Resumo Este artigo aborda o choque das facções criminosas na cidade de Fortaleza, Ceará, destacando a influência no cotidiano, na dinâmica política e na situação de moradia em bairros populares. A pesquisa utilizou uma abordagem qualitativa, envolvendo análise de matérias de jornais, entrevistas e incursões aos territórios afetados. A perspectiva compreensiva adotada no artigo considera o ponto de vista de múltiplos agentes envolvidos, evidenciando o domínio consistente das facções em determinados territórios e seu influxo substantivo na vida das comunidades locais. Essa influência ocorre no âmbito das políticas públicas de habitação, afetando diretamente as decisões diárias das pessoas ante o controle ilegal exercido pelos grupos armados. Fortaleza Ceará cotidiano populares qualitativa jornais afetados envolvidos locais habitação armados

Abstract The article addresses the impact of criminal factions on the city of Fortaleza, state of Ceará, and highlights their influence on the daily life, political dynamics, and housing situation of popular neighborhoods. The study used a qualitative approach involving the analysis of newspaper articles, interviews, and visits to the affected territories. The comprehensive perspective adopted in the article considers the point of view of multiple agents involved, emphasizing the consistent dominance of factions over certain territories and their substantive impact on the lives of local communities. This influence occurs within the scope of public housing policies and directly affects people's daily decisions in the face of the illegal control exercised by armed groups. Fortaleza Ceará life dynamics neighborhoods articles interviews involved communities peoples people s groups

ABSTRACT Leishmaniasis is a serious public health concern in the Northeastern region of Brazil, where the sand fly fauna is well studied, although few species have been identified as competent vectors. The detection of Leishmania spp. parasites in wild-caught sand flies could help sanitary authorities draw strategies to avoid the transmission of the parasites and, therefore, the incidence of leishmaniases. We detected Leishmania DNA in wild-caught sand flies and correlated that data with aspects of sand fly ecology in the Caxias municipality, Maranhao State, Brazil. The sand flies were sampled in the peridomicile (open areas in the vicinity of human residences) and intradomicile (inside the residences) from July/2019 to March/2020. Leishmania DNA was detected in females, targeting a fragment of the Internal Transcribed Spacer (ITS1) from ribosomal DNA. Among the fourteen species of sand flies identified, five (Lutzomyia longipalpis, Nyssomyia whitmani, Evandromyia evandroi, Micropygomyia trinidadensis, and Micropygomyia quinquefer) harbored DNA of Leishmania (Leishmania) amazonensis. The most abundant species in rural (Ny. whitmani: 35.2% and Ev. evandroi: 32.4%) and urban areas (Lu. longipalpis: 89.8%) are the permissive vectors of L. (L.) amazonensis, especially Ny. whitmani, a known vector of causative agents of cutaneous leishmaniasis. Although Lu. longipalpis is the vector of L. (L.) infantum, which was not detected in this study, its permissiveness for the transmission of L. (L.) amazonensis has been reported. We suspect that visceral leishmaniasis and cutaneous leishmaniasis are caused by L. (L.) amazonensis, and the transmission may be occurring through Lu. longipalpis, at least in the urban area.

RESUMO Objetivo: Descrever a incidência de tuberculose ativa e a ocorrência de eventos adversos do tratamento com isoniazida em pacientes diagnosticados com tuberculose latente (TBL), portadores de doenças inflamatórias crônicas e tratados com agentes imunobiológicos em uma área endêmica no Brasil. Métodos: O diagnóstico de TBL foi feito com base em anamnese, exame clínico, radiografia de tórax e teste tuberculínico (TT). O tratamento profilático foi realizado segundo diretrizes brasileiras com isoniazida por seis meses. Resultados: Foram estudados 101 pacientes entre julho de 2011 e julho de 2015. Desses, 55 (54,46%) eram mulheres (média de idade = 53,16 ± 1,76 anos) e 46 (45,54%) eram homens (média de idade = 45,39 ± 2,13 anos), sendo que 79 (78,22%) foram tratados com agentes imunobiológicos e 22 (21,78%) com outros agentes imunomoduladores ou imunossupressores. Na triagem para TBL, 53 pacientes (52,48%) apresentaram TT ≥ 10 mm. A radiografia de tórax alterada por imagens compatíveis com TBL foi observada em 36 pacientes (35,64%). O tratamento profilático com isoniazida mostrou uma eficácia de 95,05% (96/101). É relevante mencionar que 84 (83,17%) dos pacientes não apresentaram nenhum efeito adverso à isoniazida e, desses, 83 (98,81%) completaram o tratamento profilático (p = 0,002). Tuberculose ativa foi diagnosticada em 5 (6,33%) dos 79 pacientes tratados com agentes imunobiológicos e em 1 (4,55%) dos 22 pacientes tratados com outros imunomoduladores/imunossupressores. Conclusões: O uso de isoniazida por seis meses mostrou-se seguro e eficaz no tratamento da TBL nesses pacientes, o que é essencial para reduzir o risco de desenvolvimento de tuberculose ativa.

ABSTRACT Objective: To describe the incidence of active tuberculosis and the occurrence of adverse events after isoniazid treatment in patients with latent tuberculosis infection (LTBI) who also had chronic inflammatory diseases and were treated with immunobiologic agents in an endemic area in Brazil. Methods: The diagnosis of LTBI was based on anamnesis, clinical examination, chest X-ray, and a tuberculin skin test (TST). Patients received prophylactic treatment (isoniazid for six months) in accordance with the Brazilian guidelines. Results: A total of 101 patients were evaluated between July of 2011 and July of 2015. Of those, 55 (54.46%) were women (mean age, 53.16 ± 1.76 years) and 46 (45.54%) were men (mean age, 45.39 ± 2.13 years). A total of 79 patients (78.22%) were being treated with immunobiologic agents and 22 (21.78%) were being treated with immunomodulatory or immunosuppressive agents. In the screening for LTBI, 53 patients (52.48%) had a TST induration ≥ 10 mm. Chest X-ray findings consistent with LTBI were observed in 36 patients (35.64%). Isoniazid preventive therapy was effective in 96 (95.05%) of the 101 patients evaluated. It is of note that 84 (83.17%) of the patients experienced no adverse effects from the use of isoniazid and that 83 (98.81%) of those patients completed the prophylactic treatment (p = 0.002). Active tuberculosis was diagnosed in 5 (6.33%) of the 79 patients treated with immunobiologic agents and in 1 (4.55%) of the 22 patients treated with other immunomodulators/immunosuppressants. Conclusions: A six-month course of isoniazid proved to be safe and effective in the treatment of LTBI, which is essential to reducing the risk of developing active tuberculosis.

ABSTRACT This study investigated the potential of Bacillus thuringiensis isolates obtained in the Cerrado region of the Brazilian state of Maranhão for the biological control of Aedes aegypti larvae. The isolates were obtained from soil samples and the identification of the B. thuringiensis colonies was based on morphological characteristics. Bioassays were run to assess the pathogenicity and toxicity of the different strains of the B. thuringiensis against third-instar larvae of A. aegypti. Protein profiles were obtained by sodium dodecyl sulfate polyacrylamide gel electrophoresis. Polymerase chain reaction assays were used to detect the toxin genes found in the bacterial isolates. Overall, 12 (4.0%) of the 300 isolates obtained from 45 soil samples were found to present larvicidal activity, with the BtMA-104, BtMA-401 and BtMA-560 isolates causing 100% of mortality. The BtMA-401 isolate was the most virulent, with the lowest median lethal concentration (LC50) (0.004 × 107 spores/mL), followed by the Bacillus thuringiensis var. israelensis standard (0.32 × 107 spores/mL). The protein profiles of BtMA-25 and BtMA-401 isolates indicated the presence of molecular mass consistent with the presence of the proteins Cry4Aa, Cry11Aa and Cyt1, similar to the profile of Bacillus thuringiensis var. israelensis IPS-82. Surprisingly, however, none of the cry and cyt genes analyzed were amplified in the isolate BtMA-401. The results of the present study revealed the larvicidal potential of B. thuringiensis isolates found in the soils of the Cerrado region from Maranhão, although further research will be necessary to better elucidate and describe other genes associated with the production of insecticidal toxins in these isolates.

We investigated the use of Bacillus thuringiensis isolated in the state of Amazonas, in Brazil, for the biological control of the dengue vector Aedes aegypti. From 25 soil samples collected in nine municipalities, 484 bacterial colonies were obtained, 57 (11.78%) of which were identified as B. thuringiensis. Six isolates, IBt-03, IBt-06, IBt-07, IBt-28, IBt-30, and BtAM-27 showed insecticidal activity, and only BtAM-27 presents the five genes investigated cry4Aa, cry4Ba, cry10Aa, cry11Aa, and cry11Ba. The IBt-07 and IBt- 28, with lower LC50 values, showed equal toxicity compared to the standards. The isolates of B. thuringiensisfrom Amazonas constitute potential new means of biological control for A. aegypti, because of their larvicidal activity and the possibility that they may also contain new combinations of toxins.

Introdução: Bacillus thuringiensis, tem sido usado mundialmente para o controle de culicídeos, especialmente no combate ao Aedes aegypti. Várias formulações vêm sendo fabricadas, no entanto, a efetividade desses inseticidas variam bastante de acordo com as condições ambientais. Objetivo: avaliar a influência dos fatores abióticos na efetividade de B. thuringiensis var. israelensis para larvas de Ae. Aegypti. Métodos: realizou-se bioensaio experimental no campus do CESC/UEMA, com utilização de 20 tanques de cimento, destes, 10 ficaram expostos aos fatores ambientais, e apenas 5 foram tratados e 5 serviram como controle. Os outros 10 tanques foram colocados à sombra, também 5 tratados e 5 não tratados (controle). Após o tratamento foram colocadas 25 larvas em estádio L 3 em cada tanque e realizadas leituras de mortalidade após 24 horas e a cada 7 dias. Semanalmente foram coletadas amostras de água de todos os tanques para medir o número de esporos viáveis e avaliar a reciclagem bacteriana. Resultados e Discussão: o larvicida apresentou eficácia inicial, matando 100 % das larvas nos tanques que estavam ao sol e a sombra. Os fatores ambientais, insolação, temperatura e pluviometria afetaram negativamente a efetividade do produto, pois se observou diminuição na eficácia do produto ao longo da realização do experimento. Observou-se variação do número de esporos ao longo do desenvolvimento do experimento, demonstrando que a bactéria apresenta potencial de reciclagem. Conclusão: esses dados servem como parâmetros para melhoramento de inseticidas à base de Bti, no sentido de se fabricar formulações mais adequadas às condições ambientais da nossa região.

Introduction: Bacillus thuringiensis , has been used worldwide for the control of mosquitoes, particularly in combating Aedes aegypti. Various formulations have been made however, the effectiveness of these insecticides vary varies considerably according to the environmental conditions. Objective: to evaluate the influence of abiotic factors on the effectiveness of B. thuringiensis var. israelensis to against larvae of Ae. aegypti. Methods: we conducted bioassay experiments in the campus of the CESC / UEMA. With use of 20 Twenty cement tanks, of these, were used, 10 of which were exposed to environmental factors, and only. Of these, 5 were treated and 5 served as controls. The other 10 tanks were placed in the shade, also again 5 were treated and 5 untreated were not (control). After treatment, the 25 stage L 3 larvae were placed in 25 L 3 each stage tank and mortality. Mortality readings were taken after 24 hours and every 7 days. Weekly water samples were collected from all tanks to measure once a week to check the number of viable spores and evaluate bacterial recycling. Results and discussion: the larvicidal efficacy: The larvicide showed initial efficacy, killing 100 % of the larvae in tanks that were located both in the sun and in the shade. Environmental factors, sunlight, temperature and rainfall negatively affected the effectiveness of the product, because for there was a reduction in the effectiveness of the product throughout the experiment. It was observed variation in the number of spores during the development of the experiment demonstrating, showing that the bacterium has potential recyclability. Conclusion: these data serve as parameters for improving to in Bti-based insecticides, in order to make the with a view to making formulations more suited toin keeping with the environmental conditions of our region.

Introducción: la Bacillus thuringiensis se ha utilizado en muchas regiones del mundo para el control de los mosquitos, sobre todo en el combate contra el Aedes aegypti. Se han elaborado varias formulaciones; sin embargo, la efectividad de esos insecticidas varía considerablemente según las condiciones ambientales. Objetivo: evaluar la influencia de los factores abióticos en la efectividad de la B. thuringiensis var. israelensis contra larvas de Ae. aegypti. Métodos: se realizaron bioensayos experimentales en el campus de la CESC / UEMA. Se utilizaron 20 tanques de cemento, 10 de los cuales quedaron expuestos a factores ambientales. De ellos, 5 fueron tratados y 5 sirvieron como controles. Los otros 10 tanques fueron ubicados en la sombra, y también en este caso 5 fueron tratados y 5 no (controles). Después del tratamiento, se colocaron 25 larvas en estadio larval L3 en cada tanque. Se realizaron lecturas de mortalidad luego de 24 horas y cada 7 días. Se tomaron muestras de agua de todos los tanques una vez a la semana para comprobar el número de esporas viables y evaluar el reciclaje bacteriano. Resultados y discusión: el larvicida mostró eficacia inicial, matando el 100 % de las larvas de tanques ubicados tanto al sol como en la sombra. Los factores ambientales, la luz solar, la temperatura y la lluvia afectaron negativamente la efectividad del producto, constatándose una reducción de la misma a lo largo del experimento. Se observaron variaciones en el número de esporas durante el experimento, lo que demuestra que la bacteria presenta potencial de reciclaje. Conclusión: los datos obtenidos sirven de parámetros para el mejoramiento de los insecticidas a base de Bti, con vistas a elaborar formulaciones más acordes con las condiciones ambientales de nuestra región.

Trata-se de um inquérito amostral (743 questionários), realizado nos meses de abril a novembro de 2009 em dez escolas públicas municipais, previamente sorteadas e localizadas em oito bairros da cidade de Caxias. Avaliou-se por meio da aplicação de questionários fechados, o conhecimento dos estudantes sobre a Leishmaniose Visceral (LV), seu vetor e prevenção. Os resultados mostraram mudanças com maior percentual de acertos quanto às respostas sobre a transmissão da doença e quanto aos sintomas da LV no homem e no cão após as campanhas. Contudo, as campanhas educativas são necessárias como medidas para fortalecer a participação da população no combate à LV, pois antes do trabalho educativo a maioria dos estudantes disse que se prevenia da doença evitando contato com cães doentes, entretanto, após as campanhas os mesmos disseram evitar acúmulo de lixo. A pesquisa pode servir como subsídio para orientar novas ações educativas das equipes locais de controle da LV.

This is a sample survey (743 questionnaires) conducted in the months from April to November 2009 in ten pre-selected public schools located in eight districts of the city of Caxias. The students' knowledge of viral leishmaniasis (VL) and its transmission and prevention was evaluated through closed questionnaires. The results showed changes with the highest percentage of correct answers for answers about the transmission of disease and the symptoms of VL in humans and dogs after the campaign. However, educational campaigns are necessary measures to strengthen public participation in combating VL since before the educational work the majority of students stated that the disease was prevented by avoiding contact with sick dogs, however, after the campaign they stated that they avoid accumulations of trash. The research may serve as input to orient further educational actions of local teams for the control of VL.

Trata-se de um inquérito amostral (743 questionários), realizado nos meses de abril a novembro de 2009 em dez escolas públicas municipais, previamente sorteadas e localizadas em oito bairros da cidade de Caxias. Avaliou-se por meio da aplicação de questionários fechados, o conhecimento dos estudantes sobre a Leishmaniose Visceral (LV), seu vetor e prevenção. Os resultados mostraram mudanças com maior percentual de acertos quanto às respostas sobre a transmissão da doença e quanto aos sintomas da LV no homem e no cão após as campanhas. Contudo, as campanhas educativas são necessárias como medidas para fortalecer a participação da população no combate à LV, pois antes do trabalho educativo a maioria dos estudantes disse que se prevenia da doença evitando contato com cães doentes, entretanto, após as campanhas os mesmos disseram evitar acúmulo de lixo. A pesquisa pode servir como subsídio para orientar novas ações educativas das equipes locais de controle da LV.

This is a sample survey (743 questionnaires) conducted in the months from April to November 2009 in ten pre-selected public schools located in eight districts of the city of Caxias. The students' knowledge of viral leishmaniasis (VL) and its transmission and prevention was evaluated through closed questionnaires. The results showed changes with the highest percentage of correct answers for answers about the transmission of disease and the symptoms of VL in humans and dogs after the campaign. However, educational campaigns are necessary measures to strengthen public participation in combating VL since before the educational work the majority of students stated that the disease was prevented by avoiding contact with sick dogs, however, after the campaign they stated that they avoid accumulations of trash. The research may serve as input to orient further educational actions of local teams for the control of VL.

INTRODUÇÃO: A dengue constitui de um sério problema de saúde pública mundial, com casos sendo registrados anualmente nas regiões tropicais e subtropicais. O Aedes aegypti(Linnaeus, 1762) é o principal vetor da doença, um mosquito domiciliado de fácil dispersão e sobrevivência, com capacidade de utilizar variados recipientes artificiais como criadouro. Em vista disso, neste trabalho investigou-se os tipos de recipientes potenciais criadouros de A. aegypti na Cidade de Caxias, Maranhão, Brasil. MÉTODOS: Inicialmente, a pesquisa foi desenvolvida em três bairros e 900 imóveis analisados no período da seca e das chuvas (agosto a outubro de 2005 e fevereiro a abril de 2006, respectivamente). Um segundo período de amostragem ocorreu de setembro de 2006 a agosto de 2007 em que inspeções de cinco ciclos foram desenvolvidas em um dos bairros com 300 imóveis amostrados. RESULTADOS: Os recipientes de armazenamento de água representaram 55,7% (n=1.970) e 48,5% (n=1.836) do total dos inspecionados, e maior produtividade de imaturos de A. aegypti, com proporção de 23,7 e 106,1 por recipiente no peridomicílio, nas estações seca e chuvosa respectivamente. No intradomicílio, também foi mais representativo, 86,4% (n=973) e 84,6% (n=900), apresentando média de 7,9 e 108,3 indivíduos, nas duas estações. O maior número de recipientes com água foi registrado em setembro e outubro 2006 (1.342), obtendo-se maior número de positivos (70) no mês de maio, sendo (94%) pertencentes ao grupo armazenamento. CONCLUSÕES: Armazenamento são os principais criadouros de A. aegypti, contribuindo na manutenção do vetor na cidade de Caxias, Maranhão.

INTRODUCTION: Dengue is a serious public health problem worldwide, with cases reported annually in tropical and subtropical regions. Aedes aegypti (Linnaeus, 1762), the main vector of dengue, is a domiciliary species with high dispersal and survival capacities and can use various artificial containers as breeding sites. We assessed potential container breeding sites of A. aegypti in the municipality of Caxias, Maranhão, Brazil. METHODS: In the initial phase, we analyzed 900 properties in 3 neighborhoods during the dry and rainy seasons (August-October 2005 and February-April 2006, respectively). During the second sampling period, September 2006-August 2007, we used 5 assessment cycles for 300 properties in a single neighborhood. RESULTS: During the dry and rainy seasons, water-storage containers comprised 55.7% (n = 1,970) and 48.5% (n = 1,836) of the total containers inspected, and showed the highest productivity of immature A. aegypti; we found 23.7 and 106.1 individuals/container, respectively, in peridomicile sites. In intradomicile sites, water-storage containers were also the most important breeding sites with 86.4% (n = 973) and 85.6% (n = 900) of all containers and a mean of 7.9 and 108.3 individuals/container in the dry and rainy seaso-October 2006 (1,342). The highest number of positives (70) was recorded in May, mostly (94%) in storage containers. CONCLUSIONS: Storage containers are the principal and most productive A. aegypti breeding sites and are a major contributing factor to the maintenance of this vector in Caxias.

Trata-se de um inquérito amostral (700 entrevistas) realizado em 14 Escolas Públicas da Rede Municipal de Ensino na cidade de Caxias, Estado do Maranhão. O inquérito foi realizado entre julho e dezembro de 2007, em escolas localizadas em sete bairros periféricos da zona oeste, os quais apresentaram registros de alta densidade de imaturos de Aedes aegypti nos últimos três anos. Avaliou-se por meio da aplicação de questionário fechado, o conhecimento dos escolares sobre o dengue, seu vetor e prevenção. Os resultados mostraram que as escolas do bairro Trizidela, com melhores condições sociais e urbanas em relação aos demais bairros periféricos, apresentaram estudantes com conhecimentos mais adequados. Contudo, as campanhas educativas são necessárias como medidas para fortalecer as mudanças de comportamento da população, pois foi mencionada a existência de criadouros nas áreas examinadas, com maior prevalência dos recipientes de armazenamento no bairro Tamarineiro. A pesquisa pode servir como subsídio para orientar novas ações educativas das equipes locais de controle do dengue.

This study describes a survey (n=700) carried out in 14 elementary schools in the municipality of Caxias, State of Maranhão, Brazil. The survey was conducted between July and December 2007 in schools from seven neighborhoods on the outskirts of the western part of the municipality, where for the past three years high densities of immature Aedes aegypti mosquitoes have been recorded. The students' knowledge of dengue, its vector, and disease prevention was evaluated by targeted questionnaires. The students with the most comprehensive knowledge were found in schools in the Trizidela neighborhood, which has better social and urban conditions than the other neighborhoods. Moreover, educational campaigns are necessary to reinforce behavioral changes of the population, because the existence of breeding sites in the areas examined was mentioned, especially in the Tamarineiro neighborhood. The survey can be used to assist with new educational activities of local teams working with dengue control.

Trata-se de um inquérito amostral (700 entrevistas) realizado em 14 Escolas Públicas da Rede Municipal de Ensino na cidade de Caxias, Estado do Maranhão. O inquérito foi realizado entre julho e dezembro de 2007, em escolas localizadas em sete bairros periféricos da zona oeste, os quais apresentaram registros de alta densidade de imaturos de Aedes aegypti nos últimos três anos. Avaliou-se por meio da aplicação de questionário fechado, o conhecimento dos escolares sobre o dengue, seu vetor e prevenção. Os resultados mostraram que as escolas do bairro Trizidela, com melhores condições sociais e urbanas em relação aos demais bairros periféricos, apresentaram estudantes com conhecimentos mais adequados. Contudo, as campanhas educativas são necessárias como medidas para fortalecer as mudanças de comportamento da população, pois foi mencionada a existência de criadouros nas áreas examinadas, com maior prevalência dos recipientes de armazenamento no bairro Tamarineiro. A pesquisa pode servir como subsídio para orientar novas ações educativas das equipes locais de controle do dengue.

This study describes a survey (n=700) carried out in 14 elementary schools in the municipality of Caxias, State of Maranhão, Brazil. The survey was conducted between July and December 2007 in schools from seven neighborhoods on the outskirts of the western part of the municipality, where for the past three years high densities of immature Aedes aegypti mosquitoes have been recorded. The students' knowledge of dengue, its vector, and disease prevention was evaluated by targeted questionnaires. The students with the most comprehensive knowledge were found in schools in the Trizidela neighborhood, which has better social and urban conditions than the other neighborhoods. Moreover, educational campaigns are necessary to reinforce behavioral changes of the population, because the existence of breeding sites in the areas examined was mentioned, especially in the Tamarineiro neighborhood. The survey can be used to assist with new educational activities of local teams working with dengue control.

OBJETIVO: Traçar o perfil clínico-epidemiológico de pacientes candidatos ao uso de fármacos anti-TNF-α diagnosticados como portadores de tuberculose latente (TBL) e avaliar os desfechos do tratamento profilático com isoniazida. MÉTODOS: Análise descritiva prospectiva seguida de um estudo analítico observacional transversal dos desfechos do tratamento profilático em um grupo de 45 candidatos ao uso de fármacos anti-TNF-α. A avaliação dos pacientes constou de anamnese, exame clínico, radiografia de tórax e teste tuberculínico (TT) por Mantoux. RESULTADOS: A idade média dos pacientes foi 45 anos, e 56,0% dos pacientes eram mulheres. Doenças reumatológicas crônicas, doenças dermatológicas crônicas e doença de Crohn estavam presentes em 46,7%, 40,0% e 13,3% dos pacientes, respectivamente. A média de enduração do TT foi 14,6 mm (variação: 5-30 mm). A maioria dos pacientes (n = 30; 66,7%) apresentou enduração > 10 mm. Dos 16 pacientes com cicatriz vacinal BCG, a média de enduração foi de 15,7 mm, sendo que 14 tiveram enduração > 10 mm. Os resultados de radiografia de tórax foram considerados normais e com alterações mínimas em 64,4% e em 35,6%, respectivamente. Apenas 1 paciente (2,2%) abandonou o tratamento com isoniazida, 41 (91,2%) completaram o tratamento, 2 (4,4%) tiveram de interromper o tratamento por hepatite medicamentosa, e 1 (2,2%) foi transferido para outro hospital. Dos que completaram o tratamento, 5 apresentaram efeitos colaterais leves. CONCLUSÕES: A determinação do perfil dos candidatos ao uso de inibidores do TNF-α é importante para o manejo do tratamento da TBL, bem como para estabelecer protocolos clínicos de uso e acompanhamento do uso desses fármacos

OBJECTIVE: To determine the clinical and epidemiological profile of patients who are candidates for TNF-α inhibitor use and are classified as having latent tuberculosis (LTB), as well as to evaluate the outcomes of prophylactic treatment with isoniazid. METHODS: A prospective descriptive analysis followed by an analytical, observational, cross-sectional study of the outcomes of prophylactic treatment in a group of 45 candidates for TNF-α inhibitor use. We evaluated the patients through anamnesis, clinical examination, chest X-ray, and tuberculin skin test (TST) using the Mantoux method. RESULTS: The mean age was 45 years, and 56.0% of the patients were female. Chronic rheumatic diseases, chronic dermatological diseases, and Crohn's disease were present in 46.7%, 40.0%, and 13.3% of the patients, respectively. The mean TST induration was 14.6 mm (range: 5-30 mm). The majority (n = 30) of the 45 patients (66.7%) had an induration > 10 mm. In the 16 patients with BCG vaccination scars, the mean induration was 15.7 mm, and 14 of those patients had an induration > 10 mm. Chest X-ray results were considered normal, with minimal alterations, in 64.4% and 35.6% of the patients, respectively. The treatment with isoniazid was abandoned by 1 patient (2.2%) and completed by 41 (91.2%), whereas it was interrupted because of drug-induced hepatitis in 2 (4.4%), and 1 patient (2.2%) was transferred to another hospital. Of those who completed the treatment, 5 experienced mild side effects. CONCLUSIONS: Determining the profile of candidates for TNF-α inhibitor use is important for the management of LTB treatment and for the establishment of clinical protocols for the use and monitoring of the use of these medications

Intestinal barrier function and serum concentrations of rifampin, isoniazid and pyrazinamide were studied in healthy controls and patients with active pulmonary tuberculosis. A case-control study of 29 controls and 30 cases attending at the Health Center, July, 2004 to December, 2005 was conducted. The body mass index was significantly reduced in cases compared to controls (p < 0.001). The intestinal paracellular transport of lactulose was significantly (p = 0.019) reduced in cases compared to controls. The transcellular transport of mannitol and the lactulose:mannitol ratio were not significantly (p = 0.0698) reduced in cases compared to controls. Low serum concentrations of rifampin, isoniazid and pyrazinamide were observed in 81% (48/59), 92% (54/59) and 28% (12/59), respectively, in all individuals. The results demonstrated a marked decrease on intestinal paracellular transport in patients with active pulmonary tuberculosis and reduced serum concentrations of rifampin and isoniazid in both groups.

Hb H Disease is caused by the loss or inactivation of three of the four functional a-globin genes. Patients present chronic hemolytic anemia and splenomegaly. In some cases, occasional blood transfusions are required. Deletions are the main cause of this type of thalassemia (α-thalassemia). We describe here an unusual case of Hb H disease caused by the combination of a common αº deletion [-(α)20.5] with a rare point mutation (c.427T > A), thus resulting in an elongated and unstable α-globin variant, Hb Icaria, (X142K), with 31 additional amino-acid residues. Very high levels of Hb H and Hb Bart's were detected in the patient's red blood cells (14.7 and 19.0%, respectively). This is the first description of this infrequent association in the Brazilian population.

A microlitíase alveolar pulmonar (MAP) é uma doença rara que atinge ambos os pulmões, caracterizada pela presença de pequenos cálculos (fosfato de cálcio) nos espaços alveolares. Relatamos o caso de uma paciente do sexo feminino, de 26 anos, cujo diagnóstico foi confirmado com base nos achados marcantes na radiografia de tórax e tomografia computadorizada de alta resolução. A paciente, gestante de 28 semanas, retornou ao hospital 10 meses após o diagnóstico apresentando insuficiência respiratória hipoxêmica e com distúrbio ventilatório restritivo grave à espirometria. Após completadas 32 semanas e 4 dias de gestação, foi submetida aparto cesariano, com sucesso para mãe e filha. A MAP tem evolução clínica variável. Tem provável caráter autossômico recessivo e associação com história familiar positiva. A etiologia é incerta, e muitos autores especulam que haja um defeito enzimático local responsável pelo acúmulo intra-alveolar de cálcio. Relatos de pacientes com MAP que engravidaram são excepcionais, sendo o presente caso o primeiro descrito no Brasil. O curso dessa doença costuma ser lentamente progressivo, e os pacientes geralmente falecem devido à insuficiência cardiorrespiratória. O presente caso ilustra a necessidade de se oferecer aconselhamento genético e orientações sobre o risco de gravidez às pacientes, especialmente em casos de doença avançada. Atualmente, a única terapia efetiva é o transplante pulmonar.

Pulmonary alveolar microlithiasis (PAM) is a rare disease that affects both lungs. It is characterized by the presence of small calculi (calcium phosphate) within the alveolar spaces. We report the case of a 26-year-old female whose diagnosis was based on characteristic findings on chest X-rays and high-resolution computed tomography scans. The patient, 28 weeks pregnant, was rehospitalized 10 months after the diagnosis, presenting hypoxemic acute respiratory failure and severe restrictive ventilatory defect on spirometry. After 32 completed weeks of gestation (228 days), she was submitted to cesarean section, and the outcome was successful for mother and newborn. PAM has a variable clinical course. It is suggestive of an autosomal recessive inheritance pattern and has been associated with positive family history. The etiology of PAM is unclear, and many authors speculate that there is a local enzymatic defect responsible for the intra-alveolar accumulation of calcium. Reports of patients with PAM who become pregnant are exceptional, and this is the first case described in Brazil. The course of this disease is usually slow and progressive, and patients typically die of cardiorespiratory failure. The present case illustrates the need to offer female patients, especially those with advanced disease, genetic counseling and orientation regarding the risks of pregnancy. Currently, the only effective therapy is lung transplantation.