Risk Factors for Death in Children with Visceral Leishmaniasis

Visceral leishmaniasis (VL) is a deadly disease caused by a protozoan called Leishmania. It is transmitted to humans from infected animals by a sandfly bite. Most people actually manage to control the infection and do not get sick, while others develop a range of symptoms. VL impairs the production of blood components and causes the immune system to malfunction, thus anemia, bleeding, and bacterial infections often complicate the disease and can lead to death. To identify risk factors for death from VL, the authors studied 546 children in a referral center in Recife, Brazil. They looked at clinical history, physical examination and full blood counts on the assumption these could be easily assessed in peripheral health facilities. They found that the presence of fast breathing, jaundice, mucosal (e.g. gum) bleeding and bacterial infections would each increase the risk of death in three to four-fold. The presence of very low counts of neutrophils and platelets would increase the risk of death in three and 12-fold respectively. This knowledge can help clinicians to anticipate the use of antibiotics or transfusion of blood products in high risk patients, who would potentially benefit from transfer to centers with advanced life support facilities

The prevalence and adequacy of antibiotic prescriptions in Hospital de Clínicas de Porto Alegre

Durante o dia 30 de julho de 1987, foram estudados alguns aspectos envolvendo o uso de antibióticos no Hospital de Clínicas de Porto Alegre. De 432 pacientes internados, 182 (42%) estavam utilizando antibióticos,e destes, 42% recebiam a medicação de forma inadequada. Dos antibióticos usados terapeuticarhente, os mais prescritos foram ampicilina, penicilina, cefalosporinas e amicacina. Entre os usados profilaticamente, destacaram-se cefa/osporinas, gentamicina e ampicilina. O trabalho sugere que o controle do uso de antibióticos pode reduzir a adoção inapropriada destes agentes.On July 30th 1987 there was made a survey to evaluate the antibiotic use in the Hospital de Clínicas de Porto Alegre. 432 patients were investigated and 182 (42%) were under antimicrobial therapy. This group showed 42% o f patients receiving antimicrobians inappropriately. The antibiotics most used therapeuticaly were ampicillin, penicillin, cefalosporin and amikacin. For prophylaxis the most used were cefalosporin, gentamicin and ampicillin. This paper suggests that contra/ procedures can reduce the inappropriate use of antimicrobial agents in our hospital