João Carlos da Costa

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.

Salmonella tricuspid endocarditis in an intravenous drug abuser with human immunodeficiency virus infection

We describe a case of Salmonella tricuspid endocarditis in an intravenous drug abuser with human immunodeficiency virus infection. He was successfully treated with antibiotics with no clinical relapse. To our knowledge, this is the first case of this kind reported in the literature. Physicians should be on the alert for this potentially curable cardiac complication of human immunodeficiency virus infection.

Lymphocyte transformation test in patients with paracoccidioidomycosis

The lymphocyte transformation test (LTT) by phytohemagglutinin was carried out on lymphocyte cultures from patients with paracoccidioidomycosis, in medium with autologous plasma (from the patient) or homologous plasma (from an unaffected individual), and lymphocyte cultures from unaffected and apparently normal individuals, in medium with autologous plasma (from the individual) or homologous plasma (from a patient with paracoccidioidomycosis). Blastogenesis was evaluated morphologically by ‘blast’ percentage, and the results analyzed according to clinical form of the disease and general condition of the patient. In the medium containing autologous plasma, percentages below the lower limit of the confidence interval for the distribution of the values for apparently normal individuals were encountered more frequently among patients with diffuse extrapulmonary paracoccidioidomycosis and in poor general condition. When the lymphocytes from patients with the disease were cultured in medium containing homologous plasma, blastogenesis increased in most cases. The lymphocytes of unaffected individuals exhibited a lower response more frequently when cultured in medium containing plasma from patients with the disease than when cultured in medium containing their own plasma. These results suggest the existence of factor(s) inhibiting blastogenesis in the plasma of these patients. In addition to such factor(s), an intrinsic lymphocyte defect may also occur in some patients, which might prevent a greater response to phytohemagglutinin even in homologous plasma. Smears of lymphocytes cultured in autologous plasma and obtained from patients, especially those with diffuse extrapulmonary diasease and in regular or poor general condition, and smears from most of the controls whose lymphocytes were cultured in the plasma of these patients revealed deeply stained cells with altered morphology and considerably reduced in number. The decreased blastic transformation might be linked with these abnormalities, possibly caused by factor(s) inhibiting blastogenesis in the culture medium containing patient plasma.

Expressão epidemiológica de outras doenças sexualmente transmissíveis entre portadores de AIDS

Objetivou-se avaliar a frequencia de outras doencas sexualmente transmissiveis (DST) em pacientes portadores de AIDS, identificando-se suas associacoes epidemiologicas e possiveis relacoes com as categorias de exposicao ao virus. Os dados foram coletados dos prontuarios medicos, identificando-se as DST com base em dados de anamnese, exame fisico e exames laboratoriais. Dos portadores de HIV/AIDS, atendidos no hospital estudado, de janeiro de 1986 a janeiro de 1992, 207 constituiram a amostra estudada. Dos pacientes estudados, 88 (42,5%) apresentaram alguma DST e 119 (57,5%) nao, resultando proporcao de pacientes com DST/pacientes sem DST igual a 0,7. As DST mais prevalentes foram hepatite B (33, 3%), sifilis (30, 3%) e gonorreia (12, 9%). Quanto as categorias de exposicao dos individuos ao HIV, a mais prevalente foi a sanguinea (44,9%), seguida pela sexual (21,3%), sexual e sanguinea (17, 9%) e indeterminada em 15, 9%. Comparando particularmente as categorias de transmissao sexual e sanguinea do HIV e a presenca de outras DST, estas foram significativamente mais frequentes nos casos cuja categoria de exposicao referida foi a sexual.

Ultrastructure of lymphocytes from patients with paracoccidioidomycosis in the lymphocyte transformation test by phytohemagglutinin

The morphology and ultrastructure of peripheral blood lymphocytes from patients with paracoccidioidomycosis (PCM) and from unaffected individuals (controls) were studied before and after Ficoll-Hypaque separation and at the end of culture, stimulated with phytohemagglutinin. Patient lymphocytes were cultured in medium with autologous plasma (from the patient himself) and with homologous plasma (from an unaffected donor), while donor lymphocytes were cultured in medium with plasma from a patient or with plasma from the donor himself. The Ficoll-Hypaque mixture caused no morphological or ultrastructural changes in the lymphocytes of patients or of unaffected donors. Patient lymphocytes cultured in medium with autologous plasma showed different degrees of cytoplasmic and nuclear alterations, such as organelle dissolution, vacuoles, amorphous masses, deformed nuclei, and absence of nucleoli. Lymphocytes from control individuals cultured in patient plasma also showed ultrastructural alterations, though they were less marked, and a reduced number of ‘blasts’. Patient lymphocytes cultured in medium with homologous plasma (from a control individual) showed a morphology similar to that of lymphocytes from control individuals cultured in medium with their own plasma, although with a lower number of ‘blasts’. On the basis of the results obtained using that methodology, we draw the following conclusions: (1) separation by Ficoll-Hypaque does not seem to alter the ultrastructure of patient or donor lymphocytes; (2) patients with diffuse PCM and more markedly impaired general condition can exhibit lymphocytes with morphological and ultrastructural alterations capable of affecting their biological systems and functionality; (3) the morphological and ultrastructural abnormalities and the reduced blastogenesis observed in patient lymphocytes cultured in autologous plasma and in control lymphocytes cultured with patient plasma appear to be due to factor(s) present in the plasma of PCM patients.

Pesquisa de anticorpos para sífilis e toxoplasmose em recém-nascidos em hospital de Ribeirão Preto, SP, Brasil

Foram aplicados testes para pesquisa dos niveis de IgM (por imunodifusao radial simples) e de anticorpos para sifilis (FTA- ABS-IgG e IgM, VDRL e Wassermann (W) e toxoplasmose (imunofluorescencia IgG (IFI-IgG) e IgM (IFI-IgM) em 408 casos de recem-nascidos (RN) do Hospital das Clinicas da Faculdade de Medicina de Ribeirao Preto da Universidade de Sao Paulo (Brasil), escolhidos casualmente no periodo de 01/07 a 09/10/198 1. O fator reumatoide (FR) foi pesquisado para excluir resultados falso-positivos para anticorpos classe IgM. Os soros IFI-IgG positivos, e eventualmente falso-negativos a IFI-IgM para toxoplasmose, foram tratados por cromatografia em gel. Um soro positivo para FR foi tratado com gamaglobulina humana agregada pelo calor antes da pesquisa de anticorpos IgM. Confrontou-se os soros reagentes para sifilis com dados de prontuarios dos respectivos RN e maes. Foram reagentes a pelo menos um dos testes para sifilis 7,0% dos RN; o FTA-ABS-IgG foi positivo em 89,3%, o VDRL em 67,8% e o W em 60,7%. Um soro foi FTA-ABS-IgM reagente. A co-positividade entre FTA-ABS-IgG e VDRL foi 60,7%; entre FTA-ABS-IgG e W 53,6% e entre VDRL e W 60%. A confrontacao mostrou que em 53,5% dos RN a sorologia foi positiva ao nascimento, em 3,6% negativa e em 42,9% nao havia dados. O seguimento clinico-sorologico revelou que 2 RN evoluiram com sinais de lues congenita e outros 2 a suspeita clinica foi descartada pela sorologia de controle; em 21 nao havia dados. Foram reagentes a IFI-IgG para toxoplasmose 71,3% dos RN e 100% nao reagentes a IFI-IgM antes e apos a cromatografia. No periodo estudado nao houve diagnostico clinico de toxoplasmose congenita. Tres RN apresentaram valores de IgM aumentados, mas nao houve diagnostico clinico ou laboratorial de lues ou toxoplasmose congenitas nos mesmos. Sugere-se a nivel local introducao do FTA-ABS-IgG para triagem mais abrangente da sifilis congenita.Tests were performed for the determination of IgM levels (by simple radial immunodiffusion) and antibodies for syphilis (FTA-ABS-IgG and IgM, VDRL and Wassermann (W)) and toxoplasmosis (indirect immunofluorescence IgG (IFI-IgG) and IgM (IFI-IgM)) in 408 new-borns (NB) sera at the University Hospital of the Faculty of Medicine of Ribeirao Preto, USP, selected at random from July 1 to October 9, 1981. Only 3 NB showed greater than normal values of IgM levels in serum, but no clinical or laboratory diagnosis of congenital syphilis or toxoplasmosis was made for them. Two hundred and 91 infants (71.3%) were IFI-IgG positive for toxoplasmosis and none IFI-IgM, before or after chromatography. No clinical diagnosis of congenital toxoplasmosis was made during the period studied. The rheumatoid factor (RF) was determined in order to exclude false-positive results for antibodies of the IgM class. All possible false-negative sera to IFI-IgM and IFI-IgG positive for toxoplasmosis were treated by gel chromatography. Only one positive serum for RF was treated with heat-aggregated gamma-globulin before being tested for the presence of IgM antibodies. Sevem percent of the NB (28) were positive to at least one of the tests for syphilis. FTA-ABS-IgG was positive in 89.3% of them, VDRL in 67.8% and W in 60.7%. Only one serum sample was positive for FTA-ABS-IgM. The concordance of positivity between FTA-ABS-IgG and VDRL was 60.7%; 53.6% between FTA-ABS-IgG and W and 60% between VDRL and W. The syphilis-positive sera were compared with the data in the medical records of the respective NB and their mothers. It was shown that among the 28 NB with positive tests for syphilis only 5 3.5 % of them were detected at birth, 3.6% had negative serology and no data were available for 42.9%. Clinical and/or serological follow-up disclosed that 2 NB evolved with signs of congenital syphilis, 2 were suspected to have syphilis, and were treated but control serology ruled out this possibility, and no data were available for 24. A new screening strategy for this disease and the introduction of the FTA-ABS-IgG test for a more extensive selection of congenital syphilis is suggested.

Contribuição das doenças infecciosas e parasitárias na morbi-mortalidade de Ribeirão Preto, SP (Brasil)

Apresentam-se os resultados da mortalidade e morbidade cansadas por doencas infecciosas e parasitarias (Grupo I da Classificacao Internacional de Doencas). Os dados de mortalidade basearam-se em informacoes da Secretaria de Saude do Estado de Sao Paulo; os de morbidade, em estatisticas de egressos hospitalares produzidos pelo Centro de Processamento de Dados Hospitalares, do Departamento de Medicina Social da Faculdade de Medicina de Ribeirao Preto e nos resultados de um levantamento de morbidade por entrevistas domiciliarias. Enquanto as estatisticas de mortalidade exibiram, no ano de 1974, uma proporcao de 15,2% de doencas desse Grupo, em 1975 as estatisticas hospitalares mostraram 3,3% e as entrevistas domiciliarias 5,2%.Apresentam-se os resultados da mortalidade e morbidade cansadas por doencas infecciosas e parasitarias (Grupo I da Classificacao Internacional de Doencas). Os dados de mortalidade basearam-se em informacoes da Secretaria de Saude do Estado de Sao Paulo; os de morbidade, em estatisticas de egressos hospitalares produzidos pelo Centro de Processamento de Dados Hospitalares, do Departamento de Medicina Social da Faculdade de Medicina de Ribeirao Preto e nos resultados de um levantamento de morbidade por entrevistas domiciliarias. Enquanto as estatisticas de mortalidade exibiram, no ano de 1974, uma proporcao de 15,2% de doencas desse Grupo, em 1975 as estatisticas hospitalares mostraram 3,3% e as entrevistas domiciliarias 5,2%.

Submitral aneurysm and the new imaging modalities: Will magnetic resonance imaging be necessary?

Submitral aneurysm is a rare cardiac malformation commonly reported in young adult African ancestry. Transthoracic echocardiogram is a gold standard test for diagnosis. Magnetic resonance imaging provides detailed anatomic and functional information of the heart. We present a case of a large bilobed submitral aneurysm in-witch the magnetic resonance imaging confirmed the same findings of the transthoracic echocardiography and in addiction also showed a parietal thrombus.

Participação do Mycoplasma pneumoniae na etiologia de infecções respiratórias agudas em Ribeirão Preto, São Paulo, Brasil

Mycoplasma pneumoniae isolation was attempted in respiratory fluids from 64 patients with respiratory infection Complement fixation test (CF) and counterimmunoelectrophoresis (CIE) were used for Mycoplasma antibody detection using the patient sera. Mycoplasma pneumoniae was not isolated. Serologic diagnosis were positives in 3.1% (2/64) by CF test and 1.6% (1/64) by CIE. Serologic tests done in 200 health controls showed 4% (8/200) positives by CIE and 1% (2/200) by CF. The results showed differences in sensitivity among the serologic tests. CF seems to be more indicated for Mycoplasma infection diagnosis while, CIE could be used for Mycoplasmas serosurveys. The prevalence of Mycoplasma pneumoniae infections was low (3.1%) in the 64 patients during our study period.

Multimodality imaging of a huge subaortic left ventricular aneurysm in a child

A subannular left ventricular aneurysm is very rare, and is mostly considered to be a congenital anomaly. A subannular left ventricular aneurysm is classified based on the type of its own orifice—submitral or subaortic. Subaortic left ventricular aneurysm occurs less frequently compared with a submitral type of subannular aneurysm. We hereby describe a rare case of a huge bilobed subaortic aneurysm, in which the orifice was located just below the left coronary cusp diagnosed with multimodality imaging in a child.