RESUMO
BACKGROUND: Although there are theoretical reasons for believing that asthma and atopy may be negatively correlated with tuberculosis, epidemiological studies have had conflicting findings. OBJECTIVE: To determine if people with confirmed tuberculosis were less likely to be atopic and less likely to have atopic disease including asthma compared to those with no previous tuberculosis. METHODS: Patients in Lima, Peru with a prior history of tuberculosis were identified from clinic records in this cohort study. A representative sample of individuals without a prior tuberculosis diagnosis was recruited from the same community. Allergen skin prick testing was performed to classify atopic status. Allergic rhinitis was identified by history. Asthma was defined by symptoms and spirometry. Eosinophilic airway inflammation was measured using exhaled nitric oxide levels. RESULTS: We evaluated 177 patients with, and 161 individuals without, previous tuberculosis. There was a lower prevalence of atopy among people with prior tuberculosis on univariate analysis (odds ratio 0.57; 95% confidence interval 0.37-0.88) but, after adjustment for potential confounders, this was no longer statistically significant (aOR 0.64, 95% CI 0.41-1.01). The prevalence of allergic rhinitis (aOR 0.76, 95% CI 0.47 to 1.24 and asthma (aOR 1.18, 95% CI 0.69 to 2.00) did not differ significantly between the two groups. We also found no significant difference in the prevalence of elevated exhaled nitric oxide (aOR 1.30, 95% CI 0.78 to 2.17) or a combined index of atopic disease (aOR 0.86, 95% CI 0.54 to 1.36). CONCLUSION: In this urban environment in a middle-income country, prior tuberculosis may be associated with a reduced risk of atopy but does not protect against asthma and atopic disease.
Assuntos
Asma/epidemiologia , Hipersensibilidade Imediata/epidemiologia , Rinite Alérgica/epidemiologia , Tuberculose/epidemiologia , Adulto , Estudos de Coortes , Estudos Transversais , Feminino , Humanos , Modelos Logísticos , Masculino , Análise Multivariada , Peru/epidemiologia , Prevalência , Testes Cutâneos , Espirometria , Adulto JovemRESUMO
BACKGROUND: Globally, >30 000 children fall sick with multidrug-resistant (MDR) tuberculosis every year. Without robust pediatric data, clinical management follows international guidelines that are based on studies in adults and expert opinion. We aimed to identify baseline predictors of death, treatment failure, and loss to follow-up among children with MDR tuberculosis disease treated with regimens tailored to their drug susceptibility test (DST) result or to the DST result of a source case. METHODS: This retrospective cohort study included all children ≤15 years old with confirmed and probable MDR tuberculosis disease who began tailored regimens in Lima, Peru, between 2005 and 2009. Using logistic regression, we examined associations between baseline patient and treatment characteristics and (1) death or treatment failure and (2) loss to follow-up. RESULTS: Two hundred eleven of 232 (90.9%) children had known treatment outcomes, of whom 163 (77.2%) achieved cure or probable cure, 29 (13.7%) were lost to follow-up, 10 (4.7%) experienced treatment failure, and 9 (4.3%) died. Independent baseline predictors of death or treatment failure were the presence of severe disease (adjusted odds ratio [aOR], 4.96; 95% confidence interval [CI], 1.61-15.26) and z score ≤-1 (aOR, 3.39; 95% CI, 1.20-9.54). We did not identify any independent predictors of loss to follow-up. CONCLUSIONS: High cure rates can be achieved in children with MDR tuberculosis using tailored regimens containing second-line drugs. However, children faced significantly higher risk of death or treatment failure if they had severe disease or were underweight. These findings highlight the need for early interventions that can improve treatment outcomes for children with MDR tuberculosis.
Assuntos
Antituberculosos/uso terapêutico , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Adolescente , Fatores Etários , Antituberculosos/farmacologia , Criança , Pré-Escolar , Feminino , Genótipo , Humanos , Lactente , Recém-Nascido , Perda de Seguimento , Masculino , Testes de Sensibilidade Microbiana , Mycobacterium tuberculosis/efeitos dos fármacos , Mycobacterium tuberculosis/genética , Peru , Prognóstico , Estudos Retrospectivos , Índice de Gravidade de Doença , Falha de Tratamento , Resultado do Tratamento , Tuberculose Resistente a Múltiplos Medicamentos/diagnóstico , Tuberculose Resistente a Múltiplos Medicamentos/microbiologia , Tuberculose Resistente a Múltiplos Medicamentos/mortalidadeRESUMO
Para recolectar la información se realizaron 100 visitas domiciliarias; se aplicaron 2 instrumentos para c/u, (calidad de atención y apgar familiar); para la tabulación, se utilizaron tablas de contingencia; la información se presento a razón de disparidad, determinando la fuerza de asociación entre los factores de riesgo estudiados, de acuerdo con las hipótesis planteadas. Se pudo determinar que la insatisfacción de los usuarios para la calidad de los servicios ofertados por el H.M.R.S. es un factor predisponente para inasistencia a los controles por consulta externa. Se identificó que no hay evidencia estadísticamente, que el presentar insatisfacción, representa un factor asociado para la inasistencia a tratamiento por consulta externa. Para la funcionalidad familiar, se demostró que el 96.7% de cada 100 casos presentan disfuncionalidad familiar, y un 89.7% de cada 100 controles también presentan disfunción familiar, demostrando que esta variable es una característica principal de los pacientes mentales en general. Para concluir, la calidad de atención como la funcionalidad familiar, representan un factor predisponente a presentar inasistencia, pero no son la principal causa por la cual los usuarios del Hospital Mental Rudesindo Soto ( HMRS) no acuden a los controles programados por consulta externa de acuerdo a lo investigado.
For the harvesting of the information 100 domiciliary visits were realised; 2 instruments for c/u were applied, (quality of attention and to apgar familiar); for the tabulation, contingency tables were used, and the information I appear at the rate of disparity, determining the force of association between the studied factors of risk, in agreement with the raised hypotheses. With the investigation it was possible to be determined that the dissatisfaction of the users for the quality of the services supplied by the H.M.R.S is a factor prearranger for inasistencia to the controls by external consultation. I identify myself that there is no evidence statistically, that presenting/displaying dissatisfaction, represents a factor associated for the inasistencia treatment by external consultation. For the familiar functionality, one demonstrated that the 96,7% of each 100 cases present/display familiar disfunctionality, and 89,7% of each 100 controls also present/display familiar dysfunction, demonstrating that this variable is a basic characteristics of the mental patients generally. In order to conclude, the quality of attention like the familiar functionality, represents a factor prearranger to present/display inasistencia, but they are not the main cause by which the users of the HMRS do not go to the controls.
Assuntos
Qualidade da Assistência à Saúde , Pessoas Mentalmente Doentes , Cooperação e Adesão ao TratamentoRESUMO
Se revisaron las historias de 107 niños con infección respiratoria aguda (IRA) baja que tenían una IgM positiva para Mycoplasma pneumoniae. La edad más afectada fue la de 2 a 6 años (58 por ciento). El tiempo de evolución antes de la consulta fue de 1 a 180 días, con un promedio de 10.7 días. El motivo de consulta más frecuente fue tos (95.3 por ciento), tos prolongada en el 22.45 por ciento, seguida de fiebre (73.5 por ciento), expectoración y rinitis (32.7 por ciento) respectivamente. Al examen se encontró: Sibilancias (67.3 por ciento), estertores crepitantes (30.8 por ciento) fiebre (37 por ciento), faringitis (15.9 por ciento), otitis (13.1 por ciento) y sinusitis (12 por ciento). El hallazgo radiológico más frecuente fue atrapamiento de aire (21.8 por ciento) derrame pleural abacteriano. La proteína C reactiva fue de < 4 mg por ciento en el 70.8 por ciento. El tratamiento fue a base de macrólidos, principalmente claritromicina (72-6 por ciento), broncodilatadores (40 por ciento) y estos asociados a esteroides en el 25.8 por ciento de los casos