ABSTRACT
SETTING: Tuberculosis (TB) remains a challenge in Brazil, particularly among prison inmates. OBJECTIVE: To assess TB prevalence by active case finding in a public prison in southern Brazil. DESIGN: Prison inmates were screened for TB using the presence of cough and chest X-ray (CXR) from October 2014 to August 2016. Presence of cough, irrespective of duration, and abnormal CXRs were further investigated using laboratory tests. RESULTS: Of 10 326 inmates screened, 196 had confirmed TB (1898/100 000 inmates screened). At the first screening, 1759 inmates presented with cough only, 16 of whom had TB; among those with only abnormal CXR (n = 1273), 92 had TB. Xpert was positive in 155 patients, and negative in 15; these results were confirmed using culture. The remaining 26 patients did not undergo Xpert testing and were confirmed using microscopy (27%), culture (42%) or both (31%). CONCLUSION: The combined use of symptom screening (cough) and CXR was much more effective in maximising TB yield than using either method alone. If patients presenting with cough alone had not been investigated, 10% of TB patients would have been missed; if those with abnormal CXR but no cough had not been investigated, 51% of TB patients would have been missed. We detected high TB prevalence in this prison by using active case finding.
Subject(s)
Mass Screening/methods , Prisoners/statistics & numerical data , Tuberculosis/epidemiology , Adolescent , Adult , Brazil/epidemiology , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Prevalence , Risk Factors , Tuberculosis/diagnosis , Young AdultABSTRACT
PURPOSE: The influence of ambient factors on the results of refractive surgery is not well-known. This study evaluated the influence of temperature and humidity on laser in situ keratomileusis (LASIK) outcomes. METHODS: Two hundred thirty-seven patients who underwent LASIK at the Clivan Instituto de Oftalmologia in Salvador--Bahia--Brazil, between May 1999 and March 2000, were evaluated. A total of 156 (65.8%) patients were female. Mean age was 30.3 +/- 7.6 years. Refractive errors: 197 patients (83.12%) had compound myopic astigmatism, 17 patients (7.17%) had myopia, 11 patients (4.64%) had compound hyperopic astigmatism, and 12 patients (5.07%) had other. Results at 15 and 60 days after LASIK were compared according to different levels of temperature and humidity in the operating room during the procedure. RESULTS: Patients whose spherical equivalent refraction varied between -0.50 to +0.50 D at 15 days after LASIK had surgery performed when the temperature was 25.1 +/- 1.4 degrees C and humidity was 45.1 +/- 4.2%; for the others, temperature was 24.7 +/- 1.5 degrees C (P = .12) and humidity was 43.0 +/- 4.0% (P = .002). The linear regression coefficient showed that lower temperature levels were associated with lower spherical equivalent refractions at 60 days after LASIK (r2 = .14; P = .03) but not at 15 days after LASIK (P = .98). The evaluation of humidity indicated an influence at 15 days after LASIK (r2 = .44; P = .04), as well as at 60 days (r2 = .45; P = .0002). CONCLUSION: Operating room environment may influence LASIK outcomes; humidity may be more significant than temperature.
Subject(s)
Corneal Stroma/surgery , Humidity , Keratomileusis, Laser In Situ , Refractive Surgical Procedures , Temperature , Adult , Female , Humans , Male , Operating Rooms , Treatment Outcome , Visual AcuityABSTRACT
The Philippines is an archipelago of about 7000 islands, with an area about the size of England, situated just above the equator in Southeast Asia. It has a population of 70 million. The Philippines has had extensive commercial and social contact with Asian neighbors, specifically the Chinese, even before the 377 years of Spanish colonization from 1521 to 1898 and the 48 years of American rule from 1898 to 1946. More than 80% of Filipinos are Catholics; the rest are Muslims and Protestants of various denominations, including those who belong to Filipino church groups. Infectious diseases such as tuberculosis, amoebiasis, typhoid fever, and malaria are still prevalent, and arteriosclerosis, cancer, and stroke are common and on the rise.
Subject(s)
General Surgery/education , Curriculum , Education, Medical, Undergraduate , General Surgery/history , Health Maintenance Organizations , History, 16th Century , History, 17th Century , History, 18th Century , History, 19th Century , History, 20th Century , Internship and Residency , Philippines , Research , Schools, Medical , WorkforceABSTRACT
PURPOSE: To assess the influence of age, disease severity at admission and therapeutic interventions on the higher in-hospital case-fatality rate of acute myocardial infarction (MI) in women. METHODS: A retrospective cohort study involving a total of 388 acute MI patients (50 deaths). The following variables were treated as possible explanatory factors for the association between gender and case-fatality rate of acute MI: age (< 60 vs > or = 60 years), duration of symptoms, Killip class, type of infarction (Q wave vs non-wave), comorbidities, previous history of stroke and specific therapeutic interventions for acute MI (aspirin, beta-blocking drugs, and thrombolytic agents). Logistic regression models were used to assess the influence of potential confounders on the association between gender and in-hospital death. RESULTS: The in-hospital case-fatality rate of acute MI was higher in women (19.5% vs 9.4%) than in men (odds ratio (OR) = 2.34; 95% CI = 1.12-4.47). Although women were significantly older than men (p < 0.01), the association between gender and death was reduced only by 15 percent after adjusting for age (OR = 1.99; 95% CI = 1.07-3.67). This association became weaker after taking into account disease severity at admission (OR = 1.84; 95% CI = 0.90-3.74) and therapeutic interventions for acute MI (OR = 1.50; 95% CI = 0.67-3.38). CONCLUSION: Differences in age cannot fully explain the higher case-fatality rate in women than in men with acute MI. Severity of disease at admission and differences in therapeutic interventions might play an important role in the higher case-fatality rate of acute MI among women.
Subject(s)
Hospital Mortality , Myocardial Infarction/mortality , Age Factors , Aged , Cohort Studies , Female , Humans , Male , Middle Aged , Myocardial Infarction/therapy , Patient Admission , Retrospective Studies , Risk Factors , Severity of Illness Index , Sex Distribution , Sex FactorsABSTRACT
OBJETIVO - Avaliar a influência da idade, da gravidade da doença e das intervençöes terapêuticas na maior letalidade hospitalar do infarto agudo do miocárdio (IAM) em mulheres. MÉTODOS - Estudo de coorte retrospectivo, envolvendo 388 pacientes com IAM (50 óbitos). Foram avaliadas, como possíveis explicaçöes para a associaçäo entre sexo e letalidade hospitalar do IAM, as variáveis: idade (menor que 60 vs menor ou igual 60 anos), duraçäo de sintomas, classe Killip, tipo de IAM (com ou sem ondas Q), comorbidades, história de acidente vascular cerebral e intervençöes terapêuticas para o IAM (ácido acetil-salicílico, betabloqueadores e agentes trombolíticos). Modelos de regressäo logística foram usados para avaliar a influência de potenciais variáveis confundidoras na associaçäo entre sexo e letalidade hospitalar do IAM. RESULTADOS - A letalidade hospitalar do IAM foi mais alta em mulheres (19,5 'por cento' vs 9,4 'por cento') do que em homens (odds ratio (OR)=2,34;IC 95 'por cento'=1,12-4,47). Embora as mulheres fossem significativamente (p menor que 0,01) mais idosas, a associaçäo entre sexo e morte reduziu-se em apenas 15 'por cento' após ajuste para idade (OR=1,99;IC 95 'por cento'=1,07-3,67). Esta associaçäo tornou-se mais fraca ao se considerar a gravidade da doença na admissäo (OR=1,84;IC 95 'por cento'=0,90-3,74) e intervençöes terapêuticas para o IAM (OR=1,50;IC=0,67-3,38). CONCLUSÄO - Diferenças de idade näo podem explicar completamente a maior letalidade do IAM em mulheres. A gravidade da doença na admissäo e diferenças de abordagen terapêutica devem desempenhar importante papel na maior letalidade hospitalar do IAM em mulheres.
