Tuberculosis among South American immigrants in São Paulo municipality: an analysis in space and time.

OBJECTIVE: To identify spatial and temporal, and spatial variation in temporal trends in clusters of tuberculosis (TB) among South American migrants residing in São Paulo municipality, SP, Brazil, between 2006 and 2013. DESIGN: An ecological descriptive study was conducted using data obtained from official TB reports and the 2010 Brazilian demographic census. Clusters were identified using scan statistics and SaTScan software; those with P < 0.05 were considered statistically significant. Social and economic characteristics of residents within the clusters were investigated. RESULTS: One high-risk spatial cluster (relative risk [RR] 4.46, P < 0.001) for TB was identified. Bolivian immigrants comprised the majority of immigrants residing in this area. One purely temporal high-risk cluster was identified between 2011 and 2013 (RR 1.55, P = 0.001). In one of the spatial variation in temporal trends clusters, the annual increase in TB incidence was 17.54% inside the cluster and 5.17% outside. CONCLUSIONS: We found areas of high risk for TB among South American immigrants. These areas and those with increasing trends of TB incidence must be prioritised by TB control programmes.

Avaliação in vitro do potencial antimicrobibiano do decoto de cascas de romã (Punica granatum L. ) sobre amostras de saliva de escolares / In vitro assessment of the antimicrobial effects of pomegranate (Punica granatum L.) peel decoction on saliva samples

Existem vários esforços para o desenvolvimento de produtos capazes de reduzir ou eliminar os microrganismos patogênicos presentes na cavidade oral. A literatura relata uma série de efeitos adversos associados ao uso contínuo destes produtos, dentre eles vômitos, diarreia e o escurecimento da dentina. A indução da resistência microbiana é um dos fatores de destaque relacionado ao uso destes produtos. Neste trabalho, o decocto de romã (Punica granatum L.), obtido a partir das cascas do fruto, foi utilizado para avaliação de seu potencial antimicrobiano sobre cepas de Pseudomonas aeruginosa, Candida albicans e Enterococcus faecalis, sendo ativos contra os dois primeiros microrganismos. A aplicação do decocto sobre os microrganismos presentes em amostras de saliva de crianças mostrou halos de inibição semelhantes ao obtido com a solução de clorexidina a 0,12%. A atividade antimicrobiana do decocto de romã aponta esta preparação como uma fonte em potencial para o desenvolvimento de produtos de uso oral...

Several products have been developed to eliminate or reduce potential pathogenic microorganisms of the oral microbiome. The continuous use of these synthetic products can result in side effects such as vomiting, diarrhea, darkening of the teeth and the induction of microbial resistance. Pomegranate (Punica granatum) peel decoction was tested to assess its antimicrobial activity. In vitro analysis showed the decoction had antimicrobial activity against strains of Pseudomonas aeruginosa and Candida albicans, but none was detected against Enterococcus faecalis. When tested on saliva samples from children, the decoction showed great potential in reducing the load of microorganisms, the inhibition haloes produced with saliva samples being similar to those of the antimicrobial control (0.12% chlorhexidine). The pomegranate peel decoction in water could thus provide a promising source for developing solutions for use against oral diseases...

Determinants of in-hospital mortality in women with acute myocardial infarction who underwent primary coronary angioplasty.

INTRODUCTION: According to recent data, women have a greater risk of dying from an acute coronary event. The determinants of this ominous prognosis are not completely understood. Preliminary analysis of our data suggested that this poorer prognosis is also observed in the subgroup of patients with acute myocardial infarction submitted to direct coronary angioplasty (PTCA). This finding prompted us to investigate gender differences and their determinants in this particular context. OBJECTIVE: To identify risk factors associated with the greater in-hospital mortality of women with acute infarction who underwent PTCA. METHODS: One hundred and forty-five consecutive patients with acute myocardial infarction who underwent direct PTCA in the same hospital were studied retrospectively. Data were collected from the database of the catheterisation laboratory and from clinical files. The following parameters were analysed: in-hospital mortality, age, prevalence of diabetes mellitus, history of coronary heart disease, time elapsed from beginning of symptoms to coronary intervention, peak values of CK and MB-CK, number of coronary arteries with significant disease at angiography, culprit lesion localisation, and prevalence of shock on admission. For statistical analysis, cross-tabulation (Pearson x2) and comparison of means (Student's t test) were employed when appropriate; an error of 5% was admitted for the rejection of the null hypothesis. RESULTS: Women (n = 39) represented 26.9% of sample. In hospital mortality was 28.2% (n = 11) for women and 11.3% (n = 12) for men (p = 0.014). The prevalence of coronary heart disease before the current acute event, the time elapsed from beginning of symptoms to coronary intervention, and maximum values of CK and MB-CK were similar in both genders. Differences between women and men were found as regards the following variables (women vs men): age (61.7 +/- 10 vs 56.1 +/- 12.6 years), prevalence of left main disease (15.3 vs 1.9%) and prevalence of shock (41 vs 17%) and diabetes (38.7 vs 13.6%). Considering women and men who died, only disease severity as evaluated by the number of vessels involved distinguished both genders (p = 0.05). CONCLUSIONS: In our experience, women admitted with acute myocardial infarction and treated by direct PTCA are, on average, older than men and have a greater prevalence of shock at admission, of left main disease and of diabetes, and more severe coronary artery disease. In the present series and as regard in-hospital mortality, disease severity as evaluated by the number of vessels involved is the only variable that discriminates women from men.

The clinical management of HIV-related dementia and other memory disorders in the residential drug treatment environment.

Human immunodeficiency virus (HIV)-related dementia and other memory and attention disorders are described in terms of etiology, incidence, and symptoms. Assessment for cognitive impairment includes basic screening (examples are given), or a thorough neuropsychological evaluation. Implications for treatment within the residential drug treatment environment include: (a) providing accurate information to staff and residents; (b) identifying residents' anticipatory anxiety; (c) supportive counseling of residents; (d) coaching residents in the use of coping strategies; (e) creating environmental support; and (f) frequent reassessment of treatment goals, including the appropriateness of independent living. Helpful concrete suggestions are listed.

Effects of orally administered ritodrine on carbohydrate and lipid metabolism in pregnant patients with abnormal glucose tolerance.

The metabolic effects of a widely used betamimetic agent (ritodrine) were studied in two groups of pregnant patients with abnormal glucose tolerance. No significance modification of various metabolic parameters was detected when the drug was orally administered in standard doses for at least 1 week. The possible reasons for this finding are discussed. Following the absence of any diabetogenic effect, a prolonged use of betamimetics to achieve tocolysis seems to be safe even in patients with metabolic disorders.

Poly-plethysmographic study on the effects of ritodrine on the cardiovascular system of patients in labour.

The effects of ritodrine infusion on the cardiovascular system of six women in threatened or premature labour are reported. In contrast to other betamimetics, ritodrine caused a moderate rise in systolic blood pressure, the corresponding fall in diastolic pressure leading to a widened pulse pressure but no risk of hypotension. Ritodrine caused a rise in cardiac output, and was well tolerated by the patients. Special care should be taken in treating patients with known heart disease.