Analysis of antimicrobials' consumption profile in a University Hospital of Western Paraná, Brazil

The objective of this study was to analyze the variation in antimicrobials' consumption and the costs related to their use at a University Hospital between 1999 and 2004. The annual consumption of nine antimicrobials, expressed in DDD/100 patients-day, and the direct costs with their acquisition were evaluated. Analysis of variance and regression techniques were used to compare data, considering a significance level of 5%. The most consumed antimicrobials were amikacin and ceftriaxone. In general, antimicrobials consumption, expressed in DDD/100 patients-day, increased from 9.21 in 1999 to 25.08 in 2004 (p<0.0001). When analyzing antimicrobial consumption as related to specific hospital units, the ICU showed the highest consumption followed by Chemotherapy and Medical Clinical units, respectively. In addition, the number of patients-day increased from 2671/month in 1999 to 3502/month in 2004, p<0.0001. As a consequence, total expenditure with antimicrobials increased from R$98.89 per 100 patients-day in 1999 to R$ 731.26 in 2004, p<0.0001. Between 1999 and 2004 significant increases in both consumption and financial expenditure with antimicrobials were observed.O trabalho teve por objetivo analisar a variação do consumo e gastos financeiros com antimicrobianos em Hospital Universitário entre 1999 e 2004. Analisou-se 9 antimicrobianos, sendo o consumo expresso em DDDs/100 pacientes-dia e o preço médio de compra obtido do relatório da farmácia hospitalar. As variações anuais no consumo, o consumo por tipo de unidades de internação e gastos com cada antimicrobiano foram estudadas por análise de variância. Adotou-se 5% como limiar de significância. Os antimicrobianos mais consumidos no período foram amicacina e ceftriaxona. Observou-se aumento no consumo dos antimicrobianos selecionados de 9,21 DDDs/100 pacientes-dia em 1999 para 25,08 em 2004 (p<0,0001). Entre as unidades de internação, a UTI apresentou o maior consumo médio, seguindo-se as unidades de Quimioterapia e Clínica Médica. A média mensal de pacientes-dia atendidos aumentou de 2671 em 1999 para 3502 em 2004 (p<0,0001). Observou-se aumento significativo nos gastos totais com antimicrobianos no período (R$98,89 x R$ 731,26 por 100 pacientes-dia entre 1999 e 2004, p<0,0001). Observou-se aumento significativo tanto na utilização quanto no gasto financeiro por 100 pacientes-dia diretamente relacionado à aquisição dos antimicrobianos estudados.State University of Western Paraná Faculty of Pharmacy Department of Hospital PharmacyFederal University of São Paulo Department of MedicineUNIFESP, Department of MedicineSciEL

The risk of acquiring the new influenza A(H1N1) for Brazilian travelers to Chile, Argentina and the USA

We estimate the risk of acquiring the new influenza A(H1N1) for Brazilian travelers to Chile, Argentina and the USA. This is done by a mathematical model that quantifies the intensity of transmission of the new virus in those countries and the probability that one individual has of acquiring the influenza depending on the date of arrival and time spent in the area. The maximum estimated risk reached 7.5 cases per 10,000 visitors to Chile, 17 cases per 10,000 travelers to Argentina and 23 cases per 10,000 travelers to the USA. The estimated number of imported cases until 27 July is 57 ± 9 from Chile, 136 ± 27 from the USA and 301 ± 21 from Argentina, which are in accord with the official figures. Estimating the number of imported cases was particularly important for the moment of the disease introduction into this country, but it will certainly be important again as a tool to calculate the number of future imported cases from northern countries in our next inter-epidemic season, were imported cases can constitute again the majority of the new influenza burden to the Brazilian health services.HCFMUSP - LIM01FAPESP(FAPERJ) Fundacao de Amparo a Pesquisa do Estado do Rio de Janeir

Dengue e risco da reintrodução da febre amarela urbana no Estado de São Paulo

OBJETIVO: Propor um modelo matemático para a estimativa da reprodutibilidade basal, R0, para a febre amarela urbana em uma área infestada pela dengue. MÉTODOS: O método utilizado considera que, como ambas as doenças são transmitidas pelo mesmo vetor (Aedes aegypti), poder-se-ia aplicar todos os parâmetros quantitativos relativos ao mosquito, estimados pela fase inicial da curva de crescimento de casos de dengue, à dinâmica da febre amarela. Demonstra-se que o R0 da febre amarela é em média 43% menor que o da dengue. Esta diferença deve-se à viremia mais prolongada da dengue, bem como ao menor período de incubação extrínseco daquele vírus no mosquito. RESULTADOS: Apresenta-se a aplicação desta análise matemática à situação epidemiológica da dengue no estado de São Paulo, para o ano de 2001, onde o número de casos de dengue aumentou de 3.582, em 2000 para 51.348, em 2001. Calculou-se o valor de R0 para a febre amarela para cada cidade do estado que tinha R0 para dengue maior que um. Estimou-se o número total de pessoas desprotegidas, sem vacina, e que vivem em áreas de alto risco para a febre amarela urbana. CONCLUSÕES: Foi demonstrado que existe, um grande contingente de pessoas não vacinadas contra febre amarela vivendo em áreas infestadas por Aedes aegypti no Estado de São Paulo, até aquela data (2001).OBJECTIVE: To propose a mathematical method for the estimation of the Basic Reproduction Number, R0, of urban yellow fever in a dengue-infested area. METHODS: The method is based on the assumption that, as the same vector (Aedes aegypti) causes both infections, all the quantities related to the mosquito, estimated from the initial phase of dengue epidemic, could be applied to yellow fever dynamics. It is demonstrated that R0 for yellow fever is, on average, 43% lower than that for dengue. This difference is due to the longer dengue viremia and its shorter extrinsic incubation period. RESULTS: In this study the analysis was expanded to the epidemiological situation of dengue in São Paulo in the year 2001. The total number of dengue cases increased from 3,582 in 2000 to 51,348 in 2001. It was then calculated R0 for yellow fever for every city which have shown R0 of dengue greater than 1. It was also estimated the total number of unprotected people living in highly risky areas for urban yellow fever. CONCLUSIONS: Currently there is a great number of non-vaccinated people living in Aedes aegypti infested area in the state of São Paulo

Metallo‐beta‐lactamases among imipenem‐resistant Pseudomonas aeruginosa in a brazilian university hospital

INTRODUCTION: Imipenem-resistant Pseudomonas aeruginosa resulting from metallo-&#946;-lactamases has been reported to be an important cause of nosocomial infection and is a critical therapeutic problem worldwide, especially in the case of bacteremia. OBJECTIVES: To determine the frequency of metallo-&#946;-lactamases among imipenem-resistant Pseudomonas aeruginosa isolates and to compare methods of phenotypic and molecular detection. METHODS: During 2006, 69 imipenem-resistant Pseudomonas aeruginosa samples were isolated from blood and tested for metallo-&#946;-lactamase production using both phenotypic methods. Minimal Inhibitory Concentratrions (MIC) (&#956;g/mL) was determined with commercial microdilution panels. Pulsed Field Gel Electrophoresis (PFGE) was performed among metallo-&#946;-lactamase producers. RESULTS: Of all the blood isolates, 34.5% were found to be imipenem-resistant Pseudomonas aeruginosa. Positive phenotypic tests for metallo-&#946;-lactamases ranged from 28%-77%, and Polymerase Chain Reaction (PCR) were positive in 30% (of note, 81% of those samples were blaSPM-1 and 19% were blaVIM-2). Ethylenediamine tetracetic acid (EDTA) combinations for the detected enzymes had low kappa values; thus, care should be taken when use it as a phenotypic indicator of MBL. Despite a very resistant antibiogram, four isolates demonstrated the worrisome finding of a colistin MIC in the resistant range. PFGE showed a clonal pattern. CONCLUSION: Metallo-&#946;-lactamases among imipenem-resistant Pseudomonas aeruginosa were detected in 30.4% of imipenem-resistant Pseudomonas aeruginosa isolates. This number might have been higher if other genes were included. SPM-1 was the predominant enzyme found. Phenotypic tests with low kappa values could be misleading when testing for metallo-&#946;-lactamases. Polymerase Chain Reaction detection remains the gold standard

MODELING the INTERACTION BETWEEN AIDS and TUBERCULOSIS

A deterministic model is proposed for the study of the dynamics of acquired immunodeficiency syndrome (AIDS) and tuberculosis (TB) co-infection. the model is comprised by a set of sixteen ordinary differential equations representing different states of both diseases, and it is intended to provide a theoretical framework for the study of the interaction between both infections. Numerical simulations of the model resulted in three striking outcomes: first, the pathogenicity of Human Immunodeficiency Virus (HIV) is enhanced by the presence of TB, and vice-versa; second, the prevalence of AIDS is higher in the presence of TB; and third, relative risk analysis demonstrated a much stronger influence of AIDS on TB than the other way around.ESCOLA PAULISTA MED,BR-04023 São Paulo,BRAZILUNIV São Paulo,INST PHYS,São Paulo,BRAZILHCFMUSP,BR-01246 São Paulo,BRAZILESCOLA PAULISTA MED,BR-04023 São Paulo,BRAZILWeb of Scienc

Maximum equilibrium prevalence of mosquito-borne microparasite infections in humans.

To determine the maximum equilibrium prevalence of mosquito-borne microparasitic infections, this paper proposes a general model for vector-borne infections which is flexible enough to comprise the dynamics of a great number of the known diseases transmitted by arthropods. From equilibrium analysis, we determined the number of infected vectors as an explicit function of the model's parameters and the prevalence of infection in the hosts. From the analysis, it is also possible to derive the basic reproduction number and the equilibrium force of infection as a function of those parameters and variables. From the force of infection, we were able to conclude that, depending on the disease's structure and the model's parameters, there is a maximum value of equilibrium prevalence for each of the mosquito-borne microparasitic infections. The analysis is exemplified by the cases of malaria and dengue fever. With the values of the parameters chosen to illustrate those calculations, the maximum equilibrium prevalence found was 31% and 0.02% for malaria and dengue, respectively. The equilibrium analysis demonstrated that there is a maximum prevalence for the mosquito-borne microparasitic infections

Dynamics of the 2006/2007 dengue outbreak in Brazil

We analyzed dengue incidence in the period between October 2006-July 2007 of 146 cities around the country were Larval Index Rapid Assay (LIRA) surveillance was carried out in October 2006. Of these, we chosen 61 cities that had 500 or more cases reported during this period. We calculated the incidence coefficient, the force of infection (») and the basic reproduction number (R0) of dengue in those 61 cities and correlated those variables with the LIRA. We concluded that » and R0 are more associated with the number of cases than LIRA. In addition, the average R0 for the 2006/2007 dengue season was almost as high as that calculated for the 2001/2002 season, the worst in Brazilian history.CNPqFAPESPFMUSP - H

Effect of progressive resistance exercise on strength evolution of elderly patients living with HIV compared to healthy controls

OBJECTIVES: Human Immunodeficiency Virus (HIV) infection worsens the frailty of elderly people, compromising their quality of life. In this study we prospectively evaluated eleven patients living with HIV and 21 controls older than 60 years and without prior regular physical activity, who engaged in a one-year progressive resistance exercise program to compare its effects on muscular strength, physical fitness and body composition. METHODS: Exercises for major muscular groups were performed 2 times/week, under professional supervision. Strength increase was evaluated bimonthly, while body composition, lipid and glycaemic profiles (only of those living with HIV) and physical fitness were evaluated before and after the one-year training. RESULTS: The participants living with HIV were lighter, had smaller Body Mass Index and were initially much weaker than controls. However, their strength increased more (1.52-2.33 times the baseline values for those living with HIV x 1.21-1.48 times for controls, p<0.01), nullifying the differences initially seen. These effects were seen independently of gender, age or baseline physical activity. In addition, those living with HIV improved their fasting glucose levels and showed a tendency to improve their lipids after the one year training program. These effects were slightly more pronounced among those not using protease inhibitors, although not significantly. CONCLUSIONS: Resistance exercise safely increased the strength of older patients living with HIV adults, allowing them to achieve performance levels observed among otherwise healthy controls. These findings favor the recommendation of resistance exercise for elderly adults living with HIV adults