Reabilitação funcional e barreiras para atividade física na COVID-longa: um ensaio clínico randomizado / Functional rehabilitation and barriers to physical activity after COVID-19: a randomized clinical trial

O estudo teve como objetivo analisar as barreiras percebidas à prática de atividade física durante um programa de treinamento multicomponente em adultos e idosos pós infecção por COVID-19. Realizou-se um ensaio clínico randomizado com 40 participantes (19 grupo controle e 21 grupo intervenção). Foram coletadas informações sociodemográficas, de saúde e de barreiras para a prática de atividade física, antes, 12 e 24 semanas após o início da intervenção. A medida das barreiras para a prática de atividade física foi obtida por meio de uma escala válida composta por 16 itens. As diferen-ças de barreiras entre os grupos e ao longo de tempo foi analisada a partir das Equações de Estimativa Generalizada, α = 0,05. As barreiras mais citadas pelos dois grupos na linha de base foram "Preguiça, cansaço ou desânimo" (71%), "Dores, lesões ou incapacidade" (38%) e "Falta de motivação" (48%). As análises principais indicaram que ambos os grupos tiveram redução na frequência da barreira "Pre-guiça, cansaço ou desânimo" na 12ª semana (p = 0,003), porém voltando aos valores iniciais na 24ª semana (p = 0,441). Já a barreira "Por causa da epidemia de coronavírus" foi reduzida na 12ª semana (p = 0,704) e ainda mais reduzida na 24ª semana (p = 0,158), comportamento também similar entre os grupos. Como principal conclusão, barreiras para atividade física podem ser reduzidas pela parti-cipação em programas de exercício supervisionado e recomendação para a prática de atividade física

The study aimed to analyze perceived barriers to physical activity during a multicomponent training pro-gram in adults and seniors post-COVID-19 infection. A randomized clinical trial was conducted with 40 participants (19 control group and 21 intervention group). Sociodemographic, health, and barriers to physical activity information were collected before, 12 and 24 weeks after the start of the intervention. The measure of barriers to physical activity was obtained through a valid scale composed of 16 items. Differences in barriers between groups and over time were analyzed using Generalized Estimating Equations, α = 0.05. The most frequently mentioned barriers at baseline by both groups were "Laziness, fatigue, or lack of enthusiasm" (71%), "Pain, injuries, or disability" (38%), and "Lack of motivation" (48%). The main analyses indicated that both groups had a reduction in the frequency of the barrier "Laziness, fatigue, or lack of enthusiasm" at week 12 (p = 0.003), but returned to initial values at week 24 (p = 0.441). The barrier "Because of the coronavirus epidemic" was reduced in week 12 (p = 0.704) and further reduced in week 24 (p = 0.158), with a similar pattern between groups. The key conclusion is that barriers to physical activity can be reduced through participation in supervised exercise programs and recommendations for physical activity

Genomic monitoring unveils a high prevalence of severe acute respiratory syndrome coronavirus 2 Omicron variant in vaccine breakthrough cases in Bahia, Brazil

SUMMARY OBJECTIVE: Genome sequencing has been proved to be an excellent tool to monitor the molecular epidemiology of the disease caused by severe acute respiratory syndrome coronavirus 2, i.e., coronavirus disease 2019. Some reports of infected, vaccinated individuals have aroused great interest because they are primarily being infected with circulating variants of concern. To investigate the cases of infected, vaccinated individuals in Salvador, Bahia, Brazil, we performed genomic monitoring to estimate the magnitude of the different variants of concern in these cases. METHODS: Nasopharyngeal swabs from infected (symptomatic and asymptomatic), vaccinated or unvaccinated individuals (n=29), and quantitative reverse transcription polymerase chain reaction cycle threshold value (Ct values) of ≤30 were subjected to viral sequencing using nanopore technology. RESULTS: Our analysis revealed that the Omicron variant was found in 99% of cases and the Delta variant was found in only one case. Infected, fully vaccinated patients have a favorable clinical prognosis; however, within the community, they become viral carriers with the aggravating factor of viral dissemination of variants of concern not neutralized by the currently available vaccines. CONCLUSION: It is important to acknowledge the limitations of these vaccines and to develop new vaccines to emergent variants of concern, as is the case of influenza vaccine; going through new doses of the same coronavirus vaccines is "more of the same."

Óbitos por Covid -19 no estado da Bahia: da captação à publicação / Deaths by Covid -19 in the state of Bahia: from capture to publication / Muertes por Covid -19 en el estado de Bahía: desde la captura hasta la publicación

Identificada inicialmente em Wuhan, na China, a Covid-19 causada pelo novo coronavírus da síndrome respiratória (SARS-CoV-2) provocou um alerta global. Diante desse cenário emergencial, o Brasil, assim como outros países, tem vivenciando grandes mudanças nas ações e serviços em saúde. Na Bahia, a velocidade de disseminação da doença ocasionou um aumento significativo na notificação de casos e óbitos, promovendo uma restruturação no processo de trabalho da vigilância epidemiológica estadual para atuar de forma oportuna na captação, investigação e classificação de casos, e publicação e recomendações de medidas sanitárias. Este trabalho objetiva descrever o processo de trabalho na vigilância epidemiológica de óbitos por Covid-19 no estado da Bahia. Trata-se de um relato de experiência do processo de trabalho de análise dos óbitos por Covid-19 no período de março a dezembro de 2020. A trajetória metodológica foi estruturada em análise documental, relatórios de investigação, ferramentas de notificação do Ministério da Saúde e outros sistemas oficiais, como o Formulário Eletrônico do SUS ­ FormSUS, produzido pela Diretoria de Vigilância Epidemiológica para identificar os óbitos por Covid-19 nos hospitais da Bahia em tempo hábil, facilitando o processo de captação, investigação, análise e publicação de informação de mortalidade. Observou-se que a estruturação de um processo organizado e aplicado ao fluxo de trabalho possibilitou a qualificação e a fidedignidade das informações dos óbitos por Covid-19, garantindo mudanças incrementais no âmbito da vigilância e segurança das informações publicadas, essenciais para o planejamento das ações de prevenção e controle.

Initially identified in Wuhan, China, Covid-19 caused by the respiratory syndrome coronavirus (SARS-CoV-2) has triggered a global alert. Faced with this emergency scenario, Brazil, like other countries, has been experiencing major changes in health actions and services. In the state of Bahia, the rapid spread of the disease increased significantly the notification of cases and deaths, promoting a restructuring in the work process of state epidemiological surveillance to act in a timely manner in capturing, investigating and classifying cases, publishing and recommending sanitary measures. This paper aims at describing the work process in the epidemiological surveillance of deaths by Covid-19 in the state of Bahia. This is an experience report of Covid-19 death analysis work process, from March to December 2020. The methodological trajectory was structured in document analysis, investigation reports, notification tools from the Ministry of Health and others official systems, and the SUS FormSUS Electronic Form, produced by the Epidemiological Surveillance Directorate (Divep) to identify deaths by Covid-19 by hospitals in Bahia in a timely manner, facilitating the process of capturing, investigating, analyzing and publishing information of mortality. It was observed that the structuring of an organized process and application to the workflow enabled the qualification and reliability of death information by Covid-19, ensuring incremental changes in the scope of surveillance and security in the published information, essential for planning prevention and control actions.

Inicialmente identificado en Wuhan, China, el covid-19 causante del síndrome respiratorio agudo grave (SARS-CoV-2) ha desencadenado una alerta global. Ante este escenario de emergencia, Brasil, al igual que otros países, ha venido experimentando importantes cambios en las acciones y servicios de salud. En Bahía, la velocidad de propagación de la enfermedad provocó un aumento significativo en la notificación de casos y defunciones, promoviendo una reestructuración en el proceso de trabajo de la vigilancia epidemiológica estadual para actuar de manera oportuna en la recopilación, investigación, clasificación de casos, publicación y recomendación de medidas preventivas. Este artículo tiene como objetivo describir el proceso de trabajo en la vigilancia epidemiológica de las muertes por covid-19 en el estado de Bahía. Es un informe de experiencia del proceso de trabajo de análisis de muertes por covid-19, de marzo a diciembre de 2020. La trayectoria metodológica se estructuró en análisis de documentos, informes de investigación, herramientas de notificación del Ministerio de Salud y otros sistemas oficiales, así como el Formulario Electrónico SUS FormSUS, elaborado por la Dirección de Vigilancia Epidemiológica (Divep) para identificar las muertes por covid-19 en los hospitales de Bahía de manera oportuna, lo que facilita el proceso de recopilación, investigación, análisis y publicación de información sobre mortalidad. Se observó que la estructuración de un proceso organizado y aplicado al flujo de trabajo permitió la calificación y confiabilidad de la información de muertes por covid-19, asegurando cambios incrementales en el alcance de la vigilancia y seguridad de la información publicada, fundamental para planificar la prevención y el control.

Clinical and laboratory findings of acute Zika virus infection in patients from Salvador during the first Brazilian epidemic

Abstract Several major epidemics of Zika fever, caused by the ZIKA virus (ZIKV), have emerged in Brazil since early 2015, eventually spreading to other countries on the South American continent. The present study describes the clinical manifestations and laboratory findings of patients with confirmed acute ZIKV infection during the first epidemic that occurred in Salvador, Brazil. All included patients were seen at the emergency room of a private tertiary hospital located in Salvador, Brazil from 2015 through 2017. Patients were considered eligible if signs of systemic viral febrile disease were present. All individuals were tested for ZIKV and Chikungunya infection using PCR, while rapid test was used to detect Dengue virus antibodies or, alternatively, the NS1 antigen. A diagnosis of acute ZIKV infection was confirmed in 78/434 (18%) individuals with systemic viral febrile illness. Positivity was mainly observed in blood, followed by saliva and urine. Coinfection with Chikungunya and/or Dengue virus was detected in 5% of the ZIKV-infected patients. The most frequent clinical findings were myalgia, arthralgia and low-grade fever. Laboratory analysis demonstrated normal levels of hematocrit, platelets and liver enzymes. In summary, in acute settings where molecular testing remains unavailable, clinicians face difficulties to confirm the diagnosis of ZIKV infection, as they rely only on clinical examinations and conventional laboratory tests.

Síndrome de leigh: a propósito de um caso clínico com mutação no dna mitocondrial / Leigh syndrome: a case report with a mitochondrial dna mutation

RESUMO Objetivo: A síndrome de Leigh é uma doença neurodegenerativa com incidência de 1:40.000 nados-vivos. Apresenta ampla heterogeneidade clínica, bioquímica e genética, mas com alterações neuropatorradiológicas homogêneas. Não existe tratamento específico, e o prognóstico é reservado. O objetivo deste estudo foi familiarizar os profissionais de saúde com a doença. Descrição do caso: Menina de 16 meses, com hipotonia axial e atraso do desenvolvimento psicomotor. Dos exames realizados: cariótipo, potenciais auditivos evocados e avaliação oftalmológica normais; presença de hiperlactacidemia e hipocitrulinemia. Após a realização de ressonância magnética cerebral sob anestesia, observou-se agravamento da hipotonia com necessidade de internação por episódios de cianose/apneia. O eletroencefalograma não mostrou atividade epileptiforme. A neuroimagem revelou hipersinal lenticular bilateral com lesão do putâmen e do globo pálido esquerdo. Encontrou-se a mutação 8993T>G (MT-ATP6) no DNA mitocondrial. Comentários: De 10 a 30% dos doentes com síndrome de Leigh apresentam mutações do DNA mitocondrial. A descompensação com agravamento neurológico após intervenção anestésica está descrita e, nesse caso, apoiou o diagnóstico. Importante alertar para casos semelhantes, com diminuição de exames invasivos para diagnóstico.

ABSTRACT Objective: Leigh syndrome is a neurodegenerative disorder with an incidence of 1:40,000 live births. It presents wide clinical, biochemical, and genetic heterogeneity, but with homogenous neuropatoradiological alterations. There is no specific treatment, and the prognosis is reserved. This case report aimed familiarize health professionals with the disease. Case Description: A 16-month-hold girl who was followed in outpatient clinic due to axial hypotonia and delayed psychomotor development. Karyotype, auditory evoked potentials and ophthalmologic evaluation were normal. Evidence of hyperlactacidemia and hypocitrullinemia was detected in the patient. After performing brain magnetic resonance under anesthesia, hypotonia got worse, and the patient was hospitalized after an episode of cyanosis and apnea. The electroencephalogram showed no epileptiform activity. Neuroimaging revealed bilateral lenticular hyperintensity, especially in the putamen and in the left globus pallidus regions. Molecular analysis revealed an 8993T>G (MT-ATP6) mutation in the mitochondrial DNA. Comments: Between 10 and 30% of individuals with Leigh syndrome have mitochondrial DNA mutations. The decompensation after anesthetic intercurrences is typically associated with neurological deterioration and, in this case, increased the diagnosis suspicion. It is important to alert for similar cases and to reduce invasive diagnostic tests if the diagnosis is suspected.

Antiretroviral changes during the first year of therapy / Mudanças de terapia antirretroviral durante o primeiro ano de tratamento

Summary Introduction: The Brazilian HIV/AIDS management and treatment guideline (PCDT), published in 2013, recommends and standardizes the use of highly active antiretroviral therapy (HAART) in all adult patients, in spite of LTCD4 count. This study aimed to analyze the first year of HAART use in patients from a reference center on HIV/AIDS management in Fortaleza, Ceará. Method: This descriptive study reviewed all prescription forms of antiretroviral regimens initiation and changes from January to July 2014. All antiretroviral regimen changes that occurred during the first year of therapy were evaluated. Data were analyzed with SPSS version 20. Mean, standard deviation and frequency, Student's t and Mann-Whitney tests calculations were used, with significance at p<0.05. Results: From 527 patients initiating HAART, 16.5% (n=87) had a regimen change in the first year. These patients were mostly male (59.8%; n=52), aged 20 to 39 years, with only one HAART change (72.4%; n=63). Efavirenz was the most often changed drug, followed by tenofovir, zidovudine and lopinavir/ritonavir. Mean time of HAART changes was 120 days, with adverse reactions as the most prevalent cause. HAART was effective in decreasing viral load since second month of treatment (p=0.003) and increasing LTCD4 lymphocytes since fifth month (p<0.001). Conclusion: The main cause of initial HAART changes was adverse reaction and most patients had only one change in the HAART regimen. HAART prescription was in accordance to the PCDT from 2013.

Resumo Introdução: O Protocolo Clínico e Diretrizes Terapêuticas para manejo da infecção pelo HIV em adultos (PCDT) de 2013 recomenda e normatiza início de terapia antirretroviral (TARV) em pacientes com qualquer contagem de LTCD4. O objetivo do estudo foi analisar o primeiro ano de TARV de pacientes em acompanhamento em um centro de referência em HIV/AIDS de Fortaleza, Ceará. Método: O estudo descritivo revisou formulários de solicitação de início e modificação de TARV em pacientes que iniciaram tratamento entre janeiro e julho de 2014. Foram avaliadas todas as mudanças que ocorreram durante o primeiro ano de terapia. Os dados foram analisados no programa Statistical Package for the Social Sciences (SPSS) versão 20. Foram calculados médias, desvios padrão, frequências, testes t Student e Mann-Whitney, com significância de p<0,05. Resultados: Dos 527 pacientes que iniciaram TARV, 16,5% (n=87) realizaram troca no primeiro ano. A maioria era do sexo masculino (59,8%; n=52), de 20 a 39 anos, com apenas uma mudança da TARV (72,4%; n=63). Efavirenz foi o fármaco mais substituído, seguido por tenofovir, zidovudina e lopinavir/ritonavir. O tempo médio de ocorrência das modificações da TARV foi de 120 dias, tendo reações adversas como causas principais. TARV foi efetiva na queda da carga viral desde o 2ºmês de tratamento (p=0,003) e na elevação de LTCD4 desde o 5º mês (p<0,001). Conclusão: Os principais fatores envolvidos em modificações de TARV inicial foram reações adversas, com apenas uma mudança de esquema na maioria dos pacientes. O manejo da TARV estava de acordo com o PCDT de 2013.

Bacterial contamination in milk kitchens in pediatric hospitals in Salvador, Brazil

Milk may represent an important source of infectious agents to hospitalized pediatric patients. To describe the bacterial microflora isolated from the hands, stools, pharynx of all workers at milk kitchens in pediatric hospitals in the city of Salvador, Brazil, as well as in the formulas prepared by them, we carried out this cross-sectional study with all 91 workers from the 20 milk kitchens of all the public and private hospitals in Salvador, Brazil. Hand and pharynx swabs and stool samples were collected from all workers, as well as samples of the milk and formulas delivered by the kitchens. All samples were cultured for the detection of pathogenic and non-pathogenic bacteria. Pathogenic bacteria were isolated from 20 (22.0 percent) and 8 (8.8 percent) cultures of the hands and pharynx of the workers, respectively. No pathogenic bacteria were isolated from stool samples. Pathogenic bacteria were isolated from 17 (18.7 percent) milk samples. The prevalence of pathogenic bacteria in hand swabs was significantly higher in workers from public (37.8 percent) than from private (6.5 percent) hospitals (prevalence ratio [PR]=5.8; p<0.01). Pathogenic bacteria were isolated from two (4.4 percent) workers from public hospitals and six (13.0 percent) workers from private hospitals (PR=0.38; p=0.27). Pathogenic bacteria were isolated from 11 (24.4 percent) milk samples from public hospitals and 6 (13.0 percent) from private hospitals (PR=1.9; p=0.16). A high prevalence of contamination was found, mainly on the hands of workers on units for manipulation of milk. Preventive efforts should be intensified and focus primarily on effective hand washing and continuous work supervision.

Avaliação do conhecimento geral de médicos emergencistas de hospitais de Salvador - Bahia sobre o atendimento de vítimas com parada cardiorrespiratória / Assessment of the general knowledge of emergency physicians from the hospitals of the city of Salvador (Brazil) on the care of cardiac arrest patients

OBJETIVO: Identificar a proporção de médicos emergencistas com habilitação em cursos de imersão (SAVC - Suporte Avançado de Vida em Cardiologia e SAVT - Suporte Avançado de Vida no Trauma), relacionando variáveis: idade, sexo, especialidade médica, titulação e tipo de hospital com o grau de conhecimento teórico no atendimento de vítimas de parada cardiorrespiratória. MÉTODOS: Foram avaliados de forma consecutiva, de novembro/2003 a julho/2004, os emergencistas de hospitais públicos e privados da cidade de Salvador - Bahia, que voluntariamente aceitaram participar do estudo. Esses responderam a um questionário construído de informações das variáveis de interesse: perfil do profissional, realização ou não dos cursos de imersão SAVC e SAVT, avaliação cognitiva com 22 questões objetivas sobre ressuscitação cardiopulmonar. Calculou-se para cada participante um valor de acertos indicado como variável escore. Esse questionário foi validado a partir do resultado do escore dos instrutores do curso SAVC em Salvador - BA. RESULTADOS: Dos 305 médicos que responderam ao questionário, 83 (27,2 por cento) haviam realizado o curso SAVC, tendo como média da variável escore o valor de 14,9+3,0, comparada com os 215 médicos (70,5 por cento) que não o haviam feito e cuja média foi de 10,5+3,5 (p=0,0001). A média do escore dos 65 cardiologistas (21,5 por cento) foi de 14,1+3,3, comparada com os 238 médicos (78,5 por cento) que eram de outras especialidades, com média de 9,7+3,7(p=0,0001). Não foi identificada diferença da média do escore entre os médicos que haviam ou não realizado o curso SAVT (p=0,67). CONCLUSÃO: Na amostra avaliada, o conhecimento teórico sobre ressucitação cárdio-pulmonar (RCP) foi superior naqueles profissionais que realizaram o SAVC, diferente do que ocorreu naqueles que realizaram o SAVT. Os especialistas em Cardiologia que realizaram o SAVC demonstraram um conhecimento teórico superior, sobre o atendimento de vítimas de parada cárdio-respiratória (PCR), quando...

OBJECTIVE: To identify the proportion of emergency physicians certified in immersion courses (ACLS - Advanced Cardiac Life Support and ATLS - Advanced Trauma Life Support) correlating the variables of age, gender, medical specialty, academic title, and type of hospital with the level of theoretical knowledge on the care of Cardiac Arrest (CA) victims. METHODS: Emergency physicians from public and private hospitals of the city of Salvador, State of Bahia - Brazil, were consecutively evaluated from November, 2003 to July, 2004. They volunteered to participate in the study, and responded to a questionnaire consisting of information on the following variables of interest: professional profile, participation or not in ACLS and ATLS immersion courses, and cognitive assessment with 22 objective questions on Cardiopulmonary Resuscitation (CPR). A score of correct answers was calculated for each participant, and then designated as score variable. This questionnaire was validated based on the result of the score obtained by ACLS course instructors in Salvador, BA. RESULTS: Of the 305 physicians who responded to the questionnaire, 83 (27.2 percent) had attended the ACLS course and had a mean score variable of 14.9+3.0 compared with the 215 physicians (70.5 percent) who had not attended the course and whose mean was 10.5+ 3.5 (p=0.0001). The mean score of the 65 cardiologists (21.5 percent) was 14.1+3.3 compared with the mean of 9.7+3.7(p=0.0001) of the 238 physicians (78.5 percent) from other specialties. No difference was observed in the mean scores between physicians who had attended the ATLS course or not (p=0.67). CONCLUSION: In the sample studied, theoretical knowledge on CPR was higher among physicians who had attended the ACLS course, as opposed to those who had attended the ATLS course. Cardiologists who had attended the ACLS demonstrated a higher theoretical knowledge on the care of CA patients when compared to physicians from other specialties taken as whole - Internal...

A epidemia das armas / The firearms epidemic

Ressalta-se a nova influência das Organizações Não Governamentais (ONGs) na elaboração de políticas internacionais, como na proteção ambiental, na proibição de minas terrestres e, agora, no controle de armas de fogo. Avalia-se o impacto da proliferação de armas de fogo no que tange a saúde pública e os altos índices de morte a elas relacionadas no Brasil. Analisam-se os mitos sobre o uso de armas como autodefesa e a importância do conhecimento científico sobre o tema. Defende-se uma política de prevenção e controle de armas de fogo com base nos métodos de controle epidemiológico aplicados na saúde pública e a ineficácia das políticas de guerra. Enumeram-se os aspectos do Estatuto do Desarmamento que ainda não foram implementados, advertindo-se para as tentativas de anular ou enfraquecer a nova lei, e para a importância de a sociedade civil se mobilizar para defender o Estatuto e torná-lo uma realidade.

Risk factors for infection by extended-spectrum beta-lactamase producing Klebsiella pneumoniae in a tertiary hospital in Salvador, Brazil

Nosocomial infection caused by extended-spectrum beta-lactamase producing Klebsiella pneumoniae (ESBL-Kp) have been frequently reported worldwide. We have no information on such problems in Bahia, Brazil. OBJECTIVES: Evaluate the risk factors for nosocomial infections caused by ESBL-Kp, in a tertiary hospital, in Bahia, Brazil. MATERIAL AND METHODS: We evaluated all reported cases of nosocomial infections caused by ESBL-Kp in a private, tertiary hospital, in Salvador, Brazil, from 2000 through 2004. We compared patients with a diagnosis of ESBL-Kp (cases) and patients infected by non-ESBL producing K. pneumoniae (controls). Mean age, underlying disease, and frequency of invasive procedures were compared between the two groups. History of previous use of antibiotics was also analyzed. RESULTS: Based on multivariate analysis, previous use of antibiotics, diagnosis of malignant diseases, and diabetes mellitus were independent risk factors for acquisition of ESBL-Kp infection. No correlation was found for age, use of corticosteroids, diagnosis of chronic renal failure or AIDS, and infection by ESBL-Kp. CONCLUSION: Our findings suggest that the use of antibiotics or underlying disease that increases the chance of antibiotic are the main risk factors for ESBL-Kp infections. Programs focusing on rational use of antibiotics are mandatory for prevention and control of such infections.

Use of rhu-GM-CSF in pulmonary tuberculosis patients: results of a randomized clinical trial

It has been postulated that deficient or incomplete clinical and/or microbiological response to tuberculosis treatment is associated with cell-mediated immunological dysfunction involving monocytes and macrophages. A phase 2 safety trial was conducted by treating patients with either recombinant human granulocyte-macrophage colony-stimulating factor (rhu-GM-CSF) or a placebo, both in combination with anti-tuberculosis chemotherapy. Thirty-one patients with documented pulmonary tuberculosis were treated with rifampin/isoniazid for six months, plus pyrazinamide for the first two months. At the beginning of treatment, rhu-GM-CSF (125æg/M²) was randomly assigned to 16 patients and injected subcutaneously twice weekly for four weeks; the other 15 patients received a placebo. The patients were accompanied in the hospital for two weeks, then monthly on an out patient basis, for 12 months. Clinical outcomes were similar in both groups, with no difference in acid-fast bacilli (AFB) clearance in sputum at the end of the fourth week of treatment. Nevertheless, a trend to faster conversion to negative was observed in the rhu-GM-CSF group until the eighth week of treatment (p=0.07), after which all patients converted to AFB negative. Adverse events in the rhu-GM-CSF group were local skin inflammation and an increase in the leukocyte count after each injection, returning to normal 72 hours after rhu-GM-CSF injection. Three patients developed SGOP and SGPT > 2.5 times the normal values. All patients included in the GM-CSF group were culture negative at six months, except one who had primary TB resistance. None of the patients had to discontinue the treatment in either group. We conclude that rhu-GM-CSF adjuvant immunotherapy could be safely explored in a phase 3 trial with patients who have active tuberculosis

High prevalence of giardiasis and stronglyloidiasis among HIV-infected patients in Bahia, Brazil

Diarrhea due to intestinal microbial infections is a frequent manifestation among HIV-infected patients. It has been postulated that HIV-infected patients may have special types of intestinal infections, and that immune activation from such parasites may affect the progression of HIV disease. To evaluate these associations, the frequency of infections was examined in HIV-infected patients in Bahia, Brazil. To determine the potential impact of the presence of intestinal parasitic infections on HIV disease progression, a retrospective study approach was used. The medical charts of 365 HIV-infected patients who had been treated at the AIDS Clinic of the Federal University of Bahia Hospital were reviewed, and the prevalence of parasites was compared with 5,243 HIV-negative patients who had attended the hospital during the same period of time. Among HIV-infected subjects, CD(4) count, RNA plasma viral load (VL), and number of eosinophils were compared according to their stool examination results. The overall prevalence of each parasite was similar for HIV-positive and HIV-negative patients. However, the prevalence of S. stercoralis (p<10(-7)) and G. lamblia (p=0.005) was greater for HIV-infected subjects. The mean CD(4) count and viral load of HIV patients in our clinic who had stool examinations was 350 cells +/- 340 and 4.4 +/- 1.4 log RNA viral load, respectively. In this patient group there was no clear association between the level of the absolute CD(4) count or the viral load and a specific parasitic infection. The presence of an intestinal parasitic infection was not associated with faster progression of the HIV disease among HIV-infected patients. We conclude that strongyloidiasis and giardiasis are more frequent in HIV-infected patients in Bahia, Brazil. If this association is due to immune dysregulation, as has been proposed elsewhere, it must occur in patients after only minor shifts in CD(4) count from normal levels, or as a result of immune dysfunction not represented by CD(4) count. These infections do not appear to alter the progression of HIV disease.

Aids prevention - condom use and perceptions among college students

Study design: analytical survey. Purposes: 1) to get knowledge on college students' perceptions and behavior concerning condom use for AIDS prevention; 2) to provide subsides for planning educational inerventions. Methods: An exploratory study preceded the elaboration of the self-administered questionnaire employed for data collection. College students from three different cities of the State of Säo Paulo, Brazil integrated a convenient sample. Results: Seven hundred and eleven college students compounded the sample presenting the following characteristics: 43,0 percent were male students and 57,0 percent, female ones with ages varying from 17 to 32 years; 65,4 percent of the males and 43,9 percent of the females stated having had previous sexual intercourse. Research data disclosed the majority of them as having a reduced or regular risk perception level of getting AIDS/HIV; students of both genders declared their distrust regarding the efficacy of preventive measures. They reported having a low level of confidency condom use and a high level of confidence in a well-known sexual partner as a means for avoiding HIV/AIDS. Conclusion: An increment in the number of researches on social and cultural components associated to risk behaviors regarding AIDS/HIV infection is mandatory in order ot guide the planning for further educational interventions aimed to control AIDS/HIV epidemic

Calculation of HIV infection rates and projection of the number of cases AIDS in Säo Paulo, Brazil using a backcalculation methods

Reconstruction of HIV infection rates and a projection of the number of AIDS cases in the City of Säo Paulo were determined using a backcalculation method. AIDS cases reported to the Centro de Vigilância Epidmiológica , the State Surveillance Departmen in Säo Paulo were adjusted for reporting delays through 1993 using a non-parametric delay distribution. The incubation period distribution was derived from a multicenter cohort study in the United States and modelled in two stages: infection to CD4+ 200/mmü and CD4+ 200/mmü to AIDS diagnosis. After 1990, a factor reflecting the influence of treatment on the incubations distribution was used. Estimates were generated for the following risk cathegories: homosexual/bisexual men, heterosexuals, and IV drug users (IDU). HIV infection rates peaked at approximately 10,000 new infections annually in the mid-1980s, followed by a tendency to stabilize around 4,000 new annual infections in the early 1990s. HIV infection curves varied among risk cathegories with a decrease in infections in homosexual and bisexual men, but a continuous rise in incidence rates estimated for heterosexuals. By projecting AIDS incidence rates a slight upward trend was seen with approximately 4,600 new cases expected in 1997. It is notable that over 4,400 cases would be expected in 1997, even if no new HIV infections occurred. Backcalculation methods are expected to be useful for evaluating changes in infection and disease in various risk groups, and the effects of therapy.

Tumores carcinóides de pulmäo: estudo comparativo entre as variantes clássica e atípica com ênfase do seguimento clinico e aspectos morfológicos e imuno-histoquímicos / Carcinoid tumors of the lung: a histological, immunohistochemical and follow-up of atypical and typical variants

Dez casos de tumores carcinóide de pulmäo, tratados cirurgicamente entre 1977 e 1984, foram analisados à histologia e imuno-histoquímica. Compararam-se os padröes histológicos com os dados de seguimento clínico em nove deles. Seis mostraram histologicamente padräo em mosaico e trabecular. Houve um caso de padräo oncocitóide, um de fusiforme e dois foram diagnosticados como variantes atípicas. A imunohistoquímica, todos os casos mostraram reaçöes positivas, com variaçäo desde um padräo difuso com enolase e cromogranina até positividade focal com proteína S-100. No seguimento, os casos com atipia falecram respectivamente 16 e 26 meses após a cirurgia, com metástases sistêmicas. Um caso clássico desenvolveu metástase hepática e retrocular antes do 84§ mês de seguimento e o restante mostra-se assintomático. O diagnóstico diferencial entre a variante atípica e outras neoplasias pulmonares, como paragangliomas e carcinoma anaplásico de pequenas células, é discutido

Angiodema hereditário: a propósito de uma família afetada / Angiodema hereditary: apropos of 1 family affected

A partir do diagnóstico de angioedema hereditário em uma paciente, identificamos oito familiares afetados e pudemos confirmar laboratorialmente a doença em três deles. A paciente que motivou o diagnóstico apresentava manifestaçöes de angioedema associado predominantemente aos períodos menstruais, tendo apresentado vários episódios de edema de glote, havendo necessidade de se realizar traqueostomia em quatro ocasiöes. Após iniciar terapêutica com danazol houve diminuiçäo considerável da sintomatologia, bem como um maior espaço de tempo entre as crises. Os dois outros familiares que tiveram laboratorialmente comprovada a diminuiçäo da enzima inibidora de C1 eram filhos da paciente e apresentavam sintomatologia com menor gravidade que a observada na genitora