Mauro Abrahão Rozman

Resistência do Mycobacterium tuberculosis às drogas em pacientes HIV+ em cinco municípios da Baixada Santista, São Paulo, Brasil

Since the early 1990s, an increase in Mycobacterium tuberculosis drug resistance has been reported, with high prevalence among HIV+ patients. We evaluated the sensitivity patterns of M. tuberculosis, resistance rate, and predisposing factors among HIV+ patients in Santos, Sao Vicente, Cubatao, Praia Grande, and Guaruja, Sao Paulo State, Brazil. The medical charts of 301 patients with positive cultures for M. tuberculosis from 1993 to 2003 were reviewed. Resistance occurred in 57 patients (18.9%), as follows: 32 (10.6%) displayed multidrug-resistant tuberculosis (resistant to at least Rifampicin and Isoniazid); 4 (1.3%) were resistant to two or more drugs; and 21 (7%) were resistant to a single drug. Acquired resistance was observed in 70.1% of cases. Drug resistance was significantly associated with previous tuberculosis treatment, duration of HIV diagnosis, and previous hospitalization. In logistic regression analysis, only previous tuberculosis treatment adjusted by age remained as an independent risk factor (OR = 5.49; 95%CI: 2.60-11.60). Drug resistance to at least one drug in 18.9% and multidrug resistance in 10.6% of cases highlight the relevance of this problem in HIV patients in the Baixada Santista.

HIV infection and related risk behaviors in a community of recyclable waste collectors of Santos, Brazil

OBJETIVO: Estimar a soroprevalencia de HIV, Hepatites B e C e sifilis e descrever os comportamentos de risco associados a sua transmissao entre coletores autonomos de lixo. METODOS: Um inquerito soroepidemiologico foi conduzido na cidade de Santos (SP), em 2005. Um total de 315 individuos foi incluido no estudo, dos quais 253 submeteram-se a testes sorologicos para HIV, Hepatites B e C e sifilis. A analise estatistica consistiu de analises uni e bivariadas (tabulacao cruzada e odds ratio) e analise multivariada (por regressao logistica), relacionando a infeccao por HIV com os fatores de risco estabelecidos e soropositividade. RESULTADOS: As soroprevalencias totais foram: HIV, 8,9%; Hepatite B, 34,4%; Hepatite C, 12,4%; e sifilis, 18,4%. A amostra foi caracterizada por predominância de individuos do sexo masculino, com baixos niveis economicos e educacionais e sujeitos a exposicao parenteral e sexual ao HIV e outras doencas sexualmente transmissiveis. Os resultados da analise multivariada indicaram que fatores de risco ligados tanto a exposicao sexual quanto a parenteral estao significativamente associados ao HIV nesta comunidade. CONCLUSOES: As soroprevalencias encontradas no estudo foram aproximadamente 10 a 12 vezes maiores que a media nacional. Estas comunidades sao socialmente marginalizadas e geralmente nao reconhecidas pelos programas nacionais como populacoes de risco potencial.OBJECTIVE To estimate the seroprevalence of HIV, hepatitis B and C and syphilis and to describe risk behaviors associated to their transmission among recyclable waste collectors. METHODS A seroepidemiological survey was carried out in the city of Santos, Southeastern Brazil, in 2005. A total of 315 individuals were enrolled in the survey, of which 253 subjects underwent serological testing HIV, hepatitis B and C and syphilis. Statistical analysis consisted of univariate and bivariate analyses (cross-tabulation and odds ratio) and multivariate analysis (by logistic regression), relating HIV infection with established risk behaviors and seropositivity. RESULTS Overall seroprevalences were: HIV, 8.9%; hepatitis B, 34.4%; hepatitis C, 12.4%; and syphilis, 18.4%. Subjects were characterized by a predominance of males with low educational and economic levels, subjected to parenteral and sexual exposures to HIV and other sexually transmitted infections. Multivariate analysis results indicated that risk factors for both sexually and parenterally related exposure were significantly associated with HIV in this community. CONCLUSIONS Seroprevalences found in the study were approximately 10 to 12 times higher than the national average. These communities are socially marginalized and generally not recognized by national programs as potentially endangered populations.

Necropsia e mortalidade por causa mal definida no Estado de São Paulo, Brasil

OBJECTIVE: To investigate the proportion of deaths with an ill-defined cause in the Brazilian state of Sao Paulo between 1980 and 2002, taking into account the influence of autopsies on this proportion. METHOD: Data on the number of deaths were obtained from the Brazilian Ministry of Health. The communities of the state of Sao Paulo were divided into three groups: (1) municipalities with a service to verify the cause of death (and that may conduct an autopsy), (2) municipalities without a cause of death verification service, and (3) the region of Baixada Santista, which had an extremely large increase in the proportion of deaths from ill-defined causes between 1980 and 1995. The impact of autopsies on the proportion of deaths with an ill-defined cause was defined based on the classification made by the first physician evaluating the cause of death, that is, the physician who referred the case to the verification service for autopsy or who completed the death certificate without referring the case to the verification service. Deaths from external causes were excluded, since autopsy is mandatory in these cases. The following were evaluated: (1) proportion of cases classified by the first evaluating physician as having an ill-defined cause, (2) proportion of autopsies in relation to the total number of deaths (except from external causes), and (3) proportion of deaths classified as ill-defined by the first evaluating physician but explained by the autopsy. RESULTS: The proportion of deaths classified by the first evaluating physician as having an ill-defined cause increased over the 1980-2002 period in all three groups studied: the municipalities with a verification service, the municipalities without a verification service, and in the Baixada Santista region. For the state of Sao Paulo overall, the increase was almost 30% over that 1980-2002 period. For the 1998-2002 period, the average proportion of autopsies compared to the total number of deaths (except from external causes) was 21.2% in the municipalities with a verification service, 6.4% in the municipalities without a verification service, and 2.6% in Baixada Santista. The proportion of deaths in 1998-2002 initially classified as having an ill-defined cause but that was explained by autopsy was 92.9% in the municipalities with a verification service, 32.5% in the municipalities without a verification service, and 10.7% in Baixada Santista. CONCLUSIONS: The performance of autopsies accounts for the difference in proportional mortality with an ill-defined cause in the three groups of communities studied. The increase in the number of deaths classified as ill-defined by the first evaluating physician occurring in the state of Sao Paulo over the 1980-2002 period suggests an important decline in the quality of death certificates completed at that first level. More research should be done on the reasons for that change.

Anemia em catadores de material reciclável que utilizam carrinho de propulsão humana no município de Santos

OBJETIVO: Estimar a prevalencia de anemia e analisar os fatores de risco a ela associados nos catadores de material reciclavel que utilizam carrinho de propulsao humana do municipio de Santos - Sao Paulo. METODO: Estudo transversal com 253 catadores foi realizado em julho de 2005. A coleta de informacoes foi feita por meio de questionario com informacoes sobre caracteristicas individuais, ocupacionais e dieteticas. Foi realizada avaliacao antropometrica e coletado sangue venoso para hemograma completo e sorologias de HIV, HCV, HBV e sifilis. A analise estatistica foi feita por analise uni e multivariada (regressao logistica), relacionando a anemia aos fatores de risco. RESULTADOS: A prevalencia de anemia foi de 38,3%. As variaveis que mostraram associacao independente com anemia no modelo multivariado foram: sexo (OR 4,11; IC95%: 1,56-10,87), infeccao pelo HIV (OR 9,23; IC95%: 2,93-29,1), IMC (OR 0,21; IC95%: 0,07-0,64), anos de trabalho como catador (OR 4,54; IC95%: 1,29-16,0), consumo de leite (OR 0,36; IC95%: 0,16-0,81) e de proteina animal (OR 0,39; IC95%: 0,15-0,97). CONCLUSAO: A prevalencia de anemia entre catadores de material reciclavel e elevada mesmo apos a obrigatoriedade de adicao de ferro nas farinhas de trigo e milho. Os catadores sao excluidos das acoes de protecao a saude do trabalhador, previstas na legislacao. Acoes de saude dirigidas a essa categoria profissional devem ser implementadas, garantindo a acessibilidade aos servicos de saude.

HIV and related infections in a sample of recyclable waste collectors of Brazil

Tasked by the Ministry of Health the Chinese Medical Association organized experts to develop these Guidelines for Diagnosis and Treatment of HIV/AIDS. Based on the latest national and international research developments these guidelines adopt an evidence-based approach taking into account the characteristics of Chinas situation. Topics include epidemiology etiology pathogenesis pathological changes clinical presentation and staging laboratory tests diagnosis highly active antiretroviral therapy (HAART) diagnosis and treatment of common opportunistic infections (OIs) prevention of mother-to-child transmission (PMTCT) and post-exposure prophylaxis. Special attention focuses on the antiretroviral therapy. Features of these guidelines include: 1) systematic and comprehensive coverage from basic science to the clinical from treatment to prophylaxis; 2) evidence-based medicine that avoids recommending views and approaches yet to be proven; 3) clinically practical and innovative buildingupon the consensus from Chinese experts (particularly in regard to HIV clinical staging and diagnostic criteria) epidemiology of HIV and AIDS in China and the clinical characteristics of Chinese AIDS patients; 4) recommendation of HAART regimens based on in-country drug availability. (excerpt)As the Brazilian economic crisis got worse in the 1980s thousands of people started to collect waste from the streets and disposal areas and sold it to recycling mills. In Brazil it is estimated that the number of recyclable waste collectors increased from 150000 in 1999 to 500000 in 2004. An important aspect characterizing this vulnerable group is the fact that most preventive policies related to sexually transmitted infections are aimed at groups and populations more exposed to them but excluding the marginal group of street dwellers like the great majority of waste collectors. This work follows a long line of research dealing with HIV transmission dynamics in socially vulnerable communities of Brazil. (excerpt)

Incidência de dermatoses em neonatos de enfermaria para gestantes de risco em hospital público

RESUMOobjetivos: O principal objetivo deste trabalho foi estudar as dermatoses em uma populacao especifica de recem-nascidos do Hospital Guilherme Alvaro (Santos, SP), verificando-se a possivel correlacao dessas dermatoses com doencas apresentadas pelas maes durante a gestacao.Metodos:Mil criancas recem-nascidas foram examinadas nas primeiras 36 horas de vida e reexaminadas todos os dias seguintes, ate a alta hospitalar. As variaveis paternas e as dos recem-nascidos foram submetidas a analise para se detectarem relacoes significativas estatisticamente.Resultados:As dermatoses mais diagnosticadas foram: mancha mongolica (69,8%), [...]

Incidence of skin conditions in neonates born at a public hospital associated with some variables in pregnant women at risk

OBJECTIVES To verify the incidence of skin diseases in newborns of pregnant women at risk of a public hospital in the city of Santos, Brazil (Hospital Guilherme Alvaro), determining the potential relation between these dermatoses and diseases presented by the mothers. METHODS A total of 1,000 neonates were examined in the first 36 hours of life. The examination was repeated daily in each child up to hospital discharge. The paternal and newborn variables were submitted to analysis to detect statistically significant associations. RESULTS The most frequent skin disorders were: Mongolian spot (69.8%), erythema toxicum neonatorum (19.7%), Port-wine stain (angiomatous naevi) (13.9%), and hypertrichosis lanuginose (10.3%). CONCLUSIONS Minipuberty had a low incidence in neonates of diabetic mothers. The incidence of Mongolian spot was very low among newborns classified as caucasian.

Infecção por HIV e comportamentos de risco relacionados em coletores de lixo de Santos, Brasil

OBJETIVO: Estimar a soroprevalencia de HIV, Hepatites B e C e sifilis e descrever os comportamentos de risco associados a sua transmissao entre coletores autonomos de lixo. METODOS: Um inquerito soroepidemiologico foi conduzido na cidade de Santos (SP), em 2005. Um total de 315 individuos foi incluido no estudo, dos quais 253 submeteram-se a testes sorologicos para HIV, Hepatites B e C e sifilis. A analise estatistica consistiu de analises uni e bivariadas (tabulacao cruzada e odds ratio) e analise multivariada (por regressao logistica), relacionando a infeccao por HIV com os fatores de risco estabelecidos e soropositividade. RESULTADOS: As soroprevalencias totais foram: HIV, 8,9%; Hepatite B, 34,4%; Hepatite C, 12,4%; e sifilis, 18,4%. A amostra foi caracterizada por predominância de individuos do sexo masculino, com baixos niveis economicos e educacionais e sujeitos a exposicao parenteral e sexual ao HIV e outras doencas sexualmente transmissiveis. Os resultados da analise multivariada indicaram que fatores de risco ligados tanto a exposicao sexual quanto a parenteral estao significativamente associados ao HIV nesta comunidade. CONCLUSOES: As soroprevalencias encontradas no estudo foram aproximadamente 10 a 12 vezes maiores que a media nacional. Estas comunidades sao socialmente marginalizadas e geralmente nao reconhecidas pelos programas nacionais como populacoes de risco potencial.OBJECTIVE To estimate the seroprevalence of HIV, hepatitis B and C and syphilis and to describe risk behaviors associated to their transmission among recyclable waste collectors. METHODS A seroepidemiological survey was carried out in the city of Santos, Southeastern Brazil, in 2005. A total of 315 individuals were enrolled in the survey, of which 253 subjects underwent serological testing HIV, hepatitis B and C and syphilis. Statistical analysis consisted of univariate and bivariate analyses (cross-tabulation and odds ratio) and multivariate analysis (by logistic regression), relating HIV infection with established risk behaviors and seropositivity. RESULTS Overall seroprevalences were: HIV, 8.9%; hepatitis B, 34.4%; hepatitis C, 12.4%; and syphilis, 18.4%. Subjects were characterized by a predominance of males with low educational and economic levels, subjected to parenteral and sexual exposures to HIV and other sexually transmitted infections. Multivariate analysis results indicated that risk factors for both sexually and parenterally related exposure were significantly associated with HIV in this community. CONCLUSIONS Seroprevalences found in the study were approximately 10 to 12 times higher than the national average. These communities are socially marginalized and generally not recognized by national programs as potentially endangered populations.