Epidemiology and control strategies for tuberculosis in countries with the largest prison populations

ABSTRACT Tuberculosis (TB) is a serious infectious disease, and its control is considered a challenge, especially among vulnerable populations such as prisoners. The occurrence of TB in prisons is an alarming public health problem in many countries. This integrative review aims to describe the epidemiology of TB and control strategies for this disease in countries with the largest prison populations. Studies have shown that it is essential to know the prevalence of TB in prisons of each country. This is because it can serve as an indication of the need for action in prisons to reduce TB rates, including improving the structure of prison environments, rapidly and accurately diagnosing new cases, identifying drug-resistant strains, and implementing effective and directly observed treatment for TB.

Laboratory diagnosis for Covid-19: A mini-review

Abstract Coronavirus disease (COVID-19) is a pandemic caused by a new coronavirus, called SARS-CoV-2. This disease was first identified in December 2019 and rapidly developed into a challenge to the public health systems around the world. In the absence of a vaccine and specific therapies, disease control and promotion of patient health are strongly dependent on a rapid and accurate diagnosis. This review describes the main laboratory approaches to making a diagnosis of COVID-19 and identifying those previously infected with SARS-CoV-2.

Helicobacter pylori infection and associated factors / Infecção por Helicobacter pylori e fatores associados / Infección por Helicobacter pylori y factores asociados

Background and Objectives: Helicobacter pylori is linked to gastroduodenal pathologies. To determine the frequency and potential risk factors of the H. pylori infection. Material and methods: A cross-sectional study was conducted, including 227 patients, submitted to upper gastrointestinal endoscopy. A questionnaire was applied to the patients, before endoscopy. The biopsy specimens were obtained from the antrum and gastric body for histology and PCR. The chi-square test was used for the categorical data analysis. P-values<0.05 were considered statistically significant.Results: 66.5% patients were positive for H. pylori. Based on the questionnaires applied to the patients, it was verified that marital status, smoking, alcohol consumption, toilet, education level and monthly family income had no significant association with the presence of H. pylori (p>0.05). However, we observed a significant association between the number of persons per household and presence of H. pylori (p=0.04). A statistically significant relation also was found between H. pylori and the patient's age (p=0.04) and between the histological and endoscopic diagnoses and the H. pylori infection (p≤0.01). Conclusions: We found a significant relation between household crowding and presence of H. pylori, which seems facilitate the person-to-person transmission H. pylori within families. Our results also suggest a cohort phenomenon. The increase in the frequency of H. pylori infection according to age may be due the acquisition of bacterium predominantly in childhood, when the sanitary conditions were deficient, and not during adulthood. Once acquired and untreated, the persistent H. pylori infection might have led to the development of severe gastroduodenal diseases.(AU)

A physiology-based approach to a patient with hyperkalemic renal tubular acidosis / Abordagem diagnóstica de um paciente com acidose tubular renal hipercalêmica

ABSTRACT Hyperkalemic renal tubular acidosis is a non-anion gap metabolic acidosis that invariably indicates an abnormality in potassium, ammonium, and hydrogen ion secretion. In clinical practice, it is usually attributed to real or apparent hypoaldosteronism caused by diseases or drug toxicity. We describe a 54-year-old liver transplant patient that was admitted with flaccid muscle weakness associated with plasma potassium level of 9.25 mEq/L. Additional investigation revealed type 4 renal tubular acidosis and marked hypomagnesemia with high fractional excretion of magnesium. Relevant past medical history included a recent diagnosis of Paracoccidioidomycosis, a systemic fungal infection that is endemic in some parts of South America, and his outpatient medications contained trimethoprim-sulfamethoxazole, tacrolimus, and propranolol. In the present acid-base and electrolyte case study, we discuss a clinical approach for the diagnosis of hyperkalemic renal tubular acidosis and review the pathophysiology of this disorder.

RESUMO A acidose tubular renal hipercalêmica é uma acidose metabólica de ânion gap normal que invariavelmente indica anormalidade na secreção de íons potássio, amônio e hidrogênio. Na prática clínica, está geralmente atribuída a um estado de hipoaldosteronismo real ou aparente, causado por doenças ou toxicidade por drogas. Descrevemos um paciente de 54 anos, transplantado hepático, que foi admitido com fraqueza muscular associada à hipercalemia, potássio plasmático de 9,25 mEq/L. A investigação adicional revelou acidose tubular renal tipo 4 e importante hipomagnesemia com elevada fração de excreção de magnésio. A história patológica pregressa incluía um diagnóstico recente de Paracoccidioidomicose - uma infecção sistêmica fúngica endêmica que ocorre em algumas partes da América do Sul -, e as medicações de uso habitual continham sulfametoxazol-trimetoprim, tacrolimus e propranolol. No presente relato de caso, discutiremos uma abordagem clínico-laboratorial para o diagnóstico da acidose tubular renal hipercalêmica, assim como da hipomagnesemia, revisando a fisiopatologia desses transtornos.

Drug resistance in helicobacter pylori / A resistência de Helicobacter pylori aos antimicrobianos

ABSTRACT Background Helicobacter pylori has a worldwide distribution and is associated with the pathogenesis of various diseases of the digestive system. Treatment to eradicate this microorganism involves the use of a combination of antimicrobials, such as amoxicillin, metronidazole, clarithromycin, and levofloxacin, combined with proton pump inhibitors. Although the current therapy is effective, a high rate of treatment failure has been observed, mainly because of the acquisition of point mutations, one of the major resistance mechanisms developed by H. pylori. This phenomenon is related to frequent and/or inappropriate use of antibiotics. Conclusion This review reported an overview of the resistance to the main drugs used in the treatment of H. pylori, confirming the hypothesis that antibacterial resistance is a highly local phenomenon and genetic characteristics of a given population can influence which therapy is the most appropriate.

RESUMO Contexto Helicobacter pylori tem uma distribuição a nível mundial, e está associado a patogênese de várias doenças do sistema digestivo. O tratamento para a erradicação deste microrganismo envolve a utilização de uma combinação de agentes antimicrobianos, tais como amoxicilina, metronidazol, claritromicina e levofloxacino, combinados com inibidores da bomba de prótons. Embora a terapia atual seja eficaz, uma elevada taxa de fracasso de tratamento tem sido observada, principalmente devido à aquisição de mutações pontuais, um dos principais mecanismos de resistência desenvolvida por H. pylori, relacionado com o uso frequente e/ou inadequado dos antibióticos. Conclusão Esta revisão abordou uma visão geral da resistência às principais drogas utilizadas no tratamento de H. pylori, confirmando a hipótese de que a resistência bacteriana é um fenômeno altamente local e as características genéticas de uma dada população podem influenciar qual terapia é a mais apropriada.

Bonding brackets on white spot lesions pretreated by means of two methods

Abstract Objective: The aim of this study was to evaluate the shear bond strength (SBS) of brackets bonded to demineralized enamel pretreated with low viscosity Icon Infiltrant resin (DMG) and glass ionomer cement (Clinpro XT Varnish, 3M Unitek) with and without aging. Methods: A total of 75 bovine enamel specimens were allocated into five groups (n = 15). Group 1 was the control group in which the enamel surface was not demineralized. In the other four groups, the surfaces were submitted to cariogenic challenge and white spot lesions were treated. Groups 2 and 3 were treated with Icon Infiltrant resin; Groups 4 and 5, with Clinpro XT Varnish. After treatment, Groups 3 and 5 were artificially aged. Brackets were bonded with Transbond XT adhesive system and SBS was evaluated by means of a universal testing machine. Statistical analysis was performed by one-way analysis of variance followed by Tukey post-hoc test. Results: All groups tested presented shear bond strengths similar to or higher than the control group. Specimens of Group 4 had significantly higher shear bond strength values (p < 0.05) than the others. Conclusion: Pretreatment of white spot lesions, with or without aging, did not decrease the SBS of brackets.

resumo Introdução: o objetivo do presente estudo foi avaliar a resistência ao cisalhamento de braquetes colados ao esmalte desmineralizado e pré-tratado com uma resina infiltrante de baixa viscosidade (Icon, DMG) ou com um selante ionomérico (Clinpro XT Varnish, 3M Unitek), com e sem envelhecimento. Métodos: setenta e cinco (75) amostras de esmalte bovino foram divididas em cinco grupos (n = 15). No Grupo 1 (controle), a superfície do esmalte não foi desmineralizada. Nos outros quatro grupos, as superfícies foram submetidas ao desafio cariogênico e as lesões de manchas brancas foram tratadas previamente à colagem de braquetes. Nos Grupos 2 e 3, as lesões foram tratadas com a resina Icon; nos Grupos 4 e 5, com o selante Clinpro XT Varnish. Após o tratamento, os Grupos 3 e 5 foram envelhecidos artificialmente. Os braquetes foram colados, sobre as lesões tratadas, utilizando-se o sistema adesivo Transbond XT, e a resistência ao cisalhamento foi avaliada em máquina universal de ensaios. A análise estatística foi realizada por meio da análise de variância e, posteriormente, pelo teste post-hoc de Turkey. Resultados: todos os grupos testados apresentaram resistência ao cisalhamento semelhante ou maior do que o grupo controle. As amostras do Grupo 4 apresentaram valores de resistência ao cisalhamento significativamente maiores (p < 0,05) do que as dos demais grupos. Conclusão: o tratamento das manchas brancas, com ou sem envelhecimento, não diminuiu a resistência ao cisalhamento dos braquetes.

cagE as a biomarker of the pathogenicity of Helicobacter pylori

Introduction Helicobacter pylori infection is associated with gastro-duodenal diseases. Genes related to pathogenicity have been described for H. pylori and some of them appear to be associated with more severe clinical outcomes of the infection. The present study investigates the role of cagE as a pathogenicity biomarker of H. pylori compare it to cagA, vacA, iceA and babA2 genes and correlate with endoscopic diagnoses. Methods Were collected biopsy samples of 144 dyspeptic patients at the Hospital of the Federal University of Rio Grande, Rio Grande do Sul, Brazil. After collection, the samples were sent for histological examination, DNA extraction and detection of all putative pathogenicity genes by PCR. Results Of the 144 patients undergoing endoscopy, 57 (39.6%) presented H. pylori by histological examination and PCR by detection of the ureA gene. Based on the endoscopic diagnoses, 45.6% (26/57) of the patients had erosive gastritis, while 54.4% (31/57) had enanthematous gastritis. The genes cagA, cagE, vacAs1/m1, vacAs1/m2 and iceA1 were related to erosive gastritis, while the genes vacAs2/m2, iceA2 and babA2 were associated to enanthematous gastritis. We found a statistically significant association between the presence of cagE and the endoscopic diagnosis. However, we detect no statistically significant association between the endoscopic diagnosis and the presence of cagA, vacA, iceA and babA2, although a biological association has been suggested. Conclusions Thus, cagE could be a risk biomarker for gastric lesions and may contribute to a better evaluation of the H. pylori pathogenic potential and to the prognosis of infection evolution in the gastric mucosa. .