Outcomes of TB Treatment by HIV Status in National Recording Systems in Brazil, 2003–2008

BACKGROUND: Although the Brazilian national reporting system for tuberculosis cases (SINAN) has enormous potential to generate data for policy makers, formal assessments of treatment outcomes and other aspects of TB morbidity and mortality are not produced with enough depth and rigor. In particular, the effect of HIV status on these outcomes has not been fully explored, partly due to incomplete recording in the national database. METHODOLOGY/PRINCIPAL FINDINGS: In a retrospective cohort study, we assessed TB treatment outcomes, including rates of cure, default, mortality, transfer and multidrug resistant TB (MDR-TB) among a purposively chosen sample of 161,481 new cases reported in SINAN between 2003 and 2008. The study population included all new cases reported in the six States with the highest level of completeness of the HIV status field in the system. These cases were mostly male (67%), white (62%), had pulmonary TB (79%) and a suspect chest X ray (83%). Treatment outcomes were best for those HIV negative cases and worst for those known HIV positive patients (cure rate of 85.7% and 55.7% respectively). In multivariate modeling, the risk of having an unfavorable outcome (all outcomes except cure) was 3.09 times higher for those HIV positive compared with those HIV negative (95% CI 3.02-3.16). The risk of death and default also increased with HIV positivity. The group without a known HIV status showed intermediate outcomes between the groups above, suggesting that this group includes some with HIV infection. CONCLUSIONS: HIV status played an important role in TB treatment outcomes in the study period. The outcomes observed in those with known HIV were poor and need to be improved. Those in the group with unknown HIV status indicate the need for wider HIV testing among new TB cases

Multi-messenger observations of a binary neutron star merger

On 2017 August 17 a binary neutron star coalescence candidate (later designated GW170817) with merger time 12:41:04 UTC was observed through gravitational waves by the Advanced LIGO and Advanced Virgo detectors. The Fermi Gamma-ray Burst Monitor independently detected a gamma-ray burst (GRB 170817A) with a time delay of ~1.7 s with respect to the merger time. From the gravitational-wave signal, the source was initially localized to a sky region of 31 deg2 at a luminosity distance of 40+8-8 Mpc and with component masses consistent with neutron stars. The component masses were later measured to be in the range 0.86 to 2.26 Mo. An extensive observing campaign was launched across the electromagnetic spectrum leading to the discovery of a bright optical transient (SSS17a, now with the IAU identification of AT 2017gfo) in NGC 4993 (at ~40 Mpc) less than 11 hours after the merger by the One- Meter, Two Hemisphere (1M2H) team using the 1 m Swope Telescope. The optical transient was independently detected by multiple teams within an hour. Subsequent observations targeted the object and its environment. Early ultraviolet observations revealed a blue transient that faded within 48 hours. Optical and infrared observations showed a redward evolution over ~10 days. Following early non-detections, X-ray and radio emission were discovered at the transient’s position ~9 and ~16 days, respectively, after the merger. Both the X-ray and radio emission likely arise from a physical process that is distinct from the one that generates the UV/optical/near-infrared emission. No ultra-high-energy gamma-rays and no neutrino candidates consistent with the source were found in follow-up searches. These observations support the hypothesis that GW170817 was produced by the merger of two neutron stars in NGC4993 followed by a short gamma-ray burst (GRB 170817A) and a kilonova/macronova powered by the radioactive decay of r-process nuclei synthesized in the ejecta

Ecological phytochemistry of Cerrado (Brazilian savanna) plants

The Cerrado (the Brazilian savanna) is one of the vegetation formations of great biodiversity in Brazil and it has experienced strong deforestation and fragmentation. The Cerrado must contain at least 12,000 higher plant species.We discuss the ecological relevance of phytochemical studies carried out on plants from the Cerrado, including examples of phytotoxicity, antifungal, insecticidal and antibacterial activities. The results have been classified according to activity and plant family. The most active compounds have been highlighted and other activities are discussed. A large number of complex biochemical interactions occur in this system. However, only a small fraction of the species has been studied from the phytochemical viewpoint to identify the metabolites responsible for these interactions

Reliability intra-and inter-examiner of the head postural assessment by computerized photogrammetry

Scientific articles about reliability of photogrammetry for cervical spine posture evaluation are infrequent. The aim of the present investigation is to verify intra-and inter-examiner reliability of the computerized photogrammetry method for head postural evaluation in lateral view. Twenty-five young women, between 20 and 30 years old, were positioned seated in an upright position and photographed in lateral view. The photographs were imported to Corel Draw X13 program for postural evaluation by computerized photogrammetry. Analyses of intra-and inter-examiner reliability were performed for the angles: condyle-acromion (ACA), menton-sternum (AME) and Frankfurt (AF). The photogrammetry was performed by two examiners: EA and EB. For intra-examiner analyses, EA assessed the pictures twice (A1 and A2) for the same angles within 3 months. For the inter-examiner analyses, EB performed the photogrammetry for the same angles (B1) in order to compare with the data from EA. Using the interclass correlation coefficient (ICC) we observed an excellent correlation in the intra-examiner analysis (A1 and A2) for the angles: ACA and AME (both with ICC=1.0); and AF (ICC=0.78). For the inter-examiner analyses between A1 and B1, it was observed: ACA (ICC=0.24), AME (ICC=0.26) and AF (ICC=0.00). For the comparison between A2 and B1, the ICC values were: 0.23; 0.27 and 0.00, respectively for ACA, AME and AF, classified as weak correlations. In conclusion, the photogrammetry is reliable when performed by the same examiner. The inter-examiner assess showed low reliability, what could have been compromised by the reduced experience of the EB in applying the method

Risco reprodutivo e renda familiar: análise do perfil de gestantes

Em face do desafio de enfrentar a morbimortalidade materna e perinatal, a discussão sobre risco reprodutivo e sua associação com situações de vulnerabilidade em saúde é relevante à saúde publica. A pesquisa realizada teve como objetivos descrever o perfil de risco reprodutivo de 3440 mulheres matriculadas em um serviço de pré-natal de alto risco, entre 2006 e 2008, e investigar sua relação com renda familiar e situações de vulnerabilidade em saúde. Trata-se de estudo transversal que teve como fonte o banco de dados do pré-natal. O perfil econômico do grupo estudado é de baixa renda. Encontrou-se associação entre baixa renda familiar e malformações fetais, gravidez antes dos 15 anos e HIV. Renda familiar mais elevada foi associada à idade materna acima de 35 anos, translucência nucal alterada, ginecopatias e abortamento habitual. Os achados podem refletir situações de vulnerabilidade de mulheres de baixa renda, como condições de saúde desfavoráveis e menor acesso e utilização de serviços de saúde. É necessário obter um maior conhecimento do perfil do risco reprodutivo no Brasil e sua distribuição segundo características socio­demográficas, visando ao aperfeiçoamento das práticas assistenciais