Tuberculosis diagnostic pathway in a municipality in south-eastern Brazil.

OBJECTIVE: To analyse the pathway taken by tuberculosis (TB) patients from the first contact with the health services and the diagnosis of TB disease. METHOD: In a survey conducted in a south-eastern municipality of Brazil prioritised for TB control, a structured questionnaire was applied to 100 TB patients under treatment; secondary data recorded in two information systems were also collected for analysis. Diagrams were constructed to represent the patient pathway through the health services up to diagnosis. RESULTS: The emergency services were the point of entry into care for the majority of the patients. Those who first attended primary health care (PHC) centres needed to visit other health services for diagnosis. CONCLUSION: Our study shows that multiple visits to multiple health services are required for the majority of patients to be diagnosed with TB. It is necessary to reinforce the referral path established for TB diagnosis and communication among providers, who should play a clear role in obtaining early diagnosis.

Caffeic acid phenethyl ester effects in the kidney during ischemia and reperfusion in rats anesthetized with isoflurane.

BACKGROUND: The purpose of this investigation was to examine the effect of caffeic acid phenethyl ester (CAPE) in renal ischemia/reperfusion injury in rats anesthetized with isoflurane (iso). METHODS: We randomly assigned 26 male Wistar rats anesthetized with isoflurane, intubated and mechanically ventilated to 3 groups: G1 (controls; n = 8), G2 (CAPE; n = 10), and G3 (ethanol; n = 8). Mean arterial pressure was monitored for anesthetic control. Intraperitoneal CAPE (G2) or ethanol (G3) injections were administered 40 minutes before left renal ischemia. All animals underwent right nephrectomy and the left kidney was submitted to ischemia for 25 minutes. Serum creatinine (cr) values were determined at the beginning (M1), end (M2), and 24 hours after the experiment (M3) upon intracardiac blood samples. The left kidney was removed for histologic analysis, using a scale for tubular necrosis (0-5, injury maximum). Statistical analysis was applied to serum creatinine and histological score injury considering statistical differences to be significant when P < .05. RESULTS: The cr values in the CAPE were significantly higher at M2 (0.8 mg/mL; P = .0012) and M3 (3.7 mg/mL; P = .0014) than the control (0.5 and 0.9 mg/mL) or G3 (0.6 and 1.0 mg/mL), respectively. Histologic examination showed the CAPE group to display more pericapsular tubular necrosis (3.0 [2.0; 3.0]) than the G1 group (2.0 [1.0; 2.0]) or G3 group (1.5 [1.0; 2.0]; P < .001). The CAPE group displayed more medullary tubular necrosis (2.0 [2.0; 3.0] than G1 (2.0 [1.0; 2.0] or G3 (1.0 [0.0; 2.0]; P < .001). CONCLUSION: CAPE promoted greater functional and anatomic renal injury when rats were anesthetized with iso than control or ethanol groups, as demonstrated by histologic analysis and serum values.

Access to tuberculosis diagnosis in Itaboraí City, Rio de Janeiro, Brazil: the patient's point of view.

SETTING: Itaboraí Municipality in Rio de Janeiro, Brazil. OBJECTIVE: To evaluate access to tuberculosis (TB) diagnosis for users of the Family Health Program (FHP) and Reference Ambulatory Units (RAUs). DESIGN: A cross-sectional study was conducted in Itaboraí City, Rio de Janeiro, Brazil. Between July and October 2007, a sample of 100 TB patients registered consecutively with the TB Control Program was interviewed using the primary care assessment tool. The two highest scores, describing 'almost always' and 'always', or 'good' and 'very good', were used as a cut-off point to define high quality access to diagnosis. RESULTS: FHP patients were older and had less education than RAU interviewees. Sex and overcrowding did not differ in the two groups. Patient groups did not differ with regard to the number of times care was sought at a unit, transport problems, cost of attending units and availability of consultation within 24 h. Adequate access to diagnosis was identified by 62% of the FHP patients and 53% of the RAU patients (P = 0.01). CONCLUSION: In Itaboraí, Rio de Janeiro, TB patients believe that the FHP units provide greater access to TB diagnosis than RAUs. These findings will be used by the Department of Health to improve access to diagnosis in Itaboraí.