Assuming that the IS6110-restriction fragment length polymorphism (RFLP) changes at a constant rate of 3.2 years, this methodology was applied to demonstrate, for the first time, variant patterns of Mycobacterium tuberculosis (MTB) in multiple isolates obtained at short time intervals from sputum and blood of an HIV + patient with multiple admissions to the Emergency Room and to the multidrug-resistant tuberculosis (MDR-TB) Reference Center of a secondary-care hospital in Rio de Janeiro, Brazil. In sputum, the IS6110-RFLP appeared in isolates with two variant patterns with 10 and 13 IS6110 copies. However, blood presented only the pattern corresponding to 10 copies, suggesting compartmentalization. With regard to the exact match of 10 of 13 bands, this may be a subpopulation with the same clonal origin and this may be related to the IS6110 transposition. A susceptibility test demonstrated an MDR profile (INH R , RIF R , SM R , and EMB R ), with the sputum isolate also exhibiting EMB S (R = resistant; S = sensitive). A gene mutation confirmed resistance only to streptomycin. There was agreement between the results of the phenotypic test and the clinical response to MDR-TB treatment, suggesting serious implications with regard to treatment administration based exclusively on molecular methods, and calling attention to the fact that more effective control strategies against the emergence of MDR strains must be implemented by the TB control program to prevent transmission of MDR-MTB strains at health facilities in areas highly endemic for TB.
Background The most common way of consuming nicotine is in tobacco cigarettes. Nicotine causes intense addiction. The National Cancer Institute coordinates and executes the Tobacco Control Program in Brazil, through actions that encourage the adoption of healthier lifestyles. In this context, homeopathy has used Heteroisotherapic medicines formulated according to the homeopathic pharmaceutical technology with scientific evidence of efficacy in the detoxification of substances and metals, and in the desensitization of foods or medicines. Aims Promote the importance of the cognitive-behavioral approach in combination with the homeopathic treatment against smoking. Methodology In the initial phase of the randomized double-blind clinical study (CEP / HUCFF / UFRJ 65622916.2.0000.5257), the effectiveness of the 6CH heteroisotherapeutic drug was assessed. Volunteers were recruited and in-person welcoming meetings, using the cognitive-behavioral approach, were carried out to inform them about the risks of smoking and the benefits of quitting. In addition, they were supported and guided during the smoking cessation process so that they could deal with the withdrawal syndrome, the psychological dependence and the constraints associated with smoking. Results and discussion 84 participants were selected according to the inclusion criteria, and divided by randomization into two groups: the Test Group (heteroisotherapeutic medication) and the Control Group (homeopathic medication Nux vomica 6CH). Both groups will be followed for 12 months. The combination of the following approaches has led to a significant increase in the cessation rate: I. Prepare the smoker for solving his own issues; II. Stimulate skills to resist temptations to smoke; III. Prepare to prevent relapse; IV. Prepare to deal with stress. Studies show that, regardless the duration of these approaches, there is an increase in the abstinence rate. Moreover, the longer the total approach time (frequency multiplied by the time spent on each contact), the higher the abstinence rate. On the other hand, from a total approach time of 90 minutes on, there is no further increase in the abstinence rate. Conclusion The partial results obtained so far demonstrate that the cognitive-behavioral approach played a decisive role in the groups performance, favoring the treatment adherence as well as the group cohesion around the Project's objective, contributing to the effectiveness of the medicine, a decreased anxiety, improved sleep, cessation or decrease in the number of cigarettes smoked per day and the abstinence rate.
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