Abandonment of therapy in multidrug-resistant tuberculosis: Associated factors in a region with a high burden of the disease in Perú / Abandono del tratamiento en tuberculosis multirresistente: factores asociados en una región con alta carga de la enfermedad en Perú

Introduction: In the context of multidrug-resistant tuberculosis, abandonment of therapy represents a serious public health problem that affects the quality of life of patients, families, and communities. Managing this phenomenon places a burden on health systems since it causes free sources of transmission in the community, thereby increasing prevalence and mortality. Thus, there is a need to study factors associated with this problem. Objective: This study sought to identify risk factors associated with the abandonment of therapy by patients with multidrug-resistant tuberculosis in the Peruvian region of Callao. Materials and methods: We conducted an analytical case-control study (cases=80; controls=180) in patients under treatment from January 1st, 2010, to December 31, 2012. Risk factors were identified using logistic regression; odds ratios (OR) and 95% confidence intervals (CI) were calculated. Results: The multivariate analysis identified the following risk factors: Being unaware of the disease (OR=23.10; 95% CI 3.6-36.79; p=0.002); not believing in healing (OR=117.34; 95% CI 13.57-124.6; p=0.000); not having social support (OR=19.16; 95% CI 1.32-27.77; p=0.030); considering the hours of attention to be inadequate (OR=78.13; 95% CI 4.84-125.97; p=0.002), and not receiving laboratory reports (OR=46.13; 95% CI 2.85-74.77; p=0.007). Conclusion: Health services must focus on the early detection of conditions that may represent risk factors to proactively implement effective, rapid and high-impact interventions.

Introducción. En la tuberculosis multirresistente, el abandono del tratamiento constituye un grave problema de salud pública que afecta la calidad de vida de los pacientes, sus familias y la comunidad. El enfrentarlo supone una carga para los sistemas sanitarios debido a que provoca fuentes de transmisión libre en la comunidad e incrementa la prevalencia y la mortalidad. De ahí, la necesidad de investigar los factores asociados con esta situación. Objetivo. Determinar los factores de riesgo asociados con el abandono del tratamiento en pacientes con tuberculosis multirresistente en la región de Callao (Perú). Materiales y métodos. Se hizo un estudio analítico de casos y controles (80 casos y 180 controles) en tratamiento entre el 1° enero del 2010 y el 31 diciembre del 2012. Los factores se determinaron mediante regresión logística, y se calcularon los odds ratios (OR) y los intervalos de confianza (IC) del 95 %. Resultados. En el análisis multivariado se determinaron los siguientes factores de riesgo: no tener conocimiento de la enfermedad (OR=23,10; IC95%: 3,6-36,79; p=0,002); no creer en la curación (OR=117,34; IC95%: 13,57-124,6; p=0,000); no tener apoyo social (OR=19,16; IC95%: 1,32-27,77; p=0,030); no considerar adecuado el horario de atención (OR=78,13; IC95%: 4,84-125,97; p=0,002), y no recibir los resultados de laboratorio (OR=46,13; IC95%: 2,85-74,77; p=0,007). Conclusión. Los servicios de salud deben esforzarse en la determinación precoz de las condiciones que podrían convertirse en factores de riesgo, lo cual ayudaría a implementar preventivamente intervenciones efectivas, rápidas y de alto impacto.

Abandono del tratamiento en tuberculosis multirresistente: factores asociados en una región con alta carga de la enfermedad en Perú / Abandonment of therapy in multidrug-resistant tuberculosis: Associated factors in a region with a high burden of the disease in Perú

Resumen Introducción. En la tuberculosis multirresistente, el abandono del tratamiento constituye un grave problema de salud pública que afecta la calidad de vida de los pacientes, sus familias y la comunidad. El enfrentarlo supone una carga para los sistemas sanitarios debido a que provoca fuentes de transmisión libre en la comunidad e incrementa la prevalencia y la mortalidad. De ahí, la necesidad de investigar los factores asociados con esta situación. Objetivo. Determinar los factores de riesgo asociados con el abandono del tratamiento en pacientes con tuberculosis multirresistente en la región de Callao (Perú). Materiales y métodos. Se hizo un estudio analítico de casos y controles (80 casos y 180 controles) en tratamiento entre el 1° enero del 2010 y el 31 diciembre del 2012. Los factores se determinaron mediante regresión logística, y se calcularon los odds ratios (OR) y los intervalos de confianza (IC) del 95 %. Resultados. En el análisis multivariado se determinaron los siguientes factores de riesgo: no tener conocimiento de la enfermedad (OR=23,10; IC95%: 3,6-36,79; p=0,002); no creer en la curación (OR=117,34; IC95%: 13,57-124,6; p=0,000); no tener apoyo social (OR=19,16; IC95%: 1,32-27,77; p=0,030); no considerar adecuado el horario de atención (OR=78,13; IC95%: 4,84-125,97; p=0,002), y no recibir los resultados de laboratorio (OR=46,13; IC95%: 2,85-74,77; p=0,007). Conclusión. Los servicios de salud deben esforzarse en la determinación precoz de las condiciones que podrían convertirse en factores de riesgo, lo cual ayudaría a implementar preventivamente intervenciones efectivas, rápidas y de alto impacto.

Abstract Introduction: In the context of multidrug-resistant tuberculosis, abandonment of therapy represents a serious public health problem that affects the quality of life of patients, families, and communities. Managing this phenomenon places a burden on health systems since it causes free sources of transmission in the community, thereby increasing prevalence and mortality. Thus, there is a need to study factors associated with this problem. Objective: This study sought to identify risk factors associated with the abandonment of therapy by patients with multidrug-resistant tuberculosis in the Peruvian region of Callao. Materials and methods: We conducted an analytical case-control study (cases=80; controls=180) in patients under treatment from January 1st, 2010, to December 31, 2012. Risk factors were identified using logistic regression; odds ratios (OR) and 95% confidence intervals (CI) were calculated. Results: The multivariate analysis identified the following risk factors: Being unaware of the disease (OR=23.10; 95% CI 3.6-36.79; p=0.002); not believing in healing (OR=117.34; 95% CI 13.57-124.6; p=0.000); not having social support (OR=19.16; 95% CI 1.32-27.77; p=0.030); considering the hours of attention to be inadequate (OR=78.13; 95% CI 4.84-125.97; p=0.002), and not receiving laboratory reports (OR=46.13; 95% CI 2.85-74.77; p=0.007). Conclusion: Health services must focus on the early detection of conditions that may represent risk factors to proactively implement effective, rapid and high-impact interventions.

Quality of life and stability of tooth color change at three months after dental bleaching.

PURPOSE: Intracoronary bleaching is a minimally invasive, alternative treatment that addresses aesthetic concerns related to non-vital teeth discoloration. However, to the best of our knowledge, no studies have assessed the psychosocial impacts of such procedures on patients' aesthetic perceptions. The aim of this study was to evaluate aesthetic perceptions and the psychosocial impact of patients up to 3 months after their teeth had been bleached with hydrogen peroxide (35%) and carbamide peroxide (37%) using the walking bleach technique. METHODS: The patients were randomly divided into two groups according to the bleaching agent used: G1 = hydrogen peroxide 35% (n = 25) and G2 = carbamide peroxide 37% (n = 25). Non-vital bleaching was performed in four sessions. Color was objectively (ΔE) and subjectively (ΔSGU) evaluated. Aesthetic perception and psychosocial factors were evaluated before, 1 week and 1 month after the bleaching using the Oral Health Impact Profile (OHIP) and Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) questionnaires. RESULTS: The color change (ΔE) values at 1 month were G1 = 16.80 ± 6.07 and G2 = 14.09 ± 4.83. These values remained stable until the third month after treatment (p > 0.05). There was a decrease in the values of OHIP-aesthetics and PIDAQ after treatment versus baseline (p < 0.05). This status was maintained through the third month after treatment. CONCLUSIONS: Both agents were highly effective and had a positive impact on the aesthetic perception and psychosocial impact of patients, values that also remained stable over time. Non-vital bleaching yields positive and stable impacts on aesthetic perception and psychosocial factors. ClinicalTrials.gov identifier NCT02718183.

Effectiveness and effect of non-vital bleaching on the quality of life of patients up to 6 months post-treatment: a randomized clinical trial.

OBJECTIVES: The aim of this study was to evaluate the esthetic perception of patients at 6 months after bleaching of non-vital teeth with 35% of hydrogen peroxide and 37% of carbamide peroxide using a walking bleach technique. We also assessed psychosocial impacts as well as the clinical effectiveness and stability of the color change. MATERIALS AND METHODS: The teeth bleaching treatment was randomly assigned to two groups according to the bleaching agent used: G1 HP = 35% of hydrogen peroxide (n = 25) and G2 CP = 37% of carbamide peroxide (n = 25). The non-vital bleaching was performed in four sessions using the walking bleach technique. The color was objectively (ΔE) and subjectively (ΔSGU) evaluated. The esthetic perception and psychosocial factors were evaluated before treatment as well as one and 6 months post-treatment using Oral Health Impact Profile (OHIP) esthetics and Psychosocial Impact of Dental Esthetics Questionnaire (PIDAQ). RESULTS: The color change (ΔE) at 6 months (G1 = 14.53 ± 5.07 and G2 = 14.09 ± 6.61) for both color groups remained stable until the 6-month post-treatment (p > 0.05). There was a decrease in the values of OHIP esthetics and PIDAQ after treatment compared to the baseline (p < 0.05), and this effect was maintained 6 months post-treatment. CONCLUSIONS: Both agents were highly effective and maintained the color stability at 6 months; this positively affected the esthetic perception and psychosocial impact of patients who also remained stable over time. CLINICAL RELEVANCE: Non-vital bleaching produces a positive and stable impact on the esthetic perception and psychosocial factors at medium-term follow-ups.

Projected shifts in Coffea arabica suitability among major global producing regions due to climate change.

Regional studies have shown that climate change will affect climatic suitability for Arabica coffee (Coffea arabica) within current regions of production. Increases in temperature and changes in precipitation patterns will decrease yield, reduce quality and increase pest and disease pressure. This is the first global study on the impact of climate change on suitability to grow Arabica coffee. We modeled the global distribution of Arabica coffee under changes in climatic suitability by 2050s as projected by 21 global circulation models. The results suggest decreased areas suitable for Arabica coffee in Mesoamerica at lower altitudes. In South America close to the equator higher elevations could benefit, but higher latitudes lose suitability. Coffee regions in Ethiopia and Kenya are projected to become more suitable but those in India and Vietnam to become less suitable. Globally, we predict decreases in climatic suitability at lower altitudes and high latitudes, which may shift production among the major regions that produce Arabica coffee.

Alteraciones de Número en Dentición de Pacientes entre 2 y 12 Años de Edad con Disrafias Labio Alvéolo Palatina Atendidos en la Unidad de Odontopediatría del Hospital Regional Antofagasta, Chile / Dentition Number Alterations in Patients between 2 and 12 Years of Age with Cleft Alveolus Palate Examined at the Pediatric Dental Unit of the Regional Hospital Antofagasta, Chile

Se realizó un estudio de las alteraciones de número dientes en 71 pacientes entre 2 y 12 años de edad, portadores de Fisura Labio Alvéolo Palatina del Hospital Regional de Antofagasta, atendidos entre Abril del 2004 y Julio del 2010, utilizando las fichas clínicas, radiografías panorámicas, oclusales o periapicales. Se encontró una prevalencia de agenesias dentarias en un 57,75%, de dientes supernumerarios en un 23,95%. Sólo el 18,4% de los niños no presentó alteraciones de número. En la distribución por sexo, en los niños la fisura labial y fisura labio alvéolo palatina bilateral presentó una mayor frecuencia, mientras que en las niñas las fisuras palatinas y fisuras labio alvéolo palatinas unilaterales fueron más frecuentes. Según el tipo de fisura, la más frecuente fue la fisura labio alvéolo palatina unilateral con un 64,79%. La frecuencia de agenesias en el lado de la fisura fue de un 89,3%. El diente más afectado en las agenesias fue el incisivo lateral con un 78,6% en los niños entre 2 a 6 años, y con un 100% en los niños entre 7 y 12 años. Se observó que el 61,5% de los niños con agenesia tenían 1 diente afectado, el 30,8% mostraron 2 dientes afectados y solo el 7,7% presentó 3 o más dientes afectados.

The present study was carried out to research alterations of teeth in 71 patients, whose ages were between two and twelve years old and who exhibited alveolus cleft lip palate. These patients were treated at The Regional Hospital in Antofagasta around April 2004 and July 2010, therefore, we used the tabs clinics, panoramic radiograph, occlusal and periapical radiographs. A prevalence of tooth agenesis in 57.75% of supernumerary teeth in 23.95% was found and 18.4% of children did not show any modification of number. In connection with the distribution by sex of the cleft lip and cleft lip bilateral alveolar palatine presented a high frequency in boys , and the palate clefts with fissure unilateral alveolus cleft lip were frequently observed in girls. Regarding to the types of cleft lip, the most frequent found was the alveolar cleft lip palate unilateral with 64.70% over the total of the fissures. On the other hand, the frequency of agenesis, related to fissure was 89.3%. The most affected tooth in agenesis was the lateral incisor with 78.6% in children whose ages were from 2 to 6 years old, and 100% in children from 7 to 12.It was also observed that 61.5% of children with agenesis had one affected tooth, 30.8 % had two affected teeth and only 7.7% had three or more affected teeth.

Population structure among mycobacterium tuberculosis isolates from pulmonary tuberculosis patients in Colombia.

BACKGROUND: Phylogeographic composition of M. tuberculosis populations reveals associations between lineages and human populations that might have implications for the development of strategies to control the disease. In Latin America, lineage 4 or the Euro-American, is predominant with considerable variations among and within countries. In Colombia, although few studies from specific localities have revealed differences in M. tuberculosis populations, there are still areas of the country where this information is lacking, as is a comparison of Colombian isolates with those from the rest of the world. PRINCIPAL FINDINGS: A total of 414 M. tuberculosis isolates from adult pulmonary tuberculosis cases from three Colombian states were studied. Isolates were genotyped using IS6110-restriction fragment length polymorphism (RFLP), spoligotyping, and 24-locus Mycobacterial interspersed repetitive units variable number tandem repeats (MIRU-VNTRs). SIT42 (LAM9) and SIT62 (H1) represented 53.3% of isolates, followed by 8.21% SIT50 (H3), 5.07% SIT53 (T1), and 3.14% SIT727 (H1). Composite spoligotyping and 24-locus MIRU- VNTR minimum spanning tree analysis suggest a recent expansion of SIT42 and SIT62 evolved originally from SIT53 (T1). The proportion of Haarlem sublineage (44.3%) was significantly higher than that in neighboring countries. Associations were found between M. tuberculosis MDR and SIT45 (H1), as well as HIV-positive serology with SIT727 (H1) and SIT53 (T1). CONCLUSIONS: This study showed the population structure of M. tuberculosis in several regions from Colombia with a dominance of the LAM and Haarlem sublineages, particularly in two major urban settings (Medellín and Cali). Dominant spoligotypes were LAM9 (SIT 42) and Haarlem (SIT62). The proportion of the Haarlem sublineage was higher in Colombia compared to that in neighboring countries, suggesting particular conditions of co-evolution with the corresponding human population that favor the success of this sublineage.

Histiocitosis dendrocítica (histiocitosis de células de langerhans), manifestaciones orales y craneofaciales: reporte de tres casos / Dendrocitic histiocytosis (langerhans cell histiocytosis), oral and craniofacial manifestations: report of three cases

La Histiocitosis de células de Langerhans (HCL) corresponde a una proliferación anormal de células dendríticas, de tipo clonal, cuyo espectro clínico general incluye compromiso de la piel y las mucosas, las uñas, el hueso, la médula ósea, el hígado, el bazo, linfonodos, el pulmón, el tracto gastrointestinal inferior, el sistema endocrino y el sistema nervioso central. En este trabajo presentamos tres casos de la enfermedad, con manifestaciones orales y craneofaciales, analizadas desde el punto de vista clínico (examen extra e intra oral), imagenológico (tomografías computadas) e histopatológico (expresión de marcador específico CD1a). Dos casos fueron clasificados como HCL de presentación aguda diseminada y uno como presentación crónica. Los pacientes fueron tratados oportunamente con quimioterapia según el protocolo del Programa Infantil Nacional de Drogas Antineoplásicas.

The Langerhans cell histiocytosis (LCH) corresponds to an abnormal proliferation of dendritic cells, clonal type, which usually involves compromise of skin and mucous membranes, nails, bone, bone marrow, liver, spleen, lymph nodes, lung, lower gastrointestinal tract, endocrine system and the central nervous system. We present three cases of the disease, with oral and craniofacial manifestations, analyzed from the clinical perspective (intra and extra oral exam), imaging (CT scans) and histopathological (specific marker CD1a expression). Two cases were classified as acute disseminated LCH presentation and one as a chronic disease. Patients were treated with chemotherapy timely according to the protocol of the National Child Program of Antineoplastic Drugs.

Levels of interleukin-21 in patients with untreated chronic periodontitis.

BACKGROUND: A growing body of evidence suggested that interleukin (IL)-21 enhances the effector phase during T-cell responses. The aim of our study is to determine the levels of IL-21 in periodontal sites from patients with chronic periodontitis and controls. METHODS: The population studied consisted of 34 patients (15 with chronic periodontitis and 19 healthy patients). Twenty samples (10 gingival crevicular fluid [GCF] and 10 gingival biopsies) were collected from each group before the patients with periodontitis received periodontal treatment. Total protein concentrations were measured in all samples; the presence of IL-21 was confirmed by immunohistochemistry and Western blot, and IL-21 levels were quantified through an enzyme-linked immunosorbent assay. Statistical analyses were performed using statistical software. Data were expressed as patient means ± SDs or medians (interquartile ranges) by using the χ(2), Student t, and Mann-Whitney U tests. RESULTS: GCF IL-21 was mainly detected in patients with chronic periodontitis (P <0.05). Levels of IL-21 in gingival tissues were significantly higher in patients with chronic periodontitis compared to healthy individuals (P <0.05). The Western blot and immunohistochemical staining confirmed the presence of IL-21 in periodontal tissues and GCF. CONCLUSION: IL-21 was highly expressed in patients with chronic periodontitis, especially in gingival biopsies; therefore, IL-21 might play a role in the T-cell response.

Chemokine monocyte chemoattractant protein-3 in progressive periodontal lesions in patients with chronic periodontitis.

BACKGROUND: Chemokines are central in the activation and direction of leukocyte subsets to target tissues. However, the monocyte chemoattractant protein-3 (MCP-3) has not been associated with chronic periodontitis. Chronic periodontitis is an infection showing episodic supporting tissue destruction. The aim of this study is to determine the levels and expression of MCP-3 in periodontal sites characterized by active periodontal connective tissue destruction. METHODS: The study population consisted of 15 patients with a progression of periodontitis (15 of 56 patients), 18 patients with chronic periodontitis, and 10 healthy subjects without periodontal disease. As determined by the tolerance method, the 15 patients with moderate to advanced chronic periodontitis showed a progression of periodontitis over a 4-month period. Periodontitis was characterized by at least six sites with a probing depth >or=5 mm, clinical attachment level >or=3 mm, and radiographic bone loss. Gingival crevicular fluid was collected using a paper strip. The total protein concentration was determined. An enzyme-linked immunosorbent assay was performed to determine the total amount of MCP-3, and an immunoWestern blot was conducted to assess molecular MCP-3 forms. To determine the MCP-3 expression by immunohistochemistry, gingival biopsies were obtained from patients with chronic periodontitis and healthy subjects during third-molar extraction surgery. Statistical analyses were performed using statistical software. Data were expressed as subject means +/- SD, using the chi(2) and Student t tests. RESULTS: The total amount and concentration of chemokine MCP-3 were significantly higher in patients with chronic periodontitis than in healthy subjects (8.25 pg versus 0.53 pg, P = 0.006 and 2.95 pg/microl versus 0.45 pg/microl, P = 0.04, respectively). Active sites showed a significantly higher total amount and concentration of MCP-3 than inactive sites (11.12 versus 2.88 pg, P value = 0.005 and 3.95 versus 1.02, P value = 0.005, respectively). Western blot and immunohistochemical staining confirmed the presence of MCP-3 in periodontal disease, with observable differences between patients with chronic periodontitis and healthy subjects. CONCLUSIONS: MCP-3 was highly expressed in patients with chronic periodontitis, particularly in those with progressive periodontal lesions. MCP-3 could be involved in the recruitment of inflammatory cells toward periodontal tissues during the progression of the disease.

Levels of interferon-gamma and transcription factor T-bet in progressive periodontal lesions in patients with chronic periodontitis.

BACKGROUND: Periodontitis is an infection with an episodic pattern of tissue-support destruction. During the generation of a primary CD4(+) T helper 1 (Th1) response, interferon-gamma (IFN-gamma) acts as a positive regulator by selectively inducing Th1 differentiation through increased transcription of T-bet. The aims of this work were to determine IFN-gamma levels in samples of gingival crevicular fluid (GCF) and to determine IFN-gamma and transcription factor T-bet expression in gingival tissue from patients undergoing the progression of chronic periodontitis. METHODS: One hundred six patients with moderate or advanced chronic periodontitis were selected. Periodontitis was characterized by at least six sites with probing depth >or=5 mm, clinical attachment loss >or=3 mm, and radiographic bone loss. Periodontitis progression was determined by the tolerance method. GCF was collected using a paper strip, and enzyme-linked immunosorbent assay was performed to determine the total amount of IFN-gamma. Gingival biopsies were obtained from patients for real-time reverse transcription-polymerase chain reaction to determine IFN-gamma and T-bet expression. Statistical analysis was performed using statistical software. Data were expressed as subject means +/- SD. The chi(2) and Student t tests were used. RESULTS: The total amount and concentration of cytokine IFN-gamma were significantly higher in active sites than in inactive sites (99.90 versus 68.90 pg; P = 0.03; 106.62 pg/mg versus 75.64 pg/mg, P = 0.04, respectively). Active sites showed a significantly lower Delta cycle threshold (Ct) of IFN-gamma than inactive sites (P = 0.04), whereas the expression of transcription factor T-bet was increased 1.42-fold in active sites compared to inactive sites. CONCLUSION: The total amount and concentration of cytokine IFN-gamma in GCF samples and transcription factor T-bet expression were increased in progressive periodontal lesions in patients with chronic periodontitis.

Characterization of progressive periodontal lesions in chronic periodontitis patients: levels of chemokines, cytokines, matrix metalloproteinase-13, periodontal pathogens and inflammatory cells.

BACKGROUND AND AIMS: Periodontitis is an infection with an episodic nature of tissue support destruction. The aim of this work was to determine the levels of chemokines, cytokines, matrix metalloproteinase-13, periodontal pathogens and inflammatory cells in periodontal sites characterized by active periodontal connective tissue destruction. MATERIAL AND METHOD: Fifty-six patients with moderate or advanced severity of chronic periodontitis were selected. Periodontitis was characterized by at least six sites with probing depth > or =5 mm, clinical attachment level > or =3 mm and radiographic bone loss. Periodontitis progression was determined by the tolerance method. Receptor activator for nuclear factor kappa B-ligand (RANK-L), monocyte chemoattractant protein-1 (MCP-1), tumour necrosis factor-alpha (TNF-alpha), IL-1beta, MMP-13, Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsithia and inflammatory cells levels were determined. Statistical analysis was performed using the Stata 7.0 software. Data were expressed as mean+/-SD and paired samples t-test and chi(2) tests were used. RESULTS: Higher RANK-L, IL-1beta and MMP-13 activity levels were observed in active sites (p<0.05). The proportion of P. gingivalis, A. actinomycetemcomitans, T. forsythia and the number of CD4(+) T were higher in active than in inactive sites (p>0.05). CONCLUSION: The detection of periodontopathic bacteria, host matrix metalloproteinases and cytokines in periodontitis patients with lesions undergoing episodic attachment loss could partially explain the mechanisms associated with the destruction of the supporting tissues of the tooth.