A DECADE TREND OF MULTIDRUG RESISTANT TUBERCULOSIS IN SÃO PAULO STATE, BRAZIL.

The aim of this retrospective study was to review all the notified cases of multidrug-resistant tuberculosis (MDR-TB) in São Paulo State (Brazil), as well as to describe and discuss the clinical, microbiological and radiologic aspects in a single reference center, within the same state, from 2000 to 2012. There were 1,097 notifications of MDR-TB in São Paulo State over this period, 70% affecting men aged on average 38 years (10-77). There was a significant fall in the MDR-TB mortality rate from 30% to 8% (2000-2003 versus 2009-2012). The same trend was observed in the cases studied at the reference center. The number of notified cases increased and death rate reduced from 37.5% (2000-2005) to 3.4% (2006-2012). Among the 48 drug-resistant TB cases, 17 non-tuberculous Mycobacteria were isolated in the sputum culture of nine patients, without any clinical significance. TB and fungus co-infection was diagnosed in 15% (7/48) of these cases: three with confirmed chronic pulmonary aspergillosis and four with positive serological markers for paracoccidioidomycosis. Overall, the reports show that MDR-TB diagnosis and cure rates have increased, while the mortality rate has decreased significantly in São Paulo State including in the studied reference center.

A family history of serious complications due to BCG vaccination is a tool for the early diagnosis of severe primary immunodeficiency.

Severe Combined Immunodeficiency (SCID) is one of the most severe forms of primary immunodeficiency (PID). Complications of BCG vaccination, especially disseminated infection and its most severe forms, are known to occur in immunodeficient patients, particularly in SCID. A carefully taken family history before BCG injection as well as delaying vaccination if PID is suspected could be a simple and effective method to avoid inappropriate vaccination of an immunodeficient child in some cases until the prospect of newborn screening for SCID has been fully developed. We describe a patient with a very early diagnosis of SCID, which was suspected on the basis of the previous death of two siblings younger than one year due to severe complications secondary to the BCG vaccine. We suggest that a family history of severe or fatal reactions to BCG should be included as a warning sign for an early diagnosis of SCID.

Growth of children with isolated Robin sequence treated by nasopharyngeal intubation: importance of a hypercaloric diet.

OBJECTIVE: To compare the growth curves (weight and length) of two groups of infants with isolated Robin sequence (RS) treated with nasopharyngeal intubation (NPI), one group receiving a hypercaloric diet and the other receiving a normal diet for age, and compare the growth rates and duration of NPI between the two groups. DESIGN: Prospective longitudinal study. SETTING: Hospital de Reabilitação de Anomalias Craniofaciais, Universidade de São Paulo, Bauru, Brazil, 1998 to 2000. PATIENTS: Twenty-three children with isolated RS treated by prolonged NPI. INTERVENTIONS: Nine children received a milk formula supplemented with 5% to 7% glucose polymers and 3% to 5% medium chain triglycerides (group 1), and 14 children received a milk formula only (group 2). Weight and length were measured at birth and every month up to 6 months of life for the construction of weight and length growth curves. The time of use of the nasogastric tube, age at the beginning of NPI, and duration of NPI were also determined. RESULTS: No significant difference in length was observed between the two groups. The mean weight curves obtained for the two groups were below the 50th percentile of the National Center for Health Statistics, but weight gain was higher in group 1. The duration of NPI was shorter in this group. CONCLUSIONS: The hypercaloric diet led to an improvement in nutritional status, which in turn contributed to improved respiratory conditions in isolated RS.

Placental transfer of naturally acquired, maternal cytomegalovirus antibodies in term and preterm neonates.

Maternal antibodies may protect the fetus and neonate against severe forms of CMV-caused disease, therefore this study investigated the efficiency of the placental transfer of naturally acquired, maternal total anti-cytomegalovirus (CMV) IgG and neutralizing antibodies at different gestational ages. The study was conducted on 182 healthy CMV-seropositive Brazilian mothers and their 196 infants who were not infected congenitally with CMV, as determined by CMV detection in urine. The study groups were composed of 44 infants aged 28-30 weeks; 51 infants aged 31-33 weeks; 62 infants aged 34-36 weeks, and 39 infants of gestational age > or = 37 weeks. Quantitative detection of total CMV IgG was carried out using EIA and virus neutralizing titers were determined by a microneutralization assay in sera from mothers and infants. CMV IgG levels and neutralizing titers of the infants correlated with maternal levels (r=0.873 and r=0.841, respectively). The efficiency of placental transfer of these antibodies was enhanced significantly as gestation progressed until 34-36 weeks, when values similar to those of full-term infants (90-100%) were found. Transfer ratios were significantly higher for neutralizing compared to total CMV IgG antibodies at gestational age 31-33 weeks (100% vs. 84%, respectively) and at gestational age 28-30 weeks (75% vs. 60%, respectively). We conclude that placental transfer of naturally acquired maternal CMV neutralizing and total CMV IgG antibodies are similarly efficient above 34 weeks of gestational age. At less than 34 weeks of gestational age, transfer of neutralizing antibodies may be favored and these antibodies reach the neonatal serum of 99% of these premature infants.

Saúde perinatal: metodologia e características da populaçäo estudada / Perinatal health: methodology and some characteristics of the population studied

Descrever os procedimentos metodológicos e algumas características demógrafo-sociais e da atençäo médica da populaçäo estudada em um projeto de pesquisa em saúde perinatal realizado no Município de Ribeiräo Preto, SP, Brasil, em 1994, visando a realizar comparaçöes históricas com indicadores de saúde materno-infantil. Entre junho de 1978 e maio de 1979 foram estudados todos os nascimentos hospitalares de Ribeiräo Preto através de entrevistas com as mäes, onde eram obtidos dados sobre hábitos maternos e paternos, situaçäo social da família, atençäo médica à gestaçäo e parto, duraçäo da gestaçäo e dados antropométricos e de mortalidade dos recém-nascidos. Em 1994 foi realizado novo estudo dos nascimentos ocorridos no município naquele ano(todos os nascimentos hospitalares observados num período de 4 meses), e também a mortalidade desse grupo até um ano após o parto, e o peso e comprimento da criança eram aferidos logo após o nascimento. A mortalidade infantil foi avaliada através do levantamento de todos os óbitos de crianças nascidas durante o período do projeto até um ano após seu encerramento. Foram analisados 3663 nascimentos, dos quais 3579 eram nascimentos únicos; destes, 2846 eram procedentes do município estudado. Quando comparados com os dados do estudo anterior, verifica-se que houve aumento da freqüência de alguns indicadores como mäes adolescentes, prematuridade, baixo peso ao nascer e parto cesáreo; por outro lado, houve diminuiçäo da metade da mortalidade infantil e seus componentes.