Estudio retrospectivo de la endocarditis infecciosa en diferentes grupos de riesgo / Infective endocarditis in an internal medicine ward

Background: Due to the increasing number of intravenous drug users, subjects with immune deficiencies or with prosthetic valves, infective endocarditis (IE) continues to be prevalent and to have a high mortality. Aim: To review all cases of infective endocarditis diagnosed in an Internal Medicine Service. Material and methods: Retrospective review of medical records of all patients with infective endocarditis, hospitalized in an Internal Medicine ward, between 1989 and 2003. Dukes criteria were used to define definitive, possible and less probable cases of IE. Results: Eighty seven patients with definite IE were identified (66 males, age range 19-84 years), with a mean incidence of 5.3 per 1000 hospitalizations. IE in intravenous drugs users was usually caused by Staphylococcus aureus and presented high risk of embolism (RR: 3,21). Subjects aged over 70 years had a relative risk of mortality of 5.5. Hospital acquired IE was associated with advanced age and IV catheters appeared as the only predisposing factor. Patients with prosthetic valves were also older, their main complication was abscess formation and their mortality was higher. Conclusions: A closer approach to differential conditions of patients, according to age, intravenous drug use or the presence of prosthetic valves, is necessary

Um estudo sobre situações de risco para contaminação pelo vírus HIV em usuários de drogas da cidade de Porto Alegre / A study on high risk of HIV transmission among drug users in Porto Alegre, RS

Utilizando-se como base uma amostra de 695 usuários de drogas de Porto Alegre, recrutados através de técnicas não convencionais de amostragem, foram realizados dois estudos subsequentes, utilizando como instrumento de coleta um formulário padrão auto-administrado (CRA), que cobre aspectos relativos ao uso de drogas, testagem HIV, comportamento sexual e preocupação com a transmissão do vírus. O instrumento foi adaptado a partir de um formulário norteamericano, sendo submetido a tradução reversa e validação concorrente. O primeiro estudo teve como objetivo descrever as características da população de usuários de drogas que é atendida em locais-chave de Porto Alegre. As variáveis gênero,faixa etária, escolaridade, práticas de risco (atuais e passadas), uso atual de drogas, e uso de drogas injetáveis foram analisadas com o objetivo de investigar sua possível relação com o estado HIV da amostra estudada, através de análises bivariadas...

Risk factors for shooting gallery use among drug injectors in Puerto Rico

Needle sharing is one of the principal risk behaviors leading to HIV transmission among injection drug users (IDUs). Shooting galleries, a social context where IDUs rent, share, and borrow needles, are locations usually found near drug markets. This study, which interviewed 1,700 IDUs from May 1989 to June 1990, assesses sociodemographic characteristics and HIV risk behaviors among shooting gallery users in Puerto Rico. Multivariate analyses showed that shooting gallery use is associated with speedball (a concoction of heroin and cocaine) injection, income from illegal activities and previous drug treatment. Shooting gallery users were more likely to rent, share, and borrow needles, and less likely to always use bleach and water to clean needles. Strategies to reduce shooting gallery use among drug injectors are discussed

Mycobacterium tuberculosis infection among crack and injection drug users in San Juan, Puerto Rico

This study aims to determine the prevalence of Mycobacterium tuberculosis infection and its association with HIV and other health risk factors among drug users. A sample of 716 IDUs and crack users were enrolled from community sites. Consenting subjects were tested for HIV serum antibody status. Drug users with an unknown PPD status were administered a PPD skin test and an anergy panel of three antigens (Candida, mumps and tetanus). Overall, 68 (10.3 percent) were reactive to the PPD skin test, 240 (34.7 percent) were HIV positive and 195 (29.5 percent) showed cutaneous anergy. Participants infected with tuberculosis (TB) were more likely to be HIV seropositive, and to have a history of incarceration and residential drug treatment than those not infected. In addition, TB infection was more prevalent among intravenous drug users (IDUs) and shooting gallery managers. These findings suggest that drug users should be considered at high risk for TB and HIV infection. Innovative programs to monitor both infections among drug users are needed to arrest what can become a dual epidemic of HIV and TB in the near future

A descriptive-exploratory study of outcome and some biopsychosocial characteristics of drug dependent veterans in Puerto Rico

I. OBJECTIVE: The authors attempted to correlate outcomes with various significant biopsychosocial variables in drug dependent veterans receiving outpatient treatment at San Juan V.A.M.C. II. METHODS: The clinical charts of 120 inactive patients were examined using a 50 item questionnaire. The data was processed and analyzed using the EpiInfo v.5 computer program. The outcome of the patients was measured using a Goal Attainment Scale Technique with demonstrated validity and reliability. III. RESULTS: The patients retention in treatment for 12 or more visits and its relationship to good outcomes was the most significant finding of this study (P < 0.00000000, 80.5 of patients improved). Only 5 of patients with 3 or less visits showed positive outcomes. Another variable associated with good outcomes was a supportive wife (P < 0.02). HIV reactivity was strongly correlated with IV drug use (P < 0.037). IV. CONCLUSIONS: The strong correlation of the retention of patients in treatment for 12 or more visits and good outcomes should alert clinicians and policy makers as to the importance of available and effective treatments in the fight against substance abuse and mental health problems. This study also showed that a supportive family member is usually the best social asset that patients and therapists have in their fight for sobriety

HIV/AIDS risk perception, HIV risk behaviors, and HIV seropositivity among injection drug users in Puerto Rico

This paper assesses the factors related to self perception of developing AIDS among a group of 1,568 Puerto Rican injection drug users (IDUs). Incarceration history, years of drug injection, sharing needles, renting and borrowing needles, sharing rinse water or cooker, and having an IDU sex partner yielded a moderate association with HIV/AIDS risk perception. Use of sterile needles, shooting drugs alone, having had previous treatment episodes, and all the variables related to health status were also moderately associated with HIV/AIDS risk perception. A logistic regression model based on backwards elimination procedure, which included statistically significant variables in the bivariate analyses, yielded the variables living with children, sex with an IDU partner, shooting drugs alone, perception of health, having had a sexually transmitted disease, and results of HIV testing as statistically significant (p < 0.05)