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Tuberculosis (TB) and depression is common and is associated with poor TB outcomes. The World Health Organization End TB Strategy explicitly calls for the integration of TB and mental health services. Interpersonal Counseling (IPC) is a brief evidence-based treatment for depression that can be delivered by non-mental health specialists with expert supervision. The goal of this study was to explore potential barriers and facilitators to training non-specialist providers to deliver IPC within the TB Control Program and primary care in Itaboraí, Rio de Janeiro state. Data collection consisted of six focus groups (n = 42) with health professionals (n = 29), program coordinators (n = 7), and persons with TB (n = 6). We used open coding to analyze the data, followed by deductive coding using the Chaudoir multi-level framework for implementation outcomes. The main structural barriers identified were poverty, limited access to treatment, political instability, violence, and social stigma. Organizational barriers included an overburdened and under-resourced health system with high staff turnover. Despite high levels of stress and burnout among health professionals, several provider-level facilitators emerged including a high receptivity to, and demand for, mental health training; strong community relationships through the community health workers; and overall acceptance of IPC delivered by any type of health provider. Patients were also receptive to IPC being delivered by any type of professional. No intervention-specific barriers or facilitators were identified. Despite many challenges, integrating depression treatment into primary care in Itaboraí using IPC was perceived as acceptable, feasible, and desirable.

Single BCG vaccination has been considered as a protective factor against asthma. However the effect of a second dose of BCG on the prevalence rate of asthma and asthma-allergic rhinitis-eczema comorbidity has not been studied exclusively among adolescents. In this ISAAC protocol-based cross sectional study we assessed the association between one single versus two doses of BCG among 2213 individuals aged 13-14 years old. We found no association between BCG revaccination and asthma, associated (OR = 0.68, 95% CI, 0.37-1.25) or not to allergic rhinitis and/or atopic eczema (OR = 1.07, 95% CI, 0.84-1.36)., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Opuntia ficus-indica Mill. (forage cactus) is farmed with relative success in the semi-arid region of the Brazilian northeast for commercial purposes, particularly as forage and food. Endophytic microorganisms are those that can be isolated inside plant tissues and can be a new source to production of enzymes with different potentialities. The objective of this study was to describe the richness of endophytic fungi from O. ficus-indica and to detect the capacity of these species to produce extracellular hydrolytic enzymes. Forty-four endophytic fungi species were isolated. Among them, the most commonly found were Cladosporium cladosporioides (20.43%) and C. sphaerospermum (15.99%). Acremonium terricola, Monodictys castaneae, Penicillium glandicola, Phoma tropica and Tetraploa aristata are being reported for the first time as endophytic fungi for Brazil. The majority of isolated fungi exhibited enzymatic potential. Aspergillus japonicus and P. glandicola presented pectinolytic activity. Xylaria sp. was the most important among the other 14 species with positive cellulase activity. All 24 isolates analysed were xylanase-positive. Protease was best produced by isolate PF103. The results indicate that there is a significant richness of endophytic fungi in O. ficus-indica, and that these isolates indicate promising potential for deployment in biotechnological processes involving production of pectinases, cellulases, xylanases and proteases.

Objectives: To assess the frequency of hospitalizations and emergency department visits of children and adolescents before and after the enrollment in an asthma program., Methods: Medical records of 608 asthmatics younger than 15 years were assessed retrospectively. The frequency of hospitalizations and emergency department visits caused by exacerbations were evaluated before and after enrollment in an asthma program. Patients were treated with medications and a wide prophylactic management program based on the Global Initiative for Asthma (GINA). The before asthma program (BAP) period included 12 months before enrollment, whereas the after asthma program (AAP) period ranged from 12 to 56 months after enrollment., Results: In the BAP period, there were 895 hospitalizations and 5,375 emergency department visits, whereas in the AAP period, there were 180 and 713, respectively. This decrease was significant in all statistical analyses (p = 0.000)., Conclusions: Compliance with the GINA recommendations led to a significant decrease in the frequency of hospitalizations and emergency department visits in children and adolescents with asthma.

Background: Despite the major public health importance of visceral leishmaniasis (VL) in Latin America, well-designed studies to inform diagnosis, treatment and control interventions are scarce. Few observational studies address prognostic assessment in patients with VL. This study aimed to identify risk factors for death in children aged less than 15 years admitted for VL treatment in a referral center in northeast Brazil., Methodology/principal Findings: In a retrospective cohort, we reviewed 546 records of patients younger than 15 years admitted with the diagnosis of VL at the Instituto de Medicina Integral Professor Fernando Figueira between May 1996 and June 2006. Age ranged from 4 months to 13.7 years, and 275 (50%) were male. There were 57 deaths, with a case-fatality rate of 10%. In multivariate logistic regression, the independent predictors of risk of dying from VL were (adjusted OR, 95% CI): mucosal bleeding (4.1, 1.3-13.4), jaundice (4.4, 1.7-11.2), dyspnea (2.8, 1.2-6.1), suspected or confirmed bacterial infections (2.7, 1.2-6.1), neutrophil count <500/mm³ (3.1, 1.4-6.9) and platelet count <50,000/mm³ (11.7, 5.4-25.1). A prognostic score was proposed and had satisfactory sensitivity (88.7%) and specificity (78.5%)., Conclusions/significance: Prognostic and severity markers can be useful to inform clinical decisions such as whether a child with VL can be safely treated in the local healthcare facility or would potentially benefit from transfer to referral centers where advanced life support facilities are available. High risk patients may benefit from interventions such as early use of extended-spectrum antibiotics or transfusion of blood products. These baseline risk-based supportive interventions should be assessed in clinical trials.

Fumaric aciduria is a rare metabolic disease, with 40 cases reported so far. Fumarase deficiency leads mainly to brain abnormalities, developmental delay, and great accumulation of fumaric acid in urine. This work presents the first case of fumaric aciduria described in Brazil, which presented with some interesting clinical and biochemical findings such as colpocephaly, hepatic alterations, and marked metabolic acidosis since birth. Common findings were ventriculomegaly, hypotonia, and microcephaly. Biochemically, besides the high urinary fumaric acid excretion, atypical elevation of plasma citrulline, tyrosine and methionine levels were also observed. In order to show all features and variants of fumaric aciduria, literature data of 40 patients was reviewed and compared with the case reported here. Findings in all these patients demonstrate that this disorder does not yet have its phenotype completely defined; it is important that more patients be described.

Methicillin-resistant Staphylococcus aureus (MRSA) is a major agent of hospital infections worldwide. In Brazil, a multiresistant MRSA lineage (ST239-SCCmecIIIA), the so-called Brazilian epidemic clone (BEC), has predominated in all regions. However, an increase in nosocomial infections caused by non-multiresistant MRSA clones has recently been observed. In the present study, 45 clinical isolates of MRSA obtained from a university hospital located in Natal city, Brazil, were identified by standard laboratory methods and molecularly characterized using staphylococcal chromosome cassette mec (SCCmec) typing and pulsed-field gel electrophoresis. Antimicrobial susceptibility testing was carried out using CLSI methods. The MRSA isolates studied displayed a total of 8 different pulsed-field gel electrophoresis patterns (types A to H) with predominance (73%) of pattern A (BEC-related). However, MRSA harboring SCCmec type IV were also identified, 3 (7%) of which were genetically related to the pediatric clone--USA800 (ST5-SCCmecIV). In addition, we found a considerable genetic diversity within BEC isolates. MRSA displaying SCCmecIV are frequently susceptible to the majority of non-beta-lactam antibiotics. However, emergence of multiresistant variants of USA800 was detected.

This retrospective study concerned 41 infectious bursal disease virus (IBDV) isolates obtained from Brazilian broiler and layers flocks by reverse transcription-polymerase chain reaction. Twenty-five of them were identified as very virulent (vv) by restriction enzyme analysis and by further nucleotide and phylogenetic analysis. All of them had the typical amino acid residues, and all clustered in a phylogenetic tree with the vvIBDV strains. Four amino acid substitutions, at positions D213N, G254D, S317R, and D323E, were common to 3 vv isolates, Br/03/DB, Br/03/CK, and Br/04/CR, and differed from other vv isolates and strains. These isolates came from the same locale, but were collected in different years, indicating that the vvIBDVs circulating on Brazilian farms are undergoing slight but continuous exchanges.

This study had the aim of isolating and identifying keratinophilic fungi from soil and correlating them with dermatomycosis agents. According to our results, the predominance of Trichophyton tonsurans as a dermatomycosis agent among children in the city of Recife, PE, is probably due to children's greater contact with soil.

Analyses on 1,576 clinical specimens from hospitalized patients were performed with the aim of determining the prevalence of methicillin-resistant Staphylococcus spp isolated in the Januário Cicco Teaching Maternity Hospital in Natal, Rio Grande do Norte, in 2002 and 2003. The samples were collected, processed and identified according to standard procedures, for each clinical specimen. In vitro susceptibility profiles were obtained using the Kirby-Bauer method. 188 strains of Staphylococcus spp were isolated: 105 were identified as Staphylococcus aureus and 83 as coagulase-negative Staphylococcus. Staphylococcus aureus was isolated most often in secretions, whereas coagulase-negative Staphylococcus was most prevalent in blood cultures. The high (41.5%) prevalence of methicillin-resistant Staphylococcus spp shows the need for immediate prophylactic measures aimed at impeding the dissemination of this phenomenon.

Fungi comprehend a heterogeneous group of heterotrophic microorganisms that act as saprobes or parasites or, less frequently, as symbionts living in association with other organisms. They are cosmopolitan and important components of ecosystems. Considering the small number of Brazilian papers on the filamentous mycota in marine environments, and the need to improve knowledge of the diversity of these microfungi in "Casa Caiada" and "Bairro Novo" beaches, Olinda, PE, the aim of this work was to isolate and identify the fungi from sand and water samples of these ecosystems. Thirty two samplings of sand (surface and 20 cm deep) and water (surface and 1 m deep) were carried out during the dry and rainy seasons, in low and high tide. From each sand sample, a suspension was made with 50 g of sand diluted in 90 mL of sterilized distilled water. From each sand suspension and water sample, 0.5 mL was spread, in triplicate, onto Petri dishes containing Sabouraud Agar added of chloramphenicol. The plates were incubated at 28 degrees C (+/-2 degrees C). Fifty seven species were isolated, identified, and classified in 20 genera. Aspergillus and Penicillium were the most frequent genera in both sand and water, with a total of 11 and 19 species, respectively.

From 1988 to 1995, our laboratory at the Institute of Chemistry of the Federal University of Rio de Janeiro, in Rio de Janeiro, screened 2650 samples from 2000 high-risk patients (mostly children) for Inborn Errors of Metabolism (IEM). Chemical tests, various chromatographic techniques and enzyme assays were performed on urine, plasma and in some cases, cerebrospinal fluid (CSF). A total of 145 cases of IEM (7.2%) was identified. These were related to: the metabolism of amino acids (41) and carbohydrates (17), organic acids (7), lysosomal enzymes (61), membrane transport system (16), metals (2), intestinal disaccharidases (1) and porphyrin metabolism (3). Furthermore, a relevant number of patients with abnormal findings is still under investigation. Biochemical results and clinical symptoms are presented and the importance of reference laboratories for the detection of IEM is stressed.