaliado o percentual de ativação e de agregação plaquetária.

Equine platelet-rich plasma (PRP) frozen at -196°C in liquid nitrogen using DMSO as a cryoprotectant in two different concentrations (3% and 6%) was evaluated, using platelet morphology and aggregometry as the final parameters. Twelve PRP samples were used in two repetitions. The samples were submitted to slow cooling prior to frozen (-0.07°C/minute) until they reached the temperature of 4-5°C. Platelet cryopreserved in 3% or 6% DMSO, presented similar efficacy when the percentage of activation and platelet aggregation was evaluated.

Comportamento ingestivo e desempenho produtivo de cordeiros mantidos em pastagem tropical e recebendo diferentes suplementações / Ingestive behavior and productive performance of lambs maintained in tropical pasture receiving different supplements

Avaliaram-se os efeitos dos tipos de suplementação sobre o desempenho produtivo e o comportamento ingestivo diurno de cordeiros mestiços Santa Inês mantidos em pastagem de capim-aruana (Panicum maximum cv. Aruana) sobressemeado com aveia branca (Avena sativa L.) e azevém (Lolium multiflorum Lam.), em um delineamento inteiramente ao acaso, com três tratamentos e três repetições. Os cordeiros foram distribuídos aleatoriamente em três sistemas alimentares, com seis animais cada, sendo: PAST - cordeiros mantidos exclusivamente a pasto; SIL - cordeiros mantidos em pastagem recebendo suplementação (1,0% do peso vivo) com silagem de milho; CONC - cordeiros mantidos em pastagem recebendo suplementação (1,0% do peso vivo) com concentrado. Os cordeiros suplementados com concentrado apresentaram ganho de peso médio diário 37,5% superior aos mantidos em pastagem, mas não diferiram da suplementação com silagem de milho. O tempo de pastejo foi superior para os animais não suplementados quando comparados aos animais suplementados. Cordeiros mantidos a pasto e suplementados com silagem de milho ou concentrado ganham mais peso do que os cordeiros não suplementados.

The aim of this work was to evaluate the types of supplementation on performance and the diurnal feeding behavior of crossbred Santa Inês lambs maintained in aruana (Panicum maximum cv. Aruana) pasture grass overseeding with oat (Avena sativaL.) and Italian ryegrass (Lolium multiflorum Lam.) pasture in a completely randomized design with three treatments and three replications. The lambs were randomly assigned to three food systems of six animals each, PAST - lambs fed only pasture; SIL - lambs fed pasture and supplemented (1% of live weight) with corn silage; CONC - lambs fed pasture and supplemented with concentrate. Animals supplemented with concentrate presented average daily gain 37,5% higher, but did not differ from supplementation with corn silage. Grazing time was higher for non-supplemented animals compared with supplemented animals. Lambs maintained in pasture and supplemented with corn silage or concentrate gain more weight than non-supplemented lambs.

The effect of palm oil addition to the diet of dairy sheep on the immune response.

The aim of this study was to evaluate whether a diet based on palm oil has any influence on the immune response and on the number of eggs per gram of faeces (EPG) of gastrointestinal nematodes (GIN) in dairy sheep. To address this issue, 30 ewes in early lactation were confined and divided into three groups (n = 10) receiving a daily isoproteic and isoenergetic diet. Palm oil was added to the feed at different concentrations: 0% (control; group A), 4% (group B) and 6% (group C). The animals were treated with levamisole 10 days before the beginning of the experiment. Faecal samples were collected and analysed for EPG on day zero of the experiment. On days 60 and 120, individual faecal and blood samples were collected, and the FAMACHA(©) score for assessing clinical anaemia was carried out. The groups receiving palm oil showed a significant reduction in EPG in relation to the control group (A) on day 120. Serum immunoglobulin levels (IgG, IgM and IgE) and proinflammatory cytokine levels (TNF-α, IL-1 and IL-6) were significantly increased on days 60 and 120 (p < 0.05) in groups B and C. Therefore, these results suggest that palm oil stimulates the immune response in sheep, thus reducing EPG of GIN. The hypothesis that palm oil has direct anthelmintic activity should be tested in future studies.

Pullout bond strength of fiber posts luted to different depths and submitted to artificial aging.

INTRODUCTION: The extension of fiber post cementation often does not seem to influence the fracture resistance of restorations. This study evaluated the effects of cementation depths on the retention of fiber posts submitted to artificial aging. METHODS: One hundred and sixty bovine incisors were selected to assess post retention. Following endodontic treatment, the canals were flared with diamonds burs. Postholes were prepared in lengths of 5 or 10 mm, after which fiber posts were relined with composite resin and luted with RelyX ARC or RelyX Unicem. The samples were then submitted to thermal and/or mechanical cycling before testing their pullout bond strengths. Absence of cycling was used as a control. The results of each cement were submitted to two-way and post hoc Tukey tests (α=0.05). RESULTS: Independent of the aging protocol, a depth of 10 mm showed higher pullout bond strength than did 5 mm, except for RelyX Unicem without cycling. For RelyX ARC, thermomechanical cycling resulted in lower values than in the absence of cycling. Mechanical cycling alone promoted the highest bond strength when the posts were luted with RelyX Unicem. CONCLUSION: The effect of artificial aging on the pullout bond strength is dependent on the type of material and the depth.

Avaliação da carcaça de cabritos Saanen alimentados com dietas com grãos de oleaginosas / Carcass evaluation of Saanen kids fed oilseeds diets

Foram utilizados 16 cabritos Saanen não castrados dos 15,16±1,60kg até 30,61±0,33kg de peso vivo, distribuídos em delineamento inteiramente ao acaso, alimentados com dietas (tratamentos) com grãos de linhaça, girassol ou canola. A dieta-controle foi formulada com feno de aveia, farelo de soja, milho moído e suplemento vitamínico-mineral. Os pesos da carcaça quente e fria e os rendimentos da carcaça e de cortes comerciais não foram modificados pelos tratamentos. A dieta com grãos de canola resultou em maior perda por resfriamento da carcaça e menor proporção de gordura no lombo, e a proporção de osso no lombo foi maior para os animais que receberam linhaça ou canola. Os teores de umidade, proteína, lipídios totais e cinzas do músculo Longissimus dorsi não foram alterados com a adição dos grãos de oleaginosas. A dieta com grãos de linhaça resultou em aumento do teor de ômega-3 no músculo, e o teor de colesterol e a razão ômega-6/ômega-3 foram menores nos tratamentos que continham linhaça, girassol e canola. A inclusão dos grãos de oleaginosas nas dietas não alterou as características quantitativas da carcaça de cabritos Saanen, mas melhorou a qualidade da carne, que apresentou menos colesterol e mais ômega-3, com o uso de linhaça.

Sixteen non-castrated Saanen kids from 15.16±1.60kg to 30.61±0.33kg of body weight, allotted into completely randomized experimental design, were fed experimental diets (treatments) containing flaxseed, sunflower, or canola oilseeds, and a control diet based on oat hay, soybean meal, ground corn, and vitamin-mineral supplement. Hot and cold carcass weight, carcass and commercial cuts yields were not modified by treatments. Canola seed in diets resulted in greater weight loss by cooling and lower loin fat proportion. Loin bone proportion was higher for kids fed flaxseed or canola. The moisture, protein, lipid, and ash contents in the Longissimus dorsi were not affected by oilseeds inclusion. Flaxseed in the diet increased the omega-3 content in muscle. Cholesterol content and omega-6/omega-3 ratio were lower to the treatments with flaxseed, sunflower, and canola. Oilseeds in diets of Saanen kids did not alter the carcass quantitative traits, but improved the quality of meat, with less cholesterol and more omega-3 using flaxseed.

Thrombocytopenia in patients with dengue virus infection in the Brazilian Amazon.

Thrombocytopenia may be occasionally observed in dengue fever (DF) but is a constant feature and one of the diagnostic criteria of dengue hemorrhagic fever (DHF). Its clinical presentation and relevance is still poorly described in the literature. Patients with fever and bleeding were referred to a tertiary care center in Manaus, in the Western Brazilian Amazon during the outbreak of dengue in 2001. They were hospitalized for clinical observation and supportive care. Platelet counts were performed on admission and throughout the hospitalization. Only patients with a serological confirmation or viral isolation of the dengue virus were included. One hundred and seventy eight patients were enrolled in the study (118 with DF and 60 with DHF). There was no association between the presence of active bleeding and the degree of thrombocytopenia on admission (P = 0.302). A positive tourniquet test, hematemesis and ecchymoses were more frequent in DHF patients (P < 0.05). Patients with DHF had lower platelet counts than patients with DF (P < 0.001). There was a positive correlation between platelet counts and plasma albumin levels (r = 0.217; P = 0.016) and a negative correlation with ALT values (r = -0.3; P = 0.001). Clinical manifestations of thrombocytopenia are not related only to the number of peripheral platelets in dengue infection, but its recovery is associated with clinical improvement. The level of platelets correlates with the vascular leakage of proteins and liver damage.

The rarity of infection with Leishmania (Viannia) braziliensis among patients from the Manaus region of Amazonas state, Brazil, who have cutaneous leishmaniasis.

The frequency of Leishmania ( Viannia) braziliensis infection was assessed in 79 of the 138 patients with cutaneous leishmaniasis who attended a reference outpatient unit in Manaus, Amazonas state, between the August and December of 1997. The disease was characterized by one or more cutaneous ulcers, the skin lesions being frequently associated with satellite lymph-node enlargement. All parasite isolates were identified using monoclonal antibodies and enzyme electrophoresis. Only two (2.8%) of the 71 patients from whom parasites were successfully isolated were found to be infected with L. ( V.) braziliensis, the other 69 isolates being identified, from their isoenzyme profiles, as L. ( V.) guyanensis. In the Manaus region, therefore, almost all human cutaneous leishmaniasis is the result of infection with L. (V.) guyanensis, and L. ( V.) braziliensis is a relatively rare cause of the disease.

Comparison of cutaneous leishmaniasis due to Leishmania (Viannia) braziliensis and L. (V.) guyanensis in Brazil: therapeutic response to meglumine antimoniate.

We conducted a quasi-experimental study to compare the response to meglumine antimoniate in patients with localized cutaneous leishmaniasis from two endemic areas of Brazil that were infected by two Leishmania species. Sixty-one were infected by Leishmania (Viannia) braziliensis (group B) and 57 by L. (V.) guyanensis (group G). All had a parasitologically proven diagnosis and were treated with 20 mg of pentavalent antimonial (SbV)/kg/day given intravenously or intramuscularly for 20 days. Main outcomes were diagnosed using clinical criteria three months after treatment and patients were followed for six months. Intention-to-treat analysis showed a higher failure rate in group G (relative risk [RR] = 1.5, 95% confidence interval [CI] = 1.1-2.0, chi2 = 7.44, P = 0.006). The analysis using an explanatory approach including 52 patients from group B and 49 from group G, who were regularly treated and followed for six months, showed a low cure rate (50.8% in group B and 26.3% in group G) with a greater risk of failure in the latter group (RR = 1.7, 95% CI = 1.2-2.5, chi2 = 8.56, P = 0.003). The effect of the etiologic agent remained significant after adjusting for age, disease duration, and site and number of lesions that were identified as predictors of failure in a logistic regression model. We concluded that Leishmania species constitute an important factor in predicting the outcome of cutaneous leishmaniasis treated with a pentavalent antimonial.

Parasite persistence in treated chagasic patients revealed by xenodiagnosis and polymerase chain reaction.

Polymerase chain reaction (PCR) was compared with xenodiagnosis performed 20 years after trypanocidal chemotherapy to investigate parasite clearance. Eighty-five seropositive individuals for Chagas disease presenting a positive xenodiagnosis were treated with specific drugs; 37 in the acute phase and 48 in the chronic phase. Fifteen chronic asymptomatic patients received a placebo. Treatment in the acute phase led to PCR negative results in 73% of the cases, while xenodiagnosis was negative in 86%. In the chronic phase, PCR was negative in 65% of the patients and 83% led to xenodiagnosis negative results. Regarding the untreated group (placebo), 73% gave negative results by xenodiagnosis, of which 36% were positive by PCR. Individuals that were considered seronegative (n=10), presented unequivocally negative results in the PCR demonstrating the elimination of parasite DNA. Seventeen individuals had their antibodies titers decreased to such a level that the final results were considered as doubtful and 16 of them presented negative PCR. The molecular method represents a clear advantage over conventional techniques to demonstrate persistent infections in Chagas disease patients that underwent chemotherapy.

[A 13-year clinical study on 190 chronic chagasic patients from Mambaí, Goiás, Brazil]. / Estudo clínico durante 13 anos de 190 chagásicos crônicos de Mambaí, Goiás, Brasil.

A prospective study was performed on the clinical, electrocardiographic (ECG) and radiologic aspects of the esophagus in 190 chagasic patients, for on average follow-up period of 13 years. We found 108 (56.8%) patients who remained in the same clinical state, 72 (37.9%) patients with progressive illness and 10 (5.3%) patients whose previous ECG abnormalities subsided. Thirty nine out of 72 patients with progressive disease developed cardiopathy or aggravation of previous illness, 32 developed into megaesophagus or an existing picture deteriorated and 12 developed or showed worsening of the colopathy. Of 72 patients, 11 presented with associated forms. The development of cardiopathy was greater in males 29.6% (21/71) than in females 15.1% (18/119), p =0.015. There were 19 new cases of cardiopathy, and 20 of aggravated previous disease. The incidence of megaesophagus was 14.9% (23/154), with nine patients whose previous disease worsened. The progression of colopathy was greater in females 9.2% (11/119) than in males 1.4% (1/71), p = 0.026.

Estudo clínico durante 13 anos de 190 chagásicos crônicos de Mambaí, Goiás, Brasil / A 13-year clinical study on 190 chronic chagasic patients from Mambaí, Goiás, Brazil

A prospective study was performed on the clinical, electrocardiographic (ECG) and radiologic aspects of the esophagus in 190 chagasic patients, for on average follow-up period of 13 years. We found 108 (56.8%) patients who remained in the same clinical state, 72 (37.9%) patients with progressive illness and 10 (5.3%) patients whose previous ECG abnormalities subsided. Thirty nine out of 72 patients with progressive disease developed cardiopathy or aggravation of previous illness, 32 developed into megaesophagus or an existing picture deteriorated and 12 developed or showed worsening of the colopathy. Of 72 patients, 11 presented with associated forms. The development of cardiopathy was greater in males 29.6% (21/71) than in females 15.1% (18/119), p =0.015. There were 19 new cases of cardiopathy, and 20 of aggravated previous disease. The incidence of megaesophagus was 14.9% (23/154), with nine patients whose previous disease worsened. The progression of colopathy was greater in females 9.2% (11/119) than in males 1.4% (1/71), p = 0.026.

Foram estudados prospectivamente 190 chagásicos, do ponto de vista clínico, eletrocardiográfico e abreugráfico do esôfago, no período médio de 13 anos, sendo encontrados 108 (56,8%) com a forma clínica inalterada, 72 (37,9%) com doença progressiva e 10 (5,3%) nos quais houve normalização do eletrocardiograma. Nos 72, em que a doença progrediu, 39 desenvolveram cardiopatia ou agravaram a já existente, 32 evoluíram para, ou pioraram o megaesôfago prévio e, 12 evoluíram para colopatia ou agravaram a já existente. Dentre os 72, 11 tinham formas clínicas associadas. A evolução da cardiopatia foi maior no sexo masculino 29,6% (21/71) que no feminino 15,1% (18/119), p = 0,015. Houve 19 casos novos de cardiopatia e 20 agravaram a cardiopatia prévia. A incidência de megaesôfago foi 14,9% (23/154) e nove agravaram o megaesôfago já existente. A evolução da colopatia foi maior no sexo feminino 9,2% (11/119), que no masculino 1,4% (1/71), p =0,026.

[Evaluation of secondary bacterial infection's influence on the course of cutaneous leishmaniasis in Corte de Pedra, Bahia]. / Avaliação da influência da infecção bacteriana secundária na evolução da leishmaniose cutânea em Corte de Pedra, Bahia.

In order to study the prevalence of secondary bacterial infection in ulcerated lesions and its relationship to the healing process, 84 leishmaniotic patients were evaluated. Diagnosis of the secondary infection was made by bacterial aerobic culture of peripheral tissue specimen of the ulcer. All patients received antimonial therapy during 20 days and washed their ulcers with common soap. Cases were composed mainly of adolescent and adult farmer patients with single lesions. The evaluated ulcers were encountered on legs and feet in 47.6%. Secondary bacterial infection was found in 45/83 (54.2%), and was more frequent in lesions located below the knee. Staphylococcus aureus predominated (89%). The ulcers' healing process, evaluated in 79 patients one month after finishing treatment, was not influenced by the secondary bacterial infection.

Sensitivity of the polymerase chain reaction for the diagnosis of cutaneous leishmaniasis due to Leishmania (Viannia) guyanensis.

The sensitivity of the polymerase chain reaction (PCR) in 35 consecutive outpatients with cutaneous leishmaniasis caused by Leishmania (Viannia) guyanensis was evaluated using, as gold standard, the in vitro isolation of the parasite through culture of aspirates of the cutaneous ulcers. All isolates were identified using electrophoretic enzyme analysis. Patients were mainly young males with recent onset disease without prior specific treatment. PCR was performed using DNA extracted from fresh frozen biopsies of cutaneous ulcers. The reaction used a pair of oligonucleotides that amplify the conserved region of the minicircle molecule. PCR showed 100% sensitivity (95% CI from 90.0 to 100.0). These results were similar to the visualization of amastigotes in imprint preparations of cutaneous biopsy tissue and the inoculation of biopsy material in golden hamsters. Despite the high sensitivity of the PCR, in this particular clinical setting of cutaneous leishmaniasis caused by L. (V.) guyanensis in the Brazilian Amazon, it appears that the method of choice for diagnosis should be the direct visualization of amastigotes using imprint preparations and the PCR reserved for those patients with negative imprint results.

Avaliação da influência da infecção bacteriana secundária na evolução da leishmaniose cutânea em Corte de Pedra, Bahia / Evaluation of secondary bacterial infection's influence on the course of cutaneous leishmaniasis in Corte de Pedra, Bahia

In order to study the prevalence of secondary bacterial infection in ulcerated lesions and its relationship to the healing process, 84 leishmaniotic patients were evaluated. Diagnosis of the secondary infection was made by bacterial aerobic culture of peripheral tissue specimen of the ulcer. All patients received antimonial therapy during 20 days and washed their ulcers with common soap. Cases were composed mainly of adolescent and adult farmer patients with single lesions. The evaluated ulcers were encountered on legs and feet in 47.6%. Secondary bacterial infection was found in 45/83 (54.2%), and was more frequent in lesions located below the knee. Staphylococcus aureus predominated (89%). The ulcers' healing process, evaluated in 79 patients one month after finishing treatment, was not influenced by the secondary bacterial infection.

Foram avaliados 84 pacientes leishmanióticos com o objetivo de verificar a prevalência de infecção bacteriana secundária das úlceras cutâneas e de estudar sua relação com a cicatrização das lesões. A infecção secundária foi diagnosticada mediante cultura bacteriana aeróbica de amostra de tecido da lesão. Todos os pacientes receberam tratamento antimonial durante 20 dias e fizeram lavagem da úlcera com água e sabão comum. A casuística foi composta principalmente de adolescentes e de adultos dedicados à lavoura, apresentando lesão única. Em 47,6%, as úlceras estudadas estavam localizadas nas pernas e nos pés. Verificou-se infecção secundária em 45/83 (54,2%), sendo mais freqüente nas lesões localizadas abaixo dos joelhos. O Staphylococcus aureus predominou (88,9%). A reepitelização completa das úlceras, avaliada em 79 pacientes um mês após o fim do tratamento, não foi influenciada pela infecção secundária.

Comparison of cutaneous leishmaniasis due to Leishmania (Viannia) braziliensis and L. (V.) guyanensis in Brazil: clinical findings and diagnostic approach.

We compared the clinical findings and diagnostic methods for 66 patients with cutaneous leishmaniasis in the state of Bahia, Brazil, who were infected by Leishmania (Viannia) braziliensis (group A), with those for 68 patients in the state of Amazonas, Brazil, who were mainly infected by Leishmania (Viannia) guyanensis (group B). Differences were observed with regard to number, size, and location of skin lesions and to the pattern of lymphatic involvement. Patients in group B had smaller and more numerous lesions, which were frequently located above the waist, versus the larger but less numerous lesions among patients in group A, which were usually located on the lower limbs. Lymphatic involvement was present in 55 (83.3%) of the 66 patients in group A and in 42 (61.8%) of the 68 patients in group B (P=0.005). The positivity rates of imprints and skin culture procedures were higher in group B. Sensitivity of in vitro culture of skin aspirates was 47.0% and 91.2% for groups A and B, respectively (P<.001). Although hamster inoculation showed similar results in both groups, the interval before development of disease was shorter in group B. Our data provide substantial evidence that indicate that the disease caused by these species differs with regard to clinical presentation and diagnostic approach.

Evaluation of the impact of chemical control measures and entomological surveillance on Chagas' disease in the counties of Mambaí and Buritinópolis, Goiás State, Brazil.

Epidemiological surveillance activities were implemented in 1980 in Mambaí and Buritinópolis counties, Goiás State. Twenty years later the authors evaluated the impact of these vector control measures on Chagas' disease transmission, based on entomological indicators. Entomological investigation was conducted using the man-hour technique and covering all domiciles. In order to study vector food sources the stomach contents of triatomines were analyzed using the modified precipitins technique. Triatomines were shown to be present in 48 (71.6%) of the 67 locations. Peridomiciliary infestation rates in Mambaí and Buritinópolis were 8.7% and 12.1%, respectively, while intradomiciliary rates were 0.7% and 1.2%. Triatoma sordida was the species identified in 97.3% of all captured specimens. It was also the only species found to be naturally infected with Trypanosoma cruzi. Birds were the most frequent food source (45%) for Triatoma sordida. The most significant result was the complete absence of Triatoma infestans in the two counties.

[Socioeconomic factors and attitudes towards household prevention of American cutaneous leishmaniasis in an endemic area in Southern Bahia, Brazil]. / Fatores sócio-econômicos e atitudes em relação à prevenção domiciliar da leishmaniose tegumentar americana, em uma área end emica do sul da Bahia, Brasil.

A survey was conducted to identify socioeconomic conditions and attitudes towards household prevention of American cutaneous leishmaniasis in Corte de Pedra, located in the county of Tancredo Neves, an endemic region in southern Bahia, Brazil. A questionnaire was applied in July 1997, focusing on social and economic variables, habits, and attitudes towards prevention of arthropod bites. All families (100%) living in the study area were surveyed, comprising 168 households with 851 individuals. Approximately 66.7% of the families earned up to one minimum wage, supporting an average of 5.1 residents per household. Most (57.2%) of the families did not use any type of protection against bites. Fumigation by burning various types of materials was the most customary form of prevention. Individual protection measures were rarely used. Since there was evidence of household and peridomiciliary transmission in the study area, use of impregnated bed nets is an alternative for intradomiciliary protection.

[Comparative study between sodium stibogluconate BP 88 and meglumine antimoniate in cutaneous leishmaniasis treatment. II. Biochemical and cardiac toxicity]. / Estudo comparativo entre estibogluconato de sódio BP 88 e antimoniato de meglumina no tratamento da leishmaniose cutânea. II. Toxicidade bioquímica e cardíaca.

Toxicity of two antimonial pentavalents were evaluated in 111 patients with cutaneous leishmaniasis. Forty-seven patients received meglumine antimoniate (Group I) and 64 patients, sodium stibogluconate BP 88 (Group II), 20 mg Sbv/kg/day for 20 days. Evaluation of aminotransferases, alkaline phosphatase, amilase, creatinine, urea, urine analysis and electrocardiogram were performed at baseline, on the tenth and twentieth day of treatment. Greater frequency of aminotransferase abnormal levels were observed on the tenth and twentieth days in group II (p < 0.001) and a greater proportion of amilase abnormal levels at the tenth day in the same group (p < 0.001). There was a greater variation of aminotransferases, alkaline phosphatase and amilase in the first ten days of treatment in group II (p < 0.01). On the twentieth day there was a greater variation of aminotransferase levels in group II (p = 0.02 and p = 0.03, respectively). Forty-three percent of group I and 54% of group II showed electrocardiographic abnormalities (p = 0.30).

[Clinical study of falciparum malaria in children in Manaus, AM, Brazil]. / Estudo clínico da malária falciparum em crianças em Manaus, AM, Brasil.

The clinical characteristics of falciparum malaria were studied among 61 children, aged 0 to 14 treated at a reference center in Manaus, from October to December 1997. The symptoms observed were fever (98.4%), headache (80.3%), chills (68.9%), perspiration (65. 6%), myalgia (59.0%), nausea (54.1%), lumbar pain (49.2%), vomiting (49.2%), cough (45.9%), arthralgia (31.1%), diarrhea (34.4%), dyspnea (8.2%), convulsions (8.2%) and dizziness (4.9%). Pallor and anaemia were found more frequently in children under five years old. Anaemia was associated with high levels of parasitaemia. Fifty-eight (91.5%) patients had uncomplicated malaria, 3 (4.9%) had severe malaria and the lethality was 1.6%.