Educational strategy intervention and remote supervision on the post-discharge management of tuberculosis diagnosed in the hospital: Randomized clinical trial.

INTRODUCTION: One of the most serious problems in TB control is non-adherence to treatment leading to the risk of drug resistance and subsequent treatment failure. OBJECTIVES: To assess the impact of an educational strategy intervention and remote supervision on the post-discharge management of new cases of TB diagnosed in hospital on TB cure rate. Secondarily, to assess the impact of this intervention on default rate. METHODS: Randomized control trial conducted at a general, tertiary care, university affiliated hospital. New cases of TB diagnosed in hospital were included. The primary outcome was cure rate and secondary outcome was default rate. Analysis was carried out by modified intention to treat. RESULTS: A total of 169 new tuberculosis patients were enrolled. Among them, 80 were assigned to intervention group and 89 to control group. The cure rate was 71.3% in the intervention group and 58.4% in the control group. In the multivariate binary logistic regression model to evaluate the effect of the intervention, controlled by age, sex, current smoking status and directly observed treatment short, intervention was independently associated with cure rate (OR = 0.47; 95% CI: 0.24-0.94; P = 0.033).There was a significant difference in the default rate between the control and intervention groups (18.0% vs 5.0%, respectively, P = 0.039). CONCLUSION: An educational strategy intervention and remote supervision on the post-discharge management of new cases of TB with in-hospital diagnosis had a positive effect of small magnitude on cure rate. Secondarily, the treatment default rate has been significantly decreased with the intervention.

Influenza A non-H1N1 associated with acute respiratory failure and acute renal failure in a previously vaccinated cystic fibrosis patient. / Influenza A não H1N1 associada à insuficiência respiratória e à insuficiência renal aguda em paciente com fibrose cística previamente vacinado.

In the 2014 - 2015 season, most influenza infections were due to A (H3N2) viruses. More than two-thirds of circulating A (H3N2) viruses are antigenically and genetically different (drifted) from the A (H3N2) vaccine component of 2014 - 2015 northern and southern Hemisphere seasonal influenza vaccines. The purpose of this paper is to report a case of seasonal influenza A non-H1N1 infection that occurred in June 2015 in an adult cystic fibrosis patient with severe lung disease previously vaccinated with the anti-flu trivalent vaccine. The patient evolved to respiratory and renal failure (without rhabdomyolysis) and was placed under mechanical ventilation and hemodialysis. The clinical outcome was positive after 39 days of hospital stay. In addition, the patient was clinically stable after 18 months of follow-up. With the recent advances in critical care medicine and in cystic fibrosis treatment, survival with advanced pulmonary disease in cystic fibrosis presents new questions and potential problems, which are still being formulated.

Influenza A não H1N1 associada à insuficiência respiratória e à insuficiência renal aguda em paciente com fibrose cística previamente vacinado / Influenza A non-H1N1 associated with acute respiratory failure and acute renal failure in a previously vaccinated cystic fibrosis patient

RESUMO No período sazonal compreendido entre 2014 e 2015, a maior parte das infecções por influenza decorreu do vírus influenza A H3N2. Mais de dois terços dos vírus influenza A H3N2 circulante eram antigênica e geneticamente diferentes (drift) do componente A H3N2 da vacina da influenza sazonal 2014 - 2015 para os hemisférios norte e sul. O objetivo deste trabalho foi relatar um caso de infecção por influenza A sazonal não H1N1 ocorrido em junho de 2015 em um paciente adulto com fibrose cística com doença pulmonar grave, previamente vacinado com a vacina antigripal trivalente. O paciente evoluiu com insuficiências respiratória e renal (sem rabdomiólise), sendo submetido à ventilação mecânica e à hemodiálise. A evolução clínica foi positiva após 39 dias de permanência hospitalar. Ainda, o paciente permaneceu clinicamente estável após seguimento de 18 meses. Com os avanços recentes na medicina intensiva e no tratamento, a sobrevivência com uma doença pulmonar avançada na fibrose cística apresenta novas questões e problemas potenciais, que ainda estão sendo formulados.

ABSTRACT In the 2014 - 2015 season, most influenza infections were due to A (H3N2) viruses. More than two-thirds of circulating A (H3N2) viruses are antigenically and genetically different (drifted) from the A (H3N2) vaccine component of 2014 - 2015 northern and southern Hemisphere seasonal influenza vaccines. The purpose of this paper is to report a case of seasonal influenza A non-H1N1 infection that occurred in June 2015 in an adult cystic fibrosis patient with severe lung disease previously vaccinated with the anti-flu trivalent vaccine. The patient evolved to respiratory and renal failure (without rhabdomyolysis) and was placed under mechanical ventilation and hemodialysis. The clinical outcome was positive after 39 days of hospital stay. In addition, the patient was clinically stable after 18 months of follow-up. With the recent advances in critical care medicine and in cystic fibrosis treatment, survival with advanced pulmonary disease in cystic fibrosis presents new questions and potential problems, which are still being formulated.