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BACKGROUND: Four main chronic conditions may be involved in the tuberculosis pathogenic process and/or clinical evolution: HIV/AIDS, diabetes mellitus, mental illness, and Chronic Obstructive Pulmonary Disease. This study aimed to determine the spatiotemporal pattern of tuberculosis (TB) associated with multimorbidity in Brazil. METHODS: Ecological study use data from the Notifiable Diseases Information System (SINAN), collected from the electronic portal of the Department of Informatics of the SUS (DATASUS). These data included TB cases that were reported between 2007 and 2021 and were associated with two or more chronic clinical health conditions (multimorbidity). RESULTS: A total of 7,795 cases of TB associated with multimorbidity were recorded, with an average growth trend of 4.6% per year (95% Confidence Interval (CI): 3.3-5.9; p<0.001) and higher growth in the first temporal segment (2007 to 2011) (8.9%; 95%CI: 4.2-13.9; p=0.002). The spatial analysis, after Bayesian smoothing, highlighted the main municipalities states of the study, namely: São Paulo (19.8%; n = 297), Porto Alegre (23.6%; n = 354), and Rio de Janeiro (44.8%; n = 672). The proportion of extremely poor (ß=-0.002), the bolsa família program (ß=0.002), the average per-person income (ß=0.001), and the percentage of the population living in households with a density of more than 2 people per bedroom (ß=0.001) were related to chronic health conditions. CONCLUSIONS: These findings will stimulate public action to manage this situation. However, as this is still a recent topic in the literature, we encourage the development of studies on the synergistic characteristics of TB and other clinical conditions.

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ABSTRACT Background: Four main chronic conditions may be involved in the tuberculosis pathogenic process and/or clinical evolution: HIV/AIDS, diabetes mellitus, mental illness, and Chronic Obstructive Pulmonary Disease. This study aimed to determine the spatiotemporal pattern of tuberculosis (TB) associated with multimorbidity in Brazil. Methods: Ecological study use data from the Notifiable Diseases Information System (SINAN), collected from the electronic portal of the Department of Informatics of the SUS (DATASUS). These data included TB cases that were reported between 2007 and 2021 and were associated with two or more chronic clinical health conditions (multimorbidity). Results: A total of 7,795 cases of TB associated with multimorbidity were recorded, with an average growth trend of 4.6% per year (95% Confidence Interval (CI): 3.3-5.9; p<0.001) and higher growth in the first temporal segment (2007 to 2011) (8.9%; 95%CI: 4.2-13.9; p=0.002). The spatial analysis, after Bayesian smoothing, highlighted the main municipalities states of the study, namely: São Paulo (19.8%; n = 297), Porto Alegre (23.6%; n = 354), and Rio de Janeiro (44.8%; n = 672). The proportion of extremely poor (β=-0.002), the bolsa família program (β=0.002), the average per-person income (β=0.001), and the percentage of the population living in households with a density of more than 2 people per bedroom (β=0.001) were related to chronic health conditions. Conclusions: These findings will stimulate public action to manage this situation. However, as this is still a recent topic in the literature, we encourage the development of studies on the synergistic characteristics of TB and other clinical conditions.

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RESUMO Objetivo: identificar o padrão espaço-temporal da mortalidade por tuberculose e seus fatores a ela relacionados. Método: estudo ecológico, usando como unidade de análise os municípios do estado do Ceará, Brasil, durante o período de 2001 a 2017. A mortalidade por tuberculose foi analisada por técnicas de análise temporal e espacial. Resultados: no período, foram notificados 1.513 óbitos por tuberculose. Detectou-se aumento anual médio de 15% na mortalidade (Intervalo de Confiança 95%: 6,2 - 24,6). Os indicadores que mais influenciaram a mortalidade foram: esperança de vida ao nascer (β=3,38), domicílios com abastecimento de água e esgotamento sanitário inadequados (β=-0,01) e probabilidade de sobrevivência até os 60 anos (β=-2,26). Conclusão: este estudo evidenciou o aumento no padrão temporal da mortalidade por tuberculose ao longo dos anos. Deve-se, portanto, enfatizar estratégias de cuidado voltadas à adesão ao tratamento e de saúde pública voltadas à melhoria do ambiente da população.

ABSTRACT Objective: to identify the spatio-temporal pattern of tuberculosis mortality and its related factors. Method: ecological study, using as unit of analysis the municipalities of the state of Ceará, Brazil, during the period from 2001 to 2017. Tuberculosis mortality was analyzed by temporal and spatial analysis techniques. Results: in the period, 1,513 deaths from tuberculosis were reported. An average annual increase of 15% in mortality was detected (95% Confidence Interval: 6.2 - 24.6). The indicators that most influenced mortality were life expectancy at birth (β=3.38), households with inadequate water supply and sanitation (β=-0.01) and probability of survival to 60 years (β=-2.26). Conclusion: this study evidenced the increase in the temporal pattern of tuberculosis mortality over the years. Care strategies aimed at treatment adherence and public health strategies aimed at improving the environment of the population should therefore be emphasized.

RESUMEN Objetivo: identificar el patrón espacio-temporal de la mortalidad por tuberculosis y los factores relacionados. Método: Estudio ecológico, utilizando como unidad de análisis los municipios del estado de Ceará, Brasil, durante 2001 a 2017. La mortalidad por tuberculosis se analizó mediante técnicas de análisis temporal y espacial. Resultados: se notificaron 1.513 muertes por tuberculosis en el periodo. Se detectó un aumento medio anual del 15% de la mortalidad (intervalo de confianza del 95%: 6,2 - 24,6). Los indicadores que más influyeron en la mortalidad fueron: la esperanza de vida al nacer (β=3,38), los hogares con suministro de agua y saneamiento inadecuados (β=-0,01) y la probabilidad de sobrevivir hasta los 60 años (β=-2,26). Conclusión: este estudio evidenció el aumento del patrón temporal de la mortalidad por tuberculosis a lo largo de los años. Por lo tanto, se debe hacer hincapié en las estrategias de atención dirigidas a la adherencia al tratamiento y en las estrategias de salud pública dirigidas a mejorar el entorno de la población.

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BACKGROUND: Over 66 million people worldwide have been diagnosed with COVID-19. Therefore, understanding their clinical evolution beyond hospital discharge is essential not only from an individual standpoint, but from a populational level. OBJECTIVES: Our primary aim was to assess the impact of COVID-19 on health-related quality of life (HRQoL) 3 months after hospital discharge. Additionally, we screened for anxiety and depression and assessed important clinical outcomes. METHODS: This was a single-center cohort study performed in Sao Paulo (Brazil), in which participants were contacted by telephone to answer a short survey. EQ-5D-3L was used to assess HRQoL and clinical data from patients' index admission were retrieved from medical records. RESULTS: We contacted 251 participants (59.8% males, mean age 53 years old), 69.7% of which had presented with severe COVID-19. At 3 months of follow-up, 6 patients had died, 51 (20.3%) had visited the emergency department again and 17 (6.8%) had been readmitted to hospital. Seventy patients (27.9%) persisted with increased dyspnoea and 81 had a positive screening for anxiety/depression. Similarly, patients reported an overall worsening of EQ-5D-3L single summary index at 3 months compared to before the onset of COVID-19 symptoms (0.8012 (0.7368 - 1.0) vs. 1.0(0.7368 - 1.0), p < 0.001). This affected all 5 domains, but especially pain/discomfort and anxiety/depression. Only female sex and intensive care requirement were independently associated with worsening of HRQoL. CONCLUSION: Patients hospitalized for COVID-19 frequently face persistent clinical and mental health problems up to 3 months following hospital discharge, with significant impact on patients' HRQoL.

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Type 2 diabetes mellitus (T2DM) is associated with an increase of premature appearance of several disorders such as cardiac complications. Thus, we test the hypothesis that a combination of a high fat diet (HFD) and low doses of streptozotocin (STZ) recapitulate a suitable mice model of T2DM to study the cardiac mitochondrial disturbances induced by this disease. Animals were divided in 2 groups: the T2DM group was given a HFD and injected with 2 low doses of STZ, while the CNTRL group was given a standard chow and a buffer solution. The combination of HFD and STZ recapitulate the T2DM metabolic profile showing higher blood glucose levels in T2DM mice when compared to CNTRL, and also, insulin resistance. The kidney structure/function was preserved. Regarding cardiac mitochondrial function, in all phosphorylative states, the cardiac mitochondria from T2DM mice presented reduced oxygen fluxes when compared to CNTRL mice. Also, mitochondria from T2DM mice showed decreased citrate synthase activity and lower protein content of mitochondrial complexes. Our results show that in this non-obese T2DM model, which recapitulates the classical metabolic alterations, mitochondrial function is impaired and provides a useful model to deepen study the mechanisms underlying these alterations.

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Objective: To determine the rate and factors related to non-visualization of locally advanced breast cancer (LABC) by mammography. Method: Prospective, cross-sectional study, conducted in a cohort of consecutive patients with LABC treated at a tertiary cancer hospital. All patients were systematically examined and underwent high-resolution mammography (conventional equipment) in two views (craniocaudal and mediolateral oblique). A blind study was performed in which mammograms were mixed with routine and where radiologists were unaware of the clinical data. Three radiologists evaluated the examinations. In the patients in whom the findings were negative, the possible causes responsible for not identifying the tumor on mammography were evaluated. After the radiological report, the examinations were reviewed, and the radiological data were added to the standard form, making up the database of the present study. Descriptive statistics were used to compare factors related to non-visualization of tumors, namely the chi-square test and the Mann-Whitney test. Result: Eighty-five patients were evaluated. The average size of the tumors was 6.96 cm, and 20% of cases were not identified on mammography. Among the causes, 76.4% had dense parenchyma, 17.6% were not visible on examination, and in 5.8%, the lesion was not noticed by the radiologist (false negative examination). The only factor found when LABC was not identified was the type of breast parenchyma (p=0.04). Conclusion: Clinical history and changes in physical examination should be considered in the report to the radiologist. High breast density was the major obstacle to mammography diagnosis.

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É apresentado um caso clínico no qual houve o uso da técnica de clareamento dental extracoronário dos arcos superior e inferior seguida da técnica de clareamento intracoronário do elemento 11, que se apresentava escurecido devido a um tratamento endodôntico mal executado. O dente 11 foi submetido a um retratamento endodôntico bem-sucedido e a posterior clareamento intracoronário. Foram sugeridas modificaçöes na técnica convencional para evitar complicaçöes, como a reabsorçäo cervical

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