Background Histoplasmosis is highly endemic in the American continent. This condition is associated with a high mortality, particularly in people living with HIV/AIDS (PLWHA). Diagnosis of histoplasmosis is usually late in South America, as Histoplasma antigen detection is rarely available. Here we determined the prevalence, risk factors, and outcome of histoplasmosis in PLWHA in Brazilian hospitals. Methods This was a prospective cohort study (2016–2018) involving 14 tertiary medical centers in Brazil. We included hospitalized PLWHA presenting with fever and additional clinical findings. Patients were investigated at each participant center with classical mycology methods. Also, Histoplasma antigen detection was performed in urine samples (IMMY). Probable/proven histoplasmosis was defined according to European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group/National Institute of Allergy and Infectious Diseases Mycoses Study Group criteria. Results From 616 eligible patients, 570 were included. Histoplasmosis was identified in 21.6% (123/570) of patients. Urine antigen testing increased the diagnostic yield in 53.8%, in comparison with standard mycology methods. Variables independently associated with histoplasmosis were CD4+ count <50 cells/mm 3 , use of an antiretroviral (protective effect), and sample collection in the Northeast region of Brazil. Dyspnea at presentation was independently associated with death. Histoplasmosis was more frequent than tuberculosis in patients with low CD4+ counts. Overall 30-day mortality was 22.1%, decreasing to 14.3% in patients with antigen-based diagnosis. Conclusions Histoplasmosis is a very frequent condition affecting PLWHA in Brazil, particularly when CD4+ counts are lower than 50 cells/mm 3 . Antigen detection may detect earlier disease, with a probable impact on outcomes. Access to this diagnostic tool is needed to improve clinical management of PLWHA in endemic countries.
Background COVID-19 presented great challenges for not only those in the field of health care but also those undergoing medical training. The burden on health care services worldwide has limited the educational opportunities available for medical students due to social distancing requirements. Objective In this paper, we describe a strategy that combines telehealth and medical training to mitigate the adverse effects of the COVID-19 pandemic. Methods A toll-free telescreening service, Telecoronavirus, began operations in March 2020. This service was operated remotely by supervised medical students and was offered across all 417 municipalities (14.8 million inhabitants) in the Brazilian state of Bahia. Students recorded clinical and sociodemographic data by using a web-based application that was simultaneously accessed by medical volunteers for supervision purposes, as well as by state health authorities who conducted epidemiological surveillance and health management efforts. In parallel, students received up-to-date scientific information about COVID-19 via short educational videos prepared by professors. A continuously updated triage algorithm was conceived to provide consistent service. Results The program operated for approximately 4 months, engaging 1396 medical students and 133 physicians. In total, 111,965 individuals residing in 343 municipalities used this service. Almost 70,000 individuals were advised to stay at home, and they received guidance to avoid disease transmission, potentially contributing to localized reductions in the spread of COVID-19. Additionally, the program promoted citizenship education for medical students, who were engaged in a real-life opportunity to fight the pandemic within their own communities. The objectives of the education, organization, and assistance domains of the Telecoronavirus program were successfully achieved according to the results of a web-based post-project survey that assessed physicians’ and students’ perceptions. Conclusions In a prolonged pandemic scenario, a combination of remote tools and medical supervision via telehealth services may constitute a useful strategy for maintaining social distancing measures while preserving some practical aspects of medical education. A low-cost tool such as the Telecoronavirus program could be especially valuable in resource-limited health care scenarios, in addition to offering support for epidemiological surveillance actions.
We report three cases of severe COVID-19 due to the SARS-CoV-2 P.1 lineage in a familial cluster detected in Salvador, Bahia-Brazil. All cases were linked to travel by family members from the state of Amazonas to Bahia in late December 2020. This report indicates the cryptic transmission of the SARS-CoV-2 P.1 lineage across Brazil and highlights the importance of genomic surveillance to track the emergence of new SARS-CoV-2 variants of concern.
Fonte de auxílio à pesquisa: não financiado.Conflitos de interesse: os autores declaram que não há conflitos de interesses.
Introdução/Objetivo O objetivo deste estudo foi relatar a experiência com o uso compassivo do Tocilizumab (um anticorpo monoclonal cujo alvo é o receptor da interleucina-6) na vida real durante a pandemia da COVID 19. Métodos Uma série de casos retrospectiva dos indivíduos admitidos desde Fevereiro de 2020 a Janeiro de 2021, todos diagnosticados com infecção pela COVID 19 (RT PCR swab nasal positivo). Um valor de p < 0,05 foi considerado significante. O estudo foi aprovado pelo Comitê de Ética em Pesquisa da UNEB sob o CAAE 34279620.4.0000.0057 Resultados Um total de 52 pacientes (86,5% homens, média de idade 51,2+11,3 anos) receberam Tocilizumab durante o internamento hospitalar. As comorbidades mais comuns foram, em ordem decrescente: Hipertensão Arterial ( 70,8%), Obesidade (56,5%), Dislipidemia ( 35,7%), Diabetes Mellitus (33,3%), Doença Arterial Coronariana (23,7%), Arritmias Cardíacas ( 21,4%), Asma (15,4%) e Neoplasias Malignas (8,3%). Os pacientes ficaram internados em média 16,1 + 13,2 dias, e a dose média de Tocilizumab utilizada foi igual a 773,7 + 82,8 mg. A maior parte dos pacientes ( 90,8%) tinham acometimento multifocal de vidro fosco na tomografia de tórax. Os piores valores das variáveis clínicas e laboratoriais avaliados durante o internamento foram: FR 21,3 + 1,15 ipm, FC 90,2+ 8 bpm, PaO2/FiO2 287,13 + 154,5, PCR 13,9+8,1 mg/dL, Lactato 3,6+4,4. Usaram Ventilação Mecânica não Invasiva 6,7% e Ventilação Mecânica Invasiva 30% e Circulação Extracorpórea (ECMO 6,7%). Uma proporção de 18,8% dos indivíduos entraram em hemodiálise. A mortalidade encontrada foi igual a 7,7%. Em uma análise de regressão logística, as variáveis significativamente associados com uma maior chance de óbito foram presença de Diabetes Mellitus, Obesidade, Realização de Hemodiálise e lactato elevado (R2 = 0,53 com p = 0,069). Conclusões O uso de tocilizumabe na presente série de casos esteve associada a uma mortalidade de 7,7%. As variáveis associadas com um pior prognóstico foram a presença de obesidade e diabetes mellitus, além de realizar hemodiálise e ter lactato elevado. Este trabalho teve o apoio da Fundação Maria Emília para o autor Aquiles Camelier.
Introdução/Objetivo O objetivo deste estudo foi analisar os fatores de risco associados a chance de óbito em indivíduos internados com SARS CoV 19 (COVID 19) em um hospital privado. Métodos Foram coletados, retrospectivamente, uma série de casos dos indivíduos diagnosticados com infecção pela COVID 19 (RT-PCR swab nasal - positivo) e internados no Hospital Alianca - Rede DOR, desde Fevereiro de 2020 a Janeiro de 2021. Foi realizada uma análise de regressão logística para estudar as variáveis clínicas associadas com um maior risco de morte. Um valor de p < 0,005 foi considerado estatisticamente significante. O estudo foi aprovado pelo Comitê de Ética em Pesquisa da UNEB sob o CAAE 34279620.4.0000.0057. Resultados Um total de 400 pacientes (58,5% homens, média de idade 63,7+17,6 anos) foram avaliados. As comorbidades mais comuns (nos prontuários com registro das comorbidades) foram, em ordem decrescente: Hipertensão Arterial (55,5%), Diabetes Mellitus (30,8%), Dislipidemia (23,6%) Obesidade (15,5%), Neoplasias Malignas (6,3%), Asma e DPOC (5% e 5,8% dos casos). Os sintomas mais comuns: Febre (66,8%), Tosse (61,3 %) e Dispneia (47,0%). Os pacientes ficaram internados em média 14,6 + 10,5 dias. A mortalidade geral foi igual a 14,8%. Usaram Ventilação Mecânica Invasiva 25% e Circulação Extracorpórea (ECMO 0,5% - 2 pacientes). Hemodiálise foi necessária em 5,8%. Em uma análise de regressão logística, foram incluídas as variáveis significativamente associadas com uma maior chance de óbito: Uso de Ventilação Mecânica, p < 0,0001; Lactato elevado, p < 0,0001; Uso de Hemodiálise, p<0,02 e as comorbidades asma brônquica (p<0,02) e Hipertensào Arterial Sistêmica (p < 0,05). Foi construído um modelo matemático de regressão logística que revelou um R2 = 0,43 com p < 0,0001. Conclusões As variáveis associadas com um pior prognóstico foram a presença de Asma Brônquica e Hipertensão Arterial Sistêmica, além de lactato elevado e uso de Ventilação Mecânica Invasiva e hemodiálise. Este trabalho teve o apoio da Fundação Maria Emília para o Autor Aquiles Camelier.
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