Leishmaniose visceral: série histórica de pacientes hospitalizados e correlação com o clima em área endêmica de Minas Gerais, Brasil

Background:Over the last decade, a few cases of visceral leishmaniasis (VL) have been reported in some provinces of northeastern Iran. We aimed to investigate clinical and laboratory findings of VL among children who admitted to the pediatric ward in a referral hospital in Mashhad, northeastern Iran.Methods:A retrospective study, between 1997 and 2017, was performed on the data sheet registered for children with confirmed VL at the referral Emam Reza Hospital in Mashhad. Hematological and biochemical profiles of the patients were analyzed.Results:A total of 35 children with VL, confirmed by the presence of amastigotes of Leishmania in Giemsa stained smears of the bone marrow, had been recorded through 20 yr. The mean age of patients was 3.7±4 yr. The majority of the patients suffered from hepatosplenomegaly (100%, n=35/35), followed by prolonged fever and pallor (91%, n=32/35), weight loss (85%, n=30/35). The main laboratory findings were anemia (94.1%), leukopenia (52.9%) and thrombocytopenia (70.5%). Almost one-third (37.1%; 13/35) of VL patients inhabited in rural areas of the Bojnoord district as a known VL endemic focus in northeastern Iran.Conclusion:Our preliminary data showed that the origin of VL is still in some districts other than Mashhad, where VL just will be diagnosed.

Visceral leishmaniasis (VL) is a severe parasitic disease caused by Leishmania spp., with a significant impact on pediatric populations, particularly in endemic regions. The diagnosis of VL in children requires a high index of suspicion, as clinical manifestations-such as prolonged fever, hepatosplenomegaly, and pancytopenia-overlap with other infectious and hematologic diseases. While serological and molecular tests aid in detection, bone marrow aspiration remains the gold standard for definitive diagnosis. In this case series, we describe five pediatric patients diagnosed with VL in Italy, emphasizing the importance of a timely and accurate diagnostic approach. Liposomal amphotericin B (LAmB) is the first-line treatment in Southern Europe due to its high efficacy and reduced toxicity. Our patients received a standard regimen of 3 mg/kg daily for five days, plus an additional dose on day 10, leading to rapid clinical improvement. However, some cases required supportive care, such as red blood cell transfusions, particularly in patients with co-infections. Despite being a neglected disease, VL is re-emerging in Europe, influenced by climate change, increased pet ownership, and migration from endemic regions. Prevention strategies focus on vector control, canine vaccination, and public health awareness. The global rise in pediatric VL highlights the need for improved surveillance, access to affordable treatments, and the development of effective vaccines to mitigate the disease burden in both endemic and non-endemic areas.

HomeCirculation: Arrhythmia and ElectrophysiologyVol. 9, No. 12Atrial Pathology Findings in a Patient With PRKAG2 Cardiomyopathy and Persistent Atrial Fibrillation Free AccessResearch ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessResearch ArticlePDF/EPUBAtrial Pathology Findings in a Patient With PRKAG2 Cardiomyopathy and Persistent Atrial Fibrillation Eduardo Back Sternick, MD, PhD, Stanley de Almeida Araújo, MD, Elizabeth Ribeiro da Silva Camargos, MD, PhD and Geraldo Brasileiro Filho, MD, PhD Eduardo Back SternickEduardo Back Sternick From the University Hospital, Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, Brazil (E.B.S.); Anatomia Patológica, Universidade Federal de Ouro Preto, Minas Gerais, Brazil (S.d.A.A.); Anatomia Patológica, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (E.R.d.S.C.); and Centro de Microscopia da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (G.B.F.). , Stanley de Almeida AraújoStanley de Almeida Araújo From the University Hospital, Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, Brazil (E.B.S.); Anatomia Patológica, Universidade Federal de Ouro Preto, Minas Gerais, Brazil (S.d.A.A.); Anatomia Patológica, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (E.R.d.S.C.); and Centro de Microscopia da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (G.B.F.). , Elizabeth Ribeiro da Silva CamargosElizabeth Ribeiro da Silva Camargos From the University Hospital, Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, Brazil (E.B.S.); Anatomia Patológica, Universidade Federal de Ouro Preto, Minas Gerais, Brazil (S.d.A.A.); Anatomia Patológica, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (E.R.d.S.C.); and Centro de Microscopia da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (G.B.F.). and Geraldo Brasileiro FilhoGeraldo Brasileiro Filho From the University Hospital, Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, Brazil (E.B.S.); Anatomia Patológica, Universidade Federal de Ouro Preto, Minas Gerais, Brazil (S.d.A.A.); Anatomia Patológica, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (E.R.d.S.C.); and Centro de Microscopia da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (G.B.F.). Originally published18 Nov 2016https://doi.org/10.1161/CIRCEP.116.004455Circulation: Arrhythmia and Electrophysiology. 2016;9:e004455A white male patient aged 52 years with permanent atrial fibrillation and left ventricular hypertrophy because of glycogen storage cardiomyopathy, heterozygous for c.905G>A p.(Arg302Gln) PRKAG2 missense mutation on exon 7, was admitted because of partial pacemaker extrusion and pocket infection. His mother and 5 brothers carry the same mutation and were previously reported.1 A dual chamber pacemaker was implanted 20 years earlier because of third-degree atrioventricular block. Pacemaker leads and generator were explanted under extracorporeal circulation. A fragment from the base of the right atrial appendage was assessed for microscopic analysis. Percutaneous endomyocardial right ventricle (RV) biopsy was undertaken 1 year before. Morphological changes in ventricular myocardium in PRKAG2 cardiomyopathy have been reported,2 but there are no data on atrium pathology. Atrial section (Figure [A through C]) stained with periodic acid–Schiff (Figure [A]) and hematoxylin and eosin (Figure [B]) shows intense vacuolization of the myofibers with abundant gross granular inclusions—glycogen—(arrows) within vacuoles. There is no cardiomyocyte architecture disarray. Masson trichrome staining (Figure [C] and [F]) shows normal collagen fibers (blue) in the extracellular matrix, without fibrosis. Lower (Figure [D through F]) show histopathology findings in the RV, which were similar to those in the atrium, with vacuolization, absence of myocardial disarray, inflammatory cells, and fibrosis, findings consistent with RV histopathology previously reported.2 Transmission electron microscopy image from RV septum (D) shows mitochondria within abundant glycogen (small granules), between myofibrils.Download figureDownload PowerPointFigure. Atrial section (A–C) stained with periodic acid–Schiff (A) and hematoxylin and eosin (B) shows intense vacuolization of the myofibers with abundant gross granular inclusions—glycogen—(arrows) within vacuoles. There is no cardiomyocyte architecture disarray. Masson trichrome staining (C and F) shows normal collagen fibers (blue) in the extracellular matrix, without fibrosis. D to F, lower, Show histopathology findings in the right ventricle (RV), which were similar to those in the atrium, with vacuolization, absence of myocardial disarray, inflammatory cells, and fibrosis, findings consistent with RV histopathology. Transmission electron microscopy image from RV septum (D) shows mitochondria (M) within abundant glycogen (small granules), between myofibrils (MF).Patients with R302Q have a high incidence of atrial fibrillation.3 Ventricular preexcitation and hypertrophy, which are commonly present in these patients, may be contributors. It has also been suggested that in the absence of fibrosis, a reduction of pH because of increased glycogen content could influence ionic channels function, which may contribute to atrial fibrillation maintenance. Further studies are warranted in this model of persistent atrial fibrillation without fibrosis.DisclosuresNone.FootnotesCorrespondence to Eduardo Back Sternick, MD, PhD, Alameda do Morro 85, Torre 4, ap 1900, Vila da Serra, Minas Gerais, 34000000 Nova Lima, Brazil. E-mail [email protected]

To explore current patterns of diagnosis and treatment, quantify household economic impact and identify household strategies to cover the costs of visceral leishmaniasis (VL) care in rural Bangladesh. Structured interviews with 113 VL patients from 87 households documenting all provider visits and expenditures for health care for VL, and the ways in which the expenditures were covered. Patients paid a median of 7 visits to six different providers before beginning VL treatment. All visited the subdistrict government hospital at least once. While health care, including antileishmanial drug therapy, is officially available free of charge at government facilities, 79% of patients reported making informal payments for provider access, diagnostics and drug administration; only 14% of patients received their full drug course from this source. For the 58% of patients who purchased the full treatment course, drug cost constituted 34% of direct expenditure. Median direct expenditure for one VL patient was US$87 and median income lost was $40; median total expenditure was 1.2 times annual per capita income of our study population. Households employed multiple coping strategies to cover expenditures, most commonly sale or rental of assets (62%) and taking out loans (64%). Visceral leishmaniasis treatment causes a major economic burden in affected families. Control strategies for VL should facilitate timely, affordable diagnosis and treatment of patients to decrease the infection reservoir and to alleviate the economic burden of VL on households.

HaemophiliaVolume 17, Issue 2 p. 313-314 Detection of int1h-related inversion of the factor VIII gene S. F. PIO, S. F. PIO Fundação Hospitalar do Estado de Minas Gerais (FHEMIG), Belo Horizonte, Minas Gerais, BrazilSearch for more papers by this authorC. MÜHLE, C. MÜHLE Department of Psychiatry and Psychotherapy, University of Erlangen-Nuernberg, Germany and Department of Pediatrics, Medical University of Innsbruck, AustriaSearch for more papers by this authorG. C. DE OLIVEIRA, G. C. DE OLIVEIRA CEBio and Genomics and Computational Biology Group, Centro de Pesquisa René Rachou, FIOCRUZ, Belo Horizonte, Minas Gerais, BrazilSearch for more papers by this authorS. M. REZENDE, S. M. REZENDE Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, BrazilSearch for more papers by this author S. F. PIO, S. F. PIO Fundação Hospitalar do Estado de Minas Gerais (FHEMIG), Belo Horizonte, Minas Gerais, BrazilSearch for more papers by this authorC. MÜHLE, C. MÜHLE Department of Psychiatry and Psychotherapy, University of Erlangen-Nuernberg, Germany and Department of Pediatrics, Medical University of Innsbruck, AustriaSearch for more papers by this authorG. C. DE OLIVEIRA, G. C. DE OLIVEIRA CEBio and Genomics and Computational Biology Group, Centro de Pesquisa René Rachou, FIOCRUZ, Belo Horizonte, Minas Gerais, BrazilSearch for more papers by this authorS. M. REZENDE, S. M. REZENDE Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, BrazilSearch for more papers by this author First published: 22 September 2010 https://doi.org/10.1111/j.1365-2516.2010.02392.xCitations: 2 Suely Meireles Rezende, Faculdade de Medicina, Universidade Federal de Minas Gerais, Avenida Alfredo Balena, 190 – 2nd floor – room 243, ZIP 30130-110, Belo Horizonte – Minas Gerais – Brazil.Tel./fax: +55 31 34099746/45;e-mail: [email protected] Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article.Citing Literature Volume17, Issue2March 2011Pages 313-314 RelatedInformation

ABSTRACTBackground: Visceral leishmaniasis (VL) is a public health problem and is a relevant cause of death in developing countries. This study aimed to evaluate the 20-year survival and predictors of worse prognosis in patients with VL admitted to a reference hospital for the treatment of infectious diseases between 1995 and 2016 in northern Minas Gerais, an area of high endemicity for VL. Methods: This retrospective cohort study was conducted at a hospital in northern Minas Gerais, Brazil. All patients with VL were evaluated over a 20-year period. The medical records were thoroughly analyzed. Cox regression analysis was performed to estimate factors associated with the probability of survival. Results: The cohort included 972 individuals, mostly male children <10 years old, from urban areas who presented at admission with the classic triad of fever, hepatosplenomegaly, and skin pallor. The mean hemoglobin level was 7.53 mg/dl. The mean interval between symptom onset and hospital admission was 40 days. The instituted therapies ranged from pentavalent antimonates to amphotericin, or both. The probability of survival was reduced to 78% one year after symptom onset. Hemoglobin levels and age were strongly associated with the probability of survival. Conclusions: Regardless of the mechanism underlying the reduction in hemoglobin and the non-modifiable factors of age, early initiation of drug treatment is the most appropriate strategy for increasing survival in patients with VL, which challenges health systems to reduce the interval between the onset of symptoms and hospital admission.

Objetivou-se neste trabalho realizar um balanço sobre a produção científica na área da história da educação que diz respeito ao tema da escolarização no sertão de Minas Gerais, entre o período de 1880 e 1945. A investigação concentrou-se em mapear os trabalhos publicados em quatro revistas acadêmicas especializadas na área, utilizando o descritor “Minas Gerais”. Após as análises, verificou-se o pouco investimento dos pesquisadores nos estudos sobre a história da escolarização no sertão de Minas Gerais. Dessa forma, acredita-se que a história da educação em perspectiva regionalizada pode vir a subsidiar descobertas já existentes que tracem um itinerário global e nacional sobre os objetos investigados, bem como contribuir para novas descobertas na área.

We performed a systematic review of the literature to investigate the efficacy and safety of pentamidine isethionate for the treatment of human tegumentary and visceral leishmaniasis. A total of 616 papers were evaluated, and 88 studies reporting data on 3108 cases of leishmaniasis (2082 patients with tegumentary leishmaniasis and 1026 with visceral leishmaniasis) were finally included. The majority of available studies were on New World cutaneous leishmaniasis and visceral leishmaniasis caused by Leishmania donovani. At the same time, few data are available for Old World cutaneous leishmaniasis, mucosal leishmaniasis, and visceral leishmaniasis caused by L. infantum. Pooled cure rate for tegumentary leishmaniasis was 78.8% (CI 95%, 76.9-80.6%) and 92.7% (CI 95%, 88.3-97.1%) according to controlled randomized trial and observational studies and case report and case series respectively. Pooled cure rate for visceral leishmaniasis was 84.8% (CI 95%, 82.6-87.1%) and 90.7% (CI 95%, 84.1-97.3%) according to controlled randomized trial and observational studies and case report and case series, respectively. Comparable cure rate was observed in recurrent and refractory cases of visceral leishmaniasis. Concerning the safety profile, among about 2000 treated subjects with some available information, the most relevant side effects were six cases of arrhythmia (including four cases of fatal ventricular fibrillation), 20 cases of irreversible diabetes, 26 cases of muscular aseptic abscess following intramuscular administration. Pentamidine isethionate is associated with a similar cure rate of the first-line anti-leishmanial drugs. Severe and irreversible adverse effect appear to be rare. The drug may still have a role in the treatment of any form of human leishmaniasis when the first-line option has failed or in patients who cannot tolerate other drugs also in the setting of travel medicine. In difficult cases, the drug can also be considered as a component of a combination treatment regimen.

Objectives To describe the clinical and epidemiological characteristics and analyze factors associated with deaths due to visceral leishmaniasis among children at a hospital in the southwest of Maranhão state. Methods This was a cross-sectional study conducted in Imperatriz, Maranhão, based on case reporting forms held on the Notifiable Health Conditions Information System provided by the Regional Epidemiological Surveillance and Disease Control Center. The study included all records of visceral leishmaniasis cases in children admitted to a pediatric referral hospital in Imperatriz between 2010 and 2021. Data were analyzed using descriptive statistics, determining absolute and relative values of the variables investigated. Odds ratios (OR) and 95% confidence intervals (95%CI) were calculated using univariate and multivariate regression. Results A total of 404 cases of the disease were recorded, of which 43 resulted in death. Of these, the majority were new cases (95.4%), females (53.5%), of mixed race/skin color (65.1%), and resident in the urban zone (60.5%) who presented clinical manifestations such as enlarged spleen (88.4%), skin pallor (86.0%), weight loss (69.8%), edema (60.5%), fever (95.4%), and enlarged liver (51.2%). In the final regression model, living in the rural zone was considered a risk factor (OR 2.96; 95%CI 1.35; 6.50), while being between 1 and 4 years old was a protective factor (OR 0.23; 95%CI 0.11; 0.50) against death from the disease. Conclusion The findings highlighted the need for targeted strategies to improve early diagnosis and management of visceral leishmaniasis, especially in rural areas.

To describe the clinical and epidemiological characteristics and analyze factors associated with deaths due to visceral leishmaniasis among children at a hospital in the southwest of Maranhão state. This was a cross-sectional study conducted in Imperatriz, Maranhão, based on case reporting forms held on the Notifiable Health Conditions Information System provided by the Regional Epidemiological Surveillance and Disease Control Center. The study included all records of visceral leishmaniasis cases in children admitted to a pediatric referral hospital in Imperatriz between 2010 and 2021. Data were analyzed using descriptive statistics, determining absolute and relative values of the variables investigated. Odds ratios (OR) and 95% confidence intervals (95%CI) were calculated using univariate and multivariate regression. A total of 404 cases of the disease were recorded, of which 43 resulted in death. Of these, the majority were new cases (95.4%), females (53.5%), of mixed race/skin color (65.1%), and resident in the urban zone (60.5%) who presented clinical manifestations such as enlarged spleen (88.4%), skin pallor (86.0%), weight loss (69.8%), edema (60.5%), fever (95.4%), and enlarged liver (51.2%). In the final regression model, living in the rural zone was considered a risk factor (OR 2.96; 95%CI 1.35; 6.50), while being between 1 and 4 years old was a protective factor (OR 0.23; 95%CI 0.11; 0.50) against death from the disease. The findings highlighted the need for targeted strategies to improve early diagnosis and management of visceral leishmaniasis, especially in rural areas.

To the Editor: The presence of Kaposi sarcoma and leishmaniasis in the same cutaneous lesion, which has been observed in six cases (1-6), often reveals infection of peritumoral skin (1,3,4) (i.e., within the noninvolved areas immediately surrounding the abnormal portion of the skin biopsy). Subsequent to our previous report (4), we have seen two additional instances of leishmaniasis in perineoplastic dermis of Kaposi's sarcoma. A similar situation was described in the letter of Abajo et al. In contrast, the presence of Leishmania in clinically uninvolved skin (i.e., within a biopsy specimen taken distant from lesional skin) of human immunodeficiency virus (HIV)-infected patient with visceral leishmaniasis (VL) has not been looked for. As we mentioned in our article (4), only one patient had Leishmania in such "normal" skin documented with the technique of split-skin smear. However, with this procedure, a sharp distinction cannot be made between simple peripheral blood infestation of the dermis versus actual cutaneous involvement. Since our previous report (4), we have seen one additional case of "silent" leishmaniasis in two normal skin biopsy specimens of a HIV-infected patient with a prolonged fever, who had refused bone marrow aspiration. All cases demonstrating Leishmania in "normal" skin showed an extravascular pattern of infestation. This finding demonstrates, in HIV-infected patients with VL, a widespread involvement of skin by Leishmania, which differs from a simple peripheral blood dissemination. In comparison to bone marrow aspirate, the diagnostic value of peripheral blood smears for discovery of VL in HIV-infected subjects remain low (7). As with both marrow aspiration, normal results on skin biopsy could be useful in confirming the diagnosis of VL. On the other hand, in HIV-infected patients with Mediterranean VL the skin could act as a reservoir of infection and allow human-to-human transmission. Abajo et al. mention a new example of presumed "silent" leishmaniasis (E. F. Dandén, P. Penas, L. Rios, J. Fraga, J. Alvar, A. Garcia-Diez, unpublished observations). Although their report is not yet published, on the basis of their letter, two questions still remain to be answered. First, are their cases best categorized as cutaneous leishmaniasis or VL with a cutaneous involvement? The other unknown is whether or not the biopsy specimens demonstrating the "silent" leishmaniasis were obtained adjacent to or distant from the clinically apparent cutaneous lesion. C. Perrin, M.D. P. Del Giudice, M.D. B. Taillan, M.D. Y. Lefichoux, M.D. JF. Michiels, M.D. Departments of Pathology, Infectious Disease, Internal Medicine, and Parasitology Laboratory; University of Nice; Nice, France

Visceral leishmaniasis (VL) is a severe infectious disease caused by a protozoan parasite: Leishmania donovani in East Africa and the Indian subcontinent and Leishmania infantum in Latin America and the Mediterranean basin. Not all leishmanial infections lead to overt clinical disease, but in those infected persons who do develop the disease, multiplication of the parasite in the reticulo-endothelial system causes prolonged fever, anaemia, hepatosplenomegaly and weight loss. VL is fatal if it is not adequately treated. The drugs currently used to treat VL can have severe side effects and the clinical presentation of VL is not sufficiently specific to guide treatment. Highly accurate (both sensitive and specific), cheap and simple rapid diagnostic tests (RDTs) are therefore crucial for case-management of VL. Early case detection followed by adequate treatment is also central to control of VL because, as yet, no vaccine is available and the long-term impact of vector control is unclear. Although the need for accurate VL diagnostics is obvious, innovation in this field has been slow. Since the 1980s, the main objective of VL diagnostics development has been to replace the direct demonstration of parasites in tissue smears, a technique that is invasive and requires considerable expertise, by a ‘field test’ that is more appropriate for use in a VL-endemic context. Several serological tests have been developed, but none are specific for VL disease as such, although they have proved useful in combination with a clinical case definition. New diagnostic tools are needed for more than just the confirmation of VL disease. No alternatives to parasitological methods are yet available to establish test of cure in treated VL patients. Clinicians do not have the tools to distinguish re-infection from relapse in cases of recurrence, and control programmes do not have validated assays for the surveillance of drug resistance in parasites. Furthermore, in the context of the VL elimination initiative, it would be desirable to have better markers of leishmanial infection at the population level. Any evaluation of a new diagnostic device should carefully identify its intended purpose. Too often developers and researchers confuse a device for the detection of leishmanial infection with a device for the confirmation of VL disease, and this is particularly the case for nucleic-acidbased assays. PCR is usually highly sensitive for detection of leishmanial infection, but this does not mean PCR will be useful for the confirmation of acute VL disease in patients in endemic areas, as many carriers of the infection in these areas will be PCRpositive without developing VL disease. This article will focus specifically on the evaluation of RDTs for confirmation of VL disease.

IntroductionProlonged fever occurs with infectious and noninfectious diseases but is poorly studied in intensive care units. The aims of this prospective multicenter noninterventional study were to determine the incidence and etiologies of prolonged fever in critically ill patients and to compare outcomes for prolonged fever and short-lasting fever.MethodsThe study involved two periods of 2 months each, with 507 patients hospitalized ≥ 24 hours. Fever was defined by at least one episode of temperature ≥ 38.3°C, and prolonged fever, as lasting > 5 days. Backward stepwise logistic regression was performed to identify the independent factors associated with prolonged fever versus short-lasting fever.ResultsProlonged or short-lasting fever occurred in 87 (17%) and 278 (55%) patients, respectively. Infectious and noninfectious causes were found in 54 (62%) and 27 (31%) of 87 patients, respectively; in six patients (7%), prolonged fever remained unexplained. The two most common sites of infection were ventilator-associated pneumonia (n = 25) and intraabdominal infection (n = 13). Noninfectious fever (n = 27) was neurogenic in 19 (70%) patients and mainly associated with cerebral injury (84%). Independent risk factors for prolonged fever were cerebral injury at admission (OR = 5.03; 95% CI, 2.51 to 10.06), severe sepsis (OR = 2.79; 95% CI, 1.35 to 5.79), number of infections (OR = 2.35; 95% CI, 1.43 to 3.86), and mechanical-ventilation duration (OR = 1.05; 95% CI, 1.01 to 1.09). Older patients were less likely to develop prolonged fever. ICU mortality did not differ between the two groups.ConclusionsProlonged fever was common, mainly due to severe infections, particularly ventilator-associated pneumonia, and mixed infectious causes were frequent, warranting systematic and careful search for multiple causes. Neurogenic fever was also especially frequent.

Efficacy and safety of single-dose liposomal amphotericin B for visceral leishmaniasis in a rural public hospital in Bangladesh: a feasibility study.

A Secretaria de Estado de Saúde de Minas Gerais (SES/MG), em parceria com o Programa Nacional de Gestão de Custos do Ministério da Saúde, implantou o Projeto OtimizaSUS, parte do Programa Valora Minas. Esse projeto ofereceu suporte técnico e financeiro a 145 hospitais em Minas Gerais para promover a gestão de custos conforme as diretrizes do Ministério da Saúde. O estudo qualitativo realizado analisou os benefícios, desafios e estratégias utilizados para a implantação do sistema de gestão de custos em hospitais de Minas Gerais. Entre os benefícios, destacam-se a melhor compreensão dos custos hospitalares, otimização na distribuição de recursos e estímulo à adoção de práticas mais eficazes. A SES/MG adotou estratégias como a implantação em fases do OtimizaSUS, segmentação dos hospitais, contratação de profissionais especializados e colaboração com a Fundação Hospitalar do Estado de Minas Gerais (FHEMIG). No entanto, enfrentou desafios, como a necessidade de adesão de autoridades e hospitais ao sistema, a adequação de diferentes sistemas de gestão de custos, e a manutenção e aprimoramento contínuos do programa. Em resumo, a iniciativa demonstrou ser uma ferramenta valiosa para aprimorar a gestão de custos e otimizar o uso de recursos no sistema de saúde de Minas Gerais.