Prevalence of alcohol, tobacco, and illicit drugs consumption during teenage pregnancy: an observational, prospective, and cross-sectional study.

BACKGROUND: Teenage pregnancy is a significant public health issue in Mexico; its prevalence oscillates around 20% of all pregnancies. Concurrently, alcohol, tobacco, and illicit drug use have become more common in this age group. METHODS: To estimate the prevalence of substance exposure in a population of pregnant teenagers, we conducted a prospective, observational, and cross-sectional study. The protocol was approved by the institutional review board. On informed consent, we asked 420 consecutive pregnant youngsters cared for at the outpatient obstetric service of a tertiary public regional women's and children's hospital in Nuevo León, in northeast Mexico, to answer a previously validated questionnaire to estimate the prevalence of alcohol, tobacco, or illicit drugs use during pregnancy. RESULTS: Of the 420 participants, 317 (75.5%) consumed at least one substance during pregnancy. Alcohol, either alone or in combination, was consumed by 300 (71.7%) participants. Tobacco was used by 117 (27.8%) participants, almost always in combination with other substances, while marijuana and other illicit drugs were consumed by 92 (21.9%) participants. Approximately one-fourth of the participants, 102 (24.1%) reported no substance use during pregnancy. CONCLUSIONS: In this series, the reported prevalence of alcohol, tobacco, and illicit drugs consumption during pregnancy, explored with a validated instrument, is higher than that previously reported in our country. This fact offers a worrying picture of another set of factors adding to the burden of teenage pregnancy.

INTRODUCCIÓN: El embarazo en la adolescencia ha adquirido gran importancia en la salud pública en México; su prevalencia oscila alrededor del 20% de los embarazos. Paralelamente, el consumo de alcohol, tabaco y drogas ilícitas en este periodo es cada vez más común en estas jóvenes. MÉTODOS: Para estimar la prevalencia de exposición a estas substancias en adolescentes embarazadas, se llevó a cabo un estudio prospectivo, observacional y transversal. El protocolo fue aprobado por los Comités de Ética e Investigación. Previo consentimiento informado, se solicito a 420 jóvenes embarazadas atendidas en la clínica prenatal del hospital materno-infantil más grande en Nuevo León, que respondieran un cuestionario previamente validado para estimar la prevalencia del consumo de substancias. RESULTADOS: De 420 participantes, 317 (75.5%) consumieron al menos una de estas sustancias durante el embarazo. El alcohol, solo o en combinación, fue consumido por 300 (71.5%). El tabaco fue usado por 117 (27.8%), casi siempre en combinación con otras sustancias, mientras que la mariguana y otras drogas ilícitas fueron consumidas por 92 (21.9%) participantes. Alrededor de una cuarta parte del grupo estudiado (24.1%) reportó no haber consumido ninguna de estas substancias en su embarazo. CONCLUSIONES: En nuestra serie, la prevalencia de consumo de alcohol, tabaco y drogas ilícitas durante el embarazo, explorada con un instrumento validado, es mayor de la reportada en estimaciones previas en nuestro país. Estos datos ofrecen un panorama preocupante de una serie de factores que se agregan a la carga del embarazo en la adolescencia.

Prevalence of alcohol, tobacco, and illicit drugs consumption during teenage pregnancy: an observational, prospective, and cross-sectional study / Prevalencia del consumo de alcohol, tabaco y drogas ilícitas durante el embarazo en adolescentes: un estudio observacional, prospectivo y transversal

Abstract Background: Teenage pregnancy is a significant public health issue in Mexico; its prevalence oscillates around 20% of all pregnancies. Concurrently, alcohol, tobacco, and illicit drug use have become more common in this age group. Methods: To estimate the prevalence of substance exposure in a population of pregnant teenagers, we conducted a prospective, observational, and cross-sectional study. The protocol was approved by the institutional review board. On informed consent, we asked 420 consecutive pregnant youngsters cared for at the outpatient obstetric service of a tertiary public regional women´s and children´s hospital in Nuevo León, in northeast Mexico, to answer a previously validated questionnaire to estimate the prevalence of alcohol, tobacco, or illicit drugs use during pregnancy. Results: Of the 420 participants, 317 (75.5%) consumed at least one substance during pregnancy. Alcohol, either alone or in combination, was consumed by 300 (71.7%) participants. Tobacco was used by 117 (27.8%) participants, almost always in combination with other substances, while marijuana and other illicit drugs were consumed by 92 (21.9%) participants. Approximately one-fourth of the participants, 102 (24.1%) reported no substance use during pregnancy. Conclusions: In this series, the reported prevalence of alcohol, tobacco, and illicit drugs consumption during pregnancy, explored with a validated instrument, is higher than that previously reported in our country. This fact offers a worrying picture of another set of factors adding to the burden of teenage pregnancy.

Resumen Introducción: El embarazo en la adolescencia ha adquirido gran importancia en la salud pública en México; su prevalencia oscila alrededor del 20% de los embarazos. Paralelamente, el consumo de alcohol, tabaco y drogas ilícitas en este periodo es cada vez más común en estas jóvenes. Métodos: Para estimar la prevalencia de exposición a estas substancias en adolescentes embarazadas, se llevó a cabo un estudio prospectivo, observacional y transversal. El protocolo fue aprobado por los Comités de Ética e Investigación. Previo consentimiento informado, se solicito a 420 jóvenes embarazadas atendidas en la clínica prenatal del hospital materno-infantil más grande en Nuevo León, que respondieran un cuestionario previamente validado para estimar la prevalencia del consumo de substancias. Resultados: De 420 participantes, 317 (75.5%) consumieron al menos una de estas sustancias durante el embarazo. El alcohol, solo o en combinación, fue consumido por 300 (71.5%). El tabaco fue usado por 117 (27.8%), casi siempre en combinación con otras sustancias, mientras que la mariguana y otras drogas ilícitas fueron consumidas por 92 (21.9%) participantes. Alrededor de una cuarta parte del grupo estudiado (24.1%) reportó no haber consumido ninguna de estas substancias en su embarazo. Conclusiones: En nuestra serie, la prevalencia de consumo de alcohol, tabaco y drogas ilícitas durante el embarazo, explorada con un instrumento validado, es mayor de la reportada en estimaciones previas en nuestro país. Estos datos ofrecen un panorama preocupante de una serie de factores que se agregan a la carga del embarazo en la adolescencia.

Avaliação da conduta dos consumidores em relação às Boas Práticas de higiene em restaurantes self-service situados no município de Valença, RJ / Evaluation of consumer conduct on good hygienic practices in self-service restaurants located in the municipality of Valença, RJ

A fim de oferecer uma refeição de qualidade, os serviços de alimentação (SA) devem, além de atender as normas das Boas Práticas de Fabricação, alertar consumidores sobre condutas higiênicas no ato de montagem dos pratos. Objetivou-se avaliar a conduta de Boas Práticas de higiene de consumidores que frequentam SA do tipo self-service. Foram avaliadas atitudes consideradas de risco de contaminação durante o ato de montagem dos pratos. Quase ¾ dos consumidores não higienizaram as mãos antes de se servirem e mais de » trocaram os utensílios entre as preparações. Os resultados apontaram comportamentos que podem comprometer a segurança das refeições oferecidas. Conclui-se que a conduta higiênico-sanitária dos consumidores no ato de se servir deve ser melhorada, para isso, ações educativas e ilustrativas in loco devem ser adotadas.(AU)

Avaliação das Boas Práticas de Fabricação em estabelecimentos produtores e comercializadores de sanduíche natural / Evaluation of good manufacturing practices in natural sandwich production and marketing establishments

A mudança no estilo de vida aumentou a busca por alimentação fora do domicílio que seja saudável, segura e de rápido acesso. Objetivou-se avaliar as condições higiênico-sanitárias de estabelecimentos que manipulam e comercializam sanduíches naturais. Foi aplicado o check list, em três estabelecimentos (E1, E2 e E3), baseado na RDC 216/2004 e275/2002. Os itens não conformes relacionados aos manipuladores e documentações destacaram-se em relação aos demais. Concluiu-se que o não cumprimento de parte das normas de Boas Práticas de Fabricação (BPF), principalmente em relação à conduta dos manipuladores e a documentação, contribuiu para a condição higiênico-sanitária regular dos E1 e E3. Desta forma, programas de capacitação e elaboração do manual de BPF promoveriam melhorias efetivas nos estabelecimentos.(AU)

Impacto de ações de capacitação em Boas Práticas de Fabricação na condição higiênico-sanitária de restaurantes self-service do município de Valença-RJ / Evaluation of hygienicosanitary quality control in food and training services in good manufacturing practices for food manipulators in the municipality of Valença, RJ

Considerando que os serviços de alimentação (SA) estão entre os principais estabelecimentos envolvidos nos surtos de doenças transmitidas por alimentos, objetivou-se avaliar o impacto da capacitação em Boas Práticas de Fabricação nas condições higiênico-sanitárias (CHS) de três restaurantes self-service (R1, R2 e R3). A avaliação ocorreu antes e após o treinamento através da aplicação do check list da RDC 275/2002 com adaptações da RDC 216/2004 e a classificação de acordo com o percentual de conformidade em grupos, tais como G1 (76 a 100%), G2 (51 a 75%) e G3 (0 a 50%). Os resultados apontaram evolução em R1 de G2 para G1 e nos demais de G3 para G2. Conclui-se que o processo de capacitação contribuiu com a melhoria global das CHS, indicando a necessidade de implantação de um programa de treinamentos constante para estes estabelecimentos.(AU)

Avaliação da conduta dos consumidores em relação às Boas Práticas de higiene em restaurantes self-service situados no município de Valença, RJ / Evaluation of consumer conduct on good hygienic practices in self-service restaurants located in the municipality of Valença, RJ

A fim de oferecer uma refeição de qualidade, os serviços de alimentação (SA) devem, além de atender as normas das Boas Práticas de Fabricação, alertar consumidores sobre condutas higiênicas no ato de montagem dos pratos. Objetivou-se avaliar a conduta de Boas Práticas de higiene de consumidores que frequentam SA do tipo self-service. Foram avaliadas atitudes consideradas de risco de contaminação durante o ato de montagem dos pratos. Quase ¾ dos consumidores não higienizaram as mãos antes de se servirem e mais de » trocaram os utensílios entre as preparações. Os resultados apontaram comportamentos que podem comprometer a segurança das refeições oferecidas. Conclui-se que a conduta higiênico-sanitária dos consumidores no ato de se servir deve ser melhorada, para isso, ações educativas e ilustrativas in loco devem ser adotadas.

Avaliação das Boas Práticas de Fabricação em estabelecimentos produtores e comercializadores de sanduíche natural / Evaluation of good manufacturing practices in natural sandwich production and marketing establishments

A mudança no estilo de vida aumentou a busca por alimentação fora do domicílio que seja saudável, segura e de rápido acesso. Objetivou-se avaliar as condições higiênico-sanitárias de estabelecimentos que manipulam e comercializam sanduíches naturais. Foi aplicado o check list, em três estabelecimentos (E1, E2 e E3), baseado na RDC 216/2004 e275/2002. Os itens não conformes relacionados aos manipuladores e documentações destacaram-se em relação aos demais. Concluiu-se que o não cumprimento de parte das normas de Boas Práticas de Fabricação (BPF), principalmente em relação à conduta dos manipuladores e a documentação, contribuiu para a condição higiênico-sanitária regular dos E1 e E3. Desta forma, programas de capacitação e elaboração do manual de BPF promoveriam melhorias efetivas nos estabelecimentos.

Impacto de ações de capacitação em Boas Práticas de Fabricação na condição higiênico-sanitária de restaurantes self-service do município de Valença-RJ / Evaluation of hygienicosanitary quality control in food and training services in good manufacturing practices for food manipulators in the municipality of Valença, RJ

Considerando que os serviços de alimentação (SA) estão entre os principais estabelecimentos envolvidos nos surtos de doenças transmitidas por alimentos, objetivou-se avaliar o impacto da capacitação em Boas Práticas de Fabricação nas condições higiênico-sanitárias (CHS) de três restaurantes self-service (R1, R2 e R3). A avaliação ocorreu antes e após o treinamento através da aplicação do check list da RDC 275/2002 com adaptações da RDC 216/2004 e a classificação de acordo com o percentual de conformidade em grupos, tais como G1 (76 a 100%), G2 (51 a 75%) e G3 (0 a 50%). Os resultados apontaram evolução em R1 de G2 para G1 e nos demais de G3 para G2. Conclui-se que o processo de capacitação contribuiu com a melhoria global das CHS, indicando a necessidade de implantação de um programa de treinamentos constante para estes estabelecimentos.

Procesos atencionales como predictores cognitivos de la comprensión lectora / Attentional processes as cognitive predictors of reading comprehension

Los estímulos ambientales y socioafectivos que recibe un niño en los primeros años de vida son fundamentales para el aprendizaje y el desarrollo de las habilidades lectoras. En este sentido, gran parte de la población infantil colombiana no alcanza el nivel de dominio lector esperado para la edad, quizá debido a diferentes aspectos contextuales que merman su capacidad cognitiva básica. Este estudio busca comprender si pueden ser considerados los procesos atencionales, como predictores cognitivos de la comprensión lectora de niños y niñas en un colegio distrital de la ciudad de Bogotá. Se empleó un diseño no experimental de un grupo aleatorizado, que se implementó a 30 niños y niñas. La evaluación neuropsicológica se realizó mediante los siguientes instrumentos: Sub pruebas Escala de Inteligencia Wechsler para Niños IV -WISC-IV- (dígitos en orden directos, dígitos en orden inverso, letras y números, animales, búsqueda de símbolos), Trail Making Test (parte B) y Sub pruebas Evaluación Neuropsicológica Infantil -ENI- (precisión y comprensión de oraciones). Se realizó un análisis correlacional de las puntuaciones obtenidas, mediante el coeficiente de correlación de Pearson, lo que permitió determinar que el proceso atencional dividido, tanto visual como verbal, tiene una correlación significativa (r = 0.61 y r = 0.40) con el proceso de comprensión lectora de los niños y niñas evaluados

Environmental stimuli and side effects that occur in the first years of life are fundamental for learning and the development of reading skills. In this sense, a large part of the Colombian child population does not reach the level of readership expected for age, probably to the different contextual contexts that diminish their basic cognitive capacity. This study seeks to understand if attentional processes can be performed as cognitive predictors of reading comprehension of children in a school in the city of Bogotá. A non-experimental design of a randomized group was implemented, which was implemented for 30 children. The neuropsychological evaluation was carried out through the following instruments: Sub tests Intelligence Scale for Children IV-WISC-IV- (Titles in direct order, Titles in reverse numbers, Letters and numbers, Animals, Search of symbols), Trail test (Part B) and Sub tests Infant Neuropsychological Evaluation -ENI- (precision and understanding of sentences). A correlational analysis of the scores obtained was carried out, using the Pearson correlation coefficient, which corresponds to determine the split division process, both visual and verbal, has a significant correlation (r = 0.61 and r = 0.40) with the process of comprehension Reading of the boys and girls evaluated.

Insights into the population structure of Mycobacterium tuberculosis using spoligotyping and RDRio in a southeastern Brazilian prison unit.

Tuberculosis (TB) is still a serious public health problem, continuing to be an important threat for confined populations. We used spoligotyping to estimate the genotypic clades of Mycobacterium tuberculosis isolates from inmates in two blocks in a southeastern Brazilian prison unit, with TB incidence rate of 8185/100.000. The Latin American Mediterranean (LAM) clade is well represented in the country, and the LAM specific molecular markers, RD(Rio) large sequence polymorphism and the SNP on the Rv3062 [ligB(1212)], were used to characterize spoligotype signatures from prison isolates. Typing of RD(Rio) and ligB increase LAM clade from 66.7% (n=72/108) to 69.4% (n=75). The LAM2 SIT17 (n=23) and SIT179 (n=12) signatures comprised one third of all isolates, followed by Haarlem (11.5%, n=12), T (8.7%, n=9) and X (5.7%, n=6) clades. Strains with unknown signatures represented 5.5% (n=6), and four (3.7%) did not match any lineage. We observed RD(Rio) among 64 (59.2%) isolates, and 54 (50%) were of the LAM clade. In particular, the LAM2/RD(Rio) sub-lineage was significantly associated with clustering (p=0.02) and its frequency was higher (32%) when compared to that of the previous general TB cases in RJ (4.29%). Overall cluster frequency defined by spoligotyping/IS6110-RFLP was 62%. The two evolutionary markers helped to evaluate some LAM signature misconceptions and demonstrate that LAM2/RD(Rio) was found with high frequency, hitherto being unnoticed. All these data, allied to high clustering, imply that public health measures to minimize the escalation of TB in prison is essential, and both spoligotyping as well as RD(Rio) would be useful tools to monitor the effects of the measures with respect to M. tuberculosis lineage variation.

Evaluation of rapid tests for human immunodeficiency virus as a tool to detect recent seroconversion

The identification of recent HIV infection is important for epidemiological studies and to monitor the epidemic. The objective of this study was to evaluate two rapid tests that are easily available to the Brazilian scientific community for using as markers of recent HIV infection. The Rapid Test - HIV-1/2 Bio-Manguinhos (Bio-Manguinhos/Fiocruz, Brazil) and the Rapid Check HIV 1&2 (NDI-UFES, Center for Infectious Diseases, Universidade Federal do Espírito Santo) were tested, using 489 samples with HIV positive serology, from blood donors, previously classified as recent or long-term infection by serological testing algorithm for recent HIV seroconversion (STARHS) or LS-HIV Vitros assay methods. The samples were diluted prior to testing (1:50 and 1:100 for the Rapid Test - HIV-1/2 Bio-Manguinhos, and 1:500 and 1:600 for the Rapid Check HIV 1&2). Negative samples were considered recent infection, whereas those showing any color intensity were associated with long-term infection. The best dilutions were 1:100 for HIV-1/2 Bio-Manguinhos test (Kappa = 0.840; overall agreement = 0.93), and 1:500 for the Rapid Check HIV 1&2 (Kappa = 0.867; overall agreement = 0.94). The results suggest that both rapid tests can be used to detect recent seroconversion.

Evaluation of rapid tests for human immunodeficiency virus as a tool to detect recent seroconversion.

The identification of recent HIV infection is important for epidemiological studies and to monitor the epidemic. The objective of this study was to evaluate two rapid tests that are easily available to the Brazilian scientific community for using as markers of recent HIV infection. The Rapid Test - HIV-1/2 Bio-Manguinhos (Bio-Manguinhos/Fiocruz, Brazil) and the Rapid Check HIV 1&2 (NDI-UFES, Center for Infectious Diseases, Universidade Federal do Espírito Santo) were tested, using 489 samples with HIV positive serology, from blood donors, previously classified as recent or long-term infection by serological testing algorithm for recent HIV seroconversion (STARHS) or LS-HIV Vitros assay methods. The samples were diluted prior to testing (1:50 and 1:100 for the Rapid Test - HIV-1/2 Bio-Manguinhos, and 1:500 and 1:600 for the Rapid Check HIV 1&2). Negative samples were considered recent infection, whereas those showing any color intensity were associated with long-term infection. The best dilutions were 1:100 for HIV-1/2 Bio-Manguinhos test (Kappa = 0.840; overall agreement = 0.93), and 1:500 for the Rapid Check HIV 1&2 (Kappa = 0.867; overall agreement = 0.94). The results suggest that both rapid tests can be used to detect recent seroconversion.

Turismo en salud: una tendencia mundial que se abre paso en Colombia / Health tourism: a global trend making its way in Colombia

El concepto de turismo en salud no es nuevo; básicamente se trata de personas que viajan fuera de sus países de residencia con el objetivo de buscar servicios médicos o de bienestar en otros países. Los factores que han conducido a la creciente popularidad de esta modalidad de turismo son el alto costo de la atención en salud en el país de origen, largos tiempos de espera para ciertos procedimientos, la facilidad y accesibilidad de los viajes internacionales y las mejoras en la tecnología y los estándares de atención en muchos países. Los estándares de calidad son importantes cuando se trata del cuidado de la salud, por tal causa muchos hospitales internacionales de hoy ven en la obtención de la acreditación internacional una forma de a traer a pacientes de diferentes países del mundo. Aunque es bien conocido que Colombia se ha convertido en una referencia para las personas que desean realizarse cirugías estéticas, según menciona Andrade (2010) el mercado se ha abierto a otro tipo de intervenciones relacionadas más con el tema de salud que con el de belleza, generando un gran potencial en el mercado colombiano, enfocándose en la intervenciónen varias especialidades como lo es cirugía cardiovascular, oncología, neurocirugía y ortopedia.

Health tourism is not a new concept. It basically consists of people who travel abroad in search of medical care or welfare in other countries. The factors that led to the growing popularity of this form of tourism are the high cost of health care in the country of origin, the long waiting times for certain procedures, the ease and accessibility of international travel and the improvements in technology, as well as the health care standards in several countries. Quality standards are important when it comes to health care and therefore many international hospitals nowadays see international accreditation as a way to attract patients from different countries around the world. Although it is a well known fact that Colombia has become a point of reference for people who wish to undergo a esthetic surgeries, according to Andrade (2010), the market has opened to another type of interventions more closely related to the matter of health, rather than beauty, generating a great potential in the Colombian market, focusing on interventions in several specialties, such as cardiovascular surgery, oncology, neurosurgery and orthopedics.

Performance of parallel screening of Brazilian blood donors with two human immunodeficiency virus immunoassays: implications for sequential immunoassay testing algorithms in other countries.

BACKGROUND: In Brazil it is mandatory to screen donors for human immunodeficiency virus (HIV) antibodies using two immunoassays (IAs) in parallel. Confirmatory testing is performed only on reactive donors who return for counseling. The goal of this analysis was to determine if concordant IA reactivity accurately predicts infection and can be used for HIV incidence and/or prevalence analyses. STUDY DESIGN AND METHODS: We reviewed HIV screening and confirmatory results obtained for 307,407 donations in the first year of the REDS-II study in Brazil (2007) and for 2,304,755 donations collected from 1996 to 2006 in one of the REDS-II sites (São Paulo, Brazil). RESULTS: In the São Paulo site, 11,410 (0.50%) HIV IA-reactive donations were discarded, but only 2095 (0.09%) were reactive to both IAs. Western blot was positive on 1002 (48%) dual-IA-reactive donors who returned for counseling. Only four HIV-infected donors were detected who had been missed at screening by one of the IAs; all occurred before 2002. The positive predictive value (PPV) of dual-IA reactivity varied from 45.8 to 100%, with 80% to 90% PPVs when using IAs from different manufacturers. If both assays yielded signal-to-cutoff (S/C) values of 3.0 or more, PPVs ranged from 91% to 99%, with approximately 99% sensitivity for true HIV seropositivity. CONCLUSION: Parallel testing of all donations has limited efficacy when highly sensitive IAs are used. Reactivity by two sequential IAs is useful for prevalence studies if the assays are from different manufacturers and especially if high S/C values are considered.

Enhanced classification of Chagas serologic results and epidemiologic characteristics of seropositive donors at three large blood centers in Brazil.

BACKGROUND: A major problem in Chagas disease donor screening is the high frequency of samples with inconclusive results. The objective of this study was to describe patterns of serologic results among donors to the three Brazilian REDS-II blood centers and correlate with epidemiologic characteristics. STUDY DESIGN AND METHODS: The centers screened donor samples with one Trypanosoma cruzi lysate enzyme immunoassay (EIA). EIA-reactive samples were tested with a second lysate EIA, a recombinant-antigen based EIA, and an immunfluorescence assay. Based on the serologic results, samples were classified as confirmed positive (CP), probable positive (PP), possible other parasitic infection (POPI), and false positive (FP). RESULTS: In 2007 to 2008, a total of 877 of 615,433 donations were discarded due to Chagas assay reactivity. The prevalences (95% confidence intervals [CIs]) among first-time donors for CP, PP, POPI, and FP patterns were 114 (99-129), 26 (19-34), 10 (5-14), and 96 (82-110) per 100,000 donations, respectively. CP and PP had similar patterns of prevalence when analyzed by age, sex, education, and location, suggesting that PP cases represent true T. cruzi infections; in contrast the demographics of donors with POPI were distinct and likely unrelated to Chagas disease. No CP cases were detected among 218,514 repeat donors followed for a total of 718,187 person-years. CONCLUSION: We have proposed a classification algorithm that may have practical importance for donor counseling and epidemiologic analyses of T. cruzi-seroreactive donors. The absence of incident T. cruzi infections is reassuring with respect to risk of window phase infections within Brazil and travel-related infections in nonendemic countries such as the United States.

Isoniazid-resistant Mycobacterium tuberculosis strains arising from mutations in two different regions of the katG gene.

OBJECTIVE: To analyze and compare the mutations in two different regions of the katG gene, which is responsible for isoniazid (INH) resistance. METHODS: We analyzed 97 multidrug-resistant Mycobacterium tuberculosis strains isolated in cultures of sputum samples obtained from the Professor Hélio Fraga Referral Center, in Brasília, Brazil. Another 6 INH-sensitive strains did not present mutations and were included as controls. We used PCR to amplify two regions of the katG gene (GenBank accession no. U06258)-region 1, (from codon 1 to codon 119) and region 2 (from codon 267 to codon 504)-which were then sequenced in order to identify mutations. RESULTS: Seven strains were resistant to INH and did not contain mutations in either region. Thirty strains carried mutations in region 1, which was characterized by a high number of deletions, especially at codon 4 (24 strains). Region 2 carried 83 point mutations, especially at codon 315, and there was a serine-to-threonine (AGC-to-ACC) substitution in 73 of those cases. The analysis of region 2 allowed INH resistance to be diagnosed in 81.4% of the strains. Nine strains had mutations exclusively in region 1, which allowed the proportion of INH-resistant strains identified to be increased to 90.6%. CONCLUSIONS: The number of mutations at codon 315 was high, which is consistent with cases described in Brazil and in other countries, and the analysis of region 1 resulted in a 9.2% increase in the rate at which mutations were identified.

Resistência do Mycobacterium tuberculosis à isoniazida por mutações em duas regiões diferentes do gene katG / Isoniazid-resistant Mycobacterium tuberculosis strains arising from mutations in two different regions of the katG gene

OBJETIVO: Analisar e comparar as mutações em duas regiões diferentes do gene katG, responsáveis pela resistência à isoniazida (INH). MÉTODOS: As análises foram feitas em 97 cepas de Mycobacterium tuberculosis multirresistentes isoladas de culturas de escarro provenientes do Centro de Referência Professor Hélio Fraga. Outras 6 cepas, sensíveis à INH, não apresentaram mutações e foram incluídas como controle. Duas regiões do gene katG (GenBank nº de acesso U06258) - região 1, do códon 1 até o códon 119, e região 2, do códon 267 até o códon 504 - foram amplificadas por PCR e sequenciadas para a identificação das mutações. RESULTADOS: Sete cepas eram resistentes à INH e não mostraram mutação nas duas regiões. Trinta cepas apresentaram mutações na região 1, que se caracterizou por um grande número de deleções, especialmente no códon 4 (24 cepas). A região 2 mostrou 83 mutações pontuais, principalmente no códon 315, com 73 casos de troca de serina (AGC) para treonina (ACC). A análise da região 2 permitiu o diagnóstico de resistência à INH em 81,4 por cento das cepas. Nove cepas tiveram mutações somente na região 1, e isso permitiu o aumento de identificação de cepas resistentes à INH para 90,6 por cento. CONCLUSÕES: O número de mutações do códon 315 foi elevado, compatível com os casos descritos no Brasil e em outros países, e a análise da região 1 aumentou a detecção de mutações em mais 9,2 por cento.

OBJECTIVE: To analyze and compare the mutations in two different regions of the katG gene, which is responsible for isoniazid (INH) resistance. METHODS: We analyzed 97 multidrug-resistant Mycobacterium tuberculosis strains isolated in cultures of sputum samples obtained from the Professor Hélio Fraga Referral Center, in Brasília, Brazil. Another 6 INH-sensitive strains did not present mutations and were included as controls. We used PCR to amplify two regions of the katG gene (GenBank accession no. U06258)-region 1, (from codon 1 to codon 119) and region 2 (from codon 267 to codon 504)-which were then sequenced in order to identify mutations. RESULTS: Seven strains were resistant to INH and did not contain mutations in either region. Thirty strains carried mutations in region 1, which was characterized by a high number of deletions, especially at codon 4 (24 strains). Region 2 carried 83 point mutations, especially at codon 315, and there was a serine-to-threonine (AGC-to-ACC) substitution in 73 of those cases. The analysis of region 2 allowed INH resistance to be diagnosed in 81.4 percent of the strains. Nine strains had mutations exclusively in region 1, which allowed the proportion of INH-resistant strains identified to be increased to 90.6 percent. CONCLUSIONS: The number of mutations at codon 315 was high, which is consistent with cases described in Brazil and in other countries, and the analysis of region 1 resulted in a 9.2 percent increase in the rate at which mutations were identified.

Clinical evolution of a group of patients with multidrug-resistant TB treated at a referral center in the city of Rio de Janeiro, Brazil.

OBJECTIVE: To analyze the clinical characteristics and evolution of a group of patients with positive sputum cultures for multidrug-resistant (MDR) Mycobacterium tuberculosis and treated at a referral center in the city of Rio de Janeiro, Brazil. METHODS: Based on the positive results in sputum cultures for MDR M. tuberculosis, 50 patients were selected, and their clinical data were obtained from the Brazilian Ministry of Health MDR-TB Database. The frequencies of noncompliance, relapses, failures and previous treatments for TB up to diagnosis of MDR-TB were compiled. The radiological patterns were classified as unilateral or bilateral, and with or without cavitation. Two years after the end of the standard treatment for MDR-TB, the outcome (cure, failure, noncompliance or death) for each patient was evaluated and reassessed every two years. The post-treatment follow-up period was eight years. RESULTS: The mean number of previous treatments was 2.3 +/- 0.9. The mean interval between the initial diagnosis and the development of MDR-TB was 2.0 +/- 1.7 years. Two years after the initial treatment for MDR-TB, 2 patients had abandoned treatment, 8 had died, 18 had been cured, and 22 had presented treatment failure. The bivariate analysis showed that bilateral pulmonary involvement and cavitary pattern markedly reduced the chances for cure, with a relative risk of 1-0.6 (40%) and 1-0.7 (30%), respectively. At the end of the follow-up period, 2 patients had abandoned treatment, 9 had presented treatment failure, 17 had been cured, and 22 had died. CONCLUSIONS: Bilateral pulmonary involvement and cavity pattern greatly reduced the chances for cure of the patients with MDR-TB. Most patients who presented treatment failure died within the 8-year follow-up period.

Evolução clínica de um grupo de pacientes com TB multirresistente atendidos em um centro de referência na cidade do Rio de Janeiro / Clinical evolution of a group of patients with multidrug-resistant TB treated at a referral center in the city of Rio de Janeiro, Brazil

OBJETIVO: Analisar as características clínicas e a evolução de um grupo de pacientes com culturas de escarro positivas para Mycobacterium tuberculosis multirresistente (MR) e tratados em um centro de referência no município do Rio de Janeiro. MÉTODOS: A partir dos resultados de M. tuberculosis MR em culturas de escarro, foram selecionados 50 pacientes cujos dados clínicos foram obtidos através do Banco de Dados TBMR do Ministério da Saúde. Foram considerados a frequência de abandono, as recidivas, as falências e os tratamentos prévios para TB até o diagnóstico de TBMR. O padrão radiológico foi classificado em uni- ou bilateral, e cavitário ou não. Dois anos após o término do tratamento padronizado para TBMR, o desfecho (cura, falência, abandono ou óbito) de cada paciente foi avaliado e repetido a cada dois anos. O período de seguimento foi de oito anos após o tratamento. RESULTADOS: A média do número de tratamentos prévios foi de 2,3 ± 0,9. O tempo médio entre o diagnóstico inicial e o desenvolvimento de TBMR foi de 2 ± 1,7 anos. Após dois anos do tratamento inicial para TBMR houve 2 abandonos, 8 óbitos, 18 curas e 22 falências. A análise bivariada mostrou que o comprometimento pulmonar bilateral e o padrão cavitário reduziram acentuadamente a chance de cura, com risco relativo de 1-0,6 (40 por cento) e 1-0,7 (30 por cento), respectivamente. Ao final do seguimento, houve 2 abandonos, 9 falências, 17 curas e 22 óbitos. CONCLUSÕES: O comprometimento pulmonar bilateral e lesões cavitárias reduziram a possibilidade de cura dos pacientes com TBMR. A maioria dos pacientes com falha de tratamento evoluiu para óbito no período de 8 anos.

OBJECTIVE: To analyze the clinical characteristics and evolution of a group of patients with positive sputum cultures for multidrug-resistant (MDR) Mycobacterium tuberculosis and treated at a referral center in the city of Rio de Janeiro, Brazil. METHODS: Based on the positive results in sputum cultures for MDR M. tuberculosis, 50 patients were selected, and their clinical data were obtained from the Brazilian Ministry of Health MDR-TB Database. The frequencies of noncompliance, relapses, failures and previous treatments for TB up to diagnosis of MDR-TB were compiled. The radiological patterns were classified as unilateral or bilateral, and with or without cavitation. Two years after the end of the standard treatment for MDR-TB, the outcome (cure, failure, noncompliance or death) for each patient was evaluated and reassessed every two years. The post-treatment follow-up period was eight years. RESULTS: The mean number of previous treatments was 2.3 ± 0.9. The mean interval between the initial diagnosis and the development of MDR-TB was 2.0 ± 1.7 years. Two years after the initial treatment for MDR-TB, 2 patients had abandoned treatment, 8 had died, 18 had been cured, and 22 had presented treatment failure. The bivariate analysis showed that bilateral pulmonary involvement and cavitary pattern markedly reduced the chances for cure, with a relative risk of 1-0.6 (40 percent) and 1-0.7 (30 percent), respectively. At the end of the follow-up period, 2 patients had abandoned treatment, 9 had presented treatment failure, 17 had been cured, and 22 had died. CONCLUSIONS: Bilateral pulmonary involvement and cavity pattern greatly reduced the chances for cure of the patients with MDR-TB. Most patients who presented treatment failure died within the 8-year follow-up period.