Vitamin K antagonists (VKAs) remain as the most prescribed drug for treatment and prevention of thrombotic disorders in many countries, despite the recent approval of the new oral anticoagulants (NOACs). Although effectiveness and safety of VKAs are tightly associated to maintaining the patient within the international normalised ratio (INR) therapeutic range (TWR), they have been likened to NOACs when patients are in good INR control (≥66% of TWR). Therefore, assessing the safety of patients should be a priority in the selection of the anticoagulation therapy. The aim of this study was to evaluate the association between CYP2C9*2, CYP2C9*3, VKORC1, CYP4F2*3, ABCB1 C3435T, APOE, CYP2C19*2 and CYP2C19*17 gene polymorphisms and treatment safety in 128 patients diagnosed with atrial fibrillation or venous thromboembolism during the initial first seven months of acenocoumarol therapy. After the first month, VKORC1-T-allele and APOE-E3/E3 genotype were independently associated to higher time above therapeutic range (TAR) and lower time below the therapeutic range (TBR). After seven months, VKORC1 T-allele predicted higher TAR, and was also associated to increased INR>4, particularly the TT-genotype (odds ratio [OR]: 32; 95% confidence interval [CI95%]: 6-175; p=810⁻⁵). C-alleles for CYP2C9*3 (OR: 5.5; CI95%: 1.8-17; p=0.003) and ABCB1 (OR: 8.9;CI95%: 1.1-70; p=0.039) independently influenced on INR>6 . Patients VKORC1-TT/ABCB1-C remained 26.8% [19.7-38.9] TAR, with associated relative risk (RR) for INR>4 1.8 higher (CI95%: 1.2-2.5; p=0.015). Patients VKORC1-TT also presented the highest risk of bleeding events (RR: 3.5;CI95%: 1.4-8.4; p=0,010). In conclusion, VKORC1, CYP2C9*3, APOE and ABCB1 genotypes should be considered in prevention of overanticoagulation and bleeding events in the initiation of acenocoumarol therapy.

Actinomyces europaeus was first described in 1997 as a new species causing predominantly skin and soft-tissue infections. Mastitis due to A. europaeus is an unusual condition. This article reports a case of primary breast abscess caused by A. europaeus in a postmenopausal woman.

Acute bacterial meningitis (ABM) is a public health problem worldwide and, in Brazil, in the 1990s, an average of 28,000 cases of meningitis were reported annually 1 . In an etiological survey in northeastern Brazil in the 1980s, Bryan et al 2 reported that N. meningitides (meningococcus) was the most prevalent ABM pathogen, followed by Haemophilus influenzae type b (Hib) and Streptococcus pneumoniae (pneumococcus) 2 . However, after the introduction of the anti-Hib conjugated vaccine to the public vaccination program in 1999, there was a significant decrease in the incidence of cases of ABM due to H. influenzae in Brazil 3 .Because of the high mortality rate and long-term sequels, fast and accurate diagnosis and appropriate treatment of ABM are fundamental for a good outcome 4 . The initial antibiotic regimen is usually empirical, and therefore, knowledge of the epidemiological profile of ABM in the community could lead to the best therapeutic choice 5 .In the present study, we describe the epidemiological profile of ABM at Giselda Trigueiro Hospital (GTH), a reference center for infectious diseases in the State of Rio Grande do Norte, Brazil, between 2005 and 2008. We are not aware of any previous study on the epidemiology of ABM in this Brazilian state.This study consisted of a descriptive retrospective survey of the cases of ABM that were attended at GTH between 2005 and 2008. During the period of this study, the hospital could not afford a pediatric ward, and children were sent to pediatric hospitals after diagnosis and initial treatment.Information on age, sex, home location (rural or urban area), laboratory results, criteria for diagnostic confirmation, previous use of antibiotics and outcome were collected from the official records of the Brazilian compulsory notification system (SINAN), which were available in the hospital' s epidemiology department. The data were analyzed through SPSS (Statistical Package for the Social Sciences), version 13.0.The diagnoses of cases with clinical signs and symptoms of ABM were confirmed in accordance with at least one of the following criteria: 1) cerebrospinal fluid (CSF) culture; 2) CSF Gram stain; 3) blood culture or blood Gram stain; 4) latex agglutination test on CSF; and 5) CSF presenting pleocytosis (> 500 cells/mm 3 ), predominantly polymorphonuclear neutrophils, protein level > 40mg/dl and glucose level < 40mg/dl. Two cases did not fit the above criteria and their diagnosis were confirmed post-mortem by means of autopsy.Blood and CSF were seeded in chocolate agar enriched with 5% sheep blood. The latex agglutination test was used to identify polysaccharide antigens from N. meningitides, S. pneumoniae and Hib in CSF. Gram's method consisted of a primary stain with crystal violet, followed by the addition of iodine, rapid decolorization with acetone, and staining with basic fuchsin.The antibiotic susceptibility of the S. pneumoniae was identified by means of the disk diffusion method, in accordance with the definitions of the National Committee for Clini...

20 dias (p=0,022; ORaj=3,40; IC= 1,19-9,69) e a transfusão sanguínea (p=0,022; ORaj=2,06; IC= 1,11-3,83) são fatores independentes de risco para a doença. CONCLUSÕES: O estudo demonstra uma alta incidência da patologia no serviço. O baixo peso ao nascer, um tempo prolongado de oxigenoterapia, bem como a transfusão sanguínea são fatores associados ao desenvolvimento da retinopatia da prematuridade. Idade gestacional não é um dado confiável para a triagem dos neonatos realizada pelo setor.]]>