Factors Associated with Tuberculosis Treatment Default in an Endemic Area of the Brazilian Amazon: A Case Control-Study

SETTING: Treatment default is a serious problem in tuberculosis control because it implies persistence of infection source, increased mortality, increased relapse rates and facilitates the development of resistant strains. OBJECTIVE: This study analyzed tuberculosis treatment default determinants in the Amazonas State to contribute in planning appropriate control interventions. DESIGN: Observational study with a retrospective cohort using Brazilian Disease Notification System data from 2005 to 2010. A nested case control study design was used. Patients defaulting from treatment were considered as 'cases' and those completing treatment as 'controls'. In the analysis, 11,312 tuberculosis patients were included, 1,584 cases and 9,728 controls. RESULTS: Treatment default was observed to be associated to previous default (aOR 3.20; p<0.001), HIV positivity (aOR 1.62; p<0.001), alcoholism (aOR 1.51; p<0.001), low education level (aOR 1.35; p<0.001) and other co-morbidities (aOR 1.31; p = 0.05). Older patients (aOR 0.98; p = 0.001) and DOT (aOR 0,72; p<0.01) were considered as protective factor for default. CONCLUSIONS: Associated factors should be considered in addressing care and policy actions to tuberculosis control. Information on disease and treatment should be intensified and appropriate to the level of education of the population, in order to promote adherence to treatment and counter the spread of multidrug resistance to anti-TB drugs

Effect of High vs Low Doses of Chloroquine Diphosphate as Adjunctive Therapy for Patients Hospitalized With Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection: A Randomized Clinical Trial.

There is no specific antiviral therapy recommended for coronavirus disease 2019 (COVID-19). In vitro studies indicate that the antiviral effect of chloroquine diphosphate (CQ) requires a high concentration of the drug.To evaluate the safety and efficacy of 2 CQ dosages in patients with severe COVID-19. This parallel, double-masked, randomized, phase IIb clinical trial with 81 adult patients who were hospitalized with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was conducted from March 23 to April 5, 2020, at a tertiary care facility in Manaus, Brazilian Amazon. - Patients were allocated to receive high-dosage CQ (ie, 600 mg CQ twice daily for 10 days) or low-dosage CQ (ie, 450 mg twice daily on day 1 and once daily for 4 days). - Label: Main Outcomes and Measures Primary outcome was reduction in lethality by at least 50% in the high-dosage group compared with the low-dosage group. Data presented here refer primarily to safety and lethality outcomes during treatment on day 13. Secondary end points included participant clinical status, laboratory examinations, and electrocardiogram results. Outcomes will be presented to day 28. Viral respiratory secretion RNA detection was performed on days 0 and 4. Out of a predefined sample size of 440 patients, 81 were enrolled (41 [50.6%] to high-dosage group and 40 [49.4%] to low-dosage group). Enrolled patients had a mean (SD) age of 51.1 (13.9) years, and most (60 [75.3%]) were men. Older age (mean [SD] age, 54.7 [13.7] years vs 47.4 [13.3] years) and more heart disease (5 of 28 [17.9%] vs 0) were seen in the high-dose group. Viral RNA was detected in 31 of 40 (77.5%) and 31 of 41 (75.6%) patients in the low-dosage and high-dosage groups, respectively. Lethality until day 13 was 39.0% in the high-dosage group (16 of 41) and 15.0% in the low-dosage group (6 of 40). The high-dosage group presented more instance of QTc interval greater than 500 milliseconds (7 of 37 [18.9%]) compared with the low-dosage group (4 of 36 [11.1%]). Respiratory secretion at day 4 was negative in only 6 of 27 patients (22.2%). - Label: Conclusions and Relevance The preliminary findings of this study suggest that the higher CQ dosage should not be recommended for critically ill patients with COVID-19 because of its potential safety hazards, especially when taken concurrently with azithromycin and oseltamivir. These findings cannot be extrapolated to patients with nonsevere COVID-19

Comportamento de gramíneas forrageiras sob condições de pastejo intensivo por bovinos na região semi-árida do Nordeste do Brasil.

O trabalho teve o objetivo de identificar gramíneas forrageiras, capazes de resistir a condições adversas e ao manejo deficiente empregado pelos produtores da egião.bitstream/CPATSA/7722/1/SDC56.pd

Chemical composition and metabolizable energy values of corn germ meal obtained by wet milling for layers

An experiment was carried out to determine the chemical composition, metabolizable energy values, and coefficients of nutrient digestibility of corn germ meal for layers. The chemical composition of corn germ meal was determined, and then a metabolism assay was performed to determine its apparent metabolizable energy (AME) and apparent metabolizable energy corrected for nitrogen (AMEn) values and its dry matter and gross energy apparent metabolizability coefficients (CAMDM and CAMGE, respectively). In the 8-day assay (four days of adaptation and four days of total excreta collection), 60 29-week-old white Lohman LSL layers were used. A completely randomized experimental design, with three treatments with five replicates of four birds each, was applied. Treatments consisted of a reference diet and two test diets, containing 20 or 30% corn germ meal. Results were submitted to analysis of variance and means were compared by the Tukey tests at 5% probability level. The chemical composition of corn germ meal was: 96.39% dry matter, 49.48% ether extract, 1.87% ashes, 7243 kcal gross energy/kg, 11.48% protein, 0.19% methionine, 0.21% cystine, 0.48% lysine, 0.40% threonine, 0.72% arginine, 0.35% isoleucine, 0.83% leucine, 0.57% valine, and 0.37% histidine, on as-fed basis. There were no statistical differences in AME, AMEn, CAMDM, and CAMGE values with the inclusion of 20 and 30% corn germ meal in the diets. On dry matter basis, AME, AMEn, CAMDM, and CAMGE values of corn germ meal were: 4,578 and 4,548 kcal/kg, 4,723 and 4,372 kcal/kg, 64.95 and 61.86%, respectively

Oral Transmission of Trypanosoma cruzi, Brazilian Amazon

In the Brazilian Amazon, the suspected source of infection in an outbreak of acute Chagas disease involving 10 patients was Euterpe oleracea (açaí berry) juice. Patient blood and juice samples contained Trypanosoma cruzi TcIV, indicating oral transmission of the Chagas disease agent