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1.
Rev. gaúch. enferm ; 40: e20190050, 2019. tab
Article in English | LILACS (Americas) | ID: biblio-1043028

ABSTRACT

Abstract Objective: analyzing the aspects associated with case outcomes and the international border situation when it comes to patients with tuberculosis (TB) associated with comorbidities. Method: exploratory descriptive epidemiological study, analyzing all new cases of TB with comorbidities reported in 2013 on SISNAN in the cities at the border of the state of Paraná and Paraguay. The variables used were: sociodemographic, clinical and operational. To analyze the data, descriptive analysis and the chi-square test were applied. Results: 227 cases of tuberculosis associated with comorbidities were reported and 70.9% were from cities bordering Paraguay. Alcoholism (22.0%) and AIDS (13.7%) were the most common comorbidities. The chi-square test presented a statistical association of border cities with negative outcomes and not performing directly observed treatments. Conclusion: Through the study, it was possible to find that the location of border cities can be determinant for a negative outcome.


Resumen Objetivo: Analizar los aspectos asociados al cierre del caso y a la situación de frontera internacional entre enfermos de tuberculosis con comorbilidad. Método: Estudios epidemiológico, descriptivo exploratorio, analizando todos los casos nuevos de TB con comorbilidad notificados en el año 2013 en SISNAN en municipio de frontera del Estado de Paraná con Paraguay. Las variables utilizadas fueron: sociodermográficas, clínicas y operacionales. Para analizar los datos se aplicó análisis descriptiva y el test qui-cuadrado. Resultados: De los 227 casos de tuberculosis con comorbilidades, el 70,9% eran de municipios que hacían frontera con Paraguay. El alcoholismo (22,0%) y el sida (13,7%) fueron las comorbilidades más frecuentes. La prueba que qui-cuadrado presentó asociación estadística para los municipios de frontera con desenlace desfavorable y que no realizan el tratamiento directamente observado. Conclusión: Por el estudio, es posible identificar que la localización de los municipios de frontera puede ser determinante para un desempeño desfavorable.


Resumo Objetivo Analisar os aspectos associados ao desfecho do caso e à situação de fronteira internacional entre doentes de tuberculose com comorbidades. Método: Estudo epidemiológico, descritivo exploratório, analisando todos os casos novos de Tuberculose com comorbidades notificados no ano 2013 no Sistema de Informação de Agravos de Notificação em municípios de fronteira do estado do Paraná com o Paraguai. As variáveis utilizadas foram: sociodemográficas, clínicas e operacionais. Para analisar os dados aplicou-se análise descritiva e o teste qui-quadrado. Resultados: Dos 227 casos de tuberculose com comorbidades, 70,9% eram de municípios que faziam fronteira com o Paraguai. O alcoolismo (22,0%) e a aids (13,7%) foram as comorbidades mais frequentes. O teste que qui-quadrado apresentou associação estatística para os municípios de fronteira com desfecho desfavorável e que não realizam o tratamento diretamente observado. Conclusão Pelo estudo, é possível identificar que a localização dos municípios de fronteira pode ser determinante para um desempenho desfavorável.


Subject(s)
Humans , Male , Pregnancy , Adult , Young Adult , Tuberculosis/complications , Tuberculosis/drug therapy , Paraguay , Brazil , Epidemiologic Studies , Urban Health , Treatment Outcome , Internationality , Middle Aged
2.
Rev. argent. coloproctología ; 29(1): 25-27, Sept. 2018. ilus
Article in Spanish | LILACS (Americas) | ID: biblio-1015245

ABSTRACT

La tuberculosis (TBC) es una enfermedad infecciosa crónica, granulomatosa, transmisible, producida por el microorganismo Mycobacterium tuberculosis o bacilo de Koch. Puede presentarse como enfermedad pulmonar, extrapulmonar o ambas. La presentación extrapulmonar, es rara, representando aproximadamente el 11% de todos los casos. El objetivo del presente trabajo es comunicar un caso clínico de tuberculosis de localización extrapulmonarr infrecuente: la región perianal. (AU)


Tuberculosis (TB) is a chronic infectious, granulomatous, transmissible disease produced by the Mycobacterium tuberculosis microorganism or Koch's bacillus.It can present as lung disease, extrapulmonary disease or both.Extrapulmonary presentation is rare, representing approximately 11% of all cases. The objective of the present work is to report a clinical case of tuberculosis of uncommon extrapulmonary location: the perianal region. (AU)


Subject(s)
Humans , Male , Aged , Anus Diseases/diagnosis , Tuberculosis/diagnosis , Tuberculosis/drug therapy , Diagnosis, Differential , Anal Canal/pathology , von Willebrand Diseases , Rectal Fistula/etiology , Colectomy , Treatment Adherence and Compliance , Mycobacterium tuberculosis/isolation & purification , Antitubercular Agents/therapeutic use
4.
J. bras. pneumol ; 44(2): 112-117, Mar.-Apr. 2018. tab, graf
Article in English | LILACS (Americas) | ID: biblio-893903

ABSTRACT

ABSTRACT Objective: To evaluate the impact of the use of the molecular test for Mycobacterium tuberculosis and its resistance to rifampin (Xpert MTB/RIF), under routine conditions, at a referral hospital in the Brazilian state of Bahia. Methods: This was a descriptive study using the database of the Mycobacteriology Laboratory of the Octávio Mangabeira Specialized Hospital, in the city of Salvador, and georeferencing software. We evaluated 3,877 sputum samples collected from symptomatic respiratory patients, under routine conditions, between June of 2014 and March of 2015. All of the samples were submitted to sputum smear microscopy and the Xpert MTB/RIF test. Patients were stratified by gender, age, and geolocation. Results: Among the 3,877 sputum samples evaluated, the Xpert MTB/RIF test detected M. tuberculosis in 678 (17.5%), of which 60 (8.8%) showed resistance to rifampin. The Xpert MTB/RIF test detected M. tuberculosis in 254 patients who tested negative for sputum smear microscopy, thus increasing the diagnostic power by 59.9%. Conclusions: The use of the Xpert MTB/RIF test, under routine conditions, significantly increased the detection of cases of tuberculosis among sputum smear-negative patients.


RESUMO Objetivo: Avaliar o impacto do teste rápido molecular automatizado Xpert MTB/RIF, utilizado para a detecção de Mycobacterium tuberculosis e sua resistência à rifampicina, em condições de rotina, em um hospital de referência no estado da Bahia. Métodos: Estudo descritivo retrospectivo utilizando o banco de dados do Laboratório de Micobacteriologia do Hospital Especializado Octávio Mangabeira, localizado na cidade de Salvador, e um programa de georreferenciamento. Entre junho de 2014 e março de 2015, foram incluídas no estudo 3.877 amostras de escarro coletadas de pacientes sintomáticos respiratórios em condições de rotina. Todas as amostras coletadas foram submetidas tanto à baciloscopia quanto a Xpert MTB/RIF. Os pacientes foram estratificados por sexo, idade e georreferenciamento. Resultados: Das 3.877 amostras de escarro analisadas, Xpert MTB/RIF detectou a presença de M. tuberculosis em 678 pacientes (17,5%). Desses, 60 (8,8%) apresentaram resistência à rifampicina. O Xpert MTB/RIF detectou 254 pacientes com baciloscopia negativa, representando um acréscimo diagnóstico de 59,9%. Conclusões: A implantação do Xpert MTB/RIF, sob condições de rotina, teve um impacto significativo no aumento da detecção de casos de tuberculose em pacientes com baciloscopia negativa.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Sputum/microbiology , Tuberculosis/diagnosis , Molecular Diagnostic Techniques/methods , Diagnostic Tests, Routine/methods , Mycobacterium tuberculosis/isolation & purification , Reference Values , Rifampin/therapeutic use , Tuberculosis/microbiology , Tuberculosis/drug therapy , Brazil , Reproducibility of Results , Retrospective Studies , Sensitivity and Specificity , Treatment Outcome , Drug Resistance, Bacterial/drug effects , Tertiary Care Centers , Microscopy/methods , Antibiotics, Antitubercular/therapeutic use , Mycobacterium tuberculosis/drug effects
5.
Rev. chil. enferm. respir ; 34(1): 62-69, 2018.
Article in Spanish | LILACS (Americas) | ID: biblio-959409

ABSTRACT

Resumen Para el control epidemiológico de la tuberculosis (TBC) se requiere de una terapia de alta eficacia, que logre eliminar la trasmisión mediante la curación de los pacientes. Las reacciones adversas a fármacos (RAM) contribuyen a una menor eficiencia del tratamiento. La RAM hepática es la más temida y puede llegar a ser mortal. Esta se ha relacionado a factores de riesgo como la edad avanzada, el género femenino, ciertas razas, características del metabolismo enzimático de los fármacos, asociación de fármacos, presencia de infecciones por virus de hepatitis B, C y VIH, desnutrición, trasplantados renales, embarazo, puerperio y consumo de alcohol. No existen pautas de monitoreo de la función hepática en forma regular, por lo que se recomienda la vigilancia estrecha de la aparición de síntomas sugerentes de toxicidad hepática. En algunas condiciones de alto riesgo de RAM hepática el juicio clínico podría determinar el monitoreo bioquímico de la función hepática.


Epidemiological control of tuberculosis (TB) requires a highly efficient therapy, to be able to eliminate transmission of tuberculosis. Adverse drug reactions (ADR) contribute to decrease the efficiency of treatment. Hepatic ADR is the most feared and can become fatal and has been related to risk factors such as advanced age, female gender, non-caucasian ethnic groups, characteristics of enzymatic metabolism of drugs, drug associations, presence of hepatitis B, C and HIV virus infections, malnutrition, kidney transplants, pregnancy, puerperium and alcohol consumption. There are no guidelines for monitoring liver function on a regular basis. Therefore a close monitoring of the appearance of symptoms suggestive of liver toxicity is recommended. In some conditions of high risk of hepatic ADR, clinical judgment could indicate the biochemical monitoring of liver function.


Subject(s)
Humans , Tuberculosis/complications , Tuberculosis/epidemiology , Antitubercular Agents/adverse effects , Tuberculosis/drug therapy , Sex Factors , Risk Factors , Age Factors
6.
Article in English | LILACS (Americas) | ID: biblio-961188

ABSTRACT

ABSTRACT Objective: to investigate the planning pathways in the transfer of Directly Observed Treatment of tuberculosis. Method: a qualitative study conducted using interviews and a semi-structured guide, administered to five subjects who were among the coordinators and managers of the tuberculosis control programs, and the secretary of health of a municipality in the south of Brazil. Situational Strategic Planning and Discourse Analysis of the French matrix were the theoretical and analytical references used, respectively. Results: three reflexive axes were identified: weaknesses in the process of planning the Directly Observed Treatment transfer, antagonism between planning and daily requirements and formulation of planning and execution. Lack of systematization regarding the planning and execution for transfer the Directly Observed Treatment policy, demonstrates the fragility and incipience of this activity, and the possibility of its non-existence. Conclusion: the urgent need for managers and coordinators to better appropriate the theoretical framework for changing public policies, and the related planning mechanisms, includes a proposal for reorganization and qualification of the diffusion process, both practical-operative and political-organization.


RESUMO Objetivo: investigar o processo de planejamento da transferência da política do Tratamento Diretamente Observado da tuberculose. Método: estudo qualitativo, realizado por meio de entrevistas e roteiro semiestruturado aplicado a cinco sujeitos, dentre coordenadores e gestores dos programas de controle da tuberculose e o secretário de saúde de um município do Sul do Brasil. O Planejamento Estratégico Situacional e a Análise de Discurso de matriz francesa foram os referenciais teórico e analítico utilizados, respectivamente. Resultados: três eixos reflexivos sobressaíram: as fragilidades no processo de planejamento da transferência do Tratamento Diretamente Observado; o antagonismo entre o planejamento e as exigências cotidianas; e a formulação do planejamento e sua execução. A assistematização do planejamento para a execução da transferência do Tratamento Diretamente Observado indica não apenas a fragilidade e incipiência dessa atividade, mas também a possibilidade de sua inexistência. Conclusão: é notória a premente necessidade de os gestores e coordenadores se apropriarem melhor tanto do referencial teórico da transferência de políticas públicas quanto dos próprios mecanismos de planejamento em si, incluindo, nesse sentido, uma proposta de reorganização e qualificação do processo difusor, prático-operativo e político-organizativo.


RESUMEN Objetivo: investigar el proceso de planificación de la transferencia de la política del Tratamiento Directamente Observado de la tuberculosis. Método: estudio cualitativo realizado por medio de entrevistas y con guión semiestructurado, aplicado en cinco sujetos: coordinadores y gestores de los programas de control de la tuberculosis y el secretario de salud de un municipio del sur de Brasil. La Planificación Estratégica Situacional y el Análisis de Discurso de matriz francesa fueron los referenciales teóricos y analíticos utilizados, respectivamente. Resultados: tres ejes reflexivos se destacaron: las fragilidades en el proceso de planificación de la transferencia del Tratamiento Directamente Observado; el antagonismo entre la planificación y las exigencias cotidianas y la formulación de la planificación; y su ejecución. La falta de sistematización, de la planificación para la ejecución de la transferencia del Tratamiento Directamente Observado, nos indica no apenas la fragilidad e insipiencia de esta actividad, pero además la posibilidad de que este no exista. Conclusión: es notaria la urgente necesidad de los gestores y coordinadores de conocer mejor tanto el referencial teórico de la transferencia de políticas públicas como los propios mecanismos de planificación, incluyendo con ese propósito una propuesta de reorganización y calificación del proceso difusor, práctico operativo y político organizativo.


Subject(s)
Humans , Tuberculosis/drug therapy , Planning Techniques , Directly Observed Therapy , Delivery of Health Care/organization & administration , Public Policy , Brazil , Qualitative Research
7.
Saúde Soc ; 26(4): 1015-1025, Oct.-Dec. 2017.
Article in Portuguese | LILACS (Americas) | ID: biblio-962557

ABSTRACT

Resumo Este artigo apresenta e discute dados de uma pesquisa realizada nas comunidades de Manguinhos, município do Rio de Janeiro, sobre o tratamento da tuberculose no contexto de violência urbana. Para isso, toma-se como base as teorias das ciências sociais e humanas. O estudo aborda as representações sociais que influíram na interação entre os atores envolvidos nesse processo, profissionais de saúde e doentes acometidos por tuberculose e usuários e/ou traficantes de drogas, como resultado de construções históricas e contradições sociais determinadas pelo contexto social de violência em que estavam inseridos. O método da pesquisa foi qualitativo, com entrevistas semidiretivas que seguiram um roteiro etnográfico. A interpretação das respostas buscou significados a partir de categorias temáticas, visando sua articulação em categorias mais amplas. Os achados revelaram que as interações entre os usuários e os profissionais de saúde eram determinadas pela forma de perigo, medo e estigma em relação à tuberculose e violência.


Abstract This paper presents and discusses data from a research conducted in the Manguinhos neighborhood communities, municipality of Rio de Janeiro (RJ, Brazil), on tuberculosis treatment within the context of urban violence. For that purpose, social and human sciences theories were considered. The study approaches the social representations that have influenced the interaction between the actors involved in this process, healthcare providers, and people affected by tuberculosis and drug users and/or drug dealers, which are consequence of historic constructions and social contradictions established by the social context of violence where they were inserted. The research method was qualitative, with semi-directive interviews following an ethnographic script. The interpretation of the answers searched for meanings based on thematic categories, aiming at their articulation in wider categories. The findings revealed that the interactions between users and healthcare providers occurred under an atmosphere of danger, fear, and stigma in relation to tuberculosis and violence.


Subject(s)
Humans , Male , Female , Tuberculosis/drug therapy , Violence , Fear , Social Stigma , Drug Trafficking , Health Personnel
8.
Rev. chil. enferm. respir ; 33(1): 54-61, mar. 2017. tab
Article in Spanish | LILACS (Americas) | ID: biblio-844396

ABSTRACT

During 2016, American Thoracic Society: ATS, Centers for Disease Control and Prevention: CDC and Infectious Disease Society of America: IDSA jointly sponsored the development of Guidelines for the treatment of drug-susceptible tuberculosis using the P-I-C-O (Patient-Intervention-Comparison-Outcome) system to answer nine questions. The preferred regimen for treating adults with drug-susceptible tuberculosis, consider a 2 month intensive phase with isoniazid (INH), rifampin (RIF), pyrazinamide (PZA), and ethambutol (EMB) followed by a continuation phase of 4 months of INH and RIF For patients who have cavitation on the initial chest radiograph and have positive cultures at completion of 2 months therapy, it is recommended to extend the continuation phase to prevent relapse. EMB can be discontinued as soon as susceptibility to INH and RIF is demonstrated. The guidelines also makes recommendations for the management in different clinical situations as in patients co-infected with HIV and in extrapulmonary tuberculosis. In tuberculous pericarditis no longer is recommended the routinely use of corticosteroids together with the anti TB treatment. In the case of tuberculous meningitis it is recommended the addition of corticosteroids and to extend the continuation phase to 9-12 months.


Durante el año 2016, la American Thoracic Society: ATS, Centers for Disease Control and Prevention: CDC y la Infectious Disease Society of America: IDSA desarrollaron en conjunto una guía de recomendaciones para el tratamiento de la tuberculosis (TBC) sensible, empleando el sistema P-I-C-O (Patient-Intervention-Comparison-Outcome) para contestar 9 preguntas. El régimen de terapia farmacológica óptima para el paciente con TBC sensible considera una fase intensiva de 2 meses de duración con isoniacida (H), rifampicina (R), pirazinamida (Z) y etambutol (E) seguida de una fase de continuación por 4 meses de H y R. En los casos con cavitación en la radiografía de tórax inicial y en pacientes con cultivo de esputo positivo al segundo mes de tratamiento, se propone prolongar la fase de continuación con el propósito de reducir el riesgo de recaída. La guía también recomienda retirar el etambutol una vez que se haya demostrado la sensibilidad a H y R. Se hacen además recomendaciones de manejo en distintas situaciones clínicas como en pacientes co-infectados con VIH y en las TBC extrapulmonares. En la pericarditis TBC se sugiere no utilizar de forma rutinaria la terapia corticoesteroidal coadyuvante al tratamiento anti TBC. En el caso de la TBC meníngea se recomienda usar corticoesteroides y prolongar la quimioterapia durante la fase de continuación a 9 -12 meses.


Subject(s)
Humans , Antitubercular Agents/administration & dosage , Surveys and Questionnaires , Tuberculosis/drug therapy , Treatment Outcome
9.
Rev. Inst. Med. Trop. Säo Paulo ; 59: e28, 2017. tab, graf
Article in English | LILACS (Americas) | ID: biblio-842784

ABSTRACT

ABSTRACT The present study aimed to assess the association of outcomes with comprehension, adherence and behavioral characteristics of tuberculosis (TB) patients using fixed-dose combination (FDC) therapy in the city of Contagem, MG, Brazil. This study used standardized questionnaires to collect data. Outcomes included cure in 77.2% (64/ 83), noncompliance with treatment in 20.4% (17/ 83), and absence of organ failure or death cases. The rate of adherence to treatment was high (71.1% - 59/ 83), while the level of comprehension of the treatment was insufficient for the majority of patients (72.3% - 60/ 83). When a greater number of medicines was used, the chance of noncompliance with treatment increased exponentially (p = 0.00 - OR 1.72). Light-skinned black patients, alcoholics and those who live with HIV/ AIDS showed a significant association with noncompliance with treatment (p=0.039 - OR 3.38, p=0.002 - OR 4.68, and p=0.001 - OR 9.68, respectively). Comprehension also presented a significant association with noncompliance with treatment (p=0.01 and OR 5.76 and CI 1.49-22.29). The probability of noncompliance with treatment in the first few months was greater than in the subsequent months. This study demonstrates that if the TB patients had a better understanding of the treatment, the outcome would have been more favorable as regards a proper cure.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Antitubercular Agents/therapeutic use , Patient Compliance/statistics & numerical data , Tuberculosis/drug therapy , Brazil , Combined Modality Therapy , Comprehension , Prospective Studies , Socioeconomic Factors , Treatment Outcome
10.
Esc. Anna Nery Rev. Enferm ; 21(4): e20170075, 2017. tab
Article in English | LILACS (Americas), BDENF | ID: biblio-891678

ABSTRACT

Abstract Objective: Analyze the actions developed in Primary Health Care (PHC) to promote adherence to tuberculosis (TB) treatment in the perception of patients and nursing team. Methods: Cross-sectional epidemiological study conducted at the PHC of Campinas-SP, through structured interviews with 18 corresponding questions on the perception of professionals (183) and patients (165). Chi-square test and Fisher's exact test were used. Results: Actions such as the promotion of autonomy and time for the patient to talk about doubts and concerns, guidance to seek information in books and/or on the Internet on the disease, and for the family to perform TB tests, undergo directly observed treatment, schedule monthly consultations, delivery of written information on treatment and incentive were actions more perceived by the professionals than patients reported receiving. Conclusions: The identification of gaps in the offer of actions for adherence to TB treatment can help health services to change and improve the practice and the epidemiological scenario of the disease.


Resumen Objetivo: Analizar acciones desarrolladas en servicios de Atención Primaria de Salud (APS) para promover adhesión al tratamiento de Tuberculosis (TB) en visión de enfermos y profesionales de enfermería. Métodos: Estudio epidemiológico transversal, realizado en APS de Campinas-SP, mediante entrevista estructurada de 18 preguntas pertinentes a percepción de profesionales (183) y enfermos (165). Se aplicó test Chi-cuadrado y exacto de Fisher. Resultados: Acciones como promoción de autonomía y tiempo para consultas de dudas y preocupaciones del enfermo, para que el familiar realice exámenes de TB, ejecución de tratamiento directamente observado, agendado de consulta mensual, entrega de información escrita sobre tratamiento y oferta de incentivo, fueron acciones más observadas por los profesionales que por los enfermos. Conclusiones: La identificación de vacíos en la oferta de acciones de adhesión al tratamiento de TB puede colaborar a que los servicios de salud modifiquen y mejoren la práctica y el escenario epidemiológico de la enfermedad.


Resumo Objetivo: Analisar as ações desenvolvidas nos serviços de Atenção Básica (AB) para promover a adesão ao tratamento da Tuberculose (TB) na percepção de doentes e profissionais de enfermagem. Métodos: Estudo epidemiológico transversal, realizado na AB de Campinas-SP, por meio de entrevista estruturada com 18 questões correspondentes na percepção de profissionais (183) e doentes (165). Utilizou-se teste qui-quadrado e exato de Fisher. Resultados: Ações como a promoção de autonomia e tempo para o doente falar de dúvidas e preocupações, familiar realizar exames para a TB, realização de tratamento diretamente observado, agendamento de consulta mensal, entrega de informação escrita sobre o tratamento, oferta de incentivo foram ações mais percebidas pelos profissionais, do que os doentes afirmaram receber. Conclusões: A identificação de lacunas na oferta de ações para a adesão ao tratamento da TB pode ajudar os serviços de saúde a modificar e melhorar a prática e o cenário epidemiológico da doença.


Subject(s)
Humans , Medication Adherence , Nurse Practitioners/statistics & numerical data , Primary Health Care , Tuberculosis/drug therapy , Tuberculosis/prevention & control
12.
Article in English | WPRIM (Western Pacific) | ID: wprim-8654

ABSTRACT

Although tuberculosis is largely a curable disease, it remains a major cause of morbidity and mortality worldwide. Although the standard 6-month treatment regimen is highly effective for drug-susceptible tuberculosis, the use of multiple drugs over long periods of time can cause frequent adverse drug reactions. In addition, some patients with drug-susceptible tuberculosis do not respond adequately to treatment and develop treatment failure and drug resistance. Response to tuberculosis treatment could be affected by multiple factors associated with the host-pathogen interaction including genetic factors and the nutritional status of the host. These factors should be considered for effective tuberculosis control. Therefore, therapeutic drug monitoring (TDM), which is individualized drug dosing guided by serum drug concentrations during treatment, and pharmacogenetics-based personalized dosing guidelines of anti-tuberculosis drugs could reduce the incidence of adverse drug reactions and increase the likelihood of successful treatment outcomes. Moreover, assessment and management of comorbid conditions including nutritional status could improve anti-tuberculosis treatment response.


Subject(s)
Antitubercular Agents/blood , Arylamine N-Acetyltransferase/genetics , Chromatography, High Pressure Liquid , Drug Monitoring , Humans , Nutritional Status , Pharmacogenetics , Tandem Mass Spectrometry , Tuberculosis/drug therapy
13.
Article in English | WPRIM (Western Pacific) | ID: wprim-8638

ABSTRACT

Pharmacogenetic testing for clinical applications is steadily increasing. Correct and adequate use of pharmacogenetic tests is important to reduce unnecessary medical costs and adverse patient outcomes. This document contains recommended pharmacogenetic testing guidelines for clinical application, interpretation, and result reporting through a literature review and evidence-based expert opinions for the clinical pharmacogenetic testing covered by public medical insurance in Korea. This document aims to improve the utility of pharmacogenetic testing in routine clinical settings.


Subject(s)
Anticoagulants/therapeutic use , Antidepressive Agents/therapeutic use , Antimetabolites, Antineoplastic/therapeutic use , Antitubercular Agents/therapeutic use , Arylamine N-Acetyltransferase/genetics , Coronary Artery Disease/drug therapy , Cytochrome P-450 CYP2C19/genetics , Cytochrome P-450 CYP2C9/genetics , Cytochrome P-450 CYP2D6/genetics , Depressive Disorder/drug therapy , Genotype , Isoniazid/therapeutic use , Laboratories, Hospital/standards , Methyltransferases/genetics , Pharmacogenomic Testing/methods , Platelet Aggregation Inhibitors/therapeutic use , Pulmonary Embolism/drug therapy , Ticlopidine/analogs & derivatives , Tuberculosis/drug therapy , Vitamin K Epoxide Reductases/genetics , Warfarin/therapeutic use
14.
Med. infant ; 23(3): 217-223, Sept.2016. tab, ilus
Article in Spanish | LILACS (Americas) | ID: biblio-884251

ABSTRACT

La prevención, el diagnóstico y el tratamiento de la Tuberculosis Infantil (TBI), no ha sido suficientemente reconocida como causa importante de enfermedad y muerte entre los 0 a 14 años. El objetivo del presente trabajo fue analizar la situación epidemiológica de la TBI en la Región Sanitaria V (RSV), provincia de Buenos Aires. Es un estudio observacional longitudinal, realizado entre el 1º de enero del 2000 y el 31 de diciembre de 2014. Se efectuó un análisis de tendencia sobre un total de 2.142 casos de Tuberculosis Infantil, calculada por regresión lineal simple y expresada como variación anual promedio (VAP). Se analizó el número de casos notificados y tasas de incidencia(TI) por 100.000 habitantes de todas las formas de TBI, TBI pulmonar (TBIP) y TBIP confirmada por bacteriología. La TBP se estudió desagregada en dos grupos de edad: 0 a 4 y 5 a 14 años. Resultados: La tasa de incidencia de TBI y la tasa de incidencia de la TBIP presentaron una tendencia neta al descenso, con una declinación mayor al 5% y similar a la TBIP entre los 0 a 4 años y entre los 5 a 14 años. En cambio, la tasa de incidencia de la TBIP confirmada del total de los casos y en los dos subgrupos, la tendencia al descenso fue mínima y no resultó estadísticamente significativa. La TB se mantiene como un riesgo de salud en la RSV, con la mayor afectación en edades jóvenes, hecho que refleja la tendencia de una transmisión reciente y que se asocia cuando no se ha logrado controlar la enfermedad (AU)


Prevention, diagnosis, and treatment of childhood tuberculosis (childhood TB) is underrecognized as an important cause of disease and death between 0 and 14 years of age. The aim of this study was to analyze the epidemiological situation of childhood TB in the Public Health Region V (PHRV), the province of Buenos Aires. In a longitudinal, observational study conducted between January 1, 2000 and December, 2014.A trend analysis was performed in a total of 2,142 cases of childhood TB, calculated by simple linear regression and expressed as average annual rate (AAR). The number of reported cases and incidence rate (IR) were calculated per 100,000 inhabitants of all forms of childhood TB, childhood lung TB, and childhood lung TB confirmed by bacteriological tests. Lung TB was assessed according to age group: 0 to 4 and 5 to 14 years. Results: IR of childhood TB and IR of childhood lung TB showed a net downward trend, with a greater than 5% decrease and similar to childhood lung TB between children between 0 and 4 years and those between 5 and 14 years of age. However, the IR of confirmed childhood lung TB of the total of cases and in the two subgroups showed a minimal downward trend and was not statistically significant. TB remains a health risk in PHRV, with a higher incidence in children, reflecting a trend of recent transmission and associated with a lack of disease control (AU)


Subject(s)
Humans , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Argentina/epidemiology , Incidence , Tuberculosis, Multidrug-Resistant , Tuberculosis/diagnosis , Tuberculosis/drug therapy , Tuberculosis/epidemiology , Observational Study
15.
Rev. Esc. Enferm. USP ; 50(4): 622-627, July-Aug. 2016. tab
Article in English | LILACS (Americas) | ID: lil-794938

ABSTRACT

Abstract OBJECTIVE To identify the socioeconomic and clinical-epidemiological factors related to tuberculosis in new cases and retreatment cases. METHOD Comparative study with 126 patients, of which 42 were retreatment cases after default attended in a reference center, and 84 were new cases completing the first treatment and treated in Basic Health Units. The collection of primary data was through interview, and of secondary data by records of the Notifiable Diseases Information System. Comparative analysis between the two groups. RESULTS The new cases differ from retreatment cases regarding educational level. The clinical-epidemiological profile shows a significant difference in relation to performance of the tuberculin skin test, and the HIV test result (positive) in favor of new cases. In relation to performance of sputum culture and the result (positive) of the first sputum smear of the first and second samples, in favor of retreatment cases. CONCLUSION The two groups are significantly different in clinical and epidemiological characteristics that show the access to exams.


Resumen OBJETIVO Identificar factores socioeconómicos y clínico-epidemiológicos asociados con la tuberculosis en casos nuevos y en casos en retratamiento. MÉTODO Estudios comparativo de 126 pacientes, siendo 42 casos en retratamiento por abandono atendidos en un Centro de Referencia y 84 casos nuevos concluyendo el primer tratamiento, atendidos en Unidades Básicas de Salud. Relevamiento de datos primarios por entrevista y datos secundarios por la Ficha de Información de Agravios de Notificación. Análisis comparativo entre ambos grupos. RESULTADOS Los casos nuevos difieren de los en retratamiento en cuanto a la escolaridad. El perfil clínico-epidemiológico muestra que hay diferencia significativa en cuanto a la realización de la prueba tuberculínica y el resultado de la prueba VIH (positivo) a favor de los casos nuevos. En cuanto a la realización del cultivo de esputo y el resultado (positivo) de la baciloscopia de esputo de la primera y la segunda muestras, están a favor de los casos en retratamiento. CONCLUSIÓN Ambos grupos difieren significativamente por características clínico-epidemiológicas que retratan el acceso a estudios.


Resumo OBJETIVO Identificar fatores socioeconômicos e clínico-epidemiológicos associados à tuberculose em casos novos e em casos em retratamento. MÉTODO Estudo comparativo de 126 pacientes, sendo 42 casos em retratamento por abandono atendidos num Centro de Referência e 84 casos novos concluindo o primeiro tratamento, atendidos em Unidades Básicas de Saúde. Levantamento de dados primários por entrevista e dados secundários pela Ficha de Informação de Agravos de Notificação. Análise comparativa entre os dois grupos. RESULTADOS Os casos novos diferem dos em retratamento quanto à escolaridade. O perfil clínico-epidemiológico mostra que há diferença significativa quanto à realização do teste tuberculínico e o resultado do teste HIV (positivo) a favor dos casos novos. Quanto à realização da cultura de escarro e o resultado (positivo) da baciloscopia de escarro da primeira e da segunda amostras, a favor dos casos em retratamento. CONCLUSÃO Os dois grupos diferem significativamente por características clínico-epidemiológicas que retratam o acesso a exames.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Young Adult , Antitubercular Agents/therapeutic use , Tuberculosis/drug therapy , Cross-Sectional Studies , Retreatment , Treatment Failure , Tuberculosis/diagnosis , Tuberculosis/epidemiology
16.
Ciênc. saúde coletiva ; 21(7): 2147-2160, Jul. 2016. tab, graf
Article in Portuguese | LILACS (Americas) | ID: lil-785907

ABSTRACT

Resumo Tuberculosis in Brazilian prisons: an integrative review of the literature O objetivo deste estudo foi sistematizar o conhecimento produzido sobre tuberculose em presídios brasileiros. Foi realizada uma revisão integrativa nas bases Medline, Lilacs e biblioteca eletrônica SciELO, com os descritores: “Tuberculosis”, “Prisons” e “Brazil”. Entre os 61 registros encontrados, 33 foram avaliados (28 duplicados) e 21 incluídos na revisão (12 excluídos segundo critério). Verifica-se que os estudos contribuem efetivamente para conhecer a magnitude da doença entre detentos e para a escolha dos métodos de triagem e diagnóstico mais adequados ao cenário prisional. São fornecidos índices de incidência e prevalência de tuberculose ativa e latente, além de dados sobre o perfil de sensibilidade e genotípico dos isolados clínicos. O conhecimento dos dados apresentados reforça a necessidade da adoção de medidas voltadas à detecção, tratamento e acompanhamento de casos. Sugere-se que os novos desafios para a investigação científica, estejam vinculados ao desenvolvimento de saberes específicos acerca do manejo do problema num ambiente repleto de particularidades como o presídio.


Abstract The scope of this study was to organize the knowledge produced on tuberculosis in Brazilian prisons in a systematic manner. A comprehensive review was conducted in the Medline and Lilacs databases and the SciELO electronic library using the key words: “Tuberculosis,” “Prisons” and “Brazil.” Of the 61 records found, 33 were evaluated (28 duplicated records) and 21 included in the review (12 excluded according to the criteria adopted). These studies contribute effectively to improve the knowledge regarding the scale of the disease among inmates, as well as to the choice of screening and diagnostic methods most appropriate to the prison setting. The incidence rates and prevalence of active and latent tuberculosis are presented, in addition to data on the profile of drug and genotype susceptibility of the clinical results. Awareness of the data presented highlights the need to adopt measures aimed at case detection, treatment and follow-up. It is suggested that the new challenges for scientific research should be linked to the development of specific knowledge about dealing with the problem in an environment full of specificities such as a prison.


Subject(s)
Humans , Prisons , Tuberculosis/diagnosis , Tuberculosis/drug therapy , Tuberculosis/epidemiology , Brazil
17.
Rev. enferm. UERJ ; 24(1): e8425, jan.-fev. 2016.
Article in Portuguese | LILACS (Americas), BDENF | ID: biblio-947071

ABSTRACT

Objetivo: conhecer a opinião dos profissionais de saúde sobre o tratamento diretamente observado da tuberculose. Método: estudo descritivo de natureza qualitativa, realizado com enfermeiros e médicos que atuam na atenção primária em 15 municípios que integram a 15ª Regional de Saúde do Paraná. Os dados foram coletados nos meses de junho e julho de 2013, por meio de entrevistas semiestruturadas. Utilizou-se análise de conteúdo, o que deu origem à categoria Tratamento diretamente observado: potencialidades e fragilidades. Foram entrevistados 20 enfermeiros e 10 médicos que atuam em ações de controle da tuberculose. Resultados: embora o tratamento diretamente observado não esteja implantado em todos os municípios, devido ao baixo número de casos, os profissionais reconhecem sua importância. Contudo, existem dificuldades para a implementação dessa estratégia, como a falta de tempo, de recursos humanos e de transporte. Conclusão: neste sentido, é imprescindível a melhoria da organização e oferta de serviços de saúde.


Objective: to discover the opinions of directly observed treatment for tuberculosis. Method: qualitative, descriptive study held by primary care nurses and doctors in the 15 municipalities that make up the 15th Health Region of Paraná State. Data were collected by semi-structured interviews of 20 nurses and 10 physicians working in tuberculosis control actions in June and July 2013. Content analysis yielded the category Directly observed treatment: strengths and weaknesses. Results: although, due to the low number of cases, directly observed treatment is not implemented in all municipalities, practitioners do recognize its importance. However, difficulties in implementing the strategy include lack of time, human resources and transport. Conclusion: in this regard, it is essential to improve health service organization and delivery.


Objetivo: conocer la opinión de los profesionales de salud sobre el tratamiento directamente observado de la tuberculosis. Método: estudio descriptivo, cualitativo, realizado junto a enfermeros y médicos que trabajan en la atención primaria en 15 ciudades que componen la 15ª Regional de Salud de Paraná. Los datos fueron recolectados en junio y julio de 2013, a través de entrevistas semiestructuradas. Se ha utilizado el análisis de contenido, lo que originó la categoría Tratamiento Directamente Observado: fortalezas y debilidades. Fueron entrevistados 20 enfermeros y 10 médicos que trabajan en las acciones de control de la tuberculosis. Resultados: aunque el tratamiento directamente observado no se haya implementado en todos los municipios, debido al bajo número de casos, los profesionales están conscientes de su importancia. Sin embargo, existen dificultades en la aplicación de esa estrategia: falta de tiempo, de recursos humanos y de transporte. Conclusión: en este sentido, es esencial la mejora de la organización y la prestación de servicios de salud.


Subject(s)
Humans , Primary Health Care , Tuberculosis , Nursing , Directly Observed Therapy , Patient Care Team , Tuberculosis/drug therapy , Tuberculosis/therapy , Evaluation Studies as Topic , Epidemiology, Descriptive , Family Health Strategy
18.
Rev. méd. (La Paz) ; 22(1): 42-46, 2016. ilus
Article in Spanish | LILACS (Americas) | ID: lil-797314

ABSTRACT

El síndrome de lóbulo medio es una entidad caracterizada por colapso recurrente y crónico del lóbulo medio del pulmón derecho, dentro de esta entidad se conocen dos formas obstructiva y no obstructiva con etiologías variadas incluyendo procesos infecciosos como la tuberculosis, cáncer y otros. La fibrobroncoscopia es la herramienta más útil para realizar el diagnóstico diferencial. Se presenta el caso de un paciente de 26 años con síndrome de lóbulo medio por tuberculosis hematógena, miliar y neumónica con caverna con alta probabilidad de absceso. En relación a la etiología tuberculosa del síndrome de lóbulo medio, se han descrito casos ligados a tuberculosis endobronquial con y sin afectación parenquimatosa, esta entidad ha mostrado ser difícil de diagnosticar ya que la baciloscopia con frecuencia es negativa, requiriendo el empleo de TC de tórax, fibrobroncoscopia y sobre todo cultivo de lavado broncoalveolar y/o histopatología de muestras obtenidas.


Middle lobe syndrome is a condition characterized by recurrent and chronic collapse of the middle lobe of the right lung, within this entity obstructive and nonobstructive two forms with varied etiologies including infectious diseases such as tuberculosis, cancer and others are known. Bronchoscopy is the most useful for the differential diagnosis tool. We present the case of a patient of 26 years of middle lobe syndrome hematogenous miliary tuberculosis and pneumonic cavern with high probability of abscess is presented. Regarding the tuberculous etiology of middle lobe syndrome cases have been reported linked to endobronchial tuberculosis with and without parenchymal involvement, this entity has proven to be difficult to diagnose because the smear is often negative, requiring the use of chest CT, bronchoscopy and culture especially bronchoalveolar lavage and/or histopathology specimens obtained.


Subject(s)
Humans , Adult , Tuberculosis/drug therapy , Middle Lobe Syndrome , Rifampin/administration & dosage , Sepsis/diagnosis
19.
Rev. gaúch. enferm ; 37(1): e51467, 2016. tab
Article in Portuguese | LILACS (Americas) | ID: biblio-960716

ABSTRACT

RESUMO Objetivos avaliar o acompanhamento e desfecho do tratamento de casos de tuberculose pulmonar no programa de controle da tuberculose de um município prioritário do Sul do Brasil. Métodos estudo quantitativo, descritivo, documental, utilizando prontuários das pessoas com tuberculose em tratamento entre 2009-2013, a coleta ocorreu entre junho e julho de 2014 no Programa de Controle da Tuberculose. Utilizou-se estatística descritiva. Resultados a média de consultas, entre os 629 pacientes, foi de 7,2 por paciente, com intervalo médio de 1,03 meses entre as consultas. A média de baciloscopias foi de 2,7 exames por paciente, durante o período estudado. O desfecho do tratamento foi 87,8% de cura, 8,3% de abandono e 6,5% de óbitos. Conclusões apesar do alcance da taxa de cura, o abandono ainda é elevado, sendo necessário explorar estratégias para melhor a adesão ao tratamento, e o comprometimento da gestão municipal em articular o acompanhamento na atenção primária à saúde.


RESUMEN Objetivo evaluar el seguimiento y tratamiento de la tuberculosis pulmonar en el programa de control de la tuberculosis en una ciudad prioridad en el sur de Brasil. Método estudio cuantitativo, descriptivo, documental, usando los registros de personas con tuberculosis tratados entre 2009-2013, los datos fueron recogidos entre junio y julio de 2014 en el programa de control de la tuberculosis. Se utilizó estadística descriptiva. Resultados entre los 629 pacientes el número medio de visitas fue de 7,2 por paciente, con un intervalo medio de 1,03 meses entre las visitas, y la media fue de 2,7 microscopías por paciente, no periodo del estudio. El resultado del tratamiento fue del 87,8% de curación, el 8,3% de deserción y 6,5% de muertes. Conclusión a pesar de la tasa de curación, el abandono es aún elevado, siendo necesario explorar estrategias para mejorar la adherencia al tratamiento, así como el compromiso de la gestión municipal en el seguimiento conjunto de los pacientes con tuberculosis por la atención primaria.


ABSTRACT Objectives To monitor and assess the outcome of treatment for pulmonary tuberculosis in the tuberculosis control program in a prioritized municipality in Southern Brazil. Methods a quantitative study, descriptive, documentary, using records of people with tuberculosis in treatment between 2009-2013, the collection took place between June and July 2014 in the Tuberculosis Control Program. Descriptive statistics was used. Results The average number of consultations among the 629 patients was 7.2 per patient, with a mean interval of 1.03 months between visits. The average of smears was 2.7 tests per patient during the study period. The outcome of treatment was a cure rate of 87.8%, an abandonment rate of 8.3% and 6.5% of deaths. Conclusions despite the cure rate, abandonment is still high, thus, it is necessary to explore strategies for better adherence to treatment, and the commitment of the municipal administration in articulating monitoring in primary health care.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Young Adult , Tuberculosis/drug therapy , Office Visits/statistics & numerical data , Patient Dropouts/statistics & numerical data , Tuberculosis/epidemiology , Tuberculosis/diagnostic imaging , Urban Population , Brazil/epidemiology , Patient Acceptance of Health Care/statistics & numerical data , Comorbidity , HIV Infections/diagnosis , HIV Infections/epidemiology , Survival Rate , Treatment Outcome , Diabetes Mellitus/epidemiology , Diagnostic Tests, Routine/statistics & numerical data , Middle Aged , Antitubercular Agents/therapeutic use
20.
International Journal of Mycobacteriology. 2016; 5 (1): 14-20
in English | IMEMR (Eastern Mediterranean) | ID: emr-177657

ABSTRACT

Background: Antituberculosis drugs cause hepatotoxicity in some individuals leading to acute liver failure, which results in death. Such phenomena limit the clinical use of drugs, contributing to treatment failure that possibly causes drug resistance. Furthermore, associated risk factors for the development of antituberculosis-drug-induced hepatotoxicity [anti-TB-DIH] are found to be controversial among different study findings


Methods: A prospective cohort study was conducted from May 2014 to October 2014 in Dawro Zone, Tercha District Hospital Laboratory, South Ethiopia. One hundred and twenty-four new tuberculosis-positive individuals available from Tercha Hospital and five health centers during data collection were consecutively included. The sociodemographic data and anthropometric measurement were obtained. Then, 5 mL of venous blood was drawn from each individual, and the alanine transaminase, aspartate transaminase, and total bilirubin were measured photometrically at baseline, and then continuously monitored by measuring these liver enzymes every 2 weeks for 2 months. Data were analyzed with SPSS version 20 for Windows [SPSS Inc., Chicago, IL, USA]


Results: The incidence of anti-TB-DIH was found to be 8% [10 patients out of 124]. Raised serum transaminase and bilirubin level, as well as signs and symptoms of hepatotoxicity [nausea, anorexia, vomiting, malaise, and jaundice], were observed in the cases. The onset of hepatotoxicity ranged from 13 days to 58 days [median, 26 days] after treatment was initiated. Of the various risk factors analyzed, only high alcohol intake was associated with the incidence of anti-TB-DIH [odds ratio = 9.3, 95% confidence interval 1.8-47, p <.007]. Age, gender, extent of tuberculosis disease, and malnutrition were not significantly associated with anti-TB-DIH


Conclusion: The incidence of anti-TB-DIH in Dawro Zone was high. The drug responsible for the hepatotoxicity was not known. However, chronic high alcohol intake was associated with the development of anti-TB-DIH


Subject(s)
Humans , Male , Middle Aged , Female , Adult , Tuberculosis/drug therapy , Incidence , Chemical and Drug Induced Liver Injury , Risk Factors , Prospective Studies , Cohort Studies , Surveys and Questionnaires , Liver Function Tests , Liver/drug effects
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