Coccidioidomycosis in a reference center in Northeast Brazil: clinical/epidemiological profile and most common radiological findings.

INTRODUCTION: Coccidioidomycosis, a disease caused by Coccidioides immitis or Coccidioides posadasii, is endemic in arid climatic regions in Northeast Brazil. Its prevalence is higher among young adult males living in rural areas. Existing literature about this disease in Ceará, a Northeast Brazilian state, are scarce. Here, we aimed to outline the clinical and epidemiological profiles, radiological patterns, and therapeutic responses of patients with coccidioidomycosis in a reference center in Ceará, Brazil. METHODS: This is a descriptive study with quantitative analysis. Patients who underwent medical follow-up in São José Hospital of Infectious Diseases and received confirmed mycological diagnosis of coccidioidomycosis between January, 2007 and December 2017 were included. Epidemiological, clinical, radiological, and therapeutic response data were collected from medical charts. RESULTS: Thirty patients were included. The patients were males with median age of 30 years, and 73% were considered to have high-risk exposure to Coccidioides owing to professional activities. Cough (96.7%), dyspnea (63.3%), fever (86.7%), and pleuritic pain (60%) were the most prevalent clinical manifestations. Interstitial pattern (91.3%) was the most frequent pulmonary radiological finding. Fluconazole, amphotericin B, and itraconazole were administered for treatment (in 82.1%, 42.8%, and 21.4% of cases, respectively). A favorable outcome was observed in 83.8% of patients. CONCLUSIONS: Coccidioidomycosis was more prevalent in the central and southern regions of the State of Ceará. Understanding the local epidemiology and clinical manifestations of the disease, in addition to the pulmonary radiologic findings, may aid the early detection of coccidioidomycosis and facilitate early diagnosis.

Antibiótico e Arte: uma Proposta Inovadora em Educação Médica / Antibiotic and Art: an Innovative Approach in Medical Education

Resumo: Introdução: Com o intuito de estimular o exercício do pensamento crítico e da criatividade e considerando a complexidade vinculada ao aprendizado de antibióticos, criou-se o Teste de Sensibilidade artística aos Antimicrobianos (TSaA). Trata-se de uma atividade inovadora no ensino de antimicrobianos que avalia conhecimento e raciocínio clínico por meio de apresentações envolvendo a arte. Desde o segundo semestre de 2014, o TSaA mostrou-se uma prática integrativa no ensino de antimicrobianos para estudantes de Medicina do quinto semestre da Universidade de Fortaleza (Unifor). O objetivo deste estudo foi analisar o TSaA como metodologia de ensino/aprendizagem sobre antimicrobianos e a satisfação dos alunos com essa atividade. M étodos: Os alunos do quinto semestre do curso de Medicina foram divididos em oito grupos de 12 alunos. Os alunos receberam o desafio de utilizar a arte como ferramenta de comunicação para mostrar os seus conhecimentos sobre antimicrobianos. Cada grupo ficou responsável por apresentar conteúdos relacionados a uma classe de antimicrobiano previamente sorteada. A apresentação da atividade foi avaliada por dois docentes simultaneamente que utilizaram um instrumento específico para esse fim. Ao término do TSaA, os alunos foram convidados a responder a um questionário que abordava questões sobre a sua percepção acerca da atividade, os benefícios no contexto da aprendizagem e as dificuldades identificadas. As perguntas eram tanto objetivas quanto abertas. Resultados: Participaram do estudo 92 estudantes. A metodologia adotada para a atividade foi considerada adequada para 82% dos participantes. As formas de apresentação mais utilizadas foram encenação e música. A maioria dos participantes percebeu o TSaA como uma estratégia valiosa de facilitação de aprendizagem sobre antimicrobianos. A associação do estudo do antibiótico com a arte foi considerada uma forma divertida de aprendizagem do tema, que os levou a trabalhar de forma integrada. Na opinião dos alunos, houve realmente uma maior fixação de conteúdo com essa atividade. Conclusão: O TSaA facilitou a aprendizagem sobre antimicrobianos e estimulou a criatividade e o raciocínio crítico/lógico nos estudantes de Medicina do quinto semestre.

Abstract: Introduction: To stimulate the practice of critical thinking and creativity and considering the complexity associated with antibiotic learning, the Antimicrobial Artistic Sensitivity Test (TSaA) was created, which is an innovative activity in antimicrobial teaching that evaluates knowledge and clinical reasoning through artistic presentations. Since the second semester of 2014 (2014.2), TSaA has proven to be an integrative practice in antimicrobial teaching for fifth-semester medical students of the University of Fortaleza/CE (UNIFOR). The objectives of this study were to analyze TSaA as a methodology of antimicrobial teaching / learning and students' satisfaction with this practice. Methods: Fifth-semester medical students were divided into eight groups, each one with twelve participants. Students were challenged to show their knowledge of one class of antimicrobial drug using art as the communication tool. Each group was assigned to work with a specific class of antibiotic, which was previously randomly selected. Two teachers simultaneously evaluated the presentation, using a specific form to carry out this evaluation. In the end of the activity, students were invited to answer a questionnaire, with objective and subjective questions, addressing their perceptions of the activity, the benefits on antibiotic learning and identified difficulties. Results: A total of 92 students participated in the study. The methodology used to carry out the TSaA activity was considered adequate by 82% of the participants. Staging performance and music were the most frequently chosen forms of presentation. The majority of the participants indicated TSaA as a valuable strategy to facilitate antimicrobial learning. The association between antibiotic study and art was considered an amusing way of content learning. According to students' perception, this practice also stimulated teamwork. In the students' opinion, there was indeed a greater content learning with this activity. Conclusion: The Antimicrobial Artistic Sensitivity Test facilitated antimicrobial learning, stimulating the creativity and critical/logical thinking of fifth-semester medical students.

Coccidioidomycosis in a reference center in Northeast Brazil: clinical/epidemiological profile and most common radiological findings

Abstract INTRODUCTION: Coccidioidomycosis, a disease caused by Coccidioides immitis or Coccidioides posadasii, is endemic in arid climatic regions in Northeast Brazil. Its prevalence is higher among young adult males living in rural areas. Existing literature about this disease in Ceará, a Northeast Brazilian state, are scarce. Here, we aimed to outline the clinical and epidemiological profiles, radiological patterns, and therapeutic responses of patients with coccidioidomycosis in a reference center in Ceará, Brazil. METHODS This is a descriptive study with quantitative analysis. Patients who underwent medical follow-up in São José Hospital of Infectious Diseases and received confirmed mycological diagnosis of coccidioidomycosis between January, 2007 and December 2017 were included. Epidemiological, clinical, radiological, and therapeutic response data were collected from medical charts. RESULTS Thirty patients were included. The patients were males with median age of 30 years, and 73% were considered to have high-risk exposure to Coccidioides owing to professional activities. Cough (96.7%), dyspnea (63.3%), fever (86.7%), and pleuritic pain (60%) were the most prevalent clinical manifestations. Interstitial pattern (91.3%) was the most frequent pulmonary radiological finding. Fluconazole, amphotericin B, and itraconazole were administered for treatment (in 82.1%, 42.8%, and 21.4% of cases, respectively). A favorable outcome was observed in 83.8% of patients. CONCLUSIONS Coccidioidomycosis was more prevalent in the central and southern regions of the State of Ceará. Understanding the local epidemiology and clinical manifestations of the disease, in addition to the pulmonary radiologic findings, may aid the early detection of coccidioidomycosis and facilitate early diagnosis.

Características de um Professor Exemplar: Percepções de Estudantes e Professores / The Characteristics of a Model Teacher from the Viewpoint of Students and Teachers

Resumo: Introdução: Na área médica, a forma de ensinar e aprender vem mudando com o tempo. Dessa forma, a investigação dos atributos que tornam um professor exemplar é importante para formular novas estratégias de ensino na educação médica. O presente estudo objetiva avaliar a percepção dos discentes e docentes do curso de Medicina sobre quais qualidades o docente deve ter para ser considerado um modelo. Método: Trata de um estudo quantitativo, transversal, com estudantes e professores do curso de Medicina da Universidade de Fortaleza (Unifor). Foi aplicado aos participantes um questionário elaborado pelos autores sobre os atributos mais importantes para ser considerado um bom professor. Cada atributo deveria receber peso de 1 a 5 caso o participante o julgasse menos ou mais importante. Resultados: Participaram do estudo 74 professores e 344 alunos. As maiores médias nos dois grupos foram para a "atitude no ambiente de ensino" e "interação com os alunos e colegas", embora os professores tenham valorizado mais esses domínios (p = 0,03 e p = 0,006, respectivamente). O domínio "características pessoais" foi menos valorizado pelos alunos (p = 0,02). No domínio "atitude no ambiente de ensino", facilitar a aprendizagem e ter uma atitude ética com o paciente foram as características mais valorizadas, embora os professores tenham valorizado ainda mais este último (p = 0,001). No domínio "interação com os alunos e colegas", a capacidade de estimular a participação do aluno foi considerada menos importante pelos alunos (p = 0,001). No domínio "características pessoais", ter entusiasmo pelo ensino foi bastante valorizado, entretanto os professores tenderam a dar um peso maior que os alunos (p = 0,001). A avaliação do domínio "desenvolvimento profissional" mostrou que o envolvimento com pesquisa foi o menos valorizado pelos participantes. Conclusões: Esses resultados sugerem que, para a identificação de um professor exemplar, os dois grupos valorizaram não apenas as atitudes relacionadas à docência, mas sobretudo as atitudes no ambiente de ensino e na interação com alunos e colegas. Sugerem ainda a necessidade de desenvolver estratégias de valorização da pesquisa científica, inclusive com incentivos para uma maior participação dos docentes e discentes, ressaltando a sua a importância na formação médica.

Abstract: Introduction: Learning and teaching methods have changed over time in medical education. Therefore, there is a strong case for investigating the attributes of a model professor in order to formulate new teaching strategies in medical education. This study aimed to ascertain which character traits are viewed in the eyes of medical students and teachers as essential to the profile of a model teacher. Methods: This is a quantitative, cross-sectional study conducted with medical students and teachers of the University of Fortaleza (UNIFOR) School of Medicine. Participants were invited to respond to a questionnaire, developed by the authors, addressing the most important characteristics of a model teacher. The respondents were asked to score each characteristic from 1 to 5 to reflect its respective importance. Results: A total of 418 people were surveyed, of whom 74 were teachers and 344 students. The highest scoring characteristics in both groups were "Attitude in the teaching environment" and "Interaction with students and colleagues", although teachers placed more value on these attributes (p = 0.03 and p = 0.006 respectively). "Personality traits" was the least appreciated by the students (p = 0.02). In the "Attitude in the teaching environment" category, facilitating learning and maintaining an ethical attitude with the patient were the most valued characteristics in both groups, although the latter was more appreciated by the teachers (p = 0.001). In the "Interaction with students and colleagues" category, the ability to stimulate student participation was considered least important by the students (p = 0.001). Enthusiasm for teaching scored highly in both groups in the "Personality traits" category, though teachers tended to give rate it more highly than the students (p = 0.001). The analysis of the "Professional development" category showed that, for both groups, involvement in research was the least valued characteristic. Conclusions: These results suggest that not only attributes associated with teaching practice, but also teachers' attitudes in the teaching environment and their interaction with students and colleagues were considered by both groups as important to their identification of a model teacher. They also suggest the necessity for developing strategies to value scientific research and stimulate greater participation of both students and teachers, underlining its importance in medical training.

Avaliação da cascata de cuidado contínuo em indivíduos com HIV/AIDS em um centro ambulatorial de referência no Nordeste do Brasil / Evaluación de la cascada de cuidados en individuos con VIH/SIDA en un centro ambulatorio de referencia en el Nordeste de Brasil / Evaluation of the care cascade in individuals with HIV/AIDS at an ambulatory reference center in Northeast Brazil

HISTÓRICO: A cascata de cuidado contínuo surgiu como uma estratégia para se transpor a infecção por HIV e se alcançar o objetivo final em cuidados, que seria a supressão viral. Este estudo tem como objetivo descrever a cascata de cuidado contínuo em indivíduos com HIV/AIDS em um Serviço Ambulatorial Especializado. METODOLOGIA: Esse é um estudo de coorte retrospectivo que analisou indivíduos adultos com diagnóstico confirmado de HIV/AIDS e que iniciaram seu acompanhamento no Núcleo de Atenção Médica Integrada (NAMI) da Universidade de Fortaleza (UNIFOR), cidade de Fortaleza, estado do Ceará, na região Nordeste do Brasil. Os dados que se seguem foram usados na pesquisa: carga viral CD4+/CD8+ e carga viral do HIV. Os participantes foram classificados em dois grupos: retidos no cuidado em saúde (grupo 1) e não retidos no cuidado em saúde (grupo 2), totalizando uma coorte de 511 participantes. RESULTADO: A análise univariada entre os grupos demonstrou que havia predominância significativa de pacientes homens com média de idade mais alta no grupo 1 (p = 0,01). Um histórico prévio de dependência química, e na primeira consulta, foi mais frequente no grupo 2 (p = 0,001 e p = 0,01 respectivamente). Os pacientes do grupo 1 tinham um histórico mais frequente de infecções sexualmente transmissíveis (IST) (p=0,002) e estavam mais imunossuprimidos quando do diagnóstico (p = 0,002). O uso de terapia antirretroviral (TARV) na primeira consulta foi mais significativo no grupo de pacientes retidos (p<0,001). CONCLUSÕES: Este estudo sugere a necessidade de aprimoramento da "cascata de cuidados" através de sua expansão, na medida em que considere riscos comportamentais dinâmicos, o que poderia transpor as barreiras sistêmicas de acesso aos serviços de saúde para as pessoas que vivem com HIV/AIDS.

ANTECEDENTES: La cascada constante de tratamiento/cuidados ha emergido como una estrategia a fin de dejar atrás la infección por VIH en busca de la meta última del tratamiento, que es la supresión viral. El estudio apunta a describir la cascada de cuidados en individuos con VIH/SIDA en un Servicio Ambulatorio Especializado. MÉTODOS: El diseño del estudio es un grupo retrospectivo de individuos adultos con diagnosis confirmada del VIH/SIDA, quienes iniciaron su seguimiento en el Centro de Cuidados Médicos Integrados (NAMI) de la Universidad de Fortaleza (UNIFOR), en la ciudad de Fortaleza, estado de Ceará, en el nordeste de Brasil. Las informaciones siguientes fueron utilizadas en la investigación: CD4+/CD8+ carga viral y carga viral del VIH/SIDA. Los individuos fueron clasificados en dos grupos: retenidos (grupo 1) y no retenidos (grupo 2), totalizando una muestra de 511 participantes. RESULTADOS: El análisis de variable única entre estos grupos demostró que había una predominancia significativa de pacientes masculinos con una edad promedio más elevada en el grupo 1 (p = 0.01). Un antecedente de adicción previa a narcóticos durante la primera consulta fue más frecuente en el segundo grupo (p = 0.001 y p = 0.01 respectivamente). Los pertenecientes al grupo 1, de manera más frecuente, tenían antecedentes de infecciones sexualmente transmitidas (IST) (p = 0.002) y estaban más inmunosuprimidos a la época del diagnóstico (p = 0.002). El uso de TARV (terapia antirretroviral) en la primera consulta fue también más significativo en el grupo de pacientes retenidos (p <0.001). CONCLUSIONES: El estudio sugiere la necesidad de mejorar la "cascada de tratamiento/cuidados" mediante su expansión, a fin de abordar los riesgos de conducta dinámica, lo cual puede transponer las barreras sistémicas de acceso a los servicios de salud para las personas que conviven con VIH/SIDA.

BACKGROUND: The continuous care cascade has emerged as a strategy to transpose HIV infection to attain the ultimate goal of care, which is viral suppression. The study aims to describe the care cascade in individuals with HIV / AIDS in a Specialized Ambulatory Service. METHODS: The study design is a retrospective cohort of adult individuals with a confirmed diagnosis of HIV/AIDS who initiated their follow-up at the Integrated Medical Care Center (NAMI) of Universidade de Fortaleza (UNIFOR), in the city of Fortaleza, state of Ceará, northeastern Brazil. The following data were used in the investigation: CD4+/CD8+ viral load and HIV viral load. The subjects were classified into two groups: retained (group 1) and non-retained (group 2), totaling a sample of 511 participants. RESULTS: The univariate analysis between these groups showed that there was a significant predominance of male patients with a higher mean age in group 1 (p = 0.01). A history of previous drug addiction and at the first consultation was more frequent in the second group (p = 0.001 and p = 0.01 respectively). Patients from group 1 more often had a history of sexually-transmitted infections (STIs) (p = 0.002) and were more immunosuppressed at the time of diagnosis (p = 0.002). The use of ART at the first consultation was also more significant in the group of retained patients (p <0.001). CONCLUSIONS: The study suggests a need to improve the "cascade of care" by expanding it to address dynamic behavioral risks, which can transpose the systemic barriers of access to health services for people living with HIV/AIDS.

Is early HIV infection diagnosis at a reference center a reality in the state of Ceara?

INTRODUCTION: Early diagnosis of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) can decrease transmission and significantly affect morbidity and mortality; however, Brazil still confronts the reality of late HIV diagnosis. METHODS: Medical records of 284 HIV-positive patients were reviewed in this cross-sectional study. RESULTS: Of all patients, 28% were diagnosed in the context of health assessments, whereas 27% were symptomatic at diagnosis. Early HIV infection (Group 1) was diagnosed in 60.2% of participants. They were younger than those with late diagnosis (Group 2) (p = 0.002). CONCLUSIONS: These findings highlight the need for strategies to increase HIV testing in asymptomatic individuals and older patients.

Is early HIV infection diagnosis at a reference center a reality in the state of Ceara?

Abstract INTRODUCTION: Early diagnosis of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) can decrease transmission and significantly affect morbidity and mortality; however, Brazil still confronts the reality of late HIV diagnosis. METHODS: Medical records of 284 HIV-positive patients were reviewed in this cross-sectional study. RESULTS: Of all patients, 28% were diagnosed in the context of health assessments, whereas 27% were symptomatic at diagnosis. Early HIV infection (Group 1) was diagnosed in 60.2% of participants. They were younger than those with late diagnosis (Group 2) (p = 0.002). CONCLUSIONS: These findings highlight the need for strategies to increase HIV testing in asymptomatic individuals and older patients.

Antiretroviral changes during the first year of therapy.

INTRODUCTION: The Brazilian HIV/AIDS management and treatment guideline (PCDT), published in 2013, recommends and standardizes the use of highly active antiretroviral therapy (HAART) in all adult patients, in spite of LTCD4 count. This study aimed to analyze the first year of HAART use in patients from a reference center on HIV/AIDS management in Fortaleza, Ceará. METHOD: This descriptive study reviewed all prescription forms of antiretroviral regimens initiation and changes from January to July 2014. All antiretroviral regimen changes that occurred during the first year of therapy were evaluated. Data were analyzed with SPSS version 20. Mean, standard deviation and frequency, Student's t and Mann-Whitney tests calculations were used, with significance at p<0.05. RESULTS: From 527 patients initiating HAART, 16.5% (n=87) had a regimen change in the first year. These patients were mostly male (59.8%; n=52), aged 20 to 39 years, with only one HAART change (72.4%; n=63). Efavirenz was the most often changed drug, followed by tenofovir, zidovudine and lopinavir/ritonavir. Mean time of HAART changes was 120 days, with adverse reactions as the most prevalent cause. HAART was effective in decreasing viral load since second month of treatment (p=0.003) and increasing LTCD4 lymphocytes since fifth month (p<0.001). CONCLUSION: The main cause of initial HAART changes was adverse reaction and most patients had only one change in the HAART regimen. HAART prescription was in accordance to the PCDT from 2013.

Antiretroviral changes during the first year of therapy / Mudanças de terapia antirretroviral durante o primeiro ano de tratamento

Summary Introduction: The Brazilian HIV/AIDS management and treatment guideline (PCDT), published in 2013, recommends and standardizes the use of highly active antiretroviral therapy (HAART) in all adult patients, in spite of LTCD4 count. This study aimed to analyze the first year of HAART use in patients from a reference center on HIV/AIDS management in Fortaleza, Ceará. Method: This descriptive study reviewed all prescription forms of antiretroviral regimens initiation and changes from January to July 2014. All antiretroviral regimen changes that occurred during the first year of therapy were evaluated. Data were analyzed with SPSS version 20. Mean, standard deviation and frequency, Student's t and Mann-Whitney tests calculations were used, with significance at p<0.05. Results: From 527 patients initiating HAART, 16.5% (n=87) had a regimen change in the first year. These patients were mostly male (59.8%; n=52), aged 20 to 39 years, with only one HAART change (72.4%; n=63). Efavirenz was the most often changed drug, followed by tenofovir, zidovudine and lopinavir/ritonavir. Mean time of HAART changes was 120 days, with adverse reactions as the most prevalent cause. HAART was effective in decreasing viral load since second month of treatment (p=0.003) and increasing LTCD4 lymphocytes since fifth month (p<0.001). Conclusion: The main cause of initial HAART changes was adverse reaction and most patients had only one change in the HAART regimen. HAART prescription was in accordance to the PCDT from 2013.

Resumo Introdução: O Protocolo Clínico e Diretrizes Terapêuticas para manejo da infecção pelo HIV em adultos (PCDT) de 2013 recomenda e normatiza início de terapia antirretroviral (TARV) em pacientes com qualquer contagem de LTCD4. O objetivo do estudo foi analisar o primeiro ano de TARV de pacientes em acompanhamento em um centro de referência em HIV/AIDS de Fortaleza, Ceará. Método: O estudo descritivo revisou formulários de solicitação de início e modificação de TARV em pacientes que iniciaram tratamento entre janeiro e julho de 2014. Foram avaliadas todas as mudanças que ocorreram durante o primeiro ano de terapia. Os dados foram analisados no programa Statistical Package for the Social Sciences (SPSS) versão 20. Foram calculados médias, desvios padrão, frequências, testes t Student e Mann-Whitney, com significância de p<0,05. Resultados: Dos 527 pacientes que iniciaram TARV, 16,5% (n=87) realizaram troca no primeiro ano. A maioria era do sexo masculino (59,8%; n=52), de 20 a 39 anos, com apenas uma mudança da TARV (72,4%; n=63). Efavirenz foi o fármaco mais substituído, seguido por tenofovir, zidovudina e lopinavir/ritonavir. O tempo médio de ocorrência das modificações da TARV foi de 120 dias, tendo reações adversas como causas principais. TARV foi efetiva na queda da carga viral desde o 2ºmês de tratamento (p=0,003) e na elevação de LTCD4 desde o 5º mês (p<0,001). Conclusão: Os principais fatores envolvidos em modificações de TARV inicial foram reações adversas, com apenas uma mudança de esquema na maioria dos pacientes. O manejo da TARV estava de acordo com o PCDT de 2013.

HIV and dementia: prevalence and risk factors / HIV e demência: prevalência e fatores de risco / VIH y demencia: prevalencia y factores de riesgo

Objective: To determine the prevalence of patients at risk of developing HIV-associated neurocognitive disorder (HAND) and identify factors possibly associated with its occurence. Methods: Quantitative cross-sectional study conducted at the Specialized Care Service (Serviço de Atendimento Especializado - SAE) for HIV/Aids of the Integrated Medical Care Center (Núcleo de Atendimento Médico Integrado - NAMI) of the University of Fortaleza (Universidade de Fortaleza - UNIFOR), Fortaleza, Ceará, Brazil. We reviewed medical records of all 249 patients that started medical follow-up at SAE/NAMI since its foundation (August/2010) until January/2014, including in the analysis those who completed the international HIV dementia scale - IHDS during routine medical visits. Epidemiological, clinical and laboratory variables were collected in addition to IHDS score and the sample was classified in two groups: patients with IHDS≥10 (Group 1) and IHDS<10 (Group 2). Chisquared test was used for categorical variables and student t test, mann whitney test and linear regression were used for numerical variables. Results: The study population consisted of 178 patients with mean IHDS score of 9.5 (+/- 1.6). HAND prevalence was 41.6% (74/178) (IHDS<10). These patients presented older mean age (37.4 years) and longer mean time from HIV diagnosis to medical follow-up than the others (10.1 months) when compared to Group 2 (31 years old and 4.6 months, respectively), suggesting that these two variables were possibly associated with HAND occurrence. Conclusion: The IHDS application showed a high prevalence of HAND in the study population. More advanced age and longer time from HIV diagnosis to medical follow-up are possibly associated with its occurence.

Objetivo: Determinar a prevalência de pacientes sob risco de desenvolver desordem cognitiva relacionada ao HIV (HAND ­ HIV associated neurocognitive disorder) e identificar fatores que possivelmente estariam associados à sua ocorrência. Métodos: Estudo quantitativo, transversal, conduzido no Serviço de Atendimento Especializado (SAE) em HIV/AIDS do Núcleo de Atenção Médica Integrada (NAMI), Universidade de Fortaleza (UNIFOR), Fortaleza/Ceará/Brazil. Foram revisados todos os 249 prontuários de pacientes que iniciaram acompanhamento no SAE/NAMI desde a sua criação (agosto/2010) até janeiro/2014, incluindo-se na análise aqueles que apresentavam o registro da aplicação da escala de demência do HIV (IHDS ­ international HIV dementia scale) nas consultas de rotina. Coletaram-se variáveis epidemiológicas, clínicas e laboratoriais, além do valor do IHDS, classificando-se a amostra em dois grupos: pacientes com IHDS≥10 (Grupo 1) e IHDS<10 (Grupo 2). Utilizaram-se testes Qui-quadrado para variáveis categóricas, e T de Student, Mann Whitney e regressão linear para variáveis numéricas. Resultados: A população do estudo consistiu em 178 pacientes, com escore médio da IHDS de 9.5 (+/-1.6). A prevalência de HAND foi de 41,6% (74/178) (IHDS<10). Nesses pacientes, a idade média era mais elevada (37,4 anos) e o intervalo médio de tempo entre o diagnóstico do HIVe o início do acompanhamento era maior que os demais (10,1 meses), quando comparados com o Grupo 2 (31 anos e 4,6 meses respectivamente), sugerindo que essas duas variáveis possivelmente estavam associadas com a ocorrência da HAND. Conclusão: A utilização do IHDS demonstrou uma elevada prevalência de HAND na população estudada. A idade mais elevada e o intervalo de tempo maior entre o diagnóstico do HIV e o início do acompanhamento estão possivelmente relacionados com essa ocorrência.

Objetivo: Determinar la prevalencia de pacientes con riesgo para el desarrollo del desorden cognitivo relacionado al VIH (HAND ­ HIV associated neurocognitive disorder) y identificar los factores que posiblemente estarían asociados a su ocurencia. Métodos: Estudio cuantitativo, transversal realizado en el Servicio de Atención Especializada (SAE) en VIH/SIDA del Núcleo de Atención Médica Integrada (NAMI), Universidad de Fortaleza (UNIFOR), Fortaleza/Ceará/Brasil. Se revisó todos los 249 historiales clínicos de pacientes que iniciaron seguimiento em el SAE/NAMI desde su creación (agosto/2010) hasta enero/2014, incluyéndose en el analisis aquellos que presentabam el registro de la aplicación de la escala de demencia del VIH (IHDS ­ international HIV dementia scale) en las consultas de rutina. Se recogieron variables epidemiológicas, clinicas y de laboratório además del valor del IHDS clasificando la muestra en dos grupos: pacientes con IHDS≥10 (Grupo 1) y IHDS<10 (Grupo 2). Se utilizó las pruebas Chi-cuadrado para las variables categóricas y la prueba T de Student, Mann Whitney y regresión linear para las variables numericas. Resultados: La población del estudio fue de 178 pacientes con puntuación media para la IHDS de 9.5 (+/- 1.6). La prevalencia de HAND fue del 41,6% (74/178) (IHDS<10). En eses pacientes la edad media fue más elevada (37,4 años) y el intervalo de tiempo medio entre el diagnostico del VIH y el inicio del seguimiento fue mayor que los demás (10,1 meses) al comparar con el Grupo 2 (31 años y 4,6 meses respectivamente) lo que sugiere que esas dos variables posiblemente estaban asociadas a la ocurrencia de la HAND. Conclusión: La utilización del IHDS demonstró una elevada prevalencia de HAND en la población estudiada. La edad más elevada y el intervalo de tiempo mayor entre el diagnostico del VIH y el inicio del seguimiento están posiblemente relacionados con esta ocurrencia.

Visceral Leishmaniasis/HIV co-infection in northeast Brazil: evaluation of outcome.

UNLABELLED: Since the beginning of the HIV burden, Visceral Leishmaniasis (VL)/HIV co-infection has been diagnosed not only in areas where VL is endemic (Latin America, India, Asia, Southern Europe), but also in North America, were it is considered an opportunistic disease. Clinical presentation, diagnostic tests sensitivity and treatment response in this population differs from VL alone. OBJECTIVES: To evaluate factors related to an unfavorable outcome in patients with VL/HIV diagnosis in a reference center in northeast Brazil. METHODS: Co-infected patients, diagnosed from 2010 to 2012, were included. Data from medical records were collected until one year after VL treatment completion. RESULTS: Forty-two HIV-infected patients were included in the study. Anemia, leukopenia, and thrombocytopenia were present in 95%, 70.7%, and 63.4%, respectively. Mean T CD4+ (LTCD4) lymphocyte count was 183 cells/dL. Highly active antiretroviral therapy (HAART) was being used by 54.7% of cases. A favorable outcome was seen in 71.4% of cases. Recurrence of VL occurred in nine patients and deaths were secondary to infectious complications (3/42 patients). Very low LTCD4 count (<100 cells/dL) was the only independent variable associated with an unfavorable outcome in multivariate analysis (p=0.03). CONCLUSION: Low LTCD4 count at presentation was associated with unfavorable outcome in VL/HIV patients.

Hepatitis b, c nnd hiv co-infections seroprevalence in a northeast Brazilian center / Soroprevalencia da co-infeccao hepatite B, C e HIV em um centro no Nordeste do Brazil

Context The occurrence of HIV and hepatitis B (HBV) and C (HCV) virus associations is of great concern since co-infected patients respond poorly to antiviral treatment and usually progress to chronic and more complicated hepatic disease. In Brazil, these co-infections prevalence is not well known since published data are few and sometimes demonstrate conflicting results. Also, a significant number of co-infected individuals are HBV/HCV asymptomatic carriers, leading to under notification. Objectives The present study aimed to determine the prevalence of the HBV and HCV infection in a recently diagnosed HIV population in the state of Ceará/Brazil. Methods Retrospective cohort, with >18yo patients diagnosed HIV+ from 2008-2010. First year medical attention information was collected. Results A total of 1.291 HIV+ patients were included. HBV serologies were collected in 52% (23% had previous hepatitis B, 3.7% were co-infected) and HCV in 25.4% (1.5% had previous hepatitis C, 5.4% co-infection). The majority of HBV/HIV patients referred multiple sexual partners/year, 28% homosexualism and 20% bisexualism. In the HCV/HIV group 38.8% individuals had > one sexual partner/year and 22.2% used intravenous drugs. Conclusion The study reinforce the need for better training healthcare workers and providing laboratory support for a prompt hepatitis diagnosis and adequate medical management to avoid complications and decrease viral spread. .

Contexto A ocorrência da associação de HIV com a hepatite por vírus B (HVB) e C (HVC) é preocupante visto que os pacientes coinfectados tendem a ter uma resposta pior à terapia antiviral e uma chance maior de progredirem para a cronificação da doença hepática e suas complicações. No Brasil, os estudos publicados sobre a prevalência dessas coinfecções ainda são escassos e, muitos deles, com resultados conflitantes entre si. Além disso, muitos pacientes coinfectados são portadores assintomáticos dos vírus das hepatites o que causa um atraso no seu diagnóstico, com consequente subnotificação de casos. Objetivos Este estudo objetiva determinar a prevalência da infecção pelo HVB e HVC em pacientes recém-diagnosticados com HIV no Ceará/Brasil. Métodos Coorte retrospectivo com pacientes >18 anos, diagnosticados HIV+ de 2008-2010. Foram coletados dados referentes ao primeiro ano de acompanhamento desses pacientes através de revisão de prontuário: fatores de risco para HIV, HBV e HCV e resultados de provas sorológicas para esses vírus. Resultados Foram acompanhados 1291 pacientes HIV+. Testes sorológicos para HBV foram realizados em 52% dos casos: 23% apresentavam hepatite B prévia e 3,7% eram coinfectados. Apenas 25,4% tinham testes sorológicos para HCV: 1,5% tinham hepatite C prévia e 5,4% eram coinfectados. A maioria dos pacientes HBV/HIV referia ter múltiplos parceiros sexuais em um ano. Homossexualismo e bissexualismo estavam presentes em 28% e 20% respectivamente. No grupo HCV/HIV 38,8% referia múltiplos parceiros sexuais em um ano e o uso de drogas endovenosas ocorreu em 22,2% dos casos. Conclusão O estudo reforça a necessidade de um treinamento dos profissionais de saúde e de facilitação do acesso do paciente ...

Hepatitis B, C and HIV co-infections seroprevalence in a northeast Brazilian center.

CONTEXT: The occurrence of HIV and hepatitis B (HBV) and C (HCV) virus associations is of great concern since co-infected patients respond poorly to antiviral treatment and usually progress to chronic and more complicated hepatic disease. In Brazil, these co-infections prevalence is not well known since published data are few and sometimes demonstrate conflicting results. Also, a significant number of co-infected individuals are HBV/HCV asymptomatic carriers, leading to under notification. OBJECTIVES: The present study aimed to determine the prevalence of the HBV and HCV infection in a recently diagnosed HIV population in the state of Ceará/Brazil. METHODS: Retrospective cohort, with >18yo patients diagnosed HIV+ from 2008-2010. First year medical attention information was collected. RESULTS: A total of 1.291 HIV+ patients were included. HBV serologies were collected in 52% (23% had previous hepatitis B, 3.7% were co-infected) and HCV in 25.4% (1.5% had previous hepatitis C, 5.4% co-infection). The majority of HBV/HIV patients referred multiple sexual partners/year, 28% homosexualism and 20% bisexualism. In the HCV/HIV group 38.8% individuals had > one sexual partner/year and 22.2% used intravenous drugs. CONCLUSION: The study reinforce the need for better training healthcare workers and providing laboratory support for a prompt hepatitis diagnosis and adequate medical management to avoid complications and decrease viral spread.

Risk factors for nosocomial infection in a Brazilian neonatal intensive care unit.

This study was designed to describe the epidemiology and risk factors for nosocomial infection (NI) in a Brazilian neonatal intensive care unit (NICU). This study was a retrospective cohort from January to December, 2003. All neonates admitted to the NICU. Infection surveillance was conducted according to the NNIS, CDC. Chi-square test and logistic regression model were performed for statistical analyses. The study was conducted at a public, tertiary referral NICU of a teaching hospital in the Northeast of Brazil. A total of 948 medical records were reviewed. Overall NI incidence rate was 34%. The main neonatal NI was bloodstream infection (68.1%), with clinical sepsis accounting for 47.2%, and pneumonia was the second most common NI (8.6%). Multivariate analysis identified seven independent risk factors for NIs: birth weight, exposure to parenteral nutrition, percutaneous catheter, central venous catheter or mechanical ventilation, abruptio placentae and mother's sexually transmitted disease (STD). Neonates from mothers with STD or abruptio placentae, those weighing less than 1,500 g at birth or those who used invasive devices were at increased risk for acquiring NI.

Risk factors for nosocomial infection in a Brazilian neonatal intensive care unit

This study was designed to describe the epidemiology and risk factors for nosocomial infection (NI) in a Brazilian neonatal intensive care unit (NICU). This study was a retrospective cohort from January to December, 2003. All neonates admitted to the NICU. Infection surveillance was conducted according to the NNIS, CDC. Chi-square test and logistic regression model were performed for statistical analyses. The study was conducted at a public, tertiary referral NICU of a teaching hospital in the Northeast of Brazil. A total of 948 medical records were reviewed. Overall NI incidence rate was 34 percent. The main neonatal NI was bloodstream infection (68.1 percent), with clinical sepsis accounting for 47.2 percent, and pneumonia was the second most common NI (8.6 percent). Multivariate analysis identified seven independent risk factors for NIs: birth weight, exposure to parenteral nutrition, percutaneous catheter, central venous catheter or mechanical ventilation, abruptio placentae and mother's sexually transmitted disease (STD). Neonates from mothers with STD or abruptio placentae, those weighing less than 1,500 g at birth or those who used invasive devices were at increased risk for acquiring NI.

Qualidade do ar do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo e sua relação com a síndrome dos edifícios doentes / Air quality in the University of São Paulo/School of Medicine Hospital and its relation to the sick building syndrome

O estudo da qualidade do ar de interiores tem assumido importância relevante pelo surgimento de doenças devido à baixa qualidade do ar. Síndrome do Edifício Doente (SED) é o conjunto de sinais e sintomas causados pela má qualidade do ar nesses ambientes. Este estudo foi conduzido para avaliar a qualidade do ar do Hospital das Clínicas através da medida dos níveis de propágulos fúngicos (NPF) e identificar queixas da SED nos seus ocupantes. Concluímos que o diagnóstico de SED pode ser estabelecido nas áreas estudadas. A classificação de um ambiente como seguro baseado apenas no NPF parece controversa já que se evidenciou uma alta incidência de queixas da SED mesmo em áreas com NPF < 750ufc/m³.Studies evaluating air quality became relevant with the identification of specific diseases in occupants of contaminated indoor areas. Sick Building Syndrome (SBS) is defined by signs and symptoms caused by the inadequate air quality of such environments. This study was conducted to evaluate the air quality of the University Hospital by determining fungal spore levels (FSL) and identify signs and symptoms of the SBS in their occupants. We conclude that the diagnosis of the SBS in the studied areas can be made since a high incidence of complaints related to the SBS was found even with FSL £750cfu/m³. Determination of the safety of environments based on thresholds of FSL seems controversial...