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INTRODUCTION: Tuberculosis contacts are candidates for active and latent tuberculosis infection screening and eventual treatment. However, many losses occur in the different steps of the contacts' cascade of care. Reasons for this are poorly understood. OBJECTIVE: To describe the different steps where losses in the contact cascade occur and to explore knowledge and attitudes regarding tuberculosis transmission/prevention and perceptions about tuberculosis services in order to understand the reasons for losses from the tuberculosis service users' perspective. DESIGN: We collected routine data from the index case and contact registry books and from patients' records to build the cascade of care of contacts in 12 health facilities in three Brazilian cities with high tuberculosis incidence rates. During a knowledge, attitudes and practices (KAP) survey, trained interviewers administered a semi-structured questionnaire to 138 index cases and 98 contacts. RESULTS: Most of the losses in the cascade occurred in the first two steps (contact identification, 43% and tuberculin skin testing placement, 91% of the identified contacts). Among KAP-interviewed contacts, 67% knew how tuberculosis is transmitted, 87% knew its key symptoms and 81% declared they would take preventive therapy if prescribed. Among KAP-interviewed index cases, 67% knew they could spread tuberculosis, 70% feared for the health of their families and 88% would like their family to be evaluated in the same services. CONCLUSION: Only a small proportion of contacts are evaluated for active and latent tuberculosis, despite their-and their index cases'-reasonable knowledge, positive attitudes towards prevention and satisfaction with tuberculosis services. In these services, education of service users would not be a sufficient solution. Healthcare workers' and managers' perspective, not explored in this study, may bring more light to this subject.

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The objective of this study was to compare gender differences among tuberculosis patients in a city with a high incidence of tuberculosis. This was a cross-sectional questionnaire-based study involving 560 tuberculosis patients (373 males and 187 females). Sociodemographic and clinical data, as well as data related to diagnostic criteria and treatment outcome, were collected (from the questionnaires and medical records) and subsequently compared between the genders. The median time from symptom onset to diagnosis was 90 days. There were no differences between the genders regarding the clinical presentation, diagnostic criteria, previous noncompliance with treatment, time from symptom onset, number of medical appointments prior to diagnosis, or treatment outcome. Gender-specific approaches are not a priority in Brazil. However, regardless of patient gender, the delay in diagnosis is a major concern.

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O objetivo deste estudo foi comparar diferenças entre os gêneros nos pacientes com tuberculose em uma cidade com alta incidência da doença. Este foi um estudo transversal com base em questionário envolvendo 560 pacientes com tuberculose (373 homens e 187 mulheres). Características sociodemográficas e clínicas, assim como critérios diagnósticos e desfecho do tratamento, foram coletados dos questionários e fichas médicas e posteriormente comparados entre os gêneros. A mediana do tempo do surgimento de sintomas até o diagnóstico foi de 90 dias. Não foram encontradas diferenças entre os gêneros relativas à apresentação clínica, critério diagnóstico, abandono prévio de tratamento, tempo do surgimento de sintomas, número de consultas antes do diagnóstico ou desfecho do tratamento. A abordagem diferenciada para os gêneros não é uma prioridade no Brasil. A demora no diagnóstico, no entanto, é um problema maior a despeito do gênero.

The objective of this study was to compare gender differences among tuberculosis patients in a city with a high incidence of tuberculosis. This was a cross-sectional questionnaire-based study involving 560 tuberculosis patients (373 males and 187 females). Sociodemographic and clinical data, as well as data related to diagnostic criteria and treatment outcome, were collected (from the questionnaires and medical records) and subsequently compared between the genders. The median time from symptom onset to diagnosis was 90 days. There were no differences between the genders regarding the clinical presentation, diagnostic criteria, previous noncompliance with treatment, time from symptom onset, number of medical appointments prior to diagnosis, or treatment outcome. Gender-specific approaches are not a priority in Brazil. However, regardless of patient gender, the delay in diagnosis is a major concern.

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BACKGROUND: Tuberculosis (TB) treatment default is a major constraint of TB control, resulting in continued disease transmission and possibly the emergence of multidrug resistance. Marginalized populations may abandon treatment before being cured. The objective of this study was to evaluate the socioeconomic status (SES) of TB patients and identify potential incentives for improving treatment compliance by SES. MATERIAL AND METHODS: A cross-sectional survey was conducted in a public health unit in Duque de Caxias, a county with one of the lowest per capita incomes in Rio de Janeiro state. From November 2003 to March 2004, 305 TB patients answered an anonymous questionnaire on socio-demographic aspects, household items and family income, history of previous treatment default, and on incentives for improving treatment adherence. Incentives were classified as economic, administrative, health service support, and habits, and scored as fundamental (3), important (2), desirable (1), or irrelevant (0). RESULTS: Health service support incentives had the highest scores overall. The aggregate economic incentive score correlated with SES (r = -0.191, p = 0.001). Among the 20% poorest patients, 16.7% had a previous history of default vs. 1.6% among the wealthiest (p = 0.004). Patients with a history of treatment default were significantly more likely to choose health service support incentives than other patients (r = -0.263, p = 0.039). CONCLUSIONS: Professional commitment will be needed to effect the necessary changes in health service support. Financial support for food and transportation subsidies may be required to improve treatment compliance among the poorest TB patients, i.e. those most likely to have previously defaulted from treatment.

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Fetus-in-fetu (FIF) is a rare pathological condition, which presents as a congenital tumor, usually in the abdomen or retroperitoneum. A few cases have been reported in the cranial cavity, cervical spine, ovarium, scrotum and liver. We presently report a case of intrapulmonary FIF in a 12-year-old girl who was on treatment for pulmonary tuberculosis and had no symptoms related to the tumor. To our knowledge this is the first reported case of FIF with pulmonary presentation.

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The incidence of AIDS and other sexually transmitted diseases (STDs) is increasing among adolescents. In order to better understand high-risk sexual behavior among students, a cross-sectional study based on a self-answered anonymous questionnaire was conducted in 10 public and private high schools in Rio de Janeiro, Brazil. Data were obtained on sociodemographics, knowledge of STD/AIDS, and sexual behavior. Among 945 students aged 13-21, 59% were sexually initiated, and the median age at first sexual intercourse was 15 years (range: 7-19). Although 94% reported being aware of the need for condom use for protection, only 34% informed always using condoms during sex. Low family income was associated with unsatisfactory knowledge (OR = 9.40; 95% CI = 6.05-14.60) and inconsistent condom use (OR = 11.60; 95% CI = 5.54-24.30). However, unsatisfactory knowledge was not associated with inconsistent condom use. School-based educational programs should focus on sexual behavior more than on transmission of knowledge, as well as targeting low-income students.

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The incidence of AIDS and other sexually transmitted diseases (STDs) is increasing among adolescents. In order to better understand high-risk sexual behavior among students, a cross-sectional study based on a self-answered anonymous questionnaire was conducted in 10 public and private high schools in Rio de Janeiro, Brazil. Data were obtained on sociodemographics, knowledge of STD/AIDS, and sexual behavior. Among 945 students aged 13-21, 59 percent were sexually initiated, and the median age at first sexual intercourse was 15 years (range: 7-19). Although 94 percent reported being aware of the need for condom use for protection, only 34 percent informed always using condoms during sex. Low family income was associated with unsatisfactory knowledge (OR = 9.40; 95 percent CI = 6.05-14.60) and inconsistent condom use (OR = 11.60; 95 percent CI = 5.54-24.30). However, unsatisfactory knowledge was not associated with inconsistent condom use. School-based educational programs should focus on sexual behavior more than on transmission of knowledge, as well as targeting low-income students

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Introdução: a tuberculose pleural tem uma evolução benigna, mesmo quando associada à infecção pelo HIV. Com o objetivo de compreender os mecanismos imunológicos envolvidos neste fenômeno, nós comparamos as concentrações de citocinas e subgrupos de células imunológicas no líquido e tecido pleural de pacientes com tuberculose pleural com e sem infecção pelo HIV. Material e métodos: foram incluídos 42 pacientes com o diagnóstico de tuberculose pleural dos quais 12 infectados pelo HIV. A análise imunohistoquímica do tecido pleural foi realizada em 21 pacientes utilizando os seguintes anticorpos monoclonais: anti-CD4, anti-CD8, anti-delta TCR, anti-perforina e anti-fasL. A concentração de citocinas (IL-2,IL-4, IL-10, IL-12 e IFN-) foi medida pelo método ELISA no líquido pleural de 29 pacientes. Resultados: a mediana das proporções de células CD8+ e perforina+ foi superior nos pacientes infectados pelo HIV. A proporção de células CD4+, FasL+ e delta-TCR+ foram semelhantes nos dois grupos. A IL-4 foi indetectável em todos os pacientes. Três de nove pacientes infectados pelo HIV apresentaram uma concentração de IL-2 superior a 40 pg/ml (p=0,02). Conclusões: as concentrações de IFN-, IL-10 e IL-12 foram semelhantes nos dois grupos. A citotoxicidade mediada pela perforina e a IL-2 parecem ter um papel importante na proteção contra Mycobacterium tuberculosis nos estádios iniciais da infecção pelo HIV. As células CD8+ do tecido pleural podem ser uma fonte alternativa de síntese de IFN- em pacientes com tuberculose pleural co-infectados pelo HIV.

Introduction: pleural tuberculosis (TB) has a benign course whether associated or not to HIV infection. To understand the immune mechanisms involved in this phenomenon, we compared cytokine concentrations and subsets of immune cells in the pleural fluid/tissue from patients with TB pleurisy with and without HIV co-infection. Material and methods: forty-two patients diagnosed with pleural TB were included, twelve of whom were HIV-infected. Immunohistochemical analysis of pleural tissue was performed in 21 patients with TB pleurisy with and without HIV co-infection. Material and methods: forty-two patients diagnosed with pleural TB were included, twelve of whom were HIV-infected. Immunohistochemical analysis of pleural tissue was performed in 21 patients using the following monoclonal antibodies: anti-CD4, anti CD-8, anti-delta TCR, anti-perforin and anti FasL. Cytokine (IL-2, OÇ-4, IL-10, IL-12 amd IFN-) concentration was measured by the ELISA method in the pleural fluid of 29 patients. Results: the median proportions of CD8+ and perforin + cells were higher in HIV-infected patients. The proportions of CD4+, FasL+ and delta-TCR+ cells were similar in both groups. IL-4 was undetectable in all patients. Three out of nine HIV-infected patients had IL-2 concentration ouver 40pg/ml (p=0.02). Conclusion: the concentrations of IFN-, IL-10 and IL-12 were similar in both groups. Perforin-mediated cytotoxicity and IL-2 may play an important role in protection against Mycobacterium tuberculosis in the early stages of HIV infection. Pleural CD8+ cells may be an alternative source for IFN- in HIV-infected patients with tuberculosis.

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OBJETIVO: Avaliar o valor da punçäo-biópsia pleural no diagnóstico das doenças inflamatórias da pleura. MÉTODO: Foi feito um estudo retrospectivo de 82 toracocenteses realizadas durante um período de 42 meses em uma enfermaria de clínica médica no Rio de Janeiro. Os aspectos bioquímico, citológico e bacteriológico do líquido pleural e o exame histopatológico do fragmento pleural foram correlacionados com o diagnóstico final. A sensibilidade e os valores preditivos da concentraçäo protéica e da percentagem de linfócitos no líquido pleural foram calculados utilizando diferentes valores de corte. RESULTADOS: Dos 82 pacientes, 73 (89 por cento) tinham tuberculose. Todos os pacientes com menos de 35 anos tinham tuberculose. O valor preditivo negativo para o diagnóstico de tuberculose aumentou de 17,1 por cento para 66,7 por cento utilizando 4,5g/dL e 2,5g/dL, respectivamente, como valores de corte para a concentraçäo de protéina no líquido pleural. O valor preditivo positivo, de 94,2 por cento. A pesquisa de BAAR no líquido pleural foi negativa nas 82 amostras. A sensibilidade do exame histopatológico da pleura foi de 69,2 por cento para o diagnóstico de tuberculose. CONCLUSÄO: A tuberculose foi a causa mais comum de derrame pleural em todos as faizas etárias. O exame que mais contribuiu para confirmar este diagnóstico foi a análise histopatológica. Os autores sugerem que a punçäo pleural e a biópsia sejam realizadas simultaneamente nas populaçöes em que a tuberculose tenha alta prevalência

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Three hundred and fifty two medical records of AIDS inpatients were analysed in a retrospective study to establish the frequency, clinical patterns and etiology of AIDS-related diarrhea. Diarrhea was observed in 58.8 per cent of the patients, being a chronic symptom in 65.7 per cent, and the first complaint in 24.6 per cent. The most common cause of diarrhea was coccidea and the etiology remained unknown in 56.1 per cent of the patients. Routine stool examination was the most sensitive method in the diagnosis of diarrhea. In countries with limited resources, the use of stool examinations seems to provide appropriate clinical management. The implementation of an objective protocol could improve the etiologic diagnosis of AIDS-related diarrhea without the burden of more complex and invasive technologies.

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O objetivo deste estudo foi o de estimar a prevalência da infecçäo pelo HIV nas diferentes formas clínicas de tuberculose e comparar a apresentaçäo clínica desta infecçäo nos pacientes soropositivos e soronegativos. Um estudo transversal foi realizado com 127 pacientes que preencheram os críterios diagnósticos de tuberculose do Ministério da Saúde do Brasil. Todos os pacientes foram submetidos a um teste sorológico anti-HIV (ELISA). A prevalência da infecçäo pelo HIV foi elevada. Cinqüenta e três pacientes (42 por cento) estavam infectados pelo HIV. A tuberculose pulmonar foi a apresentaçäo clínica mais freqüente (102 pacientes, dos quais 42 estavam infectados pelo HIV, p=0,97). A tuberculose extrapulmonar foi observada...

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