Objective: To determine the prevalence of bronchial asthma among university hospital employees between the ages of 20 and 44 based on the criteria established in the European Community Respiratory Health Survey. Methods: A descriptive, prospective, randomized, stratified prevalence study was conducted, in which questionnaires completed between April and October of 2002 by 351 employees of the Universidade Federal de Pernambuco (Federal University at Pernambuco) Hospital das Clínicas were evaluated. For sample characterization, the independent variables used were the signs and symptoms of asthma, and one dependent variable (physician-diagnosed asthma, characterized by data related to attacks occurring within the 12 months preceding the study) was included. Results: The prevalence of asthma was 10.7%. Nocturnal dyspnea, chest tightness and nocturnal cough were the most frequent symptoms, although statistically significant correlations with asthma were found exclusively among females (p = 0.03, p = 0.04 and p = 0.001, respectively). Nocturnal dyspnea, wheezing within the last 12 months, dyspnea with wheezing and the use of asthma medication were more frequent among individuals between 20 and 29 years of age. The last two variables presented statistical significance (p < 0.001). Undertreatment of asthma was identified in 35 (10.7%) of the cases. Conclusions: The results of this pioneering study show that asthma prevalence in a sample composed of employees of a university hospital located in a developing country was slightly higher than that found in the literature and suggest that working in a university hospital does not reduce the frequency of undertreatment.

Keywords: Asthma/diagnosis; Asthma/epidemiology; Hospitals, university; Questionnnaires

Smoking is a serious public health problem. The campaign against tobacco is largely supported by health professionals, especially doctors. The physician is a model for the community and therefore should give the example avoiding smoking. Objectives: This work seeks to evaluate the magnitude and the distribution of smoking habit among physicians in Rio Grande, state of Rio Grande do Sul, southern Brazil, and characterize the smoking doctor's profile. Method: Data were obtained, in 1999, through application and analysis of a questionnaire, based on the model proposed by WHO, among 333 physicians of whom 213 (64%) were men and 120 (36%) were women. The average age of the sample was 43 (± 10.5) years with 65.1% between 30 and 50 years. Results: Smoking prevalence was 18.3% (15.9% regular smokers and 2.4% occasional smokers). Regular smoking prevalence was 17.8% among males and 12.5% among females, with no significant statistic difference (p > 0.05). The mean number of cigarettes smoked was 24.3 packets/years, being superior among men and increasing with age. It was verified that 86.8% of the smokers began smoking before 20 years of age, due to their desire or friends' influence in 63.2% of the cases. Conclusion: Although smoking prevalence among Rio Grande physicians is lower than in other countries, it is still unacceptable. Since this class has a decisive role in the prevention and fight against smoking, a specific campaign against tobacco among these professionals would greatly justify.

Keywords: Smoking. Prevalence. Physicians. Epidemiological

Epidemiologic data on idiopathic pulmonary fibrosis are relatively scarce, and its real incidence and prevalence are unknown. Recent studies suggest that idiopathic pulmonary fibrosis mortality is rising in developed countries. Objectives: To describe idiopathic pulmonary fibrosis mortality in the State of Rio Grande do Sul (RS), Brazil, from 1970 to 2000, analyzing its trend and comparing it with that from other countries. Methods: Prevalence study, using data from the Brazilian Institute of Geography and Statistics (IBGE), analyzing death certificates in which idiopathic pulmonary fibrosis was stated as ultimate cause of death. Results: Annual mortality adjusted to population was 0.22/100,000 persons in the 1970's, 0.3/100,000 persons in the 1980's, and 0.48/100,000 persons in the 1990's. Total mortality rised 36% from 1970 to 1980, and 70% from 1980 to 1990. Mortality adjusted to population rised 36% and 60% during the same periods. The rise in both total and adjusted mortality from IPF was statistically significant (p < 0.05). The mean mortality rate per 100,000 persons during 1996 to 1998, however, was 0.683, corresponding to a rise of 70% when compared to the previous three-year period, which was 0.4 (p = 0.0002), probably reflecting encoding practices. Conclusion: There was a significant increase in IPF mortality in RS from 1970 to 2000, in part due to changes in coding practices. This increase is in conformity with observations in other countries, althought mortality rates in RS are considerably lower.

Keywords: Pulmonary fibrosis. Mortality.

Introduction: A considerable increase in asthma and atopy prevalence has been noticed worldwide through the last decades, however, in our country, epidemiological data are still insufficient. Objective: This study was carried out to determine the prevalence of asthma and atopy in a group of students, and compare these data with those found in two previous studies undertaken in Porto Alegre, Rio Grande do Sul. Methods: Asthma prevalence was identified through a questionnaire applied to 855 students from five schools of Porto Alegre. The students submitted to skin tests who presented, at least, one positive reaction were considered atopic. The signature of an informed consent from one of the parents was required for the skin test performance. Results: Prevalence was found to be 42.5% and 22% of cumulative and active asthma, respectively, with predominance in females. Atopy was identified in 50.1% of the sample. These results were significantly higher than the 6.7% (1980) and 16% (1989) of cumulative asthma, 10.9% (1989) of active asthma and 15.8% (1980) of atopy found in the two previous studies. Conclusion: A high prevalence of asthma and atopy was identified in our students. Future studies should be performed to elucidate the phenomenon herein demonstrated.

Keywords: Asthma. Epidemiology. Atopy.

Introduction: During the period from 1970 to 1992, mortality from asthma in children and young adults increased in Rio Grande do Sul. The present study aimed at assessing this phenomenon in patients of the same age group, now extending the time period to 1998. Methods: The death certificates of 157 patients aged between 5 and 19 years in which asthma was reported to be the cause of death during 1970-80 were reviewed. Testing for trends was conducted using the log-linear, S-curve, and quadratic models. Results: Asthma mortality rate ranged from 0.04 to 0.399/100,000. Among the tested models, S curve trend model showed the best accuracy for the adjusted time series: r2=0.59; mean absolute percentage error (MAPE) = 23.48; mean absolute deviation (MAD) = 0.035; mean square deviation (MSD) = 0.0021. These results suggest that a plateau has probably been reached. The quadratic model also showed good accuracy values suggesting that a decrease in the coefficients probably started to occur. In this model, the estimated maximal point value was found in the 25th year (1994). Conclusions: Stabilization of asthma death rates is starting to occur in Rio Grande do Sul and it is likely that a decrease will take place.

Keywords: Asthma. Mortality. Brazil.

Background: Acute pulmonary histoplasmosis is a respiratory infection occurring when an otherwise healthy individual inhales a large quantity of fungal propagules. Length of exposure determines disease severity. An epidemic is influenced by factors affecting the growth and transmission of Histoplasma capsulatum var. capsulatum in nature. Objective: To identify epidemiological and clinical aspects of patients with acute pulmonary histoplasmosis in the state of Rio Grande do Sul (RS) and compare these aspects with those of other cluster outbreaks reported in Brazil. Method: The charts of 212 patients diagnosed with histoplasmosis over a 25-year period (1977-2002) were obtained from the archives of the Laboratório de Micologia from Complexo Hospitalar Santa Casa (Santa Casa Hospital Mycology Laboratory), in the city of Porto Alegre (RS). In reviewing these patient charts, we identified and included in the study cases of acute pulmonary histoplasmosis in which there was a positive culture and/or histopathological findings consistent with the diagnosis. Outbreaks were defined as one confirmed case or positive immunodifusion Histoplasma capsulatum with compatible clinical history. All reported Brazilian outbreaks were reviewed. Results: Of the 212 patient charts reviewed, 18 (8.5%) were selected for inclusion in the study. Among those 18 patients, ages ranged from 8 to 63 years (median, 35.4), and 67% were male. Epidemiological histories were suggestive of the disease in 11 patients (61%). The most common disease type, seen in 17 patients (95%), was primary acute pulmonary histoplasmosis, and there was a predominance of isolated cases. Conclusion: The identification of isolated cases and the presence of cluster outbreaks demonstrate the abundance of H. capsulatum in the soil and, together with the occurrence of all forms of the disease, confirms the assumption that Rio Grande do Sul is a hyperendemic region for histoplasmosis.

Keywords: Key words - Histoplasmosis/epidemiology. Histoplasmosis/diagnostic. Histoplasma. Medical records. Retrospective studies.

Objective: Epidemiologic survey of respiratory diseases that cause hospital admissions at the Internal Medicine Service, Hospital Geral de Caxias do Sul (SCM-HG), a tertiary university hospital in the State of Rio Grande do Sul, Southern Brazil. Patients and methods: Retrospective study conducted at SCM-HG between November 1998 and November 1999. Data were obtained from medical records and included: a) major admission cause; b) associated diseases; c) sazonal variability; d) hospitalization length; e) mortality. Results: There were 1,200 admissions at SCM-HG, 228 (19%) caused by a respiratory disease. COPD (41.3%), pneumonias (29.8%) and bronchial asthma (9.6%) were the most prevalent. Fifty subjects (21.9%) presented comorbidity: cardiac failure (7.7%), systemic arterial hypertension (6.4%) and diabetes mellitus (4.4%). Pneumonias predominated between September and November, bronchial asthma frequency raised in October and November, and COPD prevailed from May to November. The admissions had an average duration of 10.4 ± 10 days. Twenty-six (11.4%) patients died. Conclusions: 1) Respiratory diseases were responsible for approximately 1/5 of the admissions. 2) COPD patients represented the biggest quota of admissions. 3) Patients with respiratory diseases stayed for a long time as compared with the others hospitalized patients (10.4 versus 7.7 days). 4) COPD, pneumonias and bronchial asthma behaved as expected regarding sazonal variability.

Keywords: Lung diseases. Asthma. Pneumonia. Epidemiology. University hospitals. Patient admission.

Background: In recent decades, the prevalence of asthma has increased. Objectives: To determine the prevalence of asthma symptoms in children and adolescents from 2 to 14 years of age living in Porto Alegre (in the state of Rio Grande do Sul, Brazil) and to determine any potential correlations with socioeconomic profile, treatment and smoking in the home. Methods: A transversal study based on interviews of all families seeking medical attention in June of 2000. Results: The prevalence of asthma symptoms was 49.5%. In 66.8% of families, total income was less than four times the minimum wage, and in more than 50% of homes, the parents had had less than five years of schooling. In 98.5%, prophylactic asthma treatment was not used. In the 174 families studied, 38.7% of mothers and 43.7% of fathers were smokers (32.7% overall). Correlations were found between the following variables: exposure to smoking in the home and number of asthma attacks in the last year (p = 0.02; RR = 2.9; CI: 1.1 - 4.5); maternal level of education and number of attacks in the last year (p = 0.03; RR = 2.03; CI: 1.01 - 4.19); close living quarters and number of attacks in the last year among children exposed to second-hand smoke (p = 0.04; RR = 2.7; CI: 1.4 - 5.1); hospitalization and number of attacks in the last year (p = 0.004; RR = 1.46; CI: 1.15 -1.86); hospitalization and close living quarters (p = 0.03; RR = 1.47; CI: 1.15 -1.86). In children below the age of five, there was correlation between maternal smoking and number of attacks in the last year (p = 0.03; RR = 1.79; CI: 1.04 - 3.08). Conclusion: The prevalence of asthma symptoms was high. The community studied has limited socioeconomic resources, and there is therefore a lack of adequate treatment for asthma. Our results demonstrate the need for prioritized, standardized treatment programs that would give healthcare workers access to the appropriate materials and means of evaluation necessary for asthma control.

Keywords: Key words: Asthma. Prevalence. Smoking in the home. Treatment between episodes of asthma.

Objective: The aim of this study was to determine the prevalence of macrolide-resistant S. pneumoniae and to identify its phenotypic and genotypic characteristics. Methods: Strains of S. pneumoniae isolated in the city of Porto Alegre between May 2002 and August 2004 from samples collected from different anatomical sites were analyzed. For the agar diffusion test, disks of erythromycin, clarithromycin, azithromycin and clindamycin were used. The minimum inhibitory concentrations of erythromycin were determined for macrolide-resistant isolates by the agar dilution method. Macrolide-resistant isolates were phenotyped by agar diffusion test and genotyped by polymerase chain reaction. Results: A total of 229 pneumococcal strains were evaluated, 12 (5.2%) of which were macrolide-resistant. Among the 12 resistant strains, 9 (75%) presented the MLSB phenotype, and 3 (25%) presented the M phenotype. Polymerase chain reaction testing indicated that 8 MLSB phenotype isolates harbored the ermB gene only, whereas the mefE gene was present in all 3 M phenotype isolates. One MLSB phenotype isolate presented both genes. Conclusion: In Porto Alegre, the S. pneumoniae resistance to macrolides is still low since such resistance is due primarily to the presence of the ermB gene expressing the MLSB phenotype.

Objective: In view of the relevance of co-infection with tuberculosis and human immunodeficiency virus, this study was designed to determine tuberculosis prevalence and identify factors related to tuberculosis in patients residing in a region in which both infections are highly prevalent. Methods: All patients treated during 1999 at the HIV/AIDS Clinic of the Universidade Federal do Rio Grande (Rio Grande Federal University) University Hospital were evaluated retrospectively, from the time of human immunodeficiency virus diagnosis, in terms of the incidence of tuberculosis and its relationship to sociodemographic, behavioral and immunological factors. Results: The sample included 204 patients, and tuberculosis prevalence was found to be 27%. The multivariate analysis showed a significant correlation between the development of tuberculosis and being of African descent (odds ratio: 4.76; 95% confidence interval: 1.93-11.72) and an inverse correlation between the development of tuberculosis and the TCD4+ lymphocyte count at the time of human immunodeficiency virus diagnosis (odds ratio: 0.995; 95% confidence interval: 0.993-0.997). When analyzed separately, other variables were found to be potential risk factors: being of the male gender (odds ratio: 2.49; 95% confidence interval: 1.15-5.39); and using illicit drugs (odds ratio: 2.1; 95% confidence interval: 1.02-4.31). Conclusion: The factors responsible for the development of tuberculosis among patients who are human immunodeficiency virus seropositive include immunological, socioeconomic and demographic factors. The high rate of tuberculosis prevalence among the seropositive patients underscores the urgent need to implement strategies that combine rapid identification and prompt treatment of individuals with active or latent infection, as well as of those with whom they have been in contact.

Keywords: HIV Infections/complications; AIDS-related opportunistic infections/complications; Tuberculosis/etiology; Tuberculosis/epidemiology

Background: Asthma is the most common chronic disease among adolescents. Objective: To determine the prevalence of asthma and asthma-related symptoms using the International Study of Asthma and Allergies in Childhood (ISAAC) protocol to evaluate adolescents in the city of Santa Maria, located in the state of Rio Grande do Sul, Brazil. Method: A cross-sectional study evaluating 3066 schoolchildren from 13 to 14 years of age, selected by random sampling, as indicated in the ISAAC protocol. Data were collected from March to June of 2003 using the standardized ISAAC questionnaire, which was completed by the adolescents in the classroom and under the supervision of the researchers. Results: A total of 3066 valid questionnaires (95.5%) were collected. Among the asthma-related symptoms evaluated, the following prevalences were determined: history of wheezing: 42.1%; wheezing within the last 12 months: 16.7%; four or more wheezing attacks within the last 12 months: 1.9%; sleep disturbance on one or more nights a week within the last 12 months: 3.8%; impaired speech within the last 12 months: 3.8%; history of asthma: 14.9%; wheezing after exercise within the last 12 months: 19%; dry cough at night within the last 12 months: 32.4%. Values were significantly higher among females. Conclusion: The prevalence of asthma-related symptoms among adolescents living in the city of Santa Maria was high, predominantly among the females. However, the rate was comparable to the international average and was lower than those observed in larger metropolitan areas in Brazil. These findings underscore the need for regional studies in order to better understand the prevalence of asthma in Brazil.

Keywords: Asthma. Adolescent. Epidemiology.

A pneumonia por Pneumocystis carinii (PPC), que é a infecção oportunista que mais comumente põe em risco a vida de pacientes com síndrome da imunodeficiência adquirida (SIDA), tem sido há bastante tempo associada a outros estados de imunodeficiência. Os relatos iniciais sugeriram que a apresentação clínica da PPC em SIDA difere de sua apresentação em outras situações, embora ambas tenham sofrido modificações nos últimos anos. O objetivo do presente estudo é comparar os achados clínicos e laboratoriais da PPC em SIDA com os de pacientes portadores de PPC sem SIDA. Foram revisados os prontuários médicos de todos os pacientes em nossa instituição que tiveram o diagnóstico confirmado de PPC e SIDA durante o ano de 1994 (17 pacientes) e sem SIDA no período de 1992-1994 (dez pacientes). Quando da apresentação, os pacientes sem SIDA tinham uma duração de sintomas significativamente menor (8,4 ± 7,7 vs 19,5 ± 10,2 dias, p < 0,05), menor PaO2 média a ar ambiente (47 ± 8,2 vs 63 ± 10mmHg, p < 0,05), e mais freqüente infiltrado unilateral no radiograma do tórax (60 vs 6%, p < 0,05). O índice de mortalidade da PPC foi marcadamente maior nos pacientes sem SIDA (40 vs 6%, p < 0,05), e este fato estava associado com retarde no início do tratamento específico nestes pacientes. Devido a seu curso mais agudo, apresentação radiológica atípica e alto índice de mortalidade, concluímos que o diagnóstico de PPC deve ser afastado em pacientes que recebem terapia imunossupressora e que profilaxia anti-PPC deve ser fortemente considerada em pacientes que serão imunossuprimidos.

Keywords: PPC-AIDS. PPC não-AIDS.

Objetivo: Realizar a tradução para a língua portuguesa e a adaptação cultural para uso no Brasil do Quality of Communication Questionnaire (QOC) para pacientes com DPOC em cuidados paliativos. Métodos: Após a aprovação do autor do questionário e do comitê de ética da instituição, a versão original do QOC com 13 itens foi traduzida, de forma independente, por dois tradutores brasileiros com fluência na língua inglesa. Uma síntese das duas traduções foi realizada por uma médica bilíngue e os dois tradutores, que chegaram a um consenso, gerando uma versão na língua portuguesa. Essa versão foi retraduzida por dois tradutores nativos de países de língua inglesa com fluência na língua portuguesa. Para resolver quaisquer discrepâncias, um comitê de especialistas comparou a versão original com todas as versões produzidas e, assim, obteve-se a versão pré-final do QOC. O pré-teste foi aplicado em 32 pacientes internados em UTIs de três hospitais públicos da grande Florianópolis (SC) para avaliar a clareza e a aceitabilidade cultural da versão pré-final do QOC. Resultados: A média de idade dos pacientes foi de 48,5 ± 18,8 anos. A maioria dos itens foi bem compreendida e aceita, recebendo pontuações ≥ 8. Um item, sobre morte, suscitou dificuldades na compreensão dos participantes do pré-teste. Ao submeter a retradução ao autor do QOC, ele solicitou alterações em dois itens, que foram acatadas. Após essas alterações, a versão final foi aprovada. Conclusões: A tradução e a adaptação cultural do QOC para uso no Brasil foi concluída com sucesso.

Keywords: Doença pulmonar obstrutiva crônica; Inquéritos e questionários; Comunicação; Unidades de terapia intensiva.

Streptococcus pneumoniae resistance to penicillin was studied in two hospitals in Caxias do Sul, Rio Grande do Sul, Brazil, between May 1998 and November 2001. From the 176 strains of invasive Streptococcus pneumoniae that were identified, 2.28% (CI 0.62-5.74) presented intermediate resistance, and 3.42% (CI 1.26-7.31) presented high-level resistance. Conclusion was that the use of penicillin in Caxias do Sul was still justified as treatment of pneumococcal pneumonia, differently from other centers where the penicillin was replaced by other antibiotics. These results confirm the statement of IDSA (Infectious Diseases Society of America) guideline for the management of community-acquired pneumonia in adults, that the choice of antimicrobial drug to treat pneumococcal pneumonia should be guided by local or regional prevalence of resistance to penicillin.

Objective: To determine the drug resistance profile of Mycobacterium tuberculosis in the state of Mato Grosso do Sul, Brazil, between 2000 and 2006. Methods: Descriptive study of reported tuberculosis cases in the Brazilian Case Registry Database. We included only those cases in which M. tuberculosis culture was positive and sensitivity to drugs (rifampicin, isoniazid, streptomycin and ethambutol) was tested. Löwenstein-Jensen and Ogawa-Kudoh solid media were used for cultures, as was an automated liquid medium system. Sensitivity tests were based on the proportion method. Results: Among the 783 cases evaluated, males predominated (69.7%), as did patients in the 20-49 year age bracket (70%), a diagnosis of pulmonary tuberculosis (94.4%) and positive HIV serology (8.6%); 645 (82.4%) were new cases, and 138 (17.6%) had previously been treated. Resistance to at least one drug was found in 143 cases (18.3%). The primary resistance (PR) rate was, respectively, 8.1%, 1.6%, 2.8% and 12.4%, for monoresistance, multidrug resistance (MDR), other patterns of resistance and resistance to at least one drug, whereas the acquired resistance (AR) rate was 14.5%, 20.3%, 10.9% and 45.7%, respectively, and the combined resistance (CR) rate was 9.2%, 4.9%, 4.2% and 18.3%, respectively. In PR, streptomycin was the most common drug, whereas isoniazid was the most common in AR and CR (7.2% and 3.7%, respectively). Conclusions: These high levels of resistance undermine the efforts for tuberculosis control in Mato Grosso do Sul. Acquired MDR was 12.7 times more common than was primary MDR, demonstrating that the previous use of drug therapy is an indicator of resistance. These levels reflect the poor quality of the health care provided to these patients, showing the importance of using the directly observed treatment, short course strategy, as well as the need to perform cultures and sensitivity tests for the early diagnosis of drug resistance.

Keywords: Tuberculosis; Drug resistance, multiple; Mycobacterium tuberculosis.

Objective: To investigate operational aspects of tuberculin skin test (TST) use in tuberculosis control programs and at specialized Brazilian National Sexually Transmitted Diseases/AIDS and Viral Hepatitis Program health care clinics in priority municipalities for tuberculosis control in the state of Mato Grosso do Sul, Brazil. Methods: This was a descriptive, cross-sectional, epidemiological survey. Data on qualifications/training of professionals administering TSTs, timing of the TST, procedures in cases of loss to follow-up (reading), material availability, and material storage were collected through interviews and technical visits. For the 2008-2009 period, we determined the numbers of screenings in vulnerable populations, of TSTs performed, and of patients treated for latent tuberculosis. Results: We interviewed 12 program managers in six municipalities. Some programs/clinics did not perform TSTs. Nursing teams administered the TSTs, results were read by non-specialists, and specialization/refresher courses were scarce. The PPD RT23 was stored in 5-mL flasks under appropriate conditions. Insulin syringes were commonly used. Testing was available during business hours, three times a week. In cases of loss to follow-up, telephone calls or home visits were made. Of the 2,305 TSTs evaluated, 1,053 (46%) were performed in indigenous populations; 831 (36%) were screenings in prisons, performed for training; and only 421 (18%) involved contacts of tuberculosis patients or vulnerable populations. Four vulnerable patients and 126 indigenous subjects were treated for latent tuberculosis. Conclusions: These priority municipalities showed operational difficulties regarding human resources, materials, and data records.

Keywords: Tuberculin test; Health services research; HIV; Latent tuberculosis; Chemoprevention.

Objective: Pleurodesis is an effective alternative for the control of malignant pleural effusions. However, there is as yet no consensus regarding the indications for the procedure and the techniques employed therein. The objective of this study was to evaluate how pleurodesis is performed in South and Central America. Methods: Professionals who perform pleurodesis completed a questionnaire regarding the indications for the procedure, the techniques used therein, and the outcomes obtained. Results: Our sample comprised 147 respondents in Brazil, 49 in other South American countries, and 36 in Central America. More than 50% of the respondents reported performing pleurodesis only if pleural malignancy had been confirmed. However, scores on dyspnea and performance status scales were rarely used as indications for the procedure. Nearly 75% of the respondents in Brazil and in Central America preferred to perform pleurodesis only for recurrent effusions and stated that lung expansion should be 90-100%. Talc slurry, instilled via medium-sized chest tubes, was the agent most often employed. Thoracoscopy was performed in less than 25% of cases. Fever and chest pain were the most common side effects, and empyema occurred in ≤ 14% of cases. The mean survival time after the procedure was most often reported to be 6-12 months. Conclusions: There was considerable variation among the countries evaluated in terms of the indications for pleurodesis, techniques used, and outcomes. Talc slurry is the agent most commonly used, and thoracoscopy is the technique of choice in Brazil. Pleurodesis is an effective procedure that has few side effects, as evidenced by the low complication rates and high survival times.

Keywords: Pleural effusion, malignant; Pleura; Pleurodesis.

Objetivo: Avaliar o processo diagnóstico da tuberculose pulmonar em indígenas menores de 15 anos, por meio do Sistema de Pontuação do Ministério da Saúde Modificado (SP-MSm), em crianças e adolescentes com resultados negativos na baciloscopia. Métodos: Estudo descritivo retrospectivo de 49 casos de tuberculose em indígenas menores de 15 anos no estado do Mato Grosso do Sul entre 2007 e 2010. Resultados: Dos 49 pacientes, 27 (56%) eram menores de 5 anos, 33 (67%) apresentavam sintomas sugestivos de tuberculose, 24 (49%) tinham baixo peso, e 36 (73,5%) haviam sido vacinados com BCG. O teste tuberculínico foi reator em 28 pacientes (57%). Dentre esses, 18 (64%) apresentaram enduração ≥ 10 mm. Foram realizadas radiografias de tórax em 37 pacientes (76%), sendo que 31 (84%) fizeram apenas um exame. Desses 37 pacientes, os achados radiológicos eram sugestivos de tuberculose em 16 (43%), de infiltrado/condensação em 10 (27%) e normais em 4 (11%). As Equipes de Saúde Indígena foram responsáveis pelo diagnóstico em 31 (63%) dos casos, mas o SP-MS original só foi utilizado em 14 (45%). Os escores do SP-MSm foram determinados em 30 pacientes (61%). Dos 30 casos pontuados, os resultados dos escores indicaram diagnóstico de tuberculose muito provável, possível e pouco provável em 16 (53%), 11 (37%) e 3 (10%), respectivamente. Conclusões: A proporção de diagnóstico muito provável e possível foi concordante com o diagnóstico padrão do serviço (90%), evidenciando a aplicabilidade epidemiológica do SP-MSm para o diagnóstico da tuberculose pulmonar em indígenas, de forma compatível com a realidade do serviço de saúde prestado.

Keywords: Tuberculose pulmonar/diagnóstico; Serviços de saúde do indígena/normas; Serviços de saúde do indígena/organização & administração.

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.

Keywords: Poverty; Tuberculosis; Income.

Air pollution is a major public health problem in the Amazon forest and in large Brazilian cities. During September of 2005, high concentrations of smoke from biomass burning were observed in the city of Rio Branco. An ecological study was conducted to evaluate the relationship between daily concentrations of particulate matter < 2.5 μm (PM2.5) and the number of respiratory disease (RD)-related emergency room visits. Daily PM2.5 concentrations exceeded recommended air quality limits on 23 days. The incidence of RDs was higher among children < 10 years of age. There was a significant positive correlation between PM2.5 concentrations and asthma emergency room visits.

Keywords: Air pollution/adverse effects; Fires; Respiratory tract diseases/epidemiology; Asthma; Space-time clustering.