Como eu faço avaliação ecocardiográfica de pericardite constritiva / My approach to echocardiographic assessment for constrictive pericarditis

A pericardite constritiva (PC) é uma condição na qual a cicatrização e perda de elasticidade do pericárdio resultam em enchimento ventricular prejudicado, disfunção diastólica e insuficiência cardíaca direita. O diagnóstico dessa patologia é desafiador, sendo frequente a necessidade de técnicas de imagem multimodal, dentre as quais a ecocardiografia representa a modalidade de imagem inicial para a avaliação diagnóstica, além de permitir a diferenciação da PC da cardiomiopatia restritiva (CMR) e outras condições que mimetizam constrição. (AU)

Constrictive pericarditis (CP) is a condition in which scarring and loss of elasticity of the pericardium result in impaired ventricular filling, diastolic dysfunction, and right heart failure. The diagnosis of this pathology is challenging, with frequent need for multimodal imaging techniques, among which echocardiography represents the initial imaging modality for the diagnostic evaluation, in addition to allowing the differentiation of CP from restrictive cardiomyopathy (RCM) and other conditions that mimic constriction. (AU)

Paciente con quistes pulmonares y diagnóstico de coinfección con tuberculosis e hidatidosis: reporte de un caso pediátrico / Patient with pulmonary cysts and diagnosis of co-infection with tuberculosis and hydatidosis. Pediatric cases report

Existen numerosas entidades en la población pediátrica que pueden presentarse en forma de quistes o como lesiones de similares características. De estas patologías, las infecciosas son las más frecuentes. Se presenta el caso de una paciente oriunda de Bolivia con migración reciente a la Argentina que presentó una coinfección con tuberculosis e hidatidosis pulmonar. Ambas infecciones se pueden presentar con signos y síntomas similares y, aunque la asociación citada es poco frecuente en la bibliografía, ciertos mecanismos inmunitarios podrían intervenir en la coinfección de parásitos helmintos y micobacterias. Ambas patologías son infecciones prevalentes en nuestra región y deben ser tenidas en cuenta entre los diagnósticos diferenciales ante pacientes con imágenes quísticas o cavitarias pulmonares.

Numerous entities in the pediatric population can present in the form of cysts or as lesions with similar characteristics. Of the pathologies that can cause these images in children, infectious diseases are the most frequent. We present the case of a native of Bolivia with recent immigration to Argentina who presented a pulmonary co-infection with tuberculosis and hydatidosis. Both infections can present with similar signs and symptoms and although this association is rarely reported in the literature, certain immunological mechanisms could intervene in the causal association of co-infection between helminth parasites and mycobacteria. Both pathologies are very prevalent infections in our region and should be taken into account among the differential diagnoses in patients with cystic or cavitary pulmonary diseases.

Terapias biológicas y tuberculosis en pediatría / Biological therapies and tuberculosis in pediatrics

En los últimos años, ha habido un aumento sostenido del uso de terapias inmunomoduladoras como las terapias biológicas y en un período más reciente, de las terapias con moléculas pequeñas. Estos tratamientos constituyen un factor de riesgo más para enfermar de tuberculosis en adultos y aunque en menor grado, también en niños, especialmente con el uso de anti TNF-α, por lo que antes de iniciar una terapia biológica, hay que descartar la tuberculosis activa y la latente. En el tratamiento de una tuberculosis activa producida por un biológico se debe prolongar la etapa de continuación a 9 meses. Es importante el seguimiento clínico prolongado en años de quienes usan o han completado el uso de estas terapias. Hay que posponer la vacunación BCG en los hijos de madres que usaron terapias biológicas durante la gestación hasta la edad 6 a 12 meses de los niños. El foco de esta revisión está centrado en la tuberculosis por progresión de una forma latente a una activa o por un contacto estrecho con una persona con tuberculosis pulmonar en pacientes que reciben terapias biológicas anti TNF alfa de uso inmunoreumatológico.

In recent years, there has been a sustained increase in the use of immunomodulatory therapies such as biologic therapies and, more recently, small molecule therapies. Those therapies have become another risk factor for tuberculosis in adults and, although to lesser degree, also in children, especially some of them, such as anti-TNF α. Before starting biological therapy, active tuberculosis and latent tuberculosis must be ruled out. In the treatment of active tuberculosis caused by a biologic, the continuation stage should be extended to 9 months. Long-term clinical follow-up in years of those who use them or have completed their use, is important. BCG vaccine should be postponed in children of mother who used biologic therapies during pregnancy until the children ́s age 6 to 12 months. The focus of this review is centered on tuberculosis due to progression from a latent to an active form or due to close contact with a person with pulmonary tuberculosis in patients receiving anti-TNF alpha biological therapies for immunorheumatology use.

Assessment of factors associated with potential drug-drug interactions in patients with tuberculosis and HIV/AIDS

Abstract INTRODUCTION: The concomitant use of antituberculosis and antiretroviral drugs, as well as drugs to treat other diseases, can cause drug-drug interactions. This study aimed to describe potential drug-drug interactions (pDDI) in patients with TB and HIV/AIDS co-infection, as well as to analyze possible associated factors. METHODS: This study was performed in a reference hospital for infectious and contagious diseases in the southeastern region of Brazil and evaluated adult patients co-infected with tuberculosis and HIV/AIDS. A cross-sectional study was conducted in which sociodemographic, clinical, and pharmacotherapeutic characteristics were assessed. The pDDI were identified using the Drug-Reax software. Association analysis was performed using either a chi-squared test or a Fisher's exact test. Correlation analysis was performed using the Spearman's coefficient. RESULTS: The study included 81 patients, of whom 77 (95.1%) were exposed to pDDI. The most frequent interactions were between antituberculosis and antiretroviral drugs, which can cause therapeutic ineffectiveness and major adverse reactions. A positive correlation was established between the number of associated diseases, the number of drugs used, and the number of pDDI. An association was identified between contraindicated and moderate pDDI with excessive polypharmacy and hospitalization. CONCLUSIONS: We found a high frequency of pDDI, especially among those hospitalized and those with excessive polypharmacy. These findings highlight the importance of pharmacists in the pharmacotherapeutic monitoring in these patients.

Tuberculosis associated with diabetes mellitus by age group in Brazil: a retrospective cohort study, 2007-2014

ABSTRACT Diabetes mellitus (DM) has important implications for tuberculosis (TB), as it increases the risk for disease activation and is associated with unfavorable TB treatment outcomes. This study analyzed the association between TB and DM (TBDM) in Brazil from 2007 to 2014. This was a retrospective cohort study carried out in 709,429 new cases of TB reported to the national disease notification system of the Brazilian Ministry of Health. Sociodemographic and clinical data, test results, and treatment outcomes were analyzed. TBDM was found in 6.0% of TB cases, mostly in men aged 18-59 years. The lethality rate was 5.1% higher in all age groups with diabetes, except in those older than 60 years of age. The frequency of multi-drug-resistant tuberculosis (MDR-TB) in patients with DM was higher in those without DM, with a 1.6- to 3.8-fold increase in the odds of MDR-TB. The elderly showed an increase in the prevalence of TBDM from 14.3% to 18.2%. Women were more likely to have DM, and elderly women had 41.0% greater chance of having DM. Relapse was significant among patients younger than 17 years of age. TBDM was high in Brazil, affected all age groups, and was associated with unfavorable TB treatment outcomes. We emphasize the need for strategies for the clinical management of diabetic tuberculosis patients in Brazil aiming at minimizing relapses, deaths, and MDR-TB.

Nota informativa Tuberculosis y COVID-19 (19 de marzo 2020) / Tuberculosis and COVID-19 Information Note (March 19, 2020)

A medida que el mundo se une para hacer frente a la pandemia del COVID-19, es importante garantizar que los servicios y operaciones esenciales para hacer frente a los problemas de salud prevalentes, continúen protegiendo la vida de las personas con TB y otras enfermedades o condiciones de salud. Los servicios de salud, incluidos los programas nacionales para combatir la TB, deben involucrarse activamente para garantizar una respuesta efectiva y rápida al COVID-19.

Tuberculosis y síndrome inflamatorio de reconstitución inmunológica. Caso pediátrico / Tuberculosis and immune reconstitution inflammatory syndrome. Pediatric case

La tuberculosis es una enfermedad muy frecuente en nuestro medio. A pesar de que la detección precoz y el tratamiento adecuado logran la curación en la mayoría de los pacientes, la dificultad en el diagnóstico, el abandono del tratamiento y la aparición de resistencia a los fármacos tradicionales generan que, en la actualidad, continúe siendo un importante problema de salud pública. En la Argentina, la tasa de morbilidad es de 25/100 000 habitantes, con un leve aumento en la mortalidad.Se presenta el caso de una paciente pediátrica con tuberculosis, que tuvo múltiples complicaciones asociadas a la enfermedad y a su tratamiento, entre las cuales se incluye el síndrome in-flamatorio de reconstitución inmunológica, también conocido como reacción paradojal al tratamiento antituberculoso. Este representa una consecuencia clínica adversa al restablecimien-to de la inmunidad en el paciente que padece una infección sistémica grave, como la tuberculosis miliar.

Tuberculosis is a very frequent disease in our environment. Although early detection and adequate treatment achieve cure in most patients, the difficulty in diagnosis, the abandonment of treatment and the appearance of resistance to traditional drugs generate that at present it continues to represent an im-portant public health problem. In Argentina, the morbidity rate is 25/100,000 inhabitants, with a slight increase in mortality.We present the case of a pediatric patient with tuberculosis and multiple complications associated with the disease and its treatment. One of these complications was the immune re-constitution inflammatory syndrome or paradoxical reaction to antituberculosis treatment. It represents an adverse clinical con-sequence of the restoration of immunity in the patient suffering from a serious systemic infection such as miliary tuberculosis.

Tuberculose e diabetes: associação com características sociodemográficas e de diagnóstico e tratamento. Brasil, 2007-2011 / Tuberculosis and diabetes: association with sociodemographic characteristics and diagnosis and treatment of tuberculosis. Brazil, 2007-2011

RESUMO: Introdução: A comorbidade tuberculose e diabetes ainda continua um desafio para a saúde pública mundial. Objetivo: Analisar o perfil sociodemográfico e as características do diagnóstico e tratamento dos casos de tuberculose com e sem diabetes no Brasil. Métodos: Estudo transversal, com dados do Sistema de Informação de Agravos de Notificação e do Sistema de Gestão Clínica de Hipertensão Arterial e Diabetes Mellitus da Atenção Básica, no período de 2007 a 2011. Modelo de regressão de Poisson com variância robusta foi utilizado para estimar a razão de prevalência (RP) e seus respectivos intervalos de confiança. Resultados: A comorbidade estudada foi encontrada em 7,2% dos casos. Modelo hierárquico mostrou maior RP entre indivíduos do sexo feminino (RP = 1,31; intervalo de confiança de 95% - IC95% 1,27 - 1,35); maior associação nas faixas etárias 40-59 anos e ≥ 60 anos (RP = 11,70; IC95% 10,21 - 13,39 e RP = 17,49; IC95% 15,26-20,05) e com resultado positivo da baciloscopia - primeira amostra (RP = 1,40; IC95% 1,35 - 1,47). Reingresso após abandono e abandono foram inversamente associados na comorbidade (RP = 0,66; IC95% 0,57 - 0,76 e RP = 0,79; IC95% 0,72 - 0,87). Conclusão: Os achados, como a relação inversa do abandono ao tratamento da tuberculose no grupo das pessoas com comorbidade, reforçam a importância de ações integradas nos serviços para mudar o cenário dessa desafiadora comorbidade.

ABSTRACT: Introduction: Tuberculosis and diabetes comorbidity remains a challenge for global public health. Objective: To analyze the sociodemographic profile and the diagnostic and treatment characteristics of tuberculosis cases with and without diabetes in Brazil. Methods: This is a cross-sectional study with data from the Notifiable Diseases Information System and the Hypertension and Diabetes Mellitus Primary Care Clinical Management System, from 2007 to 2011. We adopted a Poisson regression model with robust variance to estimate the prevalence ratios (PR) and their respective confidence intervals. Results: We found the studied comorbidity in 7.2% of cases. The hierarchical model showed a higher PR among women (PR=1.31; 95% confidence interval - 95%CI 1.27-1.35); a greater association in the age groups 40-59 years and ≥ 60 years (PR=11.70; 95%CI 10.21-13.39, and PR=17.49; 95%CI 15.26-20.05), and in those with positive sputum smear microscopy results - 1st sample (PR=1.40; 95%CI 1.35-1.47). Return after treatment discontinuation and treatment discontinuation were inversely associated with comorbidity (PR=0.66; 95%CI 0.57-0.76 and PR=0.79; 95%CI 0.72-0.87). Conclusion: The findings, such as the inverse relationship with tuberculosis treatment discontinuation in the group of people with comorbidity, reinforce the importance of integrated actions in health services to change the scenario of this challenging comorbidity.

Clinical and epidemiological features of tuberculosis in children and adolescents / Características clínicas e epidemiológicas da tuberculose em crianças e adolescentes / Características clínicas y epidemiológicas de la tuberculosis en niños y adolescentes

ABSTRACT Objective: To analyze the clinical and epidemiological features of tuberculosis in children and adolescents in an infectious diseases reference hospital. Method: A documental and retrospective study was carried out with 88 medical files in an infectious diseases reference hospital in the state of Ceará. Data were analyzed by univariate, bivariate and multivariate approaches. Results: It was found that, depending on the tuberculosis type, its manifestations may vary. The logistic regression model considered only pulmonary tuberculosis due to a number of observations and included female sex (95% CI: 1.4-16.3), weight loss (95% CI: 1.8-26.3), bacilloscopic screening (95% CI: 1.5-16.6) and sputum collected (95% CI: 1.4-19.4) as possible predictors. Conclusions: Children and adolescents present different manifestations of the disease depending on the tuberculosis type that affects them. Knowing the most common features of each condition could enhance early diagnosis and, consequently, result in adequate treatment and care.

RESUMO Objetivo: Analisar as características clínicas e epidemiológicas da tuberculose em crianças e adolescentes de um hospital de referência em doenças infecciosas. Método: Foi realizado um estudo documental e retrospectivo com 88 prontuários médicos em um hospital de referência em doenças infecciosas no estado do Ceará. Os dados foram analisados através das abordagens univariada, bivariada e multivariada. Resultados: Verificou-se que, dependendo do tipo de tuberculose, suas manifestações podem variar. O modelo de regressão logística considerou apenas a tuberculose pulmonar devido a um número de observações e incluiu sexo feminino (IC 95%: 1,4-16,3), perda de peso (IC 95%: 1,8-26,3) e baciloscopia (IC 95%: 1,5-16,6) com coleta de escarro (IC95%: 1,4-19,4) como possíveis preditores. Conclusão: Crianças e adolescentes apresentam diferentes manifestações da doença dependendo do tipo de tuberculose que os afeta. Conhecer as características mais comuns de cada condição pode melhorar o diagnóstico precoce e, consequentemente, levar a tratamentos e cuidados adequados.

RESUMEN Objetivo: Analizar las características clínicas y epidemiológicas de la tuberculosis en niños y adolescentes en un hospital de referencia de enfermedades infecciosas. Método: Se realizó un estudio documental y retrospectivo con 88 archivos médicos en un hospital de referencia de enfermedades infecciosas en el estado de Ceará. Se analizaron los datos por enfoques univariados, bivariados y multivariados. Resultados: Se encontró que, dependiendo del tipo de tuberculosis, sus manifestaciones pueden variar. El modelo de regresión logística consideró solo la tuberculosis pulmonar, debido a varias, observaciones e incluyó el género femenino (IC 95%: 1,4-16,3), la pérdida de peso (IC 95%: 1,8-26,3), la revisión baciloscopia (95 % CI: 1,5-16,6) y el esputo recolectado (95% CI: 1,4-19,4) como posibles predictores. Conclusiones: Los niños y adolescentes presentan diferentes manifestaciones de la enfermedad en función del tipo de tuberculosis que los afecta. Conocer las características más comunes de cada afección podría mejorar el diagnóstico temprano y, en consecuencia, resultar en un tratamiento y atención adecuados.

Enfermedad granulomatosa hepática / Hepatic granulomatous disease

Resumen Los granulomas son lesiones circunscritas compuestas principalmente por células mononucleares que surgen en respuesta a estímulos antigénicos pobremente degradables. Se encuentran en 2 a 15 % de las biopsias hepáticas; su hallazgo puede significar desde un fenómeno incidental, hasta la manifestación de una enfermedad sistémica de origen infeccioso, autoinmune o neoplásico. El cuadro clínico suele apuntar a la patología subyacente, sin embargo, la lista de condiciones asociadas es amplia y difiere con base en los antecedentes epidemiológicos y a las características basales del paciente. El elemento de mayor utilidad para su estudio es la historia clínica exhaustiva, con énfasis en viajes recientes, exposición de riesgo y consumo de fármacos o alimentos crudos o exóticos. El análisis histopatológico detallado puede auxiliar en la identificación de la etiología, por ejemplo, la presencia de granulomas epitelioides con necrosis caseosa indica tuberculosis y su ausencia, sarcoidosis; la abundancia de eosinófilos es señal de reacciones farmacológicas o infecciones parasitarias; la presencia de cuerpos extraños puede ser la causa de la enfermedad granulomatosa hepática. En este artículo describimos los aspectos clínico-patológicos básicos de esta enfermedad y proveemos un breve resumen de las etiologías más comunes, principalmente en la región de Latinoamérica.

Abstract Granulomas are circumscribed lesions mainly composed of mononuclear cells that arise in response to poorly degradable antigenic stimuli. They are found in 2-15 % of liver biopsies and the meaning of their finding can range from an incidental phenomenon to the manifestation of a systemic disease of infectious, autoimmune or neoplastic origin. Clinical presentation usually points at the underlying pathology; however, the list of associated conditions is extensive, and differs based on patient epidemiological history and baseline characteristics. The most useful element for their study is a thorough medical history, with an emphasis on recent trips, exposures and consumption of drugs or raw or exotic foods. Detailed histopathological analysis may help identify the etiology. For example, the presence of epithelioid granulomas with caseous necrosis indicates tuberculosis and, its absence, sarcoidosis; eosinophil abundance can be associated with drug reactions or parasitic infections; and the presence of foreign bodies can be the cause of granulomatous liver disease (GLD). In this article, we describe the basic clinical-pathological aspects of GLD, and provide a brief summary of the most common etiologies, with an emphasis on the Latin-American region.

Panorama de internações e mortalidade em pacientes acima de 60 anos por sequelas da tuberculose / Panorama of hospitalizations and mortality in patients over 60 years due to tuberculosis sequelae

Objetivo: Trazer um panorama dos últimos 5 anos acerca das internações e mortalidade por sequelas da tuberculose em pacientes com mais de 60 anos. Métodos: Utilização de dados disponibilizados pelo DATASUS, com as seguintes variáveis: sequelas de tuberculose (B90 do CID-10); sexo; faixa etária ≥60 anos; de janeiro de 2012 a dezembro de 2016; nas regiões brasileiras. Resultados: De 349 idosos internados por sequelas de tuberculose, 137 (39,25%) foram na Região Nordeste, 100 (28,65%) na Sudeste, 73 (20,91%) na Sul, 32 (9,16%) na Centro-Oeste e 7 (2,0%) na Norte, sendo 79 casos em 2012, 80 em 2013, 42 em 2014, 70 em 2015 e 78 em 2016. A maioria dos pacientes (216) era do sexo masculino, bem como 66,76% dos casos encontravam-se na faixa dos 60 aos 69 anos. A taxa nacional de mortalidade foi de 8,02, com 17,81 na Região Sul, 14,29 na Norte, 6,0 na Sudeste, 5,11 na Nordeste e 3,13 na Centro-Oeste. O maior número se deu em 2013 (11,25) e o menor em 2012 (5,06). A faixa etária com maior mortalidade foi a de acima de 80 anos, com 24,0, e o sexo mais predominante, o masculino, com 9,72. Conclusão: A análise dos dados epidemiológicos supracitados é essencial para um melhor manejo dos pacientes idosos, de maneira a diminuir cada vez mais os índices de complicações, tratando de maneira eficaz e monitorando atentamente quaisquer eventos durante a internação desses pacientes. (AU)

Objective: To provide an overview of the last 5 years on hospitalizations and mortality from tuberculosis sequelae in patients over 60 years of age. Methods: Use of data provided by DATASUS, with the following variables: tuberculosis sequelae (B90 of ICD- 10); gender; age range ≥60 years; from January / 2012 to December / 2016; in the Brazilian regions. Results: Of 349 elderly people hospitalized for TB sequelae, 137 (39.25%) were from the Northeast region, 100 (28.65%) from the Southeast, 73 (20.91%) from the South, 32 (9.16%) from the In the Central West, and 7 (2.0%) from the North, with 79 cases in 2012, 80 in 2013, 42 in 2014, 70 in 2015 and 78 in 2016. Most patients (216) were male, and 66.76% of the cases were in the range of 60 to 69 years. The national mortality rate was 8.02, with 17.81 in the South region, 14.29 in the North, 6.0 in the Southeast, 5.11 in the Northeast, and 3.13 in the Midwest. The highest number occurred in 2013 (11.25), and the lowest in 2012 (5.06). The age group with the highest mortality was over 80 years old, with 24.0, and male gender was the most predominant, with 9.72. Conclusion: The analysis of the abovementioned epidemiological data is essential for a better management of the elderly patients, in order to reduce the complication rates, treating effectively, and closely monitoring any events during these patients hospitalization. (AU)

Derrame pleural: análisis de la eficacia diagnóstica / Diagnostic analysis of pleural effusion

Analizar las características epidemiológicas, clínicas y efectividad del diagnóstico de derrame pleural. Métodos: estudio descriptivo, retroprospectivo transversal, con una muestra constituida por pacientes atendidos en el período enero 2013 a junio 2018 en los que se demostrase compromiso pleural, parenquimatoso pulmonar o de otro órgano y cuyo motivo de ingreso fue el estudio de derrame pleural en el Servicio de Medicina interna en el Hospital General del Oeste "Dr. José Gregorio Hernández". Tratamiento estadístico: análisis estadístico descriptivo basado en medidas de tendencia central (media y desvia- ción estándar) para las variables cuantitativas y de proporción (moda, porcentaje) en la variables categóricas y/o cualitativas. Se midió el índice Kappa entre la sospecha diagnóstica y el diagnós- tico realizado, para la valoración del grado de concordancia diagnóstica. Resultados: de 261 pacientes con derrame pleural, el 64,2% se encontraba en edad productiva, predominó el sexo mas- culino, y el nivel socioeconómico Graffar IV. La causa más frecuente de derrame pleural fue la tuberculosis pleural. La concordancia diagnóstica promedio fue de 0,70. Conclusión:Se evidenció un incremento del tiempo diagnóstico, relacionado al tiempo de obtención de resultados en los estudios paraclínicos. El cálculo del índice de concordancia entre el diagnóstico presuntivo y el definitivo fue importante(AU)

Pleural effusion is a frequent cause of admission to internal medicine wards worldwide, and is frequently secondary to clinical entities that are among the leading causes of mortality. Objective: To analyze the epidemiological, clinical characteristics and effectiveness in the diagnosis of pleural effusion. Methods:descriptive, retroprospective, transversal study, with a sample of patients treated from the period January 2013 to June 2018 in which pleural, parenchymal or pulmonary involvement of another organ were demonstrated when the reason for admission was the study of pleural effusion in the Internal Medicine Department at the Hospital General del Oeste "Dr. José Gregorio Hernández". Statistical analysis: Consisted of a descriptive statistical analysis based on measures of central tendency for the quantitative variables and proportion in the categorical and/or qualitative variables. The Kappa index was measured between the diagnostic suspicion and the diagnosis made, for the assessment of the degree of diagnostic agreement. Results: Of 261 patients with pleural effusion, 64.2% were of productive age, the male sex predominated, and the Graffar IV socioeconomic level. Pleural tuberculosis was the most common cause of pleural effusion. The average diagnostic concordance was 0.70. Conclusion:There was an increase in the diagnostic time, related to the time of obtaining results in the complementary studies. The calculation of the concordance index between the presumptive and definitive diagnosis was important(AU)

Aspects related to the outcomes of the treatment, in international borders, of cases of tuberculosis as associated to comorbidities / Aspectos relacionados con el resultado de tratamiento de los casos de tuberculosis asociados a comorbilidades en situación de frontera internacional / Aspectos relacionados ao desfecho de tratamento dos casos de tuberculose associadas à comorbidades em situação de fronteira internacional

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.

Simultaneous occurrence of Kaposi sarcoma and tuberculosis; Kaposi sarcoma and lymphoma in the same lymph node: a report on two HIV-positive patients from Zimbabwe

Abstract Reports of simultaneous infections and neoplasms in patients with acquired immune deficiency syndrome (AIDS) are occasionally seen in the literature. However, coexistent lymphoma with tuberculosis, and Kaposi sarcoma (KS) with tuberculosis occurring in the same lymph node is rare. Coexistent lesions pose diagnostic difficulties. In this article, we report two HIV-positive patients from Zimbabwe who displayed KS and tuberculosis; KS and diffuse large B-cell lymphoma in the same lymph node. We found only one similar case presentation in the literature, which was reported in India.

Epidemiología de la Tuberculosis en el Área de Salud de Pavas, Costa Rica / Epidemiology of Tuberculosis in the Pavas Health Area, Costa Rica / Epidemiologia da Tuberculose na Área de Saúde de Pavas, Costa Rica

Resumen 17. Este estudio tuvo por objetivo identificar los factores de riesgo asociados a la aparición de tuberculosis en Rincón Grande, Pavas. Se trata de una investigación cuantitativa realizada en dos fases: la primera correspondió a una descripción de los casos de tuberculosis en toda el área de estudio y la segunda, a un estudio de casos y controles con la población de Rincón Grande. En ambas fases se utilizó la totalidad de casos registrados de tuberculosis pulmonar entre 2010 y 2016. La fuente de datos fue el Sistema de Información Integrado de Salud y el libro de registro de casos. La selección de los controles fue aleatoria simple, con el total de sintomáticos respiratorios y el reporte del ELISA. Entre los resultados se denota que la incidencia en Pavas (periodo 2010-2016), osciló entre 10.2 y 22.2 casos por cada 100 000 habitantes. El 70,4% de los casos tenía entre 20 y 64 años de edad, el 59,0% correspondió a hombres; el 29,6%, a extranjeros. El 18,8% presentó antecedentes de consumo de drogas y el 51,1% tenían estudios con escolaridad primaria o menor. Los factores asociados son hacinamiento crítico, sexo (OR=1.9, IC=0.1-3.6), co-infección con VIH (OR=9.7, IC=2.3-39.6) y estado nutricional. Los hombres presentan 1.9 más veces la posibilidad de desarrollar tuberculosis y las personas con VIH presentan 9.7 veces dicha posibilidad. Se concluye que la seropositividad por VIH, las condiciones de hacinamiento, la desnutrición y el sexo masculino son factores de riesgo para la incidencia de tuberculosis en Rincón Grande.

Abstract 21. The objective of this study was to identify the risk factors associated with the appearance of tuberculosis in Rincón Grande, Pavas. This is a quantitative investigation carried out in two phases: the first corresponded to a description of the cases of tuberculosis in the entire study area and the second, to a case-control study with the population of Rincón Grande. In both phases, the totality of registered cases of pulmonary tuberculosis between 2010 and 2016 was used. The source of data was the Integrated Health Information System and the case record book. The selection of controls was simple random, with the total of respiratory symptoms and the ELISA report. Among the results it is noted that the incidence in Pavas (period 2010-2016), ranged between 10.2 and 22.2 cases per 100 000 inhabitants. 70,4% of the cases were between 20 and 64 years of age, 59,0% corresponded to men; 29,6%, to foreigners. 18,8% had a history of drug use and 51,1% had studies with primary or lower education. The associated factors are critical overcrowding, sex (OR = 1.9, CI = 0.1-3.6), co-infection with HIV (OR = 9.7, CI = 2.3-39.6) and nutritional status. Men present 1.9 times more the possibility of developing tuberculosis and people with HIV present 9.7 times that possibility. It is concluded that HIV seropositivity, crowded conditions, malnutrition and male sex are risk factors for the incidence of tuberculosis in Rincón Grande.

Resumo 25. O objetivo deste estudo foi identificar os fatores de risco associados ao aparecimento da tuberculose em Rincón Grande, Pavas. Trata-se de uma investigação quantitativa realizada em duas fases: a primeira correspondeu a uma descrição dos casos de tuberculose em toda a área de estudo e a segunda, a um estudo caso-controle com a população de Rincón Grande. Em ambas as fases, utilizou-se a totalidade dos casos registrados de tuberculose pulmonar entre 2010 e 2016. A fonte de dados foi o Sistema Integrado de Informação em Saúde e o livro de registro de casos. A seleção dos controles foi aleatória simples, com o total de sintomas respiratórios e o laudo ELISA. Entre os resultados, observa-se que a incidência em Pavas (período 2010-2016) variou entre 10,2 e 22,2 casos por 100 mil habitantes. 70,4% dos casos tinham entre 20 e 64 anos de idade, 59,0% correspondiam a homens; 29,6% para estrangeiros. 18,8% tinham histórico de uso de drogas e 51,1% tinham estudos com ensino primário ou inferior. Os fatores associados são superlotação crítica, sexo (OR = 1,9, IC = 0,1-3,6), co-infecção por HIV (OR = 9,7, IC = 2,3-39,6) e estado nutricional. Os homens apresentam 1,9 vezes mais a possibilidade de desenvolver tuberculose e as pessoas com HIV apresentam 9,7 vezes essa possibilidade. Conclui-se que a soropositividade ao HIV, condições de superlotação, desnutrição e sexo masculino são fatores de risco para a incidência de tuberculose em Rincón Grande.

Tuberculosis o colagenosis: un dilema diagnóstico / Tuberculosis or collagenosis: a diagnostic dylemma

Introducción: Colagenosis y tuberculosis comparten síntomas y signos, pero además, el trastorno autoinmune y los tratamientos inmunosupresores que reciben los pacientes con colagenosis, los hacen más vulnerables a esta infección, lo que puede constituir un dilema diagnóstico. Objetivo: Contribuir al conocimiento de la relación entre tuberculosis y colagenosis. Presentación de casos: Se presentan tres adolescentes con tuberculosis, atendidos en el Centro de Referencia Nacional para la Tuberculosis Infantil. Dos enfermos tenían diagnóstico previo de colagenosis (artritis idiopática juvenil y polimiositis) con tratamiento esteroideo en exacerbaciones o continuo desde hacía un año, respectivamente. El tercero presentó un síndrome febril prolongado con pleuresía y pericarditis, con sospecha de lupus eritematoso diseminado. Se diagnosticó tuberculosis por test de mantoux hiperérgico. El tratamiento fue prolongado con esteroides, drogas antituberculosas y pericardiotomía al inicio del proceso, con evolución tórpida y fallo de tratamiento. Todo el tiempo se trató de descartar una enfermedad del colágeno. Se confirmó por cultivo la tuberculosis en los tres pacientes y la evolución final fue satisfactoria. Se exponen las características de cada enfermo y se analiza la relación entre ambas entidades. Conclusiones: Se presentan tres casos que ejemplifican la relación entre tuberculosis y colagenosis(AU)

Introduction: Collagenosis and tuberculosis share similar symptoms and manifestations; and in addition, the autoimmune disorder and inmunosuppressive treatments that patients with collagenosis receive make them more vulnerable to this infection which can constitute a diagnostic dylemma. Objective: To contribute to a better knowledge on the relation among tuberculosis and collagenosis. Cases presentation: Three adolescents suffering collagenosis are presented. They were attended in the National Reference Center for Children Tuberculosis. Two of the patients had previous diagnostic of collagenosis (juvenile idiopatic arthritis and polymyositis) with steroids treatment in exacerbations or continuous since a year ago. The third patient presented a prolonged febrile syndrome with pleurisy and pericarditis, with suspicions of disseminated lupus erythematosus. Tuberculosis was diagnosed by the test of hyperergic Mantoux. The treatment was prolonged with steroids, antiturberculosis drugs and pericardiotomy at the beginning of the process, with bad evolution and failure of the treatment. All the time it was intended to rule out collagen disease. Tuberculosis was confirmed by culturing in the three patients and final evolution was satisfactorily. Characteristics of each patient were exposed and it was analyzed the relation among both diseases. Conclusions: Three cases that exemplify the relation among tuberculosis and collagenosis(AU)

Análisis de situación de tuberculosis en el Área Programática del Hospital General de Agudos Parmenio Piñero: Año 2017 / Analysis of tuberculosis situation at Programmatic Area of the Acute General Hospital Parmenio Piñero: 2017

El área programática del Hospital Parmenio Piñero (AP-HGAPP) se localiza en el sur de la ciudad, e incluye parte de las comunas 7, 8, 9, 10, 6 y 4. Según datos provenientes del Censo 20105, se registraron 324.179 personas viviendo en este territorio, con un porcentaje de población con Necesidades Básicas Insatisfechas de 10,4% (superior al valor promedio de CABA de 7%). Se presenta en este informe un análisis de situación de tuberculosis, tomando como eje el territorio y la población a cargo del hospital y sus centros de salud y acción comunitaria. (AU)