Eliminating tuberculosis in Latin America: making it the point

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Risk factors for default from tuberculosis treatment in HIV-infected individuals in the state of Pernambuco, Brazil: a prospective cohort study

BACKGROUND: Concomitant treatment of Human Immunodeficiency Virus (HIV) infection and tuberculosis (TB) presents a series of challenges for treatment compliance for both providers and patients. We carried out this study to identify risk factors for default from TB treatment in people living with HIV. METHODS: We conducted a cohort study to monitor HIV/TB co-infected subjects in Pernambuco, Brazil, on a monthly basis, until completion or default of treatment for TB. Logistic regression was used to calculate crude and adjusted odds ratios, 95% confidence intervals and P-values. RESULTS: From a cohort of 2310 HIV subjects, 390 individuals (16.9%) who had started treatment after a diagnosis of TB were selected, and data on 273 individuals who completed or defaulted on treatment for TB were analyzed. The default rate was 21.7% and the following risk factors were identified: male gender, smoking and CD4 T-cell count less than 200 cells/mm3. Age over 29 years, complete or incomplete secondary or university education and the use of highly active antiretroviral therapy (HAART) were identified as protective factors for the outcome. CONCLUSION: The results point to the need for more specific actions, aiming to reduce the default from TB treatment in males, younger adults with low education, smokers and people with CD4 T-cell counts < 200 cells/mm3. Default was less likely to occur in patients under HAART, reinforcing the strategy of early initiation of HAART in individuals with TB

Myocardial performance index correlates with the BODE index and affects quality of life in COPD patients

Daniela Graner Schuwartz Tannus-Silva,1 Jo&atilde;o Batista Masson-Silva,1 Lays Silva Ribeiro,1 Marcus Barreto Conde,2,3 Marcelo Fouad Rabahi1 1Faculty of Medicine, Federal University of Goias, Goi&acirc;nia, Goi&aacute;s, 2Instituto de Doen&ccedil;as do T&oacute;rax da Universidade Federal do Rio de Janeiro, Rio de Janeiro, 3Faculdade de Medicina de Petr&oacute;polis, Petr&oacute;polis, Rio de Janeiro, Brazil Background and objective: COPD, a systemic illness associated with the impairment of different organs, affects patient prognosis and quality of life. The aim of this study was to evaluate the association between right ventricle (RV) function, the BODE (body mass index, airflow obstruction, dyspnea, and exercise capacity) index (a multifunctional scale for the assessment of mortality risk), and quality of life in patients with COPD. Methods: A cross-sectional study was carried out in 107 outpatients presenting with stable COPD who underwent clinical assessment, spirometry, arterial blood gas analyses, a 6-minute walk test, electrocardiography, and echocardiogram and who responded to the Saint George&rsquo;s Respiratory Questionnaire (SGRQ). Results: Among the study subjects, 53% (57/107) were males, and the mean age was 65.26&plusmn;8.81&nbsp;years. A positive correlation was observed between RV dysfunction measured by the myocardial performance index using tissue Doppler (MPIt) and the BODE index, even after adjustment for age and partial pressure of oxygen (r2=0.47; P&lt;0.01). Patients with alterations in the MPIt had worse quality of life, and a statistically significant difference was found for different domains of the SGRQ. Patients with a normal MPIt had a mean total score of 46.2&plusmn;18.6, whereas for those with MPIt alterations, the mean total score was 61.6&plusmn;14.2 (P=0.005). These patients had a 1.49-fold increased risk of exhibiting SGRQ total score above the upper limit of the 95% CI (P=0.01). Conclusion: The findings of this study suggest that RV dysfunction as measured by the MPIt was associated with impairment in quality of life and a worse BODE index in COPD patients, irrespective of age and hypoxemia status. Keywords: COPD, right ventricle dysfunction, echocardiography, BODE score, quality of lif

Prevalence of chronic obstructive pulmonary disease among patients with systemic arterial hypertension without respiratory symptoms

Marcelo Fouad Rabahi,1,2 Sheila Alves Pereira,1 Jos&eacute; Laerte Rodrigues Silva J&uacute;nior,1,2 Aline Pacheco de Rezende,1 Adeliane Castro da Costa,2 Krislainy de Sousa Corr&ecirc;a,2,3 Marcus Barreto Conde4,5 1School of Medicine, Federal University of Goi&aacute;s, Goiania, Brazil; 2Cl&iacute;nica do Aparelho Respirat&oacute;rio (CLARE), Goiania, Brazil; 3Pontifical Catholic University of Goi&aacute;s, Goiania, Brazil; 4Faculdade de Medicina de Petr&oacute;polis/FASE, Petr&oacute;polis, Brazil; 5Instituto de Doen&ccedil;as do T&oacute;rax da Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil Background: The diagnosis of chronic obstructive pulmonary disease (COPD) is often delayed until later stages of the disease. The purpose of the present study was to determine the prevalence of COPD among adults on treatment for systemic arterial hypertension independently of the presence of respiratory symptoms. Methods: This cross-sectional study included adults aged &ge;40 years with tobacco/occupational exposure and systemic arterial hypertension diagnosed at three Primary Health Care facilities in Goiania, Brazil. Patients were evaluated using a standardized respiratory questionnaire and spirometry. COPD prevalence was measured considering the value of forced vital capacity and/or forced expiratory volume in 1 second &lt;0.70. Results: Of a total of 570 subjects, 316 (55%) met inclusion criteria and were invited to participate. Two hundred and thirty-three (73.7%) patients with arterial hypertension reported at least one respiratory symptom, while 83 (26.3%) reported no respiratory symptoms; 41 (17.6%) patients with arterial hypertension and at least one respiratory symptom, and 10 (12%) patients with arterial hypertension but no respiratory symptoms were diagnosed with COPD (P=0.24). The prevalence of COPD in people with no previous COPD diagnosis was greater among those with no respiratory symptoms (100%) than among those with respiratory symptoms (56.1%) (P=0.01). Conclusion: Our findings suggest that regardless of the presence of respiratory symptoms, individuals aged &ge;40 years with tobacco/occupational exposure and arterial hypertension may benefit from spirometric evaluation. Keywords: COPD, hypertension, public healt

Humoral response to HspX and GlcB to previous and recent infection by <it>Mycobacterium tuberculosis</it>

<p>Abstract</p> <p>Background</p> <p>Tuberculosis (TB) remains a major world health problem. Around 2 billions of people are infected by <it>Mycobacterium tuberculosis</it>, the causal agent of this disease. This fact accounts for a third of the total world population and it is expected that 9 million people will become infected each year. Only approximately 10% of the infected people will develop disease. However, health care workers (HCW) are continually exposed to the bacilli at endemic sites presenting increased chance of becoming sick. The objective of this work was to identify LTBI (latent tuberculosis infection) among all asymptomatic HCW of a Brazilian Central Hospital, in a three year follow up, and evaluate the humoral response among HCW with previous and recent LTBI to recombinant HspX and GlcB from <it>M. tuberculosis</it>.</p> <p>Methods</p> <p>Four hundred and thirty seven HCW were screened and classified into three different groups according to tuberculin skin test (TST) status: uninfected, previous LTBI and recent LTBI. ELISA test were performed to determine the humoral immune response to HspX and GlcB.</p> <p>Results</p> <p>The levels of IgG and IgM against the HspX and GlcB antigens were the same among HCW with recent and previous LTBI, as well as among non infected HCW. However, the IgM levels to HspX was significantly higher among HCW with recent LTBI (OD = 1.52 ± 0.40) than among the uninfected (OD = 1.09 ± 0.50) or subjects with previous LTBI (OD = 0.96 ± 0.51) (p < 0.001).</p> <p>Conclusion</p> <p>IgG and IgM humoral responses to GlcB antigens were similar amongst all studied groups; nevertheless IgM levels against HspX were higher among the recent LTBI/HCW.</p