Elisangela C Silva

Objective: To analyze the association of dysglycemia with clinical, laboratory, and radiographic characteristics of patients with pulmonary tuberculosis (PTB), as well as with their tuberculo-sis treatment outcomes. Methods: This was a longitudinal study involving 140 patients diag-nosed with PTB (positive cultures for Mycobacterium tuberculosis or positive Xpert MTB/RIF results from sputum samples). Patients were evaluated at diagnosis (M0), after completing the second month of treatment (M2), and at the end of treatment (MEND). At M0, the pati-ents were classified into three groups: normoglycemia+PTB (NGTB); pre-diabetes melli-tus+PTB (PDMTB), and diabetes mellitus+PTB (DMTB), in accordance with glycated hemoglo-bin levels (< 5.7%, 5.7%-6.4%, and = 6.5%, respectively). Treatment outcomes were classified as favorable (cure or treatment completion) and unfavorable (death, loss to follow-up, or treatment failure). Results: In our sample, 76 patients (61.4%) had dysglycemia, 20 of ...

APRESENTAÇÃO Este 14º volume de resumos, o 4º publicado como Suplemento da Revista Arquivos Médicos dos Hospitais e da Faculdade de Ciências Médicas da Santa Casa de São Paulo, dos Trabalhos de Conclusão do Curso (TCC) de Graduação em Enfermagem das 26ª, 27ª e 28ª turmas de alunos, foi organizado em duas grandes linhas de pesquisa. A primeira linha, Cuidar em Enfermagem, inclui estudos sobre diferentes aspectos da assistência de enfermagem nas áreas da Saúde do Adulto e do Idoso, Saúde da Mulher e Saúde da Criança e do Adolescente, inseridos nos níveis de atenção: primária, secundária e terciária. A segunda linha de pesquisa, Trabalho e Educação em Enfermagem, inclui dentre outros, estudos sobre conhecimentos, atitudes, qualidade de vida, acidentes e condições de trabalho dos enfermeiros, alunos e profissionais de saúde.As Organizadoras

<p>Lung cells were isolated on days 21, 28, 45, 120 and 150 after i.t. infection and cultured in 96-well plates, 5 x 10<sup>4</sup> cells/well. Culture supernatants were collected after 48 h of incubation and cytokine concentrations were measured by the Multiplex method. The data were obtained in three independent experiments. Significant differences between infected and uninfected groups are indicated by asterisks * (p <0.05). Mean values of groups infected by strain M299 that were significantly different from the respective mean value of groups infected by strain H37Rv are indicated by octothorpes # (p < 0.05). ND- not defined.</p

Background It is unclear whether diabetes or prediabetes affects unfavorable treatment outcomes and death in people with tuberculosis (PWTB). Methods Culture-confirmed, drug-susceptible PWTB, enrolled in the Regional Prospective Observational Research in Tuberculosis (RePORT)–Brazil cohort between 2015 and 2019 (N = 643) were stratified based on glycemic status according to baseline glycated hemoglobin. Unfavorable tuberculosis (TB) outcome was defined as treatment failure or modification, recurrence, or death; favorable outcome was cure or treatment completion. We corroborated the findings using data from PWTB reported to the Brazilian National System of Diseases Notification (SINAN) during 2015–2019 (N = 20 989). Logistic regression models evaluated associations between glycemic status and outcomes. Results In both cohorts, in univariate analysis, unfavorable outcomes were more frequently associated with smoking, illicit drug use, and human immunodeficiency virus infection. Diabet...

<p>Mice were intratracheally infected with ~100 CFU. Pathologic alterations of lung tissue were determined on day 15 p.i. (<b>A</b>), day 21 p.i. (<b>B, C</b>) and day 28 p.i. (<b>D- I</b>) by microscopy of lung sections stained with hematoxylin-eosin (<b>A- F</b>) and Ziehl-Neelsen (<b>G- I</b>). Panel <b>A</b> shows interstitial granulomatous infiltrates on day 15 p.i. Panels <b>B</b> and <b>C</b> show the development of alveolitis through infiltration of alveoli (black arrows) with inflammatory cells, predominantly by neutrophils (enclosed in black circles). Panels <b>D</b> and <b>G</b> show coalescing foci of tuberculous pneumonia leading to the formation of tubercules with extensive areas of central caseous necrosis (black stars). The peripheral zone of the necrotic lesion is amplified in <b>E</b> and <b>H</b>, demonstrating areas of alveolitis (black arrows) with thickened alveolar walls and intra-alveolar cellular exudates composed predominantly of neutrophil debris (<b>E</b>) and numerous AFB (<b>H</b>). The caseous core is amplified in <b>F</b> and <b>I</b>. Note the thrombosed septal capillaries (black arrow heads) and obstruction of small airways with cellular debris (white arrow) in the peripheral rim of the necrotic zone (<b>F</b>). Numerous extracellular AFB and clumps of bacteria can be seen in the necrotic area (<b>I</b>). Data are representative of four independent experiments. Bars represent 500 μm—in the panels D and G, 200 μm—in B, E and H, 100 μm—in A, F and I and 20 μm—in C.</p

Os efeitos do treinamento concorrente (TC) vem sendo estudado desde a década de 80. Contudo, ainda existem muitas controversas sobre o seu efeito crônico. O objetivo deste estudo foi analisar trabalhos que compararam o comportamento de variáveis relacionadas à morfologia e a performance após a realização do TC. Para tal, foram selecionados 26 artigos no PubMed, SciELO, LILACS e no Google Acadêmico que estudaram seu efeito crônico em seres humanos adultos. Após análise dessas pesquisas observou-se que o TC é capaz de proporcionar uma manutenção ou melhora da composição corporal e do VO2máx. Em relação à força máxima, todos os estudos apresentaram um aumento significativo após a realização do TC. Contudo, em altas velocidades, como na potência, em alguns casos apenas houve a manutenção dos valores iniciais. Embora o TC possa não ser compatível com o desenvolvimento da potência, quando discutimos seus benefícios relacionados à saúde, ele se mostrou eficaz.

Atualmente a saude do trabalhador vem sendo prejudicada, atraves das doencas decorrentes a jornada monotona e repetitiva de trabalho. Com as exigencias diarias aumentando, vao surgindo os fatores estressores e a sonolencia diurna, que resultam em queda de rendimento, absenteismo no trabalho. Assim o objetivo deste estudo comparar o nivel de estresse e a sonolencia diurna em servidores que realizam funcoes de trabalho leve na posicao sentada ou trabalho moderado na posicao ortostatica do Instituto Federal de Educacao, Ciencia e Tecnologia do Sul de Minas Gerais - Câmpus Muzambinho. A amostra composta por 68 individuos sendo 45 do sexo feminino e 23 do sexo masculino, todos servidores do Instituto Federal do Sul de Minas Gerias - Câmpus Muzambinho a no minimo 6 meses e com uma jornada de trabalho de oito horas diarias. Para identificacao da percepcao de estresse dos servidores, aplicou-se o Questionario de Estresse Percebido (EPS-10) e para verificarmos a sonolencia diurna utilizou-se...

Background: Interferon-gamma release assay (IGRA) has emerged as a useful tool in identifying latent tuberculosis infection (LTBI). This assay can be performed through testing platforms, such as QuantiFERON-TB Gold Plus (QFT-Plus). This in vitro test has been incorporated by several guidelines worldwide and has recently been considered for the diagnosis of LTBI by the World Health Organization (WHO). The possibility of systematically implementing IGRAs such as QFT-Plus in centers that perform LTBI screening has been accelerated by the decreased availability of tuberculin skin testing (TST) in several countries. Nevertheless, the process to implement IGRA testing in routine clinical care has many gaps. Methods: The study utilized the expertise acquired by the laboratory teams of the Regional Prospective Observational Research in Tuberculosis (RePORT)-Brazil consortium during study protocol implementation of LTBI screening of TB close contacts. Results: RePORT-Brazil includes clinical...

O grande indice de obesidade mundial e considerado um problema de saude publica e atinge principalmente a fase infantil, podendo causar problemas graves, como a diabetes e doencas do coracao. Por isso, se torna importante a deteccao de sobrepeso e obesidade nessa fase da vida. O objetivo do estudo foi investigar o perfil dos estudantes de 6 a 10 anos de idade da cidade de Muzambinho - MG, com o Indice de Massa Corporal (IMC) e o Percentual de Gordura (PG), atraves das dobras cutâneas. A amostra foi composta por 643 criancas de ambos os sexos, com 312 do sexo feminino e 331 do sexo masculino. Os resultados demonstraram que somente o grupo FEM7 na variavel IMC indicou “sobrepeso” e os meninos no grupo MAS7 e MAS10 foram classificados em “sobrepeso” e os grupos MAS9 e MAS10 apresentaram um %G classificado como “moderadamente alto”. Conclui-se que os estudantes que participaram desta pesquisa na sua maioria apresenta valores normais em relacao ao IMC e ao %G.

The IGRA has emerged as a useful tool for identifying persons with LTBI. Although the implementation of IGRAs is of utmost importance, to our knowledge there is scarce information on the identification of logistical and technical challenges for systematic screening for LTBI on a large scale.

O objetivo deste estudo foi comparar a influencia das pausas ativa e passiva na remocao do lactato em um treinamento de Step Aquatico (SA). O estudo foi realizado com oito mulheres, idade media de 30,6±11,5 anos, estatura 1,60±0,07 m e massa corporal 66,5±5,6 kg. O experimento foi realizado em quatro fases distintas: 1a familiarizacao da atividade de AS; 2a realizacao do teste de Conconi (1982) para determinacao da frequencia cardiaca de limiar (FC) para realizacao da pausa ativa (PA); 3a coletas de lactato ([La]), antes, durante e apos a realizacao da pausa passiva (PP); 4a foram realizadas os mesmos testes da etapa 3, contudo a pausa utilizada foi a ativa. Tanto na fase 3 como na fase 4 a sessao de SA apresentou as mesmas caracteristicas: aquecimento de 5 minutos, com duracao de 20 minutos utilizando uma musica de 165 bpm. A analise estatistica foi feita utilizando o teste de Shapiro Wilk para determinacao da normalidade da amostra, o teste t para amostras independentes, o teste d...

1 Molecular Micobacteriology Laboratory, Research Center in Infectious and Parasitic Diseases, Medicine School, University Hospital Clementino Fraga Filho, Federal University Rio de Janeiro, Brazil. 2Unidade de Medicina Investigativa, Laboratório Integrado de Microbiologia e Imunorregulação (LIMI), Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil. 3Development Center for Technology on Health, Fundação Oswaldo Cruz, Rio de Janeiro,Brazil. 4Ary Parreira Institute, State Secretary of Health of Rio de Janeiro, Brazil. 5Recognize the Biology Laboratory, Center of Bioscience and Biotechnology, State University of North Fluminense Darcy Ribeiro, Rio de Janeiro, Brazil.6Tuberculosis Academic Program, School of Medicine, Federal University of Rio de Janeiro,Brazil.

1 Molecular Micobacteriology Laboratory, Research Center in Infectious and Parasitic Diseases, Medicine School, University Hospital Clementino Fraga Filho, Federal University Rio de Janeiro, Brazil. 2Unidade de Medicina Investigativa, Laboratório Integrado de Microbiologia e Imunorregulação (LIMI), Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil. 3Development Center for Technology on Health, Fundação Oswaldo Cruz, Rio de Janeiro,Brazil. 4Ary Parreira Institute, State Secretary of Health of Rio de Janeiro, Brazil. 5Recognize the Biology Laboratory, Center of Bioscience and Biotechnology, State University of North Fluminense Darcy Ribeiro, Rio de Janeiro, Brazil.6Tuberculosis Academic Program, School of Medicine, Federal University of Rio de Janeiro,Brazil.

Background It is unknown whether dysglycemia is associated with Mycobacterium tuberculosis transmission. Methods We assessed epidemiological and clinical characteristics of patients with culture-confirmed pulmonary tuberculosis and their close contacts, enrolled in a multicenter prospective cohort in Brazil. Contacts were investigated at baseline and 6 months after enrollment. QuantiFERON positivity at baseline and conversion (from negative to positive at month 6) were compared between subgroups of contacts according to glycemic status of persons with tuberculosis (PWTB) as diabetes mellitus (DM) or prediabetes. Multivariable mixed-effects logistic regression models were performed to test independent associations with baseline QuantiFERON positive and QuantiFERON conversion. Results There were 592 PWTB (153 DM, 141 prediabetes, 211 normoglycemic) and 1784 contacts, of whom 658 were QuantiFERON-positive at baseline and 106 converters. Multivariable analyses demonstrated that tubercul...

BackgroundThere are scarce data on the prevalence and disease presentation of HIV in patients with tuberculosis (TB) and dysglycemia (diabetes [DM] and prediabetes [PDM]), especially in TB-endemic countries.MethodsWe assessed the baseline epidemiological and clinical characteristics of patients with culture-confirmed pulmonary TB, enrolled in a multicenter prospective cohort in Brazil (RePORT-Brazil) during 2015-2019. Dysglycemia was defined by elevated glycated hemoglobin and stratified as PDM or DM. Additionally, we used data from TB cases obtained through the Brazilian National Notifiable Diseases Information System (SINAN), during 2015-2019. In SINAN, diagnosis of diabetes was based on self-report. Logistic regression models were performed to test independent associations between HIV, dysglycemia status, and other baseline characteristics in both cohorts.ResultsIn the RePORT-Brazil cohort, the prevalence of DM and of PDM was 23.7% and 37.8%, respectively. Furthermore, the preval...

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung's disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung's disease) from 264 hospitals (89 in high-income countries, 166 in middle-income countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in low-income countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between low-income, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030. Funding Wellcome Trust.

Background Molecular tests can allow the rapid detection of tuberculosis (TB) and multidrug-resistant TB (MDR-TB). TB-SPRINT 59-Plex Beamedex® is a microbead-based assay developed for the simultaneous spoligotyping and detection of MDR-TB. The accuracy and cost evaluation of new assays and technologies are of great importance for their routine use in clinics and in research laboratories. The aim of this study was to evaluate the performance of TB-SPRINT at three laboratory research centers in Brazil and calculate its mean cost (MC) and activity-based costing (ABC). Methods TB-SPRINT data were compared with the phenotypic and genotypic profiles obtained using Bactec™ MGIT™ 960 system and Genotype® MTBDRplus, respectively. Results Compared with MGIT, the accuracies of TB-SPRINT for the detection of rifampicin and isoniazid resistance ranged from 81 to 92% and 91.3 to 93.9%, respectively. Compared with MTBDRplus, the accuracies of TB-SPRINT for rifampicin and isoniazid were 99 and 94.2...

The World Health Organization has identified India as a major hot-spot region for Mycobacterium tuberculosis infection. We have characterized the sequences of the loci associated with multidrug resistance in 126 clinical isolates of M. tuberculosis from India to identify the respective mutations. The loci selected were rpoB (rifampin), katG and the ribosomal binding site of inhA (isoniazid), gyrA and gyrB (ofloxacin), and rpsL and rrs (streptomycin). We found known as well as novel mutations at these loci. Few of the mutations at the rpoB locus could be correlated with the drug resistance levels exhibited by the M. tuberculosis isolates and occurred with frequencies different from those reported earlier. Missense mutations at codons 526 to 531 seemed to be crucial in conferring a high degree of resistance to rifampin. We identified a common Arg463Leu substitution in the katG locus and certain novel insertions and deletions. Mutations were also mapped in the ribosomal binding site of...

BackgroundNeutrophils have been associated with lung tissue damage in many diseases, including tuberculosis (TB). Whether neutrophil count can serve as a predictor of adverse treatment outcomes is unknown.MethodsWe prospectively assessed 936 patients (172 HIV-seropositive) with culture-confirmed pulmonary TB, enrolled in a multicenter prospective cohort study from different regions in Brazil, from June 2015 to June 2019, and were followed up to two years. TB patients had a baseline visit before treatment (month 0) and visits at month 2 and 6 (or at the end of TB treatment). Smear microscopy, and culture for Mycobacterium tuberculosis (MTB) were performed at TB diagnosis and during follow-up. Complete blood counts were measured at baseline. Treatment outcome was defined as either unfavorable (death, treatment failure or TB recurrence) or favorable (cure or treatment completion). We performed multivariable logistic regression, with propensity score regression adjustment, to estimate t...

1Molecular Micobacteriology Laboratory, Research Center in Infectious and Parasitic Diseases, Medicine School, University Hospital Clementino Fraga Filho, Federal University Rio de Janeiro, Brazil. 2Unidade de Medicina Investigativa, Laboratório Integrado de Microbiologia e Imunorregulação (LIMI), Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil. 3Development Center for Technology on Health, Fundação Oswaldo Cruz, Rio de Janeiro,Brazil. 4Ary Parreira Institute, State Secretary of Health of Rio de Janeiro, Brazil. 5Recognize the Biology Laboratory, Center of Bioscience and Biotechnology, State University of North Fluminense Darcy Ribeiro, Rio de Janeiro, Brazil.6Tuberculosis Academic Program, School of Medicine, Federal University of Rio de Janeiro,Brazil. 7Amsterdam Institute for Global Health and Development, Academic Medical Centre, Amsterdam, The Netherlands

Background The role of genetic polymorphisms in latent tuberculosis (TB) infection and progression to active TB is not fully understood. Methods We tested the single-nucleotide polymorphisms (SNPs) rs5743708 (TLR2), rs4986791 (TLR4), rs361525 (TNFA), rs2430561 (IFNG) rs1143627 (IL1B) as risk factors for tuberculin skin test (TST) conversion or development of active TB in contacts of active TB cases. Contacts of microbiologically confirmed pulmonary TB cases were initially screened for longitudinal evaluation up to 24 months, with clinical examination and serial TST, between 1998 and 2004 at a referral center in Brazil. Data and biospecimens were collected from 526 individuals who were contacts of 177 active TB index cases. TST conversion was defined as induration ≥5 mm after a negative TST result (0 mm) at baseline or month 4 visit. Independent associations were tested using logistic regression models. Results Among the 526 contacts, 60 had TST conversion and 44 developed active TB ...

Clinical trials that evaluate new anti-tubercular drugs and treatment regimens take years to complete due to the slow clearance of Mycobacterium tuberculosis infection and the lack of early biomarkers that predict treatment outcomes. Host Inflammation markers have been associated with tuberculosis (TB) pathogenesis. In the present study, we tested if circulating levels of C-reactive protein (CRP) and ferritin reflect mycobacterial loads and inflammation in pulmonary TB (PTB) patients undergoing anti-tuberculous therapy (ATT). Prospective measurements of CRP and ferritin, used as readouts of systemic inflammation, were performed in cryopreserved serum samples from 165 Brazilian patients with active PTB initiating ATT. Associations between levels of these laboratory parameters with mycobacterial loads in sputum as well as with sputum conversion at day 60 of ATT were tested. Circulating levels of both ferritin and CRP gradually decreased over time on ATT. At pre-treatment, concentratio...

Tuberculosis (TB) is a chronic infectious disease caused by Mycobacterium tuberculosis (Mtb) that in most cases induces irreversible necrosis of lung tissue as a result of excessive inflammatory reactions. The murine model of TB in resistant C57BL/6 mice infected with reference Mtb strains is widely used in TB studies; however, these mice do not show a necrotic pathology, which restricts their use in studies of irreversible tissue damage. Recently, we demonstrated that necrotic lung lesions could be induced in the C57BL/6 mice by highly virulent Mtb strains belonging to the modern Beijing sublineage. However, the pathogenic mechanisms leading to necrosis in this model were not elucidated. In this study, we investigated the dynamics of lung lesions in mice infected with highly virulent Beijing Mtb strain M299, compared with those infected with laboratory Mtb strain H37Rv. The data demonstrate that necrotic lung lesions in mice infected by the strain M299 were associated with enhanced...