Estratégias assistenciais para o controle da tuberculose drogarresistente: revisão integrativa da literatura / Care strategies for controlling drug-resistant tuberculosis: integrative literature review / Estrategias asistenciales para el control de la tuberculosis farmacoresistente: revisión integradora de la literatura

Objetivo: identificar, na literatura científica, estratégias assistenciais para o controle da tuberculose drogarresistente. Método: revisão integrativa da literatura, com análise de pesquisas relevantes sobre a questão nortedora: Quais são as evidências científicas sobre as estratégias assistenciais para o controle da tuberculose drogarresistente? Busca realizada nas bases Literatura Latino-Americana e do Caribe em Ciências da Saúde, Medical Literature Analysis, Índice Bibliográfico Espanhol em Ciências da Saúde e Banco de Dados em Enfermagem, entre janeiro e março de 2020. Foram incluídos dez artigos para discussão dos resultados que responderam à questão da pesquisa, atendendo aos critérios de inclusão e exclusão. Resultados: nos estudos publicados nos últimos cinco anos, 80% abordaram estratégias assistenciais para o controle da tuberculose drogarresistente e 20% evidenciaram falhas na assistência aos portadores da doença. Conclusão: a revisão da literatura identificou várias estratégias assistenciais para o controle da tuberculose drogarresistente, com destaque para a descentralização do diagnóstico e tratamento compartilhado, possibilitando uma atenção ampliada e integral aos pacientes.

Objective: from the scientific literature, to identify care strategies for controlling drug-resistant tuberculosis. Method: this integrative literature review examined relevant research on the research question ­ What is the scientific evidence on care strategies for controlling drug-resistant tuberculosis? ­ by searching Latin American and Caribbean Health Sciences Information, Medical Literature Analysis, Índice Bibliográfico Español en Ciencias de la Salud and Banco de Dados em Enfermagem, between January and March 2020. Ten articles were included in order to discuss findings that answered the research question, after meeting the inclusion and exclusion criteria. Results: of studies published in the past five years, 80% addressed care strategies for controlling drug-resistant tuberculosis and 20% revealed shortcomings in care for patients with the disease. Conclusion: the literature review identified several care strategies for controlling drug-resistant tuberculosis, particularly by decentralized diagnosis and shared treatment, allowing expanded, comprehensive patient care.

Objetivo: identificar, en la literatura científica, estrategias de asistencia para el control de la tuberculosis farmacorresistente. Método: se trata de una revisión integradora de la literatura, con análisis de investigaciones relevantes sobre la cuestión rectora: ¿Cuáles son las evidencias científicas sobre las estrategias de asistencia para el control de la tuberculosis farmacorresistente? La búsqueda fue realizada en las bases Literatura Latinoamericana y del Caribe en Ciencias de la Salud, Medical Literature Analysis, Índice Bibliográfico Español en Ciencias de la Salud y Banco de Datos en Enfermería, de enero a marzo de 2020. Se incluyeron diez artículos para discutir los resultados que respondieron a la pregunta de la investigación, cumpliendo con los criterios de inclusión y exclusión. Resultados: en los estudios publicados en los últimos cinco años, el 80% abordó estrategias de atención para el control de la tuberculosis farmacorresistente y el 20% mostró fallas en la atención de los pacientes con la enfermedad. Conclusión: la revisión de la literatura identificó varias estrategias asistenciales para el control de la tuberculosis farmacorresistente, con énfasis en la descentralización del diagnóstico y tratamiento compartido, permitiendo una atención ampliada e integral a los pacientes.

Tecnologia móvel para o cuidado de enfermagem durante a pandemia da COVID-19: relato de experiência / Mobile technology for nursing care during the covid-19 pandemic: experience report

Objetivo: Relatar a experiência de enfermeiros na utilização de uma tecnologia móvel para o cuidado de enfermagem a usuários na atenção primária e especializada durante a pandemia da COVID-19. Metodologia: Utilizou-se o método de sistematização de experiências proposto por Holliday, que possibilitou a reconstrução reflexiva da experiência coletiva vivida, por meio de cinco etapas para a explanação da experiência. Resultados: Possibilitou a elaboração de novas ferramentas para o acompanhamento de usuários atendidos pelos serviços de saúde por meio de tecnologias remotas que mediaram a assistência de enfermagem. Conclusões: O uso de tecnologia móvel possibilitou a continuidade da assistência de enfermagem durante a pandemia da COVID-19, de modo que o cuidado pode ser levado aos usuários vulneráveis, sem que houvesse o comprometimento da saúde no atual contexto epidemiológico em que a doença está em pleno processo de propagação e disseminação. (AU)

Objective: To report the experience of nurses in the use of mobile technology for nursing care for users in primary and special care during the COVID-19 pandemic.Methodology: Use the method of systematization of experiments studied by Holliday, which enabled the reflexive reconstruction of the collective experience lived, through five steps for an explanation of the experience. Results: It enabled the development of new tools for monitoring users served by health services through remote technologies that mediate nursing care. Conclusions: The use of mobile technology makes it possible to recover nursing care during a COVID-19 pandemic, the way care can be taken to vulnerable users, without interruption or health compromise in the current epidemiological context in which the disease is in progress full process of propagation and dissemination. (AU)

Objetivo: Informar sobre la experiencia de enfermeros en el uso de una tecnología móvil para la atención de enfermería para los usuarios de atención primaria y especial durante la pandemia de COVID-19. Metodología: utilice el método de sistematización de experimentos estudiados por Holliday, que permitió la reconstrucción reflexiva de la experiencia colectiva vivida, a través de cinco pasos para una explicación de la experiencia. Resultados: permitió el desarrollo de nuevas herramientas para monitorear a los usuarios atendidos por los servicios de salud a través de tecnologías remotas que median la atención de enfermería. Conclusiones: El uso de una tecnología móvil permite recuperar la atención de enfermería durante una pandemia de COVID-19, la forma en que se puede prestar atención a los usuarios vulnerables, sin interrupción o compromiso de salud em el contexto epidemiológico actual em el que la enfermedad está en progreso proceso completo de propagación y difusión. (AU)

Tuberculosis and malaria walk side by side in the Brazilian Amazon: an ecological approach.

OBJECTIVE: To assess the spatial distribution of TB and malaria incidence, as well as their spatial association with each other, regardless of environmental and socio-economic factors commonly reported as determinants of both disease rates among the municipalities of Amazonas State, Brazil between 2012 and 2015. METHODS: Through an ecological approach considering municipalities of Amazonas, Brazil, as unit of analysis, a negative binomial regression model was used to assess association between malaria and TB rates, in which the dependent variable was the average municipal tuberculosis incidence rate. RESULTS: Positive associations of overall malaria (ß = 0.100 [CI = 0.032, 0.168], P = 0.004), P. vivax malaria (ß = 0.115 [CI = 0.036, 0.195], P = 0.005), and P. falciparum malaria (ß = 0.389 [CI = -0.0124, 0.791], P = 0.057) with TB rates were found, regardless of the sociodemographic factors included in the study. CONCLUSION: In the Brazilian Amazon, TB and malaria are spatially associated. Therefore, it is very likely that co-infections also occur in this region, regardless of the HIV status.

OBJECTIF: Evaluer la distribution spatiale de l'incidence de la tuberculose (TB) et du paludisme, ainsi que leur association spatiale, indépendamment des facteurs environnementaux et socioéconomiques communément rapportés comme déterminants des taux des deux maladie dans les municipalités de l'Etat d'Amazonas, au Brésil, entre 2012 et 2015. MÉTHODES: Dans le cadre d'une approche écologique prenant en considération les municipalités d'Amazonas, au Brésil, comme unité d'analyse, un modèle de régression binomiale négatif a été utilisé pour évaluer l'association entre les taux de paludisme et de TB, dans laquelle la variable dépendante était le taux moyen d'incidence municipale de la TB. RÉSULTATS: Des associations positives entre le paludisme en général (ß = 0,100 [IC= 0,032 à 0,168], p = 0,004), le paludisme à P. vivax (ß = 0,115 [IC: 0,036 à 0,195], p = 0,005) et le paludisme à P. falciparum (ß = 0,389 [IC: - 0,0124 à 0,791], p = 0,057) avec des taux de TB ont été retrouvées quels que soient les facteurs sociodémographiques inclus dans l'étude. CONCLUSION: En Amazonie brésilienne, la TB et le paludisme sont associés spatialement. Par conséquent, il est très probable que des coinfections se produisent également dans cette région, quel que soit le statut VIH.

Temporal distribution of tuberculosis in the State of Amazonas, Brazil.

Tuberculosis (TB) is one of the infectious diseases that contributes most to the morbidity and mortality of millions of people worldwide. Brazil is one of 22 countries that accounts for 80% of the tuberculosis global burden. The highest incidence rates in Brazil occur in the States of Amazonas and Rio de Janeiro. The aim of this study was to describe the temporal distribution of TB in the State of Amazonas. Between 2001 and 2011, 28,198 cases of tuberculosis were reported in Amazonas, distributed among 62 municipalities, with the capital Manaus reporting the highest (68.7%) concentration of cases. Tuberculosis was more prevalent among males (59.3%) aged 15 to 34 years old (45.5%), whose race/color was predominantly pardo (64.7%) and who had pulmonary TB (84.3%). During this period, 81 cases of multidrug-resistant TB were registered, of which the highest concentration was reported from 2008 onward (p = 0.002). The municipalities with the largest numbers of indigenous individuals affected were São Gabriel da Cachoeira (93%), Itamarati (78.1%), and Santa Isabel do Rio Negro (70.1%). The future outlook for this region includes strengthening the TB control at the primary care level, by expanding diagnostic capabilities, access to treatment, research projects developed in collaboration with the Dr. Heitor Vieira Dourado Tropical Medicine Foundation .;Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD).; and financing institutions, such as the project for the expansion of the Clinical Research Center and the creation of a hospital ward for individuals with transmissible respiratory diseases, including TB.

Temporal distribution of tuberculosis in the State of Amazonas, Brazil

Tuberculosis (TB) is one of the infectious diseases that contributes most to the morbidity and mortality of millions of people worldwide. Brazil is one of 22 countries that accounts for 80% of the tuberculosis global burden. The highest incidence rates in Brazil occur in the States of Amazonas and Rio de Janeiro. The aim of this study was to describe the temporal distribution of TB in the State of Amazonas. Between 2001 and 2011, 28,198 cases of tuberculosis were reported in Amazonas, distributed among 62 municipalities, with the capital Manaus reporting the highest (68.7%) concentration of cases. Tuberculosis was more prevalent among males (59.3%) aged 15 to 34 years old (45.5%), whose race/color was predominantly pardo (64.7%) and who had pulmonary TB (84.3%). During this period, 81 cases of multidrug-resistant TB were registered, of which the highest concentration was reported from 2008 onward (p = 0.002). The municipalities with the largest numbers of indigenous individuals affected were São Gabriel da Cachoeira (93%), Itamarati (78.1%), and Santa Isabel do Rio Negro (70.1%). The future outlook for this region includes strengthening the TB control at the primary care level, by expanding diagnostic capabilities, access to treatment, research projects developed in collaboration with the Dr. Heitor Vieira Dourado Tropical Medicine Foundation .;Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD).; and financing institutions, such as the project for the expansion of the Clinical Research Center and the creation of a hospital ward for individuals with transmissible respiratory diseases, including TB.

Mycobacterium tuberculosis infection in young children: analyzing the performance of the diagnostic tests.

OBJECTIVE: This study evaluated the performance of the Tuberculin Skin Test (TST) and Quantiferon-TB Gold in-Tube (QFT) and the possible association of factors which may modify their results in young children (0-6 years) with recent contact with an index tuberculosis case. MATERIALS AND METHODS: A cross-sectional study including 135 children was conducted in Manaus, Amazonas-Brazil. The TST and QFT were performed and the tests results were analyzed in relation to the personal characteristics of the children studied and their relationship with the index case. RESULTS: The rates of positivity were 34.8% (TST) and 26.7% (QFT), with 14.1% of indeterminations by the QFT. Concordance between tests was fair (Kappa = 0.35 P<0.001). Both the TST and QFT were associated with the intensity of exposure (Linear OR = 1.286, P = 0.005; Linear OR = 1.161, P = 0.035 respectively) with only the TST being associated with the time of exposure (Linear OR = 1.149, P = 0.009). The presence of intestinal helminths in the TST+ group was associated with negative QFT results (OR = 0.064, P = 0.049). In the TST- group lower levels of ferritin were associated with QFT+ results (Linear OR = 0.956, P = 0.036). CONCLUSIONS: Concordance between the TST and QFT was lower than expected. The factors associated with the discordant results were intestinal helminths, ferritin levels and exposure time to the index tuberculosis case. In TST+ group, helminths were associated with negative QFT results suggesting impaired cell-mediated immunity. The TST-&QFT+ group had a shorter exposure time and lower ferritin levels, suggesting that QFT is faster and ferritin may be a potential biomarker of early stages of tuberculosis infection.

Primary multidrug-resistant tuberculosis and its control implications in the State of Amazonas, Brazil: report of 3 cases.

The occurrence of tuberculosis with first-line multidrug resistance leads to the use of alternative medications, often at higher costs, longer treatment periods, and greater clinical complexity. Here, we report 3 patients with multidrug-resistant tuberculosis. One patient with human immunodeficiency virus died before the sensitivity test was performed. The early diagnosis of multidrug-resistant tuberculosis and appropriate treatment should be priorities of the National Tuberculosis Control Program in order to break the chain of transmission. In addition, the possibility of substituting the proportion method with more modern and faster techniques should be urgently evaluated.

Primary multidrug-resistant tuberculosis and its control implications in the State of Amazonas, Brazil: report of 3 cases / Multirresistência primária da tuberculose e implicações no controle no Estado do Amazonas, Brasil: relato de três casos

The occurrence of tuberculosis with first-line multidrug resistance leads to the use of alternative medications, often at higher costs, longer treatment periods, and greater clinical complexity. Here, we report 3 patients with multidrug-resistant tuberculosis. One patient with human immunodeficiency virus died before the sensitivity test was performed. The early diagnosis of multidrug-resistant tuberculosis and appropriate treatment should be priorities of the National Tuberculosis Control Program in order to break the chain of transmission. In addition, the possibility of substituting the proportion method with more modern and faster techniques should be urgently evaluated.

O surgimento de resistência múltipla às drogas de primeira linha implica na utilização de fármacos de maior custo, com duração mais longa, maior complexidade e mais efeitos colaterais. Relatamos os casos de três pacientes com multirresistência primária aos tuberculostáticos. O portador de HIV evoluiu para óbito antes do resultado do teste de sensibilidade. Portanto, o diagnóstico precoce de tuberculose multirresistente e o tratamento adequado devem ser prioridades do Programa Nacional do Controle da Tuberculose, visando interromper a cadeia de transmissão. Além disto, é urgente que seja avaliada a substituição do método das proporções por técnicas mais modernas e mais rápidas.

Factors associated with tuberculosis treatment default in an endemic area of the Brazilian Amazon: a case control-study.

SETTING: Treatment default is a serious problem in tuberculosis control because it implies persistence of infection source, increased mortality, increased relapse rates and facilitates the development of resistant strains. OBJECTIVE: This study analyzed tuberculosis treatment default determinants in the Amazonas State to contribute in planning appropriate control interventions. DESIGN: Observational study with a retrospective cohort using Brazilian Disease Notification System data from 2005 to 2010. A nested case control study design was used. Patients defaulting from treatment were considered as 'cases' and those completing treatment as 'controls'. In the analysis, 11,312 tuberculosis patients were included, 1,584 cases and 9,728 controls. RESULTS: Treatment default was observed to be associated to previous default (aOR 3.20; p<0.001), HIV positivity (aOR 1.62; p<0.001), alcoholism (aOR 1.51; p<0.001), low education level (aOR 1.35; p<0.001) and other co-morbidities (aOR 1.31; p = 0.05). Older patients (aOR 0.98; p = 0.001) and DOT (aOR 0,72; p<0.01) were considered as protective factor for default. CONCLUSIONS: Associated factors should be considered in addressing care and policy actions to tuberculosis control. Information on disease and treatment should be intensified and appropriate to the level of education of the population, in order to promote adherence to treatment and counter the spread of multidrug resistance to anti-TB drugs.

Evaluation of new strategies for the diagnosis of tuberculosis among pediatric contacts of tuberculosis patients.

BACKGROUND: In young children, underdiagnosis and diagnostic delay have an adverse effect on morbidity and mortality of tuberculosis (TB). This study evaluated new strategies for early TB diagnosis using an outpatient protocol in children between 0 and 5 years of age, with a recent household TB contact. METHODS: Case recruitment was performed in Manaus, Amazonas, Brazil, from 2008 to 2009. Epidemiologic and clinical data, tuberculin test, chest radiograph and 2 induced sputum respiratory samples from each participant were obtained. Laboratory diagnosis was based on Lowenstein-Jensen (LJ) culture, mycobacteria growth indicator tube (MGIT) and polymerase chain reaction. We conducted a study of comparison of diagnostic tests and a study of cases and controls to identify the clinical characteristics of the population with positive culture and polymerase chain reaction results. RESULTS: A total of 102 children were evaluated. Thirty-two fulfilled criteria of suspicion of TB. MGIT was more sensitive (P = 0.035) and faster (P < 0.001) than LJ. Clinical score, MGIT, LJ and polymerase chain reaction presented no concordance or slight concordance. A positive MGIT culture was only associated with a strong tuberculin test reaction (P = 0.026). The combination of MGIT with the clinical score allowed the diagnosis of 33% more cases with little or no symptomatology compared with the exclusive use of the clinical classification. CONCLUSIONS: The sensitivity and speed of MGIT demonstrate the utility of liquid cultures for the diagnosis in children. Furthermore, these results suggest that the use of MGIT in children presenting recent household TB contact and a strong tuberculin test reaction may be a strategy to improve early TB diagnosis.

Tuberculose em Manaus, Estado do Amazonas: resultado de tratamento após a descentralização / Tuberculosis in Manaus, state of Amazon: treatment outcome decentralization

No ano de 2003, as ações de controle da Tuberculose foram descentralizadas para a rede básica de saúde de Manaus-AM. A partir dai, os resultados de tratamento apresentaram alto índice de transferência e baixo índice de cura. Foi realizado um Estudo retrospectivo e descritivo com o objetivo de estudar a situação de encerramento dos casos de tuberculose apos o processo de descentralização. Foram revisadas 4.491 fichas de notificação para correção, inserção, exclusão e vinculação de casos. Os registros de 2003 e 2004 foram comparados nas situações antes e depois da revisão. Principais resultados: aumento do percentual de cura de 42,2 por cento para 81,8 por cento no ano de 2003, e de 28,6 por cento para 76,9 por cento, no ano de 2004; diminuição do percentual de transferências de 43,5 por cento para 4,2 por cento em 2003 e de 49,6 por cento para 6,9 por cento em 2004. O estudo contribuiu para a visualização de falhas operacionais e aprimoramento das ações executadas.

In 2003, measures to control Tuberculosis have been decentralized to the primary care network in Manaus, the capital city of the State of Amazon. From that moment on, the results of treatment have shown high transfer rate and low cure rate. A retrospective and descriptive study was done to evaluate the process of closing cases of tuberculosis after the decentralization process. 4,491 notification forms were reviewed for correction, inclusion, exclusion and linkage of cases. The records of 2003 and 2004 were compared before and after the review. Main results: increase in the percentage of cure from 42.2 percent to 81.8 percent in 2003, and from 28.6 percent to 76.9 percet in 2004, decrease in the percentage of transference from 43.5 percent to 4.2 percent in 2003 and from 49.6 percent to 6.9 percent in 2004. The study has contributed to the understanding of operational failures and to improve actions taken.

[Clinical and diagnostic aspects of American tegumentary leishmaniosis in soldiers simultaneously exposed to the infection in the Amazon Region]. / Aspectos clínicos e diagnósticos da leishmaniose tegumentar americana em militares simultaneamente expostos à infecção na Amazônia.

Military exercises in the forest of the Amazon region constitute an important factor in the incidence of American cutaneous leishmaniasis in this region. This report describes 48 cases of American tegumentary leishmaniosis. All these patients acquired the disease after military exercises in the Amazon. The mean incubation time was 27.6 days. The lesions were predominantly in the upper extremities, face and neck. The majority of patients presented two lesions. Ulcers were the most common clinical manifestation. The diagnosis was obtained through skin smears of the lesions. A total of 43 cases (89.6 %) were found to be positive.

Aspectos clínicos e diagnósticos da leishmaniose tegumentar americana em militares simultaneamente expostos à infecçäo na Amazônia / Clinical and diagnostic aspects of American tegumentary leishmaniosis in soldiers simultaneously exposed to the infection in the Amazon Region

Os treinamentos militares na selva amazônica constituem importantes fatores na incidência de leishmaniose tegumentar americana na regiäo. Este trabalho descreve 48 casos de leishmaniose tegumentar americana em pacientes militares nos quais a doença se manifestou após operaçäo de treinamento na Amazônia. O período de incubaçäo médio foi de 27,6 dias. Houve predomínio de lesöes nos membros superiores, face e pescoço. A maioria dos indivíduos apresentou duas lesöes, sendo as úlceras as manifestaçöes mais freqüentes. O diagnóstico foi realizado pelo exame de escarificaçäo das lesöes, sendo confirmado pela demonstraçäo do parasito em 43 (89,6 por cento) casos