Tuberculosis and drug resistance among patients seen at an AIDS Reference Center in São Paulo, Brazil.

OBJECTIVES: To assess the frequency of resistance of Mycobacterium tuberculosis to antituberculosis drugs and the factors associated with it among patients with tuberculosis (TB) and acquired immunodeficiency syndrome (AIDS). MATERIALS AND METHODS: The medical records of TB and AIDS cases diagnosed from 1992 to 1997 in a public service for AIDS care were reviewed. RESULTS: Resistance was diagnosed in 82 (19%) of 431 cases. The mean and median values between the diagnosis of AIDS and the diagnosis of TB were 214.8 days and 70.5 days, respectively. Multidrug-resistant TB (MDR TB) occurred in 11.3% of cases. Of the 186 patients with no previous treatment, 13 (6.9%) presented primary MDR TB. Of the 90 cases with previous treatment, six (6.7%) presented monoresistance to rifampin and 27 (30%) presented MDR TB. The distribution of cases with sensitive and resistant M. tuberculosis strains was homogeneous in terms of the following variables: gender, age, category of exposure to human immunodeficiency virus (HIV), alcoholism, and homelessness. Multivariate analysis showed an association between resistance and the two following variables: previous treatment and duration of AIDS prior to TB exceeding 71 days. The rates of primary multiresistance and of monoresistance to rifampin were higher than those detected in HIV-negative patients in Brazil. CONCLUSIONS: In this patient series, M. tuberculosis resistance was predominantly of the acquired type, and resistance was independently associated with previous treatment for TB and with duration of AIDS prior to TB exceeding 71 days.

[The positivity index of the immunoenzyme reaction (ELISA) for cysticercosis in the cerebrospinal fluid (CSF) and in the serum of epilepsy patients]. / Indice de positividade da reação imunoenzimática (ELISA) para cisticercose no líquido cefalorraquidiano (LCR) e no soro de pacientes com epilepsia.

Fifty patients with epilepsy seen in three Londrina Neurological Services, in Paraná, were studied. The positivity prevalence of the enzyme-linked immunosorbent assay (ELISA) for cysticercosis in the cerebrospinal fluid (CSF) and in the serum of these patients was 34.0% and 20.0%, respectively. There was statistically significant difference when these two rates were compared with the reaction positivity in the CSF and the serum in the control group, formed by individuals without neurological diseases. There was no association between the type of seizure (generalized or partial) and the positivity index of ELISA for cysticercosis in the CSF. A greater number of patients with positive ELISA for cysticercosis in the rural area dwellers was found, in relation with the urban area dwellers. From the obtained results in our study we came to the following conclusions: 1. The high positivity ELISA rates for cysticercosis in the CSF and in the patients serum with epilepsy indicate that neurocysticercosis is an important seizure cause in Londrina, PR. 2. The positivity prevalence of ELISA for cysticercosis in CSF was greater in epileptic patients from the rural area than the ones from the urban area. 3. There was no association between the type seizure (generalized or partial) and the ELISA cysticercosis positivity rate in the CSF. 4. The high positivity prevalence of ELISA in the CSF and in the epileptic patients serum in Londrina indicates the priority of performing epidemiologic inquiry to establish the real cysticercosis prevalence in the city. ELISA may be used with this finality due to its high sensibility, its low cost and its simple performance.

[Medical pedagogy and special didactics in graduate courses at the medical school of the University of São Paulo, Brazil]. / As disciplinas de didática especial e de pedagogia médica no curso de pós-graduação da Faculdade de Medicina da Universidade de S. Paulo.

Graduate courses of medical pedagogy and special didactics at S. Paulo University Medical School are analysed. The authors present objectives, subject matters and methodologies of both courses, as well as their evaluation by the graduate students. After an initial rejection, the evaluation became very positive (67% in medical pedagogy and 82% in special didactics). Some future perspectives are discussed.

[Risks of viral infectious complications for pregnant health professionals]. / Riscos de complicações infecciosas virais para a profissional de saúde gestante.

The authors reviewed medical literature concerning viral infections potentially hazardous to pregnant health workers. Precautions are suggested specially involving AIDS and cytomegalovirus infection.