High prevalence of Cryptococcal antigenemia using a finger-prick lateral flow assay in individuals with advanced HIV disease in Santarém Municipality, Brazilian Amazon Basin.

There is scarce information about HIV-related cryptococcosis in the Brazilian Amazon basin where laboratory infrastructure is limited. The serum cryptococcal antigen (CrAg) lateral flow assay (LFA) has simplified diagnosis of cryptococcosis and is recommended for screening in advanced HIV disease. We evaluated the prevalence of cryptococcal antigenemia using finger-prick CrAg LFA in the Brazilian Amazon basin. We enrolled a prospective cohort of outpatients and hospitalized individuals with advanced HIV disease at two centers in Santarém Municipality, Northern Brazil. All individuals were > 18 years old with advanced HIV disease, regardless of antiretroviral therapy (ART) status and with no prior or current history of confirmed cryptococcal meningitis. We tested CrAg LFA on finger-prick whole blood using an exact volume transfer pipette. From August 2018 to October 2019, 104 individuals were enrolled (outpatients 62 [60%] and hospitalized 42 [40%]). Median age was 38 years (interquartile range [IQR] 30-46), and 84 (81%) were male. Sixty-five (63%) individuals were ART-naïve. Prevalence of finger-prick CrAg LFA-positive was 10.6%; 95% CI, 5.4 to 18.1%. Prevalence of finger-prick CrAg LFA-positive among individuals without neurological symptoms was 6.0%; 95% CI, 1.7-14.6%. The number needed to test to detect one CrAg-positive individual was 9.4 persons (95% CI, 5.5-18.5). Prevalence of cryptococcal antigenemia using finger-prick whole blood CrAg LFA was high. Point-of-care approach was important for the diagnosis and screening of cryptococcosis in resource-limited settings. Screening and preemptive therapy strategy should be urgently implemented in individuals with advanced HIV disease in the Brazilian Amazon basin.

This prospective cohort study was carried-out in the Brazilian Amazon basin. We used a cryptococcal rapid test in patients with AIDS. We included 104 participants, and 11 (10.6%) of them had positive results showing a high prevalence of cryptococcal antigenemia.

Representations on adherence to the treatment of Multidrug-Resistant Tuberculosis.

OBJECTIVE: To identify representations regarding adherence to the treatment of multidrug-resistant tuberculosis from the perspective of patients who were discharged upon being cured. METHOD: A qualitative study with patients who completed the drug treatment for multidrug-resistant tuberculosis in São Paulo. Social Determination was used to interpret the health-disease process, and the testimonies were analyzed according to dialectical hermeneutics and the discourse analysis technique. RESULTS: Twenty-one patients were interviewed. The majority (80.9%) were men, in the productive age group (90.4%) and on sick leave or unemployed (57.2%) during the treatment. Based on the testimonies, three categories associated with adherence to treatment emerged: the desire to live, support for the development of treatment and care provided by the health services. CONCLUSION: For the study sample, adherence to the treatment of multidrug-resistant tuberculosis was related to having a life project and support from the family and health professionals. Free treatment is fundamental for adherence, given the fragilities arising from the social insertion of people affected by the disease. Therefore, special attention is required from the health services to understand patient needs.

Hemoperitoneum after a Bothrops snakebite: Case report.

Snakebites are frequent in tropical countries. Brazil has an average of 27,000 cases per year, with a fatality rate of 0.5%, and the Bothrops genus is the most common causative agent, accounting for about 70-90% of the accidents. This report describes a case of human envenomation by a juvenile Bothrops jararaca snake in São Paulo, Brazil, in a 71 years-old man, previously healthy. He presented a life-threatening envenomation, which developed to severe hypotension, acute kidney injury and extensive peritoneal hemorrhage. The hemoperitoneum was diagnosed due to persistent hypotension associated with anemia, pain and gastrointestinal complaints. Abdominal Computed Tomography scans showed a moderate to large amount of presumable hematic material inside the abdominal cavity, predominantly in the perihepatic and perisplenic spaces. The intra-abdominal hemorrhage was not surgically addressed, and the patient was discharged 5 days after hospitalization, with the progressive absorption of the hemoperitoneum. Systemic bleeding is one of the complications and main causes of death in Bothrops envenomations. Acute peritoneal hemorrhage is one of these serious complications that must be carefully addressed since its management must take into account the risk of bleeding caused by toxins that affect hemostasis. The case described highlights the importance of early diagnosis and adequate management of this potentially fatal complication in snakebites.

Detection of Trypanosoma cruzi DTUs TcI and TcIV in two outbreaks of orally-transmitted Chagas disease in the Northern region of Brazil.

This study describes the laboratory investigation of two acute Chagas disease outbreaks that occurred in the riverside communities of Marimarituba and Cachoeira do Arua, in the Santarem municipality, Para State, located in the Northern region of Brazil, and occurred in March 2016 and August 2017, respectively. The generation of data regarding the diversity of Trypanosoma cruzi parasites circulating in the Amazon region is key for understanding the emergence and expansion of Chagas disease. This study aimed to identify T. cruzi Discrete Typing Units (DTUs) involved in two outbreaks of acute Chagas disease (ACD) directly from the patient's biological sample. Nested and multiplex PCR targeting the 24Sα (rRNA) and mini-exon genes, respectively, were used to identify T. cruzi DTU in blood samples from patients diagnosed with ACD. The samples with positive cPCR were submitted for analysis for T. cruzi DTUs, which included 13 samples from the patients with ACD by oral transmission and two samples collected from two newborns of two women with ACD, from Marimarituba and Cachoeira do Arua. The samples were classified as T. cruzi TcIV, from Marimarituba's outbreak, and T. cruzi TcI, from Cachoeira do Arua's outbreak. The molecular identification of T. cruzi may increase understanding of the role of this parasite in Chagas disease's emergence within the Amazon region, contributing to the improvement of the management of this important, but also neglected, disease.

Vulnerabilities of Arab refugees in primary health care: a scoping review.

OBJECTIVE: To map and analyze the vulnerabilities of Arab refugees in the context of primary health care. METHOD: Scoping review in which studies published in English, Spanish and Portuguese languages from 2011 onwards were reviewed. The following databases were surveyed: Cochrane, Scopus, Health System Evidence, MedLine-PubMed, CINAHL, Embase, Lilacs, Web of Science, SciELO, NYAM Grey Literature, BVS, Capes Thesis and Dissertation Database, Refworld and Journal of Refugee Studies. Data were analyzed in light of the concept of vulnerability. RESULTS: Of the 854 studies identified, 40 articles were held for analysis and extraction of vulnerability indicators in the individual, social and programmatic dimensions. Regarding the individual dimension, the main indicators identified were unemployment, unstable and overcrowded housing, lack of sanitation and access to water, mental disorders, communicable and chronic noncommunicable diseases, etc. In the programmatic dimension, were identified, mainly, health teams with work overload, lack of preparation to deal with cultural and linguistic barriers, and delays in providing care. In relation to the social dimension, lack of access to schools, to information about health programs in the host countries, and to rights, among others, were found. CONCLUSION: Vulnerabilities found highlight the disadvantage of refugees regarding health programs, services and system in host countries, in addition to highlighting the deep inequalities that affect this group. It is pointed out the need for programs and policies that promote actions, within the scope of primary health care, which recognize and respond to the health needs of refugees.

Tuberculosis from the perspective of men and women.

OBJECTIVE: To analyze aspects related to the experience of tuberculosis from the perspective of men and women with tuberculosis. METHOD: Qualiquantitative cross-sectional study. Patients with tuberculosis in the city of Campina Grande-PB were interviewed through a semi-structured questionnaire between September/2017 and January/2018. Discourse Analysis and Chi-Square test were performed. RESULTS: Sixty-three subjects were interviewed, of which 34 (54.0%) were men. There was an association of the category gender with level of education (p = 0.004), work activity (p = 0.023), time spent on activities outside the home (p = 0.013), and time spent on activities at home (p = 0.001). The analysis of the statements specially revealed that men perceive their role as the family's main provider and the women with a social role of caregiver, often postponing the search for a health care due to fear of not being able to perform this role in the family and/or in society. CONCLUSION: The weakness caused by the disease and the long duration of treatment changed the interviewees' routine, causing suffering and frustration, with consequences in the performance of social roles within the family and in society, constituting a barrier to adherence to tuberculosis treatment.

Suspected vertical transmission of Chagas disease caused by DTU TcIV in an infection probably transmitted orally, during anoutbreak in the Brazilian Amazon.

This study describes difficulties in the monitoring of a child born during an oral outbreak of Chagas disease, in which there are several indications that the transmission occurred through the congenital route: 1. the mother was in the third trimester of pregnancy when she was infected; 2. She presented high parasitemia at the time of delivery; 3. In both, the mother and her daughter, T. cruzi was classified as DTU TcIV. The parasites were not found in the blood at birth and the infection was detected only three months later in an asymptomatic infant. As the mother and her child live in a highly endemic area, vector transmission could not be excluded during this period.

Vulnerabilities and clinical manifestations in scorpion envenomations in Santarém, Pará, Brazil: a qualitative study.

OBJECTIVE: To describe elements of vulnerabilities and clinical manifestations of the victims of scorpionism in Santarem-Pará. METHOD: Quantitative and qualitative study with a theoretical framework of Twenty-eight patients stung by scorpions were interviewed by applying a semi-structured instrument. Data were analyzed according to the technique of discourse analysis. RESULTS: Seventeen patients (60.7%) were male and eight (28.6%) were illiterate. Twenty-two (78.5%) patients were small farmers. This study revealed that these patients had an important individual, social and programmatic vulnerability. Interviews revealed limited knowledge about prevention and first aid after the envenomation. Programmatic vulnerability is highlighted because there is difficulty in accessing health services due to the great geographical extension of the Amazon region and also a lack of experience of the health care workers in caring for scorpion sting victims. CONCLUSION: This research accurately reveals previously described neuromuscular and sensory nervous system disorders in these victims of scorpionism. As far as we know, this is the first study that addresses the vulnerability of scorpionism using qualitative methodology.

Unusual case of lagochilascariasis with breast involvement: the first case report in pregnancy.

Lagochilascariasis is a neglected neotropical helminthiasis, responsible for human infections through the ingestion of raw or undercooked meat from wild animals infected by larvae encysted in their tissues. It is characterized by a chronic evolution with periods of remission and recurrences, affecting mainly the head and neck regions. It can progress to death by invasion of the central nervous system. It is caused by the Lagochilascaris minor nematode, first described in 1909 and mainly found in the Brazilian Amazon ecosystem, notably in Para State. In May 2010, a 15-year-old female, born in the city of Aveiro, Para State, was hospitalized in the city of Santarem, Para State, presenting with cervical and spinal abscesses and osteolytic lesions at T3-T5 level. During hospitalization, white larvae identified as L. minor were observed in a cervical subcutaneous fistula. After the surgical drainage of abscesses, albendazole 400 mg/day was started, with improvement of symptoms. The patient abandoned the follow-up and in January 2016, during the 20th week of pregnancy, she was readmitted to the Santarem Municipal Hospital with new cervical abscesses in the infra-mammary region, with numerous larvae exiting by subcutaneous left breast fistulas. The antiparasitic treatment was restarted due to possible reactivation of the infection in the spine and dissemination to the central nervous system. Ten weeks after hospital discharge, the patient had resolution of the fistulas and decreased abscesses, without gestational complications. This is the first case report of lagochilascariasis during pregnancy, as well as of involvement of mammary glands.

Social incentives for adherence to tuberculosis treatment.

OBJECTIVE: To analyze the influence of social incentives for adherence to tuberculosis (TB) treatment. METHOD: Qualitative study, in which 26 primary health care professionals of São Paulo were interviewed in 2015.Their testimonies were submitted to the speech analysis technique. The theoretical reference was the social determination of the health-disease process. Ethical procedures were observed. RESULTS: TB is related to precarious living conditions. Incentives such as the basic food basket and transportation stipends are relevant for patients' adherence to treatment, as well as to the create bonds between the patient and the health team. FINAL CONSIDERATIONS: The incentives strengthened adherence to TB treatment. However, interventions in the context of public measures must transcend the remedial dimension and be guided towards the transformation of the TB situation, which means supporting processes that modify living conditions.

A case of envenomation caused by Oxybelis fulgidus (Serpentes, Colubridae) in Brazilian Amazon.

A case of a bite inflicted by Oxybelis fulgidus in the wilds of Amazon is reported. The patient was a 67-year-old man who presented with dizziness, tachycardia and local pain, with erythema and bleeding in his left arm. The venom of Oxybelis fulgidus, a neotropical rear-fanged snake, contains one of the four three-finger toxins already isolated from colubrid snakes, called fulgimotoxin. He was treated with oral analgesics and returned to the ambulatory in 48 hours, with good evolution. We report tirst authenticated case of adult Oxybelis fulgidus with signs of mild local envenoming without evidence of systemic envenoming.

Detection of Trypanosoma cruzi DTUs TcI and TcIV in two outbreaks of orally-transmitted Chagas disease in the Northern region of Brazil

ABSTRACT This study describes the laboratory investigation of two acute Chagas disease outbreaks that occurred in the riverside communities of Marimarituba and Cachoeira do Arua, in the Santarem municipality, Para State, located in the Northern region of Brazil, and occurred in March 2016 and August 2017, respectively. The generation of data regarding the diversity of Trypanosoma cruzi parasites circulating in the Amazon region is key for understanding the emergence and expansion of Chagas disease. This study aimed to identify T. cruzi Discrete Typing Units (DTUs) involved in two outbreaks of acute Chagas disease (ACD) directly from the patient's biological sample. Nested and multiplex PCR targeting the 24Sα (rRNA) and mini-exon genes, respectively, were used to identify T. cruzi DTU in blood samples from patients diagnosed with ACD. The samples with positive cPCR were submitted for analysis for T. cruzi DTUs, which included 13 samples from the patients with ACD by oral transmission and two samples collected from two newborns of two women with ACD, from Marimarituba and Cachoeira do Arua. The samples were classified as T. cruzi TcIV, from Marimarituba's outbreak, and T. cruzi TcI, from Cachoeira do Arua's outbreak. The molecular identification of T. cruzi may increase understanding of the role of this parasite in Chagas disease's emergence within the Amazon region, contributing to the improvement of the management of this important, but also neglected, disease.

Simultaneous occurrence of pulmonary tuberculosis and carcinomatous lymphangitis.

Tuberculosis is an important cause of mortality due to its high prevalence, considering that one third of the worlds population is infected with the tuberculosis bacillus. We report the first case of carcinomatous lymphangitis associated with active pulmonary tuberculosis. Carcinomatous lymphangitis is a rare event that may be confounded with tuberculosis because of its radiographic and clinical characteristics.

Vulnerabilities of Arab refugees in primary health care: a scoping review / Vulnerabilidades de refugiados árabes na atenção primária à saúde: uma revisão de escopo

ABSTRACT OBJECTIVE To map and analyze the vulnerabilities of Arab refugees in the context of primary health care. METHOD Scoping review in which studies published in English, Spanish and Portuguese languages from 2011 onwards were reviewed. The following databases were surveyed: Cochrane, Scopus, Health System Evidence, MedLine-PubMed, CINAHL, Embase, Lilacs, Web of Science, SciELO, NYAM Grey Literature, BVS, Capes Thesis and Dissertation Database, Refworld and Journal of Refugee Studies. Data were analyzed in light of the concept of vulnerability. RESULTS Of the 854 studies identified, 40 articles were held for analysis and extraction of vulnerability indicators in the individual, social and programmatic dimensions. Regarding the individual dimension, the main indicators identified were unemployment, unstable and overcrowded housing, lack of sanitation and access to water, mental disorders, communicable and chronic noncommunicable diseases, etc. In the programmatic dimension, were identified, mainly, health teams with work overload, lack of preparation to deal with cultural and linguistic barriers, and delays in providing care. In relation to the social dimension, lack of access to schools, to information about health programs in the host countries, and to rights, among others, were found. CONCLUSION Vulnerabilities found highlight the disadvantage of refugees regarding health programs, services and system in host countries, in addition to highlighting the deep inequalities that affect this group. It is pointed out the need for programs and policies that promote actions, within the scope of primary health care, which recognize and respond to the health needs of refugees.

RESUMO OBJETIVO Mapear e analisar as vulnerabilidades de refugiados árabes no contexto da atenção primária à saúde. MÉTODO Revisão de escopo em que foram analisados estudos publicados nos idiomas inglês, espanhol e português, a partir de 2011. As bases foram Cochrane, Scopus, Health System Evidence , MedLine-PubMed, CINAHL, Embase, Lilacs, Web of Science , SciELO, NYAM Grey Literature , BVS, Banco de teses e dissertações Capes, Refworld e Journal of Refugee Studies. A análise dos dados foi realizada à luz do conceito de vulnerabilidade. RESULTADOS Dos 854 estudos identificados, restaram 40 artigos para análise e extração dos indicadores de vulnerabilidade nas dimensões individual, social e programática. Em relação à dimensão individual, os principais indicadores identificados foram desemprego, moradias instáveis e superlotadas, falta de saneamento e de acesso à água, agravos mentais, doenças transmissíveis e crônicas não transmissíveis etc. Na dimensão programática foram identificadas, principalmente, equipes de saúde com sobrecarga de trabalho, falta de preparo para lidar com as barreiras culturais e linguísticas, demora para o atendimento. Em relação à dimensão social, constatou-se falta de acesso às escolas, à informação sobre os programas de saúde dos países de acolhida, aos direitos, entre outros. CONCLUSÃO As vulnerabilidades constatadas evidenciam desvantagem dos refugiados perante os programas, serviços e sistema de saúde nos países de acolhida, além de colocar em evidência as profundas desigualdades que incidem nesse grupo. Aponta-se a necessidade de programas e políticas que promovam ações, no âmbito da atenção primária à saúde, que reconheçam e respondam às necessidades de saúde de refugiados.

Tuberculosis from the perspective of men and women / Tuberculosis desde la perspectiva del hombre y de la mujer / A tuberculose na perspectiva do homem e da mulher

ABSTRACT Objective: To analyze aspects related to the experience of tuberculosis from the perspective of men and women with tuberculosis. Method: Qualiquantitative cross-sectional study. Patients with tuberculosis in the city of Campina Grande-PB were interviewed through a semi-structured questionnaire between September/2017 and January/2018. Discourse Analysis and Chi-Square test were performed. Results: Sixty-three subjects were interviewed, of which 34 (54.0%) were men. There was an association of the category gender with level of education (p = 0.004), work activity (p = 0.023), time spent on activities outside the home (p = 0.013), and time spent on activities at home (p = 0.001). The analysis of the statements specially revealed that men perceive their role as the family's main provider and the women with a social role of caregiver, often postponing the search for a health care due to fear of not being able to perform this role in the family and/or in society. Conclusion: The weakness caused by the disease and the long duration of treatment changed the interviewees' routine, causing suffering and frustration, with consequences in the performance of social roles within the family and in society, constituting a barrier to adherence to tuberculosis treatment.

RESUMEN Objectivo: Analizar aspectos relacionados con la experiencia de la tuberculosis desde la perspectiva de hombres y mujeres con tuberculosis. Método: Estudio transversal cualicuantitativo. Fueron entrevistados pacientes con tuberculosis del municipio de Campina Grande-PB, por medio de cuestionario semiestructurado, entre septiembre/2017 y enero/2018. Se realizaron Análisis del Discurso y Chi-Cuadrado. Resultados: Sesenta y três sujetos fueron entrevistados, de los cuales 34 (el 54,0%) eran del sexo masculino. Hubo asociación de la categoria género con escolaridad (p = 0,004), actividad laboral (p = 0,023), tiempo dedicado a actividades fuera del domicilio (p = 0.013) y tiempo dedicado a las actividades em el domicilio (p = 0,001). El análisis de las declaraciones reveló, principalmente, que el hombre percibe su rol como principal proveedor de la familia y, la mujer, em el rol social de cuidadora, postergando muchas veces la búsqueda de un servicio de salud por temor a no poder realizar ese rol en la familia y/o en la sociedad. Conclusión: La debilidad provocada por la enfermedad y la larga duración del tratamiento modificaron la rutina de los entrevistados, provocando sufrimiento y frustración, con consecuencias en el desempeño de los roles sociales en la familia y en la sociedad, constituyendo una barrera para la adherencia al tratamiento de la tuberculosis.

RESUMO Objetivo: Analisar aspectos relacionados à vivência da tuberculose na perspectiva de homens e mulheres portadores de tuberculose. Método: Estudo transversal qualiquantitativo. Entrevistou-se, por meio de questionário semiestruturado, pacientes com tuberculose no município de Campina Grande-PB, entre setembro/2017 e janeiro/2018. Realizou-se Análise de Discurso e teste Qui-Quadrado. Resultados: Entrevistaram-se 63 sujeitos, sendo 34 (54,0%) do sexo masculino. Evidenciou-se associação da categoria gênero com escolaridade (p = 0,004), atividade de trabalho (p = 0,023), tempo despendido em atividades fora do domicílio (p = 0,013) e tempo despendido em atividades no domicílio (p = 0,001). A análise dos depoimentos revelou, principalmente, que o homem percebe seu papel como provedor principal da família e, a mulher, no papel social de cuidadora, adiando muitas vezes a busca por um serviço de saúde com receio de não conseguir exercer esse papel na família e/ou na sociedade. Conclusão A debilidade causada pela doença e a longa duração do tratamento mudaram a rotina dos entrevistados, causando sofrimento e frustração, com decorrências no desempenho dos papéis sociais no interior da família e na sociedade, constituindo-se em barreira na adesão ao tratamento da tuberculose.

Injuries caused by freshwater stingrays in the Tapajós River Basin: a clinical and sociodemographic study.

INTRODUCTION: Freshwater stingray envenomations are an important cause of morbidity in riverine populations living in various regions of Brazil. The sequelae include temporary or permanent disability. This study aimed to identify sociodemographic, clinical, and therapeutic aspects related to stingray injuries in such populations. METHODS: This cross-sectional study was conducted in the Extractive Reserve of Tapajos-Arapiuns, located in the municipalities of Santarém and Aveiro (Pará State). A convenience sample comprising 300 local adults was used to obtain data by means of a questionnaire/ interview. RESULTS: Overall, 19 (6.3%) participants reported having sustained a stingray injury in the 12 months prior to the study. All 19 were injured either while fishing (n=13 [68.4%]) or engaging in other riverine activities. Most injuries [n=14 (73.7%)] occurred from September through November, and most injured respondents [n=15 (78.9%)] reported seeing stingrays at beaches. Severe pain and the appearance of ulcers in the later stages of envenomation were described by 18 (94.7%) and 12 (63.2%) participants, respectively. CONCLUSIONS: Freshwater stingray injuries, which should be considered occupational injuries, are common in the study area, especially in places like beaches or in the lakes that form during the dry season, when stingrays are routinely observed. A significant proportion of respondents was unaware of the correct first aid measures and had insufficient resources to treat the complications of these injuries in the locality where they reside. Interactive activities involving local residents - such as lectures and the distribution of simple pamphlets providing information about stingray injuries - are needed.

Spatial distribution of scorpions according to the socioeconomic conditions in Campina Grande,State of Paraíba, Brazil.

INTRODUCTION: Due to its frequency and morbidity, such as that caused by scorpions have achieved public health importance in certain regions of the world. The present exploratory ecological study aimed to characterize the epidemiological profile and spatial distribution of scorpion stings in Campina Grande, State of Paraíba in Northeastern Brazil. METHODS: Geographical information system techniques were used to record the scorpion stings, and Google Earth software, Track Maker, and ArcGIS 10 Esri were used as geocoding databases. The Moran test was used to evaluate spatial correlation, and the Pearson chi-square test was used to analyze associations between scorpion stings and socioeconomic variables. RESULTS: The study evaluated 1,466 scorpion stings. Envenomations were more frequent among women (n = 908, 61.9%), and most patients were aged 13-28 years (n = 428, 29.2%). The Southern region of the city had the largest number of registered cases (n = 548, 37.4%), followed by the Western region (n = 510, 34.8%). CONCLUSIONS: Spatial analysis of scorpionism revealed an irregular occurrence in Campina Grande. Further, no association was observed between the socioeconomic factors analyzed and the geographic location of the scorpion envenomations. Detection of spatial areas with an increased risk of scorpionism can help prioritize adoption of preventive measures in these regions to reduce the associated incidence and morbidity.

Vulnerabilities in snakebites in Sao Paulo, Brazil.

OBJECTIVE: To describe elements of vulnerability of victims of snakebite. METHODS: This qualitative, descriptive, cross-sectional study had, as theoretical framework, the concept of vulnerability in individual, social, and programmatic dimensions. We interviewed 21 patients admitted into a hospital specialized in the care of accidents caused by venomous animals. The interviews were analyzed according to a discourse analysis technique. RESULTS: Patients were mainly young men, living in remote countryside areas, where health services frequently have limited resources. We found social and individual conditions of vulnerability, such as precarious schooling, low professional qualification, housing without access to piped water, no sewage treated, and no regular garbage collection, and lack of knowledge on this health problem. Regarding the programmatic dimension, we found limited accessibility to the health services that could affect the prognosis and the frequency of sequelae and deaths. CONCLUSIONS: Considering such vulnerabilities evoke the need to improve the program for control the Accidents by Venomous Animals and the training of health workers, we highlight the potential use of the concept of vulnerability, which may amplify the understanding and the recommendations for the practice and education related to snakebites.

The incidence of tuberculosis and its relation to social inequalities: Integrative Review Study on PubMed Base / La incidencia de la tuberculosis y su relación con las desigualdades sociales: Estudio de revisión integradora en la Base PubMed / A ocorrência da tuberculose e sua relação com as desigualdades sociais: Estudo de revisão Integrativa na Base PubMed

Abstract Objective: to identify how the literature presents the relation between tuberculosis and social inequalities. Method: integrative review in which the combination of the descriptors "tuberculosis" and "social iniquity" guided the search for articles available in PubMed. A total of 274 articles were identified, and after reading the title and abstract, 13 studies were selected. The empirical material was analyzed according to the hermeneutics, highlighting the variables related to social inequalities, seeking to understand the main themes that embody the association between tuberculosis and social inequalities. Results: In general, the literature presents the social inequalities as factors that can interfere in the cure and/or control of the disease, such as age, income, unemployment, unskilled labor, access to health services, among others. Therefore, it does not include a deeper relationship between the organization of society and the production of the disease. Conclusion and implications for practice: A comprehensive understanding of tuberculosis disease is required, in order to expand interventions to support the control and elimination of the disease and, above all, the reduction of social inequalities. The understanding of tuberculosis as a disease enables expanding strategies to face it.

Resumen Objetivo: identificar cómo la literatura presenta la relación de la tuberculosis y desigualdades sociales. Método: revisión integrativa en que la combinación de los descriptores "tuberculosis" y "social iniquity" orientaron la investigación de artículos disponibles en el PubMed. Se identificaron 274 artículos, y después de la lectura del título y resumen, se seleccionaron 13 estudios. El material empírico fue analizado según la hermenéutica, con destaque a las variables relacionadas a las desigualdades sociales, buscando aprehender los principales temas que corporifican la asociación entre tuberculosis y desigualdades sociales. Resultados: En general, la literatura presenta las desigualdades sociales como factores que pueden interferir en la cura y/o control de la enfermedad, especialmente: edad, ingresos, desempleo, trabajo no calificado, acceso a servicios de salud, entre otros. No incluye, por lo tanto, una relación más profunda entre la organización de la sociedad y la producción de la enfermedad. Conclusión e implicación para la práctica: Se requiere comprensión totalizante de la enfermedad por tuberculosis, con la finalidad de ampliar intervenciones para que apoyen el control y la eliminación de la enfermedad y, sobre todo, la reducción de las desigualdades sociales. La comprensión de la tuberculosis como una enfermedad relacionada con la determinación social posibilita ampliar las estrategias para su enfrentamiento.

Resumo Objetivo: Identificar como a literatura apresenta a relação entre a tuberculose e as desigualdades sociais. Método: Revisão integrativa em que a combinação dos descritores "tuberculosis" e "social inequity" orientaram a pesquisa de artigos disponíveis no PubMed. Foram identificados 274 artigos e, após a leitura do título e resumo, foram selecionados 13 estudos. O material empírico foi analisado segundo a hermenêutica, com destaque às variáveis relacionadas às desigualdades sociais, buscando-se apreender os principais temas que corporificam a associação entre a tuberculose e as desigualdades sociais. Resultados: De modo geral, a literatura apresenta as desigualdades sociais como fatores, que podem interferir na cura e/ou no controle da doença, com destaque para: idade, renda, desemprego, trabalho não qualificado, acesso aos serviços de saúde, entre outros. Não inclui, portanto, uma relação mais profunda entre a organização da sociedade e a produção da doença. Conclusão e Implicações para a prática: Requer-se compreensão totalizante do adoecimento por tuberculose, com a finalidade de ampliar intervenções que apoiem o controle e a eliminação da enfermidade e, sobretudo, a redução das desigualdades sociais. A compreensão da tuberculose como uma doença relacionada à determinação social possibilita ampliar as estratégias para o seu enfrentamento.