Lineamientos técnicos para el diagnóstico y control de la tuberculosis en el laboratorio clínico / Technical guidelines for the diagnosis and control of tuberculosis in the clinical laboratory

El trabajo desarrollado en los laboratorios, es importante no solo por su rol en el diagnóstico de las enfermedades transmisibles como la tuberculosis, sino también en el control de la evolución del tratamiento de los pacientes, así como la evaluación epidemiológica y operacional. Tiene como función principal, la detección de fuentes de infección tuberculosa a través de métodos como pruebas moleculares, cultivo, baciloscopia y prueba de flujo lateral para lipoarabinomanano (LF-LAM). La elección de la técnica más conveniente y su estandarización permite la obtención de resultados comparables a lo largo de todo el país, además de facilitar la capacitación, así como la ampliación de la cobertura. El propósito de los presentes lineamientos, es proporcionar al personal de laboratorio clínico del Sistema Nacional Integrado de Salud (SNIS) y de otras instituciones prestadoras de servicios de salud, información sobre los procedimientos técnicos aplicables para el diagnóstico bacteriológico de la tuberculosis

The work carried out in the laboratories is important not only for its role in the diagnosis of communicable diseases such as tuberculosis, but also in the control of the evolution of the treatment of patients, as well as the epidemiological and operational evaluation. Its main function is to detect sources of tuberculosis infection through methods such as molecular tests, culture, bacilloscopy and lateral flow test for lipoarabinomanan (LF-LAM). The choice of the most appropriate technique and its standardization allows for comparable results throughout the country, in addition to facilitating training, as well as expanding coverage. The purpose of these guidelines is to provide clinical laboratory staff with

Varied clinical presentations of genitourinary tuberculosis: A case series at a tertiary Philippine hospital / Philippine Journal of Obstetrics and Gynecology

@#Genitourinary tuberculosis (GUTB) represents a critical aspect of extra‑pulmonary tuberculosis (TB). While it is the second most common form of this disease, its diverse clinical presentations pose a substantial challenge. This report, titled “Varied Clinical Presentations of Genitourinary Tuberculosis: A Case Series from a Tertiary Philippine Hospital,” aims to shed light on the intricacies of GUTB diagnosis, treatment, and its broader implications. In this case series, we present five unique clinical scenarios. Cases 1, 2, and 3, having completed TB treatment, developed spontaneous genitourinary fistulae. Case 4 was initially managed as interstitial cystitis, while Case 5 underwent diverticulectomy for a urethral diverticulum. The diagnosis of GUTB as the underlying cause in these cases, despite conventional treatment, highlights the diagnostic challenges posed by this disease. All five patients, experienced irritative voiding symptoms and recurrent urinary tract infections with limited improvement following antibiotic therapy. Imaging studies consistently revealed upper urinary tract involvement. Importantly, only one case exhibited histologic evidence of granuloma suggestive of GUTB, and microbiologic confirmation of Mycobacterium tuberculosis infection was obtained in only two cases. This underscores the need for a multidimensional diagnostic approach. The findings in this case series emphasize that GUTB diagnosis, often reliant on clinical findings supported by imaging studies and suggestive cystoscopy findings, remains critical for prognosis, even in the absence of microbiologic confirmation. Beyond the individual cases, this series offers insights into the complexity of GUTB, raising questions about the overall management and implications for TB control.

Penicillium marneffei infection after renal transplantation: one case report / 中华器官移植杂志

Clinical data were retrospectively reviewed for one case of penicillium marneffei infection after renal transplantation (RT) to explore a proper management of peniciliosis marneffei (PSM)transplantation.This case had a history of pulmonary tuberculosis and underwent RT due to uremia.After discharging, postoperative recovery was excellent.Recurrent cough occurred at Month 7 post-operation.Fiberoptic bronchoscopy and pulmonary CT indicated a possibility of pulmonary tuberculosis.However, a definite diagnosis of PSM was confirmed by next generation sequencing (NGS) and pathogenic bacteria culture of alveolar lavage fluid.After adjusting immunosuppressive agents and regular antifungal treatment with voriconazole, respiratory symptoms improved and pulmonary CT hinted at a resorption of lesion.Features of pulmonary CT and bronchoscopic examination were nearly similar to those of tuberculosis.Thus early bacterium culture and NGS may aid an definite diagnosis.Voriconazole is an effective treatment of the disease.

Diagnostic and Treatment Delay among New Pulmonary Tuberculosis Patients in Southern India: A Cross-Sectional Study

Background: Delay in diagnosis and treatment enhances tuberculosis (TB) transmission and mortality. Understanding causes for delay can help in TB elimination by 2025, the stated goal of India. Objectives: Estimate diagnostic and treatment delay in Ernakulam district of Kerala, identify associated factors, and determine health-seeking behavior and knowledge regarding TB among new pulmonary TB patients. Materials and Methods: Community-based cross-sectional study among the new pulmonary TB patients registered under Revised National TB Control Program. Patients interviewed in-person and data collected using pretested semi-structured questionnaire. Descriptive statistics expressed as frequency, percent, interquartile range, median, and mean. The Chi?square test was used to assess statistical significance (P < 0.05) of association. Backward conditional method logistic regression done using variables with P < 0.2 in univariate analysis and adjusting for possible confounders. Results: Two hundred and twenty-nine patients interviewed and the median patient, health-care system, and treatment delay were 25 days, 22 days, and 1 day, respectively. While the patient delay (>30 days) and treatment delay (>2 days) were seen in 47.6% and 41% of patients, respectively, health?care system delay was seen in 79.9% of the patients. Choosing pharmacy for initial treatment (adjusted odds ratio [aOR] = 5.217), unskilled occupation (aOR = 3.717), female gender (aOR = 3.467), previously not heard about TB (aOR = 3.410), and lower education level (aOR = 2.774) were the independent predictors of the patient delay. Visiting two or more doctors (aOR = 5.855) and initially visiting a doctor of undergraduate qualification (aOR = 3.650) were the independent predictors of health?care system delay. The diagnosis in private sector (aOR = 8.989), not being admitted (aOR = 3.441), and age above 60 years (aOR = 0.394) was the independent predictors of treatment delay. Conclusion: Initial treatment from pharmacy, consulting multiple physicians, and diagnosis by private sector cause significant delay in diagnosis and treatment of pulmonary TB.

From Scylla to Charybdis: Fixed drug combinations for tuberculosis and increased ethambutol-induced optic neuropathy in India

Purpose: To describe the increase in prevalence of ethambutol-induced optic neuropathy (EON) in patients presenting to a single tertiary referral eye care center in India after introduction of weight-based fixed dose combinations and an increase in duration of ethambutol use from 2016 in the Revised National Tuberculosis Control Program. Methods: This was a retrospective, observational, referral hospital-based study of 156 patients with a diagnosis of EON presenting to a single tertiary referral eye care center between January 2016 and December 2019. The main outcome measure was to assess the increase in prevalence of EON cases presenting to our tertiary care institute. Results: During the 4-year study period, 156 new patients were diagnosed with EON. A total of 101 patients (64.7%) were males and 55 (35.3%) were females. The most common age group affected was 41–60 years. The significant complaint at presentation was decreased vision in all the patients. A rising trend in the number of patients diagnosed as EON was seen, with the prevalence increasing from 16 cases in 2016, 13 cases in 2017, and 31 cases in 2018 to 96 cases in 2019. Conclusion: The results of this study indicated an alarming increase in the trend of EON cases presenting to our tertiary care institute.

Percepção dos profissionais de enfermagem sobre a assistência à tuberculose numa unidade básica de saúde prisional em Santarém - PA / Nursing professionals' perception of tuberculosis assistance in a basic prison health unit in Santarém PA

Introdução: A tuberculose é um agravo à saúde extremamente relevante, ocorrendo de maneira prevalente no sistema prisional do Brasil. Apesar da existência de legislação específica e de uma política de controle dessa enfermidade, a operacionalização das ações do Programa de Controle da Tuberculose ainda enfrenta dificuldades para sua implementação dentro das unidades prisionais, isto porque a configuração estrutural, logística e hierárquica das unidades diferem das unidades de saúde externas. Objetivo: Conhecer a percepção da equipe de enfermagem sobre a assistência à saúde prestada à pessoa privada de liberdade (PPL) com tuberculose dentro do Centro de Recuperação Agrícola Silvio Hall de Moura em Santarém Pará. Método: Trata-se de um estudo exploratório, descritivo, com abordagem qualitativa, cujos dados foram coletados por meio de entrevistas com os profissionais de enfermagem do Centro de Recuperação Agrícola Silvio Hall de Moura em Santarém Pará e analisados conforme os parâmetros e variáveis descritas: no Manual de Recomendações para o Controle da Tuberculose no Brasil (2011), no Manual de Intervenções Ambientais para o Controle da Tuberculose nas Prisões (2012) e no Plano Nacional de Saúde no Sistema Penitenciário (2005). Resultados e discussão: Fizeram parte dessa pesquisa 8 profissionais da equipe de enfermagem da unidade de saúde prisional, observou-se que 50% (04) dos profissionais são do sexo masculino, 33,3% (3) dos profissionais possuem nível superior, entretanto apenas 25% (2) desempenham função de enfermeiro da unidade prisional, quanto ao tempo observou-se que 66,6% variam de 1 a 10 anos e 100% dos enfermeiros possuem curso de especialização. Quanto às variáveis qualitativas, observou-se que a unidade de saúde prisional passou a funcionar dentro do CRASHM há pouco mais de um ano, sendo assim, até o momento dessa pesquisa não haviam sido implementadas ações efetivas do programa de TB. Relacionado ao conhecimento dos profissionais sobre TB demonstraram fragilidade em dizer o que é a doença, assim como seu modo de transmissão e prevenção. Quando ocorre o ingresso do interno é feita a avaliação psicossocial, assim como a anamnese. No que se refere à conduta preconizada em casos suspeitos de tuberculose, apesar de apresentar lacunas e dificuldades quanto à logística e a estrutura física do prédio, uma vez que não tem um espaço específico para que o paciente fique isolado, o diagnóstico é realizado e o tratamento é feito pela instituição. Entretanto em alguns casos o paciente recebe liberdade condicional ou fica em prisão domiciliar para continuar o tratamento na unidade mais próxima à sua residência, esta medida geralmente é acionada pelo próprio paciente junto à justiça, já que a unidade não dispõem de espaço físico suficiente para deixá-lo separado das outras pessoas privadas de liberdade. Tais medidas demonstram que o sistema é precário e dificulta a assistência de enfermagem dentro das instituições, levando a uma situação conflituosa entre as medidas de saúde e as ações de segurança do presídio. Conclusões: Após um ano de implantação da Unidade de Saúde no CRASHM, o Programa de Controle da Tuberculose se encontra parcialmente implementado, com a elaboração de palestra sobre o tema, divulgação de instrumentos de veiculação de conhecimento sobre tuberculose como folders. Além disso, a equipe de enfermagem passou a receber orientações sobre a conduta diante dos casos suspeitos. Em consonância a tal achado, e sabendo da importância da informação no processo de agilidade no diagnóstico de TB, optou-se por elaborar como Produto Técnico da presente dissertação um material educativo o Guia de Boas Práticas na Prevenção e Controle da Tuberculose, que poderá ser útil para a instrumentalização da equipe de enfermagem e dos profissionais da saúde.

Introduction: Tuberculosis is an extremely relevant health problem, occurring prevalently in the prison system in Brazil. Despite the existence of specific legislation and a policy to control this disease, the operationalization of the actions of the Tuberculosis Control Program still faces difficulties for its implementation within the prison units, because the structural, logistical and hierarchical configuration of the units differ from the units external health services. Objective: To know the perception of the nursing team about health care provided to persons deprived of liberty (PPL) with tuberculosis at the Agricultural Recovery Center Silvio Hall de Moura in Santarém Pará. Method: This is an exploratory, descriptive study, with a qualitative approach, whose data were collected through interviews with nursing professionals from the Agricultural Recovery Center Silvio Hall de Moura in Santarém Pará and analyzed according to the parameters and variables described: in Manual of Recommendations for the Control of Tuberculosis in Brazil (2011), in the Manual of Environmental Interventions for the Control of Tuberculosis in Prisons (2012) and in the National Health Plan in the Penitentiary System (2005). Results and discussion: 8 professionals of the nursing team of the prison health unit took part in this research, it is observed that 50% (04) of the professionals are male, 33.3% (3) of the professionals have higher education, however only 25% (2) work as a nurse in the prison unit, regarding the time it was observed that 66.6% vary from 1 to 10 years and 100% of nurses have a specialization course. As for qualitative variables, it was observed that the prison health unit started operating within CRASHM just over a year ago, so, until the time of this research, effective actions of the TB program had not been implemented. Related to the professionals' knowledge about TB, they showed weakness in saying what the disease is, as well as its mode of transmission and prevention. When the intern enters, the psychosocial assessment is carried out, as well as the anamnesis. Regarding the conduct recommended in suspected cases of tuberculosis, despite presenting gaps and difficulties regarding the logistics and the physical structure of the building, since there is no specific space for the patient to be isolated, the diagnosis is made and the treatment is done by the institution. However, in some cases the patient receives parole or is under house arrest to continue treatment in the unit closest to his residence, this measure is usually triggered by the patient himself in court, since the unit does not have enough physical space to leave it separated from other people deprived of liberty. Such measures demonstrate that the system is precarious and makes nursing care within institutions difficult, leading to a conflict between health measures and prison security actions. Conclusions: After one year of implementation of the Health Unit at CRASHM, the Tuberculosis Control Program is partially implemented, with the elaboration of a lecture on the theme, dissemination of instruments for disseminating knowledge about tuberculosis such as folders. In addition, the nursing team started to receive guidance on the conduct of suspected cases. In line with this finding, and knowing the importance of information in the agility process in the diagnosis of TB, it was decided to elaborate as an Technical Product of this dissertation an educational material the Guide to Good Practices in the Prevention and Control of Tuberculosis, which it may be useful for instrumentalizing the nursing team and health professionals.

Analysis of Risk Factors Affecting Sputum Conversion at the End of Intensive Phase Under DOTS for Treatment of Pulmonary Tuberculosis

Introduction: Microbiologically confirmed pulmonarytuberculosis patients under Revised National TuberculosisControl Programme (RNTCP) are treated with a 6-monthshort-course chemotherapy (SCC) regimen irrespectiveof co-morbid conditions. The aim of present study was todetermine the time taken for SSC conversion with standardcurrent treatment with anti-tubercular drugs and analysis ofrisk factors if any delaying it. We undertook this prospectivestudy to compare sputum conversion rates (smear) at the endof intensive phase (IP) of Category regimen.Material and methods: was a prospective study which wasconducted for a period of eleven months from August 2018 toJune 2019 at Department of Respiratory Medicine, K.N ChestHospital, S.N Medical College, Jodhpur Rajasthan India.Patients visiting Department of Respiratory medicine and whowere diagnosed as pulmonary tuberculosis by sputum smearexamination were included in study.Result: Sputum smear-positive patients are infectious to closecontacts as well as to community as they continue to expelbacilli for a variable period of time after initiation of DOTSregimen. Most patients undergo sputum conversion by theend of 3rd month. Patients who have predominant cavitatorydisease in radiology, high smear grading before treatment, aprior history of DS/DR tuberculosis are more likely to havedelayed sputum smear conversion.Conclusion: There need to mandate DST at the starting ofDOTS in line with latest RNTCP guidelines to prevent thedevelopment of MDR strains and failures. Also there is astrong need to constitute strong infection control measures tillpatients are labelled as noninfectious.

Reducing the burden of Tuberculosis: an emphasis on improving awareness among caregivers

Background: Tuberculosis (TB) is one of the common communicable disease affecting human beings since ancient times. Though effective chemotherapy emerged during 20th century had raised hope towards eliminating TB burden, it still remains as a distant goal. Awareness about TB among close contacts of active disease is of paramount importance in preventing its spread and promoting early diagnosis and treatment. This study aimed to assess the knowledge about tuberculosis among caregivers of tuberculosis patients.Methods: This was a cross sectional study that enrolled 300 subjects who were then caregivers of tuberculosis patients admitted in the Department of Pulmonary Medicine. Subjects were interviewed according to a predesigned panel of questions meant to assess their basic knowledge and perceptions about tuberculosis symptomatology, diagnostic modalities, treatment and prevention.Results: About 90.3% (n=271) of subjects had heard about TB previously and about 37.7% (n=113) considered themselves to be well aware of it. Most of them believed TB to be communicable (90.3%, n=271). Majority believed that TB affects lungs only (n=206, 68.7%), with most commonly perceived symptom being cough (n=285, 95%). Knowledge regarding disposal of sputum was poor (n=110, 36.7%). About 168 (56%) subjects considered usage of face mask by the patient as an effective tool for TB prevention.Conclusions: Caregivers of tuberculosis patients lack proper knowledge about major aspects of the disease. Public awareness and care giver education programs needs to be implemented along with standard TB care to reduce transmission of TB among close contacts.

Assessment of case detection performance of tuberculosis patients registered for treatment in tuberculosis units of Satara district, Maharashtra

Background: Tuberculosis is a chronic, communicable, infectious disease caused by mycobacterium tuberculosis bacilli usually affecting lungs primarily resulting in pulmonary tuberculosis. Objective: The objective of this study was to evaluate the Revised National Tuberculosis Control Program (RNTCP) through the assessment of case detection performance of the patients registered for treatment under RNTCP in tuberculosis units (TUs). Materials and Methods: The present record-based, observational cross-sectional study was carried out under district tuberculosis centre, Satara, involving all the 10 TUs. District tuberculosis centre is located in the campus of District Hospital, Satara. The functioning of RNTCP under district tuberculosis centre at the level of TUs was studied from 2012 to 2014. Fifty slides of sputum smear positive and 50 slides of sputum smear negative for tuberculosis were selected randomly. Results: Tuberculosis suspect rate was found consistently increasing from 2012 to 2014 in majority of TUs except Umbraj TU. Sputum positive rate was also consistently low in Umbraj TU. Sputum positive smear rate was higher in Bel-Air TU consistently from 2012 followed by Satara TU. Annualized new smear-positive case detection rate was higher in Satara and Bel-Air TUs in 2012; however, it was within the range of 68–83% in 2012 which rose to 86.9% in 2013 at Koregaon and 89.5% at Wai TU in 2014. Conclusion: Tuberculosis suspect rate is consistently low at both Umbraj and Bel-Air TU. Sputum smear-positive rate is consistently higher at Satara and Bel-Air TU.

Incidence of adverse drug reactions in patients taking anti-tuberculosis treatment

Background: High incidence of infection has caused a large number of morbidity and mortality which is partly due to serious adverse reactions induced by Anti-Tuberculosis (Anti-TB) drugs. In present prospective study an attempt is made to estimate the incidence and risk factor for ADRs among patients treated for tuberculosis.Methods: All the new patients starting their treatment with selected six DOT center were enrolled in study. All patient's complete clinical history was recorded. They were followed regularly for occurrence of ADR till end of their treatment.Results: Total of 108 patients (67 male and 41 female) had taken and completed their treatment during the study period (March 2007 - April 2008) and were observed for occurrence of ADR during their treatment period. Out of total108, 28 patients (25.9%) experienced one of the ADR, out of 28 patients, 12 (42.85%) patients developed GIT intolerance, and hepatitis was seen in 8 (28.57%) patients, while 4 (14.48%) patients developed skin reactions. Only 3 (7.14%) patient developed dizziness and loss of balance, which was relieved by reduction of dose of streptomycin.Conclusions: With close monitoring and on time action, RNTCP DOTs regimens can be safely and successfully administrated.

Gender Differences in Treatment Outcome of Tuberculosis Patients under the Revised National Tuberculosis Control Programme

Aim: The present study was undertaken to find out the sex differences in the notification rates and treatment outcomes of Tuberculosis (TB) patients, registered under the Revised National Tuberculosis Control Programme (RNTCP) in a rural Tuberculosis Unit (TU) in Thorrur, Warangal Dist., Telangana. Methods: This is a retrospective record based study was carried out among a total of 585 cases registered under the RNTCP between January'2011 to December'2012. Notification rates of TB, clinical forms of Tuberculosis and disease treatment outcomes recorded in the registers were analysed. Based on genders outcomes were defined in accordance with the standard RNTCP definitions. Results: Among the total of 585 patients 220 (80%) were male and 55 (20%) were female with male female ratio of 4:1. In patients less than 20 years of age the notification rates among males and females were similar. In other age groups male were more likely to be notified compared to females and the difference was statistically significant, while new smear positive and retreatment cases were significantly more than females, among females new smear positive and new extra pulmonary cases significantly lower. Among the new smear positive in females 39.3% were cured compared to 49.4% males which was again significant statistically. Male patients outnumbered female in all unfavorable outcome like death, failure, and default. Conclusion: The present study demonstrates a gender difference in the notification rates, clinical presentations and treatment outcomes of patients with TB integrated research is necessary to find the reasons for these differences. Such studies will be helpful in improving the efficacy of the RNTCP

Diagnóstico do programa de controle da tuberculose no município de Goiana / Diagnosis of the tuberculosis control program in the city of Goiana

Objetivo: Levando em consideração a magnitude da Tuberculose no mundo, nas Américas, no Brasil e no estado de Pernambuco, este estudo se propõe a verificar o Programa de Controle da Tuberculose no município de Goiana ­ PE, com o intuito de revelar o nível que se encontra as unidades de saúde da família. Métodos: Trata-se de um estudo de caráter descrito e transversal, sendo estudadas as (23) unidades do município, para os componentes de estrutura e processo por meio da aplicação de um questionário. Para análise dos dados foi utilizado o Programa Microsoft Excel 2010. Resultados: Revelam fragilidades no componente vigilância e mostra unidades classificadas em nível baixo para o componente educação, com mínimo e máximo variando de (0) a (100). Conclusão: Esta classificação constitui importante ferramenta para tomada de decisão tanto pela gestão como pelas equipes de saúde potencializando o processo de trabalho.(AU)

Objective:Taking into account the magnitude of Tuberculosis in the world, in the Americas, in Brazil and in the state of Pernambuco, this study proposes to verify the Program of Control of Tuberculosis in the city of Goiana ­ PE, with the aim of revealing the level of family health units. Methods: It is a study of described character and transversal, being studied the (23) units of the municipality for the components of structure and process by means of the application of a questionnaire. For data analysis, the Microsoft Excel 2010 were used. Results: Reveal weaknesses in the surveillance component and shows units classified at low level for the education component with minimum and maximum ranging from (0) to (100). Conclusion: This classification is an important tool for decision making both by the management and by the health teams, enhancing the work process.(AU)

Report on Mini Symposium “Vertical to horizontal: How to use the available resources - the experience and its application for UHC” / 国際保健医療

<p>  The vertical program to control tuberculosis in the 1950’s through 1960’s helped the development of the horizontal program of Universal Health Coverage launched in 1961 in Japan. Vertical and horizontal intervention do not compete each other but collaborate with each other. The same should be true for the present day context of global health, namely vertical intervention for tuberculosis, HIV/AIDS and malaria control and the horizontal UHC intervention.</p>

Tuberculosis: tendencia, pronóstico y factores de riesgo afines en la provincia de Santiago de Cuba (2004-2014) / Tuberculosis: tendency, prognosis and common risk factors in Santiago de Cuba (2004-2014)

Se realizó un estudio descriptivo, transversal y retrospectivo, con vistas a describir la evolución histórica de la incidencia de la tuberculosis en la provincia de Santiago de Cuba, desde 2004 hasta 2014. El universo quedó constituido por 100,0 % de los casos nuevos notificados por tarjeta de enfermedades de declaración obligatoria. Se mostró una tendencia descendente de esta afección, la cual se mantuvo en zona de éxito; la media histórica predominó en pacientes de 25-44 años, aunque en el 2014 descendió en este grupo. Se evidenciaron cambios importantes en la frecuencia de factores de riesgo, pues disminuyó ostensiblemente el grupo de institución cerrada, ancianos y alcoholismo; solo hubo un incremento del tabaquismo. Para los próximos 2 años se pronosticó un riesgo de enfermar de menos de 2 casos por cada 100 000 habitantes.

A descriptive, cross-sectional and retrospective study, aimed at describing the historical course of the tuberculosis incidence in Santiago de Cuba, was carried out from 2004 to 2014. The universe was constituted by 100.0% of the new cases notified by compulsory declaration diseases records. A descending tendency of this disorder was shown, which stayed in the success area; the historical mean in patients aged 25 to 44 prevailed, although in 2014 it decreased in this group. Important changes were evidenced in the frequency of risk factors, because the closed institution, elderly and alcoholism groups diminished ostensibly; there was only an increase of nicotine addiction. For the next 2 years there was a risk prediction of getting sick of less than 2 cases for every 100 000 inhabitants.

Aporte de los inmigrantes a la tuberculosis en un Servicio de Salud de Chile / Contribution of immigrants to tuberculosis in a Health Service in Chile

The assessment of Chilean Tuberculosis Control Program shows a growing increase of tuberculosis cases in foreign patients in communes of the city of Santiago with higher incidence of this disease. Through the evaluation of the cases diagnosed in a decade we found an increasing contribution of foreigners, ranging from about 10% in 2005 to 30% in 2014. The greatest proportion of tuberculosis cases in foreigners was detected in Santiago, the commune with the highest incidence. In this area, tuberculosis incidence ranged from 17% in 2005, to 29% in 2015. Treatment efficiency in foreigners (87.6%) is close to our national goal (90%) and better than in Chilean patients (81.5%). We found a higher proportion of foreign cases defaulting therapy (11%) in relation to Chilean (7.7%), but the death rate in foreigners was less than in Chileans (1.5 versus 10.6%). We must strengthen tuberculosis control strategies focused on foreigner populations.

La evaluación del Programa de Control de la Tuberculosis de Chile muestra un creciente aumento de casos de tuberculosis en pacientes extranjeros en las comunas de Santiago de mayor incidencia de esta enfermedad. Mediante la evaluación de los casos diagnosticados durante una década se comprobó un creciente aporte de casos de tuberculosis en el grupo de inmigrantes, desde cerca de 10% el año 2005 hasta cerca de 30% en 2014. La mayor proporción de casos de extranjeros ocurre en la comuna de mayor incidencia (Santiago), con cifras iniciales de 17% el año 2005, llegando a 29% en 2015. La eficacia del tratamiento en los inmigrantes (87,6%) está cerca de la meta nacional (90%) y es mejor que la de los chilenos (81,5%). Encontramos una proporción mayor de casos extranjeros que abandonan la terapia (11%) en relación a los chilenos (7,7%), pero la letalidad en extranjeros es menor (1,5%) que la de los chilenos (10,6%). Se deberán reforzar las estrategias de control de tuberculosis, focalizadas en la población extranjera.

Historia del Programa de Control de la Tuberculosis de Chile / History of the Program of Control of Tuberculosis in Chile

A book on the history of the Program of Control of Tuberculosis in Chile, recently published by the Ministry of Health as a landmark of the Public Health of the country, is commented. His author, the distinguished historian Marcelo López Campillay goes over the different stages of the tuberculosis epidemic in Chile and the successive attempts to control it. First with a modern control program and later with a program aimed at the elimination of tuberculosis as a public health problem, with a target of less than 5 cases per 100,000 inhabitants by 2020. The successes and difficulties of the program through its different stages are explained by the testimonies from its main protagonists and conductors. Complementary contributions about this exciting history are given.

Se comenta la publicación del Ministerio de Salud sobre la historia del Programa de Control de la Tuberculosis, como un hito dentro de la Salud Pública de Chile. Su autor, el distinguido historiador Marcelo López Campillay, recorre las distintas etapas vividas por la epidemia de tuberculosis en Chile y los sucesivos intentos de controlarla a través de un Programa de Control de la Tuberculosis moderno, que ha ido evolucionando a un programa cuya meta es la eliminación de la enfermedad como problema de salud pública, con una meta de menos de 5 casos por 100.000 habitantes para el año 2020. Se detallan los éxitos y dificultades que ha tenido que enfrentar el programa en sus distintas etapas, basados en los testimonios de sus principales protagonistas y se agregan aportes complementarios sobre esta interesante historia.

How better is random blinded re‑checking results in Revised National TB Control Programme, India.

Background: The Revised National Tuberculosis Control Programme (RNTCP) is implementing the External Quality assurance (EQA) and Random blinded re-checking (RBRC) as one of its important component. This nationwide study was conducted to determine (1) the number and types of RBRC errors and (2) the sensitivity and specificity among rechecked slides. Materials and Methods: The study was based on the monthly RBRC reports submitted by ~13,000 designated microscopy centres (DMCs) across the country under routine programmatic settings in 2010. The DMCs reports were compiled at district, state and national level. Results: A total of 11, 89,564 slides were rechecked from 11,039 DMCs. Of which 99.5% of rechecked slides did not have any errors. The sensitivity and specificity of the rechecked slides had 98% sensitivity and 100% specificity. Conclusion: RBRC is the crucial component of EQA and the results from the programme are found to be satisfactory. Based on the study findings, the earlier value of 80% sensitivity used for calculation of annual sample size for RBRC has been increased to 90% sensitivity. The annual RBRC sample size for DMCs has been increased by 1.5–2 folds.

Medicina, política y bien común: 40 años de historia del programa de control de la tuberculosis (1973−2013) / Medicine, politics and common good: 40 years of history of the tuberculosis control program (1973-2013)

En esta oportunidad nos ofrece una reseña bibliográfica de su libro lanzado en octubre de 2015, primero de la serie "Hitos de la Salud Pública en Chile", cuyo objetivo es preservar la memoria histórica y registrar las buenas prácticas de la Salud Pública chilena.(AU)

This time he offers us a bibliographic review of his book launched in October 2015, first of the series "Milestones of Public Health in Chile", whose objective is to preserve the historical memory and record the good practices of Chilean Public Health.(AU)

Record based evaluation of revised national tuberculosis control program (in Jamnagar District).

Background and Objectives: Tuberculosis will continue to be a major problem in foreseeable future because there is still large pool of infection in the community. Study is carried out to evaluate the impact of RNTCP and to identify the trend of Tuberculosis in Jamnagar district. Methods: A retrospective analysis of the recorded data from 2005 to 2012 obtained from District Tuberculosis centre, Jamnagar was carried out. The indicators used are: Annualized case notification, three month sputum conversion rate, success rate, mortality etc. Results: Downward trend of case notification rate is observed after 2009 except annualized new smear positive case which was not reached to 70% after 2008. The district had attained consistently satisfactory sputum conversion rates and success rate. Upward trend of failure cases is observed. Defaulter rate among the Retreatment cases was high. Mortality rate is more than 5% among New Smear Positive cases and around 12% among re treatment cases since 2008. Conclusion and Interpretation: there is still some challenges i.e. downward trend of case detection, Very low new smear negative case detection, high mortality, rising trend of failure cases etc. So, there is need of review of all activities and take sincere efforts to combat these challenges.

Calidad de la ejecución del Programa Nacional de Control de la Tuberculosis en el Policlínico Universitario "José Martí" / Quality in the implementation of the National Program of Tuberculosis Control in "José Martí" University Polyclinic

Se realizó una investigación observacional, descriptiva y de corte transversal, a fin de evaluar la calidad en la ejecución del Programa Nacional de Control de la Tuberculosis en el área de salud del Policlínico Universitario "José Martí" de Santiago de Cuba, durante el año 2010, para lo cual se aplicó la metodología propuesta por la Facultad de Salud Pública de La Habana. Fueron valorados la estructura, el proceso y los resultados, sobre la base de criterios, indicadores y estándares, según lo establecido en el Programa y los criterios de expertos. Los resultados demostraron que existían algunas deficiencias en la ejecución y vigilancia del Programa, debido al desconocimiento del personal médico y de enfermería acerca de las medidas de control de la enfermedad, con insuficiencias importantes en cuanto a la pesquisa y el estudio de personas con sospecha de la infección, por lo que se retardaba el diagnóstico de los afectados, con el consiguiente incremento del tiempo en que permanecían contagiados, a pesar de tener buenas condiciones objetivas para llevarlo a cabo. Solo fue diagnosticado 75,0 % de los afectados en la atención primaria, y en sentido general el cumplimiento del Programa fue evaluado como deficiente, por lo que se recomendó insistir en la capacitación de los profesionales de la salud, de modo que se eleve la competencia de ellos al respecto.

An observational, descriptive and cross-sectional investigation was carried out, in order to evaluate the quality in the implementation of the National Program of Tuberculosis Control in the health area from «José Martí¼ University Polyclinic in Santiago de Cuba, during the year 2010, for which the methodology proposed by the Public Health Faculty from Havana was applied. The structure, process and the results were evaluated, on the basis of criteria, indicators and standards, according to the Program and the experts' criteria. The results demonstrated that some deficiencies existed in the implementation and surveillance of the Program, due to the medical and nursing staff `s ignorance on the control measures of the disease, with remarkable inadequacies as for the screening and the study of patients candidates for the infection, so that the diagnosis of those patients affected was delayed, with the subsequent increment of time during which they remained contaminated, in spite of having good objective conditions to be carry out. Only 75.0% of the affected patients was diagnosed in the primary care, and in general the implementation of the Program was evaluated as inadequate, so that it was recommended to insist in the training of the health professionals, so that their competence rises in this respect.