Western boundary currents (WBC) influence the global ocean circulation and climate, whereas it locally reaches out differently the continental margins relief. This study analyses the response of WBC over their interactions with the corn of South America Margin. Particularly, the North and East sectors of Rio Grande do Norte (RN) on northeastern Brazil are investigated based upon bathymetry, in situ currents measurements, and simulations of oceanic currents using the CROCO model. The RN margin provides a critical pathway to the WBC along the East and North sectors, which are narrow and retracted shelves (up to 40 km offshore) with steep upper continental slopes (1:11). These sectors are separated by the shallower topography of the Touros High which extends 80 km offshore. The results reveal that the interactions of the Northern Brazilian Undercurrent (NBUC) with the RN northern margin physiography produces a recirculating current region forced by current shear. Eddies and meanders are explicit in February and August, with meander predominance in the latter month because of the increasing of wind intensity eastward. The accelerated core position of NBUC (> 1.0 m.s1) corresponds to the upper slope region of Touros High on both months, and confirms the constrain effect of the margin on the NBUC. The change of margin direction from the N-S to E-W leads to the decreasing of current velocity (~0.1m.s1) near the northern continental slope. This contrast produces an abrupt variation in the shear velocities forming vortices and meanders. Thus, the physiography of the Touros High, the margin directions, and the intensity of the winds control these features development on a regional scale. These oceanic events near the shelf slope affect the sedimentary and ecological system on Brazilian Equatorial continental shelves.

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Dissertação de Mestrado

Tuberculosis is a common complication and leading cause of death in HIV infection. Antiretroviral therapy (ART) lowers the risk of tuberculosis but may not be sufficient to control HIV-related tuberculosis. Isoniazid preventive therapy (IPT) reduces tuberculosis incidence significantly but is not widely used. We analysed tuberculosis incidence in 11 026 HIV-infected patients receiving medical care at 29 public clinics in Rio de Janeiro Brazil between 1 September 2003 and 1 September 2005. Data were collected through a retrospective medical record review. We determined rates of tuberculosis in patients who received neither ART nor IPT only ART only IPT or both ART and IPT. The overall tuberculosis incidence was 2.28 cases/100 person-years (PY) [95% confidence interval (CI) 2.06-2.52]. Among patients who received neither ART nor IPT incidence was 4.01/100 PY. Patients who received ART had an incidence of 1.90/ 100 PY (95% CI 1.66-2.17) and those treated with IPT had a rate of 1.27/100 PY (95% CI 0.41-2.95). The incidence among patients who received ART and IPT was 0.80/ 100 PY (95% CI 0.38-1.47). Multivariate Cox proportional hazards modeling revealed a 76% reduction in tuberculosis risk among patients receiving both ART and IPT (adjusted relative hazard 0.24; P less than 0.001) after adjusting for age previous tuberculosis diagnosis and CD4 cell counts at baseline. The use of both IPT and ART in HIV-infected patients is associated with significantly reduced tuberculosis incidence. In conjunction with expanded access to ART the wider use of IPT in patients with HIV will improve tuberculosis control in high burden areas. (authors)

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The impact of antiretroviral therapy and isoniazid preventive therapy on tuberculosis incidence in HIV-infected patients in Rio de Janeiro, Brazil

To determine the frequency of N-acetyltransferase 2 (NAT2) polymorphisms, the NAT2 acetylation profile and its relation to the incidence of gastrointestinal adverse drug reactions (ADRs), anti-tuberculosis (TB) drug-induced hepatotoxicity, and the clinical risk factors for hepatotoxicity in a population from Brazil. Two hundred and fifty-four Brazilian TB patients using isoniazid (INH), rifampicin (RMP), and pirazinamide (PZA) were tested in a prospective cohort study. NAT2 genotyping was performed by direct PCR sequencing. The association between gastrointestinal ADRs/hepatotoxicity and the NAT2 profile genotype was evaluated by univariate analysis and multiple logistic regression. Of the 254 patients analyzed, 69 (27.2%) were slow acetylators and 185 (72.8%) were fast acetylators. Sixty-five (25.6%) patients were human immunodeficiency virus (HIV)-positive. Thirty-three (13%) and 14 (5.5%) patients developed gastrointestinal ADR and hepatotoxicity, respectively. Of the 14 hepatotoxicity patients, nine (64.3%) were slow acetylators and five (35.7%) were fast acetylators. Sex, age, presence of hepatitis C virus, alcohol abuse, and baseline aminotransferases were not found to be risk factors for hepatotoxicity. However, logistic regression analysis revealed that slow acetylator status and the presence of HIV (p < 0.05) were independent risk factors for hepatotoxicity. Our findings show that HIV-positive patients that have the slow acetylation profile are significantly associated with a higher risk of developing hepatotoxicity due to anti-TB drugs.

Association of slow N-acetyltransferase 2 profile and anti-TB drug-induced hepatotoxicity in patients from Southern Brazil

O objetivo do artigo foi propor, a partir da analise da situacao e da interacao entre a tuberculose e a Aids, estrategias que minimizem o impacto epidemiologico de uma doenca sobre a outra no Brasil. Analisa-se a maneira como politicas de saude para o controle da epidemia de HIV/Aids - como acesso aos anti-retrovirais, campanhas para o conhecimento precoce da infeccao pelo HIV e adesao ao tratamento - impactam as metas de controle da tuberculose. Discutem-se tambem a implementacao de acoes para prevencao do aparecimento de tuberculose no individuo infectado com HIV, deteccao precoce da tuberculose-doenca e garantia de adesao ao tratamento. Sao feitas consideracoes sobre o papel que o Brasil pode desempenhar no cenario global de desenvolvimento de arsenal terapeutico e a necessidade de trabalho articulado das areas programaticas de tuberculose e de HIV/Aids.

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Tuberculosis and HIV infection in Brazil: magnitude of the problem and strategies for control

Tuberculous meningitis (TBM) is a severe infection of the central nervous system, particularly in developing countries. Prompt diagnosis and treatment are necessary to decrease the high rates of di...

Adenosine deaminase and tuberculous meningitis--a systematic review with meta-analysis.

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II Consenso Brasileiro de Tuberculose: Diretrizes Brasileiras para Tuberculose 2004

Objetivo: Determinar a efetividade do tratamento com esquemas alternativos para casos confirmados de tuberculose multirresistente (TBMR) primaria e adquirida, em pacientes ambulatoriais. Metodos: Casos de TBMR foram definidos como cultura e isolamento de M. tuberculosis e perfil de resistencia in vitro a pelo menos a rifampicina, isoniazida e a uma terceira droga dos esquemas padronizados no Brasil, tanto pelo metodo convencional (LJ) quanto pelo sistema radiometrico BACTEC. Desenho: Ensaio clinico, multicentrico, nao randomizado e controlado. Os pacientes foram arrolados entre abril de 1995 e dezembro de 1997, no total de 197. Por diversas razoes 10 casos foram excluidos da analise. Em abril de 1998 permaneciam em tratamento 36 pacientes. Foram analisados 149 casos com duracao media de tratamento de 14 meses sem interrupcao. Os regimes foram escolhidos conforme o perfil de sensibilidade: 1) estreptomicina, ofloxacina, terizidona, etambutol, clofazimina ou 2) amicacina, ofloxacina, terizidona, etambutol e clofazimina. Demografia: sexo: masculino - 68,4%, feminino - 31,5%; media de idade - 36,9 anos (14-71 anos); prevalencia de HIV - 1,9%; taxa de resistencia primaria - 8%, taxa de resitencia secundaria - 92%. Resultados parciais: 120 (79,5%) pacientes negativaram a cultura no periodo de 3 meses; cura - 53%, falencia - 31%, obito - 6%, abandono - 10%. Definicoes: cura - tratado por 12 meses, com 6 meses de tratamento apos 2 culturas consecutivas negativas; abandono - tratamento e consultas descontinuados; obito - morte causada por TB apos 2 meses de tratamento; falencia - persistencia de positividade na cultura em 12 meses seguidos. Conclusao: O maior preditor da multirresistencia no estudo foi tratamento previo irregular ou incompleto. Outros preditores (p < 0,05) foram: ser homem, ter lesao radiologica cavitaria bilateral e ter mais de 2 anos de doenca. A taxa de conversao bacteriologica em escarro e cultura foi alta em 6 meses de tratamento.

/pdf/estudo-de-efetividade-de-esquemas-alternativos-para-o-4ejdkzb6uc.pdf

Ninarosa Calvazara Cardoso

Papers

II Consenso Brasileiro de Tuberculose: Diretrizes Brasileiras para Tuberculose 2004

Estudo de efetividade de esquemas alternativos para o tratamento da tuberculose multirresistente no Brasil