ABSTRACT
O abandono do tratamento de tuberculose é uma questão relevante e preocu- pante na saúde pública mundial. Mediante uma revisão integrativa, esse estudo busca identificar os possíveis fatores que levam ao abandono do tratamento. Foi realizada pes- quisa em estudos indexados nas bases de dados: Biblioteca Virtual em Saúde (BVS) e Scientific Eletronic Library Online (SciELO), no período de 2017 a 2021, utilizando-se os seguintes descritores (DeCS): tuberculose, agente antituberculose e tuberculose pul- monar. Ao fim, foram selecionados onze estudos, publicados nos idiomas português, es- panhol e inglês. Os resultados mostraram que o abandono está relacionado a fatores de diversas esferas, com destaque para as esferas social, da saúde e a do próprio tratamento. Como perfil das pessoas dos casos de abandono, em geral, observou-se que elas são eco- nomicamente ativas, com faixa etária entre 15 e 49 anos, possuem baixa escolaridade, baixa renda e é comum que os usos abusivos de álcool e drogas sejam apresentados como comorbidades relevantes. Portanto, o trabalho evidenciou os principais fatores associados ao abandono do tratamento de tuberculose e a importância da participação de diferentes atores como forças que somarão para diminuir a ocorrência do problema em questão.
Treatment abandonment for tuberculosis is a relevant and pressing public health issue worldwide. Through an integrative review, this study seeks to identify pos- sible factors leading to treatment abandonment. We searched studies indexed in the fol- lowing databases: Virtual Health Library (VHL) and Scientific Electronic Library Online (SciELO), from 2017 to 2021, using the following descriptors (DeCS): tuberculosis, antituberculosis agent and pulmonary tuberculosis. In the end, eleven studies were selec- ted, published in Portuguese, Spanish and English languages. The results showed that the abandonment is related to factors of several spheres, especially the social, health and tre- atment spheres. As a profile of the people in the abandonment cases, in general, it was observed that they are economically active, between 15 and 49 years old, have low edu- cation, low income, and it is common that the abuse of alcohol and drugs are presented as relevant comorbidities. Therefore, the work showed the main factors associated with the abandonment of tuberculosis treatment and the importance of the participation of dif- ferent actors as forces that will add up to reduce the occurrence of the problem in question. KEY WORDS: Tuberculosis; Antituberculosis Agent; Pulmonary Tuberculosis.
El abandono del tratamiento de la tuberculosis es una cuestión relevante y acuciante en la salud pública mundial. Mediante una revisión integradora, este estudio pretende identificar los posibles factores que conducen al abandono del tratamiento. Se buscaron estudios indexados en las siguientes bases de datos: Virtual Health Library (BVS) y Scientific Electronic Library Online (SciELO), desde 2017 hasta 2021, utili- zando los siguientes descriptores (DeCS): tuberculosis, agente antituberculoso y tubercu- losis pulmonar. Al final, se seleccionaron once estudios publicados en portugués, español e inglés. Los resultados mostraron que el abandono está relacionado con factores de di- versas esferas, especialmente la social, sanitaria y de tratamiento. Como perfil de las per- sonas en casos de abandono, en general, se observó que son económicamente activas, tienen entre 15 y 49 años, baja escolaridad, baja renta y es común que el abuso de alcohol y drogas se presenten como comorbilidades relevantes. Por lo tanto, el trabajo mostró los principales factores asociados al abandono del tratamiento de la tuberculosis y la impor- tancia de la participación de diferentes actores como fuerzas que sumarán para reducir la ocurrencia del problema en cuestión.
ABSTRACT
Objetivo: describir la incidencia de tuberculosis urogenital (TBUG) en los dos centros de referencia diagnóstica del sistema de salud público del departamento de Cochabamba. Métodos: estudio transversal retrospectivo desde enero de 2013 a marzo de 2020; población de estudio: pacientes con sospecha de TBUG con solicitud de cultivo para BK. Recolección de datos: base de datos de los laboratorios y revisión de los expedientes clínicos. Resultados: se identificó a 2266 pacientes con sospecha clínica de TBUG a los que se les realizó cultivos de orina para TB; de los cuales 133 (5,87%) pacientes resultaron con cultivo positivo: 87 de sexo masculino (65,4%) y 46 de sexo femenino (34,6%); De estos, 115 pacientes no cuentan con un seguimiento completo clínico ni microbiológico, de los cuales el 83,3% tenía TB renal, 11,1% genital y 5,6% vesical; el 77,8 % presentaron síntomas del tracto urinario inferior, 33,3 % tenía algún tipo de comorbilidad y 1 requirió cirugía urológica. El tratamiento antituberculoso fue el estándar en el 100%, 1 presentó reacción adversa, pero ninguna resistencia ni defunciones asociadas al tratamiento. Discusión: la incidencia del 5,87% no es despreciable, debido a que se requiere un alto índice de sospecha y contar con el cultivo para el diagnóstico, seguimiento y finalización de la terapia y de este modo disminuir el daño irreversible que afectan la funcionalidad.
Objective: to determine the incidence of urogenital tuberculosis (UGTB) in the 2 diagnostic reference centers of Cochabamba. Methods: retrospective cross-sectional study from January 2013 to March 2020; Study population: patients with suspected UGTB with culture request for BK. Data collection: Laboratory database and review of clinical records. Results: 2266 patients with clinical suspicion of UGTB who had urine cultures for TB were identified; of which 133 (5.87%) patients were culture positive: 87 male (65.4%) and 46 female (34.6%); Of these, 115 patients do not have complete follow-up and only 18 patients were evaluated, of which 83.3% had renal TB, 11.1% genital and 5.6% bladder; 77.8% had lower urinary tract symptoms, 33.3% had some type of comorbidity and 1 required urological surgery. Antituberculosis treatment was standard in 100%, 1 presented adverse reaction, but no resistance or deaths associated with the treatment. Discussion: the incidence of 5.87% is not negligible, due to the fact that a high index of suspicion is required and to have the culture for diagnosis, follow-up and termination of therapy and thus reduce irreversible damage affecting functionality.
Subject(s)
UrologyABSTRACT
Se presentó el caso de un paciente del sexo masculino de 40 años, de procedencia rural, con antecedentes patológicos de bronquiectasias y de un derrame pleural que curó espontáneamente. El mismo presentó manifestaciones compatibles con tuberculosis intestinal que debutó con tumoración en fosa iliaca derecha, fiebre y dolor abdominal. Se valoró el caso en el colectivo de Neumología, donde teniendo en cuenta la evolución clínica y resultado de los exámenes complementarios realizados, se decidió iniciar tratamiento específico antituberculoso con el diagnóstico de tuberculosis intestinal. Después de estos estudios, evolucionó favorablemente con el tratamiento protocolizado(AU)
It is presented the case of a male patient of 40 years, of rural origin, with a pathological history of bronchiectasis and a pleural effusion that cured spontaneously. The patient presented symptoms compatible with intestinal tuberculosis that began with a tumor in the right iliac fossa, fever and abdominal pain. The case was assessed in the Pneumology group, where taking into account the clinical evolution and the result of the complementary examinations, it was decided to initiate specific antituberculous treatment with the diagnosis of intestinal tuberculosis. After these studies, patient, s evolution was good with the protocolized treatment(AU)
Subject(s)
Humans , Male , Adult , Tuberculosis, Gastrointestinal/diagnosis , Tuberculosis, Gastrointestinal/therapyABSTRACT
Se denomina efecto adverso a fármacos antituberculosos (RAFAs), a una respuesta nociva y no deseada de uno o varios de los fármacos utilizados, para profilaxis, diagnostico o tratamiento de la enfermedad tuberculosa. Para adjudicarlos a la medicación se debe tener en cuenta que las dosis sean adecuadas, descartar interacciones medicamentosas y comorbilidades. Es necesario conocerlos y monitorizarlos, para evitar posibles riesgos de morbi-mortalidad. Objetivo: comunicar el caso de 4 hermanos que presentaron RAFAs, a más de 1 fármaco antituberculoso.
It is called tuberculous adverse drug effect (RAFAs), to a noxious response and not desired to one or more of the drugs used for prophylaxis, diagnosis or treatment of tuberculous disease. To attribute them to the medication, it is necessary to take into account that doses should be normal; also dismiss drug interactions and co-morbidities. It is necessary to know them and monitor them, to avoid possible risks of morbidity and mortality. Objective: to communicate the case of four brothers who presented RAFAs, to more than one TB drug.
Subject(s)
Tuberculosis , Blood Platelet Disorders , HepatitisABSTRACT
Objective: To develop a LC-MS/MS method for the quantification of TBI-166, a novel antituberculotic, in beagle dog plasma, and apply it to the pharmacokinetic and bioavailability study. Methods: The preparation of plasma sample was a simple deproteinization by the addition of acetonitrile followed by centrifugation. The separation was performed on a Symmetry C8 column (2.1 mm × 50 mm,3.5μm) with mobile phase of acetonitrile/water containing 0.1% formic acid (V/V) using a gradient elution mode at a flow rate of 0.2 ml/min. The detection was performed in positive selected reaction monitoring(SRM) mode with an electrospray ionization source. The analytes were quantified at m/z 590→478 for TBI-166 and m/z 260→183 for propranolol (internal standard,IS). Results: Linear detection responses were obtained for TBI-166 in dog plasma ranging from 2 to 1000 ng/ml. The intra- and inter-day precisions (RSD%) were no more than 10%. The average recovery was greater than 98.6%, and there was good stability and no obvious matrix effect for the quantification. The method was successfully applied in the pharmacokinetic study of TBI-166 in beagle dogs. The AUC(0-t), Cmax and Tmax of TBI-166 in male and female dogs were(897.2±318.6) and (2615.1±1524.4) h·μg/L, (65.4±2.3) and (122.0±34.6) ng/ml and (1.4±0.5) and (4.4±3.5) h after oral administration at 3 mg/kg. The t1/2z, AUC(0-t), and CL of TBI-166 in male and female dogs were (69.6±35.3) and (112.9±25.3) h, (1798.0±729.2) and (3222.4±1656.2) h·μg/L,(0.2±0.1) and (0.3±0.1) L/(h·kg) after intravenous administration at 0.5 mg/kg. Conclusion: An accurate, simple and sensitive LC-MS/MS method for the determination of TBI-166 in beagle dog plasma was developed and validated. This method was applied to the pharmacokinetic study of TBI-166 in beagle dogs. There was a gender difference on the pharmacokinetic profiles of TBI-166 in dogs. TBI-166 was eliminated slowly and the bioavailability of TBI-166 was 8.3-13.5% in male and female dogs.
ABSTRACT
Tuberculosis is an important public health problem. It is estimated that around 5-10% of patients with tuberculosis present with central nervous system involvement; meningitis and tuberculoma being two of the most frequent manifestations. The paradoxical reaction in patients undergoing antituberculosis treatment is infrequent, nevertheless it is an important consideration in patients, who after an appropriate initial response to specific treatment, present with worsening clinical and radiological signs or the appearance of new lesions.
La tuberculosis (TBC) es un problema de importancia en salud pública. Se estima que alrededor de 5 a 10% de los pacientes con TBC presentan compromiso de sistema nervioso central, siendo la meningitis y el tuberculoma las manifestaciones más frecuentes. La reacción paradojal en pacientes con tratamiento antituberculoso es infrecuente, sin embargo, es importante considerarla en pacientes que durante la terapia, luego de una respuesta inicial apropiada, presentan un empeoramiento clínico y/o radiológico o aparición de nuevas lesiones.
Subject(s)
Adolescent , Female , Humans , Antitubercular Agents/adverse effects , Tuberculosis, Meningeal/drug therapy , Tuberculosis, Pulmonary/drug therapy , Adrenal Cortex Hormones/therapeutic use , Antitubercular Agents/therapeutic use , Immunocompetence , Magnetic Resonance Imaging , Tuberculoma, Intracranial/drug therapy , Tuberculosis, Meningeal/diagnosis , Tuberculosis, Pulmonary/diagnosisABSTRACT
Se describe el caso clínico de una paciente mozambicana de 60 años, con antecedentes de infección por virus de la inmunodeficiencia humana y sacrolumbalgia, quien ingresó en el Servicio de Medicina del Hospital Central de Beira por presentar dolor en la columna dorsal, deformidad ósea avanzada, fiebre, astenia, anorexia, pérdida de peso, malestar general y disminución de la fuerza muscular en miembros inferiores desde hacía 2 meses. Los exámenes imagenológicos efectuados confirmaron el diagnóstico de tuberculosis vertebral. Se indicó tratamiento antituberculoso y fue trasladada al Servicio de Neurocirugía para corrección quirúrgica de la mencionada deformidad.
The case report of a 60 year-old woman from Mozambique, with a history of infection due to the human immunodeficiency virus and back low pain who was admitted to the Medicine Service from Beira Central Hospital for presenting with pain in the dorsal spine, advanced bony deformity, fever, asthenia, anorexia, weight loss, general discomfort and decrease of the muscles strength in lower limbs for 2 months is described. Image tests confirmed the diagnosis of vertebral tuberculosis. Antituberculous treatment was indicated and she was referred to the Neurosurgery Service for surgical correction of the mentioned deformity.
Subject(s)
Humans , Male , Aged , Acquired Immunodeficiency Syndrome , HIV , Low Back Pain , Lumbosacral Region/pathology , Tuberculosis, SpinalABSTRACT
El fenómeno de la toxicidad hepática inducida por medicamentos cobró relevancia hace algunos años con el estudio de las reacciones adversas a medicamentos. El daño producido en el hígado por un xenobiótico que altera su función es lo que se conoce como toxicidad hepática. La importancia de reconocer y diagnosticar la toxicidad hepática por medicamentos estriba en su gravedad potencial; no en vano es la causa más frecuente por la que la industria farmacéutica retira medicamentos. La tuberculosis es una pandemia que afecta a gran parte de la población mundial y junto con el VIH es una enfermedad cada vez más frecuente en Colombia. Esta enfermedad se puede considerar como una situación especial porque para su tratamiento es preciso suministrar, por largos períodos, medicamentos con potencial tóxico para el hígado.El objetivo de este artículo es revisar algunos aspectos relacionados con la toxicidad hepática secundaria a medicamentos antituberculosos, tales como: epidemiología, factores de riesgo, mecanismos de toxicidad, manifestaciones clínicas, diagnóstico, tratamiento y seguimiento.
Hepatotoxicity is the alteration of liver structure and function induced by either drugs or other substances. The importance of its proper diagnosisrests on its potential severity. It is the most frequent reason by which the pharmaceutical industry withdraws its products. Tuberculosis is a pandemicinfection affecting a large proportion of the world population. Together with HIV infection it is becoming ever more frequent in Colombia. Tuberculosisposes a special challenge because itstreatment requires the administration, during long periods, of drugs with the potential of inducing liver injury. In this article some aspects of hepatotoxicity induced by antituberculosis drugs are reviewed, namely: epidemiology, risk factors, mechanisms, clinical manifestations, diagnosis, treatment and follow-up.