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Biomedical subjects

H Rocha

Publications and source records attributed to H Rocha.

At least 109 records · Page 6Linked to original sources
PubMedDate not supplied

Etiology and mortality of bacterial meningitis in northeastern Brazil.

Little is known of the current incidence and mortality of meningitis in developing nations, especially in Latin America. We reviewed all cases of meningitis in an isolation-fever hospital in Salvador, Brazil, for the decade 1973-1982. Of all admissions, 6,751 (27%) were for meningitis; 4,100 (61%) of these cases were of definite or probable bacterial etiology. Children younger than 15 years accounted for 79% of cases, and 45% of cases were in children under 2 years. The overall case fatality rate was 33%, with 50% of these deaths occurring within 48 hours of hospitalization. Neisseria meningitidis was the etiologic agent in 32% of the cases, with a case fatality rate of 14%. Epidemics caused by N. meningitidis group C, then group A, in 1974-1978 accounted for 60% of the cases. Streptococcus pneumoniae caused 17% of cases, with a case fatality rate of 59%. Haemophilus influenzae type b, the most common cause of nonepidemic meningitis, caused 23% of all cases, with a case fatality rate of 38%. Enterobacteriaceae were the etiology in only 3.6% of patients, but the case fatality rate was 86%. Cultures were negative in 18% of cases with purulent cerebrospinal fluid. A total of 84% of H. influenzae, 40% of S. pneumoniae, 78% of Enterobacteriaceae, and 15% of N. meningitidis cases occurred in children less than 2 years of age. Case fatality rates were highest in this group. Vaccines protective for this age group are urgently needed.

Adolescent↗
PubMedDate not supplied

Problems in salmonellosis: rationale for clinical trials with newer beta-lactam agents and quinolones.

Disease syndromes caused by Salmonella species continue to be important, as evidenced by a major outbreak of infection due to multiresistant Salmonella typhimurium in 1985; this outbreak involved more than 12,000 people in five north-central states of the United States. Salmonella species have become progressively more resistant in recent years to the clinically useful antibiotics (trimethoprim-sulfamethoxazole, ampicillin, and chloramphenicol). The clinical experience accumulated thus far indicates that two new classes of antimicrobial agents, the third-generation cephalosporins and the quinolones, offer significant potential for the treatment of specific problems in salmonellosis: bacteremia and enteric fever, meningitis, osteomyelitis, and the chronic carrier state.

Ampicillin↗
PubMedDate not supplied

Tobramycin in chronic recurrent urinary tract infections.

A total of 32 adult patients of both sexes with chronic recurring urinary tract infections were treated with tobramycin in a daily dose of 1.2 mg/kg of body weight. They were randomly allocated to receive the drug at 8 or 12 hour intervals by intramuscular injection. The overall immediate disappearance of bacteriuria after therapy was 78.1 per cent; 15 days later, the cure rate dropped to 60 per cent. There was no difference between the two schedules tested. Tolerance to tobramycin was excellent. No reaction was recorded at the injection site; audiometry (performed in nine patients) and laboratory tests done prior to and after therapy did not reveal any hematologic, hepatic and/or renal toxicity, with one exception. In a patient with chronic renal failure (a patient with a solitary kidney infected with a pseudomonas sp.) there was a consistent elevation of blood urea in two separate courses of tobramycin, returning to normal within two weeks after stopping the therapy.

Adult↗
PubMedDate not supplied

Renal involvement in prolonged Salmonella bacteremia: the role of schistosomal glomerulopathy.

Renal involvement has been well documented in patients with hepatosplenic schistosomiasis and in patients with prolonged Salmonella bacteremia (PSB). Whether there is a specific renal lesion related to PSB or the chronic bacterial infection aggravates a pre-existing schistosomal glomerulopathy has been a matter of controversy. To analyze the clinical manifestations and histopathological findings of the renal involvement, 8 patients with hepatosplenic schistosomiasis and PSB (group I) were compared with 8 patients with schistosomal glomerulopathy (group II) matched by sex and glomerular disease. The mean age in group I was 17.7 years. All patients presented with hematuria, in 4 cases associated with non-nephrotic proteinuria. In group II the mean age was 23 years; nephrotic syndrome was the clinical presentation in 7 of the 8 patients in the group. All patients in group I experienced remission of the clinical and laboratory abnormalities as the salmonella infection was cured; in group II the patients had persistent, steroid-resistant, nephrotic syndrome. On histological examination, no difference was noted between the two groups, except for pronounced glomerular hypercellularity and interstitial mononuclear cell infiltration in group I. These observations strongly suggest that PSB exacerbates a pre-existing sub-clinical schistosomal glomerulopathy by the addition of active lesions directly related to the prolonged bacteremia.

Adolescent↗
PubMedDate not supplied

Is rhabdomyolysis an additional factor in the pathogenesis of acute renal failure in leptospirosis?

Leptospirosis is an important cause of acute renal failure in our environment. Although several mechanisms are implicated, the role of rhabdomyolysis in the pathogenesis of acute renal failure in leptospirosis has not been analysed. Sixteen patients with the diagnosis of leptospiroses consecutively admitted to the hospital were prospectively studied. The disease was characterized by sudden onset in all patients and, at admission, jaundice, conjunctival suffusion and myalgias. Mild to moderate proteinuria with unremarkable urinary sediment was recorded in 37.5% of the patients and abnormal levels of urea creatinine were found in 87.5% and 74.0%, respectively. Increased levels of aminotranspherase were documented in all 12 and CPK in all 10 patients studied. Serum myoglobin levels greater than 120 micrograms/l recorded in 56.2%. A correlation between myoglobin and renal failure or severity of disease, however, could not be established.

Acute Kidney Injury↗
PubMedDate not supplied

Tetanus as a cause of acute renal failure: possible role of rhabdomyolysis.

To study the frequency and examine the role of rhabdomyolysis in the acute renal failure in tetanus 18 patients with the diagnosis of generalized tetanus consecutively admitted to the infectious disease hospital were evaluated. Of these 14 were male and 4 female with mean age of 31.8 +/- 2.0 years. Except for mild proteinuria recorded in 9 patients, the urinalysis were unremarkable. Serum creatinine higher than 1.4mg/dl was recorded in 39% of the patients, abnormal levels of CPK in 87,5% and serum myoglobin greater than 120 micrograms/l in 39% of the patients. Oliguria was documented in one patient and none required dialysis therapy. No correlation was found between renal failure and myoglobin and/or CPK serum levels. Acute renal failure in tetanus was not infrequent; usually it was non-oliguric, mild and transient and not related to the severity of the disease or to serum levels of myoglobin and/or CPK.

Acute Kidney Injury↗
PubMedDate not supplied

[Is glomerulopathy due to schistosomiasis mansoni disappearing?].

Hepatosplenic form of S. mansoni infection may be accompanied by a glomerulopathy in 12-15% of cases, manifested in the majority by a nephrotic. This type of renal involvement is becoming a rare occurrence in our University Hospital (Hospital Universitário Prof. Edgard Santos) a typical general hospital in an endemic state for this parasitic disease. To investigate this fact, autopsied cases with patients with hepatosplenic form of schistosomiasis mansoni during two decades in our Hospital-1960-70, (before a therapeutic intervention in endemic areas with oxamniquine) and 1980-1990 (after the intervention) were compared in reference to number of cases and the finding of glomerulonephritis by histological examination. Even though there was a striking decrease in number of patients with advanced forms of this disease (140 as compared to 31 autopsies in these two decades), the prevalence of glomerulonephritis diagnosed was 11.4 (16 cases) in the first and 12.9 (4 cases) in the second. As there was no change in pattern of attendance in this Hospital, the drastic decrease in number of severe forms of this parasitic infection following massive therapy of the endemic population with oxamniquine is the most likely explanation not only for the decrease in number of hepatosplenic cases but, also, and as a consequence, the scarcity of cases of the schistosomal glomerulopathy observed.

Brazil↗
PubMedDate not supplied

[Bacterial infection in patients with visceral leishmaniasis].

In an analysis of 63 hospitalized cases with visceral leishmaniasis, the clinical or post-mortem diagnosis of bacterial infection was performed in 33; 13 (39.3%) patients had respiratory infection, 4 (12.1%) had skin infection, 4 had urinary tract infection, 3 (9.0%) showed ear infection and 2 (6.6%) had infection of the oral cavity. It is worth mentioning that in 7 (21%) cases there was infection in multiple sites. Gram positive and/or Gram negative organisms were isolated from 10 patients. In only two (autopsied) cases, infection with less common organisms was recorded, one with disseminated candidiasis and another with disseminated tuberculosis. Death occurred in 9 of the 63 cases, and in 8 of these, concomitant bacterial infection of importance was documented. Patients who had serum globulins lower than 4 g% had significantly more infection (p less than 0.05) than patients with globulin levels higher than 4 g%; there was no significant difference when the number of leucocytes and neutrophils in patients with associated infection was compared with those in patients without bacterial infection. The present study demonstrates that bacterial infection frequently occurs in patients with visceral leishmaniasis, and indicates an unfavourable prognosis. Even though the mechanism of increased susceptibility to infection in this condition was unclear, the widespread range of infections and of infective agents, suggests a multifactorial process.

Bacterial Infections↗
PubMedDate not supplied

[Increase in the frequency of norfloxacin and ciprofloxacin resistance of bacteria isolated from urine culture].

OBJECTIVE: To assess time trends in the frequency of norfloxacin and ciprofloxacin resistance of bacteria isolated from urine culture. METHODS: Results of all urine cultures with a bacterial growth of at least 10(5) colony-forming units per milliliter, performed at the Renal Service of the Federal University of Bahia, Brazil, from 1983 to 1994 were analyzed. The bacteria considered for this analysis were those most often isolated: Escherichia coli (n = 668), Klebsiella spp. (n = 286), Staphylococcus spp. (n = 186), Proteus spp. (n = 135) and Enterobacter spp. (n = 129). RESULTS: The frequencies of norfloxacin resistance for the periods 1983-1986, 1987-1990 and 1991-1994 were 3.2%, 5.9% and 9.1%, respectively (p-value < 0.05). The most pronounced increases in the frequencies of norfloxacin-resistance were observed for Klebsiella spp. and Enterobacter spp. The frequency of ciprofloxacin resistance was 7.4% in the period 1985-1989 and 16.5% in the period 1990-1994 (p-value < 0.05). This time trend in ciprofloxacin resistance was more striking for Enterobacter spp. and Staphylococcus spp. CONCLUSION: The results show a gradual increase in the frequency of norfloxacin and ciprofloxacin resistance of the bacteria most commonly isolated from urine cultures. The influence of previous treatment with quinolones and characteristics of the infecting bacteria on these findings are important questions to to be addressed in future investigations.

Anti-Infective Agents↗
PubMedDate not supplied

[Racial differences between patients with focal segmental glomerulosclerosis and membranoproliferative glomerulonephritis from the State of Bahia].

OBJECTIVE: To assess the association between race and type of glomerulonephritis, taking into account age, gender and the presence of hepatosplenic schistosomiasis mansoni. METHODS: Patients from the Renal Service of the Federal University of Bahia, Brazil, 80 with focal segmental glomerulosclerosis (FSG) and 50 with membranoproliferative glomerulonephritis (MPGN) were compared regarding the distribution of the racial types (black, mulatto, white). Patients with systemic lupus erythematosus or any kind of autoimmune disease were not included in the present analysis. Adjusted comparisons were performed using the Mantel-Haenszel method and a multivariate logistic regression model. RESULTS: Race was significantly associated with histologic type; the odds of being classified as black or mulatto were approximately 2.4 times higher (odds ratio = 2.43; IC 95% = 1.09-5.45) in patients with FSG than in those with MPGN. The association between race and histologic type was not influenced by the potential effects of age, gender and hepatosplenic schistosomiasis. In the multivariate logistic regression model, race was significantly associated (p = 0.037) with type of glomerulonephritis (odds ratio = 2.54; IC 95% = 1.06-6.06). CONCLUSION: A higher frequency of negroes and mulattoes in the FSG group (compared with MPGN) in this sample from the State of Bahia is consistent with findings of previous studies from the United States. The data support the possibility of a greater susceptibility to FSG among negroes and mulattoes, independently of age, gender and schistosomiasis. The identification of the mechanisms that determine this racial difference represents an important question for future investigations.

Adolescent↗