Influence of vaccine-preventable diseases and HIV infection on demand for an infectious diseases service in Rio de Janeiro State, Brazil, over 22 years – Part II (1995-2016)

Patients’ data during daily clinical care are extremely important for improving the allocation of healthcare resources and for assessing healthcare demands. The prospective gathering of these data over decades allowed us to describe the trends of infectious diseases in a tertiary hospital. The results concerning the period between 1965 and 1994 described the exponential increase in the incidence of HIV infection and its important effects on our institutional mortality. The present study describes the demand for the same hospital between 1995 and 2016. There were 4,691 admissions and the main causes of admissions were, in descending order, HIV infection (1,312, 28.0%), noninfectious diseases (447, 9.5%), meningoencephalitis (432, 9.2%), soft tissue infections (427; 9.1%), tuberculosis (272, 5.8%), pneumonias (212, 4.5%) and leptospirosis (212, 4.5%). There were 864 readmissions; most due to HIV infections (65.2%). The institutional mortality fell from 16.9% in the first two years to 5.0% in the last two years of the study. The case-fatality rates among the HIV patients decreased from more than 40% to approximately 5% over the study period. In the last two decades, the hospital experienced a decrease in demand due to vaccine-preventable diseases. The demand for children has fallen and the demand for patients over the age of 50 has increased. These results reflect the improvement in public health standards over more than half a century and the positive effects of the National Immunization Program. They also illustrate the sharp decline in the HIV case-fatality rate after the introduction of combined antiretroviral therap

Rehabilitation with implant-supported overdentures in total edentulous patients: a review

Objectives: The main aim of this review article is to discuss implant-supported overdentures (ISOs) as treatment in edentulous patients. Besides, we will try to discuss among the different treatment options in such patients and to analyze their validity when ISOs are compared with other clinical modalities. At the same time, we will try to suggest clinical guidelines supported by current clinical studies. Material and methods: We performed a Medline search and review of pertinent articles on the mentioned subject from 1986 to 2011. As a searching strategy, we used the following words: implant-supported overdentures, attachment systems, Locator attachment, cantilever, fixed prosthesis. Results and conclusions: Implant-supported overdentures constitute an accurate and predictable treatment option and achieve a higher patient's satisfaction. This type of treatment constitutes a cheaper treatment than fixed prostheses and in some patients, with loss of lip support or with an interoclusal space larger than 15 mm, the choice of implant-supported overdentures seems to prevent future aesthetic or phonetic problems

Acurácia da definição de caso suspeito de rubéola: implicações para vigilância

OBJECTIVE: To assess the performance of the rubella suspect case definition among patients with rash diseases seen at primary care units. METHODS: From January 1994 to December 2002, patients with acute rash, with or without fever, were seen at two large primary health care units and at a public general hospital in the municipality of Niterói, metropolitan area of Rio de Janeiro, Brazil. Data from clinical and serologic assessment were used to estimate the positive predictive values of the definition of rubella suspect case from the Brazilian Ministry of Health and other combination of signs/symptoms taking serologic status as the reference. Serum samples were tested for anti-rubella virus IgM using commercially available enzyme immunoassays. Positive predictive values and respective 95% confidence intervals were calculated. RESULTS: A total of 1,186 patients with an illness characterized by variable combinations of rash with fever, arthropathy and lymphadenopathy were studied. Patients with rash, regardless of other signs and symptoms, had 8.8% likelihood of being IgM-positive for rubella. The Brazilian suspect case definition (fever and lymphadenopathy in addition to rash) had low predictive value (13.5%). This case definition would correctly identify 42.3% of the IgM-positive cases, and misclassify 26.1% of the IgM-negative cases. CONCLUSIONS: These results support the recommendation to investigate and collect clinical specimens for laboratory diagnosis of all cases of rash, for surveillance purposes. Although this strategy may increase costs, the benefits of interrupting the circulation of rubella virus and preventing the occurrence of congenital rubella syndrome should pay off.OBJETIVO: Avaliar a acurácia da definição de caso suspeito de rubéola entre pacientes com doenças exantemáticas atendidos em unidades de saúde pública. MÉTODOS: A população de estudo foi constituída de pacientes com doença exantemática, com ou sem febre, atendidos em serviços de saúde pública, de janeiro de 1994 a dezembro de 2002 no município de Niterói, RJ. Dados clínicos e sorológicos foram utilizados para estimar os valores preditivos positivos da definição de caso suspeito de rubéola do Ministério da Saúde do Brasil e outras combinações de sinais e sintomas, considerando o resultado da sorologia como referência. A detecção de IgM específica para rubéola em amostras sangüíneas foi realizada por ensaio imunoenzimático. Foram calculados os valores preditivos positivos e respectivos intervalos de confiança de 95%. RESULTADOS: Foram estudados 1.186 pacientes com uma doença caracterizada por uma variada combinação de rash com ou sem febre, artropatia e linfoadenopatia. Pacientes com exantema, independentemente da presença de outros sinais e sintomas, apresentaram uma probabilidade de 8,8% de serem IgM positivos para rubéola. A definição de caso suspeito de rubéola utilizada no Brasil apresentou baixo valor preditivo positivo (13,5%). Esta definição de caso identificou corretamente 42,3% dos casos IgM positivos, e classificou de forma incorreta 26,1% dos IgM negativos. CONCLUSÕES: Os resultados indicam que as doenças exantemáticas devem ser investigadas em conjunto para fins de vigilância epidemiológica e coleta de espécimens clínicos para o diagnóstico laboratorial. Esta estratégia aumenta os custos, mas gera benefícios na interrupção da circulação do vírus e na prevenção da síndrome da rubéola congênita

Diagnosis of human herpesvirus 6B primary infection by polymerase chain reaction in young children with exanthematic disease

INTRODUCTION: Exanthem subitum is a classical rash disease of early childhood caused by human herpesvirus 6B (HHV-6B). However, the rash is frequently misdiagnosed as that of either measles or rubella. METHODS: In this study, a nested multiplex polymerase chain reaction (PCR) was used to diagnose HHV-6B primary infection, differentiate it from infections caused by HHV-6A and compare it to antibody avidity tests. The samples were separated into case group and control group according to the results of the indirect immunofluorescence assay (IFA) technique. RESULTS: From the saliva samples analyzed, HHV-6A DNA was detected in 3.2% of the case group and in 2.6% of the control group. Regarding HHV-6B, PCR detected viral DNA in 4.8% of the case group and in 1.3% of the control group. Among the serum samples studied, a frequency of 1.7% was determined for HHV-6A in the case group and 1.2% in the control group. PCR did not detect HHV-6B DNA in serum samples. The sensitivity and specificity of the PCR technique ranged from 0% to 4.8% and 97.5% to 100%, respectively, compared to IFA. CONCLUSIONS: The PCR technique was not suitable for diagnosing primary infection by HHV-6B in children with exanthematic disease and should not substitute the IFA