Tuberculose na população indígena de São Gabriel da Cachoeira, Amazonas, Brasil Tuberculosis among the indian population in São Gabriel da Cachoeira, Amazonas State, Brazil

O estudo descreve a situação da tuberculose no Município de São Gabriel da Cachoeira, Estado do Amazonas, Brasil, no período de 1997 a 2002. Este município de população predominantemente indígena constitui uma importante noso-área da Amazônia para o problema da tuberculose, cuja magnitude se expressa por intermédio do coeficiente 2,4 vezes mais elevado que a média estadual e até quatro vezes mais que a média nacional. Análises estatísticas utilizadas para avaliar a tendência em relação à associação com a idade, o sexo e a forma clínica revelaram diferenças no comportamento da endemia, quando comparados os coeficientes de incidência entre os casos de procedência urbana e rural. As taxas padronizadas mostraram a população masculina com uma incidência mais elevada que a feminina nas duas áreas de residência. A faixa etária mais atingida foi acima de 50 anos, porém a proporção de menores de 15 anos se mostrou acima dos valores esperados na população geral do país, além de apresentar diferentes níveis de gravidade nas subáreas rurais estudadas. Os achados indicam que esta situação pode ser explicada pelas desigualdades, sobretudo, relativas à acessibilidade aos serviços de saúde que, contraditoriamente, parecem menos resolutivos na área urbana.<br>This study describes the tuberculosis situation in São Gabriel da Cachoeira, Amazonas State, Brazil, from 1997 to 2002. The county, which has a predominantly Indian population, is a relevant tuberculosis area in Amazonas, since the infection rate is 2.4 to 4 times that of the overall State and national rates. The statistical analyses used to assess its association with age, gender, and clinical form showed differences in the endemic behavior, comparing the urban and rural incidence rates. Males had higher standardized incidence rates than females in both the urban and rural areas. The most heavily affected age group was greater than 50 years, but the rate among individuals under 15 years was above the overall national rate, in addition to presenting different severity levels in the rural sub-areas that were studied. The situation can be explained mainly by inequalities in access to health services, which paradoxically appear to show lower case-resolving capacity in urban areas of the county

As necessidades de saúde e vulnerabilidades de pessoas com tuberculose segundo as dimensões acesso, vínculo e adesão

Os objetivos foram conhecer a vivência das pessoas com tuberculose e identificar necessidades de saúde e vulnerabilidade frente ao adoecimento, no que diz respeito ao acesso ao tratamento, ao vínculo com a equipe de saúde e à adesão ao tratamento. Trata-se de um estudo qualitativo, desenvolvido em unidades de saúde da família. Entrevistaram-se pessoas em tratamento, utilizando-se o critério de saturação das informações. Na análise dos depoimentos utilizou-se o software Alceste. O diagnóstico tardio reflete a falta de conhecimento sobre a doença e o despreparo de alguns profissionais. O apoio constituiu um determinante no seguimento das pessoas que, sentindo-se acolhidas, foram incentivadas a seguir o esquema terapêutico. As necessidades de saúde relacionaram-se às boas condições de vida, como direito à alimentação, trabalho, moradia, educação, lazer e adoção de hábitos de vida saudáveis. Ressalta-se a valorização da vivência das pessoas em tratamento para apoiar a prática assistencial dos profissionais focada nas necessidades de saúde e vulnerabilidades da população

Perfil dos casos novos de tuberculose notificados em Ribeirão Preto (SP) no período de 2000 a 2006 Profile of new cases of tuberculosis in Ribeirão Preto, São Paulo State, in the period of 2000 to 2006

A Organização Mundial de Saúde estima que um terço da população mundial encontra-se infectada pelo Mycobacterium tuberculosis, sendo que 8-9 milhões de pessoas desenvolvem a doença e, anualmente, 2 milhões vão a óbito por tuberculose, principalmente em países e regiões com condições socioeconômicas precárias. Este estudo descreve o perfil dos casos novos de tuberculose notificados no município de Ribeirão Preto (SP) no período de 2000 a 2006. Utilizou-se um desenho descritivo do tipo coorte. Para a coleta dos dados, foi utilizado o banco de dados Epi-Tb. A forma clínica predominante foi a pulmonar. Verificou-se que 71,7% dos doentes eram do sexo masculino e adultos jovens (20-39 anos). Em relação ao tipo de supervisão, observou-se aumento gradativo da forma supervisionada ao longo do período considerado, exceto no ano de 2003. A coinfecção Tb/HIV mostrou-se superior a 25%, sendo que 12,9% dos doentes não realizaram o teste anti-HIV. Quanto ao resultado de tratamento, a cura variou de 62,7% a 76,7%, a média do abandono foi de 4,3% e óbito por tuberculose foi de 3,9%. Os resultados apresentados contribuem para o conhecimento da situação epidemiológica da tuberculose ao longo dos anos, fornecendo subsídios à tomada de decisões relacionadas principalmente às ações de prevenção e controle da doença no município.<br>The World Health Organization estimates that one third of the world population is infected by the Mycobacterium tuberculosis, while 8-9 million of people develop the disease and 2 million die each year due to tuberculosis, especially in countries and regions with precarious socioeconomic conditions. This study describes the profile of new cases of Tuberculosis notified in Ribeirão Preto, São Paulo State, in the period between 2000 and 2006. A cohort descriptive design was used. The database Epi-Tb was used for the data collection. The clinical form predominant was pulmonary. It was verified that 71.7% of patients were male and young adults (20-39 years). Regarding the type of supervision, it was observed that the supervised form presented a progressive increase along the period considered, with exception of 2003. The Tb/HIV co-infection was superior to 25%, while 12.9% of the patients performed the test. Regarding the treatment result, cure varied from 62.7% to 76.7%, the abandonment mean was 4.3% and death by tuberculosis was 3.9%. The results presented contribute for the knowledge of the tuberculosis epidemiological situation along the years studied, providing support to decision making related to prevention actions and control of the disease in the municipality

Distribuição espacial dos casos novos de tuberculose em Vitória, Estado do Espírito Santo, no período entre 2000 e 2005 Spatial distribution of new tuberculosis cases in Vitória, State of Espírito Santo, between 2000 and 2005

Realizou-se um estudo ecológico com a análise da distribuição espacial dos 979 novos casos de tuberculose entre 2000 e 2005. Utilizou-se o Método Bayesiano Empírico Local para estimação do risco. O Índice de Moram Local foi calculado para avaliação das autocorrelações entre as incidências de bairros limítrofes. Observou-se que a tuberculose distribui-se heterogeneamente entre os bairros, sendo possível identificar regiões com alto risco de adoecimento.<br>We carried out an ecological study in which the spatial distribution of 979 new tuberculosis cases between 2000 and 2005 were analyzed. The risk was estimated using the local empirical Bayesian method. The local indicators of spatial association were calculated to evaluate autocorrelations of incidence between adjoining districts. We found that the tuberculosis cases were heterogeneously distributed between districts, and it was possible to identify regions in which there was a high risk of becoming ill

BLOC-1 Brings Together the Actin and Microtubule Cytoskeletons to Generate Recycling Endosomes

Recycling endosomes consist of a tubular network that emerges from vacuolar sorting endosomes and diverts cargoes toward the cell surface, the Golgi or lysosome-related organelles. How recycling tubules are formed remains unknown. We show that recycling endosome biogenesis requires the protein complex BLOC-1. Mutations in BLOC-1 subunits underlie an inherited disorder characterized by albinism, the Hermansky-Pudlak Syndrome, and are associated with schizophrenia risk. We show here that BLOC-1 coordinates the kinesin KIF13A-dependent pulling of endosomal tubules along microtubules to the Annexin A2/actin-dependent stabilization and detachment of recycling tubules. These components cooperate to extend, stabilize and form tubular endosomal carriers that function in cargo recycling and in the biogenesis of pigment granules in melanocytic cells. By shaping recycling endosomal tubules, our data reveal that dysfunction of the BLOC-1-KIF13A-Annexin A2 molecular network underlies the pathophysiology of neurological and pigmentary disorders

Efficacy, safety, and immunogenicity of a booster regimen of Ad26.COV2.S vaccine against COVID-19 (ENSEMBLE2) : results of a randomised, double-blind, placebo-controlled, phase 3 trial

Background Despite the availability of effective vaccines against COVID-19, booster vaccinations are needed to maintain vaccine-induced protection against variant strains and breakthrough infections. This study aimed to investigate the efficacy, safety, and immunogenicity of the Ad26.COV2.S vaccine (Janssen) as primary vaccination plus a booster dose. Methods ENSEMBLE2 is a randomised, double-blind, placebo-controlled, phase 3 trial including crossover vaccination after emergency authorisation of COVID-19 vaccines. Adults aged at least 18 years without previous COVID-19 vaccination at public and private medical practices and hospitals in Belgium, Brazil, Colombia, France, Germany, the Philippines, South Africa, Spain, the UK, and the USA were randomly assigned 1:1 via a computer algorithm to receive intramuscularly administered Ad26.COV2.S as a primary dose plus a booster dose at 2 months or two placebo injections 2 months apart. The primary endpoint was vaccine efficacy against the first occurrence of molecularly confirmed moderate to severe-critical COVID-19 with onset at least 14 days after booster vaccination, which was assessed in participants who received two doses of vaccine or placebo, were negative for SARS-CoV-2 by PCR at baseline and on serology at baseline and day 71, had no major protocol deviations, and were at risk of COVID-19 (ie, had no PCR-positive result or discontinued the study before day 71). Safety was assessed in all participants; reactogenicity, in terms of solicited local and systemic adverse events, was assessed as a secondary endpoint in a safety subset (approximately 6000 randomly selected participants). The trial is registered with ClinicalTrials.gov, NCT04614948, and is ongoing. Findings Enrolment began on Nov 16, 2020, and the primary analysis data cutoff was June 25, 2021. From 34 571 participants screened, the double-blind phase enrolled 31 300 participants, 14 492 of whom received two doses (7484 in the Ad26.COV2.S group and 7008 in the placebo group) and 11 639 of whom were eligible for inclusion in the assessment of the primary endpoint (6024 in the Ad26.COV2.S group and 5615 in the placebo group). The median (IQR) follow-up post-booster vaccination was 36 center dot 0 (15 center dot 0-62 center dot 0) days. Vaccine efficacy was 75 center dot 2% (adjusted 95% CI 54 center dot 6-87 center dot 3) against moderate to severe-critical COVID-19 (14 cases in the Ad26.COV2.S group and 52 cases in the placebo group). Most cases were due to the variants alpha (B.1.1.7) and mu (B.1.621); endpoints for the primary analysis accrued from Nov 16, 2020, to June 25, 2021, before the global dominance of delta (B.1.617.2) or omicron (B.1.1.529). The booster vaccine exhibited an acceptable safety profile. The overall frequencies of solicited local and systemic adverse events (evaluated in the safety subset, n=6067) were higher among vaccine recipients than placebo recipients after the primary and booster doses. The frequency of solicited adverse events in the Ad26.COV2.S group were similar following the primary and booster vaccinations (local adverse events, 1676 [55 center dot 6%] of 3015 vs 896 [57 center dot 5%] of 1559, respectively; systemic adverse events, 1764 [58 center dot 5%] of 3015 vs 821 [52 center dot 7%] of 1559, respectively). Solicited adverse events were transient and mostly grade 1-2 in severity. Interpretation A homologous Ad26.COV2.S booster administered 2 months after primary single-dose vaccination in adults had an acceptable safety profile and was efficacious against moderate to severe-critical COVID-19. Studies assessing efficacy against newer variants and with longer follow-up are needed. Funding Janssen Research & Development. Copyright (c) 2022 The Author(s). Published by Elsevier Ltd