Specific treatment evaluation for Trypanosoma cruzi in children, in the evolution of the indeterminate phase

Doze pacientes com idades entre 7 a 12 anos, na forma indeterminada da doença de Chagas, com sorologia e xenodiagnóstico positivos, receberam tratamento específico. Dois pacientes tomaram 7mg/kg de nifurtimox durante 60 e 90 dias e 10 usaram 5-7mg/kg de benznidazol durante 60 dias. A evolução clínica foi verificada através de exame clínico, eletrocardiograma, exame radiológico contrastado do esôfago. Após o tratamento somente uma (8,3%) paciente apresentou todos os exames negativos. Oito deles foram avaliados após oito anos do tratamento e 4 acompanhados durante 20 anos. Sete (58,4%) permaneceram na forma indeterminada e 4 (33,3%) chagásicos progrediram clinicamente para cardiopatia grau II e/ou esofagopatia, apesar do tratamento precoce. São necessários estudos com maior número de crianças na fase indeterminada e acompanhamento a longo prazo para se estabelecer a influência do tratamento específico na evolução da doença de Chagas.Twelve chagasic patients between the ages of seven and twelve, in the indeterminate phase with serology and xenodiagnosis positive, received the specific treatment. Eight of these were evaluated after an eight-year treatment period and four were followed-up during 20 years. Two patients took 7mg/kg of nifurtimox during sixty and ninety days and ten of these used 5-7mg/kg of benznidazole during 60 days. The clinical outcome was verified through clinical examination, electrocardiogram and contrasted X-ray of the esophagus. After the treatment, only one patient presented negativity in all the examinations. Seven (58.4%) remained in the indeterminate form and despite the precocious treatment four chagasic patients (33.3%) progressed clinically to second degree cardiopathy and/or megaesophagus

Comparative study between artificial xenodiagnosis performed immediately and four hours after venous punch

Foi realizado xenodiagnóstico artificial, imediatamente e quatro horas após a coleta do sangue, em 63 pacientes, sendo 29 (46%) do sexo masculino e 34 (54%) do sexo feminino. A idade mínima foi 18 anos e a máxima 68, sendo a idade média 39 anos. Onze (17,5%) pacientes apresentaram resultados positivos, sendo 8 (12,7%) no exame imediato e 7 (11,1%) no exame 4 horas após. Os oito pacientes do exame imediato apresentaram 17 pools positivos e os sete do xenodiagnóstico de quatro horas mostraram 11 pools positivos (p =0,34). Quatro pacientes foram positivos exclusivamente no xenodiagnóstico imediato, três somente no exame de 4 horas e quatro positivos em ambos. Os dados autorizam realizar o xenodiagnóstico, até quatro horas após a extração do sangue, sem prejuízo no resultado do exame.Artificial xenodiagnosis was performed immediately after blood venous punch and then four hours later on 63 patients; 29 (46%) were male and 34 (54%) female, mean age 39 years (range 18 to 68 years). Eleven (17.5%) patients presented positive exams, of which eight (12.7%) were from immediate xenodiagnosis and 7 (11.1%) xenodiagnosis fours hours after. Eight patients showed 17 positive pools from immediate xenodiagnosis and 7 patients with xenodiagnosis four hours later showed 11 positive pools (p = 0.34). Four patients were positive only on immediate xenodiagnosis, three only on xenodiagnosis 4 hours after and four were positive in both. The data demonstrate that xenodiagnosis can be performed up to four hours after blood collection without impairing the test results

Parasite persistence in treated chagasic patients revealed by xenodiagnosis and polymerase chain reaction

Polymerase chain reaction (PCR) was compared with xenodiagnosis performed 20 years after trypanocidal chemotherapy to investigate parasite clearance. Eighty-five seropositive individuals for Chagas disease presenting a positive xenodiagnosis were treated with specific drugs; 37 in the acute phase and 48 in the chronic phase. Fifteen chronic assymptomatic patients received a placebo. Treatment in the acute phase led to PCR negative results in 73% of the cases, while xenodiagnosis was negative in 86%. In the chronic phase, PCR was negative in 65% of the patients and 83% led to xenodiagnosis negative results. Regarding the untreated group (placebo), 73% gave negative results by xenodiagnosis, of which 36% were positive by PCR. Individuals that were considered seronegative (n=10), presented unequivocally negative results in the PCR demonstrating the elimination of parasite DNA. Seventeen individuals had their antibodies titers decreased to such a level that the final results were considered as doubtful and 16 of them presented negative PCR. The molecular method represents a clear advantage over conventional techniques to demonstrate persistent infections in Chagas disease patients that underwent chemotherapy

Molecular epidemiology and antimicrobial susceptibility of enterococci recovered from Brazilian intensive care units

ABSTRACT: We studied the antimicrobial resistance and the molecular epidemiology of 99 enterococcal surveillance isolates from two hospitals of Brasília, Brazil. Conventional biochemical tests were used to identify the enterococcal species and the disk diffusion method was used to determine their resistance profiles. Enterococcus faecalis (76%) and E. faecium (9%) were the most prevalent species. No enterococci showed the vanA or vanB vancomycin resistance phenotypes or genotypes. Only the intrinsically resistant species E. gallinarum (n=2) and E. casseliflavus (n=3) harbored the vancomycin-resistance genes vanC1 and vanC2/3, respectively. We found E. faecalis isolates with high-level resistance to gentamicin (22%) and streptomycin (8%) and both E. faecalis and E. faecium isolates with resistance to more than two antimicrobials (84% and 67%, respectively). Nine E. faecalis isolates (12%) were resistant to ampicillin; the minimal inhibitory concentration (MIC) values were 16µg/mL (n=6) and 32µg/mL (n=3). Among these ampicillin-resistant E. faecalis, seven were also resistant to gentamicin, ciprofloxacin, rifampin, penicillin, chloramphenicol, tetracycline and erythromycin. Pulsed-field gel electrophoresis classified those isolates in three different genotypes, suggesting dissemination of genetically related ampicillin-resistant E. faecalis strains among different patients

Fármacos em crianças

Apresenta um quadro geral sobre interação de medicamentos em crianças. Expõe alguns problemas ocasionadas pela administração errada de medicamentos, alguns aspectos farmacondinâmicos e informações sobre dosagem de medicamentos em crianças

Fármacos em idosos

Apresenta um quadro geral sobre interação de medicamentos em idosos. Expõe alguns problemas ocasionadas pela administração errada de medicamentos, alguns aspectos farmacondinâmicos e farmacocinéticos, além de estratégias para melhorar o uso de medicamentos em idosos

Medicamentos em crianças

A prescrição pediátrica deve ser minuciosa, levando em conta aspectos específicos da criança, tipos de formas farmacêuticas e formulações comercialmente disponíveis, dose e indicação clínica com provas de segurança e eficácia. Dessa forma, este capítulo se propõe a discutir as interações de medicamentos em crianças

Medicamentos em idosos

Condições crônicas representam um grande risco à saúde do idoso, não só pela gravidade das enfermidades em si, mas pelo maior risco de ocorrência de tratamentos farmacológicos múltiplos e reações adversas a medicamentos, que agrava a morbimortalidade desses indivíduos. Diante disso, este capítulo propõe a discussão das interações de medicamentos em idosos