ABSTRACT
BACKGROUND: Tuberculosis, declared a global emergency by the World Health Organization, continues to be an important public health problem in Mexico, included in the first twenty causes of death. OBJECTIVE: To know the impact of drug resistance of Mycobacterium tuberculosis on treatment outcome, need of re-treatment and mortality in a cohort of patients with pulmonary tuberculosis receiving directly observed therapy, short course (DOTS). METHODS: We conducted a population-based study in a suburban region in Southern Mexico. People who had been coughing for more than two weeks underwent sputum acid-fast bacilli smear. Patients with a positive smear were recruited and underwent clinical exam, chest X-ray, HIV testing, and sputum cultures. Identification, drug susceptibility testing and restriction fragment length polymorphism analysis (RFLP) were performed in all isolates. Patients were followed every 12 months for new episodes of tuberculosis and vital status. Patients were referred for clinical care to the local program of tuberculosis. Deaths were corroborated with death certificates. Informed consent was obtained from participants. RESULTS: Between March 1995 and February 1999, tuberculosis was diagnosed in 371 patients who were followed for an average of 32 months. M. tuberculosis was cultured from 316 patients; resistance to any drug occurred in 25.0% of isolates (primary 18.8%, acquired 49.2%); only to isoniazid in 6.8% (primary 7.3%, acquired 4.8%); to isoniazid and rifampin in 6.2% (primary 1.6%, acquired 23.8%). Patients with drug resistance had a higher probability of treatment failure (OR = 16.9, CI 95% 4.5-63.0) and patients with MDR strains had a higher probability of need of re-treatment (RR = 24.4, CI 95% 8.8-67.6), and of death (RR = 4.0, CI 95% 1.5-10.7). Additional variables were found to be associated with subsequent episodes of disease and mortality: Cocaine use, chronic disease, type of radiological lesions, HIV co-infection, non-compliance and treatment delay, as well as RFLP clustering. CONCLUSIONS: In this study, we observed that drug resistance showed a severe impact on the outcome and survival; drug-resistance was the most significant factor for these negative outcomes; DOTS may not be sufficient in areas where drug resistance is considerable, and patient follow-up for longer periods of time, as compared to evaluation at the end of treatment, provides additional information which is useful for prevention and control programs.
Subject(s)
Antitubercular Agents/therapeutic use , Tuberculosis, Multidrug-Resistant/epidemiology , Tuberculosis, Pulmonary/prevention & control , Adult , Antitubercular Agents/pharmacology , Drug Resistance, Microbial , Female , Humans , Male , Mexico/epidemiology , Mycobacterium tuberculosis/drug effects , Tuberculosis, Multidrug-Resistant/prevention & control , Tuberculosis, Pulmonary/mortalityABSTRACT
BACKGROUND: Tuberculosis (TB) rates remain high in regions of Southern Mexico despite the existence of a National Tuberculosis Program. Understanding TB epidemiology in such settings would assist in the design of improved TB control and highlight the challenges confronting TB control in developing countries. METHODS: We conducted a retrospective review of treatment control cards from 1991 to 1994 in five municipalities in a semiurban region of Southern Mexico. RESULTS: The relatively high rate of TB observed, 42.6 per 100,000 inhabitants, did not change significantly during the study period. Cure rates among new cases were 79% and significantly lower among retreatment cases (62%). Directly observed therapy (DOT) was administered to 84% of patients. Approximately one-half of the retreatment cases who were not cured were compliant with therapy, suggesting that drug resistance contributed to these poor results. Of particular concern was a core group of 16 patients who had received at least three treatments. CONCLUSIONS: This region of Mexico has persistently high TB rates despite a DOT-based TB control programme which achieves an overall cure rate of 77%. There exist many retreatment cases for whom cure rates are significantly lower. These cases may serve as a core group for the dissemination of drug resistant TB. The control programme is being reinforced by a nominal register of patients, decreasing administrative barriers for drug supply to individual patients and the availability of mycobacteria cultures. In addition to these measures, in regions which are approaching the levels of efficacy recommended by the WHO it may be appropriate to consider focusing efforts on the identification and treatment of chronic cases.
Subject(s)
Tuberculosis/prevention & control , Adolescent , Adult , Aged , Analysis of Variance , Child , Child, Preschool , Communicable Disease Control/organization & administration , Female , Humans , Incidence , Infant , Infant, Newborn , Male , Mexico/epidemiology , Middle Aged , Odds Ratio , Population Surveillance/methods , Program Evaluation , Retrospective Studies , Treatment Outcome , Tuberculosis/epidemiologyABSTRACT
Se describe un caso clínico de Heautoscopia como una cognición corpórea en el cual el hallazgo del síntoma facilitó el diagnóstico de Esquizofrenia. Se puntualizan además algunos de los fenómenos psicopatológicos que permiten el diagnóstico diferencial con el Síndrome de Capgras o Delirio de Sosias
Subject(s)
Adult , Humans , Male , Paranoid Disorders/complications , Paranoid Disorders/diagnosis , Paranoid Disorders/psychology , Schizophrenia, Paranoid/complications , Schizophrenia, Paranoid/diagnosis , Schizophrenia, Paranoid/psychology , Body Image , Diagnosis, DifferentialABSTRACT
Se presenta un caso clínico de Paranoia de Renta, describiendo los elementos psicopatológicos que permiten hacer el diagnóstico