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We investigated a novel Japanese isolate of sequence type 11 (ST11), the Klebsiella pneumoniae carbapenemase-2 (KPC-2)-producing K. pneumoniae strain Kp3018, which was previously obtained from a patient treated at a Brazilian hospital. This strain was resistant to various antibiotic classes, including carbapenems, and harbored the gene blaKPC-2, which was present on the transferable plasmid of ca. 190 kb, in addition to the blaCTX-M-15 gene. Furthermore, the ca. 2.3-kb sequences (ISKpn8-blaKPC-2-ISKpn6-like), encompassing blaKPC-2, were found to be similar to those of K. pneumoniae strains from China.

This paper analyzes the relationship between the financial health and organizational form of private health care providers in Brazil. It also examines the major determinants of customer satisfaction associated with the provider's organizational form. An adjusted Altman's z-score is used as an indicator of financial health. A proxy variable based on customer complaints filed at the Brazilian National Agency for Supplementary Health is used as an indicator for customer satisfaction. The study uses a sample of 270 private health care providers and their operations over the period 2003-2005. Panel data analysis includes control variables related to market, operations, and management. Principal results indicate that: (1) private health care providers benefit from economies of scale; (2) self-funded health plans have better financial health; (3) spending on marketing does not have a significant impact on customer satisfaction in Brazil; (4) weak empirical evidence exists showing that good financial performance enhances customer's satisfaction.

We evaluated phytohemagglutinin (PHA) lymphocyte proliferation and delayed-type hypersensitivity tests in 130 Brazilian HIV-infected patients with the objective of assessing the value of these tests in staging HIV infection. Patients were divided into three groups according to their CD4+ cell counts (cells/mm3): < 200 (n = 28); 200 to 499 (n = 50); and > or = 500 (n = 52). An additional 114 individuals, who had come to the same institution for elective surgeries, were enrolled as controls. Results showed a significant decrease in PHA responses when CD4+ cell counts fell below 500 cells/mm3. This decrease was, however, indistinguishable from that of patients with < 200 cells/mm3. In contrast, skin test anergy to common antigenic preparations was only evident in the group of patients with less than 200 CD4+ cells/mm3. Decreases in PHA responses and in CD4+ cell counts were significantly correlated. Since the introduction of antiretroviral therapy is recommended when CD4+ cell counts are below 500 cells/mm3, the PHA proliferation test, in our conditions, could be useful as an additional parameter to initiate antiretroviral therapy. Further prospective studies are needed to establish the value of this test in HIV-infected patients.