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A Castelo

Publications and source records attributed to A Castelo.

At least 37 records · Page 2Linked to original sources
PubMed1996

Monovalent latex agglutination reagents for the diagnosis of nonmeningitic pneumococcal infection.

The pneumococcus is a leading cause of serious bacterial infection worldwide. Given the difficulties with available assays for the diagnosis of invasive nonmeningitic pneumococcal infection, we evaluated monovalent slide latex agglutination reagents among patients with blood culture-confirmed pneumococcal infection and control patients in Baltimore, Maryland, USA; São Paulo, Brazil; and Cairo, Egypt. Among 50 patients with invasive nonmeningitic pneumococcal infection, 23 had a positive urine test for a sensitivity of 46% (95% confidence intervals of 32% and 61%). Among 39 healthy children, 36 had a negative assay, for a specificity of 92% (95% confidence intervals of 78% and 98%). Among 80 children with pneumonia without a positive blood culture for Streptococcus pneumoniae, the specificity was 88% (95% confidence intervals of 78% and 94%). Although the assay was fairly specific, the positive predictive value using optimistic assumptions was only 73%-83%. This study suggests that this assay has a sensitivity and positive predictive value that may limit its value in some settings.

Child, Preschool↗
PubMed1995

Cost effectiveness of antituberculosis interventions.

The treatment of tuberculosis (TB) is ranked as the most cost effective of all therapeutic programmes in terms of cost per year of life saved. Nevertheless, TB kills or debilitates more adults aged between 15 and 59 years than any other disease in the world; furthermore, about 2 to 4% of the burden of disease, 7% of all deaths and 26% of all preventable deaths are directly attributable to TB. About one-third of the world's population is infected with the TB bacillus. In the developing world, more women of childbearing age die from TB than from causes directly associated with pregnancy and childbirth. The death of adults in their prime, who are parents, community leaders and producers in most societies, causes a particularly onerous burden besides being a serious public health problem. In the poorest countries, where the magnitude of the TB problem is greatest, those TB control strategies that are economically feasible tend to be less effective. Therefore, in low and middle income countries, cost-effectiveness considerations aimed at prioritising resource allocation in the health sector in general, and in TB control programmes in particular, are of paramount importance. Operationally, the main components of a TB control programme are: (i) detection and treatment of TB; and (ii) prevention of TB through BCG vaccination and chemoprophylaxis. Priority should be given to ensuring that TB patients complete their prescribed course of chemotherapy. Adequate treatment is the most effective way of preventing the spread of TB and the emergence of drug resistance. This article reviews evidence of the effectiveness and cost effectiveness of different approaches to TB care, particularly those that are applicable to low income countries, in both HIV-infected and noninfected patients. Financial implications and ways to implement directly observed therapy for TB in large urban areas are discussed, and the need to address some relevant operational issues is highlighted. The current role of chemoprophylaxis and BCG vaccination is also reviewed.

AIDS-Related Opportunistic Infections↗
PubMed1993

Benign prostatic hypertrophy treatment by transurethral radiofrequency hyperthermia with Thermex II.

We selected 50 patients with benign prostatic hyperplasia to be treated with hyperthermia at 44.5 degrees C. The treatment was performed with Thermex II. We excluded from this study all patients with a suspicion of prostatic adenocarcinoma or other previous surgical intervention on the prostate and we also excluded patients with pacemakers or coagulation problems. The follow-up time for these patients was 6 months. They were all evaluated by flow rate, measurement of postmicturation residue. Madsen score and transrectal sonography at 1, 3 and 6 months. We did not notice any modification of the prostatic volume, no modification of the urine residue but a moderate improvement of the flow rate. A significant improvement was observed on the symptom score since subjective symptoms were seen in 68% of the patients. Our results show that this method of treatment seems to compete with other classic medical treatments especially in the case of patients with a prostatic adenoma equal or smaller than 40 g and that hyperthermia is particularly active on irritative symptoms but does not compete with classic surgical procedures.

Aged↗
PubMed1992

Quantitation of red cell-bound IgG by an enzyme-linked antiglobulin test in human immunodeficiency virus-infected persons.

Anemia, thrombocytopenia, and neutropenia have been observed in patients with acquired immune deficiency syndrome (AIDS) and AIDS-related complex. To investigate whether red cells (RBCs) of patients with human immunodeficiency virus infection were coated with IgG and/or complement (C3), blood samples of 239 patients were tested. The prevalence of a positive direct antiglobulin test on RBCs was 16.7 percent. By use of an enzyme-linked antiglobulin test (ELAT) to measure more accurately the number of IgG molecules per RBC in a group of 67 patients, 30 of the 67 individuals were observed to have increased numbers (mean, 155) compared to normal controls and to patients with hypergammaglobulinemia due to multiple myeloma or chronic liver disease. Hemoglobin level was correlated with the number of IgG molecules per RBC (p = 0.008), but no correlation could be demonstrated between those numbers and serum immunoglobulin (p = 0.10) or circulating immune complexes (p = 0.38). Our results with ELAT suggest that some AIDS patients may have specific binding of IgG on the surface of their RBCs, rather than nonspecific uptake; further clinical correlations are necessary to confirm these findings.

Brazil↗
PubMed1991

Production and marketing of drugs in Brazil.

Brazil is typical of many developing countries in its struggle to provide basic healthcare for its citizens in face of national economic instability. Since pharmaceuticals represent a major component of modern healthcare, their production, regulation and use become an area of concern. It appears that any change in the current production patterns will require a major commitment from governments, understanding external economic pressures. There are pros and cons in a policy directed towards pharmaceutical self-sufficiency. Aside from production, efforts directed towards extending access to essential drugs and improving the appropriateness of use, would appear to be warranted.

Anti-Bacterial Agents↗
PubMed1990

Muscle biopsy in AIDS and ARC: analysis of 50 patients.

We report a large spectrum of histological muscle abnormalities in 50 homosexual men with AIDS and ARC. We encountered moth-eaten fibers in 76%, angulated fibers in 76%, type groupings in 62%, type 2 fiber atrophy in 58%, mononuclear endomysial and/or perimysial and/or perivascular infiltrates in 36%, necrosis and phagocytosis in 30% and target fibers in 6%. Two patients showed vasculitis and two others showed perifascicular atrophy. On the whole, 96% of the biopsies showed substantial abnormalities. Muscle involvement in AIDS seems more common than previously suspected.

AIDS-Related Complex↗
PubMed1989

Comparison of daily and twice-weekly regimens to treat pulmonary tuberculosis.

A randomised controlled trial compared the effectiveness and toxicity in pulmonary tuberculosis of two drug regimens containing rifampicin and isoniazid given daily or twice-weekly for 4 months after a 2-month period of intensive treatment with daily isoniazid, rifampicin, and pyrazinamide. 667 patients with newly diagnosed pulmonary tuberculosis were randomly allocated to continue daily treatment with isoniazid (400 mg) and rifampicin (600 mg) or to twice-weekly treatment with isoniazid (900 mg) and rifampicin (600 mg). 544 of the 667 patients (81%) completed the 6-month course (287 of 337 [85%] treated daily and 257 of 330 [79%] treated twice-weekly). Drug toxicity was not a great problem; the treatment was permanently discontinued in only 2% of patients. There was no significant difference at the end of months 5 and/or 6 of chemotherapy between the groups treated daily and twice-weekly in the proportions with bacteriological failure (at least one positive sputum culture with more than 20 colonies) or who had died from tuberculosis (17 [6%] vs 10 [3%]). Nor was there a significant difference in the relapse rate (17 [7%] treated daily vs 10 [4%] treated twice-weekly) during follow-up of 12 months. Thus, the twice-weekly regimen was at least as effective as the daily regimen for treatment of pulmonary tuberculosis.

Administration, Oral↗
PubMed1989

Staphylococcus aureus skin carriage and development of peritonitis in patients on continuous ambulatory peritoneal dialysis.

We conducted a 15-month prospective study to investigate the skin carriage of Staphylococcus aureus and the development of peritonitis in 43 patients undergoing continuous ambulatory peritoneal dialysis (CAPD). Sixteen of 43 patients (37%) were chronic carriers of S. aureus in the anterior nares and/or in the exit-site of the catheter; 12 patients (28%) were intermittent carriers, and 15 (35%) were noncarriers. Fifty episodes of peritonitis occurred during a total of 422 patient-months of observation. S. aureus was responsible for 16 episodes of peritonitis diagnosed in 15 patients. All episodes of S. aureus peritonitis occurred in chronic and intermittent carriers. Phage typing was performed on isolates from 8 patients with S. aureus peritonitis, and they were found to have the same phage type as that previously carried in the skin. We conclude that CAPD patients who are chronic or intermittent carriers of S. aureus are at higher risk of development of peritonitis than noncarriers.

Adolescent↗
PubMedDate not supplied

Tumor necrosis factor alpha (TNF-alpha) and sepsis: evidence for a role in host defense.

Serum levels of TNF-alpha were evaluated in 29 patients with sepsis, using TNF-alpha sensitive L929 cells (sensitivity = 15 pg/ml). Blood samples were collected serially at the first 24-36 h of symptoms. Seventeen patients had severe underlying disease and 12 patients had mild or no underlying disease. Shock was present in 25 patients. Overall mortality was 62.1%. TNF-alpha was detected in nine patients (range: 57.7-3,169 pg/ml). There was a tendency to detect TNF-alpha in patients with mild or no underlying disease (p = 0.07). Detection of TNF-alpha was associated with survival (p = 0.0003) even when adjusted for severity of underlying disease (p = 0.005), shock (p = 0.0005), coagulation abnormality (p = 0.002) and immunosuppressive therapy (p = 0.005), using a bivariate analysis. In this investigation, detection of circulating TNF-alpha was predictive of good outcome in septic patients, suggesting a role for this cytokine in host-defense against this kind of infection.

Adult↗
PubMedDate not supplied

HTLV infection in a group of prostitutes and their male sexual clients in Brazil: seroprevalence and risk factors.

Sera from 653 female prostitutes and 153 male sexual clients living in the city of Santos, São Paulo, Brazil, were tested for the presence of antibodies to human T cell lymphotropic virus types I and II. Seroprevalence for HTLV-I in the females was 2.8% and in the males 2.0%. Infection by HTLV-II could not be demonstrated. Seropositivity to HTLV-I was not associated with intravenous drug use, modality of sexual behaviour or a history of sexually transmitted disease. Among the prostitutes, the prevalence of anti-HTLV-I antibodies was 3 times higher in those with a history of blood transfusion (P = 0.01).

Adolescent↗
PubMedDate not supplied

Presence of circulating levels of interferon-gamma, interleukin-10 and tumor necrosis factor-alpha in patients with visceral leishmaniasis.

Experimental murine L. major infection is characterized by the expansion of distinct CD4+ T cell subsets. The Th1 response is related to production of IFN-gamma and resolution of infection, whereas Th-2 response with production of IL-4 and IL-10 and dissemination of infection. The objective of this study was to measure the circulating levels of IFN-gamma, IL-10 and TNF-alpha in patients with visceral leishmaniasis (VL) before, during and at the end of therapy and to examine the association between cytokine levels and activity of VL. Fifteen patients with VL were evaluated. The cytokine determinations were done by using the enzyme-linked immunoassay (ELISA) before, during and at the end of therapy. At baseline, we detected circulating levels of IFN-gamma in 13 of 15 patients (median = 60 pg/ml); IL-10 in 14 of 15 patients (median = 141.4 pg/ml); and TNF-alpha in 13 of 14 patients (median = 38.9 pg/ml). As patients improved, following antimonial therapy, circulating levels of IL-10 showed an exponential decay (y = 82.34 e-0, 10367x, r = -0.659; p < 0.001). IFN-gamma was no longer detected after 7/14 days of therapy. On the other hand, circulating levels of TNF-alpha had a less pronounced decay with time on therapy, remaining detectable in most patients during the first seven days of therapy (y = 36.99-0.933x, r = -0.31; p = 0.05). Part of the expression of a successful response to therapy may, therefore, include reduction in secretion of inflammatory as well as suppressive cytokines. Since IL-10 and IFN-gamma are both detected prior to therapy, the recognized cellular immune depression seen in these patients may be due to biological predominance of IL-10 (type 2 cytokine), rather than lack of IFN-gamma (type 1 cytokine) production.

Adolescent↗
PubMedDate not supplied

[The clinical parameters relevant for the differential diagnosis between mucocutaneous leishmaniasis and paracoccidioidomycosis].

We retrospectively evaluated the medical records of 15 patients diagnosed with leishmaniasis and of 28 patients diagnosed with paracoccidioidomycosis presenting with involvement of the oral-nasal-pharyngeal mucosa seen at Escola Paulista de Medicina from 1986 through 1990. These patients were compared in regard to the following variables: sex, age, time since disease onset, location of lesion, and clinical complaints. Sex, time since disease onset, lesion at the nasal septum, palate, tongue, and lips, and history of oral pain, dysphagia/odynophagia, and nasal obstruction were significantly different in the two groups of patients. The authors point out to the relevance of these findings in the differential clinical diagnosis of leishmaniasis and paracoccidioidomycosis.

Adult↗
PubMedDate not supplied

[Development of a strategy to optimize the indications for the upper gastrointestinal endoscopy in patients with dyspepsia at the primary care level].

BACKGROUND: Although dyspepsia is a highly prevalent complaint, only a small percentage of patients are found to have serious disease and to need full investigation. The selection of dyspeptic patients who really need upper gastrointestinal endoscopy (UGE) is crucial in order to avoid unnecessary costs and overload services. MATERIAL AND METHODS: 200 primary care patients (age range 16-76 years) with dyspepsia and without any evidence of organic disease were interviewed with a structured questionnaire, and afterwards they underwent UGE. Multiple logistic regression analysis identified variables that could discriminate individuals with abnormal UGE from individuals with normal UGE, as well as individuals with peptic ulcer from individuals with normal UGE. RESULTS: The variables to discriminate individuals with abnormal UGE from individuals with normal UGE were age 45 years or above, and male sex, whereas to discriminate individuals with peptic ulcer in UGE from individuals with normal UGE were age 45 years or above, male sex, smoking, fullness, and absenteeism. A practical model based on these variables was developed, showing sensitivity of 78,9%, specificity of 51,7%, positive predictive value (PPV) of 39,4 % and negative predictive value (NPV) of 86% for the detection of individuals with UGE abnormal; and sensitivity of 84%, specificity of 70%, PPV of 38% and NPV of 95% for the identification of individuals with UGE identifying peptic ulcer. CONCLUSIONS: A strategy based on a model containing clinical and social characteristics of dyspeptic patients could potentially decrease the number of unnecessary UGEs.

Adolescent↗