HLA-DQA1 and HLA-DQB1 allele diversity and its extended haplotypes in Madeira Island (Portugal).

This study shows, for the first time, high-resolution allele frequencies of HLA-DQA1 loci in Madeira Island (Portugal) and allows us to better understand and refine present knowledge on DQB1 variation, with the identification of several alleles not previously reported in this population. Estimates on haplotype profile, involving HLA-A, HLA-B, HLA-DRB1, HLA-DQA1 and HLA-DQB1, are also reported.

Human leucocyte antigens class II allele and haplotype association with Type 1 Diabetes in Madeira Island (Portugal).

This study confirms for Madeira Island (Portugal) population the Type 1 Diabetes (T1D) susceptible and protective Human leucocyte antigens (HLA) markers previously reported in other populations and adds some local specificities. Among the strongest T1D HLA associations, stands out, as susceptible, the alleles DRB1*04:05 (OR = 7.3), DQB1*03:02 (OR = 6.1) and DQA1*03:03 (OR = 4.5), as well as the haplotypes DRB1*04:05-DQA1*03:03-DQB1*03:02 (OR = 100.9) and DRB1*04:04-DQA1*03:01-DQB1*03:02 (OR = 22.1), and DQB1*06:02 (OR = 0.07) and DRB1*15:01-DQA1*01:02-DQB1*06:02 (OR = 0.04) as protective. HLA-DQA1 positive for Arginine at position 52 (Arg52) (OR = 15.2) and HLA-DQB1 negative for Aspartic acid at the position 57 (Asp57) (OR = 9.0) alleles appear to be important genetic markers for T1D susceptibility, with higher odds ratio values than any single allele and than most of the haplotypes. Genotypes generated by the association of markers Arg52 DQA1 positive and Asp57 DQB1 negative increase T1D susceptibility much more than one would expected by a simple additive effect of those markers separately (OR = 26.9). This study also confirms an increased risk for DRB1*04/DRB1*03 heterozygote genotypes (OR = 16.8) and also a DRB1*04-DQA1*03:01-DQB1*03:02 haplotype susceptibility dependent on the DRB1*04 allele (DRB1*04:01, OR = 7.9; DRB1*04:02, OR = 3.2; DRB1*04:04, OR = 22.1).

Results of implementation of preventive recommendations for tuberculosis after renal transplantation in an endemic area.

This retrospective cohort study assessed the results of the implementation of preventive recommendations for tuberculosis (TB) among renal transplant recipients in an endemic area (Rio de Janeiro, Brazil). Subjects were defined as at high risk for TB if they had latent tuberculosis infection (LTBI), reported recent close contact with individuals with TB or received a graft from a donor with LTBI. A 6-month course of isoniazid preventive therapy (IPT) was targeted to high-risk subjects. The study end point was TB confirmed by culture. Altogether, 535 patients were included. Median follow-up was 59 months. The overall cumulative incidence of TB was 2.1% while among the 274 patients in whom the preventive protocol was fully implemented, the incidence was only 0.7%. The incidence of TB among 75 high-risk recipients not treated with isoniazid (7%) was significantly higher than that observed in 209 untreated low-risk patients (1%, p = 0.006) and in 65 high-risk subjects that received IPT (no case, p = 0.03). In conclusion, the implementation of preventive recommendations for TB in an endemic area allowed the appropriate discrimination between high- and low-risk renal transplant recipients and was associated with long-term reduction in the incidence of this complication among high-risk subjects.

Outbreak of Neisseria meningitidis C in workers at a large food-processing plant in Brazil: challenges of controlling disease spread to the larger community.

SUMMARYAn outbreak of meningococcal disease (MD) with severe morbidity and mortality was investigated in midwestern Brazil in order to identify control measures. A MD case was defined as isolation of Neisseria meningitidis, or detection of polysaccharide antigen in a sterile site, or presence of clinical purpura fulminans, or an epidemiological link with a laboratory-confirmed case-patient, between June and August 2008. In 8 out of 16 MD cases studied, serogroup C ST103 complex was identified. Five (31%) cases had neurological findings and five (31%) died. The attack rate was 12 cases/100 000 town residents and 60 cases/100 000 employees in a large local food-processing plant. We conducted a matched case-control study of eight primary laboratory-confirmed cases (1:4). Factors associated with illness in single variable analysis were work at the processing plant [matched odds ratio (mOR) 22, 95% confidence interval (CI) 2·3-207·7, P<0·01], and residing <1 year in Rio Verde (mOR 7, 95% CI 1·11-43·9, P<0·02). Mass vaccination (>10 000 plant employees) stopped propagation in the plant, but not in the larger community.

Does aerobic exercise training promote changes in structural and biomechanical properties of the tendons in experimental animals? A systematic review.

To develop a systematic review to evaluate, through the best scientific evidence available, the effectiveness of aerobic exercise in improving the biomechanical characteristics of tendons in experimental animals. Two independent assessors conducted a systematic search in the databases Medline/PUBMED and Lilacs/BIREME, using the following descriptors of Mesh in animal models. The ultimate load of traction and the elastic modulus tendon were used as primary outcomes and transverse section area, ultimate stress and tendon strain as secondary outcomes. The assessment of risk of bias in the studies was carried out using the following methodological components: light/dark cycle, temperature, nutrition, housing, research undertaken in conjunction with an ethics committee, randomization, adaptation of the animals to the training and preparation for the mechanical test. Eight studies, comprising 384 animals, were selected; it was not possible to combine them into one meta-analysis due to the heterogeneity of the samples. There was a trend to increasing ultimate load without changes in the other outcomes studied. Only one study met more than 80% of the quality criteria. Physical training performed in a structured way with imposition of overloads seems to be able to promote changes in tendon structure of experimental models by increasing the ultimate load supported. However, the results of the influence of exercise on the elastic modulus parameters, strain, transverse section area and ultimate stress, remain controversial and inconclusive. Such a conclusion must be evaluated with reservation as there was low methodological control in the studies included in this review.

Alterations of tendons in patients with diabetes mellitus: a systematic review.

AIMS: To perform a systematic review of observational studies which analyse tendon alterations in patients with diabetes mellitus compared with healthy individuals. METHODS: Data collection was performed, with no language restriction, using the databases of PubMed/Medline, BIREME, CINAHL, LILACS and Cochrane, as well as the references found in these studies. Three reviewers performed independent extractions of articles. Subsequently, these reviewers analysed the articles, focusing on their methodological quality, using the appropriate scale to evaluate observational studies from the Agency for Healthcare Research and Quality. RESULTS: Six articles were included in the analysis. Of these, four had used ultrasonographic diagnostics, one computed tomography and one magnetic resonance imaging. The patient pool comprised 396 individuals. All the articles evaluated tendon thickness and presented heterogeneous results. Two articles stated thickening or increased volume of the tendons in diabetic people, one article did not report any alteration, the fourth failed to determine any alterations and the fifth showed thinning of the tendons. The arrangement of collagen fibrils and the presence of calcification were analysed in only one article (n = 80), showing that 88.10% (n = 68) of individuals with diabetes presented disorientation of collagen fibril arrangement, while only 10% (n = 1) of healthy individuals presented this condition. Regarding tendon calcification, the article showed diabetic individuals with higher values than healthy individuals. CONCLUSIONS: All the articles indicated some relation between diabetes mellitus and tendon alterations in human beings, but due to methodological drawbacks, this association could not be sustained.

Highly adherent bioactive glass thin films synthetized by magnetron sputtering at low temperature.

Thin (380-510 nm) films of a low silica content bioglass with MgO, B(2)O(3), and CaF(2) as additives were deposited at low-temperature (150°C) by radio-frequency magnetron sputtering onto titanium substrates. The influence of sputtering conditions on morphology, structure, composition, bonding strength and in vitro bioactivity of sputtered bioglass films was investigated. Excellent pull-out adherence (~73 MPa) was obtained when using a 0.3 Pa argon sputtering pressure (BG-a). The adherence declined (~46 MPa) upon increasing the working pressure to 0.4 Pa (BG-b) or when using a reactive gas mixture (~50 MPa). The SBF tests clearly demonstrated strong biomineralization features for all bioglass sputtered films. The biomineralization rate increased from BG-a to BG-b, and yet more for BG-c. A well-crystallized calcium hydrogen phosphate-like phase was observed after 3 and 15 days of immersion in SBF in all bioglass layers, which transformed monotonously into hydroxyapatite under prolonged SBF immersion. Alkali and alkali-earth salts (NaCl, KCl and CaCO(3)) were also found at the surface of samples soaked in SBF for 30 days. The study indicated that features such as composition, structure, adherence and bioactivity of bioglass films can be tailored simply by altering the magnetron sputtering working conditions, proving that this less explored technique is a promising alternative for preparing implant-type coatings.

[Left ventricle free wall rupture - a 10-year experience]. / Rotura de parede livre do ventrículo esquerdo- 10 anos de experiência.

The left ventricle free wall rupture is one of the most serious and lethal complications associated to myocardial infarction.The most common treatment in our days consists in direct closure of the rupture with pericardium or synthetic material, applied with the help of histoacryl glue, without extracorporeal circulation.Between January 2000 and September 2010, 35 consecutive patients underwent operation for left ventricle free wall rupture at our hospital.The mean age was 69,5 years and most of the patients were male ( 65,7 % ). 2,9 days was the mean time for rupture after infarction and the anterior and lateral wall were most frequently involved. 94,7 % of the patients were in shock. Surgery was performed without extracorporeal circulation using a patch of pericardium and/or Dacron Sauvage, with histoacryl glue in 85,7 % of cases.Mean time of ICU stay was 7,9 days, in-hospital global mortality 28,6 %. At 2,5 years follow-up, 86 % of the patients were alive.Despite the high morbidity and mortality associated to surgery, the procedure is now safer, simpler and quick allowing the treatment of a situation that conducted to a most certain death without management.

Development of porous HAp and ß-TCP scaffolds by starch consolidation with foaming method and drug-chitosan bilayered scaffold based drug delivery system.

The inability to maintain high concentrations of antibiotic at the site of infection for an extended period of time along with dead space management is still the driving challenge in treatment of osteomyelitis. Porous bioactive ceramics such as hydroxyapatite (HAp) and beta-tri calcium phosphate (ß-TCP) were some of the alternatives to be used as local drug delivery system. However, high porosity and high interconnectivity of pores in the scaffolds play a pivotal role in the drug release and bone resorption. Ceftriaxone is a cephalosporin that has lost its clinical popularity. But has recently been reported to exhibit better bactericidal activity in vitro and reduced probability of resistance development, in combination with sulbactam, a ß-lactamase inhibitor. In this article, a novel approach of forming HAp and pure ß-TCP based porous scaffolds by applying together starch consolidation with foaming method was used. For the purpose, pure HAp and ß-TCP were prepared in the laboratory and after thorough characterization (including XRD, FTIR, particle size distribution, etc.) the powders were used for scaffold fabrication. The ability of these scaffolds to release drugs suitably for osteomyelitis was studied in vitro. The results of the study indicated that HAp exhibited better drug release profile than ß-TCP when drug was used alone indicating the high influence of the carrier material. However, this restriction got relaxed when a bilayered scaffold was formed using chitosan along with the drug. SEM studies along with EDAX on the drug-chitosan bilayered scaffold showed closest apposition of this combination to the calcium phosphate surface.

[The impact of the "patient - prosthesis mismatch" in patients with aortic valve replacement.]. / Impacto do "patient-prosthesis mismatch" em doentes submetidos a substituição valvular aórtica.

UNLABELLED: Patient-Prosthesis Mismatch (PPM) is still a controversial matter in our days. We have PPM when the orifice area of an implanted aortic prosthesis valve is too small for the body surface area of an individual; this is, when the orifice area indexed to the body surface area is <0.8-0.9 cm2/m2. OBJECTIVE: Assess the impact of Patient-Prosthesis Mismatch in the short term and 2 years follow up in a group of patients submitted to aortic valve replacement. MATERIAL AND METHODS: The authors present a retrospective study involving 343 patients with a mean age of 64,68+/-12,4 years that were submitted to aortic valve replacement between January 2005 and December 2008. Data were collected from patients' files and direct contact with the patients, comparing the groups with and without PPM and correlating them in terms of Euroscore, demographics, type of implanted prosthesis, surgical times, ICU and hospital stay. The data related to short term and long term mortality as well as the NYHA class evolution were also obtained. RESULTS: Using the cut-off related to effective orifice area index 0,9 cm2/m2 we found PPM in 109 patients (31.7%). When comparing the two groups, we found that PPM seems to be related to advanced age (p=0.001), biological prosthesis (p=0.01) and, as expected, with use of valves less than 21 (p<0,05). A statistical significant difference was found for: 1) short-term mortality in patients with PPM (p<0,001), however, there were no differences in 2 years mortality and NYHA class between the groups; 2) aorta's cross clamping and extra corporeal circulation time (p=0.047 and p=0.036, respectively).

Task-Based Automatic Evaluation of People with Intellectual Disabilities Performed on a Robotic Table Soccer.

This paper is concerned with the automatic evaluation of selected tasks performed by people with intellectual Disabilities. According to the International Classification of Functioning, Disability and Health (ICF) system, subjects must be divided into two groups: group with no difficulty (N) and group with difficulty (D) being this classification based on performances obtained in a conventional table (CT) soccer. Three tasks, with different levels of difficulty, were proposed for performance evaluation. Experimental results were obtained on the basis of the task execution in both a CT and a robotics table (RT) soccer. All participants were able to perform tasks with the joystick on the RT soccer and the automatic evaluation system identified differences in reaction times with and without red color flag in the participants, on RT soccer. One of the tasks was completely performed by all the participants by using the RT soccer.

Epidemiology of meningococcal disease in southern Brazil from 1995 to 2003, and molecular characterization of Neisseria meningitidis using multilocus sequence typing.

OBJECTIVE: To describe the epidemiology of meningococcal disease (MD) in southern Brazil. METHODS: Retrospective cohort study among 2215 MD cases reported from 1995 to 2003 in Rio Grande do Sul (RS) State. RESULTS: The overall incidence fell by 50%; the case-fatality rate during this period was 22%. Even so, the incidence of MD remained high after the epidemic period ended in 1999. Together, the age groups of 1-4 years and infants accounted for 54.1% of reported cases with incidences of 11.3/100 000 and 31.3/100 000, respectively; 69.8% of cases were caused by Neisseria meningitidis serogroup B, which increased significantly. There was a significant decrease in serogroup C cases in the whole period. The phenotypes B:4,7:P1.19,15, B:15:P1.7,16 and B:NT:P1.3 caused almost 50% of all serotyped cases. Fifty-six isolates obtained from RS patients during the first non-epidemic year 2000 plus 20 isolates from other southern Brazilian states (Santa Catarina and Paraná), Denmark and France were typed by multilocus sequence typing. Twenty sequence types (STs) were identified, eight of them found only in RS. ST-33 (27%) and ST-259 (18%) were the most frequent; both belong to the ST-32/ET-5 complex. ST-259 cases showed a trend towards higher risk of fatal outcome. ST-259 isolates were not detected among geographic controls or in other studies in Brazil. CONCLUSION: Our data suggest that ST-33 and ST-259 clones and the emergence of the ST-103 isolates contributed to the continued high incidence of MD in RS.

Bone ingrowth in macroporous Bonelike for orthopaedic applications.

The aim of this study was to evaluate the biological behaviour of porous scaffold structures of Bonelike which is suitable for either direct clinical use or tissue engineering applications. Porous cylindrical specimens 8x10mm were implanted in the lateral aspect of the tibia of 13 patients (mean age 54 years), during osteotomy surgery for the treatment of medial compartment osteoarthritis of the knee. Implanted cylinders were retrieved at the same time as the removal of the blade plates at 3, 6, 9 and 12 months. Scanning electron microscopy and histological evaluations were performed to observe the biological responses of human bone tissue to porous Bonelike. The penetration depth was determined for all implantation periods, and after 6 months it was already possible to see new bone in the centre of the implanted cylinders, which gives 100% of penetration depth for all implantations periods except for 3 months when bone could only be seen in the peripherical region. Regarding the percentage of the area covered by new bone calculated from two-dimensional histological sections, values of 53+/-15, 76+/-12 and 88+/-9% were achieved for 6, 9 and 12 months, respectively. Due to its structural features porous Bonelike permitted effective vascularization and bone ingrowth, and therefore was fully osteointegrated as shown in the histological surveys. A slow biomaterial degradation with implantation time is envisaged since the material has displayed surface degradation. Bonelike scaffolds show potential for complete ingrowth of osseous tissue and restoration of vascularization throughout the defected site.

Raman spectroscopy as a process analytical technology (PAT) tool for the in-line monitoring and understanding of a powder blending process.

The aim of this study is to propose a strategy to implement a PAT system in the blending step of pharmaceutical production processes. It was examined whether Raman spectroscopy can be used as PAT tool for the in-line and real-time endpoint monitoring and understanding of a powder blending process. A screening design was used to identify and understand the significant effects of two process variables (blending speed and loading of the blender) and of a formulation variable (concentration of active pharmaceutical ingredient (API): diltiazem hydrochloride) upon the required blending time (response variable). Interactions between the variables were investigated as well. A Soft Independent Modelling of Class Analogy (SIMCA) model was developed to determine the homogeneity of the blends in-line and real-time using Raman spectroscopy in combination with a fiber optical immersion probe. One blending experiment was monitored using Raman and NIR spectroscopy simultaneously. This was done to verify whether two independent monitoring tools can confirm each other's endpoint conclusions. The analysis of the experimental design results showed that the measured endpoints were excessively rounded due to the large measurement intervals relative to the first blending times. This resulted in effects and critical effects which cannot be interpreted properly. To be able to study the effects properly, the ratio between the blending times and the measurement intervals should be sufficiently high. In this study, it anyway was demonstrated that Raman spectroscopy is a suitable PAT tool for the endpoint control of a powder blending process. Raman spectroscopy not only allowed in-line and real-time monitoring of the blend homogeneity, but also helped to understand the process better in combination with experimental design. Furthermore, the correctness of the Raman endpoint conclusions was demonstrated for one process by using a second independent endpoint monitoring tool (NIR spectroscopy). Hence, the use of two independent techniques for the control of one response variable not only means a mutual confirmation of both methods, but also provides a higher certainty in the determined endpoint.

Suitability evaluation of sol-gel derived Si-substituted hydroxyapatite for dental and maxillofacial applications through in vitro osteoblasts response.

UNLABELLED: Si-hydroxyapatite (Si-HAP) has been used in orthopedic, dental, and maxillofacial surgery as a bone substitute. OBJECTIVE: The aim of this investigation was to study the effect of Si substitution into the hydroxyapatite matrices and evaluate the biocompatibility effects of Si-HAP material in vitro with human osteoblasts. METHODS: Silicon-substituted hydroxyapatite (Si-HAP) bioceramic materials were prepared by incorporating small amounts of silicon into the structure of hydroxyapatite [Ca10(PO4)6(OH)2, HAP] through a sol-gel method. A series of silicon substitutions ranging from 0, 1, 3 and 5 mol%, which are comparable to the measured silicon contents in natural bone, were performed. RESULTS: Single-phase Si-HAP was obtained upon calcining the as-prepared powders up to 800 degrees C since no secondary phases, such as tricalcium phosphate (TCP), tetracalcium phosphate (TeCP) or calcium oxide (CaO), were identified by X-ray diffraction analysis. The effects of silicon-substituted hydroxyapatite (Si-HAP) materials towards the responses of human osteoblast-like (HOB) cells were investigated and compared with pure hydroxyapatite. SIGNIFICANCE: The Si-HAP indicated a significant increase in cell growth density with culture time irrespective of the amount of Si substituted in HAP. A high Si content (5 mol%) appears to promote rapid bone mineralization, since large amount of calcium phosphate minerals started to develop across the ECM by day 31 for a sample containing 5 mol% Si. On the other hand, a high Si content may result in fast dissolution of the material, owing to a decrease of HAP crystallite size, which might not be ideal for cell attachment for prolonged time periods. An optimum level of Si appears to exist at 3 mol%, which balances these effects.

[Results of an experience with the Bentall procedure]. / Cirurgia de bentall. Experiência e resultados do serviço.

OBJECTIVES: The authors report a retrospective study of patients who underwent a Bentall procedure in the Cardio-Thoracic Surgery Department of Hospital Santa Maria, Lisbon. MATERIAL AND METHODS: Data were obtained from 42 patients who underwent the Bentall procedure between 1991 and 2008. Different parameters were compared as well as the short and long term results. RESULTS: The median age was 58,5 years being 88% of patients of male gender. 32 (76,27%) presented with ascending aorta degenerative aneurism, 6 p (14,3%) with type A aortic dissection and 4p (9,5%) with Marfan syndrome. 10p(23.8%) had associated coronary artery disease and there were 6p (14.3%) who underwent emergency surgery. Among the risk factors associated, 24 p (57,1%) had hypertension, 12 p (28,6%) dyslipidemia, 4p (9,5%) had history of smoking, 7 p (16,7%) diabetes, 6 p (14,3%) CPOD, 2 p (4,8%) renal dysfunction and 2 had a recent myocardial infarction. There were 7p (16,7%) with left ventricular dysfunction (EF<40%); 25 p were in NYHA class II-III. The hospitalar mortality was of 2,77% in non-emergent cases, and 33,3% in emergent operations. After 30 days, 92,8% of patients were alive. The 1-year survival was 90,4% and after 5 years of 85,7%. CONCLUSIONS: The Bentall procedure obtained good results in short and long term and, despite the emerging of new and more complex techniques like remodelling and reimplantation, our results support the maintenance of this procedure as the preferential treatment for aortic root and valvular disease.

[Quadricuspid symmetric aortic valve]. / Válvula aórtica quadricúspide simétrica.

The quadricuspid aortic valve is a rare aortic valve congenital malformation. The 2D transthoracic ultrasound (TTU) is not always effective in diagnosing quadricuspid aortic valves. The aim of this article is to present a case treated in our department, initially diagnosed as a mainly stenotic aortic valvular disease, while reviewing the clinical cases described so far. The authors report the case of a 74 year-old female patient with a mainly stenotic aortic valvular disease diagnosed by TTU. The only known risk factor was arterial hypertension. She underwent elective surgery in June 2005. The surgery consisted in replacing the quadricuspid aortic valve by a Carpentier Perimount no 21 Ao prosthesis. There were no post-operative complications. The patient revealed no symptoms in the post-operative 6 months and 1 year follow-up visits. The quadricupid aortic valve is a rare congenital malformation, with a considerable risk of serious complications. Patients with this diagnosis should be exhaustively studied. Medical literature describes some cases of quadricuspid aortic valve operated in other clinical centres. We present here the only case operated in our department in a 20-years period.

The effectiveness of breathing patterns to control maternal anxiety during the first period of labor: A randomized controlled clinical trial.

OBJECTIVE: Assess the efficacy of the breathing patterns during the active phase of the first stage of labor for maternal anxiety. DESING: Randomised trial with two treatment arms and intention-to-treat analysis. PARTICIPANTS: One Hundred and forty patient in active labour, age between 12 and 40 years old and gestational age between 37 and 41 weeks. The breathing patterns waere made depending on the dilation phase and intensity of contraction, while the control group received routine care service. RESULTS: There was no difference between groups two hours after the first evaluation regarding to anxiety (MD 0.3 CI95% -4.2 to 4.8), pain (MD 0.0 CI95% -0.8 to 0.7), fatigue (MD -0.5 CI95% -1.4 to 2.5) and maternal satisfaction (MD 0.9 CI95% -0.1 to 2.0). CONCLUSIONS: The study results showed that the use of breathing patterns during the first period of labour were not effective to control anxiety, pain, fatigue and maternal satisfaction.

Seroprevalence of bactericidal antibodies against serogroup B and C Meningococci in a University Hospital.

Meningococcus serogroup B (MenB), clonal complex 32 (cc 32), was the Brazilian epidemic strain of meningococcal disease (MD) in the 1990's. Currently, meningococcus serogroup C (MenC), cc 103, is responsible for most of the cases of the disease in Brazil. The aim of this study was to investigate the seroprevalence of bactericidal antibody (SBA) against representative epidemic strains of MenC, (N753/00 strain, C:23:P1.22,14-6, cc103) and MenB, (Cu385/83 strain, B:4,7:P1.15,19, cc32) in students and employees of a university hospital in the State of Rio Grande do Sul (RS, Brazil). A second MenC strain (N79/96, C:2b:P1.5-2,10, cc 8) was used as a prototype strain of Rio de Janeiro's outbreak that occurred in the 1990's. Our previous study showed a 9% rate of asymptomatic carriers in these same individuals. A second goal was to compare the SBA prevalence in meningococcal carriers and non-carriers. Fifty-nine percent of the studied population showed protective levels of SBA titers (log2≥2) against at least one of the three strains. About 40% of the individuals had protective levels of SBA against N753/00 and Cu385/83 strains. Nonetheless, only 22% of the individuals showed protective levels against N79/96 strain. Significantly higher antibody levels were seen in carriers compared to non-carriers (P≤0.009). This study showed that, similar to other States in Brazil, a MenC (23:P1.22,14-6, cc103) strain with epidemic potential is circulating in this hospital. Close control by the Epidemiological Surveillance Agency of RS of the number of cases of MD caused by MenC strains in the State is recommended to prevent a new disease outbreak.

Association between serum albumin levels and in-hospital deaths due to tuberculosis.

SETTING: A tuberculosis (TB) referral hospital in the state of Bahia, north-eastern Brazil. OBJECTIVE: To evaluate the association between serum albumin at admission and in-hospital deaths due to TB. DESIGN: A prospective cohort study of 373 patients hospitalised with TB. Samples were systematically collected from all patients at hospital admission for measurement of serum albumin levels. In-hospital death was the study endpoint. Univariate analysis was used to evaluate the association between serum albumin at admission and mortality from TB, and multivariate logistic regression was used to adjust for potential confounding variables. RESULTS: The average age of the 373 patients was 41.1 years (+/-15.2); 77.2% (288/373) were male; 45 eventually died in hospital (in-hospital death rate 12.1%, 95%CI 9.0-15.7). Multivariate analysis showed that the presence of low serum albumin levels (< or =2.7 g/dl) was strongly and independently associated with in-hospital death due to TB (adjusted OR 3.38, 95%CI 1.51-7.59; P = 0.001), even after adjusting for potentially confounding variables identified in the univariate analysis (age, comorbidities, TB-human immunodeficiency virus [HIV] coinfection and history of previous default from treatment). CONCLUSION: Our results highlight the importance of measuring serum albumin levels at admission to hospital as an indicator of the prognosis for patients hospitalised with TB.