Low antimycobacterial drug concentrations have been observed in tuberculosis (TB) patients under treatment. The lactulose/mannitol urinary excretion test (L/M), normally used to measure intestinal permeability, may be useful to assess drug absorption. The objective of this research was to study intestinal absorptive function and bioavailability of rifampin and isoniazid in TB patients. A cross sectional study was done with 41 patients and 28 healthy controls, using the L/M test. The bioavailabilities of rifampin (R) and isoniazid (H) were evaluated in 18 patients receiving full doses. Urinary excretion of mannitol and lactulose, measured by HPLC, was significantly lower in TB patients. The serum concentrations of the drugs were below the expected range for R (8-24 mcg/mL) or H (3-6 mcg/mL) in 16/18 patients. Analyzing the drugs individually, 12/18 patients had low serum concentrations of R, 13/18 for H and 8/18 for both drugs. We suggest that there is a decrease in the functional absorptive area of the intestine in TB patients, which would explain the reduced serum concentrations of antituberculosis drugs. There is a need for new approaches to improve drug bioavailability in TB patients.

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.

Training and sensitization of FHP professionals were effective in promoting an increase in the number of TB cases detected in a low-income community.

O Plano Nacional de Controle da Tuberculose tem como meta diagnosticar pelo menos 92% dos casos esperados, e tratar com sucesso no mínimo 85% deles. O acompanhamento dessas metas depende da informação dos casos diagnosticados e de sua evolução. O objetivo deste estudo é verificar se existe subnotificação de casos de tuberculose que evoluíram para o óbito. Este é um estudo descritivo de dados secundários em que foi feita busca no Sistema de Informação de Agravos de Notificação (Sinan) dos óbitos ocorridos entre 1999 e 2003, que tiveram tuberculose como uma das causas múltiplas e estavam registrados no Sistema de Informação em Mortalidade (SIM), tendo como variáveis de referência o nome, data do nascimento e nome da mãe. Dos óbitos registrados, 610 tiveram tuberculose como uma das causas associadas, 204 (33,4%) deles notificados no Sinan. Em 438 (71,8%), a tuberculose foi causa básica. A média de notificações entre 1999 e 2002 foi de 37%, reduzindo-se para 19,3% em 2003 (p=0,03). Em cinco hospitais ocorreram 324 (53,1%) dos óbitos e tiveram origem 114 (55,9%) notificações. O Sinan registrou 153 evoluções para o óbito. O acréscimo da notificação dos 406 casos de tuberculose que evoluíram para o óbito acarretará incremento de 5,9% no total de casos notificados no período e de 265,4% nas evoluções para o óbito. Os casos graves de tuberculose encontram-se subnotificados, sendo o SIM uma importante fonte de resgate desses casos, que pode ser utilizada de forma rotineira e preferencialmente informatizada.

This study evaluates the serum concentrations of rifampin (RMP), isoniazid (INH), and intestinal barrier function in patients with multidrug-resistant tuberculosis (MDR-TB), drug susceptible tuberculosis (DS-TB), and health volunteers (HC; controls). Peak serum concentrations of RMP were significantly lower in MDR-TB and DS-TB as compared with HC (odds ratio [OR] = 3.125, confidence interval [CI] [1.037-9.418] and OR = 4.025, CI [1.207-13.418], respectively). The INH peak serum concentration was not significantly different between MDR-TB versus DS-TB or DS-TB versus HC. The percent of mannitol excretion was significantly lower in the MDR-TB group compared with DS-TB (13.18 versus 16.03, analysis of covariance [ANCOVA], P = 0.0369) and compared with HC (13.18 versus 16.61, ANCOVA, P = 0.0291) the other study groups. These data suggested a lower peak serum concentration of RMP for both MDR-TB and DS-TB as compared with the HC group. The data also showed a lower intestinal area of absorption in patients with tuberculosis and even worse in MDR-TB.

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.

The majority of our patients (88.5%) performed three or more self-monitoring tests daily, with more frequent testing reported by females, younger patients, those on intensive insulin regimens and of higher socio-economic status. No additional benefit was found in patients who performed self-monitoring more than four times daily. The diabetes care team must improve patients' education regarding self-monitoring of blood glucose and its benefits.

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.Keywords: Mycobacterium tuberculosis; Tuberculosis, pulmonary/epidemiology; Risk factors. ResumoObjetivo: 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%...