Previous BCG vaccination is associated with less severe clinical progression of COVID-19.

BACKGROUND: BCG vaccination, originally used to prevent tuberculosis, is known to "train" the immune system to improve defence against viral respiratory infections. We investigated whether a previous BCG vaccination is associated with less severe clinical progression of COVID-19 METHODS: A case-control study comparing the proportion with a BCG vaccine scar (indicating previous vaccination) in cases and controls presenting with COVID-19 to health units in Brazil. Cases were subjects with severe COVID-19 (O2 saturation < 90%, severe respiratory effort, severe pneumonia, severe acute respiratory syndrome, sepsis, and septic shock). Controls had COVID-19 not meeting the definition of "severe" above. Unconditional regression was used to estimate vaccine protection against clinical progression to severe disease, with strict control for age, comorbidity, sex, educational level, race/colour, and municipality. Internal matching and conditional regression were used for sensitivity analysis. RESULTS: BCG was associated with high protection against COVID-19 clinical progression, over 87% (95% CI 74-93%) in subjects aged 60 or less and 35% (95% CI - 44-71%) in older subjects. CONCLUSIONS: This protection may be relevant for public health in settings where COVID-19 vaccine coverage is still low and may have implications for research to identify vaccine candidates for COVID-19 that are broadly protective against mortality from future variants. Further research into the immunomodulatory effects of BCG may inform COVID-19 therapeutic research.

Fatores associados ao maior tempo de permanência em unidade de terapia intensiva / Factores asociados al mayor tiempo de permanencia en unidad de cuidados intensivos / Factors associated with longer stay in intensive care unit

Objetivo: identificar os fatores associados ao maior tempo de permanência dos pacientes na Unidade de Terapia Intensiva. Método: trata-se de estudo quantitativo do tipo corte transversal com 105 pacientes internados em Unidade de Terapia Intensiva de um hospital público de Salvador, Bahia. Os dados foram organizados no Stata, versão 12. Resultados: houve associação com significância estatística entre maior tempo de internação com: causas clínicas (RP=4,76 e IC95%: 1,86 - 12,19); uso de cateter venoso central (RP=5,08 e IC95%: 1,84 - 14,01); uso de ventilação mecânica (RP=3,03 e IC95%: 1,15 - 7,97); e desfecho clínico de óbito (RP=4,77 e IC95%: 1,47 - 15,42). Conclusão: os achados direcionam para ações preventivas para diminuição do tempo de internamento, como o controle de infecções mediante a utilização de técnicas assépticas no manejo de dispositivos invasivos.

Objetivo: identificar los factores asociados al mayor tiempo de permanencia de los pacientes en la Unidad de Terapia Intensiva. Método: se trata de estudio cuantitativo del tipo corte transversal con 105 pacientes internados en Unidad de Terapia Intensiva de un hospital público de Salvador, Bahía. Los datos fueron organizados en Stata, versión 12. Resultados: hubo asociación con significación estadística entre mayor tiempo de internación con: causas clínicas (RP=4,76 e IC95%: 1,86 -12,19); uso de catéter venoso central (RP=5,08 e IC95%: 1,84 - 14,01); uso de ventilación mecánica (RP=3,03 e IC95%: 1,15 - 7,97); y resultado clínico de defunción (RP=4,77 e IC95%: 1,47 - 15,42). Conclusión: los hallazgos apuntan hacia acciones preventivas para disminución del tiempo de internamiento, como el control de infecciones mediante la utilización de técnicas asépticas en el manejo de dispositivos invasivos.

Objective: to identify the factors associated with longer stay of patients in the Intensive Care Unit. Method: this is a quantitative cross-sectional study with 105 patients admitted to the Intensive Care Unit of a public hospital in Salvador, Bahia. Data were organized in Stata, version 12. Results: there was an association with statistical significance between longer hospitalization time with: clinical causes (PR=4.76 and 95%CI: 1.86 - 12.19); use of central venous catheter (PR=5.08 and 95%CI: 1.84 - 14.01); use of mechanical ventilation (PR=3.03 and 95%CI: 1.15 - 7.97); and clinical outcome of death (PR=4.77 and 95%CI: 1.47 - 15.42). Conclusion: the findings point to preventive actions to reduce hospitalization time, such as infection control using aseptic techniques in the management of invasive devices.

Correction: Geographic and socioeconomic factors associated with leprosy treatment default: An analysis from the 100 Million Brazilian Cohort.

[This corrects the article DOI: 10.1371/journal.pntd.0007714.].

The need for fast-track, high-quality and low-cost studies about the role of the BCG vaccine in the fight against COVID-19.

Bacillus Calmette-Guérin (BCG) vaccination is routine and near-universal in many low- and middle-income countries (LMIC). It has been suggested that BCG can have a protective effect on COVID-19 morbidity and mortality. This commentary discusses the limitations of the evidence around BCG and COVID-19. We argue that higher-quality evidence is necessary to understand the protective effect of the BCG vaccine from existing, secondary data, while we await results from clinical trials currently conducted in different settings.

Association between treatment outcome, sociodemographic characteristics and social benefits received by individuals with tuberculosis in Salvador, Bahia, Brazil, 2014-2016. / Associação entre desfecho do tratamento, características sociodemográficas e benefícios sociais recebidos por indivíduos com tuberculose em Salvador, Bahia, 2014-2016.

OBJECTIVE: to analyze association between tuberculosis treatment outcome, sociodemographic characteristics and receipt of social benefits. METHODS: this was a cohort study conducted in Salvador, Bahia, Brazil, in the period 2014-2016; we analyzed bivariate associations between treatment outcome, sociodemographic characteristics and social benefits. RESULTS: 216 individuals were followed, of whom 79.6% were cured; higher cure proportion was associated with schooling >9 years (87.5%; p=0.028), marital union (86.3%; p=0.031), and household density ≤2 individuals/bedroom (84.1%; p=0.013); we took as our reference individuals with schooling ≤9 years, not in marital union, and housing density >2 people/bedroom; higher cure proportion was also found among recipients of government and non-government benefits (90.5%), and among those who only received direct benefits (81.6%). CONCLUSION: schooling >9 years, marital union, and household density ≤2 individuals/bedroom were associated with higher cure; this outcome was more frequent among individuals receiving government and non-government benefits, and among individuals receiving only direct benefits.

Effect of the Bolsa Familia Programme on the outcome of tuberculosis treatment: a prospective cohort study.

BACKGROUND: Social protection interventions might improve tuberculosis outcomes and could help to control the epidemic in Brazil. The aim of this study was to evaluate the independent effect of the Bolsa Familia Programme (BFP) on tuberculosis treatment outcomes in Brazil. METHODS: We prospectively recruited and followed up individuals (aged ≥18 years) who initiated tuberculosis treatment at 42 health-care centres across seven cities in Brazil, between March 1, 2014, and April 30, 2017. Patients were interviewed at health-care centres and information about individual characteristics, socioeconomic status, living conditions, lifestyle, and comorbidities was recorded. Patients were separated into two groups according to BFP beneficiary status: BFP (exposed) or non-BFP (not exposed). Treatment outcome (cure, dropout, death, or development of drug-resistant tuberculosis or treatment failure) was recorded after 6 months of therapy. Pearson's χ2 test and ANOVA were used to compare tuberculosis treatment outcomes between the two groups, and we estimated the propensity score of being a beneficiary of the BFP using a logit model. We used multinomial regression models to evaluate the effect of the BFP on tuberculosis treatment outcomes. FINDINGS: 1239 individuals were included in the study, of whom 196 (16%) were beneficiaries of the BFP and 1043 (84%) were not. After 6 months of treatment, 912 (87%) of 1043 patients in the non-BFP group and 173 (88%) of 196 patients in the BFP group were cured of tuberculosis, 103 (10%) patients in the non-BFP group and 17 (9%) patients in the BFP group had dropped out, and 25 (3%) patients in the non-BFP group and six (3%) patients in the BFP group had died. Three (<1%) of 1043 patients in the non-BFP group developed drug-resistant tuberculosis. Being a BFP beneficiary had a positive effect for cure (average effect 0·076 [95% CI 0·037 to 0·11]) and a negative effect for dropout (-0·070 [-0·105 to 0·036]) and death (-0·002 [-0·021 to 0·017]). INTERPRETATION: BFP alone had a direct effect on tuberculosis treatment outcome and could greatly contribute to the goals of the WHO End TB Strategy. FUNDING: Brazilian National Council for Scientific and Technological Development (CNPq) and Brazilian Ministry of Health Department of Science and Technology (DECIT).

Associação entre desfecho do tratamento, características sociodemográficas e benefícios sociais recebidos por indivíduos com tuberculose em Salvador, Bahia, 2014-2016 / Asociación entre resultado del tratamiento, características sociodemográficas y beneficios sociales recibidos por individuos con tuberculosis en Salvador, Bahía, Brasil, 2014-2016 / Association between treatment outcome, sociodemographic characteristics and social benefits received by individuals with tuberculosis in Salvador, Bahia, Brazil, 2014-2016

Objetivo: analisar associação entre desfecho do tratamento da tuberculose, características sociodemográficas e benefícios sociais recebidos. Métodos: estudo de coorte desenvolvido em Salvador, Bahia, Brasil, no período 2014-2016; analisaram-se associações bivariadas entre desfecho do tratamento, características sociodemográficas e benefícios sociais. Resultados: foram acompanhados 216 indivíduos, dos quais 79,6% foram curados; maior proporção de cura associou-se com escolaridade >9 anos (87,5%; p=0,028), união conjugal (86,3%; p=0,031) e densidade domiciliar ≤2 pessoas/dormitório (84,1%; p=0,013); foram adotados como referência indivíduos com escolaridade ≤9 anos, sem união conjugal, e densidade domiciliar >2 pessoas/dormitório; maior proporção de cura também foi verificada entre indivíduos que recebiam benefícios governamentais e não governamentais (90,5%) ou somente benefícios diretos (81,6%). Conclusão: escolaridade >9 anos, união conjugal e densidade domiciliar ≤2 pessoas/dormitório associaram-se com maior proporção de cura; este desfecho foi mais frequente entre indivíduos que acumulavam benefícios governamentais e não governamentais ou recebiam somente benefícios diretos.

Objetivo: analizar la asociación entre resultados del tratamiento de la tuberculosis, características sociodemográficas y los beneficios sociales recibidos. Métodos: estudio de cohorte en Salvador, Bahia, Brasil, en el período 2014-2016; se analizaron correlaciones bivariadas entre resultados del tratamiento, características sociodemográficas y beneficios. Resultados: participaron 216 individuos, de los cuales 79,6% fueron curados; una mayor proporción de cura se asoció con escolaridad >9 años (87,5%; p=0,028), unión conyugal (86,3%; p=0,031) y densidad domiciliaria ≤2 personas/dormitorio (84,1%; p=0,013); fueron adoptados como referencia escolaridad ≤9 años, solteros y densidad domiciliaria >2 personas/dormitorio; mayor curación también se verificó entre individuos que recibían beneficios gubernamentales y no gubernamentales (90,5%) o únicamente beneficios directos (81,6%). Conclusión: escolaridad >9 años, unión conyugal y densidad domiciliaria ≤2 personas/dormitorio se asociaron con curación; este resultado fue más frecuente entre los que acumulaban beneficios gubernamentales y no gubernamentales o recibían solamente beneficios directos.

Objective: to analyze association between tuberculosis treatment outcome, sociodemographic characteristics and receipt of social benefits. Methods: this was a cohort study conducted in Salvador, Bahia, Brazil, in the period 2014-2016; we analyzed bivariate associations between treatment outcome, sociodemographic characteristics and social benefits. Results: 216 individuals were followed, of whom 79.6% were cured; higher cure proportion was associated with schooling >9 years (87.5%; p=0.028), marital union (86.3%; p=0.031), and household density ≤2 individuals/bedroom (84.1%; p=0.013); we took as our reference individuals with schooling ≤9 years, not in marital union, and housing density >2 people/bedroom; higher cure proportion was also found among recipients of government and non-government benefits (90.5%), and among those who only received direct benefits (81.6%). Conclusion: schooling >9 years, marital union, and household density ≤2 individuals/bedroom were associated with higher cure; this outcome was more frequent among individuals receiving government and non-government benefits, and among individuals receiving only direct benefits.

Effects of social protection on tuberculosis treatment outcomes in low or middle-income and in high-burden countries: systematic review and meta-analysis.

Tuberculosis (TB) is a poverty infectious disease that affects millions of people worldwide. Evidences suggest that social protection strategies (SPS) can improve TB treatment outcomes. This study aimed to synthesize such evidences through systematic literature review and meta-analysis. We searched for studies conducted in low- or middle-income and in high TB-burden countries, published during 1995-2016. The review was performed by searching PubMed/MEDLINE, Scopus, Web of Science, ScienceDirect and LILACS. We included only studies that investigated the effects of SPS on TB treatment outcomes. We retained 25 studies for qualitative synthesis. Meta-analyses were performed with 9 randomized controlled trials, including a total of 1,687 participants. Pooled results showed that SPS was associated with TB treatment success (RR = 1.09; 95%CI: 1.03-1.14), cure of TB patients (RR = 1.11; 95%CI: 1.01-1.22) and with reduction in risk of TB treatment default (RR = 0.63; 95%CI: 0.45-0.89). We did not detect effects of SPS on the outcomes treatment failure and death. These findings revealed that SPS might improve TB treatment outcomes in lower-middle-income economies or countries with high burden of this disease. However, the overall quality of evidences regarding these effect estimates is low and further well-conducted randomized studies are needed.

Effects of social protection on tuberculosis treatment outcomes in low or middle-income and in high-burden countries: systematic review and meta-analysis / Efeitos da proteção social sobre os desfechos do tratamento da tuberculose em países de renda baixa e média ou de carga alta da doença: uma revisão sistemática e meta-análise / Efectos de la protección social en los resultados del tratamiento contra la tuberculosis en países con baja o media renta y gravemente afectados: revisión sistemática y metaanálisis

Tuberculosis (TB) is a poverty infectious disease that affects millions of people worldwide. Evidences suggest that social protection strategies (SPS) can improve TB treatment outcomes. This study aimed to synthesize such evidences through systematic literature review and meta-analysis. We searched for studies conducted in low- or middle-income and in high TB-burden countries, published during 1995-2016. The review was performed by searching PubMed/MEDLINE, Scopus, Web of Science, ScienceDirect and LILACS. We included only studies that investigated the effects of SPS on TB treatment outcomes. We retained 25 studies for qualitative synthesis. Meta-analyses were performed with 9 randomized controlled trials, including a total of 1,687 participants. Pooled results showed that SPS was associated with TB treatment success (RR = 1.09; 95%CI: 1.03-1.14), cure of TB patients (RR = 1.11; 95%CI: 1.01-1.22) and with reduction in risk of TB treatment default (RR = 0.63; 95%CI: 0.45-0.89). We did not detect effects of SPS on the outcomes treatment failure and death. These findings revealed that SPS might improve TB treatment outcomes in lower-middle-income economies or countries with high burden of this disease. However, the overall quality of evidences regarding these effect estimates is low and further well-conducted randomized studies are needed.

A tuberculose (TB) é uma doença infecciosa associada à pobreza que afeta milhões de pessoas no mundo. As evidências sugerem que estratégias de proteção social podem melhorar os desfechos do tratamento da TB. O estudo teve como objetivo resumir essas evidências através de uma revisão sistemática da literatura e uma meta-análise. Foram buscados estudos realizados em países de renda baixa e média ou com carga alta de TB, publicados entre 1995 e 2016. A revisão foi realizada através de uma busca em PubMed/MEDLINE, Scopus, Web of Science, ScienceDirect e LILACS. Incluímos apenas os estudos que investigavam os efeitos das estratégias de proteção social sobre os desfechos do tratamento da TB. Foram incluídos 25 estudos na síntese qualitativa. As meta-análises foram realizadas com 9 estudos randomizados e controlados, totalizando 1.687 participantes. Os resultados mostraram que as estratégias de proteção social estavam associadas ao sucesso do tratamento da TB (RR = 1,09; IC95%: 1,03-1,14), à cura dos pacientes de TB (RR = 1,11; IC95%: 1,01-1,22) e à redução do risco de abandono do tratamento (RR = 0,63; IC95%: 0,45-0,89). Não detectamos os efeitos das estratégias de proteção social sobre a falha terapêutica ou mortalidade. Os achados mostram que as estratégias de proteção social podem melhorar os desfechos do tratamento em países com renda baixa e média ou com alta carga da doença. Entretanto, a qualidade das evidências com relação a essas estimativas de efeito é baixa, e são necessários mais estudos randomizados e bem conduzidos.

La tuberculosis (TB) es una enfermedad infecciosa, característica de la pobreza, que afecta a millones de personas en todo el mundo. Las evidencias sugieren que las estrategias de protección social (EPS) pueden mejorar los resultados del tratamiento de la TB. El objetivo de este estudio ha sido resumir tales evidencias, a través de una revisión sistemática de la literatura y metaanálisis. Buscamos estudios realizados en países de baja renta o ingresos medios y con altas tasas de morbilidad por TB, publicados durante 1995-2016. La revisión la llevamos a cabo realizando búsquedas en PubMed/MEDLINE, Scopus, Web of Science, ScienceDirect y LILACS. Incluimos sólo estudios que investigaron los efectos de las EPS en los resultados de los tratamientos contra la TB. Seleccionamos 25 estudios para realizar su síntesis cualitativa. Realizamos metaanálisis con 9 ensayos controlados aleatorios, incluyendo a un total de 1.687 participantes. Los resultados agrupados mostraron que las EPS estaban asociadas con tratamientos exitosos contra la TB (RR = 1,09; 95%CI: 1,03-1,14), la curación en pacientes de TB (RR = 1,11; 95%CI: 1,01-1,22) y con la reducción en el riesgo de abandono del tratamiento de TB (RR = 0,63; 95%CI: 0,45-0,89). No detectamos efectos de las EPS en los resultados de fracaso del tratamiento y muerte por TB. Estos hallazgos revelaron que las EPS podrían mejorar los resultados de los tratamientos por TB en las economías de países con baja renta o ingresos medios, o países con altas tasas de esta enfermedad. No obstante, la calidad general de las evidencias, en relación con estos resultados, es baja e indica que son necesarios más estudios controlados aleatorios bien realizados.

Clinical and epidemiological aspects of cases of tuberculosis associated with diabetes in Salvador, Bahia, Brazil.

INTRODUCTION:: This study compares the clinical and epidemiological features of patients with TB, with and without DM. METHODS: New cases of active pulmonary TB that occurred in Salvador, Bahia, Brazil between 2008 and 2010 were included. DM was diagnosed by based on diagnostic criteria established by the American Diabetes Association. RESULT: S: Of the 323 cases of TB, 44 (13.6%) were diabetic . Patients with TB and DM were older (44.7%), with a high level of education (34.%); had slow wound healing (23.4%) and fatigue (61.7%). CONCLUSIONS: Clinical symptoms differed between patients with TB, with and without DM.

A systematic review of East African-Indian family of Mycobacterium tuberculosis in Brazil

ABSTRACT Introduction: The Mycobacterium tuberculosis East African-Indian (EAI) spoligotyping family (belonging to lineage 1, Indo-Oceanic, defined by the region of deletion RD239) is distributed worldwide, but is more prevalent in Southeast Asia, India, and East Africa. Studies in Latin America have rarely identified EAI. In this study, we describe the occurrence of the EAI family in Brazil. Methods: EAI was identified in a systematic literature review of genetic diversity studies pertaining to M. tuberculosis in Brazil, as well as in a survey conducted in Salvador, Bahia, located in the northeastern region of this country. Results: The EAI6-BGD1 spoligotyping family and the EAI5 Spoligotype International Type (SIT) 1983 clade were the most frequently reported, with wide distribution of this particular clade described in Brazil. The distribution of other EAI spoligotyping patterns with broader worldwide distribution was restricted to the southeastern region of the country. Conclusions: EAI may be endemic at a low frequency in Brazil, with some clades indicating increased fitness with respect to this population.

Clinical and epidemiological aspects of cases of tuberculosis associated with diabetes in Salvador, Bahia, Brazil

Abstract INTRODUCTION: This study compares the clinical and epidemiological features of patients with TB, with and without DM. METHODS New cases of active pulmonary TB that occurred in Salvador, Bahia, Brazil between 2008 and 2010 were included. DM was diagnosed by based on diagnostic criteria established by the American Diabetes Association. RESULT S: Of the 323 cases of TB, 44 (13.6%) were diabetic . Patients with TB and DM were older (44.7%), with a high level of education (34.%); had slow wound healing (23.4%) and fatigue (61.7%). CONCLUSIONS Clinical symptoms differed between patients with TB, with and without DM.

A systematic review of East African-Indian family of Mycobacterium tuberculosis in Brazil.

INTRODUCTION: The Mycobacterium tuberculosis East African-Indian (EAI) spoligotyping family (belonging to lineage 1, Indo-Oceanic, defined by the region of deletion RD239) is distributed worldwide, but is more prevalent in Southeast Asia, India, and East Africa. Studies in Latin America have rarely identified EAI. In this study, we describe the occurrence of the EAI family in Brazil. METHODS: EAI was identified in a systematic literature review of genetic diversity studies pertaining to M. tuberculosis in Brazil, as well as in a survey conducted in Salvador, Bahia, located in the northeastern region of this country. RESULTS: The EAI6-BGD1 spoligotyping family and the EAI5 Spoligotype International Type (SIT) 1983 clade were the most frequently reported, with wide distribution of this particular clade described in Brazil. The distribution of other EAI spoligotyping patterns with broader worldwide distribution was restricted to the southeastern region of the country. CONCLUSIONS: EAI may be endemic at a low frequency in Brazil, with some clades indicating increased fitness with respect to this population.

Association between diabetes and tuberculosis: case-control study.

OBJECTIVE: To test the association between diabetes and tuberculosis. METHODS: It is a case-control study, matched by age and sex. We included 323 new cases of tuberculosis with positive results for bacilloscopy. The controls were 323 respiratory symptomatic patients with negative bacilloscopy, from the same health services, such as: ambulatory cases from three referral hospitals and six basic health units responsible for the notifications of new cases of tuberculosis in Salvador, Bahia. Data collection occurred between 2008 and 2010. The instruments used were structured interview, including clinical data, capillary blood glucose (during fasting or postprandial), and the CAGE questionnaire for screening of abusive consumption of alcohol. Descriptive, exploratory, and multivariate analysis was performed using conditional logistic regression. RESULTS: The average age of the cases was 38.5 (SD = 14.2) years and of the controls, 38.5 (SD = 14.3) years. Among cases and controls, most subjects (61%) were male. In univariate analysis we found association between the occurrence of diabetes and tuberculosis (OR = 2.37; 95%CI 1.04-5.42), which remained statistically significant after adjustment for potential confounders (OR = 3.12; 95%CI 1.12-7.94). CONCLUSIONS: The association between diabetes and tuberculosis can hinder the control of tuberculosis, contributing to the maintainance of the disease burden. The situation demands increasing early detection of diabetes among people with tuberculosis, in an attempt to improve disease control strategies. OBJETIVO: Testar a associação entre diabetes e tuberculose. MÉTODOS: Trata-se de estudo caso-controle, pareado por idade e sexo. Foram incluídos 323 casos novos de tuberculose com resultados positivos à baciloscopia. Os controles foram 323 sintomáticos respiratórios com baciloscopia negativa, oriundos dos mesmos serviços de saúde dos casos: ambulatórios de três hospitais de referência e seis unidades básicas de saúde responsáveis pelas notificações dos casos novos de tuberculose em Salvador, Bahia. A coleta de dados ocorreu entre 2008 e 2010. Os instrumentos utilizados foram entrevista estruturada, incluindo dados clínicos, glicemia capilar (em jejum ou pós-prandial) e o questionário CAGE para triagem de consumo abusivo de álcool. Foi realizada análise descritiva, exploratória e multivariada utilizando-se de regressão logística condicional. RESULTADOS: A média de idade dos casos foi 38,5 (DP = 14,2) anos e dos controles, 38,5 (DP = 14,3) anos. Tanto entre os casos quanto entre os controles, a maioria (61%) dos indivíduos era do sexo masculino. Na análise univariada, houve associação entre ocorrência de diabetes e de tuberculose (OR = 2,37; IC95% 1,04-5,42), que permaneceu estatisticamente significante após ajuste pelos potenciais confundidores (OR = 3,12; IC95% 1,12-7,94). CONCLUSÕES: A associação entre diabetes e tuberculose pode dificultar o controle da tuberculose, contribuindo para manutenção da elevada carga da doença. A situação demanda intensificação da detecção precoce de diabetes entre pessoas com tuberculose, na tentativa de maior efetividade das estratégias de controle da doença.

Association between diabetes and tuberculosis: case-control study / Associação entre diabetes e tuberculose: estudo caso controle

ABSTRACT OBJECTIVE To test the association between diabetes and tuberculosis. METHODS It is a case-control study, matched by age and sex. We included 323 new cases of tuberculosis with positive results for bacilloscopy. The controls were 323 respiratory symptomatic patients with negative bacilloscopy, from the same health services, such as: ambulatory cases from three referral hospitals and six basic health units responsible for the notifications of new cases of tuberculosis in Salvador, Bahia. Data collection occurred between 2008 and 2010. The instruments used were structured interview, including clinical data, capillary blood glucose (during fasting or postprandial), and the CAGE questionnaire for screening of abusive consumption of alcohol. Descriptive, exploratory, and multivariate analysis was performed using conditional logistic regression. RESULTS The average age of the cases was 38.5 (SD = 14.2) years and of the controls, 38.5 (SD = 14.3) years. Among cases and controls, most subjects (61%) were male. In univariate analysis we found association between the occurrence of diabetes and tuberculosis (OR = 2.37; 95%CI 1.04-5.42), which remained statistically significant after adjustment for potential confounders (OR = 3.12; 95%CI 1.12-7.94). CONCLUSIONS The association between diabetes and tuberculosis can hinder the control of tuberculosis, contributing to the maintainance of the disease burden. The situation demands increasing early detection of diabetes among people with tuberculosis, in an attempt to improve disease control strategies.

RESUMO OBJETIVO Testar a associação entre diabetes e tuberculose. MÉTODOS Trata-se de estudo caso-controle, pareado por idade e sexo. Foram incluídos 323 casos novos de tuberculose com resultados positivos à baciloscopia. Os controles foram 323 sintomáticos respiratórios com baciloscopia negativa, oriundos dos mesmos serviços de saúde dos casos: ambulatórios de três hospitais de referência e seis unidades básicas de saúde responsáveis pelas notificações dos casos novos de tuberculose em Salvador, Bahia. A coleta de dados ocorreu entre 2008 e 2010. Os instrumentos utilizados foram entrevista estruturada, incluindo dados clínicos, glicemia capilar (em jejum ou pós-prandial) e o questionário CAGE para triagem de consumo abusivo de álcool. Foi realizada análise descritiva, exploratória e multivariada utilizando-se de regressão logística condicional. RESULTADOS A média de idade dos casos foi 38,5 (DP = 14,2) anos e dos controles, 38,5 (DP = 14,3) anos. Tanto entre os casos quanto entre os controles, a maioria (61%) dos indivíduos era do sexo masculino. Na análise univariada, houve associação entre ocorrência de diabetes e de tuberculose (OR = 2,37; IC95% 1,04-5,42), que permaneceu estatisticamente significante após ajuste pelos potenciais confundidores (OR = 3,12; IC95% 1,12-7,94). CONCLUSÕES A associação entre diabetes e tuberculose pode dificultar o controle da tuberculose, contribuindo para manutenção da elevada carga da doença. A situação demanda intensificação da detecção precoce de diabetes entre pessoas com tuberculose, na tentativa de maior efetividade das estratégias de controle da doença.

Effect of the Brazilian conditional cash transfer and primary health care programs on the new case detection rate of leprosy.

BACKGROUND: Social determinants can affect the transmission of leprosy and its progression to disease. Not much is known about the effectiveness of welfare and primary health care policies on the reduction of leprosy occurrence. The aim of this study is to evaluate the impact of the Brazilian cash transfer (Bolsa Família Program-BFP) and primary health care (Family Health Program-FHP) programs on new case detection rate of leprosy. METHODOLOGY/PRINCIPAL FINDINGS: We conducted the study with a mixed ecological design, a combination of an ecological multiple-group and time-trend design in the period 2004-2011 with the Brazilian municipalities as unit of analysis. The main independent variables were the BFP and FHP coverage at the municipal level and the outcome was new case detection rate of leprosy. Leprosy new cases, BFP and FHP coverage, population and other relevant socio-demographic covariates were obtained from national databases. We used fixed-effects negative binomial models for panel data adjusted for relevant socio-demographic covariates. A total of 1,358 municipalities were included in the analysis. In the studied period, while the municipal coverage of BFP and FHP increased, the new case detection rate of leprosy decreased. Leprosy new case detection rate was significantly reduced in municipalities with consolidated BFP coverage (Risk Ratio 0.79; 95% CI  =0.74-0.83) and significantly increased in municipalities with FHP coverage in the medium (72-95%) (Risk Ratio 1.05; 95% CI  =1.02-1.09) and higher coverage tertiles (>95%) (Risk Ratio 1.12; 95% CI  =1.08-1.17). CONCLUSIONS: At the same time the Family Health Program had been effective in increasing the new case detection rate of leprosy in Brazil, the Bolsa Família Program was associated with a reduction of the new case detection rate of leprosy that we propose reflects a reduction in leprosy incidence.

Evaluation of preventative and control measures for congenital syphilis in State of Mato Grosso.

INTRODUCTION: Congenital syphilis is an important health problem in Brazil. This study assessed measures aimed at the prevention and control of syphilis in the State of Mato Grosso and its capital, Cuiabá. METHODS: A descriptive study cross-sectional and of time trends assessing the congenital syphilis was performed in Cuiabá and Mato Grosso between 2001 and 2011. We compared maternal sociodemographic characteristics and health care utilization related to cases of congenital syphilis during the periods from 2001 to 2006 and from 2007 to 2011. We assessed the temporal trends in this disease's incidence using a simple linear regression. RESULTS: Between 2001 and 2006 in Mato Grosso, 86.8% of the mothers who had live births with congenital syphilis received prenatal care, 90.6% presented with a nontreponemal test reagent at delivery, 96.2% had no information regarding a treponemal confirmatory test at delivery, and 77.6% received inadequate treatment for syphilis; additionally, 75.8% of their partners were not treated. There was a statistically significant reduction in prenatal visits (p = 0.004) and an increase in the proportion of mothers reactive to nontreponemal tests at delivery (p = 0.031) between the two periods. No other variables were found to differ significantly between the periods. In Cuiabá, we observed a similar distribution of variables. In the state and in the capital, the increasing trend of congenital syphilis was not statistically significant. CONCLUSIONS: The high incidence of congenital syphilis in Mato Grosso and the low levels of health care indicators for pregnant women with syphilis suggest the need to improve the coverage and quality of prenatal care.

Common mental disorders associated with tuberculosis: a matched case-control study.

INTRODUCTION: Despite the availability of treatment and a vaccine, tuberculosis continues to be a public health problem worldwide. Mental disorders might contribute to the burden of the disease. OBJECTIVE: The objective of this study was to investigate the association between common mental disorders and tuberculosis. METHODS: A matched case-control study was conducted. The study population included symptomatic respiratory patients who attended three referral hospitals and six community clinics in the city of Salvador, Brazil. A doctor's diagnosis defined potential cases and controls. Cases were newly diagnosed tuberculosis cases, and controls were symptomatic respiratory patients for whom tuberculosis was excluded as a diagnosis by the attending physician. Cases and controls were ascertained in the same clinic. Data collection occurred between August 2008 and April 2010. The study instruments included a structured interview, a self-reporting questionnaire for the identification of common mental disorders, and a questionnaire for alcoholism. An univariate analysis included descriptive procedures (with chi-square statistics), and a multivariate analysis used conditional logistic regression. RESULTS: The mean age of the cases was 38 years, and 61% of the cases were males. After adjusting for potential confounders, the odds of tuberculosis were significantly higher in patients diagnosed with a common mental disorder (OR: 1.34; 95% CI 1.05-1.70). CONCLUSION: There appears to be a positive and independent association between common mental disorders and tuberculosis; further epidemiological studies are required to increase our understanding of the possible biological and social mechanisms responsible for this association. Independent of the direction of the association, this finding has implications for the provision of care for mental disorders and for tuberculosis.

Evaluation of preventative and control measures for congenital syphilis in State of Mato Grosso

Introduction Congenital syphilis is an important health problem in Brazil. This study assessed measures aimed at the prevention and control of syphilis in the State of Mato Grosso and its capital, Cuiabá. Methods A descriptive study cross-sectional and of time trends assessing the congenital syphilis was performed in Cuiabá and Mato Grosso between 2001 and 2011. We compared maternal sociodemographic characteristics and health care utilization related to cases of congenital syphilis during the periods from 2001 to 2006 and from 2007 to 2011. We assessed the temporal trends in this disease's incidence using a simple linear regression. Results Between 2001 and 2006 in Mato Grosso, 86.8% of the mothers who had live births with congenital syphilis received prenatal care, 90.6% presented with a nontreponemal test reagent at delivery, 96.2% had no information regarding a treponemal confirmatory test at delivery, and 77.6% received inadequate treatment for syphilis; additionally, 75.8% of their partners were not treated. There was a statistically significant reduction in prenatal visits (p = 0.004) and an increase in the proportion of mothers reactive to nontreponemal tests at delivery (p = 0.031) between the two periods. No other variables were found to differ significantly between the periods. In Cuiabá, we observed a similar distribution of variables. In the state and in the capital, the increasing trend of congenital syphilis was not statistically significant. Conclusions The high incidence of congenital syphilis in Mato Grosso and the low levels of health care indicators for pregnant women with syphilis suggest the need to improve the coverage and quality of prenatal care. .

Prevalence of nutritional deficiency in patients with pulmonary tuberculosis.

OBJECTIVE: To determine the prevalence of nutritional deficiency among patients with pulmonary tuberculosis. METHODS: This was a cross-sectional study using data obtained from the Brazilian Case Registry Database and from the medical records of patients diagnosed with pulmonary tuberculosis (15-59 years of age) residing in one of the municipalities that make up the 16th Regional Health District of the state of Bahia. We calculated the incidence, lethality, and mortality rates, as well as the prevalence of nutritional deficiency, as evaluated by body mass index. Demographic, social, clinical, and epidemiological data were collected. RESULTS: Of the 72 confirmed cases of tuberculosis, 59 (81.9%) were in males, and 21 (29.2%) of the patients were in the 40-49 year age bracket. The majority (85.3%) described themselves as Mulatto or Black; 55.2% reported using alcohol; and approximately 90% were treated as outpatients. In the district and age bracket studied, the incidence of pulmonary tuberculosis was 30.6/100,000 population. Among the 72 patients, data regarding nutritional status was available for 34. Of those, 50% and 25%, respectively, presented nutritional deficiency at the beginning and at the end of treatment. No statistically significant differences were found between normal-weight and malnourished patients regarding the characteristics studied. CONCLUSIONS: The prevalence of nutritional deficiency was high among our sample of patients with pulmonary tuberculosis. This underscores the importance of nutritional follow-up for the assessment of tuberculosis treatment in the decision-making process regarding therapeutic interventions.