Bladder irrigation with amphotericin B and fungal urinary tract infection-systematic review with meta-analysis

Background: Candiduria is a hospital-associated infection and a daily problem in the intensive care unit. The treatment of asymptomatic candiduria is not well established and the use of amphotericin B bladder irrigation (ABBI) is controversial. The aim of this systematic review was to determine the best place for this therapy in practice. Methods: The databases searched in this study included MEDLINE, EMBASE, Web of Science, and LILACS (January 1960-June 2007). We included manuscripts with data on the treatment of candiduria using ABBI. The studies were classified as comparative, dose-finding, or non-comparative. Results: From 213 studies, nine articles (377 patients) met our inclusion criteria. ABBI showed a higher clearance of the candiduria 24 hours after the end of therapy than fluconazole (odds ratio (OR) 0.57, 95% confidence interval (CI) 0.32-1.00). Fungal culture 5 days after the end of both therapies showed a similar response (OR 1.51, 95% CI 0.81-2.80). The evaluation of ABBI using an intermittent or continuous system of delivery showed an early candiduria clearance (24 hours after therapy) of 80% and 82%, respectively (OR 0.87, 95% CI 0.52-1.36). Candiduria clearance at >5 days after the therapy showed a superior response using continuous bladder irrigation with amphotericin B (OR 0.52, 95% CI 0.29-0.94). The use of continuous ABBI for more than 5 days showed a better result (88% vs. 78%) than ABBI for less than 5 days, but without significance (OR 0.55, 95% CI 0.34-1.04). Conclusion: Although the strength of the results in the underlying literature is not sufficient to allow the drawing of definitive conclusions, ABBI appears to be as effective as fluconazole, but it does not offer systemic antifungal therapy and should only be used for asymptomatic candiduria. (C) 2008 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

Spontaneous tendon rupture in systemic lupus erythematosus: association with Jaccoud`s arthropathy

Tendon rupture has rarely been described in patients with systemic lupus erythematosus. From observation of three cases of Jaccoud`s arthropathy with tendon rupture, and considering that this arthropathy is more related to an inflammatory process of the tendon sheath than to synovitis per se, the intention of this study was to review the cases of tendon rupture in patients with systemic lupus erythematosus, in the hope of determining the frequency of Jaccoud`s arthropathy associated with this complication. Systematic review using MEDLINE, Scielo and LILACS databases (1966 to 2009) and the following keywords: systemic lupus erythematosus, tendon rupture, Jaccoud`s arthropathy. Secondary references were additionally obtained. Additionally, three Brazilian systemic lupus erythematosus patients who developed tendon rupture are described. Only 40 articles obtained fulfilled the previously established criteria. They were all case reports; the number of cases reported was 52 which, together with the three cases presented herein add up to 55 cases. Forty-six patients were women aged between 19 and 71 years, with a mean age of 40.1 +/- 12.4 years, and the average duration of the disease was 10 years. The most frequently observed rupture sites were the patellar and Achilles` tendons. While almost all patients described were on various doses of corticosteroids, 16 patients concomitantly had Jaccoud`s arthropathy (29%). In conclusion, the association between Jaccoud`s arthropathy and tendon rupture in systemic lupus erythematosus has been underestimated. As almost one-third of the systemic lupus erythematosus patients with tendon rupture also have Jaccoud`s arthropathy, this arthropathy may be recognized as risk marker for tendon rupture. Lupus (2010) 19, 247-254.

Adenosine deaminase and tuberculous meningitis-A systematic review with meta-analysis

Tuberculous meningitis (TBM) is a severe infection of the central nervous system, particularly in developing countries. Prompt diagnosis and treatment are necessary to decrease the high rates of disability and death associated with TBM. The diagnosis is often time and labour intensive; thus, a simple, accurate and rapid diagnostic test is needed. The adenosine deaminase (ADA) activity test is a rapid test that has been used for the diagnosis of the pleural, peritoneal and pericardial forms of tuberculosis. However, the usefulness of ADA in TBM is uncertain. The aim of this study was to evaluate ADA as a diagnostic test for TBM in a systematic review. A systematic search was performed of the medical literature (MEDLINE, LILACS, Web of Science and EMBASE). The ADA values from TBM cases and controls (diagnosed with other types of meningitis) were necessary to calculate the sensitivity and specificity. Out of a total of 522 studies, 13 were included in the meta-analysis (380 patients with TBM). The sensitivity, specificity and diagnostic odds ratios (DOR) were calculated based on arbitrary ADA cut-off values from 1 to 10 U/l. ADA values from 1 to 4 U/l (sensitivity > 93% and specificity < 80%) helped to exclude TBM; values between 4 and 8 U/l were insufficient to confirm or exclude the diagnosis of TBM (p = 0.07), and values > 8 U/l (sensitivity < 59% and specificity > 96%) improved the diagnosis of TBM (p < 0.001). None of the cut-off values could be used to discriminate between TBM and bacterial meningitis. In conclusion, ADA cannot distinguish between bacterial meningitis and TBM, but using ranges of ADA values could be important to improve TBM diagnosis, particularly after bacterial meningitis has been ruled out. The different methods used to measure ADA and the heterogeneity of data do not allow standardization of this test as a routine.

Texto para discuss??o 39 : a percep????o das chefias sobre a capacita????o nos cursos da ENAP

O presente trabalho apresenta o resultado de uma pesquisa com ???turmas abertas??? (servidores oriundos de v??rias organiza????es) e avalia genericamente a qualidade e a aplicabilidade dos cursos da ENAP no pr??prio ambiente de trabalho do servidor treinado

Sistema de educa????o a dist??ncia: cursos de treinamento para profissionais de laborat??rio (Telelab)

O Sistema de Educa????o a Dist??ncia ??? Telelab tem o prop??sito de planejar, produzir, implantar e avaliar treinamentos, em uma abordagem que favorecesse o repensar da pr??tica dos profissionais da ??rea de sa??de envolvidos com diagn??stico laboratorial das Doen??as Sexualmente Transmiss??veis (DST), da infec????o pelo HIV e das doen??as oportunistas associadas ?? aids

Cat??logo de cursos Enap - 2013

O cat??logo de cursos e atividades de aprendizagem da Escola Nacional de Administra????o P??blica (ENAP) tem como objetivo apoiar a escolha de a????es de desenvolvimento de compet??ncias de dirigentes p??blicos brasileiros

Implementa????o do exame nacional de cursos: prov??o

O Exame Nacional de cursos ?? um instrumento de avalia????o do ensino superior que verifica a aquisi????o de conhecimentos e habilidades t??cnicas dos concluintes dos cursos de gradua????o para o exerc??cio profissional. A participa????o no exame ?? obrigat??ria, sendo condi????o necess??ria para a obten????o do registro do diploma de conclus??o do curso. As provas s??o elaboradas com base nas atuais diretrizes e conte??dos curriculares. Seus conte??dos s??o definidos por uma comiss??o espec??fica para cada curso. considerando a diversidade dos projetos pedag??gicos das institui????es. Foram avaliados dez cursos at?? 1998: Administra????o; Comunica????o Social; Direito; Engenharia Civil; Engenharia El??trica; Engenharia Qu??mica; Letras; Matem??tica; Medicina Veterin??ria e Odontologia. Em 1999, ser??o avaliados, al??m desses, mais tr??s cursos: Economia; Engenharia Mec??nica e Medicina. O Exame ?? uma experi??ncia inovadora na ??rea de avalia????o educacional, contribuindo para um processo de avalia????o permanente das propostas, dos projetos e das pr??ticas pedag??gicas vigentes nas institui????es de ensino superior. Sua operacionaliza????o ?? descentralizada, envolvendo ??rg??os da administra????o federal direta e indireta, institui????es de ensino superior e entidades sem fins lucrativos, respons??veis pela elabora????o e aplica????o da provas. Seus resultados s??o amplamente disseminados, servindo de subs??dio para as a????es voltadas para a melhoria da qualidade do ensino no Pa??s

Cat??logo de cursos ENAP - 2007

O cat??logo de cursos da Escola Nacional de Administra????o P??blica (ENAP) tem como objetivo apoiar a escolha de a????es de desenvolvimento de compet??ncias de dirigentes p??blicos brasileiros

Cat??logo de cursos ENAP - 2009

O cat??logo de cursos da Escola Nacional de Administra????o P??blica (ENAP) tem como objetivo apoiar a escolha de a????es de desenvolvimento de compet??ncias de dirigentes p??blicos brasileiros

Cat??logo de cursos ENAP - 2010

O cat??logo de cursos da Escola Nacional de Administra????o P??blica (ENAP) tem como objetivo apoiar a escolha de a????es de desenvolvimento de compet??ncias de dirigentes p??blicos brasileiros

Cat??logo de cursos ENAP - 2012

O cat??logo de cursos da Escola Nacional de Administra????o P??blica (ENAP) tem como objetivo apoiar a escolha de a????es de desenvolvimento de compet??ncias de dirigentes p??blicos brasileiros

Cat??logo de cursos ENAP - 2004

O cat??logo de cursos da Escola Nacional de Administra????o P??blica (ENAP) tem como objetivo apoiar a escolha de a????es de desenvolvimento de compet??ncias de dirigentes p??blicos brasileiros

Cat??logo de cursos ENAP - 2005

O cat??logo de cursos da Escola Nacional de Administra????o P??blica (ENAP) tem como objetivo apoiar a escolha de a????es de desenvolvimento de compet??ncias de dirigentes p??blicos brasileiros

Cat??logo de cursos ENAP - 2006

O cat??logo de cursos da Escola Nacional de Administra????o P??blica (ENAP) tem como objetivo apoiar a escolha de a????es de desenvolvimento de compet??ncias de dirigentes p??blicos brasileiros

Cat??logo de cursos ENAP - 1999

O cat??logo de cursos da Escola Nacional de Administra????o P??blica (ENAP) tem como objetivo apoiar a escolha de a????es de desenvolvimento de compet??ncias de dirigentes p??blicos brasileiros