Equity in health: tuberculosis in the Bolivian immigrant community of São Paulo, Brazil.

OBJECTIVES: To analyse the profile of tuberculosis (TB) among Bolivian immigrants, investigate the impact that this population has on the trends of TB and assess equity in access to TB treatment, in the city of São Paulo, Brazil. METHODS: Descriptive study of the epidemiological profile of TB in four city districts with large Bolivian populations, comparing cases among Brazilians and Bolivians, during the 1998-2008 period was carried out. We used logistic regression to adjust the treatment outcome for potential confounders. RESULTS: We identified 2056 new TB cases: 65.7% in Brazilians, 32.1% in Bolivians and 2.2% among other nationalities. Although TB incidence remained stable (high) over the study period, the annual proportion of cases among Bolivians increased from 15.0% to 53.0%. In comparison with the Brazilians, the Bolivians were younger (median age, 24 vs. 40 years; P < 0.0001) and presented a lower unemployment rate (3.1%vs. 11.6%; P < 0.0001), a lower rate of HIV co-infection (1.5%vs. 28.5%; P< 0.001), a higher proportion of individuals receiving supervised treatment (81.5%vs. 62.0%; P < 0.0001) and a higher proportion of cures (71.6%vs. 63.2%; P< 0.0001). After having been adjusted for potential confounder, cure after treatment was not associated with nationality. CONCLUSIONS: Bolivian immigrants influenced the incidence but not the trends of TB among Brazilians in the study area. We found no significant differences between Bolivians and Brazilians regarding healthcare access or treatment outcome. Guaranteed universal health care access for all, including undocumented individuals, contributes to health equity. Specific intervention strategies are warranted for immigrants with tuberculosis.

Ultrasound predictors of mortality in monochorionic twins with selective intrauterine growth restriction.

OBJECTIVES: The aim of this study was to evaluate the use of ultrasound assessment to predict risk of mortality in expectantly managed monochorionic twin fetuses with selective intrauterine growth restriction (sIUGR). METHODS: This was a retrospective study of 101 monochorionic twin pregnancies diagnosed with sIUGR before 26 weeks of gestation. All patients were under expectant management during the observation period. At the initial evaluation, the presence or absence of each of the following abnormalities was documented: oligohydramnios; stuck twin phenomenon; severe IUGR < 3(rd) centile of estimated fetal weight; abnormal Doppler in the umbilical artery; and polyhydramnios in the larger twin. The relationships between these ultrasound findings and mortality of sIUGR fetuses were evaluated using multiple logistic regression analysis. RESULTS: Of 101 sIUGR twins, 22 (21.8%) fetuses suffered intrauterine demise and nine (8.9%) suffered neonatal death; 70 (69.3%) survived the neonatal period. Multiple logistic regression analysis revealed that the stuck twin phenomenon (odds ratio (OR): 14.5; 95% CI: 2.2-93.2; P = 0.006) and constantly absent diastolic flow in the umbilical artery (OR: 29.4; 95% CI: 3.3-264.0; P = 0.003) were significant risk factors for mortality. CONCLUSIONS: Not only abnormal Doppler flow in the umbilical artery but also severe oligohydramnios should be recognized as important indicators for mortality in monochorionic twins with sIUGR.

Prenatal diagnosis of congenital epulis: a case report.

Congenital epulis or congenital granular cell tumor, is a benign tumor that has rarely been diagnosed prenatally. We report a case of a large congenital epulis diagnosed at 26 weeks of gestation that increased in size during gestation. Color and power Doppler ultrasound examination showed marked blood flow in the tumor. The tumor could be resected completely following Cesarean section and histologically examined. We discuss the prenatal diagnosis and histogenesis of congenital epulis.

Serum N-acetyl-beta-D-glucosaminidase activity in a large population--a useful index of cardiovascular impairment.

Serum N-acetyl-beta-D-glucosaminidase (NAG) levels were measured in 1080 residents in Tanushimaru, Fukuoka, aged 20 to 84 years old, during a periodical epidemiological survey performed in 1982. Thirteen pregnant women were excluded from this study. Serum NAG levels showed an increase with age, but were not different between sexes. We found high serum NAG values in those with high blood pressure, high serum total cholesterol, low serum HDL-cholesterol, or reduced creatinine clearance rate, and women with high serum uric acid, increased skinfold thickness, or high hematocrit. Multiple regression equation was as follows: NAG = 3.53 + 0.07 (age) + 0.14 (hematocrit) + 0.03 (total skinfold thickness) + 0.04 (systolic blood pressure) - 0.03 (HDL-cholesterol) - 0.04 (mean blood pressure) - 0.01 (creatinine clearance). The multiple correlation coefficient was 0.37 (F = 24.4). We suggest that NAG may be a useful index in screening cardiovascular impairment and for cardiovascular risk factors.