RESUMO

BACKGROUND: Continuing education of healthcare workers (HCWs) is an essential strategy for the control of tuberculosis (TB) transmission, enabling HCWs in early detection and appropriate treatment of TB cases. METHODS: We developed a distance learning (DL) course on TB for nurses. We conducted a quasi-experimental before and after study to evaluate the DL community at the participant's learning level. In addition, to evaluate the DL community at the level of participant satisfaction, a cross-sectional study was carried out after the course. Nurses involved in active inpatient or outpatient care of patients were recruited to participate in the study. RESULTS: Sixty-six participants started and completed the course and they were included in the analysis. The overall mean pretest and post-test scores were 10.3 ± 2.2 and 11.4 ± 2.7, respectively. Participants increased their knowledge to a statistically significant degree (p < 0.0001). At baseline, the frequency of correct answers was very low in some questions: number of people infected by Mycobacterium tuberculosis in the world (10.6%); number of TB cases in Brazil (36.4%); contagiousness of latent TB infection (LTBI) (28.8%); and definition of active case finding (45.5%). Course feedback was mostly positive, with majority of users saying they were satisfied or totally satisfied. CONCLUSIONS: A brief DL course on TB was associated with some improvement in knowledge among nurses. The baseline knowledge was low regarding TB epidemiologic data, concepts on LTBI, and active case finding. This finding emphasizes the need to further improve the competencies and knowledge of nurses.

Assuntos

RESUMO

INTRODUCTION: Smear-negative pulmonary TB (SNPT) represents 30-60% of all pulmonary TB cases. The mortality of these patients can reach 25% in populations with high prevalence of HIV infection, and 10-20% of TB transmission at the population level are attributable to SNPT cases. METHODS: We conducted a retrospective study to evaluate epidemiological, clinical, and radiological characteristics of patients with SNPT and to compare these with patients who were diagnosed as having smear-positive pulmonary TB (SPPT). All adult patients (≥ 18 years old) with a positive culture for Mycobacterium tuberculosis, and a diagnosis of pulmonary TB were included in the study. RESULTS: 198 patients met the inclusion criteria (positive culture for Mycobacterium tuberculosis) and were included in the analysis. Of these patients, 69 (34.8%) were smear positive (SPPT) and 129 (65.2%) were smear negative (SNPT). In univariate analysis, cough, dyspnea, and hemoptysis were less frequent in SNPT patients in comparison with SPPT patients. In a multivariate model, having no cough and no radiographic pattern typical of TB were the characteristics independently associated with a diagnosis of SNPT. CONCLUSIONS: We found a very high prevalence of SNPT among patients with TB in a setting with high TB and HIV prevalence. The absence of cough in the presence of other symptoms suggestive of TB, and having no radiographic pattern typical of TB where independent predictors of SNPT.

Assuntos

RESUMO

As infecções do trato urinário (ITU) estão entre as infecções mais comuns na clínica médica e respondem a uma " grande parte dos processos infecciosos, comuniáarios e hospitalares. São caracterizadas pela invasão e multiplicação de microrganismos nas vias urinárias, habitualmente, bactérias. Este trabalho teve como objetivo investigar as ITU no municipio de Patos de Minas, em usuários do Sistema Único de Saúde (SUS), no período de agosto de 2008 a abril de 2009, através de exames realizados no Laboratório Universitário de Análises Clínicas e Toxicológicas do Centro Universitário de Patos de Minas- UNIPAM, ressaltando a idade, sexo e a prevalência dos microrganismos envolvidos e a observação da resistência/sensibilidade dos microrganismos encontrados aos antimicrobianos, Ampicilina, Ciprofloxacina, Norfloxacina, Nitrofurantoina e Sulfametoxazol-Trimetoprima. Dos 1.245 resultados de urocultura analisados, 201 (16,14%) apresentaram resultados positivos para ITU, sendo que 13,89% (173) foram do sexo feminino. A prevalência poridade se apresentou, de 20 a 39 anos com 5,4% (65), seguido pela faixa etária de 40 a 59, com 5,1% (63). Das uroculturas positivas, a prevalência foi maior para as bactérias Gram negativas (BGN), 89% (179), sendo a E. coli, presente em 66% (133) das amostras positivas. Ao analisar o perfil de sensibilidade, a Ampicilina apresentou-se sensível (S) em 43% (86) e 53% (113) resistente; a Sulfa/trimetoprima S= 61% (122) e R=38% (76); Nitrofurantoina S=77% (154) e R=21% (43); Norfloxacina S=71% (142) e R=28% (56); eo Ciprofloxacina S=75% (150), e R=24% (49). Assim conclui-se que o uso indiscriminado de antimicrobianos acaba levando a resistência.

The urinary tract infections (ITU) is an extremely common condition that occurs in all ages, from newborns to the elderly. Accordingly, this work aims to investigate the ITU in the city of Patos de Minas, in users of the Sistema Onico de Saude (SUS), from August 2008 to April 2009 in tests Laboratório Universitário de Análises Clínicas, emphasizing the age, sex and prevalence of the microorganisms involved and the observation of resistance I sensitivity to antibiotics of microorganisms found Ampicillin, Ciprofloxacin, norfloxacin, nitrofurantoin and trimethoprim-sulfamethoxazole . The 1245 results of urine culture tested, 201 (16.14%) showed positive results for ITU, with 13.89% (173) were female. The prevalence by age is presented from 20 to 39 years with 5.4% (65), followed by the age of 40 to 59, with 5.1% (63). By analyzing the profile of sensitivity, is presented Ampicillin sensitive (S) in 43% (86), 1% intermediate (/) and 53% (113) resistant; to SulfaI trimethoprim S = 61% (122), I= 1% (3) and R = 38% (76); Nitrofurantoin S = 77% (154), I= 2% (4) and R = 21% (43); Norfloxacin S= 71% (142), I= 1% (3)andR=28% (56), andCiprofloxacinS= 75% (150), I= 1% (2) andR=24% (49). Thus it is concluded that the indiscriminate use of antibiotics has led to resistance.

Assuntos

RESUMO

A síndrome da bexiga hiperativa é freqüente e pode acometer pacientes em diferentes faixas etárias. Incide mais entre mulheres a partir da quinta década de vida. Possui grande impacto negativo na qualidade de vida. Os anticolinérgicos administrados pela via oral são medicações de primeira escolha para o seu tratamento. Este relato apresenta um caso de bexiga hiperativa refratária ao uso dos anticolinérgicos que respondeu ao tratamento com a toxina botulínica A intra-vesical.

Assuntos