[Kaposi sarcoma associated with HIV infection]

Kaposi's sarcoma is the most common neoplasm in AIDS patients. In a 12-year period, 45 (8%) cases were diagnosed in 552 patients with AIDS. Epidemiological and clinical aspects are reviewed. The disease occurred predominantly in males and homosexuals. In 30 (67%) patients it was the first manifestation of AIDS. Skin and/or oral disease was the most frequent manifestation observed in our patients; 13 (29%) had visceral involvement. Previous or concommitant opportunistic diseases, systemic illness and severe immunosuppression were present in the majority of the patients. Opportunistic infections were the cause of death in 30 patients; in five others, Kaposi's sarcoma was responsible for death. Advances in antiretroviral therapy were of benefit for patients submitted to chemotherapy and may contribute to a reduction in morbidity with this neoplasm.

[Medical graduation and specialization: an apparent incompatibility]

PURPOSE

Partial results of a continuous evaluation process of the undergraduate medical course at Escola Paulista de Medicina (EPM) started in 1989 are presented.

METHODS

A survey on expectations and opinions about the medical course of EPM was carried out among faculty members, students and alumni.

RESULTS

The authors call into question that the medical formation is non-terminal as indicated by the late entry to labor market.

CONCLUSION

The authors consider that the phenomenon is not related to quality aspects but to the specialization process started during the medical course and completed only with graduated studies.

Dysrhythmic profile of human immunodeficiency virus infected patients

We prospectively studied, with 24-h Holter monitoring, 21 consecutive human immunodeficiency virus (HIV) infected patients, at all stages of the infection, in order to assess their dysrhythmic profile. Three (14.3%) patients presented one isolated run of supraventricular tachycardia, with < 10 beats, that was considered clinically irrelevant. No patient presented other clinically relevant supraventricular or ventricular tachy or bradydysrhythmias. One (4.8%) patient presented intermittent Mobitz type I second-degree AV block, two (9.5%) patients paroxistic 2:1 AV block and one (4.8%) patient presented a bifascicular block on the 12-lead ECG that persisted during the ambulatory recording. This study suggests that clinically relevant cardiac tachydysrhythmias are rare in our population of HIV infected patients. On the other hand we found an unexpectedly high incidence of cardiac impulse conduction disturbances.

Cardiac morbidity in the human immunodeficiency virus infection

PURPOSE

To evaluate the cardiac involvement in Human Immunodeficiency Virus (HIV) infection.

DESIGN

Prospective and normal individuals group controlled study.

SETTING

The departments of cardiology and infectious diseases of an university hospital.

PATIENTS

137 consecutive HIV infected patients at all stages of the infection and 40 normal noninfected controls.

MEASUREMENTS AND MAIN RESULTS

Clinical and echocardiographic evaluation was performed. Cardiac symptoms were observed in 10 (7.3%) patients, manifested as congestive heart failure. The global HIV infected population had increased left ventricular (LV) dimensions and wall thickness and decreased LV fractional shortening and ejection fraction when compared with the control population. Seven (5.1%) patients had dilated cardiomyopathy, 9 (6.5%) had global LV hypokinesis with or without LV dilatation and 17 (12.4%) had segmental LV wall motion abnormalities. Right ventricular dilatation was present in 23 (16.8%). Mitral or tricuspid regurgitation of a moderate or severe degree was found in 3 (2.2%) patients. No valvular vegetations were found. Fifty nine (43.1%) patients presented a pericardial effusion. An echocardiogram with at least one abnormality was observed in 104 (75.9%) and a severely abnormal echocardiogram in 34 (24.8%). The presence of cardiac symptoms and of abnormal and severely abnormal echocardiograms was more frequent in patients with the acquired immunodeficiency syndrome than in asymptomatic HIV infected patients. When comparing HIV-1 with HIV-2 populations the first showed increased LV systolic and diastolic diameters and LV mass index. There was no statistically significant difference between all risk behavior groups regarding the frequency of cardiac symptoms or the echocardiographic abnormalities found. HIV infected patients with CD4+ lymphocytes counts < or = 100/mm3 had more frequent abnormal and severely abnormal echocardiograms than those with CD4+ lymphocytes counts > 100/mm3.

CONCLUSIONS

Although cardiac symptoms were rare in our population, subclinical cardiac involvement detected by echocardiography was frequent and could involve any cardiac layer. It was not influenced by the patients' risk behavior. The left ventricular trophic response observed in HIV-2 infection seemed less intense than that in HIV-1 infection. Cardiac involvement was more frequent in the more advanced stages of the infection and in patients with lower CD4+ lymphocyte counts.

Fonsecaea pedrosoi: lipid composition and determination of susceptibility to amphotericin B

Conidia and mycelial cells of Fonsecaea pedrosoi ATCC 46428 were obtained for analyses of lipid composition. Total lipids, phospholipids, sterols, and qualitative sterols and fatty acid composition were determined. A higher lipid content was detected in conidia than in mycelial cells of Fonsecaea pedrosoi, which could not be attributed to total sterols and phospholipids. In both forms of this fungus, ergosterol was the only sterol detected. The minimal inhibitory concentration of amphotericin B was lower for conidia than for mycelium.