Morbimortality and determinants of reperfusion in ischemic stroke

SUMMARY BACKGROUND: Cerebrovascular accident (or stroke) and ischemic heart disease are the the major causes of death in the world. It is estimated that about 85% of strokes are ischemic in origin. Reperfusion therapy in the acute phase of ischemic stroke with a recombinant human tissue plasminogen activator is effective, but some factors influence the success of this treatment. OBJECTIVE: The aim of this study was to evaluate clinical aspects and possible determinants for reperfusion after venous thrombolysis. METHODS: This is a retrospective, cross-sectional, observational study based on a review of hospital records of inpatients diagnosed with ischemic stroke treated with intravenous thrombolysis, the main outcome being reperfusion or not. RESULTS: Data from this study revealed a predominance of females in the group of reperfused patients and males in the non-reperfused group, both maintaining moderate severity on the National Institutes of Health Stroke Scale and admission without statistical significance (p>0.18). In addition, the mean admission severity score was 13.2 for the group of reperfused patients and 14.2 for those not reperfused, and the mean ejection fraction of both groups was within normal functionality, with a mean of 0.50 for reperfused patients and 0.62 for non-reperfused patients. CONCLUSION: We found an association between successful venous chemical thrombolysis reperfusion and lower mortality in patients with acute stroke.

Morbimortality and determinants of reperfusion in ischemic stroke.

BACKGROUND: Cerebrovascular accident (or stroke) and ischemic heart disease are the the major causes of death in the world. It is estimated that about 85% of strokes are ischemic in origin. Reperfusion therapy in the acute phase of ischemic stroke with a recombinant human tissue plasminogen activator is effective, but some factors influence the success of this treatment. OBJECTIVE: The aim of this study was to evaluate clinical aspects and possible determinants for reperfusion after venous thrombolysis. METHODS: This is a retrospective, cross-sectional, observational study based on a review of hospital records of inpatients diagnosed with ischemic stroke treated with intravenous thrombolysis, the main outcome being reperfusion or not. RESULTS: Data from this study revealed a predominance of females in the group of reperfused patients and males in the non-reperfused group, both maintaining moderate severity on the National Institutes of Health Stroke Scale and admission without statistical significance (p>0.18). In addition, the mean admission severity score was 13.2 for the group of reperfused patients and 14.2 for those not reperfused, and the mean ejection fraction of both groups was within normal functionality, with a mean of 0.50 for reperfused patients and 0.62 for non-reperfused patients. CONCLUSION: We found an association between successful venous chemical thrombolysis reperfusion and lower mortality in patients with acute stroke.

Changes in serum amyloid A, plasma high-density lipoprotein cholesterol and apolipoprotein A-I as useful biomarkers for Mycobacterium tuberculosis infection.

Introduction. In recent years, cholesterol has received interest in the study of infection due to evidence of a relationship between low plasma cholesterol levels and tuberculosis (TB).Hypothesis/Gap Statement. Plasma lipid profiles of serum amyloid A (SAA), apolipoprotein A-I and high-density lipoprotein cholesterol (HDL-C) are biomarkers associated with symptomatic TB patients.Objective. We aimed to evaluate plasma lipid profiles of apolipoprotein A-I, SAA and the size of HDL as biomarkers to diagnose symptomatic TB patients.Methodology. Patients with TB symptoms attending the Instituto Brasileiro para a Investigação da Tuberculose/Fundação José Silveira (IBIT/FJS) between September 2015 and August 2016 for diagnosis of TB were studied. From 129 patients, 97 were classified as pulmonary TB and 32 as negative-bacilloscopy (non-TB group). Medical history, fasting serum and plasma were obtained. Total cholesterol (TC), HDL-C, apolipoprotein A-I and SAA were measured by enzymatic or immunochemical reaction assays. HDL size was measured by laser light-scattering.Results. In TB patients, TC (147.0±37 vs. 168±44 mg dL-1), HDL-C (37±14 vs. 55±18 mg dL-1) and apolipoprotein A-I (102±41 vs. 156±47 mg dL-1) concentrations were lower (P<0.0001), while HDL particle size (10.16±1.02 vs. 9.62±0.67 nm) and SAA levels (280±36 vs. 19±8 mg L-1) were higher (P<0.0001). Using receiver-operating characteristic curve analysis for predicting TB, the cutoff values were <83.85 mg L-1 for SAA (sensitivity=96.88 %, specificity=78.43 %, P<0.0001), >44.50 mg dL-1 for HDL-C (sensitivity=75 %, specificity=72.16 %, P<0.001) and >118.5 mg dL-1 for apolipoprotein A-I (sensitivity=83.83 %, specificity=72.22 %, P<0.001).Conclusion. SAA, HDL-C and apolipoprotein A-I are associated with TB infection and could be used as laboratory biomarkers, especially in patients who are negative for alcohol-acid-resistant bacilli.

Weight gain in patients starting Dolutegravir-based ART according to baseline CD4 count after 48 weeks of follow up

ABSTRACT Background: Excessive weight gain is a current concern among People Living with HIV (PLHIV) starting ART. Objectives: To evaluate the weight gain after 48-weeks of ART in naive patients, according with baseline CD4 count. Methods: PLHIV starting 3TC + TDF + DTG with at least 48-weeks of follow up in two AIDS referral centers were stratified by baseline CD4 count (lower or higher than 200 cells/mm3). Data on CD4 count, HIV viral load, weight/Body Mass Index (BMI), lipids and glucose levels were collected at baseline, 24 and 48 weeks of treatment. For analysis purpose, patients were categorized according to their BMI progression. Results: A total of 270 patients were included in the study. Mean CD4 count were 78.3 ± 61.7 and 536.7 ± 273 cells/mm3 for low and high CD4 count groups, respectively (p < 0.001). Baseline BMI was significantly lower in low CD4 group (21.7 vs. 23.6 Kg/m2, p < 0.001). Patients in low CD4 group gained more weight than those in high CD4 group (11.2 ± 8.5 kg vs. 2.2 ± 4.2 Kg, p = 0.004). Overall weight gain was higher in women, regardless group (13.1 ± 7.9 Kg vs. 1.4 ± 3.6 Kg for women and men, respectively, p < 0.001). The proportion of overweight/obesity significantly increased in low CD4 group. Viral suppression rate was high for both groups. At week 48 the overall proportion of overweight/obesity was like that reported for the Brazilian population. Conclusions: Weight gain in the present study indicates a "return to health" phenomenon. Excessive weight gain was more frequent in women.

Association between personality factors and health-related quality of life in type 1 diabetes patients

ABSTRACT Objectives: The objective of the present study was to evaluate a possible association between personality factors (PF) and the health-related quality of life (HRQoL) of type 1 diabetes (T1D) patients. This allows for the investigation of obstacles related to treatment type and the presence of complications in HRQoL. Materials and methods: This cross-sectional study enrolled 78 patients aged 13-67 years from two diabetes clinics. PF was evaluated using the validated questionnaire Inventory of the Five Great Personality Factors. HRQoL was determined using the Brazilian Problem Areas in Diabetes Scale (B-PAID) questionnaire. The chi-square test, Fisher's exact test, and Welch's modified two-sample t-test were used to establish relationships. Results: In this sample of 46 women and 32 men with T1D and mean A1C of 8%-9%, we observed great suffering in 58.97% and that HRQoL was worse in women. "Openness" was the most prevalent PF and "extroversion" the least prevalent. "Neuroticism" facilitated a tendency to tolerate suffering. Conclusion: T1D patients' personalities influence their treatment. The PF "neuroticism" is potentially related to better HRQoL. Brazilian T1D patients indicated great suffering in their HRQoL, which may be characteristic across the country. Women experienced worse HRQoL, which is in line with world literature. However, the limited sample size in this study warrant further research to test the hypotheses.

Musculoskeletal pain, multimorbidity and associated factors in individuals followed at a physiotherapy service: cross-sectional observational study / Dor musculoesquelética, multimorbidade e fatores associados em indivíduos acompanhados por serviço de fisioterapia: estudo observacional de corte transversal

ABSTRACT BACKGROUND AND OBJECTIVES: Musculoskeletal pain is among the most disabling conditions, aggravating multimorbidity scenarios. Difficulties in the treatment of pain and multimorbidity highlight the importance of the study of these populations. The objective of this study was to determine the frequency of musculoskeletal pain and multimorbidity, the main complaints in patients admitted to physiotherapy services. METHODS: This is a cross-sectional observational study. Patients 50 years or older were evaluated using the Brief Pain Inventory, Roland Morris Disability Questionnaire for general pain, sociodemographic and clinical data form, and timed-up-and-go test. Descriptive analyses were performed through the distribution of absolute numbers and proportions for categorical variables. RESULTS: The sample consisted of 62 patients with 2 or more painful regions, 88.7% women with a median age of 67 years [IQR 62-72], 81% with body mass index above normal, 71% hypertensive and 97% with multimorbidity. The median of painful regions was 7 [IQR 4-8], the most prevalent being low back and knees (87%); 66% of patients describe severe pain, and median pain duration of 7.5 years [IQR 3-15]. The high number of painful regions had greater interference (p<0.05) in the lives of individuals and was associated with females (p=0.04) and the occurrence of a fall in the last year (p<0.003). CONCLUSION: The described population is mostly composed of hypertensive, overweight women with multimorbidity, chronic pain and a high number of painful regions, interfering in activities and in the affective components of life. A continuous study of chronic, diffuse musculoskeletal pain and multimorbidity is necessary, seeking better interventions for these patients.

RESUMO JUSTIFICATIVA E OBJETIVOS: Dores musculoesqueléticas estão entre as condições mais incapacitantes, agravando quadros de multimorbidade. Dificuldades no tratamento da dor e multimorbidade ressaltam a importância do estudo dessas populações. O objetivo deste estudo foi determinar a frequência de dor musculoesquelética e multimorbidade, principais queixas em pacientes admitidos em serviço de fisioterapia. MÉTODOS: Este é um estudo observacional de corte transversal. Pacientes com 50 anos ou mais foram avaliados através do Inventário Breve de Dor, Questionário de Incapacidade de Roland Morris para dor em geral, formulário de dados sociodemográficos e clínicos e teste timed-up-and-go. Foram realizadas análises descritivas através da distribuição de números absolutos e proporções para as variáveis categóricas. RESULTADOS: A amostra foi composta por 62 pacientes com 2 ou mais regiões dolorosas, 88,7% mulheres com mediana de idade de 67 anos [IQR 62-72], 81% com índice de massa corpórea acima da normalidade, 71% hipertensos e 97% com multimorbidade. A mediana de regiões dolorosas foi de 7 [IQR 4-8], sendo as mais prevalentes lombar e joelhos (87%); 66% dos pacientes descrevem dor intensa e mediana da duração da dor de 7,5 anos [IQR 3-15]. O alto número de regiões dolorosas teve maior interferência (p<0,05) na vida dos indivíduos e foi associado ao sexo feminino (p=0,04) e a ocorrência de queda no último ano (p<0,003). CONCLUSÃO: A população descrita é majoritariamente composta por mulheres hipertensas, com sobrepeso, multimorbidade, dor crônica e alto número de regiões dolorosas, interferindo nos componentes de afetividade e atividades da vida. Faz-se necessário contínuo estudo da dor musculoesquelética crônica, difusa e multimorbidade, buscando melhores intervenções para estes pacientes.

Evidence of the association between adherence to treatment and mortality among patients with COPD monitored at a public disease management program in Brazil.

OBJECTIVE: To evaluate the association between adherence to treatment and mortality among Chronic Obstructive Pulmonary Disease (COPD) patients treated in the Brazilian public health system. METHODS: This is cohort study of moderate-to-severe COPD patients monitored in a public pharmaceutical care-based Disease Management Program (DMP). All subjects who died one year after the beginning of the cohort were age-matched with those who remained alive at the end of the cohort period. Treatment adherence was measured through pharmacy records. Patients who received at least 90% of the prescribed doses were considered adherent to treatment. RESULTS: Of the 333 patients (52.8% age ≥ 65 years, 67.9% male), 67.3% were adherent to treatment (adherence rate, 87.2%). Mortality was associated with lack of adherence (p = 0.04), presence of symptoms (mMRC ≥ 2) and COPD treatment use. The death was associated with non-adherence, presence of symptoms and previous hospitalization. After adjustment, non-adherent patients to treatment were almost twice times likely to die compared to those adherents (Hazard Ratio (HR) 1.86; CI 1.16-2.98, p = 0.01). CONCLUSION: Non-adherence to treatment was associated with higher mortality among moderate-to-severe COPD patients treated in the Brazilian public health system. Strategies to monitor and optimize adherence should be strengthened to reduce COPD-related mortality.

Validation of the GeneXpert Xpress SARS-CoV-2 PCR assay using saliva as biological specimen

ABSTRACT In the pandemic, rapid and accurate detection of SARS-CoV-2 is crucial in controlling the outbreak. Recent studies have shown a high detection rate using saliva/oral fluids as specimens for laboratory detection of the virus. We intended to evaluate the test performance of the Xpert Xpress SARS-CoV-2 cartridge assay in comparison to a conventional qRT-PCR testing, using saliva as biological specimen. Forty saliva samples from symptomatic participants were collected. Conventional qRT-PCR was performed for amplification of E and RdRp genes and the Xpert Xpress SARS-CoV-2 assay amplified E and N2 genes. In the conventional assay, the median cycle threshold value of the E gene was 34.9, and of the RdRp gene was 38.3. In the Xpert Xpress assay, the median cycle threshold value of the E gene was 29.7, and of the N2 gene was 31.6. These results can allow a broaden use of molecular tests for management of COVID-19 pandemic, especially in resources-limited settings.

Self-prescribed Ivermectin use is associated with a lower rate of seroconversion in health care workers diagnosed with COVID, in a dose-dependent response

ABSTRACT Background: Over-the-counter use of ivermectin amongst other drugs as SARS-CoV-2 treatment has been increasingly common, despite the lack of evidence on its clinical efficacy. Objective: To evaluate the effect of ivermectin use on production of antibodies against SARS-CoV-2 in health care workers (HCW) diagnosed with COVID-19 and of Th1/Th2 cytokines by stimulated peripheral blood mononuclear cells of the same cohort (PBMCs). Methods: This cross-sectional study evaluated seroconversion and neutralizing antibodies production in HCW at Complexo Hospitalar Universitário Professor Edgard Santos (Salvador, Brazil), diagnosed with COVID-19 from May to July, 2020, as well as in vitro production of antibody against SARS-CoV-2 and Th1/Th2 cytokines. Analyses were performed between December 2020 and February 2021. Participants were stratified according to the use of ivermectin (≤ 1 dose vs. multiple doses) for treatment of COVID-19. Results: 45 HCW were included (62% women). Mean age was 39 years, and disease severity was similar across groups. Neutralizing antibodies were detected less frequently in multiple doses (70%) vs. ≤ 1 dose (97%) groups, p = 0.02). PBMCs of patients in multiple doses group also were less likely to produce antibodies against SARS-CoV-2 following in vitro stimulation with purified spike protein in comparison with patients in ≤ 1 dose group (p < 0.001). PBMC's production of Th1/Th2 cytokines levels was similar across groups. Abdominal pain (15% vs 46%, p = 0.04), diarrhea (21% vs. 55%, p = 0.05) and taste perversion (0% vs. 18%, p = 0.05) were more frequently reported by participants that used multiple doses of ivermectin. Conclusions: Although there was no evidence for differential disease severity upon ivermectin use for treatment of COVID-19 it was associated with more gastro-intestinal side-effects and impairment of anti-SARS-CoV2 antibodies production, in a dose dependent manner. This potentially impacts the effectiveness of immune response and the risk of reinfection and warrants additional studies for clarifying the mechanisms and consequences of such immunomodulatory effects.

Anxiety, health-related quality of life, and symptoms of burnout in frontline physicians during the COVID-19 pandemic

ABSTRACT Background: COVID-19 pandemic caused increased workload and stress for health professionals involved in the care of such patients. We aimed to describe the health-related quality of life, and burnout in frontline physicians diagnosed with anxiety during the COVID-19 pandemic. Methods: This was a cross-sectional study conducted during the first-wave phase of COVID19, from September to October 2020. Questionnaires were sent electronically to 450 physicians from State of Bahia, assessing symptoms of anxiety, health-related quality of life (HRQOL) and burnout syndrome. For the categorical variables, the Pearson's chi-square test was used and difference between means was compare using the Mann-Whitney test. was Groups with and without anxiety symptoms were compared using prevalence ratios (PR). Pearson's correlation measured the correlation between WHOQOL-BREF and MBI (Maslach Burnout Inventory) domains. The Fisher r-to-z transformation was used to assess the significance of the difference between two correlation coefficients. The significance level was <0.05. Results: Out of the 450 physicians, 223 (49,6%) completely answered the questionnaire and 38 (17%) showed symptoms of anxiety. Physicians with anxiety had higher scores in emotional exhaustion (EE) (38.31 ± 8.59 vs 25.31±0.87; p = 0.0001) and depersonalization (DP) (9.0 ± 5.6 vs 5.9 ± 5.3; p = 0.001) domains, and lower scores in personal accomplishment (PA) (32.1 ± 8.2 vs 36.3 ± 7.6; p = 0.004), than those without anxiety. All correlations between WHOQOL-BREF domains and MBI in physicians without anxiety were significant (p = 0.01). Conclusion: Physicians with anxiety showed more emotional exhaustion, less personal accomplishment, and lower quality of life. All domains of WHOQOL BREF were correlated with all MBI domains among physicians without anxiety. Differences in correlation according to anxiety were remarkable in psychological HOQOL BREF domain and emotional exhaustion and depersonalization MBI domains. The effect of anxiety leading to poorer levels of perceived health needs to be further investigated.

Spirometry results after treatment for pulmonary tuberculosis: comparison between patients with and without previous lung disease: a multicenter study.

OBJECTIVE: To compare patients with and without previous lung disease, in terms of the spirometry results after they had been treated for pulmonary tuberculosis (PTB) and cured, as well as to analyze risk factors related to functional severity. METHODS: This was a cross-sectional, multicenter study conducted at four referral centers in Brazil. Patients were divided into two groups: those with a history of lung disease or smoking (LDS+ group); and those with no such history (LDS- group). Patients underwent spirometry (at least six months after being cured). Sociodemographic and clinical data were collected. RESULTS: A total of 378 patients were included: 174 (46.1%) in the LDS+ group and 204 (53.9%) in the LDS- group. In the sample as a whole, 238 patients (62.7%) had spirometric changes. In the LDS+ group, there was a predominance of obstructive lung disease (in 33.3%), whereas restrictive lung disease predominated in the LDS- group (in 24.7%). Radiological changes were less common in the LDS- group than in the LDS+ group (p < 0.01), as were functional changes (p < 0.05). However, of the 140 (79.1%) LDS- group patients with a normal or minimally altered chest X-ray, 76 (54%) had functional changes (p < 0.01). The risk factors associated with functional severity in the LDS- group were degree of dyspnea (p = 0.03) and moderate or severe radiological changes (p = 0.01). CONCLUSIONS: Impaired pulmonary function is common after treatment for PTB, regardless of the history of lung disease or smoking. Spirometry should be suggested for patients who develop moderate/severe dyspnea or relevant radiological changes after treatment for PTB.

Spirometry results after treatment for pulmonary tuberculosis: comparison between patients with and without previous lung disease: a multicenter study / Comparação entre os resultados de espirometria após tratamento para tuberculose pulmonar em pacientes com e sem doença pulmonar prévia: um estudo multicêntrico

ABSTRACT Objective: To compare patients with and without previous lung disease, in terms of the spirometry results after they had been treated for pulmonary tuberculosis (PTB) and cured, as well as to analyze risk factors related to functional severity. Methods: This was a cross-sectional, multicenter study conducted at four referral centers in Brazil. Patients were divided into two groups: those with a history of lung disease or smoking (LDS+ group); and those with no such history (LDS− group). Patients underwent spirometry (at least six months after being cured). Sociodemographic and clinical data were collected. Results: A total of 378 patients were included: 174 (46.1%) in the LDS+ group and 204 (53.9%) in the LDS− group. In the sample as a whole, 238 patients (62.7%) had spirometric changes. In the LDS+ group, there was a predominance of obstructive lung disease (in 33.3%), whereas restrictive lung disease predominated in the LDS− group (in 24.7%). Radiological changes were less common in the LDS− group than in the LDS+ group (p < 0.01), as were functional changes (p < 0.05). However, of the 140 (79.1%) LDS− group patients with a normal or minimally altered chest X-ray, 76 (54%) had functional changes (p < 0.01). The risk factors associated with functional severity in the LDS− group were degree of dyspnea (p = 0.03) and moderate or severe radiological changes (p = 0.01). Conclusions: Impaired pulmonary function is common after treatment for PTB, regardless of the history of lung disease or smoking. Spirometry should be suggested for patients who develop moderate/severe dyspnea or relevant radiological changes after treatment for PTB.

RESUMO Objetivo: Comparar os resultados da espirometria de pacientes tratados e curados para tuberculose pulmonar (TBP) com e sem doença pulmonar prévia e analisar os fatores de risco relacionados à gravidade funcional. Métodos: Estudo transversal, multicêntrico, em quatro centros de referência no Brasil. Os pacientes foram classificados em dois grupos: grupo com doença pulmonar prévia ou história de tabagismo (grupo DPT+) e grupo sem doença pulmonar prévia e sem tabagismo (grupo DPT−). Os pacientes realizaram espirometria (pelo menos seis meses após a cura), e foram coletados dados sociodemográficos e clínicos. Resultados: Foram incluídos 378 pacientes: 174 (46,1%) no grupo DPT+ e 204 (53,9%) no grupo DPT−. Na amostra total, 238 pacientes (62,7%) apresentaram alguma alteração espirométrica. No grupo DPT+ houve predominância de distúrbio ventilatório obstrutivo (em 33,3%), e distúrbio ventilatório restritivo predominou no grupo DPT− (em 24,7%). Quando comparados com o grupo DPT+, os pacientes do grupo DPT− apresentaram menos frequentemente alteração radiológica (p < 0,01) e funcional (p < 0,05). Porém, dos 140 (79,1%) do grupo DPT− com radiografia de tórax normal ou minimamente alterada, 76 (54%) apresentaram alguma alteração funcional (p < 0,01). Os fatores de risco relacionados com a gravidade funcional no grupo DPT− foram grau de dispneia (p = 0,03) e alterações radiológicas moderadas ou acentuadas. Conclusões: O comprometimento da função pulmonar é frequente após o tratamento da TBP independentemente do histórico de tabagismo ou doença pulmonar prévia. A espirometria deve ser sugerida para esses pacientes que evoluem com grau moderado/grave de dispneia e/ou alteração radiológica relevante após o tratamento da TBP.

Unusual oral findings of the toxic epidermal necrolysis in an HIV-infected patient: a case report.

Erythema multiforme (EM), Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis (TEN) have been reported as possible adverse effects of some classes of first-line antiretroviral drugs (ART) for HIV treatment. Herein we report an unusual presentation of TEN lesions associated with ART in an HIV-infected patient. The patient presented disseminated cutaneous eruption and oral lesions from the lips to the oropharynx region, causing odynophagia and dysphagia. In the tongue, circular, atypical erythematous lesions appeared, increasing in diameter over seven days and coalescing since then to complete remission. TEN treatment included efavirenz interruption, use of methylprednisolone, prophylactic antibiotic, and daily laser therapy with low-intensity red light. The circular oral lesions have not been described yet. Reporting our findings and clinical management may help diagnosing other similar cases and guide the clinical conduct. Analgesia and acceleration of oral ulcer repair with red laser therapy are recommended.

Expansion of Zika virus circulation from Africa to the Americas, 1947-2018: a literature review. / Expansão da circulação do vírus Zika da África à América, 1947-2018: revisão da literatura.

OBJECTIVE: to describe the temporal and geographical expansion of Zika virus (ZIKV) circulation in countries and territories, from the time it was first isolated until 2018. METHODS: This was a non-systematic literature review covering the period from 1947 to 2018 using the MEDLINE database and World Health Organization estimates. RESULTS: Since its isolation in 1947, ZIKV circulation spread through Africa, Asia and the Pacific before reaching the Americas in 2013, causing serious clinical manifestations; the highest seroprevalence rates were recorded in Yap (74%) and in Brazil (63%); genetic mutations, absence of immunity and high vector susceptibility may have influenced ZIKV transmissibility and help to explain the magnitude of its expansion. CONCLUSION: The spread of ZIKV circulation in the Americas was the most extensive recorded thus far, possibly as a result of population and geographical characteristics of the sites where the virus circulated.

Factors associated with mortality in HIV patients failing antiretroviral therapy, in Salvador, Brazil.

Highly active antiretroviral therapy (HAART) has significantly improved survival of people living with HIV/Aids (PLWHA). However, poor treatment adherence to HAART and other problems, still cause therapy failure and contribute to increased morbidity and mortality of PLWHA. In this retrospective cohort study (2013-2015), we sought to evaluate the factors associated with mortality of PLWHA failing HAART in 2013, who were receiving care at a reference center for sexually transmitted diseases (STD) and HIV/AIDS. A total of 165 individuals over 18 years of age who were failing antiretroviral therapy were evaluated. In two-year follow-up, 19 (11.5%) deaths were documented. There were a significant association between mortality and report of illicit drug use (53%, p < 0.01), being attended by a larger number of medical professionals (6.3 ±â€¯3.2, p = 0.02), use of firstline non-nucleoside reverse transcriptase inhibitor (74%, p = 0.01), and history of interrupting HAART ≥3 months (90%), p = 0.02). Patients who died had a significantly higher viral load (mean 49,192.4 ±â€¯35,783.6 copies/mL) than survivors (26,389.2 ±â€¯27,416 copies/mm3, p < 0.01), lower mean CD4 cell counts (127.8 ±â€¯145.6 cells/mm3 vs. 303.3 ±â€¯202.4 cells/mm3, p < 0.01), and higher frequency of previous virologic failure (89% vs. 74.7%, p < 0.01). Our results reinforce the importance of early detection and prevention of virologic failure, to reduce the mortality associated with this event.

Factors associated with mortality in HIV patients failing antiretroviral therapy, in Salvador, Brazil

ABSTRACT Highly active antiretroviral therapy (HAART) has significantly improved survival of people living with HIV/Aids (PLWHA). However, poor treatment adherence to HAART and other problems, still cause therapy failure and contribute to increased morbidity and mortality of PLWHA. In this retrospective cohort study (2013-2015), we sought to evaluate the factors associated with mortality of PLWHA failing HAART in 2013, who were receiving care at a reference center for sexually transmitted diseases (STD) and HIV/AIDS. A total of 165 individuals over 18 years of age who were failing antiretroviral therapy were evaluated. In two-year follow-up, 19 (11.5%) deaths were documented. There were a significant association between mortality and report of illicit drug use (53%, p < 0.01), being attended by a larger number of medical professionals (6.3 ± 3.2, p = 0.02), use of firstline non-nucleoside reverse transcriptase inhibitor (74%, p = 0.01), and history of interrupting HAART ≥3 months (90%), p = 0.02). Patients who died had a significantly higher viral load (mean 49,192.4 ± 35,783.6 copies/mL) than survivors (26,389.2 ± 27,416 copies/mm3, p < 0.01), lower mean CD4 cell counts (127.8 ± 145.6 cells/mm3 vs. 303.3 ± 202.4 cells/mm3, p < 0.01), and higher frequency of previous virologic failure (89% vs. 74.7%, p < 0.01). Our results reinforce the importance of early detection and prevention of virologic failure, to reduce the mortality associated with this event.

Smoking and pulmonary tuberculosis treatment failure: a case-control study.

OBJECTIVE: To determine the association between smoking and pulmonary tuberculosis treatment failure. METHODS: This was a case-control study conducted at the Brazilian Institute for Tuberculosis Research in the city of Salvador, Brazil, between 2007 and 2015. We evaluated 284 patients treated for pulmonary tuberculosis, comparing 50 cases of treatment failure with 234 control cases in which the final outcome was cure. RESULTS: Treatment failure was attributed to smoking and age rather than to gender, income, level of education, alcohol consumption, or marital status. Therefore, even after adjustment for age, the risk of treatment failure was 2.1 times (95% CI: 1.1-4.1) higher among the patients with a history of smoking. In addition, being over 50 years of age was found to increase the likelihood of treatment failure by 2.8 times (95% CI: 1.4-6.0). CONCLUSIONS: Smoking and aging are both associated with pulmonary tuberculosis treatment failure. Therefore, as part of a tuberculosis control program, health personnel should be prepared to offer strategies to promote smoking cessation and should be more careful with older patients.