ABSTRACT
Intestinal barrier function and serum concentrations of rifampin, isoniazid and pyrazinamide were studied in healthy controls and patients with active pulmonary tuberculosis. A case-control study of 29 controls and 30 cases attending at the Health Center, July, 2004 to December, 2005 was conducted. The body mass index was significantly reduced in cases compared to controls (p < 0.001). The intestinal paracellular transport of lactulose was significantly (p = 0.019) reduced in cases compared to controls. The transcellular transport of mannitol and the lactulose:mannitol ratio were not significantly (p = 0.0698) reduced in cases compared to controls. Low serum concentrations of rifampin, isoniazid and pyrazinamide were observed in 81 percent (48/59), 92 percent (54/59) and 28 percent (12/59), respectively, in all individuals. The results demonstrated a marked decrease on intestinal paracellular transport in patients with active pulmonary tuberculosis and reduced serum concentrations of rifampin and isoniazid in both groups.
Subject(s)
Adult , Female , Humans , Male , Antitubercular Agents/pharmacokinetics , Intestinal Absorption/physiology , Tuberculosis, Pulmonary/metabolism , Antitubercular Agents/blood , Antitubercular Agents/therapeutic use , Case-Control Studies , Isoniazid/blood , Isoniazid/pharmacokinetics , Isoniazid/therapeutic use , Pyrazinamide/blood , Pyrazinamide/pharmacokinetics , Pyrazinamide/therapeutic use , Rifampin/blood , Rifampin/pharmacokinetics , Rifampin/therapeutic use , Time Factors , Tuberculosis, Pulmonary/blood , Tuberculosis, Pulmonary/drug therapyABSTRACT
Low antimycobacterial drug concentrations have been observed in tuberculosis (TB) patients under treatment. The lactulose/mannitol urinary excretion test (L/M), normally used to measure intestinal permeability, may be useful to assess drug absorption. The objective of this research was to study intestinal absorptive function and bioavailability of rifampin and isoniazid in TB patients. A cross sectional study was done with 41 patients and 28 healthy controls, using the L/M test. The bioavailabilities of rifampin (R) and isoniazid (H) were evaluated in 18 patients receiving full doses. Urinary excretion of mannitol and lactulose, measured by HPLC, was significantly lower in TB patients. The serum concentrations of the drugs were below the expected range for R (8-24 mcg/mL) or H (3-6 mcg/mL) in 16/18 patients. Analyzing the drugs individually, 12/18 patients had low serum concentrations of R, 13/18 for H and 8/18 for both drugs. We suggest that there is a decrease in the functional absorptive area of the intestine in TB patients, which would explain the reduced serum concentrations of antituberculosis drugs. There is a need for new approaches to improve drug bioavailability in TB patients.
Subject(s)
Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Antitubercular Agents/pharmacokinetics , Intestinal Absorption , Isoniazid/pharmacokinetics , Rifampin/pharmacokinetics , Tuberculosis, Pulmonary/drug therapy , Antitubercular Agents/therapeutic use , Case-Control Studies , Chromatography, High Pressure Liquid , Cross-Sectional Studies , Isoniazid/therapeutic use , Lactulose/pharmacokinetics , Lactulose/urine , Mannitol/pharmacokinetics , Mannitol/urine , Permeability , Rifampin/therapeutic use , Tuberculosis, Pulmonary/metabolismABSTRACT
Avalia o conhecimento de adolescentes a respeito da fisiologia do aparelho reprodutor, identifica fatores de risco para infecção por DST/HIV, como a conduta sexual, e avalia a frequência do uso rotineiro de preservativo
Subject(s)
Humans , Male , Female , Adolescent , Reproduction , Sexual Behavior , Sexually Transmitted DiseasesABSTRACT
O conhecimento do número de óbitos, sua distribuição por sexo, faixa etária, local de residência e causa é nessário para a construção de indicadores de saúde, avaliação da distribuição dos óbitos na população e planejamento de intervenção de Saúde Pública. Para verificar se havia subnotificação de óbitos em Fortaleza, Ceará, foi realizada busca ativa de sepultamentos ocorridos em 1999 e 2000 em cemitérios da Região Metropolitana. Foram feitas listagens dos óbitos notificados à Secretaria Municipal de Saúde de Fortaleza (SMS), comparadas com os registros de óbitos pelos cemitérios. Os nomes inexistentes na lista da SMS também foram comparados aos da Secretaria de Estado de Saúde do Ceará (SESA), por meio do Epi Info, versão 6.04. Foram encontrados, não notificados, 1.633 óbitos em 1999 e 1.931 do ano 2000 (de 10.581 óbitos enumerados em 1999; e 11.854 em 2000). O acréscimo desses óbitos aumenta a taxa de mortalidade (de 5,7 para 6,5 em 1999; e de 4,9 para 5,8 por mil habitantes); e influencia, principalmente, o coeficiente de mortalidade infantil (de 26,9 para 33,1 em 1999; e de 18,5 para 26,2 por mil nascidos vivos em 2000). A qualidade das informações fica comprometida por esse tipo de coleta, mas há vantagens em conhecer a quantidade de óbitos para que se possa melhorar o estudo da mortalidade em Fortaleza