Neurocysticercosis in Ceará State, northeastern Brazil: a review of 119 cases.

Relatively little is known about the occurrence of neurocysticercosis in northeastern Brazil. There have been no published reports from the state of Ceará, but a review of the records at the Hospital São José in Fortaleza, Brazil identified 119 patients with neurocysticercosis diagnosed between January 1988 and April 1994. Patients came from 43 municipalities in Ceará. Their ages ranged from five to 74 years; the greatest number of cases were in persons 10-40 years of age; 63% were males. Seizures were the presenting complaint in 64% of the patients and headache in 22%. Two patients, each with several hundred intracranial lesions, presented with mental status changes; one was initially given the clinical diagnosis of viral meningoencephalitis. Computed tomography scans showed that 44% of the patients had five or more lesions. Cysts were found throughout the brain. The parietal lobe was the most frequent site of involvement; 85% of patients had one or more lesions there. The brain stem was involved in 8%. There was no consistent association between the severity of the clinical abnormalities and the radiologic findings. Computed tomography of the thighs was done in 10 persons; cysts were identified in nine.

Problem-based learning: application and possibilities in Brazil.

The Ministry of Health launched the Family Health Program (FHP) with the aim of establishing comprehensive primary care for families and communities. The Public Health School of Ceará has been applying problem-based learning as the instructional method for the training of the family health teams. The importance of this method and the possibility of applying it in the implementation of a new and effective approach to the continuing education of Brazilian health professionals are emphasized.

[Perinatal deaths in the city of Fortaleza: how many deaths could be prevented?]. / Mortes perinatais no município de Fortaleza, Ceará: o quanto é possível evitar?

OBJECTIVE: The main objective of this study was to explore the relationship between perinatal care and neonatal mortality as a component of the infant mortality. Indicators were selected to analyze some aspects of the quality of perinatal care attendance offered to pregnant women and their newborns. Specific attention was given to the avoidable perinatal deaths in the city of Fortaleza, Ceará. METHODS: Population-based, prospective study on incidence. The study was carried out collecting data of seventeen maternity units and two referral pediatric hospitals of the public health system in Fortaleza, the capital of the State of Ceará. All births, alive or dead, weighting 500 grams or more, along the whole year of 1995, were included in the study. The perinatal deaths' causes were studied according to the modified Wigglesworth classification (1989). RESULTS: Along the whole study period, 40,712 children were born and 1,337 perinatal deaths occurred. Among them 730 occurred during the fetal life and 607 during the first week of life. In spite of the low incidence of low-weight newborns (7.4%), the coefficients of fetal mortality were high (17.9 per thousand), as well as the perinatal mortality (32.8 per thousand) and neonatal mortality (15.1 per thousand). The number of avoidable perinatal deaths related to adequate perinatal care was estimated to be one third of the total deaths studied (458/1,323). CONCLUSIONS: The results indicate that the perinatal assistance in the city of Fortaleza is of low quality, with problems related to the health system organization and to the low quality of the care offered to women during pregnancy, at delivery and to the newborns in the delivery room as well as in neonatal wards.

Prevalence of HIV-1, HIV-2 and HTLV antibody, in Fortaleza, Ceara, Brazil, 1993-1994.

To evaluate the respective part of HIV-1, HIV-2, and human T lymphotropic virus (HTLV) infection in Fortaleza, the principal city of the Ceara state (Northeast of Brazil), a cross-sectional seroepidemiological survey was conducted from July 1993 to February 1994 in 6 selected groups: pregnant women, tuberculosis (Tb) patients, sexually transmitted disease (STD) patients, female and male commercial sex workers (CSWs) and prisoners. Sera were screened by Mixt HIV-1/HIV-2 commercial enzyme immunoassay and ELISA HTLV I/II. Each serum found positive by ELISA was confirmed by Western blot. A total of 2917 persons were interviewed, of whom 2754 (94.4%) agreed to participate and gave a blood sample. Twenty-eight were found to be HIV-1 antibody positive. The prevalence ranged from 0.25% in pregnant women to 2.9% in male CSWs. The prevalence was 1% in STD patients and 0.44% in Tb patients. None of the sera was found positive for HIV-2. The prevalence of antibodies to HTLV-1 varied from 0.12% in pregnant women to 1.21% in female CSWs. Five sera were positive for HTLV-II. These results confirm the hypothesis that the HIV epidemic in Northeastern Brazil is still limited to high risk groups. Repeated cross-sectional surveys of this type should be performed as a surveillance tool to study the dynamics of this epidemic in low prevalence areas. Defining risk factors should allow targeting of intervention strategies.

PIP: During July 1993 to February 1994, in Ceara state, Brazil, researchers conducted a cross-sectional seroepidemiological survey of 814 pregnant women, 451 tuberculosis patients, 395 sexually transmitted disease (STD) patients, 496 female and 171 male commercial sex workers (CSWs), and 427 prisoners. They aimed to determine the prevalence of HIV-1, HIV-2, and human T lymphotropic virus (HTLV). All subjects lived in Fortaleza, where the HIV epidemic is recent. They tended to be poorly educated, poor, and not married. 28 persons were positive for HIV-1. The HIV-1 prevalence rate ranged from 0.25% in pregnant women to 2.92% in male CSWs. It was 0.44% for tuberculosis patients, 1.01% for STD patients, 1.61% for female CSWs, and 1.64% for prisoners. Indeterminate results occurred in 0.4% of all subjects. They were more common in tuberculosis patients than in other groups (1.1% vs. 0.3%; p = 0.023). No one tested positive for HIV-2. The prevalence of HTLV-I ranged from 0.12% in pregnant women to 1.21% in female CSWs. It was 0.44% for tuberculosis patients, 0.51% for STD patients, 0.58% for male CSWs, and 0.47% for prisoners. Five people (1 pregnant woman, 1 tuberculosis patient, 1 female CSW, and 2 prisoners) tested positive for HTLV-II. A 45-year-old, homosexual CSW, intravenous drug user who had tuberculosis was coinfected with HIV-1 and HTLV-I. The most common risk factor for HIV-1 infection was never used condoms (48% for female CSWs to 89% for STD patients). These findings indicate that Fortaleza has a low endemicity for HIV-1 infection and that HIV-1 is still limited to high risk groups (e.g., CSWs). The authors recommend that periodic cross-sectional surveys be conducted to study the dynamics of HIV-1 infection in this low prevalence area.