Brazilian Medical Centers Research Articles

Lacrimal Gland Involvement in Blepharophimosis-Ptosis-Epicanthus Inversus Syndrome

To describe the involvement of the lacrimal gland (LG) in blepharophimosis-ptosis-epicanthus inversus syndrome (BPES). Observational, cross-sectional study. Twenty-one patients with BPES (10 female, 11 male) aged on average 15 years (range, 2-39years), from 3 Brazilian medical centers and 1 Portuguese medical center. Patients had their ocular surface evaluated with slit-lamp biomicroscopy, and tear production quantified with the Schirmer test I. The LG volumes were measured on computed tomography (CT) scans in the BPES sample and in a group of age-matched subjects imaged for nonorbital diseases. Sixteen patients were screened for mutations in the FOXL2 gene. Lacrimal meniscus height, Schirmer test I, presence of superficial punctate keratopathy (SPK), LG volume, and molecular analysis of the FOXL2 gene. Absence of LG was detected bilaterally in 9 patients (42.8%) and unilaterally in 2 patients (9.5%). When considering only patients with measurable LG, the median volume was 0.22 cm3 in the right eye (range, 0.06-0.36 cm3) and 0.24 cm3 in the left eye (range, 0.08-0.34 cm3). These values were significantly lower than those for the age-matched controls (median= 0.54 right eye and 0.53 left eye; P < 0.05). There was a significant association between deficiency of tear production and LG volume reduction and agenesis. Molecular analysis of the FOXL2 gene revealed the presence of 8 distinct mutations, 4 of them novel ones. A significant reduction of LG size or agenesis was associated with mutations affecting protein size (due to underlying changes in the stop codon location) or the DNA-binding forkhead domain (Fisher exact test, P= 0.021). In 3 probands, the underlying genetic defect was not found. This is the first study reporting LG volumes in BPES, describing a significant number of patients with LG agenesis. The association between alacrima and BPES is not incidental, and a thorough evaluation of tear production is recommended especially if ptosis surgery is planned.

Systemic sclerosis and silica exposure: a rare association in a large Brazilian cohort.

The objective of this study is to describe the characteristics of patients with Erasmus syndrome (ES) in a large SSc Brazilian cohort. Nine hundred and forty-seven SSc patients attended at the Scleroderma Outpatient Clinic at two academic medical centers in Brazil and classified as SSc according to the ACR/EULAR criteria were retrospectively studied. Information on demographics, clinical, and laboratory features was obtained by chart review. ES patients had their HLA class II characterized by PCR-SSO method as available. Among the 947 SSc patients studied, nine (0.9 %) had ES. These ES patients were predominantly male (78 %) and smokers (68 %) and presented diffuse SSc (67 %). Mean time of occupational exposure to silica was 13.7 years, with mean age at onset of 47 years. Previous history of tuberculosis was referred by 33 % of the ES patients. All the ES patients presented Raynaud's phenomenon, esophageal involvement, and interstitial lung disease (ILD). Antinuclear antibodies were present in all the ES patients, while anti-topoisomerase I was positive in 44 % and no patient had anticentromere antibody. Three different HLA-DQB alleles (0506, 0305, and 0303) were observed. Compared to non-ES cases, patients with ES were associated with male gender (p < 0.001), diffuse SSc (p < 0.05), ILD (p < 0.05), positive anti-topoisomerase I antibodies (p < 0.05), and death (p < 0.05). Multivariate analysis did not confirm that silicosis is an independent risk factor for SSc. To conclude, ES was rare in this large SSc cohort, although associated with a bad prognosis.

Factors Associated with Metabolic Syndrome in Middle-aged Women with and without HIV

Metabolic Syndrome is associated with an increased risk of cardiovascular disease, increases after menopause and it is probably more frequent in HIV women. Objective: To assess MetS and associated factors in HIV seropositive and seronegative middle-aged women. Methods: Cross-sectional study with 537 women (273 HIV seropositive and 264 HIV seronegative), between 40 and 60 years’ old receiving follow-up care in two medical centers in Brazil. MetS was diagnosed based on IDF criteria. Sociodemographic, clinical, and behavioral factors were evaluated. Results: The prevalence of MetS in the HIV group was 46.9% and 42.2% in the seronegative group (P=0.340). Multiple regression analysis showed MetS association with body mass index (BMI)>25 kg/m² (PR=2.34; 95% CI: 1.70- 3.21; P<0.001), aging (PR: 0.05, 95% CI: 1.02-1.07; P<0.001), and the use of highly active retroviral therapy (HAART) (PR: 1.48; 95% CI: 1.13-1.94; P=0.005). Conclusions: There was no association between MetS and HIV status overall. Although HAART was associated with MetS, it seems that HIV-positive women in good immunological status, after early institution of HAART and its effective use, have traditional factors associated with MetS like being overweight and having older age.

Single-Port Laparoscopy as a Feasible Technique to Approach Benign Adnexal Mass Surgically

Abstract Background: Single-incision laparoscopic surgery (SILS) was developed with the aim of reducing the invasiveness of conventional laparoscopy (ranging from 3–5 incisions). Objective: The aim of this research was to evaluate surgical findings, postoperative features, and complications in a series of 64 cases of benign adnexal mass that was approached in each case with single incision laparoscopic surgery (SILS). Materials and Methods: In a tertiary medical center in Brazil, 64 patients with presurgery diagnoses of benign adnexal masses underwent laparoscopic surgery using the SILS technique. Each patient's adnexal mass was presumed to be benign, based on each patient's echography features, patient's age, C-125 level, and menopausal status. Results: Hystologic results of all the recruited patients showed benign lesions. Benign cysts (28; 43,8%), solid teratomas (10; 15,6%), and endometriosis (8; 12,5%) were the most prevalent results. There was 1 case of an incisional hernia, the only postoperative c...

Single-Port Laparoscopy as a Feasible Technique to Approach Benign Adnexal Mass Surgically

Abstract Background: Single-incision laparoscopic surgery (SILS) was developed with the aim of reducing the invasiveness of conventional laparoscopy (ranging from 3–5 incisions). Objective: The aim of this research was to evaluate surgical findings, postoperative features, and complications in a series of 64 cases of benign adnexal mass that was approached in each case with single incision laparoscopic surgery (SILS). Materials and Methods: In a tertiary medical center in Brazil, 64 patients with presurgery diagnoses of benign adnexal masses underwent laparoscopic surgery using the SILS technique. Each patient's adnexal mass was presumed to be benign, based on each patient's echography features, patient's age, C-125 level, and menopausal status. Results: Hystologic results of all the recruited patients showed benign lesions. Benign cysts (28; 43,8%), solid teratomas (10; 15,6%), and endometriosis (8; 12,5%) were the most prevalent results. There was 1 case of an incisional hernia, the only postoperative c...

Interventional radiology and endovascular surgery in the treatment of ectopic pregnancies.

The advent of interventional radiology enabled remarkable advances in diagnosis and treatment of several situations in obstetrics and gynecology. In the field of obstetrics, these advances include temporary occlusion of the iliac arteries to the management of placenta accreta and/or prior, arteriovenous fistulas after embolization of uterine curettage and management of ectopic uterine and extra-uterine pregnancies. The non-tubal ectopic pregnancy, either cervical, abdominal, ovarian or in a cesarean scar, often represents major therapeutic challenge, especially when exists a desire to maintain fertility. Despite the systemic methotrexate therapy and surgical resection of the ectopic gestational sac be the most used therapeutic options, the interventionist approach of non-tubal ectopic pregnancies, direct injection of methotrexate in the gestational sac and intra-arterial chemoembolization of uterine arteries constitute in the currently literature viable, safe, effective modalities with low morbidity, shorter hospital stay, and rapid clinical recovery. Because of little variety of materials used, and the increase in training of specialists in the area, the radiological intervention as a treatment option in ectopic pregnancies is financially viable and present considerable accessibility in the world and at most of Brazilian medical centers.

Cryptic and rare Aspergillus species in Brazil: prevalence in clinical samples and in vitro susceptibility to triazoles.

Aspergillus spp. are among the most common causes of opportunistic invasive fungal infections in tertiary care hospitals. Little is known about the prevalence and in vitro susceptibility of Aspergillus species in Latin America, because there are few medical centers able to perform accurate identification at the species level. The purpose of this study was to analyze the distribution of cryptic and rare Aspergillus species among clinical samples from 133 patients with suspected aspergillosis admitted in 12 medical centers in Brazil and to analyze the in vitro activity of different antifungal drugs. The identification of Aspergillus species was performed based on a polyphasic approach, as well as sequencing analysis of the internal transcribed spacer (ITS) region, calmodulin, and β-tubulin genes and phylogenetic analysis when necessary. The in vitro susceptibility tests with voriconazole, posaconazole, and itraconazole were performed according to the CLSI M38-A2 document (2008). We demonstrated a high prevalence of cryptic species causing human infection. Only three isolates, representing the species Aspergillus thermomutatus, A. ochraceus, and A. calidoustus, showed less in vitro susceptibility to at least one of the triazoles tested. Accurate identifications of Aspergillus at the species level and with in vitro susceptibility tests are important because some species may present unique resistance patterns against specific antifungal drugs.

Outcomes of Breast Cancer in Brazil Related to Health Care Coverage: A Retrospective Cohort Study

Breast cancer is the most common malignancy in women in Brazil. Differences between patients with public versus private healthcare coverage about general characteristics, disease presentation, treatment of primary tumors, and clinical outcomes have not been fully investigated. A national, retrospective cohort of 3,142 patients drawn from a representative sample of Brazilian medical centers was selected. Clinical and demographic data and type of healthcare coverage were retrieved by chart review. Groups were compared using the χ(2) test. The log-rank test was used for comparison of disease-free survival (DFS), postrelapse, and overall survival (OS). Multivariate Cox regression modeling with adjustment for patient characteristics and stage at diagnosis was performed. All P values are two sided. Patients with public health coverage presented with more advanced disease at diagnosis (P < 0.001). DFS and OS for patients presenting with stage 0-II disease did not differ according to the type of healthcare coverage, whereas a significant difference in outcomes was seen for stage III-IV patients (P = 0.002 and P = 0.008, respectively). In a Cox multivariate analysis, no association was found for the type of health coverage with either DFS or OS, but there was an association for postrelapse survival (P < 0.001). In Brazil, patients with breast cancer with public health coverage present with more advanced disease, and this possibly explains worse DFS and OS when compared with those with private coverage. Earlier diagnosis and treatment of breast cancer could improve outcomes of women with public health coverage in Brazil.

Prolonged respiratory viral shedding in transplant patients

Respiratory viral infections are frequent causes of morbidity in transplant patients. We screened symptomatic adult transplant recipients for respiratory viruses in a cohort of patients attending a referral medical center in Brazil. The duration of viral shedding and the prevalence of viral codetections were also determined. During a 1‐year period (2011–2012), swabs were obtained from 50 patients. An in‐house polymerase chain reaction panel designed to detect 10 viruses was used. Viruses were identified in 19 (38%) patients, particularly parainfluenza III (32%) and the respiratory syncytial virus (20%); multiple viruses were identified in 26% of patients. Prolonged viral shedding was observed with 60% of individuals excreting viruses for >10 days. The clinical and epidemiologic relevance of prolonged viral shedding remains to be determined.

Antimicrobial activity of doripenem against Gram-negative pathogens: results from INVITA-A-DORI Brazilian study

In vitro activity of doripenem and comparator antimicrobial agents was evaluated against Gram-negative bacilli recently isolated from Brazilian private hospitals that were enrolled in the INVITA-A-DORI Brazilian Study. A total of 805 unique Gram-negative bacilli were collected from patients hospitalized at 18 medical centers between May/08 and March/09. Each hospital was asked to submit 50 single Gram-negative bacilli isolated from blood, lower respiratory tract or intraabdominal secretions. Bacterial identification was confirmed and antimicrobial susceptibility testing was performed using Clinical Laboratory Standards Institute (CLSI) microdilution method at a central laboratory. CLSI M100-S21 (2011) or US-FDA package insert criteria (tigecycline) was used for interpretation of the antimicrobial susceptibility results. Doripenem was as active as meropenem and more active than imipenem against E. coli and K. pneumoniae isolates. A total of 50.0% of Enterobacter spp. isolates were resistant to ceftazidime but 85.7% of them were inhibited at doripenem MICs < 1 µg/mL. Polymyxin B was the only agent to show potent activity against Acinetobacter spp. (MIC50/90, < 0.5/1 µg/mL) and P. aeruginosa (MIC50/90, 1/2 µg/mL). Although high rates of imipenem (53.1%) and meropenem (44.5%) resistance were detected among P. aeruginosa, doripenem showed MIC50 of 16 µg/mL against imipenem-resistant P. aeruginosa and inhibited a greater number of imipenem-resistant P. aeruginosa (10.5%) at MIC values of < 4 µg/mL than did meropenem (0.0%). In this study, doripenem showed similar in vitro activity to that of meropenem and retained some activity against imipenem-resistant P. aeruginosa isolated from Brazilian medical centers.

Antimicrobial activity of doripenem against Gram-negative pathogens: results from INVITA-A-DORI Brazilian Study

In vitro activity of doripenem and comparator antimicrobial agents was evaluated against Gram-negative bacilli recently isolated from Brazilian private hospitals that were enrolled in the INVITA-A-DORI Brazilian Study. A total of 805 unique Gram-negative bacilli were collected from patients hospitalized at 18 medical centers between May/08 and March/09. Each hospital was asked to submit 50 single Gram-negative bacilli isolated from blood, lower respiratory tract or intraabdominal secretions. Bacterial identification was confirmed and antimicrobial susceptibility testing was performed using Clinical Laboratory Standards Institute (CLSI) microdilution method at a central laboratory. CLSI M100-S21 (2011) or US-FDA package insert criteria (tigecycline) was used for interpretation of the antimicrobial susceptibility results. Doripenem was as active as meropenem and more active than imipenem against E. coli and K. pneumoniae isolates. A total of 50.0% of Enterobacter spp. isolates were resistant to ceftazidime but 85.7% of them were inhibited at doripenem MICs≤1μg/mL. Polymyxin B was the only agent to show potent activity against Acinetobacter spp. (MIC50/90,≤0.5/1μg/mL) and P. aeruginosa (MIC50/90, 1/2μg/mL). Although high rates of imipenem (53.1%) and meropenem (44.5%) resistance were detected among P. aeruginosa, doripenem showed MIC50 of 16μg/mL against imipenem-resistant P. aeruginosa and inhibited a greater number of imipenem-resistant P. aeruginosa (10.5%) at MIC values of≤4μg/mL than did meropenem (0.0%). In this study, doripenem showed similar in vitro activity to that of meropenem and retained some activity against imipenem-resistant P. aeruginosa isolated from Brazilian medical centers.

Mucopolysaccharidosis I, II, and VI: Brief review and guidelines for treatment.

Mucopolysaccharidoses (MPS) are rare genetic diseases caused by the deficiency of one of the lysosomal enzymes involved in the glycosaminoglycan (GAG) breakdown pathway. This metabolic block leads to the accumulation of GAG in various organs and tissues of the affected patients, resulting in a multisystemic clinical picture, sometimes including cognitive impairment. Until the beginning of the XXI century, treatment was mainly supportive. Bone marrow transplantation improved the natural course of the disease in some types of MPS, but the morbidity and mortality restricted its use to selected cases. The identification of the genes involved, the new molecular biology tools and the availability of animal models made it possible to develop specific enzyme replacement therapies (ERT) for these diseases. At present, a great number of Brazilian medical centers from all regions of the country have experience with ERT for MPS I, II, and VI, acquired not only through patient treatment but also in clinical trials. Taking the three types of MPS together, over 200 patients have been treated with ERT in our country. This document summarizes the experience of the professionals involved, along with the data available in the international literature, bringing together and harmonizing the information available on the management of these severe and progressive diseases, thus disclosing new prospects for Brazilian patients affected by these conditions.

Antimicrobial Resistance among Gram-Positive Bacteria Isolated in Latin American Hospitals

Antimicrobial resistance patterns of the most frequently isolated Gram-positive bacteria in selected latin American hospitals were evaluated under the auspices of the SENTRY Antimicrobial Surveillance program. The strains were consecutively collected (one per patient) between January 2003 and December 2008 and tested by reference broth microdilution methods at the monitoring central laboratory (JMI laboratories, North Liberty, Iowa, USA). A total of 12,324 Gram-positive cocci were analyzed. The organisms were isolated from bloodstream (53.2%) and skin and skin structure infections (16.4%). Resistance to oxacillin (MRSA) was observed in 40.0% of Staphylococcus aureus, varying from 32.7% in Brazil to 49.7% in Chile. Resistance to erythromycin (90.1%), clindamycin (84.4%), and levofloxacin (86.8%) was very high in MRSA. Vancomycin, linezolid and daptomycin were all very active against S. aureus strains tested (>99.9-100.0% susceptible), but daptomycin (MIC50/90, 0.25/0.5 μg/ml) was four- to eight-fold more potent than three comparators. Vancomycin resistance increased from 5.0% in 2003 to 15.5% in 2008 among enterococci (VRE); the most significant increase occurred among isolates from brazilian medical centers (from 6.9 to 31.1%). Daptomycin was the most active antimicrobial tested against enterococci in general (MIC50/90, 1/2 μg/ml; 100.0% susceptible), followed by linezolid (MIC50/90, 1/2 μg/ml; 99.9% susceptible), teicoplanin (MIC50 and MIC90 of ≤2 μg/ml; 91.3% susceptible), vancomycin (MIC50/90, 1/8 μg/ml; 89.6% susceptible). In summary, daptomycin and linezolid showed excellent in vitro activity against Gram-positive organisms (12,324) collected in latin American hospitals, including MRSA, VRE and other multidrug- resistant organisms.

Antimicrobial susceptibility of gram-positive bacteria isolated in brazilian hospitals participating in the SENTRY Program (2005-2008)

We report the antimicrobial susceptibility patterns of the most frequently isolated Gram-positive bacteria in the Brazilian hospitals participating in the SENTRY Antimicrobial Surveillance Program. The strains were consecutively collected (one per patient) between January 2005 and September 2008 and susceptibility tested by reference broth microdilution methods at the JMI Laboratories (North Liberty, Iowa, USA). A total of 3,907 Gram-positive cocci were analyzed. The Gram-positive organisms most frequently isolated from bloodstream infections were Staphylococcus aureus (2,218 strains; 20.2% of total), coagulase-negative staphylococci (CoNS; 812 strains [14.7%]), and Enterococcus spp. (754 strains; 5.0%). S. aureus ranked first (28.1%) and Enterococcus faecalis ranked 7th (4.5%) among cases of skin and soft tissue infections. S. aureus was also the second most frequently isolated pathogen from patients with lower respiratory tract infections (24.9% of cases) after Pseudomonas aeruginosa (30.5%). Resistance to oxacillin was observed in 31.0% of S. aureus and the vast majority of oxacillin-resistant (MRSA) strains were also resistant to clindamycin, ciprofloxacin and levofloxacin. Vancomycin, linezolid and daptomycin were all very active against S. aureus strains tested (>99.9-100.0% susceptible), but daptomycin (MIC(50), 0.25 g/mL and MIC(90), 0.5 g/mL) was four- to eight-fold more potent than vancomycin (MIC(50) and MIC(90) of 1 g/mL) and linezolid (MIC(50), 1 g/mL and MIC(90), 2 g/mL). Vancomycin resistance increased significantly among enterococci during the study period, but it was restrict to only one medical center until 2007 and emerged in a second medical center in 2008. Daptomycin was the most active antimicrobial tested against enterococci in general (100.0% susceptible), followed by linezolid (99.9% susceptible), ampicillin (87.4%) and vancomycin (84.6%). In conclusion, daptomycin and linezolid showed excellent in vitro activity against contemporary Gram-positive organisms (3,907) collected in Brazilian hospitals monitored by the SENTRY Program, including MRSA, vancomycin-resistant enterococci (VRE) and other multi-drug-resistant organisms. Although vancomycin resistance rates in Brazil appears to be relatively low compared to those reported in the USA, VRE has emerged and rapidly disseminated in some Brazilian medical centers.

Are routine preoperative medical tests needed with cataract surgery? Study of visual acuity outcome

Purpose. The aim of this prospective randomized clinical trial was to investigate whether routine medical testing before cataract surgery reduced the rate of ocular surgical complications and to study its impact on visual acuity outcome. Methods. The study was carried out in an academic medical center in Brazil, at State University of Campinas, between 10 February 2000 and 10 January 2001. The scheduled cataract operations were randomly assigned to one of two groups: 1) to be preceded by routine medical testing (the “routine-testing group”) or 2) not to be preceded by routine medical testing (the “selective-testing group”). If the patient was assigned to the selective-testing group, it was requested that no preoperative testing be performed unless the patient presented with a new or worsening medical problem that would warrant medical evaluation with testing. In the case of patients assigned to the routine-testing group, three tests were requested: a 12-lead electrocardiogram, a complete blood count, and measurements of serum glucose. Ocular surgical complications, preoperative and postoperative best-corrected visual acuity were recorded on a standardized form. Results. The sample of 1025 patients scheduled to undergo cataract surgery was comprised of 512 assigned to the routine-testing group and of 513 assigned to the selective-testing group. The two groups had similar proportions of operations canceled and not subsequently rescheduled, 2% in each group. The cumulative rate of ocular surgical complications was similar in the two groups, 20.5% in the routine-testing group and 19.3% in the selective-testing group (p = 0.624). The preoperative and the postoperative best-corrected visual acuity were similar in both groups (p = 0.999 in the former and p = 0.664 in the latter). Conclusions. The results of this study suggest that routine medical testing before cataract surgery did not reduce the rate of ocular surgical complications and did not influence visual acuity outcome.

Predictive value of preoperative tests in facectomy

To establish the prevalence of abnormal results in routine preoperative tests prior to facectomies and whether they influence the occurrence of perioperative clinical complications. This prospective study was developed in an academic medical center in Brazil. Besides a clinical evaluation, all patients were requested to undergo an electrocardiogram, complete blood work and fasting blood glucose test. Patients younger than 40 years of age who had had previous eye surgery, candidates for general anesthesia or who had suffered acute myocardial infarction up to three months before surgery were excluded from the study. Intraoperative medical events were recorded in a protocol form. Analysis was carried out using Fisher's test and ANOVA (analysis of variance). The sample was composed of 746 patients, 405 (54.3%) were men. The average age was 66.6+/-11.6 years. Intraoperative complications occurred in 71 (9.5%) patients. There were abnormal results in 13.5% (101 patients) of hemoglobin dosages and in 16.6% (124) of fasting blood glucose. As for electrocardiograms, abnormalities were found in 46.6% (348) of the subjects. There was a higher prevalence of electrocardiograms with abnormal values in patients who had perioperative clinical complications (p=0.02). There were no statistically significant differences between hemoglobin dosages (14.0+/-1.6 g/dL in patients without intraoperative complications and 14.3+/-1.3 g/dL in patients with complications - p=0.150) and fasting blood glucose (104+/-29 mg/dL in patients without complications and 105+/-41 mg/dL in patients with complications - p=0.850). Within the investigated routine of preoperative testing for facectomy, only the abnormal electrocardiogram results influenced the occurrence of complications in the perioperative period.

In vitro antimicrobial activity of the aminoglycoside arbekacin tested against oxacillin-resistant Staphylococcus aureus isolated in Brazilian hospitals.

Arbekacin is an aminoglycoside used in Japan for treating infections caused by gentamicin and oxacillin-resistant S. aureus (ORSA). The objective of this study was to determine the in vitro antimicrobial activity of arbekacin against 454 clinical isolates of ORSA. The isolates were consecutively collected between January and July, 2000, from patients hospitalized in 8 Brazilian medical centers. The antimicrobial susceptibility testing was performed by disk diffusion method according to NCCLS recommendations. The vast majority of the isolates, 453 strains (99.8%), were considered susceptible to arbekacin based on the criteria proposed by the Requirements for Antibiotic Products of Japan. Only 1 isolate (0.2%) was classified as resistant. On the other hand, high rates of resistance were demonstrated for other aminoglycosides, such as gentamicin (97.6% resistance) and amikacin (97.0% resistance). Resistance rate was also high for ciprofloxacin (98.0%). All isolates were considered susceptible to vancomycin. The excellent in vitro antimicrobial activity of arbekacin demonstrated in this study indicates that this antimicrobial agent may play an important role in the treatment of severe ORSA infections, especially those that show poor clinical response with vancomycin monotherapy. Since the aminoglycosides should not be used as monotherapy to treat Gram positive infections, further studies evaluating in vitro and in vivo synergistic activity of arbekacin combinations are necessary to clarify the clinical role of this aminoglycoside.

Fatores de risco para infarto do miocárdio no Brasil: estudo FRICAS

To determine risk factors related to acute myocardial infarction (AMI) in Brazil. Five hundred ninety one patients were selected in 20 medical centers in Brazil, between January/94 and March/95. Two-hundred-ninety-nine patients were cases, and 292 controls with a variety of acute diseases not related to the suspected or known risk factors for acute myocardial infarction. All data were collected through a structured questionnaire filled by the patients. The evaluation of the variables was done through univariate analysis with a significance level of 5%. The factors related to acute myocardial infarction were respectively to cases and controls: Hypercholesterolemia--210.93 +/- 46.74 mg/dl and 185.71 +/- 45.45 mg/dl, (p = 0.000); smoking--41.69% and 27.20% (p = 0.000); hypertension--52.35% and 20.88% (p = 0.000); diabetes--19.70% and 9.93% (p = 0.001); family history--related to the patient's father in 42.14% and 33.22% (p = 0.025) and to the mother in 42.14% and 30.82% (p = 0.007); socioeconomic level--88.99% and 60.20% owned house (p = 0.002); 44.45% and 33.21% owned car (p = 0.010); physical activity--56.83% and 48.28% had the habit of walking in the year prior to study entry (p = 0.029); diet--38.79% and 28.42% consumed canned food (p = 0.013). The mean weight was 72.50 +/- 26.89 kg and 69 +/- 12.26 kg (p = 0.0271). The mean height was 166.56 +/- 8.81 cm and 166.66 +/- 8.47 cm. This study confirmed the importance of hypercholesterolemia, hypertension, diabetes mellitus, overweight and family history as risk factors for acute myocardial infarction. There was a significant relation between socioeconomic level and the prevalence of acute myocardial infarction.

In vitro susceptibility to a new antimicrobial agent (imipenem) of pathogens isolated from inpatients at various centers

Imipenem is a beta lactam antibiotic, a highly potent new carbapenem with broad antibacterial spectrum. To test the "in vitro" efficacy of this antimicrobial agent in pathogens more frequent in several Medical Centers in Brazil, susceptibility testing with 10 mcg imipenem disks and, or corresponding MIC were carried out with 1231 recent isolates of 41 different bacterial species, obtained mainly from hospitalized patients in 5 different medical centers of the cities of S. Paulo, Rio de Janeiro and Salvador. Our preliminary results with this antibiotic, in final phases of clinical and laboratorial experimentation in this country, are very promissing with, 96.79% of susceptibility of test isolates to 10 mcg imipenem disks and corresponding MIC correlation of up to 4 micrograms/ml. (92.31%). Of the 9 bacterial species more frequently isolated totaling 1108 (82%) of the 1230 test isolates, disk susceptibility was 99% (E. coli), 93% (Pseudomonas aeruginosas), 87% (Staphylococcus aureus), 100% (Klebsiella pneumoniae), 98% (Klebsiella sp), 97% (Proteus mirabiles), 94% (Enterobacter sp), 100% (Streptococcus faecalis) with good MIC correlation (up to 8 mcg/ml) and 100% for the anaerobic species Bacteroides sp (MIC up to 4 micrograms/ml). "In vitro" efficacy to hospital pathogens with high frequency of resistance to most antibiotics as Pseudomonas aeruginosa and to anaerobes notably Bacteroides sp is emphasized.

Lomefloxacin activity against 2,813 clinical isolates: A collaborative study at three medical centers in Brazil

The in vitro activity of lomefloxacin was compared to norfloxacin and two parenteral drugs against 2,813 clinical isolates at three medical centers in Brazil. Considering MICs ⩽4 μg/ml as the criterion, lomefloxacin inhibited 97.9% of all enterobacteriaceae, 100% of staphylococci, 100% of Neisseria gonorrhoeae, 100% of Campylobacter pylori, 81% of Pseudomonas aruginosa, and 79% of Streptococcus spp. Norfloxacin was generally comparable in potency and spectrum, but cefotaxime and gentamicin were less effective because of high-resistance prevalence in some species. The highest rates of fluoro-quinolone resistance among the Enterobacteriaceae were in the Proteus-Providencia group of species.