Whipple disease without joint involvement in a patient with chronic diarrhea and HIV seropositive partner: case report / Doença de Whipple sem envolvimento articular em paciente com diarréia crônica e parceira HIV-soropositiva: Relato de caso

Introduction: Whipple's disease is a rare, infectious disease caused by the bacterium Tropheryma whipplei that affects multiple organs and systems. It is difficult to identifyand frequently presents as a diagnosis of exclusion due existence of conditions causing most prevalent chronic diarrhea, as AIDS and Inflammatory Bowel Disease. Case report: Herein we report the clinical findings of a 38-year-old male patient, married with a HIV seropositive woman, with a four-year course of chronic diarrhea until he received a definitive diagnosis. Treatment was started with a 15-day penicillin G regimen, followed by continued trimethoprim­sulfamethoxazole 80/400mg after hospital discharge up to current days. Conclusion: Currently, the patient remains asymptomatic and has completed clinical remission after two years of treatment. (AU)

Introdução: A doença de Whipple é uma doença infecciosa rara causada pela bactéria Tropheryma whipplei que afeta múltiplos órgãos e sistemas. É difícil de identificar e freqüentemente se apresenta como um diagnóstico de exclusão devido à existência de condições que causam diarréia crônica mais prevalentes, como AIDS e Doença Infçamatória Intestinal. Relato do Caso: Aqui, relatamos os achados clínicos de um paciente do sexo masculino de 38 anos, casado com uma mulher HIV-soropositiva, com um curso de quatro anos de diarréia crônica até receber o diagnóstico definitivo. O tratamento foi iniciado com penicilina G por 15 dias, seguido de sulfametoxazol- trimetoprim 400/80 mg após a alta hospitalar até os dias atuais. Conclusão: Atualmente, o paciente permanece assintomático e apresentado remissão clínica completa após dois anos de tratamento. (AU)

Structure for prevention of health care-associated infections in Brazilian hospitals: A countrywide study.

BACKGROUND: Minimal structure is required for effective prevention of health care-associated infection (HAI). The objective of this study was to evaluate the structure for prevention of HAI in a sample of Brazilian hospitals. METHODS: This was a cross-sectional study from hospitals in 5 Brazilian regions (n = 153; total beds: 13,983) classified according to the number of beds; 11 university hospitals were used as reference for comparison. Trained nurses carried out the evaluation by using structured forms previously validated. The evaluation of conformity index (CI) included elements of structure of the Health Care-Associated Prevention and Control Committee (HAIPCC), hand hygiene, sterilization, and laboratory of microbiology. RESULTS: The median CI for the HAIPCC varied from 0.55-0.94 among hospital categories. Hospitals with >200 beds had the worst ratio of beds to sinks (3.9; P < .001). Regarding alcoholic product for handrubbing, the worst ratio of beds to dispensers was found in hospitals with <50 beds (6.4) compared with reference hospitals (3.3; P < .001). The CI for sterilization services showed huge variation ranging from 0.0-1.00. Reference hospitals were more likely to have their own laboratory of microbiology than other hospitals. CONCLUSION: This study highlights the need for public health strategies aiming to improve the structure for HAI prevention in Brazilian hospitals.

Bacillary angiomatosis in HIV-positive patient from Northeastern Brazil: a case report.

It is a report of disseminated bacillary angiomatosis (BA) in a 23-year-old female patient, who is HIV-positive and with fever, weight loss, hepatomegaly, ascites, and papular-nodular skin lesions. The clinical and diagnostic aspects involved in the case were discussed. Bacillary angiomatosis must always be considered in the diagnosis of febrile cutaneous manifestations in AIDS.

Bacillary angiomatosis in HIV-positive patient from Northeastern Brazil: a case report / Angiomatose bacilar em paciente HIV positivo no nordeste brasileiro: relato de caso

It is a report of disseminated bacillary angiomatosis (BA) in a 23-year-old female patient, who is HIV-positive and with fever, weight loss, hepatomegaly, ascites, and papular-nodular skin lesions. The clinical and diagnostic aspects involved in the case were discussed. Bacillary angiomatosis must always be considered in the diagnosis of febrile cutaneous manifestations in AIDS.

Relato de angiomatose bacilar (AB) disseminada em paciente do sexo feminino de 23 anos, HIV positiva, com febre, emagrecimento, hepatomegalia, ascite e lesões de pele pápulo-nodulares. Foram discutidos os aspectos clínicos e diagnósticos envolvidos no caso. Angiomatose bacilar deve sempre ser considerada no diagnóstico de doença febril com manifestações cutâneas na AIDS.

[Health professionals knowledge about the prevention of pneumonia associated to mechanical ventilation at Intensive Care Unit]. / Conhecimento dos profissionais de saúde na Unidade de Terapia Intensiva sobre prevenção de pneumonia associada à ventilação mecânica.

The Pneumonia Associated to Mechanical Ventilation (PAMV) is the more important and more common infection in critic mechanically ventilated patients in the Intensive Care Unit (ICUs). This quantitative research has aimed to assess the knowledge of the health professionals about the prevention of PAMV in two public hospitals of Fortaleza, Ceará State, from June to July, 2006. A questionnaire was applied to 104 professionals, by means of the concept scales of Likert which was used as a parameter and reference to the assessment. It was calculated the average and standard digression and analyzed the knowledge of professionals in relation to the PAMV. It was observed the association between the knowledge about prevention of PAMV and other variables through the chi2 tests from Fisher-Freeman-Halton, fixing the significance level in 5%. The results obtained had suggested that the knowledge of health professionals of the two ICUs about prevention of PAMV was insignificant. We conclude that, in general, despite the professional category, the knowledge about PAMV and risk factors associated to it was only regular lower than expected and, in some cases, the situation was considerably worrying.

Conhecimento dos profissionais de saúde na Unidade de Terapia Intensiva sobre prevenção de pneumonia associada à ventilação mecânica / Health professionals knowledge about the prevention of pneumonia associated to mechanical ventilation at Intensive Care Unit

A Pneumonia Associada à Ventilação Mecânica (PAVM) é a mais importante e comum infecção que acomete os pacientes críticos ventilados mecanicamente nas Unidades de Terapia Intensiva (UTI). Este estudo, de natureza quantitativa, objetivou avaliar o conhecimento dos profissionais de saúde sobre a prevenção da PAVM em duas UTI de dois hospitais públicos de Fortaleza (CE), de junho a julho de 2006. Aplicou-se um questionário a 104 profissionais, utilizando a escala de conceitos de Likert, que serviu de parâmetro e referência para avaliação. Foram calculadas as médias e desvio padrão e analisou-se o conhecimento dos profissionais em relação à PAVM. Verificaram-se as associações entre o conhecimento sobre a prevenção da PAVM e as demais variáveis, por meio dos testes de χ2, de Fisher-Freeman-Halton, sendo fixado o nível de significância de 5 por cento. Os resultados obtidos sugeriram que o conhecimento dos profissionais de saúde das duas UTI a respeito da prevenção da PAVM se mostrou insuficiente. Concluímos que, de maneira geral, independentemente da categoria profissional, o conhecimento sobre a PAVM e fatores de risco a ela associada foi apenas regular e que a preparação dos profissionais estava abaixo do esperado, sendo em algumas situações bastante preocupante.

The Pneumonia Associated to Mechanical Ventilation (PAMV) is the more important and more common infection in critic mechanically ventilated patients in the Intensive Care Unit (ICUs). This quantitative research has aimed to assess the knowledge of the health professionals about the prevention of PAMV in two public hospitals of Fortaleza, Ceará State, from June to July, 2006. A questionnaire was applied to 104 professionals, by means of the concept scales of Likert which was used as a parameter and reference to the assessment. It was calculated the average and standard digression and analyzed the knowledge of professionals in relation to the PAMV. It was observed the association between the knowledge about prevention of PAMV and other variables through the χ2 tests from Fisher-Freeman-Halton, fixing the significance level in 5 percent. The results obtained had suggested that the knowledge of health professionals of the two ICUs about prevention of PAMV was insignificant. We conclude that, in general, despite the professional category, the knowledge about PAMV and risk factors associated to it was only regular lower than expected and, in some cases, the situation was considerably worrying.