Alcyone Artioli Machado

Acidentes perfurocortantes entre trabalhadores de enfermagem de um hospital universitário do interior paulista

The risk presented by health care workers of acquiring bloodborne pathogens is well documented by the literature, which shows that Aids and Hepatitis acquired in the work setting is a real fact. This descriptive retrospective study was conducted in a university hospital in 1998 and aimed at analyzing needlestick injuries in nursing workers. Results showed that of the 398 officially reported occupational accidents, 125 (30.40%) were needlestick injuries and that 89 (71.20%) occurred among nursing workers. The most frequent occurrences took place during medication administration (25.78%). Authors concluded that nursing workers were the most frequently victimized workers by occupational accidents involving needlestick injuries.Como mostra a literatura, o risco de trabalhadores da area da saude adquirirem patogenos veiculados pelo sangue ja esta bem documentado e demonstra que a Aids e a hepatite B e C, adquiridas de maneira ocupacional, sao, hoje, um fato concreto. Este estudo retrospectivo, de natureza descritiva, realizado em um Hospital Universitario, no ano de 1998, objetivou analisar os acidentes perfurocortantes que acometeram os trabalhadores de enfermagem. Os resultados evidenciaram que, dos 398 acidentes ocupacionais notificados oficialmente, 125 (30,40%) foram perfurocortantes e 89 (71,20%) ocorreram entre trabalhadores de enfermagem. As situacoes mais frequentes de ocorrencia se deram quando da administracao de medicamentos (25,78%). Concluiu-se que os trabalhadores de enfermagem foram os mais atingidos pelos acidentes ocupacionais envolvendo material perfurocortante.

Primary Antiretroviral Drug Resistance among HIV Type 1-Infected Individuals in Brazil

Infection with drug-resistant human immunodeficiency virus type 1 (HIV-1) has been documented in all countries that have surveyed for it and may result in an unfavorable response to therapy. The prevalence and characteristics of individuals with transmitted resistance to antiretroviral drugs have been scarcely described in Brazil. We performed antiretroviral resistance testing prior to initiation of therapy in 400 subjects enrolled from 20 centers in 13 Brazilian cities between March and September 2007. Genotyping was conducted using PCR-amplified HIV pol products by automated sequencing, and genotype interpretation was done according to the IAS-USA consensus. Of 400 eligible participants, 387 (95.8%) were successfully tested. Seven percent of antiretroviral-naive patients carried viruses with one or more major mutation associated with drug resistance. The prevalence of these mutations was 1.0% for protease inhibitors, 4.4% for nonnucleoside reverse transcriptase inhibitors, and 1.3% for nucleoside reverse transcriptase inhibitors. The frequency of multidrug resistance among the resistant strains was 13.6%. Among subjects infected with drug-resistant virus, the majority were infected with subtype B viruses (91%). Subjects from the city of São Paulo had higher transmitted resistance mutations compared to the rest of the country. Reporting a partner taking antiretroviral medications was associated with a higher chance of harboring HIV variants with major drug resistance mutations [odds ratio = 2.57 (95% confidence interval, 1.07-6.16); p = 0.014]. Resistance testing in drug-naive individuals identified 7% of subjects with mutations associated with reduced susceptibility to antiretroviral drugs. Continued surveillance of drug-resistant HIV-1 in Brazil is warranted when guidelines for HIV prophylaxis and treatment are updated. Resistance testing among drug-naive patients prior to treatment initiation should be considered, mainly directed at subjects whose partners are already on antiretroviral therapy.

Co-infecção HIV e vírus da hepatite B: prevalência e fatores de risco

The objective of this study was to assess the prevalence of hepatitis B virus and possible risk factors for this disease in 401 patients infected with the human immunodeficiency virus, followed at the University Hospital of the Ribeirao Preto Medical School, Sao Paulo State University. Each participant was submitted to a specific questionnaire and had a blood sample tested for the serologic markers HBsAg, total anti-HBcAg, anti-HBsAg and anti-HCV, using ELISA technique. The overall prevalence of hepatitis B markers was 40.9%, with 8.5% for HBsAg, 39.7% for total anti-HBcAg and 5.5% for anti-HBsAg. The variables that showed association with HBV were: age, higher education level, history of jaundice, time spent in prison, having a homosexual partner and positive markers for anti-HCV. Co-infection HBV/HCV was present in 20.4% of the participants.

Risco de infecção pelo vírus da imunodeficiência humana (HIV) em profissionais da saúde

A fim de investigar o risco ocupacional de infeccao pelo virus da imunodeficiencia humana (HIV) em profissionais da saude, foram estudados 35 casos de acidentes com material potencialmente contaminado pelo HIV, ocorridos em funcionarios do Hospital das Clinicas da Faculdade de Medicina de Ribeirao Preto da Universidade de Sao Paulo (HCFMRP-USP). Dos 36 profissionais de saude estudados, 52,8% (19/36) eram auxiliares de enfermagem, 19,4% (7/36) enfermeiras, 13,9% (5/36) atendentes de enfermagem, e 5,5% (2/36) tecnicos de enfermagem. Em 47,2% (17/36) dos casos houve exposicao parenteral a sangue (acidente com agulha). As maos e os dedos foram as areas do corpo mais atingida. Foi empregado o teste imunoenzimatico (ELISA) para deteccao de anticorpos anti-HIV, sendo realizado em todos os profissionais por ocasiao do acidente e com 1,2, 6 e 12 meses apos a exposicao. Os resultados foram negativos nao sendo registrada nenhuma soroconversao. Recomenda-se que a educacao continuada para o trabalhador de saude deve reforcar o uso das precaucoes universais, especialmente os cuidados com agulhas e outros instrumentos perfurantes.

Accidents with biological material and immunization against hepatitis B among students from the health area

O manuseio de instrumentos perfurocortantes por estudantes da area da saude e frequente na atividade academica, o que os expoe ao risco de adquirir infeccao. Este estudo teve como objetivo analisar os acidentes com material biologico, ocorridos com alunos de graduacao da area da saude. Dos 170 acidentes registrados, 83 (48,8%) ocorreram com alunos do curso de odontologia, 69 (40,6%) de medicina, 11 (6,5%) de enfermagem e em 6 (3,5%) nao havia a informacao na ficha de atendimento. A maioria (106-62,4%) ocorreu com alunos de escolas privadas e 55(32,3%) de escolas publicas. Os acidentes percutâneos ocorreram em 133 (78,2%) exposicoes e em apenas 38 (21,3%) acidentes a procura pelo atendimento especializado foi imediata. Em 127 (74,7%) acidentes o esquema vacinal contra hepatite B estava completo. Assim, torna-se imprescindivel que as escolas oferecam cursos e/ou disciplinas especificas sobre medidas de biosseguranca, incluindo aspectos relacionados a vacinacao e em especial a vacina contra hepatite B.Undergraduate students from the health area often handle piercing-cutting instruments in their academic activities, which exposes them to the risk of contracting infections. This study aimed to analyze accidents with biological material among these students. Out of 170 accidents registered, 83 (48.8%) occurred with Dentistry students, 69 (40.6%) with Medical students, 11 (6.5%) with Nursing students and in 06 (3.5%) of the cases there was no such information in the files. Most accidents, 106 (62.4%), occurred with students from private schools and 55 (32.3%) with those from public schools. Percutaneous accidents occurred in 133 (78.2%) exposures and there was immediate search for specialized health care in only 38 (21.3%) accidents. In 127 (74.7%) accidents, the immunization schedule against hepatitis B was complete. Therefore, schools need to offer courses and specific class subjects regarding biosafety measures, including aspects related to immunization, especially the vaccine against hepatitis B.

Hematological abnormalities in HIV-infected patients.

BACKGROUND Anemia, neutropenia, and thrombocytopenia are commonly observed in HIV-infected patients. This study was undertaken to evaluate the prevalence of cytopenias and their association with CD4 count. Furthermore, the association of hemoglobin concentration with mortality was also investigated. METHODS We reviewed the data of 701 HIV-infected patients followed at our institution. Blood cell counts, hemoglobin concentration, CD4 count, and viral load were recorded. We also recorded the mortality rate after 1 year in the groups with CD4 <200/μl and ≥ 200/μl according to hemoglobin concentration. RESULTS Of the total patients, 37.5% had anemia; 61.1% (110/180) were in the low CD4 group and 29.4% (153/521) were in the high CD4 group (p<0.01). Mean neutrophil counts were 2.610 × 10(9)/l and 3.204 × 10(9)/l in the low CD4 and high CD4 groups, respectively (p<0.01); mean platelet counts were 218.639 × 10(9)/l and 234.807 × 10(9)/l for the low CD4 and the high CD4 groups, respectively (p=0.03). Patients whose hemoglobin concentration was below the median value had a higher death rate in both the low CD4 (14 vs. 4 deaths, p=0.013) and high CD4 (8 vs. 1 death, p=0.0158) groups. CONCLUSIONS We found an association between CD4 count and hemoglobin level, neutrophil count, and platelet count, and that anemia was independently associated with a higher mortality.

Paracoccidioidomycosis in a patient with acquired immunodeficiency syndrome

The authors report a case of paracoccidioidomycosis and other opportunistic diseases in a patient with acquired immunodeficiency syndrome.

Esporotricose cutânea disseminada como manifestação inicial da síndrome da imunodeficiência adquirida - relato de caso

TThe authors report a case of disseminated cutaneous infection with Sporothrix schenckii in a previously asymptomatic HIV-infected 30 year-old man. Extensive cutaneous involvement was observed with suppurative collections and ulcerations. The agent was isolated in culture. Treatment with liposomal amphotericin B proved to be effective.

High frequency of the GWG (Pro Trp) envelope variant of HIV-1 in southeast Brazil

The HIV-1 variant that contains the GWG amino acid sequence in the crown of the principal neutralizing determinant (PND) has been detected in a few patients in Japan, France, and Brazil by direct sequencing. We describe for the first time the use of restriction fragment length polymorphism (RFLP) and limited DNA sequencing of the C2-V3 region of the HIV-1 envelope (env) gene to determine the prevalence of the variant in 75 HIV-1-infected Brazilian patients. Overall prevalence of the GWG sequence as indicated by RFLP was 57% (43 of 75). The prevalence in females (72%) was higher than that in males (32%) and newborns (40%). Two GFG sequences and 1 GLG sequence were also detected. This finding is relevant for the planning of vaccines and for studies of the epidemiology of HIV-1 in Brazil.

Infecção pelo vírus Influenza A (H1N1) de origem suína: como reconhecer, diagnosticar e prevenir

In March of 2009, a flu epidemic began in Mexico. Shortly thereafter, similar cases appeared in other countries, alerting authorities to the risk of a pandemic. This article details the principal signs and symptoms of infection with the swine-origin Influenza A (H1N1) virus. In addition, the measures to be taken in suspected or confirmed cases are addressed, as are the procedures to follow in relation to contacts. Furthermore, the drugs used in the prophylaxis against and the treatment of infection with the H1N1 virus are described.