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Childhood trauma (CT) increases the risk of adult depression. Buffering effects require an understanding of the underlying persistent risk pathways. This study examined whether daily psychological stress processes – how an individual interprets and affectively responds to minor everyday events – mediate the effect of CT on adult depressive symptoms.
Middle-aged women (N = 183) reported CT at baseline and completed daily diaries of threat appraisals and negative evening affect for 7 days at baseline, 9, and 18 months. Depressive symptoms were measured across the 1.5-year period. Mediation was examined using multilevel structural equation modeling.
Reported CT predicted greater depressive symptoms over the 1.5-year time period (estimate = 0.27, s.e. = 0.07, 95% CI 0.15–0.38, p < 0.001). Daily threat appraisals and negative affect mediated the effect of reported CT on depressive symptoms (estimate = 0.34, s.e. = 0.08, 95% CI 0.22–0.46, p < 0.001). Daily threat appraisals explained more than half of this effect (estimate = 0.19, s.e. = 0.07, 95% CI 0.08–0.30, p = 0.004). Post hoc analyses in individuals who reported at least moderate severity of CT showed that lower threat appraisals buffered depressive symptoms. A similar pattern was found in individuals who reported no/low severity of CT.
A reported history of CT acts as a latent vulnerability, exaggerating threat appraisals of everyday events, which trigger greater negative evening affect – processes that have important mental health consequences and may provide malleable intervention targets.
Environmental factors, size-related isotopic changes of the most abundant species and isotopic niche overlap were investigated using stable isotopes in order to evaluate spatial changes of fish trophic guilds in the Araruama Lagoon. Based on 440 muscle samples, 17 fish species were grouped into five trophic guilds. Mean salinity was above 40 at both sites sampled and a significant spatial difference was observed. The highest δ13C mean value was observed for an omnivorous species, whereas the lowest carbon signatures were found for the three fish species belonging to the planktivorous guild. Analysis of the carbon signature of fish species in lower trophic levels showed influence of salinity variation, whilst size appeared to play a role for others. A narrow δ15N difference was observed, but the piscivorous fish species showed the highest δ15N values. The Standard Ellipses Analysis (SEA) detected spatial differences and varying degrees of isotopic niche overlap among trophic guilds, but the percentages of most overlaps (<60%) suggest that, to some extent, the guilds had a unique isotopic niche space. These results are in agreement with data previously reported for the Araruama Lagoon, that found the same prey items with varying relative importance among the most abundant species. Further studies are necessary to understand how the interaction between salinity and other factors, such as migration patterns, changes in prey availability, changes in contribution of primary sources and changes in baseline isotopic signatures could affect the stable isotope signatures shown here.
Lysmata vittata is considered an invasive shrimp in the Atlantic Ocean and some characteristics might have contributed to its invasive success, such as its larval nutritional vulnerability during the early stages of development. The objective of this study was to evaluate the early larval stages of the shrimp L. vittata. Ovigerous specimens were captured in an estuarine region of north-eastern Brazil. Zoeae were assigned to two experiments: (1) the point of no return (PNR), consisting of treatments with an increasing number of days of starvation and subsequent days of feeding; and (2) the point of reserve saturation (PRS), consisting of treatments with an increasing number of days of feeding and subsequent days of starvation. Two control groups were considered: continuous starvation (CS) and continuous feeding (CF). Nutritional vulnerability was estimated by the time when 50% of the initially starved larvae (PNR50) lost the ability to moult to the next stage, when 50% of the initially fed larvae (PRS50) were capable of moulting to the next stage. In the CF, the mean development time (±SD) of the larvae that reached stage III was 4.36 ± 0.74 days with a mortality of 70%, and the mean carapace length (±SD) was 0.61 ± 0.04 mm CL. The PNR50 and PRS50 were 2.42 ± 0.14 and 1.32 ± 0.83 days, respectively. The nutritional vulnerability index (PRS50/PNR50 = 0.54) indicates that L. vittata presents intermediate dependence on exogenous food during the early larval stages, which might help our understanding of the invasive potential of this species in the Atlantic Ocean.
To determine whether chronic medical conditions mediate the association between depression and cardiovascular disease (CVD) mortality.
Data analyzed were from 6,394 subjects aged 25–74 years who participated in extensive health examinations in the NHEFS conducted between 1971 and 1975 and follow-up studies to 1992. CVD mortality was the endpoint. Depression predictors were clinically significant depressive symptoms at baseline by the GWB-D, and/or at 1982–84 by the CES-D (‘baseline’, ‘new’, or ‘twice’ depression). Chronic conditions were prevalent/incident high blood pressure, diabetes, and nonfatal CVD by examination and/or self-report. Mediation effects were assessed by stepwise adjustments of covariates and additive interactions in competing-risks regression models (accounting for other mortality causes) and logit models.
Baseline, new, and twice depression were significant predictors of CVD mortality in competing-risks models adjusted for demographics (HRs 1.3, 1.4, and 2.0), but effects were progressively weakened and became non-significant after adjustment for lifestyle factors, prevalent and incident medical conditions, respectively. CVD mortality risk was 80% higher for depression plus incident nonfatal CVD than without (HR 4.0 vs. 3.2, additive interaction), and mediation effects of depression via chronic medical conditions (particularly via incident nonfatal CVD) increased the risk by 2 to 11% in logit models, independent of all covariates.
Several levels of evidence suggest that the association between depression and CVD mortality is partially mediated by prevalent/incident chronic medical conditions, as well as unhealthy lifestyle behaviors. Patients presenting with clinically significant depressive symptoms, particularly if persistent, should be assessed for both chronic conditions and lifestyle risk factors.
When cognitive decline (CD) is present, attention is one of the impaired mental functions. CD is also associated with anxious/depressive symptoms and with some demographic variables, particularly, age.
Investigate the associations between selective attention (Stroop Test: Stroop_Word, Stroop_Color, Difference between Stroop_Word and Stroop_Color, Stroop Ratio_Word, Stroop Ratio_Color and Difference between Stroop Ratio_Word and Stroop Ratio_ Color) and CD (Montreal Cognitive Assessment/MoCA) in institutionalized elders; explore the predictive value of Stroop variables for CD, controlling anxious/depressive symptoms and sociodemographic variables.
140 institutionalized elders (mean age, M = 78.4, SD = 7.48, range = 60-97) voluntarily answered to sociodemographic questions, the MoCA, the Geriatric Anxiety Inventory/GAI, the Geriatric Depression Scale/GDS and Stroop test.
73 elders (52, 1%) had CD. Dichotomized MoCA was associated with Stroop_Word, Stroop_Color, Stroop Ratio_Word, Stroop Ratio_Color, GDS and the sociodemographic variable schooling × profession. Age and education were not tested, since MoCA was stratified according to those variables. GDS, Stroop Ratio_Word and Stroop Ratio_Color showed to predict CD.
There was an association between Stroop_Word, Stroop_Color, Stroop Ratio_Word and Stroop Ratio_Color and CD, confirming that selective attention is smaller when the elderly reveal CD. GDS and CD were, also, associated. However, there was no association between MoCA dichotomized and differences between the correct answers (Stroop_Word and Stroop_Color) and Ratios (Stroop Ratio_Word and Stroop Ratio_Color). Selective attention and depressive symptoms predicted CD. It would be important to intervene through cognitive rehabilitation with the elders to improve their attention.
Effective preventive strategies could reduce disability and the long term social and health complications associated with depression, but options are limited. Cognitive bias modification (CBM) is a novel, simple, and safe intervention that corrects the attentional and interpretive biases associated with depression.
To determine if CBM decreases the one-year onset of major depression in adults at risk.
This randomised controlled trial will recruit adults with subsyndromal depression living in Australia (parallel design, 1:1 allocation ratio). The intervention will be delivered via the internet over 52 weeks. The primary outcome of interest is the onset of a major depression according to DSM-IV-TR criteria. Secondary outcomes of interest include change in the severity of depressive (Patient Health Questionnaire, PHQ-9) and changes in attention and interpretive biases. Outcomes will be collected 3, 6, 9 and 12 months after randomisation.
Preliminary data on a subsample of 20 participants showed that the mean±SE PHQ-9 score of controls was 7.5±0.9 at study entry and 7.1±1.5 at week 6 (paired t-test=0.29, p=0.779), whereas the mean±SE score of active CBM participants was 7.4±1.0 and 4.4±1.1, respectively (paired t=6.00, p<0.001). The mean PHQ-9 difference between control and active CBM participants over 6 weeks was 2.6±1.5 points (t=1.79, p=0.090). One of 11 controls (9.1%) and 0/9 active CBM participants showed evidence of clinically significant depressive symptoms at week 6 (i.e., PHQ-9≥15).
By March 2015, 6-months preliminary data will be available on 165 participants.
A number of studies have investigated white matter abnormalities in patients with bipolar disorder (BD) using diffusion tensor imaging. However, tractography studies yielded heterogeneous results partly due to small sample sizes.
In this work we aimed to study white matter abnormalities using whole-brain tractography in a large multicenter sample of patients with BD I with and without psychotic features.
To compare mean generalized fractional anisotropy (GFA) along deep white matter tracts between patients with BD with a positive history of psychosis during illness phases, no such history and healthy controls.
We acquired diffusion-weighted MRI for 118 patients with BD I and 86 healthy controls using the same acquisition parameters and scanning hardware. We used Q-ball imaging tractography and an automatized segmentation technique to reconstruct 22 known deep white matter tracts and to obtain the mean GFA along each tract.
Patients with BD had lower GFA values than controls along the corpus callosum (body and splenium), the left cingulum and the left arcuate fasciculus, when controlling for age, gender and acquisition site. All results with an exception for the long fibers of the left cingulum were driven by patients with a positive history of psychotic symptoms.
We demonstrated a reduced integrity of interhemispheric, limbic and arcuate white matter tracts in patients with BD I. Further, interhemispheric pathways were more disrupted in patients with psychotic symptoms, underscoring the role of interhemispheric connectivity in the pathophysiology of BD with psychosis.
Jealousy is a complex emotional state and some degree is considered normal in mature love, but when does it become destructive in a relationship? There's a thin line between what is normal and what is pathologic. Pathological jealousy differs from normal by its intensity and irrationality. Obsessive and delusional jealousies are different types of pathological jealousy, difficult to distinguish, which is important, since they have different treatment. Despite the differences, both result in significant distress and carry the risk of homicide/suicide, so it's a matter deserving the psychiatrists’ attention.
Explore the psychopathological differences between obsessive and delusional jealousy and list the characteristics and difficulties in the approach to pathological jealousy.
The results were obtained searching literature included on the PubMed and Google Scholar platforms.
Delusional jealousy is characterized by strong and false beliefs that the partner is unfaithful. Individuals with obsessive jealousy suffer from unpleasant and irrational jealous ruminations that the partner could be unfaithful, accompanied by compulsive checking of partners’ behavior. This jealousy resembles obsessive-compulsive phenomenology and should be treated with SSRIs and cognitive-behavioral therapy. Delusional jealousy is a psychotic disorder and should be treated with antipsychotics.
The common issue in pathological jealousy is the problem of adherence to treatment and bad prognosis. In order to achieve better treatment outcomes, we should follow-up the patient regularly. One key factor is to explore the psychopathology and motivate the sufferer for the proper pharmacological and psychotherapeutic interventions, trying to reduce the suffering caused by ideas of unfaithfulness.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
As it has been for the last 30 years, male borderline personality are still misdiagnosed and herded into substance treatment, anger management and prison. Gender matters from the failure of clinicians to identify it in men to the failure of researchers to study how it affects men differently and the treatment implications of those dissimilarities.
The authors propose a retrospective study investigating all patients hospitalized with Borderline Personality Disorder diagnosis from 2000 to 2015 in Baixo Vouga Hospitalar Center.
From an average of 500 patients admitted per year, in the considered period, the number of men with this psychiatric diagnosis was irrelevant.
Taking into account the results, it is important recognise some gender differences in borderline personality disorder with respect to specific types of self-harm behavior, such as self-cutting or levels of psychological distress at clinical presentation in order to prevent clinical disgnosis failure.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
The majority of HIV infected patients exhibit central nervous system disorders. The most severe is dementia, which is the most common cause of non-traumatic dementia in young patients. It may affect the progression of the disease, compromising the adherence of treatment and increasing the mortality rate.
Report of a clinical case of dementia due to HIV infection in a 33-year-old male patient, admitted in the Acute Inpatient Unit of the Psychiatry and Mental Health Department in Baixo Vouga Hospital Centre.
The results were gathered based on the clinical history of the patient, his objective exam, diagnostic exams and family information and from medical research included on PubMed and Google Scholar platforms.
The patient presented evident cognitive deterioration with memory loss, attention and concentration deficits, apathy, indifference, psychomotor retardation and behavioral changes in the past few weeks, with a significant impact in his life. The patient did supplementary diagnostic tests, which showed progressive multifocal leukoencephalopathy and global and diffuse cortical atrophy involving the fronto-temporal regions and a neuropsychological assessment whose results confirmed a moderate cognitive deficit. During the hospitalization there was a positive stabilization of behavior with antiretroviral therapy and antipsychotics.
The lack of knowledge about the factors that predispose dementia in HIV patients is a relevant limitation nowadays. The clinical effectiveness of antiretroviral therapy has improved in recent years with a reduction in the prevalence of HIV dementia, which now is estimated at 10%.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Goat genotype may alter the net energy and protein requirements for maintenance (NEm and NPm, respectively) and weight gain (NEg and NPg).This study was designed to investigate and quantify the effect of goat type on NEm, NPm, NEg and NPg, and quantify the net requirements for energy and protein for dairy, meat and indigenous growing male goats. For that, comparative slaughter studies were gathered and a meta-analytical approach was used. Two distinct databases were organized: one composed of 233 individual records from 11 studies of meat (n = 81), dairy (n = 97) and indigenous (n = 55) growing male goats weighing from 4.50 to 51.0 kg, to depict NEm and NPm; and another database composed of 239 individual records from nine studies of meat (n = 87), dairy (n = 97) and indigenous (n = 55) growing male goats weighing from 4.30 to 51.0 kg, to depict NEg and NPg. Our findings showed that NEm of meat goats was 8.5% greater (336 ± 10.8 kJ/kg0.75 of empty BW; EBW) than dairy and indigenous goats (310 ± 8.20 kJ/kg0.75 EBW; P < 0.05). Whereas, NPm was not affected by goat type (1.92 ± 0.239 g/kg EBW; P = 0.91). The NPg was 185.1 ± 1.82 g/kg of EBW gain for goats weighing 5 kg BW and 192.5 ± 4.33 g/kg of EBW gain for goats weighing 45 kg BW, and thus did not change across goat type (P = 0.12). On the other hand, NEg increased from 7.29 ± 0.191 to 11.9 ± 0.386 MJ/kg of EBW in male dairy goats, and from 7.32 ± 0.144 to 15.7 ± 0.537 MJ/kg of EBW in meat and indigenous growing male goats weighing between 5 and 45 kg BW. When body protein was used as a predictor in the allometric equation instead of EBW seeking to account for the degree of maturity, goat type differences disappeared; however, this predictor showed a high variation among individuals. In conclusion, energy and protein requirements for gain in distinct goat types reflect on body composition differences. Future research should focus on better understanding the maturity degree and its consequences in the energy requirement of growing male goats and better depict the goat type effect on it, as well as on the efficiency of utilization.
Milk production intensification has led to several unwanted aspects, such as sustainability issues and environmental pollution. Among these, increased milk outputs that have been achieved over the last 70 years have led to several health and pathophysiological conditions in high yielding dairy animals, including metabolic diseases that were uncommon in the past. Increased occurrence of diverse metabolic diseases in cattle and other domestic animals is a key feature of domestication that not only affects the animals' health and productivity, but also may have important and adverse health impacts on human consumers through the elevated use of drugs and antibiotics. These aspects will influence economical and ethical aspects in the near future. Therefore, finding and establishing proper biomarkers for early detection of metabolic diseases is of great interest. In the present review, recent work on the discovery of fitness, stress and welfare biomarkers in dairy cows is presented, focusing in particular on possible biomarkers of energy balance and oxidative stress in plasma and milk, and biomarkers of production-related diseases and decreased fertility.
The stable isotope ratios of carbon (δ13C) and nitrogen (δ15N) and total mercury concentrations (THg) of the three marine catfish species Aspistor luniscutis, Bagre bagre and Genidens genidens were evaluated to understand their trophic relationship in northern Rio de Janeiro state, south-eastern Brazil. The δ13C was similar among the three marine catfishes, whereas δ15N was similar in A. luniscutis and B. bagre and lower in G. genidens. THg was higher in G. genidens and lower in B. bagre. The greater assimilation of Sciaenidae fishes and squids by A. luniscutis and B. bagre resulted in smaller isotopic niche areas and trophic diversity but higher isotopic niche overlap, trophic redundancy and evenness. For G. genidens, the similar assimilation of all prey items resulted in the broadest isotopic niche among the marine catfishes. The higher mercury content in G. genidens is consistent with an increased important contribution of prey with a higher Hg burden. The bioaccumulation process was indicated by significant correlations of δ15N and THg with total length and total mass. Additionally, a significant correlation between THg and δ15N reflected the biomagnification process through the food web.
Intermittent explosive disorder (IED) is characterised by impulsive anger attacks that vary greatly across individuals in severity and consequence. Understanding IED subtypes has been limited by lack of large, general population datasets including assessment of IED. Using the 17-country World Mental Health surveys dataset, this study examined whether behavioural subtypes of IED are associated with differing patterns of comorbidity, suicidality and functional impairment.
IED was assessed using the Composite International Diagnostic Interview in the World Mental Health surveys (n = 45 266). Five behavioural subtypes were created based on type of anger attack. Logistic regression assessed association of these subtypes with lifetime comorbidity, lifetime suicidality and 12-month functional impairment.
The lifetime prevalence of IED in all countries was 0.8% (s.e.: 0.0). The two subtypes involving anger attacks that harmed people (‘hurt people only’ and ‘destroy property and hurt people’), collectively comprising 73% of those with IED, were characterised by high rates of externalising comorbid disorders. The remaining three subtypes involving anger attacks that destroyed property only, destroyed property and threatened people, and threatened people only, were characterised by higher rates of internalising than externalising comorbid disorders. Suicidal behaviour did not vary across the five behavioural subtypes but was higher among those with (v. those without) comorbid disorders, and among those who perpetrated more violent assaults.
The most common IED behavioural subtypes in these general population samples are associated with high rates of externalising disorders. This contrasts with the findings from clinical studies of IED, which observe a preponderance of internalising disorder comorbidity. This disparity in findings across population and clinical studies, together with the marked heterogeneity that characterises the diagnostic entity of IED, suggests that it is a disorder that requires much greater research.
Epidemiological studies indicate that individuals with one type of mental disorder have an increased risk of subsequently developing other types of mental disorders. This study aimed to undertake a comprehensive analysis of pair-wise lifetime comorbidity across a range of common mental disorders based on a diverse range of population-based surveys.
The WHO World Mental Health (WMH) surveys assessed 145 990 adult respondents from 27 countries. Based on retrospectively-reported age-of-onset for 24 DSM-IV mental disorders, associations were examined between all 548 logically possible temporally-ordered disorder pairs. Overall and time-dependent hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Cox proportional hazards models. Absolute risks were estimated using the product-limit method. Estimates were generated separately for men and women.
Each prior lifetime mental disorder was associated with an increased risk of subsequent first onset of each other disorder. The median HR was 12.1 (mean = 14.4; range 5.2–110.8, interquartile range = 6.0–19.4). The HRs were most prominent between closely-related mental disorder types and in the first 1–2 years after the onset of the prior disorder. Although HRs declined with time since prior disorder, significantly elevated risk of subsequent comorbidity persisted for at least 15 years. Appreciable absolute risks of secondary disorders were found over time for many pairs.
Survey data from a range of sites confirms that comorbidity between mental disorders is common. Understanding the risks of temporally secondary disorders may help design practical programs for primary prevention of secondary disorders.
Consideration of ethical, legal, and social issues plus patient values (ELSI+) in health technology assessment (HTA) is challenging because of a lack of conceptual clarity and the multi-disciplinary nature of ELSI+. We used concept mapping to identify key concepts and inter-relationships in the ELSI+ domain and provide a conceptual framework for consideration of ELSI+ in HTA.
We conducted a scoping review (Medline and EMBASE, 2000–2016) to identify ELSI+ issues in the HTA literature. Items from the scoping review and an expert brainstorming session were consolidated into eighty ELSI+-related statements, which were entered into Concept Systems® Global MAX™ software. Participants (N = 38; 36 percent worked as researchers, 21 percent as academics; 42 percent self-identified as HTA experts) sorted the statements into thematic groups, and rated them on importance in making decisions about adopting technologies in Canada, from 1 (not at all important) to 5 (extremely important). We used Concept Systems® Global MAX™ software to create and analyze concept maps with four to sixteen clusters.
Our final ELSI+ map consisted of five clusters, with each cluster representing a different concept and the statements within each cluster representing the same concept. Based on the concepts, we named these clusters: patient preferences/experiences, patient quality of life/function, patient burden/harm, fairness, and organizational. The highest mean importance ratings were for the statements in the patient burden/harm (3.82) and organizational (3.92) clusters.
This study suggests an alternative approach to ELSI+, based on conceptual coherence rather than academic disciplines. This will provide a foundation for incorporating ELSI+ into HTA.
Increased animal productivity has reduced animal fitness, resulting in increased susceptibility to infectious and metabolic diseases, locomotion problems and subfertility. Future animal breeding strategies should focus on balancing high production levels with health status monitoring and improved welfare. Additionally, understanding how animals interact with their internal and external environment is essential for improving health, fitness, and welfare. In this context, the continuous validation of existing biomarkers and the discovery and field implementation of new biomarkers will enable us to understand the specific physiological process and regulatory mechanisms used by the organism to adapt to different environmental conditions. Thus, biomarkers may be used to monitor welfare and improve management and breeding strategies. In this article, we describe major achievements in the establishment of biomarkers in dairy cows and small ruminants. This review mainly focuses on the physiological biomarkers used to monitor animal responses to, and recovery from, environmental perturbations. We highlight future avenues for research in this field and present a timely positioning document to the scientific community.
Sleep disturbance is a symptom of and a well-known risk factor for depression. Further, atypical functioning of the HPA axis has been linked to the pathogenesis of depression. The purpose of this study was to examine the role of adolescent HPA axis functioning in the link between adolescent sleep problems and later depressive symptoms. Methods: A sample of 157 17–18 year old adolescents (61.8% female) completed the Pittsburgh Sleep Quality Inventory (PSQI) and provided salivary cortisol samples throughout the day for three consecutive days. Two years later, adolescents reported their depressive symptoms via the Center for Epidemiological Studies Depression Scale (CES-D). Results: Individuals (age 17–18) with greater sleep disturbance reported greater depressive symptoms two years later (age 19–20). This association occurred through the indirect effect of sleep disturbance on the cortisol awakening response (CAR) (indirect effect = 0.14, 95%CI [.02 -.39]). Conclusions: One pathway through which sleep problems may lead to depressive symptoms is by up-regulating components of the body’s physiological stress response system that can be measured through the cortisol awakening response. Behavioral interventions that target sleep disturbance in adolescents may mitigate this neurobiological pathway to depression during this high-risk developmental phase.
Tuberculosis (TB) is the leading cause of death among infectious diseases worldwide. Among the estimated cases of drug-resistant TB, approximately 60% occur in the BRICS countries (Brazil, Russia, India, China and South Africa). Among Brazilian states, primary and acquired multidrug-resistant TB (MDR-TB) rates were the highest in Rio Grande do Sul (RS). This study aimed to perform molecular characterisation of MDR-TB in the State of RS, a high-burden Brazilian state. We performed molecular characterisation of MDR-TB cases in RS, defined by drug susceptibility testing, using 131 Mycobacterium tuberculosis (M.tb) DNA samples from the Central Laboratory. We carried out MIRU-VNTR 24loci, spoligotyping, sequencing of the katG, inhA and rpoB genes and RDRio sublineage identification. The most frequent families found were LAM (65.6%) and Haarlem (22.1%). RDRio deletion was observed in 42 (32%) of the M.tb isolates. Among MDR-TB cases, eight (6.1%) did not present mutations in the studied genes. In 116 (88.5%) M.tb isolates, we found mutations associated with rifampicin (RIF) resistance in rpoB gene, and in 112 isolates (85.5%), we observed mutations related to isoniazid resistance in katG and inhA genes. An insertion of 12 nucleotides (CCAGAACAACCC) at the 516 codon in the rpoB gene, possibly responsible for a decreased interaction of RIF and RNA polymerase, was found in 19/131 of the isolates, belonging mostly to LAM and Haarlem families. These results enable a better understanding of the dynamics of transmission and evolution of MDR-TB in the region.