ABSTRACT Even when treated adequately, pulmonary tuberculosis can lead to pulmonary sequelae. Patients treated for PTB between 2012 and 2016 answered a standardized questionnaire and underwent chest radiography and spirometry, measurement of absolute pulmonary volume, Diffusing Capacity for Carbon Monoxide (DLCO) and the 6-min walk test (6MWT) on two occasions: within the first year after the end of treatment (follow-up 1), and one and two years after follow-up 1 (follow-up 2). A total of 55 patients they underwent spirometry, 23 (41.82%) had obstructive ventilatory disorder (OVD) and eight (14.5%) had moderate OVD. In total, 29 patients underwent pulmonary function tests (PFTs) and 24 patients underwent the 6MWT on two occasions. The functional changes after PTB treatment appear not to have varied between one and two years of follow-up. There was a correlation between low FEV1 and low DLCO (p<0.001); low DLCO and low 6MWT (p<0.001) and radiographic abnormalities and low FEV1 (p=0.033). The most frequently observed change in spirometry was found in patients with OVD.

Abstract INTRODUCTION: Hansen’s disease is no longer a public health problem in Mozambique, since 2008 (incidence under 1 / 10,000 inhabitants). The country is one of the most affected in the world and Nampula province’s Murrupula district (incidence 1.7 / 10,000) has a high deformity rate (22% in 2010). This study aimed to identify high deformity rate associated determinants and proposals for better health program results. METHODS: This study involved a descriptive quantitative survey, systematic observation of patients and health professionals, and a survey of community volunteers. Data were analyzed using Epi Info 7.2. Pearson's chi-square and Fisher’s exact test were used to assess statistical association with deformity, with a significance level of 5% and 95% confidence interval. Ethical procedures followed the Helsinki declaration (2013). RESULTS: Among 238 subjects, 175 were patients and 63 leprosy health staff. Most patients relied on subsistence agriculture facing social exclusion (43, 25%). The waiting time from first symptoms to diagnosis was over one year for 63%. Deformity affected 116 subjects (68%), particularly those who considered the disease as God’s desire (p = 0.01), and practiced traditional treatments (p = 0.001). Among leprosy health staff, 35 (52%) were not trained on diagnosis and management. CONCLUSIONS: High deformity rate is associated with low economic status, the belief that the disease is God’s desire, the use of traditional healers, late diagnosis, and poor disease management. A health education program targeting professionals and population, with infection screening and self-care groups can prevent deformities.

RESUMO Objetivo: Analisar práticas assistenciais de profissionais da equipe do Consultório na Rua (eCR) sobre o cuidado prestado aos usuários de álcool e outras drogas em Macapá-AP. Método: Estudo descritivo, qualitativo, realizado entre abril e junho de 2017. Participaram dez profissionais das eCR. Utilizaram-se cinco questões norteadoras para a coleta de dados, posteriormente analisados através da Análise de Conteúdo Temático Categorial de Bardin. Resultados: As estratégias facilitadoras do cuidado envolveram redução de danos, trabalho da equipe, criação do vínculo com os usuários, compromisso da equipe e parceria com os demais elementos da Rede de Atenção Psicossocial (RAPS). Dos fatores que dificultam o cuidado, estão o déficit de autocuidado, estrutural e de recursos humanos, e o preconceito. Conclusão: Os profissionais possuem conhecimento da finalidade e importância da eCR no fortalecimento da RAPS. Conclusão: Ao realizar uma prática baseada nas políticas públicas, o cuidado à população de rua é facilitado.

ABSTRACT Objective: To analyze the care practices of professionals from the Street Clinic team (SCt) about the care provided to users of alcohol and other drugs in Macapá, capital city of the state of Amapá. Method: Descriptive, qualitative study, carried out between April and June 2017. Ten SCt professionals participated. Five guiding questions were used for data collection, later analyzed through Bardin’s Thematic Content Analysis. Results: Facilitating care strategies involved harm reduction, teamwork, creating the link with users, team commitment and partnership with other members of the Psychosocial Care Network (PSCN). Of the factors that make care difficult, are the deficit of self-care, structural and human resources, and prejudice. Conclusion: Professionals are aware of the purpose and importance of SCt in strengthening PSCN. Conclusion: When conducting a practice based on public policies, care for the street population is facilitated.

RESUMEN Objetivo: Analizar prácticas asistenciales de profesionales del equipo del Consultorio en la Calle (eCC) sobre el cuidado prestado a usuarios de alcohol y otras drogas en Macapá-AP. Método: Estudio descriptivo, cualitativo, realizado entre abril y junio de 2017. Participaron diez profesionales de los eCC. Se utilizaron cinco preguntas orientadoras para la recolección de datos, posteriormente analizados a través del Análisis de Contenido Temático Categorial de Bardin. Resultados: Las estrategias facilitadoras del cuidado involucraron reducción de daños, trabajo del equipo, creación de vínculo con usuarios, compromiso del equipo y asociación con los demás elementos de la Red de Atención Psicosocial (RAPS). Factores que dificultan el cuidado: déficit de autocuidado, estructural y de recursos humanos, y prejuicio. Conclusión: Profesionales tienen conocimiento de la finalidad e importancia del eCC en el fortalecimiento de la RAPS. Conclusión: Al realizar una práctica basada en políticas públicas, el cuidado a la población callejera es facilitado.

ABSTRACT Objective: To analyze the care practices of professionals from the Street Clinic team (SCt) about the care provided to users of alcohol and other drugs in Macapá, capital city of the state of Amapá. Method: Descriptive, qualitative study, carried out between April and June 2017. Ten SCt professionals participated. Five guiding questions were used for data collection, later analyzed through Bardin’s Thematic Content Analysis. Results: Facilitating care strategies involved harm reduction, teamwork, creating the link with users, team commitment and partnership with other members of the Psychosocial Care Network (PSCN). Of the factors that make care difficult, are the deficit of self-care, structural and human resources, and prejudice. Conclusion: Professionals are aware of the purpose and importance of SCt in strengthening PSCN. Conclusion: When conducting a practice based on public policies, care for the street population is facilitated.

RESUMEN Objetivo: Analizar prácticas asistenciales de profesionales del equipo del Consultorio en la Calle (eCC) sobre el cuidado prestado a usuarios de alcohol y otras drogas en Macapá-AP. Método: Estudio descriptivo, cualitativo, realizado entre abril y junio de 2017. Participaron diez profesionales de los eCC. Se utilizaron cinco preguntas orientadoras para la recolección de datos, posteriormente analizados a través del Análisis de Contenido Temático Categorial de Bardin. Resultados: Las estrategias facilitadoras del cuidado involucraron reducción de daños, trabajo del equipo, creación de vínculo con usuarios, compromiso del equipo y asociación con los demás elementos de la Red de Atención Psicosocial (RAPS). Factores que dificultan el cuidado: déficit de autocuidado, estructural y de recursos humanos, y prejuicio. Conclusión: Profesionales tienen conocimiento de la finalidad e importancia del eCC en el fortalecimiento de la RAPS. Conclusión: Al realizar una práctica basada en políticas públicas, el cuidado a la población callejera es facilitado.

RESUMO Objetivo: Analisar práticas assistenciais de profissionais da equipe do Consultório na Rua (eCR) sobre o cuidado prestado aos usuários de álcool e outras drogas em Macapá-AP. Método: Estudo descritivo, qualitativo, realizado entre abril e junho de 2017. Participaram dez profissionais das eCR. Utilizaram-se cinco questões norteadoras para a coleta de dados, posteriormente analisados através da Análise de Conteúdo Temático Categorial de Bardin. Resultados: As estratégias facilitadoras do cuidado envolveram redução de danos, trabalho da equipe, criação do vínculo com os usuários, compromisso da equipe e parceria com os demais elementos da Rede de Atenção Psicossocial (RAPS). Dos fatores que dificultam o cuidado, estão o déficit de autocuidado, estrutural e de recursos humanos, e o preconceito. Conclusão: Os profissionais possuem conhecimento da finalidade e importância da eCR no fortalecimento da RAPS. Conclusão: Ao realizar uma prática baseada nas políticas públicas, o cuidado à população de rua é facilitado.

Objetivo: Avaliar a situação clínica dos pacientes em terapia antirretroviral, as taxas de adesão e descontinuação e seus fatores determinantes e intervir para melhorar o programa de luta contra o vírus da imunodeficiência humana em Nampula. Tipo de estudo: Investigação de implementação, descritiva mista. Local: Província de Nampula, Moçambique, envolvendo 10 centros de saúde. População: Pacientes em terapia antirretroviral e que descontinuaram, profissionais dos cuidados de saúde primários e praticantes tradicionais de saúde. Métodos: Investigação de implementação, aplicando inquérito a pacientes e praticantes tradicionais de saúde, entrevista semiestruturada com profissionais de saúde e praticantes tradicionais e consulta documental. Avaliada a linha de base nos centros de saúde alvo e controlo foi realizada uma ação de educação para a saúde com os pacientes e com os praticantes tradicionais e de formação médica com os profissionais de saúde nos distritos alvo. Depois foram analisados os indicadores clínicos e do programa em todos os centros de saúde. Resultados: A insegurança alimentar, discriminação e dificuldade de acesso aos serviços de saúde contribuem para uma taxa de descontinuação da terapia, atingindo 50% dos pacientes. A adesão terapêutica verifica-se em 69%. A ação foi realizada em cinco distritos, com 63 pacientes, 59 praticantes tradicionais e 96 profissionais de saúde. Nos distritos de ação verificou-se um aumento do número de Grupos de Apoio à Adesão Comunitários e de referências aos cuidados de saúde primários, bem como uma melhoria relativa do estado clínico dos pacientes e da taxa de descontinuação da terapia, sem diferença estatisticamente significativa. Conclusões: Existem diversas causas de descontinuação da terapia antirretroviral e de baixa adesão. A descontinuação da TARV é um problema grave em Nampula e resulta de fatores individuais, sociais e do sistema de saúde. Intervenções interdisciplinares de baixo custo na área da educação em saúde, associadas a extensão rural, podem inverter esta situação.

Aim: To evaluate the clinical status of HIV-infected patients under antiretroviral therapy, rates of adherence and discontinuation of medication, and their determinants, aiming to improve the program to fight human immunodeficiency virus in Nampula. Study: Implementation research, descriptive with mixed methods. Place: Nampula Province, Mozambique, involving 10 health centres. Population: Patients on antiretroviral therapy and those who discontinued therapy, primary health care professionals, and traditional healers Methods: Implementation research, applying surveys to patients and traditional healers, semi-structured interviews to health professionals and traditional healers, and documental review. Baseline evaluation was performed in both target and control primary health care centres, followed by health education sessions for patients and traditional healers, and training of health care professionals in target health centres. Finally, we compared clinical and program indicators in all health centres. Results: Food insecurity, discrimination and low accessibility to health care contribute to a discontinuation of antiretroviral therapy in up to 50% of patients. Therapeutic adherence is observed in 69% of the patients. The intervention was carried out in five districts, comprising 63 patients, 59 traditional healers and 96 health professionals. The intervention districts showed more community adherence support groups, higher number of patients referred to primary health care services, and achieved better patient clinical indicators and a lower treatment discontinuation rate, although not statistically significant. Conclusion: There are several reasons for antiretroviral therapy discontinuation and low adherence rates. Discontinuation of antiretroviral therapy is a severe problem in Nampula due to individual, social and health system factors. Interdisciplinary and low-cost interventions such as health education with extension to rural areas may change this scenario.

CONTEXTE: L'épidémie du virus de l'immunodéficience humaine au Mozambique est un problème grave de santé publique et le Ministère de la Santé a étendu le traitement antirétroviral à tous les districts du pays. Cependant, on constate un nombre élevé d'abandon du traitement encore insuffisamment évalué. L'Organisation Mondiale de la Santé recommande que les tradipraticiens de santé collaborent avec les systèmes nationaux de santé dans les pays en développement, pour combattre cette épidémie, mais il existe peu d'actions dans ce domaine à ce jour. OBJECTIF: Évaluer la connaissance des tradipraticiens sur l'infection et leur disponibilité à coopérer avec les services de santé dans la Province de Nampula au Mozambique, pour améliorer les résultats du traitement antirétroviral. LIEUX: Cinq centres de santé des districts de la Province de Nampula, au Nord du Mozambique, avec des taux élevés d'incidence du virus d'immunodéficience humaine et d'abandon du traitement MÉTHODES: Une étude mixte transversale, utilisant des interviews ciblés et des discussions de groupes focaux. Les données quantitatives étaient traitées par fréquence et les données qualitatives par analyse de discours et ethnographie locale. RÉSULTATS: Nous avons interviewé 79 tradipraticiens de santé. La perte de poids était souvent considérée comme le signal principal de suspicion d'infection par le virus d'immunodéficience humaine et certains tradipraticiens ne pas les signes de la maladie ; la majorité pensait que les antirétroviraux améliorent la qualité de vie des patients, ne prétendait pas traiter l'infection, savait qu'elle n'est pas curable, avait une idée sur le concept de bonne adhésion au traitement et référait les cas compliqués au centre de santé. En ce qui concerne l'alimentation, la moitié considérait exclusivement les céréales comme l'aliment principal ; les fruits étaient importants pour un quart ; l'eau potable est ignorée. La majorité était prête à collaborer avec le système de santé et avait des propositions de coopération pratique : la qualification et la reconnaissance individuelle et la formation intégrée avec les professionnels de santé. CONCLUSION: Les tradipraticiens connaissaient l'infection par le virus d'immunodéficience humaine et les facteurs associés, mais il y a des lacunes. Ils ont signalé qu'ils utilisaient principalement les plantes médicinales, ce qui peut contribuer au traitement des infections opportunistes et la majorité référait déjà des patients au centre de santé ; mais la collaboration nécessite une procédure éducative et une articulation structurée. Les lacunes de connaissance empêchent une coopération efficace dans le combat contre l'épidémie. Le groupe est disponible pour coopérer avec le système de santé pour améliorer les résultats du traitement antirétroviral, mais pour ça il est nécessaire d'informer et former les tradipraticiens dans un processus intégré de collaboration avec les professionnels de santé conventionnels.

ABSTRACT Symptomatic forms of toxoplasmosis are a serious public health problem and occur in around 10-20% of the infected people. Aiming to improve the molecular diagnosis of symptomatic toxoplasmosis in Brazilian patients, this study evaluated the performance of real time PCR testing two primer sets (B1 and REP-529) in detecting Toxoplasma gondii DNA. The methodology was assayed in 807 clinical samples with known clinical diagnosis, ELISA, and conventional PCR results in a 9-year period. All samples were from patients with clinical suspicion of several features of toxoplasmosis. According to the minimum detection limit curve (in CT), REP-529 had greater sensitivity to detect T. gondii DNA than B1. Both primer sets were retrospectively evaluated using 515 DNA from different clinical samples. The 122 patients without toxoplasmosis provided high specificity (REP-529, 99.2% and B1, 100%). From the 393 samples with positive ELISA, 146 had clinical diagnosis of toxoplasmosis and positive conventional PCR. REP-529 and B1 sensitivities were 95.9% and 83.6%, respectively. Comparison of REP-529 and B1 performances was further analyzed prospectively in 292 samples. Thus, from a total of 807 DNA analyzed, 217 (26.89%) had positive PCR with, at least one primer set and symptomatic toxoplasmosis confirmed by clinical diagnosis. REP-529 was positive in 97.23%, whereas B1 amplified only 78.80%. After comparing several samples in a Brazilian referral laboratory, this study concluded that REP-529 primer set had better performance than B1 one. These observations were based after using cases with defined clinical diagnosis, ELISA, and conventional PCR.

Objetivos: Avaliar a taxa de adesão à terapia antirretroviral na província de Nampula e os fatores associados ao abandono do tratamento. Tipo de estudo: Descritivo transversal misto. Local: Centros de saúde de cinco distritos da província de Nampula, Moçambique, 2014. População: Pacientes infetados pelo vírus da imunodeficiência humana em terapia antirretroviral e pacientes que abandonaram, profissionais dos cuidados de saúde primários. Métodos: Inquérito a pacientes em terapia antirretroviral e a pacientes que abandonaram a terapia, consulta documental de processos clínicos, registos da farmácia e relatórios estatísticos do programa Vírus da Imunodeficiência Humana Adquirida, entrevista aos profissionais de saúde. Resultados: A taxa de abandono da terapia atinge os 40%. Foram inquiridos 208 pacientes em tratamento e 86 abandonos, 70% do sexo feminino, entre os 18 e os 62 anos de idade. Como causa principal de abandono 36% referem discriminação, mas 58% não dispõem de alimentos suficientes e 37% apresentam depressão. A boa adesão à terapia antirretroviral (>95% das tomas de antirretrovirais) nos últimos três meses foi estimada em 69% dos pacientes, mas 36% apresentam um mau resultado de contagem de Linfócitos T CD4 e 63% não cumprem o protocolo recomendado pelo Ministério da Saúde. Conclusões: O principal motivo alegado para o abandono da terapia antirretroviral é o estigma ligado à infeção pelo vírus da imunodeficiência humana adquirida, mas a insegurança alimentar constitui igualmente um fator determinante. Nos pacientes em terapia, a adesão estimada de 69% explica a alta incidência de infeções oportunistas (27%). O abandono da terapia em Nampula é um problema grave e complexo, resultante de fatores individuais, sociais e do funcionamento dos cuidados de saúde primários. Será necessário desenvolver uma ação interdisciplinar junto de pacientes, famílias e profissionais de saúde para inverter a situação e melhorar a adesão terapêutica.

Objectives: To evaluate adherence to antiretroviral treatment in Nampula province and to identify the determinants of non-compliance. Study type: Observational study with quantitative and qualitative methods. Place: Five health centers in the Nampula province of Mozambique in 2014. Population: Patients infected with human immunodeficiency virus receiving antiretroviral treatment, patients who had abandoned treatment, and primary health care professionals. Methods: Patients on treatment and patients who were non-compliant with therapy completed a questionnaire, patient records (clinical files, pharmacy records, and statistical records) were reviewed, and interviews were conducted with health care professionals. Results: Abandonment of antiretroviral treatment reached 40%. We surveyed 208 patients on treatment and 86 patients who were non-compliant with therapy. Of these 70% were female and they were between 18 and 62 years of age. The main reason for non-compliance with treatment (36%) was stigma attached to having the infection. In addition 58% of patients do not have enough food and 37% suffer from depressive ideation. Good treatment adherence (>95% of pills were taken in the last three months) was found in 69% of patients, but 36 % of people who are adherent have a low CD4 count and 63% are not following the recommended treatment protocol. Conclusions: Perception of stigma from infection with the human immunodeficiency virus is considered the main reason for non-adherence with antiretroviral treatment, but food insecurity is also an important determinant. A treatment adherence rate of 69% explains the high incidence of opportunistic infections (27%). Abandonment of antiretroviral treatment in Nampula is a serious and complex problem due to individual, social and primary health care services factors. It will be necessary to develop an interdisciplinary intervention with patients, families, and health professionals, to reverse this situation and improve treatment adherence.

RESUMO A pesquisa avaliou a fenologia de Attalea maripa (inajá), relacionando os eventos fenológicos com a precipitação pluviométrica. Os dados foram obtidos em 100 palmeiras adultas provenientes de regeneração natural, em 3,25 hectares de área de pastagens em Bonito, PA, no período de agosto de 2009 a dezembro de 2011. Os dados foram analisados por meio de fenogramas, índice de sincronia e análise fatorial. Pelo que a pesquisa evidenciou, o padrão fenológico do inajá não é sazonal. A floração e a frutificação ocorrem durante todo o ano; são eventos de longa duração, que sofrem oscilações ao longo do ano. A fenofase espata fechada é altamente sincrônica. A frutificação é um evento fenológico pouco sincrônico. A precipitação é um fator climático importante para a fenologia do inajá, pois afeta negativamente a produção de espata aberta com flores e a queda de folhas e positivamente a queda de frutos maduros.

ABSTRACT The research evaluated the Attale amaripa (inajá) phenology relating the phenological events with rainfall. Data were obtained from 100 adult palms from natural regeneration in 3.25 acres of pasture in Bonito-PA, from August 2009 to December 2011. Data were analyzed using phenograms, synchrony index and factor analysis. The research showed that the phenological pattern of inajá is not seasonal. Flowering and fruiting occur throughout the year and are long-lasting events and suffer fluctuations throughout the year. The closed spathe phenology is highly synchronous. The fruiting is a slightly synchronous phenological event. Rainfall is a major climatic factor for phenology inajá because negatively affects production of open spathe with flowers and leaves fall and positively mature fruit drop.

A síndrome de envenenamento por ferroadas de abelhas africanizadas é causada pela inoculação de uma grande quantidade de peçonha por múltiplas ferroadas de abelhas, geralmente acima de quinhentas. A incidência de uma intoxicação severa por ferroadas de abelhas africanizadas é rara, porém letal. Este relato de caso aponta que, devido a um menor volume de distribuição do veneno, um número menor de ferroadas por abelhas africanizadas não exime o paciente de apresentar envenenamentos com desfecho desfavorável, principalmente em crianças, idosos e pessoas com baixo peso.

Envenoming syndrome from Africanized bee stings is a toxic syndrome caused by the inoculation of large amounts of venom from multiple bee stings, generally more than five hundred. The incidence of severe toxicity from Africanized bee stings is rare but deadly. This report reveals that because of the small volume of distribution, having fewer stings does not exempt a patient from experiencing an unfavorable outcome, particularly in children, elderly people or underweight people.

Em regiões de alta prevalência, Blastocystis hominis é freqüentemente encontrado em associação com Entamoeba histolytica/E. dispar em cultivos xênicos. Seu crescimento exacerbado se sobrepõe muitas vezes ao das amebas, impedindo a manutenção destas em cultura, dentro de poucas gerações. O presente estudo relata a excelente eficácia (100%) do antifúngico miconazol na eliminação de B. hominis dos cultivos de E. histolytica/E. dispar, mantendo-se a integridade dos trofozoítos das amebas. A nistatina apresentou eficácia baixa (33,3%).

In regions with high prevalence, Blastocystis hominis is frequently found in association with Entamoeba histolytica/E. dispar in xenic cultures. Its exacerbated growth is often superimposed on the growth of amebas, thus impeding the continuation of the amebas in the culture, within a few generations. The present study reports on the excellent efficacy (100%) of the antifungal agent miconazole in eliminating B. hominis from cultures of E. histolytica/E. dispar, thereby maintaining the integrity of the trophozoites of the amebas. Nystatin presented low efficacy (33.3%).

Rotavirus is a major cause of infantile acute diarrhea, causing about 440,000 deaths per year, mainly in developing countries. The World Health Organization has been recommending the assessment of rotavirus burden and strain characterization as part of the strategies of immunization programs against this pathogen. In this context, a prospective study was made on a sample of 134 children with acute diarrhea and severe dehydration admitted to venous fluid therapy in two state hospitals in Rio de Janeiro, Brazil, from February to September 2004. Rotavirus where detected by polyacrylamide gel electrophoresis (PAGE) and by an enzyme-linked immunoassay to rotavirus and adenovirus (EIARA) in 48% of the children. Positive samples for group A rotavirus (n = 65) were analyzed by reverse transcription/heminested multiplex polymerase chain reaction to determine the frequency of G and [P] genotypes and, from these, 64 samples could be typed. The most frequent G genotype was G1 (58%) followed by G9 (40%). One mixed infection (G1/G9) was detected. The only [P] genotype identified was [8]. In order to estimate the rotavirus infection frequency in children who acquired diarrhea as hospital infection in those hospitals, we studied 24 patients, detecting the pathogen in 41% of them. This data suggest that genotype G9 is an important genotype in Rio de Janeiro, with implications to the future strategies of vaccination against rotavirus, reinforcing the need of continuous monitoring of circulating strains of the pathogen, in a surveillance context.