Factors associated with hospitalization and death among TB/HIV co-infected persons in Porto Alegre, Brazil.

In locations with a high rate of tuberculosis (TB) and HIV infection, there are a number of strategies to prevent negative outcomes such as opportunistic infections, hospitalizations and death, and this article investigates risk factors for the occurrence of hospitalization and death in cases of TB/HIV co-infection in the south of Brazil. The data are taken from a population-based retrospective cohort study on cases of TB/HIV co-infection from 2009 to 2013 in Porto Alegre, Brazil. Sociodemographic, epidemiological and clinical variables were analyzed. Relative risk (RR) estimates for hospitalization and death were determined by regression models. There were 2,419 co-infection cases, of which 1,527 (63.1%) corresponded to hospitalizations, and 662 (27.4%) to death. The occurrence of hospitalization was associated with ≤ 7 years of schooling (RR = 3.47, 95%CI: 1.97-6.29), 8-11 years of schooling (RR = 2.56, 95%CI: 1.44-4.69), place of origin-district health authorities Northwest/Humaitá/Navegantes/Ilhas (RR = 2.01, 95%CI: 1.44-2.82), type of entry into the surveillance system as in cases of reentry after withdrawal (RR = 1,35, 95%CI: 1.07-1.70), closure in surveillance as in withdrawal of treatment (RR = 1.47, 95%CI: 1.18-1.83) and multidrug-resistant tuberculosis (RR = 3.94, 95%CI: 1.97-8.81). The occurrence of death was associated with age (RR = 1.07, 95%CI: 1,01-1,14), ≤ 7 years of schooling (RR = 3.94, 95%CI: 2.26-7.09), 8-11 years of schooling (RR = 2.84, 95%CI: 1.61-5.16), place of origin-district health authorities Baltazar (RR = 2.05, 95%CI: 1.48-2.86), type of entry in the surveillance system as cases of re-entry after withdrawal (RR = 1.53, 95%CI: 1.22-1.91), relapse (RR = 1.33, 95%CI: 1.03-1.73). The occurrence of hospitalizations and deaths is high among co-infected patients. Our estimation approach is important in order to identify, from the surveillance data, the risk factors for hospitalization and death in co-infected patients, so that they may receive more attention from the Brazilian national healthcare system.

Incidência e prevalência da toxoplasmose na região sul do Brasil: revisão bibliográfica / Incidence and prevalence of toxoplasmosis in the south of Brazil region: bibliographical review

O estudo objetivou realizar uma revisão bibliográfica a respeito da incidência e prevalência da toxoplasmose na região sul do Brasil e descrever sinteticamente os seus resultados. Foi realizada revisão bibliográfica, em que foram utilizadas as palavras-chaves: toxoplasmose, epidemiologia, incidência, prevalência, região sul e saúde pública, buscando artigos publicados completos, em língua portuguesa, entre os anos de 2010 e 2015. Foram encontrados 17 trabalhos que levantaram episódios específicos de prevalência, incidência ou surtos da toxoplasmose na região, mas não se conseguiu um estudo completo que traçasse um percentual global, da temática estudada no espaço definido. Os resultados, a partir destes estudos, indicaram que houve a exposição geral da população regional ao parasito e que há alta incidência e prevalência na região, mas acima de tudo revelam a negligência com relação à toxoplasmose e da importância de mais esclarecimentos a população. Não há um registro sistematizado, nem programas efetivos de informações quanto à prevenção e quanto aos modos de transmissão da doença.

The objective of this study was to carry out a literature review on the incidence and prevalence of toxoplasmosis in southern Brazil and to describe their results in a synthetical manner. A bibliographic review was carried out, in which the following keywords were used: toxoplasmosis, epidemiology, incidence, prevalence, southern region and public health, searching for articles published in Portuguese between 2010 and2015. We found 17 studies that present specific episodes of prevalence, incidence or outbreaks of toxoplasma in the region, but a complete study that did not reach a global percentage of the subject studied in the defined space was obtained. The results, from these studies, indicated that there was a general exposure of the regional population to the parasite and that there is a high incidence and prevalence in the region, but above all they reveal negligence regarding toxoplasmosis and the importance of further clarification of the population. There is no systematized record, no effective information programs on prevention and how the disease is transmitted.

A consulta ginecológica e seu potencial para produzir a integralidade da atenção em saúde / Gynecological consultation and its potential to produce completeness of attention in health / La consulta ginecológica y su potencial para producir la integralidad de la atención en salud

Objetivo: analisar a consulta ginecológica ofertada nos serviços de saúde e seu potencial para produzir a integralidade da atenção. Método: estudo exploratório-descritivo, com abordagem qualitativa, realizada com mulheres usuárias da rede de atenção básica, com enfoque na consulta ginecológica, em duas Unidades Básicas de Saúde (UBS) de dois municípios do Estado do Rio Grande do Sul. A coleta de dados deu-se por meio de Grupo Focal, utilizando-se um roteiro semiestruturado. Após a leitura dos depoimentos, os dados foram inseridos no programa NVivo 10 e submetidos à Técnica de Análise de Conteúdo na modalidade Temática. Resultados: a consulta ginecológica atende, em parte, o princípio da integralidade da atenção devido à precariedade e descontinuidade das ações entre especialidades e serviços. Conclusão: é necessário redirecionar a organização das práticas, especialmente a consulta ginecológica, em seu modo operante, valorizada pelos constructos da saúde ampliada, vínculo e escuta sensível.(AU)

Objective: to analyze the gynecological consultation offered in health services and its potential to produce comprehensive care. Method: exploratory and descriptive study with qualitative approach conducted with women users of primary care network, with a focus on gynecological consultation in two Basic Health Units (BHU) in two counties of Rio Grande do Sul State. Data collection took place through Focal Group, using a semi-structured script. After reading the testimonials, data was entered into the program NVivo 10 and subjected to Content Analysis Technique in the Thematic modality. Results: the gynecological consultation meets, to some extent, the principle of comprehensive care and this is due to precariousness and discontinuity of actions between specialties and services. Conclusion: We must redirect the organization of practices, especially the gynecological consultation in its operating mode, valued by the concepts of the perspective of comprehensive health, relationship and sensitive listening.(AU)

Objetivo: analizar la consulta ginecológica ofertada en los servicios de salud y su potencial para producir la integralidad de la atención. Método: estudio exploratorio-descriptivo, con enfoque cualitativo, realizado con mujeres usuarias de la red de atención básica, con enfoque en la consulta ginecológica, en dos Unidades Básicas de Salud (UBS) de dos municipios del Estado de Rio Grande do Sul. La recolección de datos fue por medio de Grupo Focal, utilizándose una guía semi-estructurada. Después de la lectura de los testimonios, los datos fueron inseridos en el programa NVivo 10 y sometidos a la Técnica de Análisis de Contenido en la modalidad Temática. Resultados: la consulta ginecológica atiende, en parte, el principio de la integralidad de la atención debido a la precariedad y discontinuidad de las acciones entre especialidades y servicios. Conclusión: es necesario redirigir la organización de las prácticas, especialmente la consulta ginecológica, en su modo operante, valorizada por los constructos de la salud ampliada, vínculo y escucha sensible.(AU)

Spontaneous stage differentiation of mouse-virulent Toxoplasma gondii RH parasites in skeletal muscle cells: an ultrastructural evaluation.

Although the predilection for Toxoplasma gondii to form cysts in the nervous system and skeletal and heart muscles has been described for more than fifty years, skeletal muscle cells (SkMCs) have not been explored as a host cell type to study the Toxoplasma-host cell interaction and investigate the intracellular development of the parasite. Morphological aspects of the initial events in the Toxoplasma-SkMC interaction were analysed and suggest that there are different processes of protozoan adhesion and invasion and of the subsequent fate of the parasite inside the parasitophorous vacuole (PV). Using scanning electron microscopy,Toxoplasma tachyzoites from the mouse-virulent RH strain were found to be attached to SkMCs by the anterior or posterior region of the body, with or without expansion of the SkMC membrane. This suggests that different types of parasite internalization occurred. Asynchronous multiplication and differentiation of T. gondii were observed. Importantly, intracellular parasites were seen to display high amounts of amylopectin granules in their cytoplasm, indicating that tachyzoites of the RH strain were able to differentiate spontaneously into bradyzoites in SkMCs. This stage conversion occurred in approximately 3% of the PVs. This is particularly intriguing as tachyzoites of virulent Toxoplasma strains are not thought to be prone to cyst formation. We discuss whether biological differences in host cells are crucial to Toxoplasma stage conversion and suggest that important questions concerning the host cell type and its relevance in Toxoplasma differentiation are still unanswered.

Spontaneous stage differentiation of mouse-virulent Toxoplasma gondii RH parasites in skeletal muscle cells: an ultrastructural evaluation

Although the predilection for Toxoplasma gondii to form cysts in the nervous system and skeletal and heart muscles has been described for more than fifty years, skeletal muscle cells (SkMCs) have not been explored as a host cell type to study the Toxoplasma-host cell interaction and investigate the intracellular development of the parasite. Morphological aspects of the initial events in the Toxoplasma-SkMC interaction were analysed and suggest that there are different processes of protozoan adhesion and invasion and of the subsequent fate of the parasite inside the parasitophorous vacuole (PV). Using scanning electron microscopy,Toxoplasma tachyzoites from the mouse-virulent RH strain were found to be attached to SkMCs by the anterior or posterior region of the body, with or without expansion of the SkMC membrane. This suggests that different types of parasite internalization occurred. Asynchronous multiplication and differentiation of T. gondii were observed. Importantly, intracellular parasites were seen to display high amounts of amylopectin granules in their cytoplasm, indicating that tachyzoites of the RH strain were able to differentiate spontaneously into bradyzoites in SkMCs. This stage conversion occurred in approximately 3 percent of the PVs. This is particularly intriguing as tachyzoites of virulent Toxoplasma strains are not thought to be prone to cyst formation. We discuss whether biological differences in host cells are crucial to Toxoplasma stage conversion and suggest that important questions concerning the host cell type and its relevance in Toxoplasma differentiation are still unanswered.