Introduction: COVID-19 emerged in late 2019 and quickly became a serious public health problem worldwide. This study aim to describe the epidemiological course of cases and deaths due to COVID-19 and their impact on hospital bed occupancy rates in the first 45 days of the epidemic in the state of Ceará, Northeastern Brazil. Methods: The study used an ecological design with data gathered from multiple government and health care sources. Data were analyzed using Epi Info software. Results: The first cases were confirmed on March 15, 2020. After 45 days, 37,268 cases reported in 85.9% of Ceará's municipalities, with 1,019 deaths. Laboratory test positivity reached 84.8% at the end of April, a period in which more than 700 daily tests were processed. The average age of cases was 67 (<1-101) years, most occurred in a hospital environment (91.9%), and 58% required hospitalization in an ICU bed. The average time between the onset of symptoms and death was 18 (1-56) days. Patients who died in the hospital had spent an average of six (0-40) days hospitalized. Across Ceará, the bed occupancy rate reached 71.3% in the wards and 80.5% in the ICU. Conclusions: The first 45 days of the COVID-19 epidemic in Ceará revealed a large number of cases and deaths, spreading initially among the population with a high socioeconomic status. Despite the efforts by the health services and social isolation measures the health system still collapsed.

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Recent studies have shown that the intestinal microbiota is essential for the pathogenicity but not for the multiplication of Giardia duodenalis in the intestinal lumen. The microbial components responsible for this phenomenon are not known. Twenty-eight facultative and three strictly anaerobic micro-organisms were isolated from the dominant duodenal microbiota of five patients with symptomatic giardiasis. The bacterial combinations from each patient were associated with groups (GN) of germ-free mice. Five days after the association, when their faecal populations ranged from 10 7 to 10 9 cfu=g, all groups were inoculated intragastrically with 10 5 viable trophozoites of G. duodenalis strain BT6. Two groups of germ-free (GF) and conventional (CV1) mice were also infected. Gnotobiotic animals were killed 10 days after infection and GF and CV1 animals were killed 10, 20 and 30 days after infection. More marked pathological alterations were detected in CV1 mice when compared with GF animals. Gnotobiotic animals showed intermediate pathological alterations between CV1 and GF mice. The CV1 and GF groups became infected by day 3 and faecal cyst levels were similar in both groups throughout the experiment. Total and G. duodenalis-specific IgA levels in the intestinal fluid and G. duodenalis-specific IgM and IgG levels in the serum increased during the infection and were higher in CV1 animals at all times tested when compared with GF mice. The present results confirm the stimulatory activity of the intestinal microbiota on the pathogenicity of G. duodenalis, and some combinations of microbial components of the dominant duodenal ecosystem from patients with symptomatic giardiasis can partially develop this function. However, none of these combinations was able to stimulate the protozoan pathogenicity in the same manner as the entire intestinal microbiota.

The article presents the methodology used to develop a health service responsiveness index (SRI) Na área da gestão e administração no Brasil, a partir dos anos de 1990, tanto nas organizações públicas quanto privadas, e em diferentes setores, ARTIGO ARTICLE

O artigo analisa a dimensão e segmentação do mercado supletivo de assistência à saúde no Brasil e o perfil dos seus segurados. Na primeira parte, destaca alguns elementos conceituais necessários à compreensão das características do mercado em saúde. Analisa brevemente a dimensão e o papel do setor privado de saúde em países membros da Organização para Cooperação e Desenvolvimento Econômico (OCDE) e compara com caso brasileiro. Em seguida, realiza um breve histórico do setor supletivo de saúde no Brasil e, por fim, apresenta uma análise do perfil dos segurados, tendo por base os microdados da Pesquisa Nacional de Amostra por Domicílio de 1998 (Pnad/ IBGE).

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O artigo discute a adesão aos planos de saúde entre indivíduos de camadas populares. Parte do princípio de que a análise macroestrutural é insuficiente para a compreensão desse fenômeno, e interpreta a ação social tomando como princípio a existência de um campo de possibilidades dentro do qual os indivíduos realizam escolhas e tomam decisões. A discussão baseia-se em pesquisa qualitativa, realizada pelo autor, para a qual foram entrevistados dez informantes que contrataram serviços de empresas do sistema de saúde suplementar. Analisando, a partir de três dimensões -- qualidade, acesso e segurança --as representações presentes nos discursos dos entrevistados, procura compreender a lógica subjacente às escolhas em relação à contratação de um plano de saúde. Observa-se que as representações sobre a vulnerabilidade da própria saúde possuem um papel central para a estratégia de proteção -- SUS versus planos de saúde -- posta em prática pelo sujeito.

Coinfection of SARS-CoV-2/Mycobacterium tuberculosis (MTB) in patients with HIV/AIDS has not been previously reported. Here, we present two cases of coinfection of SARS-CoV-2 and MTB in patients with HIV. The first case is a 39-year-old patient who was admitted with a 7-day history of fever, myalgia, headache, and cough. The second patient is a 43-year-old man who had a 1-month history of cough with hemoptoic sputum, evolving to mild respiratory distress in the last 7 days. Both patients already had pulmonary tuberculosis and subsequently developed SARS-CoV-2 infection during the 2020 pandemic. Nonadherence to antiretroviral treatment may have been a factor in the clinical worsening of the patients.