RESUMEN
OBJECTIVES: To characterize clinical aspects, evaluate the diagnostic opportunity, and identify factors associated with mortality in patients hospitalized for tuberculosis (TB). METHODS: Retrospective study of patients admitted for TB to a Regional Hospital in Chile between 2011 and 2019. RESULTS: 142 TB events required hospitalization in this period (38.2% of total cases). All risk groups were identified, with a significant increase in patients with diabetes mellitus. The pulmonary location was the most frequent (71.1%), followed by disseminated forms (16.2%). The sensitivity of microscopy smear in cases of pulmonary TB (isolated or combined) was 78.8% and lower in cases of bronchoalveolar lavage (58.3%). PCR was only occasionally applied (< 10%) with a sensitivity of 100% in sputum samples. Its use increased progressively and reached a positivity of 33% (6 out of 18 cases) in cases with negative sputum staining. The median time between symptom onset and diagnosis was prolonged (9 weeks), and 32.5% of all regional events were diagnosed at the hospital. Dose adjustments (22.1%), corticosteroid use (25%), and treatment interruptions were frequent (11%). Lethality reached 19%, and by multivariate analysis, only shock was associated with a fatal outcome. CONCLUSIONS: In this case series, the diagnosis of TB cases was delayed, scarcely diagnosed by molecular methods, highly concentrated at the hospital level, required admission in a large percentage of cases, and had a high case-fatality rate.
OBJETIVOS: Caracterizar aspectos clínicos, evaluar la oportunidad diagnóstica e identificar factores asociados a mortalidad en pacientes ingresados por tuberculosis (TB). MÉTODOS: Estudio retrospectivo de pacientes ingresados por TB a un Hospital Regional en Chile entre el 2011 y 2019. RESULTADOS: Un total de 142 eventos de TB requirieron hospitalización en el período (38,2% del total). Todos los grupos de riesgo fueron identificados con un aumento significativo de los pacientes con diabetes mellitus. La localización pulmonar fue la más frecuente (71,1%), seguida de la forma diseminada (2 o más sitios; 16,2%). La sensibilidad de la tinción de expectoración en casos de TB pulmonar (aislada o combinada) fue de 78,8% y más baja en casos de lavado broncoalveolar (58,3%). La PCR fue sólo ocasionalmente aplicada (< 10%) con una sensibilidad del 100% en muestras de expectoración. Su uso aumentó progresivamente en el período y el incremento diagnóstico de TB en casos con tinción negativa de expectoración estudiados con PCR fue de 33% (6 de 18 casos). La mediana entre inicio de síntomas y el diagnóstico fue prolongada (9 semanas) y el 32,5% de los eventos regionales fueron diagnosticados en el hospital. Los ajustes de dosis (22,1%), uso de corticoides (25%) e interrupciones del tratamiento fueron hechos frecuentes (11%). La letalidad alcanzó 19% y en el análisis multivariado sólo la aparición de shock se asoció a un desenlace fatal. CONCLUSIONES: En esta serie de casos, el diagnóstico de casos de TB fue tardío, infrecuentemente diagnosticado por métodos moleculares, concentrado en la atención terciaria, requirió hospitalización en un gran porcentaje de casos y tuvo una elevada letalidad.
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Humanos , Masculino , Femenino , Adolescente , Adulto , Persona de Mediana Edad , Anciano , Adulto Joven , Tuberculosis Pulmonar/diagnóstico , Tuberculosis Pulmonar/mortalidad , Tuberculosis Pulmonar/epidemiología , Esputo/microbiología , Tuberculosis/diagnóstico , Tuberculosis/mortalidad , Tuberculosis/epidemiología , Chile/epidemiología , Estudios Retrospectivos , Factores de Riesgo , Hospitalización/estadística & datos numéricosRESUMEN
OBJECTIVES: To characterize clinical aspects, evaluate the diagnostic opportunity, and identify factors associated with mortality in patients hospitalized for tuberculosis (TB). METHODS: Retrospective study of patients admitted for TB to a Regional Hospital in Chile between 2011 and 2019. RESULTS: 142 TB events required hospitalization in this period (38.2% of total cases). All risk groups were identified, with a significant increase in patients with diabetes mellitus. The pulmonary location was the most frequent (71.1%), followed by disseminated forms (16.2%). The sensitivity of microscopy smear in cases of pulmonary TB (isolated or combined) was 78.8% and lower in cases of bronchoalveolar lavage (58.3%). PCR was only occasionally applied (< 10%) with a sensitivity of 100% in sputum samples. Its use increased progressively and reached a positivity of 33% (6 out of 18 cases) in cases with negative sputum staining. The median time between symptom onset and diagnosis was prolonged (9 weeks), and 32.5% of all regional events were diagnosed at the hospital. Dose adjustments (22.1%), corticosteroid use (25%), and treatment interruptions were frequent (11%). Lethality reached 19%, and by multivariate analysis, only shock was associated with a fatal outcome. CONCLUSIONS: In this case series, the diagnosis of TB cases was delayed, scarcely diagnosed by molecular methods, highly concentrated at the hospital level, required admission in a large percentage of cases, and had a high case-fatality rate.
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Tuberculosis Pulmonar , Humanos , Estudios Retrospectivos , Masculino , Femenino , Persona de Mediana Edad , Chile/epidemiología , Adulto , Factores de Riesgo , Anciano , Tuberculosis Pulmonar/epidemiología , Tuberculosis Pulmonar/diagnóstico , Tuberculosis Pulmonar/mortalidad , Adulto Joven , Hospitalización/estadística & datos numéricos , Tuberculosis/diagnóstico , Tuberculosis/epidemiología , Tuberculosis/mortalidad , Adolescente , Esputo/microbiologíaRESUMEN
The C-X-C motif chemokine ligand 17 (CXCL17) is chemotactic for myeloid cells, exhibits bactericidal activity, and exerts anti-viral functions. This chemokine is constitutively expressed in the respiratory tract, suggesting a role in lung defenses. However, little is known about the participation of CXCL17 against relevant respiratory pathogens in humans. Here, we evaluated the serum levels and lung tissue expression pattern of CXCL17 in a cohort of patients with severe pandemic influenza A(H1N1) from Mexico City. Peripheral blood samples obtained on admission and seven days after hospitalization were processed for determinations of serum CXCL17 levels by enzyme-linked immunosorbent assay (ELISA). The expression of CXCL17 was assessed by immunohistochemistry (IHQ) in lung autopsy specimens from patients that succumbed to the disease. Serum CXCL17 levels were also analyzed in two additional comparative cohorts of coronavirus disease 2019 (COVID-19) and pulmonary tuberculosis (TB) patients. Additionally, the expression of CXCL17 was tested in lung autopsy specimens from COVID-19 patients. A total of 122 patients were enrolled in the study, from which 68 had pandemic influenza A(H1N1), 24 had COVID-19, and 30 with PTB. CXCL17 was detected in post-mortem lung specimens from patients that died of pandemic influenza A(H1N1) and COVID-19. Interestingly, serum levels of CXCL17 were increased only in patients with pandemic influenza A(H1N1), but not COVID-19 and PTB. CXCL17 not only differentiated pandemic influenza A(H1N1) from other respiratory infections but showed prognostic value for influenza-associated mortality and renal failure in machine-learning algorithms and regression analyses. Using cell culture assays, we also identified that human alveolar A549 cells and peripheral blood monocyte-derived macrophages increase their CXCL17 production capacity after influenza A(H1N1) pdm09 virus infection. Our results for the first time demonstrate an induction of CXCL17 specifically during pandemic influenza A(H1N1), but not COVID-19 and PTB in humans. These findings could be of great utility to differentiate influenza and COVID-19 and to predict poor prognosis specially at settings of high incidence of pandemic A(H1N1). Future studies on the role of CXCL17 not only in severe pandemic influenza, but also in seasonal influenza, COVID-19, and PTB are required to validate our results.
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Biomarcadores/metabolismo , Quimiocinas CXC/metabolismo , Subtipo H1N1 del Virus de la Influenza A/fisiología , Gripe Humana/diagnóstico , Pulmón/metabolismo , Mycobacterium tuberculosis/fisiología , SARS-CoV-2/fisiología , Adulto , Anciano , COVID-19/diagnóstico , COVID-19/mortalidad , Quimiocinas CXC/genética , Quimiocinas CXC/inmunología , Estudios de Cohortes , Progresión de la Enfermedad , Femenino , Humanos , Gripe Humana/mortalidad , Pulmón/patología , Masculino , México , Persona de Mediana Edad , Pandemias , Evaluación del Resultado de la Atención al Paciente , Pronóstico , Análisis de Supervivencia , Tuberculosis Pulmonar/diagnóstico , Tuberculosis Pulmonar/mortalidad , Adulto JovenRESUMEN
In this study, we aimed to assess the relationship between tuberculosis case rate and COVID-19 case fatality rate (CFR) among districts within a tuberculosis-endemic metropolitan area. We analyzed data from 43 districts in Lima, Peru. We used districts as the units of observation. Linear regressions were used to investigate the relationship between COVID-19 CFRs and tuberculosis case rates. The mean COVID-19 CFR in each district for reporting Weeks 5-32 was used as the dependent variable. Independent variable was the mean rate of confirmed pulmonary tuberculosis cases for 2017-2019 period. Analyses were adjusted by population density, socioeconomic status, crowded housing, health facility density, and case rates of hypertension, diabetes mellitus, and HIV infection. The mean COVID-19 CFR in Lima was 4.0% ± 1.1%. The mean tuberculosis rate was 16.0 cases per 10,000 inhabitants. In multivariate analysis, tuberculosis case rate was associated with COVID-19 CFR (ß = 1.26; 95% confidence interval: 0.24-2.28; p = .02), after adjusting for potential confounders. We found that Lima districts with a higher burden of tuberculosis exhibited higher COVID-19 CFRs, independent of socioeconomic, and morbidity variables.
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COVID-19/complicaciones , COVID-19/mortalidad , Tuberculosis Pulmonar/complicaciones , Tuberculosis Pulmonar/mortalidad , COVID-19/epidemiología , Ciudades , Humanos , Modelos Lineales , Perú/epidemiología , Tuberculosis Pulmonar/epidemiologíaRESUMEN
Objetivo: analisar a distribuição dos óbitos por tuberculose pulmonar no estado do Amazonas. Método: trata-se de um estudo ecológico com dados secundários do Sistema de Informação de Mortalidade, durante o período de 2007 a 2017. O software QGIs foi utilizado para elaborar um mapa digital e o software RStudio para as análises estatísticas. Na análise dos dados foi aplicado a regressão linear múltipla, o índice de Moran Global e o teste multiplicador de Lagrange. Resultados: identificou-se 1.267 casos de óbitos por tuberculose pulmonar no estado do Amazonas. A maioria dos óbitos ocorreram no sexo masculino (64,64%); solteiros (47,43%); com faixa etária ≥ 60 anos (51,14%); raça/cor parda (71,11%). Verificou-se que não existe autocorrelação espacial através do índice de Moran Global (0.0094). Conclusão: A distribuição espacial dos óbitos ocorreu de forma heterogênea nas diferentes regiões do estado Amazonas, apresentando elevadas taxas de mortalidade durante o período de 2007 a 2017.(AU)
Objective: to analyze the distribution of deaths from pulmonary tuberculosis in the state of Amazonas. Method: it is an ecological study with secondary data from the Mortality Information System, during the period from 2007 to 2017. The QGIs software was used to create a digital map and the RStudio software for statistical analysis. In the data analysis, multiple linear regression, the Moran Global index and the Lagrange multiplier test were applied. Results: 1,267 cases of deaths from pulmonary tuberculosis were identified in the state of Amazonas. Most deaths occurred in males (64.64%); singles (47.43%); aged ≥ 60 years (51.14%); race / brown color (71.11%). It was found that there is no spatial autocorrelation using the Moran Global index (0.0094). Conclusion: The spatial distribution of deaths occurred heterogeneously in different regions of the state of Amazonas, with high mortality rates during the period from 2007 to 2017.(AU)
Objetivo: analizar la distribución de muertes por tuberculosis pulmonar en el estado de Amazonas. Método: se trata de un estudio ecológico con datos secundarios del Sistema de Información de Mortalidad, durante el período de 2007 a 2017. Se utilizó el software QGIs para crear un mapa digital y el software RStudio para análisis estadístico. En el análisis de datos se aplicó regresión lineal múltiple, el índice Moran Global y la prueba del multiplicador de Lagrange. Resultados: se identificaron 1.267 casos de defunciones por tuberculosis pulmonar en el estado de Amazonas. La mayoría de las muertes ocurrieron en hombres (64,64%); solteros (47,43%); edad ≥ 60 años (51,14%); raza / color marrón (71,11%). Se encontró que no existe autocorrelación espacial usando el índice Moran Global (0.0094). Conclusión: La distribución espacial de las defunciones ocurrió de manera heterogénea en diferentes regiones del estado de Amazonas, con altas tasas de mortalidad durante el período 2007 a 2017.(AU)
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Humanos , Masculino , Femenino , Persona de Mediana Edad , Tuberculosis Pulmonar/mortalidad , Análisis Espacio-Temporal , Factores Socioeconómicos , Brasil/epidemiología , Características de la Residencia , Estudios Ecológicos , Sistemas de Información en SaludRESUMEN
Introducción: Eliminar la tuberculosis para 2035, es la propuesta de la estrategia mundial "Fin de la Tuberculosis". Objetivo: Determinar la letalidad de la tuberculosis con virus de inmunodeficiencia negativo como un indicador en la eliminación de la enfermedad. Material y Método: Se realizó un estudio descriptivo de la letalidad de los casos diagnosticados con virus de inmunodeficiencia negativo del año 2000 al 2015 en La Habana a partir de las cohortes anuales de enfermos de tuberculosis según grupos de edades; por municipios; variabilidad; tuberculosis, tuberculosis pulmonar con baciloscopia positivas (BAAR+); y los retratamientos por años. Al análisis de la letalidad por municipio se añadió la variación de la enfermedad en el estudio y según la tuberculosis pulmonar y el resultado de la baciloscopia. Resultados: La letalidad de la tuberculosis en los casos nuevos con virus de inmunodeficiencia negativo fue de 8,8 por ciento con predominio de los fallecidos por tuberculosis con 5,4 por ciento. En los casos con retratamientos fue de 16,2 por ciento. La letalidad se incrementó en 43,5 por ciento con 2,9 por ciento anual y con la edad. Los fallecidos por tuberculosis pulmonar representaron 96,6 por ciento. En los resultados se destacan cinco municipios. Conclusiones: La letalidad de la tuberculosis de casos nuevos con virus de inmunodeficiencia negativo reveló un incremento anual en la tuberculosis pulmonar y en los retratamientos; esto sugiere dificultades en el control de la enfermedad, lo que potencialmente compromete su eliminación en La Habana. Intensificar la prevención de los factores influyentes pudiera reducir este indicador(AU)
Introduction: The proposal of the End TB Strategy is to end tuberculosis by 2035 globally. Objective: To determine the lethality of tuberculosis with negative immunodeficiency virus as an indicator in the elimination of the disease. Material and Method: A descriptive study on the lethality of cases diagnosed with negative immunodeficiency virus during 2000 and 2015 was conducted in Havana. The study considered the annual cohorts of tuberculosis patients according to age groups, municipalities, variability, tuberculosis, Smear-positive pulmonary tuberculosis (BAAR +), and the retreatments by years. The variation of the disease in the study as well as the variation of pulmonary tuberculosis and the results of sputum microscopies were added to the analysis of lethality carried out in every municipality. Results: The case fatality rate of tuberculosis in new cases with negative immunodeficiency virus was 8.8 percent with a predominance of those who died from Tuberculosis (5.4 percent). In the cases of retreatments, it was 16.2 percent. Case fatality increased by 43.5 percent with 2.9 percent per year and with age. Those patients who died from pulmonary tuberculosis represented 96.6 percent. Five municipalities stand out in the results. Conclusions: The lethality of tuberculosis in new cases with negative immunodeficiency virus revealed an annual increase in pulmonary tuberculosis and retreatments, suggesting difficulties related to the control of the disease and potentially compromising its elimination in Havana. Intensifying the prevention of influencing factors could reduce this indicator(AU)
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Humanos , Tuberculosis Pulmonar/mortalidad , Epidemiología Descriptiva , MortalidadRESUMEN
Few studies have prospectively compared the relative transmissibility and propensity to cause disease of Mycobacterium tuberculosis Beijing strains with other human-adapted strains of the M. tuberculosis complex. We assessed the effect of Beijing strains on the risk for M. tuberculosis infection and disease progression in 9,151 household contacts of 2,223 culture-positive pulmonary tuberculosis (TB) patients in Lima, Peru. Child contacts exposed to Beijing strains were more likely than child contacts exposed to non-Beijing strains to be infected at baseline, by 12 months of follow-up, and during follow-up. We noted an increased but nonsignificant tendency for child contacts to develop TB. Beijing strains were not associated with TB in adult contacts. These findings suggest that Beijing strains are more transmissible in children than are non-Beijing strains.
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Composición Familiar , Mycobacterium tuberculosis/aislamiento & purificación , Tuberculosis Pulmonar/epidemiología , Adolescente , Adulto , Factores de Edad , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Mycobacterium tuberculosis/genética , Perú/epidemiología , Estudios Prospectivos , Factores de Riesgo , Análisis de Supervivencia , Tuberculosis Pulmonar/mortalidad , Tuberculosis Pulmonar/transmisión , Adulto JovenRESUMEN
OBJECTIVE: To characterise tuberculosis deaths in a region of northeast Brazil during the period from 2006 to 2017 and to identify determinants associated with areas with higher tuberculosis mortality rates. METHODS: Ecological descriptive study of deaths from tuberculosis with multivariate mapping and logistic regression, carried out from 2006 to 2017 in the 75 municipalities of Sergipe, Brazil. The focus of the analysis was the mean mortality rate from tuberculosis, dichotomised according to the median. The independent variables were selected based on the conceptual model of the social determinants of health. RESULTS: Mortality due to tuberculosis in Sergipe, Brazil, was most prevalent among males, mixed-race people, and people over 40 years old and with a low level of education. Multivariate logistic regression identified the mean incidence rate for tuberculosis (aOR: 1.06), the proportion of HIV testing (aOR: 7.10), people without primary education and with informal occupation (aOR: 1.26) and people living in urban households without waste collection service (aOR: 0.10) as determinants associated to municipalities with higher tuberculosis mortality rates, with area under the ROC curve of 84% (P-value 0.000). Mapping revealed evident spatial variability. CONCLUSIONS: The tuberculosis epidemic in Brazil is determined by access to health services, especially the provision of HIV testing among those diagnosed with tuberculosis, accelerated urbanisation with large pockets of poverty and unsanitary housing conditions, corroborating global trends.
OBJECTIF: Caractériser les décès dus à la tuberculose dans une région du nord-est du Brésil au cours de la période de 2006 à 2017 et identifier les déterminants associés aux zones où les taux de mortalité par tuberculose sont plus élevés. MÉTHODES: Etude descriptive écologique des décès par tuberculose avec une cartographie multivariée et une régression logistique, réalisée de 2006 à 2017 dans les 75 municipalités de Sergipe, au Brésil. L'analyse était axée sur le taux moyen de mortalité par tuberculose, dichotomisé selon la médiane. Les variables indépendantes ont été sélectionnées sur la base du modèle conceptuel des déterminants sociaux de la santé. RÉSULTATS: La mortalité due à la tuberculose à Sergipe, au Brésil, était plus fréquente chez les hommes, les personnes métissées, les personnes de plus de 40 ans et avec un faible niveau d'éducation. La régression logistique multivariée a identifié le taux moyen d'incidence de la tuberculose (aOR: 1,06), la proportion des tests de dépistage du VIH (aOR: 7,10), les personnes sans éducation primaire et occupant une fonction informelle (aOR: 1,26) et les personnes vivant dans des ménages en milieu urbain sans service de collecte des déchets (aOR: 0,10) comme étant des déterminants associés aux municipalités avec des taux de mortalité par tuberculose plus élevés, avec une aire sous la courbe ROC de 84 % (p=0,000). La cartographie a révélé une variabilité spatiale évidente. CONCLUSIONS: L'épidémie de tuberculose au Brésil est déterminée par l'accès aux services de santé, en particulier la fourniture des tests de dépistage du VIH chez les personnes diagnostiquées avec la tuberculose, l'urbanisation accélérée avec de grandes poches de pauvreté et les conditions de logement insalubres, corroborant les tendances mondiales.
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Tuberculosis Pulmonar/epidemiología , Adolescente , Adulto , Brasil/epidemiología , Niño , Preescolar , Demografía , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Pobreza , Factores de Riesgo , Factores Socioeconómicos , Tuberculosis Pulmonar/etiología , Tuberculosis Pulmonar/mortalidad , Tuberculosis Pulmonar/prevención & control , Adulto JovenRESUMEN
BACKGROUND: Social determinants may influence the incidence and control of tuberculosis (TB). The aim of this study was to evaluate the correlation between social determinants and pulmonary TB (PTB) incidence and treatment outcomes in different regions in Brazil. METHODS: In this ecological study, PTB incidence and treatment outcome rates as well as HIV incidence for all 5560 Brazilian cities as reported to the Brazilian Tuberculosis Program in 2010 were correlated with two social indicators, the Human Development Index (HDI) and Gini Index (GI). Cities were stratified into six groups based on location (metropolitan region or not) and size (small, medium, and large cities), and according to the regions of the country to which they belong. The Spearman correlation coefficient was used to assess the association between variables. RESULTS: In 2010, 68,729 new PTB cases were reported in Brazil, with an incidence rate of 36 cases per 100,000 inhabitants. Incidence rates and PTB mortality demonstrated a weak negative correlation with HDI and a positive correlation with GI. The correlation between HDI and GI with cure, relapse, and lost to follow-up of treatment greatly varied in the different groups of cities and regions of the country evaluated. CONCLUSIONS: There is a weak correlation between HDI and GI and PTB incidence and mortality rate. However, there is great variation between the HDI and GI and cure, relapse, and lost to follow-up in the different groups of cities and regions of the country. This suggests that for TB determination, these outcome variables might be more related to the quality of healthcare provided by services than to social determinants in the general population.
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Infecciones por VIH/epidemiología , Determinantes Sociales de la Salud , Tuberculosis Pulmonar/mortalidad , Brasil/epidemiología , Ciudades , Comorbilidad , Disparidades en Atención de Salud , Humanos , Incidencia , Factores SocioeconómicosRESUMEN
INTRODUCTION: The receptor for advanced glycation end products (RAGE) is expressed in normal lungs and is upregulated during infection. AGEs and RAGE cause oxidative stress and apoptosis in lung cells. The objective of this study is to evaluate levels of AGEs and its soluble receptor (sRAGE), and to investigate their relationship with food intake and nutritional status, in a university-affiliated hospital in Brazil. METHODS: Case-control study, from June 2017 to June 2018. AGE (carboxymethyl lysine, CML) and sRAGE were measured from blood samples by Elisa. Nutritional assessment was performed by body mass index, triceps skin-fold thickness, mid-arm circumference, mid-arm muscle circumference, bioelectrical impedance analysis, and food frequency questionnaire. RESULTS: We included in the study 35 tuberculosis (TB) patients and 35 controls. The mean sRAGE levels were higher in TB patients than in controls (68.5 ± 28.1 vs 57.5 ± 24.0 pg/mL; p = 0.046). Among cases that were current smokers, lower sRAGE levels were associated with mortality, evaluated at the end of hospitalization (p = 0.006), and with weight loss (p = 0.034). There was no statistically significant difference in CML levels and diet CML content between cases and controls. Malnutrition was more frequent in cases, but there was no correlation between nutritional parameters and CML or sRAGE levels. CONCLUSIONS: TB patients had higher sRAGE levels than controls, although it is not clear that this difference is clinically relevant. Also, sRAGE was associated with weight loss and mortality.
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Antígenos de Neoplasias/sangre , Productos Finales de Glicación Avanzada/sangre , Proteínas Quinasas Activadas por Mitógenos/sangre , Tuberculosis Pulmonar/sangre , Adulto , Brasil/epidemiología , Estudios de Casos y Controles , Ingestión de Alimentos/fisiología , Femenino , Humanos , Pulmón/metabolismo , Masculino , Persona de Mediana Edad , Evaluación Nutricional , Estado Nutricional/fisiología , Estrés Oxidativo , Estudios Prospectivos , Tuberculosis Pulmonar/mortalidad , Tuberculosis Pulmonar/fisiopatología , Pérdida de Peso , Adulto JovenRESUMEN
BACKGROUND: Xpert MTB/RIF, the most widely used automated nucleic acid amplification test for tuberculosis, is available in more than 130 countries. Although diagnostic accuracy is well documented, anticipated improvements in patient outcomes have not been clearly identified. We performed an individual patient data meta-analysis to examine improvements in patient outcomes associated with Xpert MTB/RIF. METHODS: We searched PubMed, Embase, ClinicalTrials.gov, and the Pan African Clinical Trials Registry from inception to Feb 1, 2018, for randomised controlled trials (RCTs) comparing the use of Xpert MTB/RIF with sputum smear microscopy as tests for tuberculosis diagnosis in adults (aged 18 years or older). We excluded studies of patients with extrapulmonary tuberculosis, and studies in which mortality was not assessed. We used a two-stage approach for our primary analysis and a one-stage approach for the sensitivity analysis. To assess the primary outcome of cumulative 6-month all-cause mortality, we first performed logistic regression models (random effects for cluster randomised trials, with robust SEs for multicentre studies) for each trial, and then pooled the odds ratio (OR) estimates by a fixed-effects (inverse variance) or random-effects (Der Simonian Laird) meta-analysis. We adjusted for age and gender, and stratified by HIV status and previous tuberculosis-treatment history. The study protocol has been registered with PROSPERO, number CRD42014013394. FINDINGS: Our search identified 387 studies, of which five RCTs were eligible for analysis. 8567 adult clinic attendees (4490 [63·5%] of 7074 participants for whom data were available were HIV-positive) were tested for tuberculosis with Xpert MTB/RIF (Xpert group) versus sputum smear microscopy (sputum smear group), across five low-income and middle-income countries (South Africa, Brazil, Zimbabwe, Zambia, and Tanzania). The primary outcome (reported in three studies) occurred in 182 (4·5%) of 4050 patients in the Xpert group and 217 (5·3%) of 4093 patients in the smear group (pooled adjusted OR 0·88, 95% CI 0·68-1·14 [p=0·34]; for HIV-positive individuals OR 0·83, 0·65-1·05 [p=0·12]). Kaplan-Meier estimates showed a lower rate of death (12·73 per 100 person-years in the Xpert group vs 16·38 per 100 person-years in the sputum smear group) for HIV-positive patients (hazard ratio 0·76, 95% CI 0·60-0·97; p=0·03). The risk of bias was assessed as reasonable and the statistical heterogeneity across studies was low (I2<20% for the primary outcome). INTERPRETATION: Despite individual patient data analysis from five RCTs, we were unable to confidently rule in nor rule out an Xpert MTB/RIF-associated reduction in mortality among outpatients tested for tuberculosis. Reduction in mortality among HIV-positive patients in a secondary analysis suggests the possibility of population-level impact. FUNDING: US National Institutes of Health.
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Mycobacterium tuberculosis/genética , Técnicas de Amplificación de Ácido Nucleico , Esputo/microbiología , Tuberculosis Pulmonar/diagnóstico , Adulto , Antituberculosos/uso terapéutico , Brasil/epidemiología , Causas de Muerte , Femenino , Infecciones por VIH/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Mortalidad , Mycobacterium tuberculosis/aislamiento & purificación , Oportunidad Relativa , Evaluación de Resultado en la Atención de Salud , Modelos de Riesgos Proporcionales , Sudáfrica/epidemiología , Tanzanía/epidemiología , Tiempo de Tratamiento/estadística & datos numéricos , Tuberculosis Pulmonar/tratamiento farmacológico , Tuberculosis Pulmonar/epidemiología , Tuberculosis Pulmonar/mortalidad , Zambia/epidemiología , Zimbabwe/epidemiologíaRESUMEN
Background In 2016 tuberculosis (TB) was considered the ninth leading cause of death worldwide and the leading cause of a single infectious agent, with approximately 1.6 million deaths worldwide and a lethality of 15%. Over 95% of cases and deaths are in developing countries like Colombia. AIM: To describe the sociodemographic and clinical characteristics of patients who died during TB treatment in a high complexity hospital in Cali, Colombia. METHODS: We conducted an analytic retrospective cohort during 2007-2016 in Fundación Valle del Lili. We included patients with TB diagnosis, who died during TB treatment. RESULTS: From 787 patients with TB, 69 died (8.8%). Fifty nine percent were male, the average of age was 51.9 years. There was diagnosis delay in 51% of the patients and 74% presented pulmonary TB. Sixty four percent 64 died in the first 30 days of the TB diagnosis and 61% of the deaths were attributable to TB. Twenty five percent of patients had TB/HIV coinfection. Elderly patients (> 65 years old) were associated with death in the first 30 days of TB diagnosis (p < 0,001). DISCUSSION: The lethality found in this study was higher than expected (8.8%), the majority of patients had serious comorbidities. Elderly patients were associated with early death. The main pathophysiological mechanism of death was septic shock caused by severe tuberculous pneumonia.
Asunto(s)
Tuberculosis/mortalidad , Antituberculosos/uso terapéutico , Causas de Muerte , Coinfección/clasificación , Coinfección/mortalidad , Colombia/epidemiología , Comorbilidad , Femenino , Infecciones por VIH/mortalidad , Mortalidad Hospitalaria , Hospitales , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Distribución por Sexo , Factores Socioeconómicos , Tuberculosis/clasificación , Tuberculosis/tratamiento farmacológico , Tuberculosis Pulmonar/mortalidadRESUMEN
BACKGROUND: There is uncertainty regarding which factors are associated with in-hospital mortality among patients with pulmonary TB (PTB). The aim of this systematic review and meta-analysis is to identify predictors of in-hospital mortality among patients with PTB. METHODS: We searched MEDLINE, EMBASE, and Global Health, for cohort and case-control studies that reported risk factors for in-hospital mortality in PTB. We pooled all factors that were assessed for an association, and presented relative associations as pooled odds ratios (ORs). RESULTS: We identified 2,969 records, of which we retrieved 51 in full text; 11 cohort studies that evaluated 5,468 patients proved eligible. Moderate quality evidence suggested an association with co-morbid malignancy and in-hospital mortality (OR 1.85; 95% CI 1.01-3.40). Low quality evidence showed no association with positive sputum smear (OR 0.99; 95% CI 0.40-2.48), or male sex (OR 1.09, 95% CI 0.84-1.41), and very low quality evidence showed no association with diabetes mellitus (OR 1.31, 95% IC 0.38-4.46), and previous TB infection (OR 2.66, 95% CI 0.48-14.87). CONCLUSION: Co-morbid malignancy was associated with increased risk of in-hospital death among pulmonary TB patients. There is insufficient evidence to confirm positive sputum smear, male sex, diabetes mellitus, and previous TB infection as predictors of in-hospital mortality in TB patients.
Asunto(s)
Mortalidad Hospitalaria/tendencias , Neoplasias/mortalidad , Tuberculosis Pulmonar/mortalidad , Antituberculosos/uso terapéutico , Estudios de Casos y Controles , Estudios de Cohortes , Humanos , Mycobacterium tuberculosis/efectos de los fármacos , Mycobacterium tuberculosis/aislamiento & purificación , Mycobacterium tuberculosis/patogenicidad , Neoplasias/complicaciones , Neoplasias/diagnóstico , Neoplasias/tratamiento farmacológico , Oportunidad Relativa , Factores de Riesgo , Esputo/microbiología , Análisis de Supervivencia , Tuberculosis Pulmonar/complicaciones , Tuberculosis Pulmonar/diagnóstico , Tuberculosis Pulmonar/tratamiento farmacológicoRESUMEN
Resumen Introducción: En el 2016 la tuberculosis (TBC) fue considerada la novena causa de muerte en el mundo y la primera por un único agente infeccioso, con aproximadamente 1,6 millones de muertes y una letalidad de 15%. Más de 95% de los casos de mortalidad mundial se presentan en países en vía de desarrollo como Colombia. Objetivo: Describir las características sociodemográficas y clínicas de los pacientes que fallecieron durante el tratamiento antituberculoso en un centro de alta complejidad en Cali, Colombia. Métodos: Estudio analítico de cohorte retrospectiva, realizado entre 2007-2016 en la Fundación Valle del Lili. Se incluyeron pacientes con diagnóstico de TBC con seguimiento clínico, que fallecirron por cualquier causa. Resultados: De 787 pacientes diagnosticados con TBC, murieron 69 (8,8%). La mayoría de los fallecidos (59%) fueron hombres, edad promedio de 51,9 años. Hubo retraso diagnóstico en 51% de los pacientes y 75% presentaron TBC pulmonar. El 64% murió en los primeros 30 días posteriores al diagnóstico de TBC y 61% de las muertes fueron atribuibles a TBC. Co-infección TBC e infección por VIH se presentó en 23% de los casos. La edad avanzada (> 65 años) se asoció a muerte en menos de 30 días desde el diagnóstico de TBC (p < 0,001). Discusión: La letalidad encontrada es superior a lo esperado (8,8%); la mayoría de los pacientes fallecidos presentó co-morbilidades graves. La edad avanzada se asoció a muerte temprana. El principal mecanismo fisiopatológico de muerte por TBC en este estudio fue el choque séptico secundario a neumonía grave tuberculosa.
Background In 2016 tuberculosis (TB) was considered the ninth leading cause of death worldwide and the leading cause of a single infectious agent, with approximately 1.6 million deaths worldwide and a lethality of 15%. Over 95% of cases and deaths are in developing countries like Colombia. Aim: To describe the sociodemographic and clinical characteristics of patients who died during TB treatment in a high complexity hospital in Cali, Colombia. Methods: We conducted an analytic retrospective cohort during 2007-2016 in Fundación Valle del Lili. We included patients with TB diagnosis, who died during TB treatment. Results: From 787 patients with TB, 69 died (8.8%). Fifty nine percent were male, the average of age was 51.9 years. There was diagnosis delay in 51% of the patients and 74% presented pulmonary TB. Sixty four percent 64 died in the first 30 days of the TB diagnosis and 61% of the deaths were attributable to TB. Twenty five percent of patients had TB/HIV coinfection. Elderly patients (> 65 years old) were associated with death in the first 30 days of TB diagnosis (p < 0,001). Discussion: The lethality found in this study was higher than expected (8.8%), the majority of patients had serious comorbidities. Elderly patients were associated with early death. The main pathophysiological mechanism of death was septic shock caused by severe tuberculous pneumonia.
Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Tuberculosis/mortalidad , Factores Socioeconómicos , Tuberculosis/clasificación , Tuberculosis/tratamiento farmacológico , Tuberculosis Pulmonar/mortalidad , Comorbilidad , Infecciones por VIH/mortalidad , Estudios Retrospectivos , Factores de Riesgo , Causas de Muerte , Mortalidad Hospitalaria , Distribución por Sexo , Colombia/epidemiología , Coinfección/clasificación , Coinfección/mortalidad , Hospitales , Antituberculosos/uso terapéuticoRESUMEN
Introdução: o consumo de substâncias psicoativas associado à terapêutica da tuberculose (TB) estabelece uma urgente questão de saúde pública no mundo contemporâneo. O aumento da morbimortalidade, pertinente à incidência e prevalência da tuberculose, e o consumo indevido de substâncias psicoativas, tem refletido em resultados negativos, relacionados à saúde e questões sociais, para indivíduos e seus familiares (CASSIANO, 2014). Objetivos: identificar o perfil e o padrão de consumo de substâncias psicoativas por pacientes em tratamento da tuberculose, na Unidade de Atenção Primária à Saúde; analisar a adesão ao tratamento desses pacientes que fazem consumo de substâncias psicoativas e realizar a Intervenção Breve nessa clientela, na perspectiva da adesão ao tratamento da tuberculose. Método: estudo seccional, realizado em unidades de atenção primária à saúde, na modalidade da Estratégia Saúde da Família, na cidade do Rio de Janeiro, com 114 pacientes em tratamento da tuberculose, utilizando o questionário ASSIST. Foram incluídos na amostra todos os pacientes em tratamento de tuberculose. A variável de exposição foi o consumo de substâncias psicoativas, e a de desfecho, a adesão ao tratamento. Na primeira fase, realizou-se a Intervenção Breve, na etapa do feedback. Na segunda fase, após dois meses, foi realizada a busca no prontuário para confirmação ou não da adesão. Resultados: prevalência da população masculina 71,1%, idade mediana de 39 anos, escolaridade fundamental incompleta 52,6%, cor da pele parda 42,1%, renda familiar > 1 salário mínimo 74,5%, e vivia com familiares. Prevalência para tabaco 28,0%, bebidas alcoólicas 12,3%, maconha 5,4% e cocaína /crack 3,5%. Em relação à adesão, observou-se, após dois meses da Intervenção, em levantamento realizado nos prontuários dos pacientes, prevalência da população masculina, maiores de 40 anos, escolaridade médio/superior, casados e que viviam em união, brancos, recebiam até 1 salário mínimo, viviam com parentes; estes aderiram ao tratamento de tuberculose. Conclusão: esses resultados demonstram a importância da Intervenção Breve, realizada pelos profissionais de saúde com essa clientela, diminuindo a incidência de pacientes bacilíferos, propensos à disseminação da doença.
Introduction: The consumption of psychoactive substances associated with tuberculosis (TB) therapy establishes an urgent public health issue in the contemporary world. The increase in morbidity and mortality, pertinent to the incidence and prevalence of tuberculosis and the misuse of psychoactive substances, has reflected in negative results related to health and social issues for individuals and their families (CASSIANO, 2014). The objectives of this study were: To identify the profile and the pattern of consumption of psychoactive substances of patients undergoing tuberculosis treatment in the network of basic health services; to analyze the adherence to the treatment of patients of tuberculosis who consume these substances and perform brief intervention in this clientele from the perspective of the adherence to the tuberculosis treatment. Materials and Methods: Sectional study, carried out in primary care units in the modality of the Family Health Strategy, in the city of Rio de Janeiro, with n sample of 114 patients in the treatment of tuberculosis using the ASSIST questionnaire. All patients undergoing tuberculosis treatment were included in the sample. The exposure variable was the consumption of psychoactive substances and the outcome variable adherence to treatment. In the first phase the brief intervention was carried out, in the stages of feedback, due guidance and empathically. In the second phase after two months, a search was performed on the medical record for confirmation or non-compliance. Results: Prevalence in the male population71,1%, median age 39 years, incomplete primary schooling 52,6%, brown skin color 42,1%, family income > 1 minimum wage, 74,5% lived with relatives. Prevalence for tobacco 28,0%, alcoholic beverages 12,3%, marijuana 5,4% and cocaine / crack 3,5%. Regarding adherence, after two months of Brief Intervention, with a survey in the patients' charts, a higher prevalence of adherence was observed in the male population, over 40 years old, with medium / high school education, married and living in union, whites received up to 1 minimum wage, live with relatives, adhered to the treatment of tuberculosis. Conclusions: These results demonstrate the importance of brief interventions applied by health professionals with these patients, decreasing the incidence of bacilliferous patients, prone to the spread of the disease.
Introduction: la consommation de substances psychoactives associées au traitement de la tuberculose (TB) établit un problème urgent de santé publique dans le monde contemporain. L'augmentation de la morbidité et de la mortalité, qui est pertinente pour l'incidence et la prévalence de la tuberculose et l'abus de substances psychoactives, s'est traduite par des résultats négatifs liés aux problèmes de santé et sociaux pour les individus et leurs familles (CASSIANO,2014). Buts: identifier le profil y le schéma de consommation de substances psychoactives des patients en traitement contre la tuberculose, dans le Centre de Soins de Santé Primaires; analyser l'adhésion au traitement concernant ces patients qui font usage de substances psychoactives et réaliser une Intervention brève chez cette clientèle, dans le contexte de l'adhésion au traitement de la tuberculose. Méthode : étude sectionnelle, mise en marche dans des centres de Soins de Santé Primaires dans la modalité de la Stratégie sur la Santé de la Famille à Rio de janeiro, auprès de 114 patients en traitement contre la tuberculose, par le moyen du questionnaire ASSIST. Tous les patients en traitement contre la tuberculose y ont été inclus. La variable d'exposition fut la consommation de substances psychoactives et celle de résultat l'adhésion au traitement. Dans la première phase, une intervention brève a été mise en marche, à l'étape du feedback. Dans la deuxième phase, après deux mois, fur réalisée la recherche du dossier médical pour confirmer ou pas l'adhésion. Résultats: prévalence chez la population masculine - 71,1%, âge moyen - 39 ans, scolarité primaire incomplète - 52,6%, couleur de peau brune - 42,1%, revenu familial > 1 SMIC - 74,5% et habite avec la famille. Prévalence pour tabac - 28,0%, boissons alcoolisées - 12,3%, cannabis - 5,4% et cocaïne/crack - 3,5%. Concernant l'adhésion, après deux mois de l'Intervention, au moyen d'un relevé des dossiers médicaux des patients, on a observé une plus grande prévalence d'adhésion chez la population masculine, ayant plus de 40 ans, enseignement secondaire et universitaire, mariés en cohabitation, blancs, recevant jusqu'à un SMIC, ne vivant pas avec les familiers. Ceux-ci ont adhéré au traitement contre la tuberculose. Conclusion: ces résultats démontrent l'importance de l'Intervention brève mise en marche par les professionnels de la santé, auprès de cette clientèle, ce qui diminue l'incidence de patients frottis positif enclins à la dissémination de la maladie.
Introducción: el consumo de sustancias psicoactivas asociadas a la terapia contra la tuberculosis (TB) establece un problema urgente de salud pública en el mundo contemporáneo. El aumento de la morbilidad y mortalidad, pertinente a la incidencia y prevalencia de la tuberculosis y al uso indebido de sustancias psicoactivas, se ha reflejado en los resultados negativos relacionados con la salud y las cuestiones sociales de las personas y sus familiares (CASSIANO, 2014). Objetivos: identificar el perfil y el patrón de consumo de sustancias psicoactivas de los pacientes en tratamiento contra la tuberculosis, en el Centro de Atención Primaria de Salud; analizar la adhesión al tratamiento de esos pacientes que consumen sustancias psicoactivas y realizar Intervención Breve junto a esa clientela, en el contexto de la adhesión al tratamiento de la tuberculosis. Método: estudio seccional, realizado en centros de atención primaria en la modalidad de la Estrategia Salud de la Familia en la ciudad del Rio de janeiro, junto a 114 pacientes en tratamiento contra la tuberculosis, utilizando el cuestionario ASSIST. Se han incluido en el muestreo a todos los pacientes en tratamiento contra tuberculosis. La variable de exposición fue el consumo de sustancias psicoactivas y, la de resultado, adhesión al tratamiento. En la primera fase se realizó la Intervención Breve, en la etapa del feedback. En la segunda fase, después de dos meses, se realizó la búsqueda en la historia clínica para confirmar o no la adhesión. Resultados: prevalencia en la población masculina -71,1%, promedio de edad - 39 años, enseñanza primaria incompleta - 52,6%, color de piel pardo - 42,1%, ingresos familiares > 1 salario mínimo - 74,5% y viviendo con familiares. Prevalencia para tabaco - 28,0%, bebidas alcohólicas - 12,3%, marihuana -5,4% y cocaína /crack - 3,5%. Respecto a la adhesión, tras dos meses de la Intervención, con relevamiento en las historias clínicas de los pacientes, se observó mayor prevalencia en la adhesión en la población masculina, mayores de 40 años, con escolaridad secundaria/universitaria, casados y que vivían en unión estable, blancos, recibían hasta 1 salario mínimo, no vivían con parientes. Estos adhirieron al tratamiento de tuberculosis. Conclusión: esos resultados demuestran la importancia de la Intervención Breve realizada por los profesionales de salud, con esa clientela, disminuyendo la incidencia de pacientes bacilífero propensos a la diseminación de la enfermedad.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Psicotrópicos , Tuberculosis Pulmonar/mortalidad , Intervención en la Crisis (Psiquiatría) , Cumplimiento y Adherencia al Tratamiento , Comorbilidad , Estudios Transversales , Factores de Riesgo , Trastornos Relacionados con SustanciasRESUMEN
OBJECTIVE: to describe socio-demographic and clinical characteristics and indicators of tuberculosis (TB) in Brazilian imprisoned population, from 2007 to 2013. METHODS: descriptive study with data from the Information System for Notifiable Diseases (Sinan). RESULTS: from 2007 to 2013, 38,083 TB cases were reported in the imprisoned population, equivalent to a TB prevalence of 1,236 cases/100,000 individuals; this prevalence was higher among women (1,693/100,000), indigenous people (2,874/100,000), and in the age group >60 years (4,093/100,000); there were mainly reports of cases of pulmonary TB (91.5%) and new cases (78.1%); the TB incidence rate in 2013 (904.9/100,000) was higher than 2007 (627.6/100,000), whilst the mortality rate in 2013 (16.0/100,000) was lower than 2007 (18.0/100,000). CONCLUSION: TB in the imprisoned population presents some specific characteristics and higher occurrence than in the general population; the highest prevalence in women and the highest incidence at the end of the study period stood out.
Asunto(s)
Indígenas Sudamericanos/estadística & datos numéricos , Prisioneros , Tuberculosis Pulmonar/epidemiología , Tuberculosis/epidemiología , Adolescente , Adulto , Distribución por Edad , Brasil/epidemiología , Notificación de Enfermedades , Femenino , Humanos , Incidencia , Sistemas de Información , Masculino , Persona de Mediana Edad , Prevalencia , Distribución por Sexo , Tuberculosis/etnología , Tuberculosis/mortalidad , Tuberculosis Pulmonar/etnología , Tuberculosis Pulmonar/mortalidad , Adulto JovenRESUMEN
ABSTRACT Objective: To analyze the impact that the 2009 changes in tuberculosis treatment in Brazil had on the rates of cure, tuberculosis recurrence, mortality, treatment abandonment, and multidrug-resistant tuberculosis (MDR-TB). Methods: An ordinary least squares regression model was used in order to perform an interrupted time series analysis of secondary data collected from the Brazilian Tuberculosis Case Registry Database for the period between January of 2003 and December of 2014. Results: The 2009 changes in tuberculosis treatment in Brazil were found to have no association with reductions in the total number of cases (β = 2.17; 95% CI: −3.80 to 8.14; p = 0.47) and in the number of new cases (β = −0.97; 95% CI: −5.89 to 3.94; p = 0.70), as well as having no association with treatment abandonment rates (β = 0.40; 95% CI: −1.12 to 1.93; p = 0.60). The changes in tuberculosis treatment also showed a trend toward an association with decreased cure rates (β = −4.14; 95% CI: −8.63 to 0.34; p = 0.07), as well as an association with increased mortality from pulmonary tuberculosis (β = 0.77; 95% CI: 0.16 to 1.38; p = 0.01). Although there was a significant increase in MDR-TB before and after the changes (p < 0.0001), there was no association between the intervention (i.e., the changes in tuberculosis treatment) and the increase in MDR-TB cases. Conclusions: The changes in tuberculosis treatment were unable to contain the decrease in cure rates, the increase in treatment abandonment rates, and the increase in MDR-TB rates, being associated with increased mortality from pulmonary tuberculosis during the study period. Keywords: Tuberculosis, pulmonary/epidemiology; Tuberculosis, pulmonary/drug therapy; Tuberculosis, pulmonary/mortality; Interrupted time series analysis; Drug resistance, multiple; Drug compounding.
RESUMO Objetivo: Analisar o impacto das mudanças do tratamento da tuberculose implantadas no Brasil em 2009 no número de casos de cura, de recidiva, de óbitos, de abandono e de tuberculose multirresistente (TBMR). Métodos: Foi realizada uma análise de séries temporais interrompida utilizando o modelo de regressão pelo método dos mínimos quadrados ordinários a partir de dados secundários coletados do Sistema de Informação de Agravos de Notificação da Tuberculose entre janeiro de 2003 e dezembro de 2014. Resultados: A análise mostrou independência entre as mudanças do tratamento e a redução do número total de casos (β = 2,17; IC95%: −3,80 a 8,14; 189 p = 0,47), a redução do número de novos casos (β = −0,97; IC95%: −5,89 a 3,94; p =190 0,70) e do abandono do tratamento (β = 0,40; IC95%: 199 −1,12 a 1,93; p = 0,60). Demonstrou ainda tendência à associação com a diminuição da cura (β = −4,14; IC95%: −8,63 a 0,34; p = 0,07) e associação com aumento da mortalidade por tuberculose pulmonar (β = 0,77; IC95%: 0,16 a 1,38; p = 0,01). A TBMR aumentou significativamente tanto no período anterior quanto no período posterior às mudanças do tratamento (p < 0,0001), embora de forma independente da intervenção (β = 0,13; IC95%: −0,03 a 0,29; p = 0,12). Conclusões: As mudanças no tratamento não impediram nem a diminuição na taxa de cura e nem o aumento do abandono e da TBMR; por outro lado, se associaram ao aumento de óbitos por tuberculose pulmonar durante o período do estudo.
Asunto(s)
Humanos , Tuberculosis Pulmonar/prevención & control , Tuberculosis Resistente a Múltiples Medicamentos/prevención & control , Antituberculosos/uso terapéutico , Tuberculosis Pulmonar/mortalidad , Tuberculosis Pulmonar/tratamiento farmacológico , Brasil/epidemiología , Factores de Riesgo , Tuberculosis Resistente a Múltiples Medicamentos/mortalidad , Tuberculosis Resistente a Múltiples Medicamentos/tratamiento farmacológico , Notificación de Enfermedades , Farmacorresistencia Bacteriana , Análisis de Series de Tiempo Interrumpido , Mycobacterium tuberculosis/efectos de los fármacosRESUMEN
In the care of children and adolescents with tuberculosis (TB), it is necessary to know the difficulties that many families have in accessing health care, obtaining a diagnosis, and receiving a timely treatment. Social workers, along with other members of the health care team, assist in providing access to health care resources and benefits that may favor treatment compliance and strengthen the health of this vulnerable population. Although the purpose of social workers involvement in this disease is to reduce the risk of becoming infected, sick or dying from TB, the current epidemiological situation of this disease in Argentina has faced social workers with the challenge of reconsidering new intervention strategies and revising current objectives. This study addresses their role and proposes actions that may contribute to decreasing TB morbidity and mortality in children and adolescents.
En la asistencia de niños y adolescentes enfermos de tuberculosis, se deben conocer las dificultades que tienen muchas familias para acceder a la atención médica y al diagnóstico y tratamiento oportuno. El trabajador social actúa junto con otros integrantes del equipo de salud, lo que facilita el acceso a los recursos y beneficios asistenciales que pueden favorecer la adherencia al tratamiento y fortalecer la salud de esa población vulnerable. Si bien el propósito que engloba el accionar del trabajador social en esta enfermedad es contribuir a disminuir el riesgo de infectarse, enfermar o morir de tuberculosis, la situación epidemiológica actual de esta patología en Argentina ha puesto al trabajador social frente al desafío de replantearse nuevas estrategias de intervención y revisión de objetivos. El objetivo de este trabajo es plantear su rol y proponer acciones que pueden contribuir a disminuir la morbimortalidad por tuberculosis en niños y adolescentes.
Asunto(s)
Trabajadores Sociales , Tuberculosis Pulmonar/prevención & control , Adolescente , Distribución por Edad , Argentina/epidemiología , Niño , Humanos , Relaciones Profesional-Paciente , Tuberculosis Pulmonar/diagnóstico , Tuberculosis Pulmonar/mortalidad , Tuberculosis Pulmonar/transmisión , Adulto JovenRESUMEN
BACKGROUND: Tuberculosis is the most frequent opportunistic infection and the leading cause of death among persons living with HIV in several low and middle-income countries. Mortality rates during tuberculosis treatment and death causes among HIV-1/TB co-infected patients may differ based on the immunosuppression severity, timing of diagnosis and prompt initiation of tuberculosis and antiretroviral therapy. METHODS: This was a retrospective observational study conducted in the clinical cohort of patients with HIV-1/Aids of the National Institute of Infectious Diseases Evandro Chagas, Rio de Janeiro, Brazil. All HIV-1 infected patients who started combination antiretroviral therapy up to 30 days before or within 180 days after the start of tuberculosis treatment from 2000 to 2010 were eligible. Causes of death were categorized according to the "Coding Causes of Death in HIV" (CoDe) protocol. The Cox model was used to estimate the hazard ratio (HR) of selected mortality variables. RESULTS: A total of 310 patients were included. Sixty-four patients died during the study period. Mortality rate following tuberculosis treatment initiation was 44 per 100 person-years within the first 30 days, 28.1 per 100 person-years within 31 and 90 days, 6 per 100 person-years within 91 and 365 days and 1.6 per 100 person-years after 365 days. Death probability within one year from tuberculosis treatment initiation was approximately 13%. In the adjusted analysis the associated factors with mortality were: CD4 ≤ 50 cells/mm3 (HR: 3.10; 95% CI: 1.720 to 5.580; p = 0.00); mechanical ventilation (HR: 2.81; 95% CI: 1.170 to 6.760; p = 0.02); and disseminated tuberculosis (HR: 3.70; 95% CI: 1.290 to 10.590, p = 0.01). Invasive bacterial disease was the main immediate cause of death (46.9%). CONCLUSION: Our results evidence the high morbidity and mortality among patients co-infected with HIV-1 and tuberculosis in Rio de Janeiro, Brazil. During the first year following tuberculosis diagnosis, mortality was the highest within the first 3 months, being invasive bacterial infection the major cause of death. In order to successfully intervene in this scenario, it is utterly necessary to address the social determinants of health contributing to the inequitable health care access faced by this population.