Indicadores de morbimortalidade da covid-19 em crianças e adolescentes no estado do Ceará / Covid-19 morbidity and mortality indicators in children and adolescents in the state of Ceará

Objetivo: descrever os indicadores de morbimortalidade da covid-19 em crianças e adolescentes no estado do Ceará. Métodos: trata-se de um estudo observacional, analítico, do tipo transversal que avaliou dados secundários referente às notificações de covid-19, em crianças e adolescentes, no estado do Ceará, dos anos de 2020 a 2022. A coleta de dados ocorreu por meio da base de dados da Integração das Informações da Secretaria da Saúde do Estado do Ceará. Para o processamento dos dados, utilizou-se o Microsoft Excel, o qual foi organizado em tabelas e analisado por meio de estatística descritiva. A pesquisa não necessitou de aprovação em Comitê de Ética em Pesquisa. Resultados: observou-se, tanto para o sexo feminino quanto para o masculino, que o ano de 2021 obteve o maior número de casos notificados, confirmados e óbitos, e as faixas etárias mais acometidas foram as de zero a quatro anos e adolescentes de 15 a 19 anos. Para os indicadores de incidência, o sexo feminino teve maior incidência de casos confirmados na faixa etária de 15 a 19 anos. Os indicadores de mortalidade estiveram maiores entre as crianças de zero a quatro anos do sexo masculino, nos anos 2021 e 2022. Conclusões: os achados deste estudo reforçam que alguns grupos podem ter maior risco de desfechos ruins. O que torna necessário identificar fatores associados a resultados insatisfatórios em crianças e adolescentes com covid-19.

Objective: to describe the morbidity and mortality indicators of covid-19 in children and adolescents in the State of Ceará. Methods this is an observational, analytical, cross-sectional study that evaluated secondary data regarding notifications of covid-19 in children and adolescents in the state of Ceará from 2020 to 2022. Data collection took place through the database of the Integration of Information of the Secretariat of Health of the State of Ceará. Microsoft Excel was used for data processing, they were organized in tables and analyzed using descriptive statistics. The research did not require approval from the Research Ethics Committee. Results: it was observed, for both females and males, that the year 2021 had the highest number of reported, confirmed cases and deaths, and the most affected age groups were those from zero to four years and adolescents from 15 to 19 years old. For the incidence indicators, females had a higher incidence of confirmed cases in the age group of 15 to 19 years. Mortality indicators were higher among male children aged zero to four years in the years 2021 and 2022. Conclusions: The findings of this study reinforce that some groups may be at greater risk of poor outcomes. This makes it necessary to identify factors associated with unsatisfactory outcomes in children and adolescents with covid-19.

Is Visceral Leishmaniasis the same in HIV-coinfected adults?

INTRODUCTION: Visceral Leishmaniasis is the most severe form of disease caused by the Leishmania donovani complex, with significant morbidity and mortality in developing countries. Worse outcomes occur among HIV-positive individuals coinfected with Leishmania. It is unclear, however, if there are significant differences on presentation between Visceral Leishmaniasis patients with or without HIV coinfection. METHODS: We reviewed medical records from adult patients with Visceral Leishmaniasis treated at a reference healthcare center in Fortaleza - Ceará, Brazil, from July 2010 to December 2013. Data from HIV-coinfected patients have been abstracted and compared to non-HIV controls diagnosed with Visceral Leishmaniasis in the same period. RESULTS: Eighty one HIV-infected patients and 365 controls were enrolled. The diagnosis in HIV patients took significantly longer, with higher recurrence and death rates. Kala-azar's classical triad (fever, constitutional symptoms and splenomegaly) was less frequently observed in Visceral Leishmaniasis-HIV patients, as well as jaundice and edema, while diarrhea was more frequent. Laboratory features included lower levels of hemoglobin, lymphocyte counts and liver enzymes, as well as higher counts of blood platelets and eosinophils. HIV-infected patients were diagnosed mainly through amastigote detection on bone marrow aspirates and treated more often with amphotericin B formulations, whereas in controls, rK39 was the main diagnostic tool and pentavalent antimony was primarily used for treatment. CONCLUSIONS: Clinical and laboratory presentation of Visceral Leishmaniasis in HIV-coinfected patients may differ from classic kala-azar, and these differences may be, in part, responsible for the delay in diagnosing and treating leishmaniasis, which might lead to worse outcomes.

Occupational and nosocomial transmission of varicella.

We examined varicella transmission in a hospital specialized in cancer treatment. A cases series study was made of a case of intra-hospital transmission of varicella, based on a revision of the records of patients who had been admitted during the time the index case was in the same service. Records of interviews of employees were also reviewed. During the period that the index case was in the intensive care unit, 34 patients were admitted and 35 employees worked there. Two employees and a patient developed the illness, due to transmission directly or indirectly from the index case. Although this is a service in which most of the patients are adults who have cancer, attention needs to be directed towards diagnosis and to procedures to reduce the transmission of this illness, both to healthcare professionals, and to other patients. A standard schedule for varicella prevention already exists; however, this case reinforces the need for specific vaccination of at-risk professionals.

[Cysticercosis' admissions in public health hospitals: Ceará State distribuition]. / Casos de cisticercose em pacientes internados pelo Sistema Unico de Saúde: distribuição no Estado do Ceará

The geographic distribution of case registered in the System of Hospital Information of Ceará (1996-2004) and its relation with flock swine and availability of computerized tomography scan in patients' residence city, from those were studied. 424 Patients were admitted with cysticercosis (neurocysticercosis 98.3%) originating from 75 cities. No relation existed between computerized tomography in city of residence or swine flocks and cysticercosis prevelance.

[Acute diarrhea treated by health care services in Fortaleza, Ceará State, Brazil, from 1996 to 2001]. / Comportamento das doenças diarréicas agudas em serviços de saúde de Fortaleza, Ceará, Brasil, entre 1996 e 2001.

Diarrhea is still an important cause of morbidity and mortality among children under five years old. It is not mandatory to report diarrheal diseases, and the statistics are not accurate. The objective of this study was to describe follow-up of acute diarrhea in Fortaleza, the capital of Ceará State, Brazil. From 1994 to 2001, cases of acute diarrhea were reported by 100 health care units using a standardized form, keyed-in and analyzed by month, age group, treatment plan, place of treatment, and place of residence. There were 489,069 cases reported, with an annual average of 81,511. February and March had the highest monthly rates. Incidence in infants (< 1 year) was 538.8, three times that of children from 1 to 4 years and 13 times the rate in the 5-to-9-year bracket. All areas in the city reported cases of diarrhea. Diarrhea shows a persistently high incidence, mainly among infants, and merits attention as a major public health problem.

Protocolos assistenciais para a redução de mortalidade por Sepse: revisão integrativa / Assistance protocols for reducing sepsis mortality: integrative review / Protocolos asistenciales para lareducción de mortalidad por sepse: revisión integrativa

Objetivo: identificar na literatura científica se o uso de protocolos assistenciais de identificação e tratamento precoce da sepse reduz a mortalidade em instituições hospitalares. Método: revisão integrativa realizada por meio das seguintes base de dados: SCOPUS, CINAHL, LILACS e Medline com amostra final de 27 artigos. Resultados: embora havendo uma variedade de protocolos implementados, a maioria dos estudos (n=16) corroboram entre si, sugerindo que os protocolos assistenciais para identificação e tratamento precoce de sepse e choque séptico reduzem mortalidade.Conclusão: os resultados sugerem que protocolos diminuem mortalidade de pacientes com sepse e choque séptico.(AU)

Objective: To identify in the scientific literature whether the use of care protocols for identification and early treatment of sepsis reduces mortality in hospital institutions. Method: integrative review conducted through the following databases: SCOPUS, CINAHL, LILACS and Medline with final sample of 27 articles. Results: Although a variety of protocols are in place, most studies (n = 16) support one another, suggesting that care protocols for early identification and treatment of sepsis and septic shock reduce mortality. Conclusion: Results suggest that protocols decrease mortality. of patients with sepsis and septic shock.(AU)

Objetivo: identificar en la literatura científica si el uso de protocolos de atención para la identificación y el tratamiento temprano de la sepsis reduce la mortalidad en las instituciones hospitalarias. Método: revisión integradora realizada a través de las siguientes bases de datos: SCOPUS, CINAHL, LILACS y Medline con muestra final de 27 artículos. Resultados: aunque existen varios protocolos, la mayoría de los estudios (n = 16) se apoyan entre sí, lo que sugiere que los protocolos de atención para la identificación temprana y el tratamiento de la sepsis y el shock séptico reducen la mortalidad. Conclusión: Los resultados sugieren que los protocolos disminuyen la mortalidad. de pacientes con sepsis y shock séptico.(AU)

[Distribution of acute respiratory diseases in Brazil from 1996 to 2001, Brazil]. / Doenças respiratórias agudas em serviços de saúde entre 1996 e 2001, Fortaleza, CE.

OBJECTIVE: Acute respiratory diseases -- ARD, mainly pneumonias, are the most important cause of death among children under five years of age and are responsible for severe diseases among people over sixty years of age. This study aims to describe the main epidemiological characteristics of ARD cases notified by healthcare centers. METHODS: ARD patients' records from medical consultations at 100 public health care centers and hospitals were reviewed every week in the period from 1996 to 2001 and data was filled out on a specific form. Data was classified as pneumonia and not pneumonia according to age groups. RESULTS: During this period, 2,050,845 ARD cases were informed. May and June were the months with the largest number of cases. ARDs were more frequent among children aged one to four years old. The latter concentrated about twice the number of cases of other age groups. Pneumonias represented approximately 7.7% of the ARD cases. CONCLUSIONS: The magnitude of ARD numbers may be observed and it should stimulate appropriate diagnosis, early treatment, and prevention, both in regard to the event itself and complications ensuing from it.

Custo-efetividade de teste rápido de detecção de Klebsiella spp. para rastreio hospitalar / Cost effectiveness of rapid testing for detection of Klebsiella spp. for hospital screening

Introdução: A resistência bacteriana é um problema mundial, atingindo principalmente países em desenvolvimento. Estima-se que no futuro vai matar mais que o câncer e custar 100 trilhões de dólares até 2050. Objetivo: O presente trabalho teve por objetivo identificar a razão de custo-efetividade incremental (RCEI) do rastreio de infecção por Klebsiella pneumoniae produtora de carbapenemase (KPC) conforme protocolo vigente para produção de carbamapenase em comparação com a utilização de protocolo de triagem utilizando teste rápido (PCR em tempo real). Métodos: Foi realizado estudo do tipo análise de custo-efetividade, utilizando um modelo de árvore de decisão e foram utilizados no estudo dados secundários de fontes governamentais e da literatura científica, considerando-se a perspectiva do sistema de saúde público. A população foi composta por adultos internados em hospitais em risco de infecção por KPC. Resultados: O presente trabalho identificou que o uso de testes de identificação de KPC com técnicas em tempo real é dominante em relação ao teste convencional, com razão de custo-efetividade incremental de R$ -426,53/0,3, ou seja, 1.421,76 reais por caso corretamente identificado favorável a teste molecular. Conclusões: O uso de testes rápidos para detecção de KPC pode ser considerado como um método de rastreio eficiente.

Introduction: Bacterial resistance is a worldwide problem, affecting mainly developing countries. It is estimated that in the future will kill more than cancer and cost US$ 100 trillion by 2050. Objective: The aim of this study was to identify the incremental cost-effectiveness ratio (ICER) of the screening of Klebsiella pneumoniae that produces carbapenemase (KPC) infection according to the current protocol for carbamapenase production compared to the use of screening protocol using rapid test (real-time PCR). Methods: A cost-effectiveness analysis was performed using a decision tree model. Secondary data from governmental sources and the scientific literature will be used in the study, considering the perspective of the public health system. The population was composed of adult hospitalized patients at risk of KPC infection. Results: The present work identified that the use of KPC identification tests with real-time techniques are dominant in relation to the conventional test, with cost ratio incremental effectiveness of R$ -426.53/0.3, that is, 1,421.76 reais per case correctly identified favorable to the molecular test. Conclusions: The use of rapid tests for detection of KPC Can be regarded as an efficient screening method.

Is Visceral Leishmaniasis the same in HIV-coinfected adults?

ABSTRACT Introduction: Visceral Leishmaniasis is the most severe form of disease caused by the Leishmania donovani complex, with significant morbidity and mortality in developing countries. Worse outcomes occur among HIV-positive individuals coinfected with Leishmania. It is unclear, however, if there are significant differences on presentation between Visceral Leishmaniasis patients with or without HIV coinfection. Methods: We reviewed medical records from adult patients with Visceral Leishmaniasis treated at a reference healthcare center in Fortaleza - Ceará, Brazil, from July 2010 to December 2013. Data from HIV-coinfected patients have been abstracted and compared to non-HIV controls diagnosed with Visceral Leishmaniasis in the same period. Results: Eighty one HIV-infected patients and 365 controls were enrolled. The diagnosis in HIV patients took significantly longer, with higher recurrence and death rates. Kala-azar's classical triad (fever, constitutional symptoms and splenomegaly) was less frequently observed in Visceral Leishmaniasis-HIV patients, as well as jaundice and edema, while diarrhea was more frequent. Laboratory features included lower levels of hemoglobin, lymphocyte counts and liver enzymes, as well as higher counts of blood platelets and eosinophils. HIV-infected patients were diagnosed mainly through amastigote detection on bone marrow aspirates and treated more often with amphotericin B formulations, whereas in controls, rK39 was the main diagnostic tool and pentavalent antimony was primarily used for treatment. Conclusions: Clinical and laboratory presentation of Visceral Leishmaniasis in HIV-coinfected patients may differ from classic kala-azar, and these differences may be, in part, responsible for the delay in diagnosing and treating leishmaniasis, which might lead to worse outcomes.

Pandemic influenza A (H1N1) 2009: epidemiological analysis of cases in a tropical/semi-arid region of Brazil.

INTRODUCTION: The year 2009 marked the beginning of a pandemic caused by a new variant of influenza A (H1N1). After spreading through North America, the pandemic influenza virus (H1N1) 2009 spread rapidly throughout the world. The aim of this study was to describe the clinical and epidemiological characteristics of cases of pandemic influenza in a tropical/semi-arid region of Brazil. METHODS: A retrospective study analyzed all suspected cases of pandemic influenza (H1N1) 2009 reported in the Ceará State through the National Information System for Notifiable Diseases during the pandemic period between 28 April, 2009 and November 25, 2010. RESULTS: A total of 616 suspected cases were notified, 58 (9.4%) in the containment phase and 558 (90.6%) in the mitigation phase. Most cases were of affected young people resident in the City of Fortaleza, the largest urban center in the State of Ceará. The most frequent symptoms presented by the cases with confirmed infection were fever, cough, myalgia, arthralgia, and nasal congestion. Mortality rate was 0.0009/1,000 inhabitants and lethality was 5.6%. Deaths were observed only in the mitigation phase. Mortality rates were similar for both sexes but were higher in the age group under 5 years. CONCLUSIONS: The study suggests that the influenza A (H1N1) pandemic in this tropical/semi-arid region had a lower magnitude when compared to states in the Southern and Southeastern regions of Brazil.

Incremento de casos e melhoria da informação sobre tuberculose no Estado do Ceará, Brasil, após o relacionamento de bases de dados / Increase of cases and improvement of information on tuberculosis in the state of Ceará, Brazil, after the database merger

Resumo Introdução O estudo mensurou o incremento de casos de tuberculose e a melhoria das informações sobre o registro da infecção por HIV e encerramento no SINAN TB, após seu relacionamento com o SIM e SINAN Aids. Métodos Estudo seccional baseado no relacionamento de casos diagnosticados de tuberculose e óbitos tendo tuberculose como causa básica ou associada em maiores de 15 anos, entre 2005-2014, residentes no Ceará. Resultados Houve acréscimo de 2.325 (6%) casos após relacionamento entre SINAN TB, óbitos por tuberculose (causa básica ou associada) do SIM e casos de coinfecção TB/HIV no SINAN Aids, como também melhoria das informações quanto aos critérios de encerramento e registro da infecção por HIV. O incremento foi maior em municípios de pequeno porte. Conclusão Destacam-se a importância da investigação de óbito por tuberculose, expansão de núcleos de vigilância epidemiológica nos hospitais e postos de saúde, uso de relacionamento de dados pela coordenação municipal para avaliar a subnotificação e captação oportuna dos casos pelas unidades de saúde.

Abstract Introduction The study measured the increase of tuberculosis (TB) cases and improved information on HIV infection registration and non-SINAN TB closure after its merger with SIM and SINAN AIDS. Methods This was a sectional study without treatment of diagnosed cases of tuberculosis and deaths, having TB as underlying or associated cause on people older than 15 years, from 2005 to 2014, residents in Ceará. Results There was an increase of 2,325 (6%) cases after the merger of SINAN TB, TB deaths (underlying or associated cause) SIM and cases of TB/HIV in SINAN AIDS, as well as improving information about the closure criteria and registration of HIV infection. The increase was higher in small municipalities. Conclusion The importance of tuberculosis death investigation, the expansion of epidemiological surveillance nuclei in hospitals and health stations, the use of data communication for municipal coordination to assess underreporting and timely collection of cases by health facilities are highlighted.

Factors associated with pulmonary tuberculosis among patients seeking medical attention at referral clinics for tuberculosis.

OBJECTIVE: The identification of behavioral and clinical factors that are associated with pulmonary tuberculosis might improve the detection and treatment of the disease, thereby reducing its duration and transmission. Our objective was to identify sociodemographic, clinical, and behavioral factors that are associated with the diagnosis of pulmonary tuberculosis. METHODS: This was a cross-sectional study conducted between April of 2008 and March of 2009 at three health care clinics in the city of Fortaleza, Brazil. We selected 233 patients older than 14 years of age who spontaneously sought medical attention and presented with cough for > 2 weeks. Sociodemographic, clinical, and behavioral data were collected. Sputum smear microscopy for AFB and mycobacterial culture were also carried out, as were tuberculin skin tests and chest X-rays. The patients were divided into two groups (with and without pulmonary tuberculosis). The categorical variables were compared by the chi-square test, followed by logistic regression analysis when the variables were considered significant. RESULTS: The prevalence of pulmonary tuberculosis was 41.2%. The unadjusted OR showed that the following variables were statistically significant risk factors for pulmonary tuberculosis: fever (OR = 2.39; 95% CI, 1.34-4.30), anorexia (OR = 3.69; 95% CI, 2.03-6.75), and weight loss (OR = 3.37; 95% CI, 1.76-6.62). In the multivariate analysis, only weight loss (OR = 3.31; 95% CI, 1.78-6.14) was significantly associated with pulmonary tuberculosis. CONCLUSIONS: In areas with a high prevalence of tuberculosis, weight loss could be used as an indicator of pulmonary tuberculosis in patients with chronic cough for > 2 weeks.

Paracoccidioidomycosis: description of two cases autochthonous in Ceará.

Paracoccidioidomycosis is endemic in most countries of Latin America. Brazil has the greatest number of cases, with no autochthonous case registered in the state of Ceará. The cases of two patients that had never gone outside the State of Ceará and lived at least some years in the municipality of Palmácia.

Health team training and active community surveillance: strategies for the detection of TB cases.

OBJECTIVE: To evaluate the impact that Family Health Program (FHP) team training and active surveillance have on the detection of TB cases in a low-income community in the city of Fortaleza, Brazil. METHODS: The study was performed in an area with approximately 25,000 inhabitants, served by a health care center with five FHP teams, in the city of Fortaleza, Brazil. Although all of the teams were trained, active surveillance was carried out only in one of the areas (area 5). We compared the number of TB cases detected in each of the five areas prior to and after the intervention. We also compared the number of TB cases detected in area 5 to the number of those detected in the other areas, as well as to the citywide number of reported TB cases in Fortaleza, within the same period. RESULTS: The number of TB cases detected in the area studied increased from 1 in 2002 to 22 in 2004 (p < 0.05). There was no significant difference between the number of TB cases in area 5 and that observed for each of the other four areas (p > 0.05). There was a significant increase in the number of TB cases detected in the area studied when compared to the city as a whole (p < 0.05). CONCLUSIONS: Training and sensitization of FHP professionals were effective in promoting an increase in the number of TB cases detected in a low-income community.

Histoplasmin suvvey in hiv-positive patients: rsults from an endemic area in nnortheastern Brazil / Inquerito com histoplasmina em pacientes HIV positivos: resultados de uma area endemica no nordeste do Brasil

SUMMARY Background. Disseminated histoplasmosis is common in AIDS patients with advanced immunosuppression in Ceará, Northeastern Brazil. The goal of this study was to determine the prevalence of Histoplasma infection in patients with HIV/AIDS living in Fortaleza, the capital of Ceará. Methods. Intradermal tests with histoplasmin (mycelial phase) were performed in 161 HIV patients with CD4 ≥ 350 cells/mm 3 . Evidence of recent illness was evaluated with immunodiffusion (ID) tests in 76 of these individuals. Results. A total of 11.8% of patients reacted to histoplasmin and 2.63% had ID test positive to Histoplasma. The presence of mango trees (Mangifera indica) in the patient neighborhood (OR = 2.870; 95% CI = 1.081-7.617; p = 0.040) and past activity involving soil (OR = 2.834; 95% CI = 1.045-7.687; p = 0.045) or visits to a farm (OR = 3.869; 95% CI = 1.189-12.591; p = 0.033) were significantly associated with Histoplasma infection. Conclusions. Patients with HIV living in Fortaleza have an expressive prevalence of infection with Histoplasma. .

RESUMO Introdução: Histoplasmose disseminada ocorre com grande frequência em pacientes com aids e imunossupressão avançada no Ceará, Brasil. O objetivo deste artigo é determinar a prevalência da infecção por Histoplasma em pacientes com HIV/aids residentes em Fortaleza capital. Métodos. Testes intradérmicos com histoplasmina (fase micelial), foram realizados em 161 pacientes com CD4 ≥ 350 células/mm 3 . Doença recente foi estudada por imunodifusão em 76 desses indivíduos. Resultados. Reagiram à histoplasmina, 11,8% dos pacientes e à imunodifusão para Histoplasma: 2,63%. A presença da árvore mangueira (Mangifera indica) na vizinhança (OR = 2,870; IC 95% = 1,081-7,617; p = 0,040), atividade com o solo no passado (OR = 2,834; IC 95% = 1,045-7,687, p = 0,045) e visitar sítio no passado (OR = 3,869; IC 95% = 1,189-12,591; p = 0,033); foram significativamente associados com positividade para o teste. Conclusões. Pacientes com HIV que vivem em Fortaleza apresentam uma prevalência expressiva de infecção por Histoplasma. .

Pandemic influenza A (H1N1) 2009: epidemiological analysis of cases in a tropical/semi-arid region of Brazil

Introduction The year 2009 marked the beginning of a pandemic caused by a new variant of influenza A (H1N1). After spreading through North America, the pandemic influenza virus (H1N1) 2009 spread rapidly throughout the world. The aim of this study was to describe the clinical and epidemiological characteristics of cases of pandemic influenza in a tropical/semi-arid region of Brazil. Methods A retrospective study analyzed all suspected cases of pandemic influenza (H1N1) 2009 reported in the Ceará State through the National Information System for Notifiable Diseases during the pandemic period between 28 April, 2009 and November 25, 2010. Results A total of 616 suspected cases were notified, 58 (9.4%) in the containment phase and 558 (90.6%) in the mitigation phase. Most cases were of affected young people resident in the City of Fortaleza, the largest urban center in the State of Ceará. The most frequent symptoms presented by the cases with confirmed infection were fever, cough, myalgia, arthralgia, and nasal congestion. Mortality rate was 0.0009/1,000 inhabitants and lethality was 5.6%. Deaths were observed only in the mitigation phase. Mortality rates were similar for both sexes but were higher in the age group under 5 years. Conclusions The study suggests that the influenza A (H1N1) pandemic in this tropical/semi-arid region had a lower magnitude when compared to states in the Southern and Southeastern regions of Brazil. .

Fatores associados à tuberculose pulmonar em pacientes que procuraram serviços de saúde de referência para tuberculose / Factors associated with pulmonary tuberculosis among patients seeking medical attention at referral clinics for tuberculosis

OBJETIVO: A identificação de fatores comportamentais e clínicos associados à tuberculose pulmonar pode melhorar a detecção e o tratamento dessa doença, consequentemente reduzindo sua duração e transmissão. Nosso objetivo foi identificar fatores sociodemográficos, clínicos e comportamentais associados à tuberculose pulmonar. MÉTODOS: Estudo transversal realizado entre abril de 2008 e março de 2009 em três unidades de saúde na cidade de Fortaleza (CE). Foram selecionados 233 pacientes maiores de 14 anos que procuraram atendimento médico espontaneamente e que apresentavam tosse por > 2 semanas. Foram coletados dados sociodemográficos, clínicos e comportamentais. Foram realizadas baciloscopia direta para BAAR e cultura de micobactérias, bem como testes tuberculínicos e radiografias de tórax. Os pacientes foram divididos em dois grupos (com e sem tuberculose pulmonar). As variáveis categóricas foram comparadas com o teste do qui-quadrado, seguido de análise de regressão logística quando as variáveis foram consideradas significativas. RESULTADOS: A prevalência de tuberculose pulmonar foi 41,2%. As OR não ajustadas indicaram que as seguintes variáveis foram fatores de risco significativos para tuberculose pulmonar: febre (OR = 2,39; IC95%: 1,34-4,30), anorexia (OR = 3,69; IC95%: 2,03-6,75) e perda de peso (OR = 3,37; IC95%: 1,76-6,62). Na análise multivariada, apenas perda de peso (OR = 3,31; IC95%: 1,78-6,14) associou-se significativamente com tuberculose pulmonar. CONCLUSÕES: Em áreas com elevada prevalência de tuberculose, a perda de peso poderia ser utilizada como um indicador de tuberculose pulmonar em pacientes com tosse crônica por > 2 semanas.

OBJECTIVE: The identification of behavioral and clinical factors that are associated with pulmonary tuberculosis might improve the detection and treatment of the disease, thereby reducing its duration and transmission. Our objective was to identify sociodemographic, clinical, and behavioral factors that are associated with the diagnosis of pulmonary tuberculosis. METHODS: This was a cross-sectional study conducted between April of 2008 and March of 2009 at three health care clinics in the city of Fortaleza, Brazil. We selected 233 patients older than 14 years of age who spontaneously sought medical attention and presented with cough for > 2 weeks. Sociodemographic, clinical, and behavioral data were collected. Sputum smear microscopy for AFB and mycobacterial culture were also carried out, as were tuberculin skin tests and chest X-rays. The patients were divided into two groups (with and without pulmonary tuberculosis). The categorical variables were compared by the chi-square test, followed by logistic regression analysis when the variables were considered significant. RESULTS: The prevalence of pulmonary tuberculosis was 41.2%. The unadjusted OR showed that the following variables were statistically significant risk factors for pulmonary tuberculosis: fever (OR = 2.39; 95% CI, 1.34-4.30), anorexia (OR = 3.69; 95% CI, 2.03-6.75), and weight loss (OR = 3.37; 95% CI, 1.76-6.62). In the multivariate analysis, only weight loss (OR = 3.31; 95% CI, 1.78-6.14) was significantly associated with pulmonary tuberculosis. CONCLUSIONS: In areas with a high prevalence of tuberculosis, weight loss could be used as an indicator of pulmonary tuberculosis in patients with chronic cough for > 2 weeks.

Evolution of tuberculosis-related mortality in Fortaleza, Brazil from 1980 to 2001.

OBJECTIVE: To evaluate the evolution of tuberculosis-related mortality, as well as gender-related and age-related tendencies, in the city of Fortaleza, Brazil. METHODS: A descriptive study, based on secondary data, was conducted. All deaths from tuberculosis occurring among residents of Fortaleza in the 1980-2001 period and reported to the Ministry of Health via the Mortality Database were included. The evolution of tuberculosis-related mortality was compared with that of overall mortality and with that of mortality from all infectious diseases. The tendencies of the coefficients of overall mortality and of tuberculosis-related mortality, adjusted and unadjusted for age and gender, were calculated for the study period. RESULTS: The coefficients of overall mortality and of tuberculosis-related mortality presented decreasing tendencies. The coefficient of tuberculosis-related mortality presented a decreasing tendency in individuals = 19 years of age (y = -0.0906x + 2.5133), from 20 to 59 years of age (y = -0.414x + 12.29) and 60 years of age (y = -1.2494x + 40.289), as well as in males (y = -0.3175x + 10.971) and females (y = -0.1933x + 6.8051). CONCLUSION: Despite displaying a decreasing tendency, the coefficient of tuberculosis-related mortality remains high.

Paracoccidioidomycosis: description of two cases autochthonous in Ceará

Paracoccidioidomycosis is endemic in most countries of Latin America. Brazil has the greatest number of cases, with no autochthonous case registered in the state of Ceará. The cases of two patients that had never gone outside the State of Ceará and lived at least some years in the municipality of Palmácia.

Tuberculose em ambiente hospitalar: perfil clínico em hospital terciáriodo Ceará e grau de conhecimento dos profissionais de saúde acerca das medidas de controle / Tuberculosis in hospital environment: clinical profile in a tertiary hospital from Ceará and level of knowledge of health personnel about control measures

Descrever características epidemiológicas e clínicas de pacientes internados com tuberculose (TB), além de avaliar o grau de conhecimento de profissionais de saúde acerca de conceitos fundamentais sobre TB e medidas de controle para pacientes com tuberculose pulmonar em ambiente hospitalar. Métodos: Estudo realizado em hospital terciário de Fortaleza-CE envolvendo pacientes internados com TB e profissionais de saúde responsáveis pela assistência. Uma primeira fase caracterizou-se por estudo retrospectivo com revisão de prontuários de pacientes admitidos com suspeita de TB. Em uma segunda etapa, estudo transversal com aplicação de questionário estruturado avaliou conhecimentos dos profissionais de saúde sobre o controle da TB em ambiente hospitalar. Resultados: Sessenta e sete pacientes admitidos com suspeita de TB tiveram seus prontuários avaliados. Entre os casos confirmados, a forma clínica mais freqüente foi a pulmonar (81,3%). Dos 55 pacientes internados com suspeita de tuberculose pulmonar, apenas 29 (52,7%) foram admitidos em leito de isolamento respiratório. Vinte e seis pacientes com suspeita de tuberculose pulmonar à admissão totalizaram 148 dias internados fora de isolamento respiratório (média de 4,1 dias/paciente). Avaliou-se o conhecimento de 159 profissionais de saúdeacerca de TB. Em relação à transmissão da TB, 107 (67,2%) desconheciam a transmissão por aerossóis e 109 (68,5%) desconheciam as formas clínicas que requerem isolamento respiratório. Conclusões: Tuberculose pulmonar é a forma clínica mais freqüente entre pacientes internados em hospital terciário de Fortaleza-CE. Parcela considerável de profissionais de saúde desconhece conceitos fundamentais relativos à tuberculose e essenciais para a assistência adequada e segura. Descritores: Tuberculose; Transmissão de Doença Infecciosa; Exposição a Agentes Biológicos; Pessoal de saúde.

To describe clinical and epidemiological characteristics of inpatients with tuberculosis (TB) and to assess the knowledge of health personnel on fundamental concepts about TB and control measures for pulmonary tuberculosis in a hospital environment. Methods: The study was conducted in a tertiary hospital in Fortaleza-CE and involved patients admitted with TB and health professionals responsible for assistance. A first phase was characterized by a retrospective study of medical records of patients admitted with suspected TB. In a second stage, a cross-sectional study with application of a structured questionnaire assessed the knowledge of health personnel on TB control measures in a hospital environment. Results: Sixty-seven patients admitted with suspected TB had their medical records assessed. Among the confirmed cases, the most frequent clinical form was pulmonary (81.3%). Out of 55 patients admitted with suspected pulmonary tuberculosis, only 29 (52.7%) were admitted in a respiratory isolation bed. Twenty-six patients with suspected pulmonary tuberculosis on admission stayed a total of 148 days out of a respiratory isolation bed (average 4.1 days / patient). The knowledge of 159 health professionals about TB was assessed. Regarding the transmission of TB, 107 (67.2%) were unaware of airborne transmission and 109 (68.5%) ignored the clinical forms that require respiratory isolation. Conclusions: Pulmonary tuberculosis is the most frequent clinical form among inpatients in a tertiary hospital in Fortaleza-CE. Considerable fraction of health personnel doesn?t know key concepts related to tuberculosis and essential for the proper and safe care. Descriptors: Tuberculosis; Infectious Disease Transmission; Exposure to Biological Agents; Health personnel.