Márcia Teixeira Garcia

Postexposure prophylaxis after sexual assaults: a prospective cohort study.

Objective: The objective of this study was to evaluate HIV postexposure prophylaxis (PEP) protocol in rape victims. Study: The victims were assigned to 1 of 3 categories, according to the severity of exposure (I—low, II—moderate, III—high). HIV PEP was provided to victims in groups II (Zdv + 3TC) and III (Zdv + 3TC + PI) until 72 hours after exposure. The follow-up was 6 months. Results: From May 1997 to October 2001, 347 victims were attended. PEP was offered to 278 victims (141 in group II and 137 in group III). Side effects were more common in group III (P <0.01). No seroconversion was diagnosed in the 180 victims that completed the follow-up. Univariate analysis showed that the schooling level, knowledge of the aggressors HIV status, and the use of PEP were associated with compliance. Conclusions: Triple therapy was associated with side effects, which suggested that drug regimes should be reviewed. The variables related to a high risk of HIV transmission were also significant for compliance.

Intradermal hepatitis B vaccination in patients with advanced chronic renal failure: immunogenicity and follow-up

Patients undergoing dialysis usually have a poor response to conventional hepatitis B vaccination.

Tétano acidental: análise do perfil clínico e epidemiológico de casos internados em hospital universitário

INTRODUCAO: O numero de casos notificados de tetano acidental no Estado de Sao Paulo sofreu reducao. O declinio do numero de casos de qualquer doenca sempre traz transformacoes no seu perfil epidemiologico, que devem sempre ser analisadas para aprimorar as medidas preventivas. Assim, foi analisado o perfil clinico e epidemiologico dos casos de tetano internados em hospital universitario de Campinas de 1989 a 1996. MATERIAL E METODO: Estudo descritivo e retrospectivo (serie de casos). Todos os pacientes com diagnostico de tetano de janeiro de 1989 a marco de 1996, internados no hospital universitario, foram analisados. RESULTADOS: Catorze (28%) eram da zona rural e 36 (72%) da zona urbana. A idade media foi de 47,6 anos e a mediana de 49,5. Dos pacientes da zona rural, 42,8% tinham ate 30 anos e 21,42% tinham mais de 50 anos, sendo a media 36,21 e a mediana 34,5; dos pacientes da zona urbana, 13,9% tinham ate 30 anos e 58,3% mais de 50 anos, sendo a media de 52,2 e a mediana de 54,5. A letalidade foi de 20%, mais elevada nos pacientes curarizados (60%). CONCLUSAO: Na regiao estudada existem dois padroes epidemiologicos: o rural, com maior numero de jovens, refletindo uma vacinacao inadequada, e o urbano, semelhante ao dos paises desenvolvidos, com predominio das faixas etarias mais altas.INTRODUCTION Notwithstanding its substantial decline over the last two decades, acquired tetanus is still a serious health problem in most developing countries. Epidemiological transition is often cited as an explanation for this decline, the increase in vaccination coverage of children being the most obvious cause. Few studies have looked carefully at the current epidemiological patterns of acquired tetanus in developing countries. METHODOLOGY A descriptive, retrospective (series of cases). An acute care 400 - bed university referral hospital situated in a densely populated and highly urbanized area in Southeastern Brazil (Campinas, SP). Patient records the data-base analysed were from the Epidemiological Surveillance Unit of the hospital. RESULTS In the 57 month period from January 1989 to March 1996 fifty-three patients were admitted with a diagnosis of acquired tetanus. Fifty patients had clinical confirmation, 3 were otherwise diagnosed. Thirty-two (64%) were male and 18 (36%) female. Fourteen (28%) were from rural areas and 36 (72%) from urban. Mean age was 47.6 years, with a median of 49.5. Of the rural patients, 42.85% were under 30 years and 21.42% were over 50, mean age was 36.21 with a median of 34.5. Fewer urban patients were under 30 (13.88%) than over 50 (58.33%), mean age was 52.19 with a median of 54.5. Trismus was the most frequent (92.0%) clinical sign on admittance, followed by abdominal muscular rigidity (84.0%). Treatment measures were uniform and included tetanus immune globulin, antibiotics, surgical debridement of the wound when feasible, diazepan or curare depending on the intensity of spasms. In the second half of the study period, penicillin was replaced by metronidazol. Overall case fatality rate was 20%, in patients that had to receive curare, it was 60%. Hospitalization exceeded 21 days in 56% (28) of the cases, only 10% (5) had a hospital stay of less than 7 days. CONCLUSION A high proportion of patients were from rural areas, despite an urbanization rate of more than 90%. In the Campinas region there are two different epidemiological patterns of acquired tetanus: a rural pattern, with a higher proportion of younger patients, determined by an inadequate immunization rate and an urban pattern, similar to that found in industrialized countries, with a higher proportion of older patients. RECOMMENDATIONS There is an obvious need to immunize older individuals in urban areas and young adults in rural areas. The elimination of acquired tetanus will only be achieved with a wider and more intensive adult vaccination program.

Indicadores relacionados ao retardo no diagnóstico e na instituição das precauções para aerossóis entre pacientes com tuberculose pulmonar bacilífera em um hospital terciário

BACKGROUND: The risk for nosocomial transmission of tuberculosis exists in health care institutions. OBJECTIVE: To evaluate indicators of transmission risk among patients with pulmonary tuberculosis treated at a university hospital. METHOD: A retrospective study covering the January 1997 to September of 1999 period and evaluating patients admitted to the Hospital de Clinicas of the Universidade Estadual de Campinas with pulmonary tuberculosis. Three intervals were determined: from admission to collection of sputum for acid-fast bacilli microscopy; from admission to implementation of airborne infection control measures; from sputum collection to the initiation of treatment. RESULTS: The final sample included 63 cases. Concomitant human immunodeficiency virus-positivity was found in 31.7%. Forty patients (63.5%) were admitted through the emergency room. In 42 (66.7%) patients, TB was suspected at admission. The interval between admission and sputum collection exceeded 12 hours in 27.5% of cases admitted through the emergency room and in 30.4% of those admitted directly to wards (p = 0.803). Delayed respiratory isolation occurred in 31 cases (49.2%). The delay in isolation was correlated to no diagnosis of tuberculosis at admission (p < 0.000) and lower bacillary load in the sputum (p = 0.032). Co-infection with human immunodeficiency virus (p = 0.530), hospitalization ward (p = 0.284) and underlying diseases (p = 0.541) were not correlated with delayed isolation. The interval between sputum collection and initiation of treatment was greater than 24 hours in 15.9% of the cases. CONCLUSION: Delayed isolation was observed in many cases. Policies of continuing education are called for, especially in high-risk areas.

Serum Metabolic Alterations upon Zika Infection

Zika virus (ZIKV) infection has recently emerged as a major concern worldwide due to its strong association with nervous system malformation (microcephaly) of fetuses in pregnant women infected by the virus. Signs and symptoms of ZIKV infection are often mistaken with other common viral infections. Since transmission may occur through biological fluids exchange and coitus, in addition to mosquito bite, this condition is an important infectious disease. Thus, understanding the mechanism of viral infection has become an important research focus, as well as providing potential targets for assertive clinical diagnosis and quality screening for hemoderivatives. Within this context, the present work analyzed blood plasma from 79 subjects, divided as a control group and a ZIKV-infected group. Samples underwent direct-infusion mass spectrometry and statistical analysis, where eight markers related to the pathophysiological process of ZIKV infection were elected and characterized. Among these, Angiotensin (1-7) and Angiotensin I were upregulated under infection, showing an attempt to induce autophagy of the infected cells. However, this finding is concerning about hypertensive individuals under treatment with inhibitors of the Renin-Angiotensin System (RAS), which could reduce this response against the virus and exacerbate the symptoms of the infection. Moreover, one of the most abundant glycosphingolipids in the nervous tissue, Ganglioside GM2, was also elected in the present study as an infection biomarker. Considered an important pathogen receptor at membranes outer layer, this finding represents the importance of gangliosides for ZIKV infection and its association with brain tropism. Furthermore, a series of phosphatidylinositols were also identified as biomarkers, implying a significant role of the PI3K-AKT-mTOR Pathway in this mechanism. Finally, these pathways may also be understood as potential targets to be considered in pharmacological intervention studies on ZIKV infection management.

Lessons from the epidemiological surveillance program, during the influenza A (H1N1) virus epidemic, in a reference university hospital of Southeastern Brazil

INTRODUCTION The case definition of influenza-like illness (ILI) is a powerful epidemiological tool during influenza epidemics. METHODS A prospective cohort study was conducted to evaluate the impact of two definitions used as epidemiological tools, in adults and children, during the influenza A H1N1 epidemic. Patients were included if they had upper respiratory samples tested for influenza by real-time reverse transcriptase polymerase chain reaction during two periods, using the ILI definition (coughing + temperature ≤ 38ºC) in period 1, and the definition of severe acute respiratory infection (ARS) (coughing + temperature ≤ 38ºC and dyspnoea) in period 2. RESULTS The study included 366 adults and 147 children, covering 243 cases of ILI and 270 cases of ARS. Laboratory confirmed cases of influenza were higher in adults (50%) than in children (21.6%) ( p < 0.0001) and influenza infection was more prevalent in the ILI definition (53%) than ARS (24.4%) (p < 0.0001). Adults reported more chills and myalgia than children (p = 0.0001). Oseltamivir was administered in 58% and 46% of adults and children with influenza A H1N1, respectively. The influenza A H1N1 case fatality rate was 7% in adults and 8.3% in children. The mean time from onset of illness until antiviral administration was 4 days. CONCLUSIONS The modification of ILI to ARS definition resulted in less accuracy in influenza diagnosis and did not improve the appropriate time and use of antiviral medication.