Contributions of culture and antimicrobial susceptibility tests to the retreatment of patients with pulmonary tuberculosis

Introduction This study evaluated the efficacy of retreatment of pulmonary tuberculosis (TB) with regard to treatment outcomes and antimicrobial susceptibility testing (ST) profiles. Methods This retrospective cohort study analyzed 144 patients treated at a referral hospital in Brazil. All of them had undergone prior treatment, were smear-positive for TB and received a standardized retreatment regimen. Fisher's 2-tailed exact test and the χ2 test were used; RRs and 95% CIs were calculated using univariate and multivariate binary logistic regression. Results The patients were cured in 84 (58.3%) cases. Failure was associated with relapsed treatment and abandonment (n=34). Culture tests were obtained for 103 (71.5%) cases; 70 (48.6%) had positive results. ST results were available for 67 (46.5%) cases; the prevalence of acquired resistance was 53.7%. There were no significant differences between those who achieved or not therapeutic success (p=0.988), despite being sensitive or resistant to 1 or more drugs. Rifampicin resistance was independently associated with therapeutic failure (OR: 4.4, 95% CI:1.12-17.37, p=0.034). For those cases in which cultures were unavailable, a 2nd model without this information was built. In this, return after abandonment was significantly associated with retreatment failure (OR: 3.59, 95% CI:1.17-11.06, p=0.026). Conclusions In this cohort, the general resistance profile appeared to have no influence on treatment outcome, except in cases of rifampicin resistance. The form of reentry was another independent predictor of failure. The use of bacterial culture identification and ST in TB management must be re-evaluated. The recommendations for different susceptibility profiles must also be improved.

Clinical variables associated with leprosy reactions and persistence of physical impairment

Introduction Leprosy is a chronic disease that affects skin and peripheral nerves. Disease complications include reactional episodes and physical impairment. One World Health Organization (WHO) goal of leprosy programs is to decrease the number of grade 2 impairment diagnoses by 2015. This study aims to evaluate clinical factors associated with the occurrence of leprosy reactions and physical impairment in leprosy patients. Methods We conducted a retrospective study of data from medical records of patients followed in two important centers for the treatment of leprosy in Aracaju, Sergipe, Brazil, from 2005 to 2011. We used the chi-square test to analyze associations between the following categorical variables: gender, age, operational classification, clinical forms, leprosy reactions, corticosteroid treatment, and physical impairment at the diagnosis and after cure. Clinical variables associated with multibacillary leprosy and/or reactional episodes and the presence of any grade of physical impairment after cure were evaluated using the logistic regression model. Results We found that men were more affected by multibacillary forms, reactional episodes, and grade 2 physical impairment at diagnosis. Leprosy reactions were detected in a total of 40% of patients and all were treated with corticosteroids. However, physical impairment was observed in 29.8% of the patients analyzed at the end of the treatment and our multivariate analysis associated a low dose and short period of corticosteroid treatment with persistence of physical impairments. Conclusions Physical impairment should receive an increased attention before and after treatment, and adequate treatment should be emphasized.

Depressive symptoms and harmful alcohol use in hepatitis C patients: prevalence and correlates

Introduction It is important to understand the characteristics and vulnerabilities of people who have hepatitis C because this disease is currently an important public health problem. The objective of this study was to estimate the prevalence of depressive symptoms and harmful alcohol use in patients with hepatitis C and to study the association between these outcomes and demographic, psychosocial and clinical variables. Methods This cross-sectional, descriptive and analytical study involved 82 hepatitis C patients who were being treated with pegylated interferon and ribavirin at a public university hospital. The primary assessments used in the study were the Alcohol Use Disorders Identification Test and the Beck Depression Inventory. Bivariate analyses were followed by logistic regression. Results The prevalence of depressive symptoms was 30.5% (n=25), and that of harmful alcohol use was 34.2% (n=28). Logistic regression analysis showed that individuals who were dissatisfied with their social support (OR=4.41; CI=1.00-19.33) and were unemployed (OR=6.31; CI=1.44-27.70) were at a higher risk for depressive symptoms, whereas harmful alcohol use was associated with the male sex (OR=6.78; CI=1.38-33.19) and the use of illicit substances (OR=7.42; CI=1.12-49.00). Conclusions High prevalence rates of depressive symptoms and harmful alcohol use were verified, indicating vulnerabilities that must be properly monitored and treated to reduce emotional suffering in this population.

Risk factors for hepatitis C virus transmission in the municipality of Catanduva, State of São Paulo: a case-control study

Introduction Hepatitis C virus (HCV) is primarily transmitted via contact with the blood of infected patients, although the form of contact has not been identified for a significant percentage of carriers. The present study evaluated possible risk factors for HCV transmission in a medium-sized town located in the northwest region of the State of São Paulo. Methods This was a case-control study, with the case group consisting of 190 chronic HCV carriers older than 18 years residing in the municipality of Catanduva. The control group also consisted of 190 individuals with HCV-negative serology. The groups were paired (1:1) for gender, age range (± five years), and place of residence. The same structured questionnaire was applied to all subjects, who gave written informed consent to participate in the study. The data were statistically analyzed using crude and adjusted logistic regression, and the results were expressed as odds ratios with a 95% confidence interval. Results The demographic profiles of the groups indicated a predominance of males (68.9%) and mean ages of 47.1 years (case group) and 47.3 years (control group). After adjusting for conditional regression, the following factors were found to represent risks for HCV: history of sexually transmitted disease (STD) and blood transfusion; accidents with syringes and/or needles; tattoos; and the use of non-injectable drugs and injectable medications. Conclusions The transmission of HCV via the blood route has been well characterized. Other forms of contact with human blood and/or secretions are likely to transmit the virus, although with a lower frequency of occurrence.

Risk factors associated with the transmissionof Brazilian spotted fever in the Piracicaba river basin, State of São Paulo, Brazil

INTRODUCTION : Brazilian spotted fever (BSF) is a disease transmitted by ticks for which the etiological agent is Rickettsia rickettsii. The present essay evaluates the risk factors associated with the transmission of cases of BSF in the time period between 2003 and 2013 in the Piracicaba river basin, state of São Paulo. METHODS : This essay presents a retrospective study to identify the factors associated with the transmission of cases of BSF among all suspected cases identified by the System for Epidemiological Surveillance of São Paulo (CVE). After the description of temporal distribution (onset of symptoms) and the environmental and demographic variations of the confirmed and discarded cases, a multiple logistic regression model was applied. RESULTS : We searched 569 probable locations of infection (PLI) with 210 (37%) confirmed cases of BSF and 359 (63%) discarded cases. The associated variables for the confirmation of BSF in the multiple logistic model using a confidence interval (CI) of 95% were age (OR = 1.025 CI: 1.015-1.035), the presence of Amblyomma sculptum in the environment (OR = 1.629 CI: 1.097-2.439), the collection of ticks from horses (OR = 1.939 CI: 0.999-3.764), the presence of capybaras (OR = 1.467 CI: 1.009-2.138), an urban environment (OR = 1.515 CI: 1.036-2.231), and the existence of a dirty pasture (OR = 1.759 CI: 1.028-3.003). CONCLUSIONS : The factors associated with the confirmation of BSF cases included an urban environment, age, presence of the A. sculptum vector, the collection of ticks from horses, the presence of a capybara population, and a dirty pasture environment.

Clinical conditions associated withintestinal strongyloidiasis in Rio de Janeiro, Brazil

INTRODUCTION: Strongyloides stercoralis is a soil-transmitted helminth that produces an infection that can persist for decades. The relationships between certain clinical conditions and strongyloidiasis remains controversial. This study aims to identify the clinical conditions associated with intestinal strongyloidiasis at a reference center for infectious diseases in Rio de Janeiro, Brazil. METHODS: The clinical conditions that were assessed included HIV/AIDS, HTLV infection, cardiovascular diseases, diabetes, obstructive respiratory diseases, viral hepatitis, tuberculosis, cancer, chronic renal disease, nutritional/metabolic disorders, psychiatric conditions, rheumatic diseases and dermatologic diseases. We compared 167 S. stercoralis-positive and 133 S. stercoralis-negative patients. RESULTS: After controlling for sex (male/female OR = 2.29; 95% (CI): (1.42 - 3.70), rheumatic diseases remained significantly associated with intestinal strongyloidiasis (OR: 4.96; 95% CI: 1.34-18.37) in a multiple logistic regression model. With respect to leukocyte counts, patients with strongyloidiasis presented with significantly higher relative eosinophil (10.32% ± 7.2 vs. 4.23% ± 2.92) and monocyte (8.49% ± 7.25 vs. 5.39% ± 4.31) counts and lower segmented neutrophil (52.85% ± 15.31 vs. 61.32% ± 11.4) and lymphocyte counts (28.11% ± 9.72 vs. 30.90% ± 9.51) than S. stercoralis-negative patients. CONCLUSIONS: Strongyloidiasis should be routinely investigated in hospitalized patients with complex conditions facilitate the treatment of patients who will undergo immunosuppressive therapy. Diagnoses should be determined through the use of appropriate parasitological methods, such as the Baermann-Moraes technique.

Prediction of hyperglycemia in preterm newborn infants

Many conditions are associated with hyperglycemia in preterm neonates because they are very susceptible to changes in carbohydrate homeostasis. The purpose of this study was to evaluate the occurrence of hyperglycemia in preterm infants undergoing glucose infusion during the first week of life, and to enumerate the main variables predictive of hyperglycemia. This prospective study (during 1994) included 40 preterm neonates (gestational age <37 weeks); 511 determinations of glycemic status were made in these infants (average 12.8/infant), classified by gestational age, birth weight, glucose infusion rate and clinical status at the time of determination (based on clinical and laboratory parameters). The clinical status was classified as stable or unstable, as an indication of the stability or instability of the mechanisms governing glucose homeostasis at the time of determination of blood glucose; 59 episodes of hyperglycemia (11.5%) were identified. A case-control study was used (case = hyperglycemia; control = normoglycemia) to derive a model for predicting glycemia. The risk factors considered were gestational age (<=31 vs. >31 weeks), birth weight (<=1500 vs. >1500 g), glucose infusion rate (<=6 vs. >6 mg/kg/min) and clinical status (stable vs. unstable). Multivariate analysis by logistic regression gave the following mathematical model for predicting the probability of hyperglycemia: 1/exp{-3.1437 + 0.5819(GA) + 0.9234(GIR) + 1.0978(Clinical status)} The main predictive variables in our study, in increasing order of importance, were gestational age, glucose infusion rate and, the clinical status (stable or unstable) of the preterm newborn infant. The probability of hyperglycemia ranged from 4.1% to 36.9%.

Prevalência do excesso de peso em idade pré-escolar no concelho da Murtosa: um estudo transversal

RESUMO - A prevalência de obesidade infantil em Portugal é das mais elevadas da Europa. No concelho da Murtosa (Aveiro), para estimar a prevalência de excesso de peso e obesidade entre os 3 e os 6 anos e determinar os factores que lhe estão associados, desenvolveu-se, durante o ano de 2008, um estudo transversal que consistiu na avaliação estatoponderal das crianças frequentadoras dos estabelecimentos de ensino pré-escolar do concelho e aplicação de um questionário aos pais sobre antecedentes e perinatais, hábitos alimentares, actividades da criança e características da família. Através de um modelo de regressão logística multivariada identificaram-se as variáveis associadas ao excesso de peso/obesidade. Participaram no estudo 258 crianças, estimando-se uma prevalência de excesso de peso de 15,5 % (IC 95 % : 11,6 % a 20,4 %) e de obesidade de 6,2 % (IC 95 % : 3,9 % a 9,8 % ). Observou-se uma maior prevalência de excesso de peso nos meninos (19,5 %) e de obesidade nas meninas (10,4 %). O excesso de peso materno e o hábito de comer a ver televisão aumentaram o risco de excesso de peso/obesidade (OR: 10,548; OR: 13,815); o maior número de horas de sono diário, o maior número de refeições diárias e o aumento ponderal materno durante a gravidez (OR: 0,490; OR: 0,366; OR: 0,804) associaram-se a um menor risco de excesso de peso/obesidade. Justifica-se o desenvolvimento de programas de prevenção primária e secundária da obesidade infantil dirigidos aos factores de risco modificáveis identificados, sugerindo-se a necessidade de uma abordagem familiar e da avaliação sistemática deste tipo de intervenções.

Desigualdades sociais em saúde nos idosos : um retrato para Portugal

RESUMO - Contexto: As desigualdades sociais em saúde são uma questão central de justiça social. No contexto de forte envelhecimento populacional em Portugal, as desigualdades nos idosos representam um desafio crucial para o futuro, sobre as quais existe pouca evidência. Este estudo pretende investigar a existência de desigualdades socioeconómicas em saúde nos idosos, em Portugal. Metodologia: Foram utilizados os dados para Portugal, da quarta vaga do Survey of Health, Ageing and Retirement in Europe. O estudo engloba 2017 indivíduos com 50 ou mais anos. Foram utilizados quatro indicadores de saúde: problemas de saúde, saúde auto-reportada, doenças de longa duração e atividade limitada. Foi utilizado o nível de educação como indicador socioeconómico. As desigualdades socioeconómicas foram avaliadas através de regressões logísticas multivariadas. Resultados: Existem desigualdades socioeconómicas em saúde nos idosos favoráveis aos mais educados. Os indivíduos com menor educação estão em maior risco de reportar má saúde (OR=5,5); maior risco em ter problemas de saúde, existindo um gradiente social na Hipertensão Arterial (OR=2,4) e na Artrite (OR=7,0); maior risco de doenças de longa duração (OR=1,6) e maior risco de limitação nas atividades diárias (OR=5,1). As desigualdades socioeconómicas diminuem com a idade. Conclusão: De forma a melhorar a saúde e reduzir as desigualdades socioeconómicas em saúde nos idosos, os resultados apontam para a necessidade de implementar medidas no âmbito dos problemas de saúde em que existe um gradiente social, melhorar o nível de educação da população geral e implementar medidas de educação para a saúde, aumentando a literacia em saúde nos idosos mais jovens.

Contributo para o estudo dos efeitos da passagem à situação (e idade) de reforma na frequência das principais doenças crónicas em Portugal

RESUMO - Introdução: A transição para a reforma é um acontecimento que pode acarretar alterações suscetíveis de afetar o estado de saúde. Vários estudos têm investigado os efeitos da reforma no estado de saúde, embora poucos o tenham investigado, especificamente, nas doenças crónicas. As recentes políticas de aumento da idade de reforma, assim como a ausência de consenso sobre os efeitos da reforma na saúde, atribuem-lhe ainda maior importância. Constituem objetivos do presente estudo quantificar a associação entre a Passagem à situação de reforma (e idade de reforma) e a frequência de cada uma das principais doenças crónicas, no sentido dos efeitos da reforma nestes indicadores de saúde (doença respiratória crónica, diabetes, doença cardiovascular, AVC, depressão e cancro). Material e Métodos: Desenvolveu-se um estudo transversal, no qual foram analisados os dados provenientes das amostras representativas da população portuguesa SHARE 2011 e ECOS 2013. As associações foram quantificadas através do cálculo do Odds ratio por Regressão Logística Binária com avaliação do confundimento e modificação de efeito. As variáveis de doença crónica foram medidas por auto-reporte. Foram considerados os reformados que se encontrassem em processo de reforma (ou seja, reformados há 5 anos ou menos) e que não se tivessem reformado por doença. Resultados: A reforma não se encontrou significativamente associada a nenhuma das doenças crónicas consideradas, excetuando-se: i) o cancro (na amostra ECOS), para o qual foi fator protetor; ii) e a doença cardiovascular (na amostra SHARE), para a qual teve um efeito prejudicial, mas apenas em não hipertensos. A reforma em idade antecipada pareceu encontrar-se associada a um pior estado de saúde, relativamente à reforma em idade legal (ou após). Tal observou-se no Cancro (nas amostras ECOS e SHARE), na Diabetes (na amostra SHARE), e no AVC em pessoas sem Doença Cardiovascular (na amostra SHARE). Pelo contrário, em pessoas com Doença Cardiovascular a reforma antecipada pareceu constituir um fator protetor. Discussão e conclusões: As diferenças observadas nos resultados entre amostras poderão, entre outros, atribuir-se às diferentes populações em estudo, dimensões amostrais e desenhos de amostragem. Os resultados obtidos não são muito diferentes dos que têm sido descritos na bibliografia, ainda que haja um número reduzido de estudos sobre esta matéria. Indicam que, eventualmente, as recentes alterações de aumento da idade de reforma poderão expandir o grupo de pessoas que se reformam antecipadamente, podendo resultar, eventualmente, num aumento da prevalência de doenças crónicas na população portuguesa. Os mecanismos através dos quais a reforma poderá influenciar a ocorrência de doenças crónicas permanecem por explicar, embora os seus principais fatores de risco pareçam representar importantes modificadores de efeito.

Hypertension in employees of a University General Hospital

PURPOSE: To find out the prevalence of hypertension in employees of the Hospital and relate it to social demographic variables. METHODS: Blood pressure measurement was performed with a mercury sphygmomanometer, using an appropriate cuff size for arm circumference, weight, and height in a population sample of 864 individuals out of the 9,905 employees of a University General Hospital stratified by gender, age, and job position. RESULTS: Hypertension prevalence was 26% (62% of these reported being aware of their hypertension and 38% were unaware but had systolic/diastolic blood pressures of >140 and/or >90 mm Hg at the moment of the measurement). Of those who were aware of having hypertension, 51% were found to be hypertensive at the moment of the measurement. The prevalence was found to be 17%, 23%, and 29% (P <.05) in physicians, nursing staff, and "others", respectively. The univariate analysis showed a significant odds ratio for the male gender, age >50 years, work unit being the Institute of Radiology and the Administration Building, educational level 10 years, and body mass index >30 kg/m². The multivariate logistic regression model revealed a statistically significant association of hypertension with the following variables: gender, age, skin color, family income, and body mass index. CONCLUSIONS: Hypertension prevalence was high, mainly in those who were not physicians or members of the nursing staff. High-risk groups (obese, non-white, men, low family income) should be better advised of prevention and early diagnosis of hypertension by means of special programs.

Natural history of stenosis in the iliac arteries in patients with intermittent claudication undergoing clinical treatment

PURPOSE: Inspite of the long experience with the treatment of intermittent claudication, little is known about the natural history of stenotic lesions in the iliac segment. With the advent of endovascular treatment, this knowledge has become important. METHODS: Fifty-two stenosis, diagnosed using arteriography, in 38 claudicant patients were analyzed. After a minimum time interval of 6 months, a magnetic resonance angiography was performed to determine whether there was arterial occlusion. The primary factors that could influence the progression of a stenosis were analyzed, such as risk factors (smoking, hypertension, diabetes, sex, and age), compliance with clinical treatment, initial degree of stenosis, site of the stenosis, and length of follow-up. RESULTS: The average length of follow-up was 39 months. From the 52 lesions analyzed, 13 (25%) evolved to occlusion. When occlusion occurred, there was clinical deterioration in 63.2% of cases. This association was statistically significant (P = .002). There was no statistically significant association of the progression of the lesion with the degree or site of stenosis, compliance with treatment, or length of follow-up. Patients who evolved to occlusion were younger (P = .02). The logistic regression model showed that the determinant factors for clinical deterioration were arterial occlusion and noncompliance with clinical treatment. CONCLUSIONS: The progression of a stenosis to occlusion, which occurred in 25% of the cases, caused clinical deterioration. Clinical treatment was important, but it did not forestall the arterial occlusion. Prevention of occlusion could be achieved by early endovascular intervention or with the development of drugs that might stabilize the atherosclerotic plaque.

The residual effect of deltametrine in the control of Malaria as observed on fifferent types Of walls In the Brazilian Amazon 1

The residual power of deltametrine FW (25 mg 1 .a/m2) was evaluated and compared to that of DDT (2 g i.a./m2) by means of biological tests. The different kinds of material used in constructing houses in Amazonia, such as: masonry, wood, and wattle and daub, were used. Data from logistic regression showed that the drop in mortality, the inclination of the curve in relation to time, was similar for the two insecticides in the first samples. The negative coeficient for the variable, months after application, confirmed a reduction in the activity of both insecticides. Wooden and wattle walls showed positive and negative coeficiencies respectively from the beginning. The wooden walls retained a residual effect but the wattle walls were shown to be the least indicated for the application of insecticides The experiments demonstrated a more prolonged residual effect for deltametrine as compared to DDT, and that insecticides work better on brick and cement and wooden walls than they do on wattle and daub constructions. For these reasons, it would be necessary to spray brick and cement walls every 8 months, wooden ones every 9 months and wattle constructions every 7 months to control the vectors of malaria.

Analysis of a Local HIV-1 Epidemic in Portugal Highlights Established Transmission of non-B and -G Subtypes

Existing data supports Portugal as the Western Europe country with highest HIV-1 subtype diversity. However, detailed phylogenetic studies of Portuguese HIV-1 epidemics are still scarce. Thus, our main goal was to analyze the phylodynamics of a local HIV-1 infection in the Portuguese region of Minho. Molecular epidemiological analysis was applied to data from 289 HIV-1 infected individuals followed in the reference Hospital of the province of Minho, Portugal, in which isolated viruses had been sequenced between 2000 and 2012. Viruses of the G (29.1%) and B (27.0%) subtypes were the most frequent, followed by recombinant forms (17.6%), C (14.5%), F1 (7.3%) and A1 (4.2%) subtypes. Multinomial logistic regression revealed that the odds of being infected with A1 and F1 subtype increased over the years when compared with B, G, C or recombinant viruses. As expected, polyphyletic patterns suggesting multiple and old introductions of subtypes B and G were found. However, transmission clusters of non-B and -G viruses among native individuals were also found with the dates of the most recent common ancestor estimated to the early 2000s. Our study supports that the HIV-1 subtype diversity in the Portuguese region of Minho is high and has been increasing in a manner that is apparently driven by factors other than immigration and international travel. Infections with A1 and F1 viruses in the region of Minho are becoming established and were mainly found in sexually transmitted clusters, reinforcing the need for more efficacious control measures targeting this infection route.