OS RISCOS DAS FALHAS DA PROFILAXIA À INFECÇÃO HIV COM O USO DE ANTIRRETROVIRAIS

A profilaxia da infecção HIV encontra-se desde o inicio da epidemia baseada no controle da qualidade do sangue e seus derivados, proibição do uso compartilhado de seringas em uso endovenoso, instituição obrigatória de teste anti-HIV em centros de pré-natal e campanhas públicas educacionais para uso de preservativos em todas as relações sexuais insertivas. Este enorme esforço planetário culminou com o estabelecimento no dia primeiro de dezembro como dia mundial de luta contra AIDS, cujo objetivo principal era de ressaltar medidas preventivas como pilar para controle do elevado número de casos que se avolumavam

Latex allergy: an emerging

Objectives: The current review presents the pathogenic mechanisms, diagnostic and therapeutic and preventive measures to avoid the development of complications related to latex allergy. Method: Literature search electronically from articles already published on the basis of the NCBI / PUBMED / MEDLINE. Results: Manifestations of latex allergy are related to immediate hypersensitivity such as urticaria, angioedema, asthma or even anaphylaxis, or delayed hypersensitivity by a mechanism such as allergic contact dermatitis or primary irritation. Conclusion: Prevention of exposure, replacement and use of latex-free products such as synthetic gloves are essential for those affected. Adjustments in the workplace should be done with gloves without talc, low in allergens or synthetic gloves. These preventive measures significantly reduce the prevalence of allergic reactions

Primeiro caso de leishmaniose visceral humana de transmissao autoctone no centro urbano do Rio de Janeiro: relato de caso

Visceral leishmaniasis is an anthropozoonosis that is caused by protozoa of the genus Leishmania, especially Leishmania (Leishmania) infantum, and is transmitted to humans by the bite of sandflies of the genus Lutzomyia, such as Lutzomyia longipalpis. There are many reservoirs, including Canis familiaris. It is a chronic infectious disease with systemic involvement that is characterized by three phases: the initial period, the state period and the final period. The main symptoms are fever, malnutrition, hepatosplenomegaly, and pancytopenia. This article reports a case of a patient diagnosed with visceral leishmaniasis in the final period following autochthonous transmission in the urban area of Rio de Janeiro. The case reported here is considered by the Municipal Civil Defense and Health Surveillance of Rio de Janeiro to be the first instance of autochthonous visceral leishmaniasis in humans in the urban area of this city. The patient was discharged and is undergoing a follow-up at the outpatient clinic, demonstrating clinical improvement.A leishmaniose visceral é uma antropozoonose causada por protozoários do gênero Leishmania, principalmente Leishmania (Leishmania) infantum e transmitida ao homem pela picada do flebotomíneo do gênero Lutzomyia, destacando-se no Brasil a Lutzomyia longipalpis. Os animais reservatórios são muitos, tendo o cão doméstico (Canis familiaris) como principal reservatório. Trata-se de uma doença infecciosa crônica, de envolvimento sistêmico e caracterizado por três fases: período inicial, período de estado e período final. As principais manifestações são febre, hepatoesplenomegalia, desnutrição e pancitopenia. Este artigo tem como objetivo relatar o caso de paciente diagnosticada com leishmaniose visceral em período final, de transmissão autóctone na área urbana da cidade do Rio de Janeiro. O caso relatado neste artigo é considerado, após investigação, pela Secretaria Municipal de Saúde e Defesa Civil do Rio de Janeiro como o primeiro caso autóctone de leishmaniose visceral em humanos na área urbana da cidade do Rio de Janeiro. O tratamento oferecido foi eficaz e a paciente encontra-se em acompanhamento ambulatorial

Score CTo-aBCDE : um novo score preditor de sucesso nas CTOs

© 2020 Sociedade Portuguesa de Cardiologia. Published by Elsevier España, S.L.U. This is an open access article under the CC-BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).Introduction: Patient selection for percutaneous coronary intervention (PCI) in chronic total occlusions (CTOs) is crucial to procedural success. Our aim was to identify independent predictors of success in CTO PCI in order to create an accurate score. Methods: In a single-center observational registry of CTO PCI, demographic and clinical data and anatomical characteristics of coronary lesions were recorded. Linear and logistic regression analysis were used to identify predictors of success. A score to predict success was created and its accuracy was measured by receiver operating curve analysis. Results: A total of 377 interventions were performed (334 patients, age 68±11 years, 75% male). The success rate was 65% per patient and 60% per procedure. Predictors of success in univariate analysis were absence of active smoking (OR 2.02, 95% CI 1.243-3.29; p=0.005), presence of tapered stump (OR 5.2, 95% CI 2.7-10.2; p8 with high probability (95%). Conclusion: In our sample only anatomical characteristics were predictors of success. The creation of a score to predict success, with good accuracy, may enable selection of cases that can be treated by any operator, those in which a dedicated operator will be desirable, and those with an extremely low probability of success, which should be considered individually for conservative management, surgical revascularization or PCI by a team experienced in CTO.info:eu-repo/semantics/publishedVersio

UNIVERSITY HOSPITAL CRISIS IN BRAZIL

RESUMO: Introdução: Indústria da saúde chegou aos Hospitais Universitários(HU) no Brasil, com o contencioso entre o que o paciente quer e o que o Sistema Único de Saúde pode oferecer; HUs são instituições de ensino com a missão de transformar estudantes em profissionais de saúde competentes, desenvolver programas de pesquisa, prática assistencial  na rotina hospitalar diária, além de garantir direitos formais à comunicação, decência, cortesia e respeito.Realidade e Modelo: Há tendência a transformação de instituições de ensino (HUs) em sistemas de assistência à saúde fornecedoras de atendimento médico à população utilizando a prática da medicina baseada em evidência.Política Atual:O Governo Brasileiro estabeleceu nos HU Fundações de Apoio, através das quais os recursos necessários aos HU são transferidos para cobrir suas demandas bem como facilita a possibilidade de receita de planos para seus serviços médicos.Conclusão: É necessária avaliação crítica da situação nos HUs, fortalecendo estas instituições de ensino/pesquisa como instituições completas sociais de atenção à saúde, mas que além de prover saúde, fornece serviços médicos de excelência, contribuem na formação de recursos humanos, em tecnologia e infraestrutura. Descritores:Hospital Universitário,Hospital de Ensino, Crise no Hospital Universitário

UNIVERSITY HOSPITAL CRISIS IN BRAZIL

RESUMO:Introdução: Indústria da saúde chegou aos Hospitais Universitários(HU) no Brasil, com o contencioso entre o que o paciente quer e o que o Sistema Único de Saúde pode oferecer; HUs são instituições de ensino com a missão de transformar estudantes em profissionais de saúde competentes, desenvolver programas de pesquisa, prática assistencial  na rotina hospitalar diária, além de garantir direitos formais à comunicação, decência, cortesia e respeito.Realidade e Modelo: Há tendência a transformação de instituições de ensino (HUs) em sistemas de assistência à saúde fornecedoras de atendimento médico à população utilizando a prática da medicina baseada em evidência.Política Atual:O Governo Brasileiro estabeleceu nos HU Fundações de Apoio, através das quais os recursos necessários aos HU são transferidos para cobrir suas demandas bem como facilita a possibilidade de receita de planos para seus serviços médicos.Conclusão: É necessária avaliação crítica da situação nos HUs, fortalecendo estas instituições de ensino/pesquisa como instituições completas sociais de atenção à saúde, mas que além de prover saúde, fornece serviços médicos de excelência, contribuem na formação de recursos humanos, em tecnologia e infraestrutura. Descritores:Hospital Universitário,Hospital de Ensino, Crise no Hospital Universitário

HIPPOCRATES IS CARE: HISTORY AND SOME BIOLOGICAL PATHWAYS ON CAREGIVER

Abstract Hippocrates is the mainstay of care. Plato and Aristotle state humoralism as the way that Hippocrates understands human health disorders. He closely observed patients to restore humoral equilibrium, relying on healing power of nature to recover health, rejecting drugs or any kind of procedure that could harm the individual. The development of a common ground of understanding is desirable as a process of negotiating treatment goals and methods which may create an atmosphere of support and solidarity. The concept of supportive care was formalized in Belgium in 1992 with attention to multicultural aspect of our population. The biological basis on care are backed on cortical circuitries, association of pathways, existence of several neurotransmitters, which mediates integrative process promoting behavior, emotion and cognitive. Care may influence favorably all these biological systems and help to improve quality of live or even cure the patient. Descriptors: Hippocrates is Care, Biological Basis on Care, Pathways of Care

HIPPOCRATES IS CARE: HISTORY AND SOME BIOLOGICAL PATHWAYS ON CAREGIVER

AbstractHippocrates is the mainstay of care. Plato and Aristotle state humoralism as the way that Hippocrates understands human health disorders. He closely observed patients to restore humoral equilibrium, relying on healing power of nature to recover health, rejecting drugs or any kind of procedure that could harm the individual. The development of a common ground of understanding is desirable as a process of negotiating treatment goals and methods which may create an atmosphere of support and solidarity. The concept of supportive care was formalized in Belgium in 1992 with attention to multicultural aspect of our population. The biological basis on care are backed on cortical circuitries, association of pathways, existence of several neurotransmitters, which mediates integrative process promoting behavior, emotion and cognitive. Care may influence favorably all these biological systems and help to improve quality of live or even cure the patient. Descriptors: Hippocrates is Care, Biological Basis on Care, Pathways of Care

Prevalence of asymptomatic urethritis by Chlamydia trachomatis and Neisseria gonorrhoeae and associated risk factors among males living with HIV-1

Objectives The increase in HIV transmissibility in non-ulcerative sexually transmitted infection is already well-established. It is estimated that symptomatic carriers of N. gonorrhoeae and C. trachomatis have a relative risk of 4.8-fold and 3.6-fold, respectively, for the sexual acquisition of HIV. This type of evaluation for asymptomatic urethritis is necessary to reinforce strategies to combat HIV transmission. This study aims to assess the prevalence of patients with asymptomatic urethritis among men diagnosed with HIV-1 and determine the risk factors associated with this infection. Methods We enrolled a total of 115 male patients aged 18 years or older who have been diagnosed with HIV infection and have no symptoms of urethritis or other sexually transmitted infections and who have been evaluated between May and August 2015 in a follow-up visit at the Immunology Outpatient Clinic of a Brazilian University Hospital. Results Four asymptomatic patients were positive for C. trachomatis and were considered asymptomatic carriers of urethritis. Prevalence was 3.47%. Patients who were positive for C. trachomatis urethritis had a lower mean age (p = 0.015). Conclusion The presence of asymptomatic sexually transmitted infection is a challenge in clinical practice. We recommend that, in outpatient practice, the habit of inquiring on previous sexual behavior to obtain more information about risks and associations with asymptomatic sexually transmitted infection, a routine physical examination and complementary tests to detect STI pathogens should be performed to discard these conditions. The development of rapid tests for this purpose should also be encouraged

An unusual case of bacillary angiomatosis in the oral cavity of an AIDS patient who had no concomitant tegumentary lesions – case report and review

Bacillary angiomatosis (BA) is an angioproliferative disease of immunocompromised patients that usually presents as vascular tumors in the skin and subcutaneous tissues. It is caused by chronic infections with either Bartonella henselae or B. quintana. Oral cavity BA is exceedingly rare and even rarer without simultaneous cutaneous disease. We report herein the case of a 51-year-old HIV-infected man who presented severe odynophagia and an eroded lesion on the hard palate that progressed to an oronasal fistula. No cutaneous lesions were recorded. Doxycycline led to complete resolution. To the best of our knowledge, only six previous cases of oral BA without tegumentary disease have been previously reported and none of them progressed to fistula