Factors associated with deaths among pulmonary tuberculosis patients: a case-control study with secondary data.

BACKGROUND: Tuberculosis remains an important public health problem in Brazil where over 100 000 new cases and 6000 deaths are reported every year. Current drug efficacy and wide availability should have curbed this toll. The goal was to study the factors associated with death in incident cases of pulmonary tuberculosis (PT) during treatment. METHODS: This is a case-control study including all new cases of PT reported between 2000 and 2004; cases were patients who died of any cause and controls were those cured after initial PT treatment. Data analyses included unconditional multiple hierarchical logistic regression. RESULTS: A total of 313 502 new cases of tuberculosis were reported between 2000 and 2004; 224 355 (71.6%) were cured after initial treatment and 20 721 (6.6%) died during the surveillance follow-up. Over 82% of all cases were diagnosed with PT. After controlling for significant variables, the factors associated with a higher risk of death included gender (males: odds ratio (OR) 1.4; 95% confidence interval (CI) 1.33 to 1.47), age (<5 years of age: OR 1.90; 95% CI 1.51 to 2.38; 30-59 years: OR 2.78; 95% CI 2.61 to 2.97; over 60 years: OR 10.92; 95% CI 10.09 to 11.81), positive HIV serology (OR 10.59; 95% CI 9.76 to 11.48), alcoholism (OR 1.49; 95% CI 1.36 to 1.65), mental disorder (OR 1.80; 95% CI 1.43 to 2.27) and presence of additional lung pathology on chest x ray (OR 2.22; 95% CI 1.83 to 2.70). Protective variables included education (highest level: OR 0.67; 95% CI 0.63 to 0.70). CONCLUSIONS: Preventive interventions should target the most vulnerable patients, in particular the very young and the elderly, those infected with HIV and those presenting with a mental disorder or additional lung pathology.

[Urbanization and dengue ecology]. / Urbanização e ecologia do dengue.

Demographic changes occurring in underdeveloped countries due to intense rural-urban migration since the 1960s have resulted in overcrowded cities with multiple deficiencies, particularly in housing and basic sanitation. Some 20% of the population in large and medium-sized cities live in slums or under similar conditions. Lack of regular water supply and public garbage collection foster the proliferation of potential breeding sites for Aedes aegypti (the main mosquito vector for dengue), including precarious reservoirs for potable water and disposable recipients which accumulate water, like used cans and plastic and glass bottles. Modern industries also produce large volumes of disposable materials. Propagation of the dengue virus and the spread of dengue vectors are favored by the high intensity, frequency, and speed of private and public transportation. Such factors can help explain the re-emergence of dengue, the most important arbovirus in the world today, affecting thousands of people each year.

Prevalence of celiac disease among blood donors in Brazil.

OBJECTIVE: There are no studies on the prevalence of celiac disease (CD) in either Brazil or, as far as we know, South America. The aim of this study was to determine the prevalence of CD in healthy blood donors in the city of Brasilia, Brazil. METHODS: Sera were obtained, independently of age and gender, from an unselected group of 2045 blood donors attending the Hematological Center of Brasilia. An IgG antigliadin antibody (AGA) test was used as a first-level screening step, followed by IgA-AGA test, serum IgA antiendomysium (EMA), and total serum IgA determination performed in all sera showing abnormally high IgG-AGA results. Jejunal biopsy was suggested for all subjects showing at least one of the following: IgA-EMA positivity; IgG-AGA and IgA-AGA positivity; IgG-AGA positivity and selective IgA deficiency. AGA was determined by an enzyme-linked immunosorbent assay (ELISA) technique and IgA-EMA was ascertained by indirect immunofluorescence on cryostat sections of monkey esophagus. Jejunal mucosa samples were obtained with a Watson capsule. RESULTS: Sixty-two (3.03%) blood donors had IgG-AGA above the cut-off values. Fifty-eight individuals showed isolated high values of IgG-AGA, whereas four had simultaneously increased IgG and IgA-AGA. Three patients had positive IgA-EMA test (one with both IgG- and IgA-AGA and two with only IgG-AGA) and underwent jejunal biopsies that disclosed complete villous atrophy associated with an increased number of intraepithelial lymphocytes and hypertrophic criptae. In this study group, the prevalence of biopsy-proven celiac disease was 1.47 +/- 1.66 in 1000 subjects. CONCLUSIONS: We found a prevalence of undiagnosed CD of 1:681 among apparently healthy blood donors. These preliminary results support the view that CD is not a rare disease in Brazil.

Surto de dengue em Boa Vista, Roraima Nota previa. / Dengue outbreak in Boa Vista, Roraima. Preliminary report

Os autores descrevem a ocorrencia de um surto de dengue em Boa Vista, Territorio Federal de Roraima em final de 1981 e inicio de 1982. O numero estimado de casos elevou-se a 7000, tendo sido identificados virus dos tipos 1 e 4 em uma amostra populacional. Essa e a primeira descricao de ocorrencia de um surto de dengue no Brasil

Febre amarela no Brasil - estado atual e perspectivas. / Yellow fever in Brazil - present status and perspectives

A febre amarela silvestre pode comprometer o homem que, no Brasil, penetra nas regioes de mata, na bacia do Rio Amazonas (zonas rurais da Regiao Amazonica e Centro -Oeste). Nesta revisao e dada enfase especial ao estado atual da febre amarela no Brasil, tendo em conta registros da Divisao de Febre Amarela da Superintendencia de Campanhas de Saude Publica do Ministerio da Saude (numero de casos anuais, media mensal, distribuicao etaria e por sexo), ficando evidente que o homem jovem que por atividade laboral ou de lazer adentra nestas regioes de mata esta mais exposto de contrair a febre amarela. Sao analisados tambem aspectos do Programa Nacional de Controle da Febre Amarela (vacinacao; vigilancia epidemiologica; erradicacao do Aedes aegypti das areas reinfestadas; vigilancia anti-aegypti nas areas nao infestadas), assim como os problemas e perspectivas inerentes ao controle da febre amarela no Brasil