Evaluación del Programa Integrado de Investigación en Tuberculosis promovido por la sociedad española de Neumología y Cirugía Torácica tras 11 años de funcionamiento / Evaluation of the Integrated Tuberculosis Research Program Sponsored by the Spanish Society of Pulmonology and Thoracic Surgery: 11 Years on

OBJETIVO: El objetivo del estudio fue conocer la tendencia de las variables relacionadas con la tuberculosis (TB) en España a partir del registro del Programa Integrado de Investigación en Tuberculosis (PII-TB) de la Sociedad Española de Neumología y Cirugía Torácica (SEPAR) y evaluar el PII-TB mediante indicadores relacionados con sus objetivos científicos. MÉTODO: Estudio transversal multicéntrico de base poblacional de casos nuevos de TB registrados prospectivamente por el PII-TB entre 2006 y 2016. La tendencia temporal de variables cuantitativas se realizó mediante un modelo de regresión lineal y las cualitativas mediante la prueba de χ2 de tendencia lineal. RESULTADOS: Se analizaron 6.892 casos de TB con una mediana anual de 531. La tendencia general fue significativamente decreciente en mujeres, inmigrantes, privados de libertad y en tratados inicialmente con 3 fármacos. Se incrementaron significativamente la tendencia de grupos de 40 -50 años y > 50 años, primera atención por especialista de zona, hospitalización, retraso diagnóstico, localización diseminada y extrapulmonar única, cultivo (+), realización de antibiogramas, resistencia a fármacos, tratamiento directamente observado, prolongación del tratamiento y muerte por otra causa. Los objetivos científicos del PII-TB que incrementaron significativamente fueron las publicaciones alcanzando un máximo de 8 en 2016 y con un factor de impacto total de 49,664, y también mejoraron los proyectos iniciados anualmente, presentaciones en congresos y las tesis o tesinas. CONCLUSIONES: El PII-TB proporciona información relevante sobre la TB y sus factores asociados en España. Se ha formado un amplio equipo de investigadores y se han detectado aspectos científicos positivos y otros mejorables

OBJECTIVE: The objective of the study was to determine the trend of variables related to tuberculosis (TB) from the Integrated Tuberculosis Research Program (PII-TB) registry of the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR), and to evaluate the PII-TB according to indicators related to its scientific objectives. METHOD: Cross-sectional, population-based, multicenter study of new TB cases prospectively registered in the PII-TB between 2006 and 2016. The time trend of quantitative variables was calculated using a lineal regression model, and qualitative variables using the χy test for lineal trend. RESULTS: A total of 6,892 cases with an annual median of 531 were analyzed. Overall, a significant downward trend was observed in women, immigrants, prisoners, and patients initially treated with 3 drugs. Significant upward trends were observed in patients aged 40-50 and > 50 years, first visit conducted by a specialist, hospitalization, diagnostic delay, disseminated disease and single extrapulmonary location, culture (+), sensitivity testing performed, drug resistance, directly observed treatment, prolonged treatment, and death from another cause. The scientific objectives of the PII-TB that showed a significant upward trend were publications, which reached a maximum of 8 in 2016 with a total impact factor of 49,664, numbers of projects initiated annually, presentations at conferences, and theses. CONCLUSIONS: PII-TB provides relevant information on TB and its associated factors in Spain. A large team of researchers has been created; some scientific aspects of the registry were positive, while others could have been improved

Organización del control de la tuberculosis en España: evaluación de una estrategia dirigida a fomentar la acreditación de unidades de tuberculosis / Organization of Tuberculosis Control in Spain: Evaluation of a Strategy Aimed at Promoting the Accreditation of Tuberculosis Units

INTRODUCCIÓN: Un buen control de la tuberculosis (TB) requiere disponer de personal multidisciplinario bien coordinado. El objetivo fue evaluar el impacto de la acreditación de unidades de TB (UTB) fomentada por la Sociedad Española de Neumología (SEPAR) y ver las diferencias entre los centros que se acreditaron y los que no. MATERIAL Y MÉTODOS: DISEÑO: Estudio observacional descriptivo basado en una encuesta autoadministrada entre octubre de 2014 y febrero de 2018 a 139 responsables de neumología registrados por SEPAR, antes y después de la acreditación. VARIABLES: demográficas, epidemiológicas y sobre estudio de contactos, entre otras. Análisis: descriptiva básica, cálculo de medianas para variables continuas y proporciones para categóricas. Se compararon las variables mediante el test chi-cuadrado y regresión logística. RESULTADOS: La tasa de respuesta fue del 54,7 y del 43,2% en el período pre- y postacreditación de UTB, respectivamente. No se observaron cambios en los diferentes ámbitos de atención y coordinación entre la encuesta pre- y postacreditación, ni tampoco en la organización, al analizar los centros acreditados. Al comparar los centros que se acreditaron con los que no, se detectaron diferencias significativas con relación a recogida de conclusión final, manejo de resistencias, coordinación con otros servicios, estudios de contactos o tratamiento directamente observado. CONCLUSIONES: Se ha objetivado cómo abordan la TB diferentes profesionales, se han detectado aspectos positivos y otros mejorables, y se han observando indicadores de mejor funcionamiento en los centros que se acreditaron frente a los que no lo hicieron. Se precisa una supervisión cercana de las UTB para mejorar su efectividad

INTRODUCTION: Well-coordinated multidisciplinary teams are essential for better tuberculosis (TB) control. Our objective was to evaluate the impact of Spanish Society of Pneumology (SEPAR) accreditation of TB Units (TBU) and to determine differences between the accredited and non-accredited centers. MATERIAL AND METHODS: Design Observational descriptive study based on a self-administered survey from October 2014 to February 2018 completed by 139 heads of respiratory medicine departments collected by SEPAR, before and after TBU accreditation. VARIABLES: demographic, epidemiological and contact tracing (CT) variables, among others. Analysis: basic descriptive analysis, and calculation of medians for continuous variables and proportions for categorical variables. The variables were compared using the Chi-squared test and logistic regression. RESULTS: The response rate was 54.7% and 43.2% in the pre- and post-TBU accreditation period, respectively. No differences were observed in the care and coordination variables between the pre- and post-accreditation survey, nor in the organization when only accredited centers were analyzed. When we compared the accredited and non-accredited centers, significant differences were detected in the collection of the final conclusion, management of resistance, coordination with other departments, contact tracing, and directly observed treatment

Organization of Tuberculosis Control in Spain: Evaluation of a Strategy Aimed at Promoting the Accreditation of Tuberculosis Units. / Organización del control de la tuberculosis en España: evaluación de una estrategia dirigida a fomentar la acreditación de unidades de tuberculosis.

INTRODUCTION: Well-coordinated multidisciplinary teams are essential for better tuberculosis (TB) control. Our objective was to evaluate the impact of Spanish Society of Pneumology (SEPAR) accreditation of TB Units (TBU) and to determine differences between the accredited and non-accredited centers. DESIGN: Observational descriptive study based on a self-administered survey from October 2014 to February 2018 completed by 139 heads of respiratory medicine departments collected by SEPAR, before and after TBU accreditation. VARIABLES: demographic, epidemiological and contact tracing (CT) variables, among others. ANALYSIS: basic descriptive analysis, and calculation of medians for continuous variables and proportions for categorical variables. The variables were compared using the Chi-squared test and logistic regression. RESULTS: The response rate was 54.7% and 43.2% in the pre- and post-TBU accreditation period, respectively. No differences were observed in the care and coordination variables between the pre- and post-accreditation survey, nor in the organization when only accredited centers were analyzed. When we compared the accredited and non-accredited centers, significant differences were detected in the collection of the final conclusion, management of resistance, coordination with other departments, contact tracing, and directly observed treatment. CONCLUSIONS: The approach of different professionals with regard to TB has been addressed. Positive aspects and areas for improvement have been detected, and better results were observed in the accredited versus non-accredited centers. A closer supervision of TBUs is necessary to improve their effectiveness.

Evaluation of the Integrated Tuberculosis Research Program Sponsored by the Spanish Society of Pulmonology and Thoracic Surgery: 11 Years on. / Evaluación del Programa Integrado de Investigación en Tuberculosis promovido por la sociedad española de Neumología y Cirugía Torácica tras 11 años de funcionamiento.

OBJECTIVE: The objective of the study was to determine the trend of variables related to tuberculosis (TB) from the Integrated Tuberculosis Research Program (PII-TB) registry of the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR), and to evaluate the PII-TB according to indicators related to its scientific objectives. METHOD: Cross-sectional, population-based, multicenter study of new TB cases prospectively registered in the PII-TB between 2006 and 2016. The time trend of quantitative variables was calculated using a lineal regression model, and qualitative variables using the χy test for lineal trend. RESULTS: A total of 6,892 cases with an annual median of 531 were analyzed. Overall, a significant downward trend was observed in women, immigrants, prisoners, and patients initially treated with 3 drugs. Significant upward trends were observed in patients aged 40-50 and > 50 years, first visit conducted by a specialist, hospitalization, diagnostic delay, disseminated disease and single extrapulmonary location, culture(+), sensitivity testing performed, drug resistance, directly observed treatment, prolonged treatment, and death from another cause. The scientific objectives of the PII-TB that showed a significant upward trend were publications, which reached a maximum of 8 in 2016 with a total impact factor of 49,664, numbers of projects initiated annually, presentations at conferences, and theses. CONCLUSIONS: PII-TB provides relevant information on TB and its associated factors in Spain. A large team of researchers has been created; some scientific aspects of the registry were positive, while others could have been improved.

Costes de la tuberculosis en España: factores relacionados / Tuberculosis costs in Spain and related factors

Objetivo. Analizar los costes directos e indirectos derivados del diagnóstico y tratamiento de la tuberculosis (TB) y sus factores asociados. Pacientes y métodos. Estudio prospectivo de pacientes diagnosticados de TB entre septiembre de 2014 y septiembre de 2015. Se calcularon los costes directos (estancias hospitalarias, consultas, estudios diagnósticos y tratamiento), e indirectos (absentismo laboral y pérdida de productividad, estudio de contactos y medidas rehabilitadoras). Los costes se compararon atendiendo a las variables: edad, sexo, país de origen, ingreso hospitalario, pruebas diagnósticas, tratamiento, resistencia farmacológica, tratamiento directamente observado (TDO) y días de baja laboral. Se compararon proporciones mediante Chi cuadrado y las variables significativas se incluyeron en un modelo de regresión logística calculándose las odds ratio (OR) y sus correspondientes intervalos de confianza del 95% (IC). Resultados. Fueron incluidos 319 pacientes con una edad media de 56,72 ± 20,79 €. El coste medio fue de 10.262,62 ± 14.961,66 €, y aumentaba significativamente en relación con el ingreso hospitalario, el uso de la PCR, la realización de baciloscopia y cultivo, antibiograma, tomografía axial computarizada de tórax, biopsia pleural, tratamiento de más de 9 meses, TDO y baja laboral. En el análisis multivariante mantenían asociación independiente: ingreso hospitalario (OR = 96,8; IC: 29-472,3), antibiograma (OR = 4,34; IC: 1,71-12,1), tomografía axial computarizada de tórax (OR = 2,25; IC: 1,08-4,77), TDO (OR = 20,76; IC: 4,11-148) y baja laboral (OR = 26,9; IC: 8,51-122). Conclusión. La Tuberculosis acarrea un gasto sanitario significativo. Medidas dirigidas a mejorar el control de la enfermedad y disminuir los ingresos hospitalarios serían importantes para reducirlo

Objective. To analyze the direct and indirect costs of diagnosis and management of tuberculosis (TB) and associated factors. Patients and methods. Prospective study of patients diagnosed with TB between September 2014 and September 2015. We calculated direct (hospital stays, visits, diagnostic tests, and treatment) and indirect (sick leave and loss of productivity, contact tracing, and rehabilitation) costs. The following cost-related variables were compared: age, gender, country of origin, hospital stays, diagnostic testing, sensitivity testing, treatment, resistance, directed observed therapy (DOT), and days of sick leave. Proportions were compared using the chi-squared test and significant variables were included in a logistic regression analysis to calculate odds ratio (OR) and corresponding 95% confidence intervals. Results. 319 patients were included with a mean age of 56.72 ± 20.79 years. The average cost was €10,262.62 ± 14,961.66, which increased significantly when associated with hospital admission, polymerase chain reaction, sputum smears and cultures, sensitvity testing, chest computed tomography, pleural biopsy, drug treatment longer than nine months, DOT and sick leave. In the multivariate analysis, hospitalization (OR = 96.8; CI 29-472), sensitivity testing (OR = 4.34; CI 1.71-12.1), chest CT (OR = 2.25; CI 1.08-4.77), DOT (OR = 20.76; CI 4.11-148) and sick leave (OR = 26,9; CI 8,51-122) showed an independent association with cost. Conclusion. Tuberculosis gives rise to significant health spending. In order to reduce these costs, more control of transmission, and fewer hospital admissions would be required

Factors associated with smoking among tuberculosis patients in Spain.

BACKGROUND: To determine the prevalence of smoking and analyze associated factors in a cohort of patients diagnosed with tuberculosis (TB) in Spain between 2006 and 2013. METHODS: Multicenter, cross-sectional, descriptive, observational study using a national database of TB patients, using logistic regression to calculate odds ratios (OR) and confidence intervals (CI). RESULTS: We analyzed 5,846 cases (62 % men, mean age 39 years, 33 % foreigners). 23.4 % were alcohol abuser, 1.3 % were injected drug users (IDU), 4.6 % were co-infected with HIV, and 7.5 % had a history of TB treatment. 6.6 % and 0.8 % showed resistance to one and multiple drugs, respectively. The predominant clinical presentation was pulmonary (71 %) with a cavitary radiological pattern in 32.8 % of cases. 82 % of cases were confirmed microbiologically, and 54 % were smear-positive microscopy. 2,300 (39.3 %) patients were smokers. The following factors were associated with smoking: male sex (OR = 2.26;CI:1.97;2.60), Spanish origin (OR = 2.79;CI:2.40-3.24), alcoholism (OR = 2.85;CI:2.46;3.31), IDU (OR = 2.78;CI:1.48;5.52), homelessness (OR = 1.99;CI:1.14-3.57), pulmonary TB (OR = 1.61;CI:1.16;2.24), cavitary radiological pattern (OR = 1.99;CI:1.43;2.79) and a smear-positive microscopy at the time of diagnosis (OR = 1.39;CI:1.14;1.17). CONCLUSIONS: The prevalence of smoking among TB patients is high. Smokers with TB have a distinct sociodemographic, clinical, radiological and microbiological profile to non-smokers.

Tuberculosis Costs in Spain and Related Factors. / Costes de la tuberculosis en España: factores relacionados.

OBJECTIVE: To analyze the direct and indirect costs of diagnosis and management of tuberculosis (TB) and associated factors. PATIENTS AND METHODS: Prospective study of patients diagnosed with TB between September 2014 and September 2015. We calculated direct (hospital stays, visits, diagnostic tests, and treatment) and indirect (sick leave and loss of productivity, contact tracing, and rehabilitation) costs. The following cost-related variables were compared: age, gender, country of origin, hospital stays, diagnostic testing, sensitivity testing, treatment, resistance, directed observed therapy (DOT), and days of sick leave. Proportions were compared using the chi-squared test and significant variables were included in a logistic regression analysis to calculate odds ratio (OR) and corresponding 95% confidence intervals. RESULTS: 319 patients were included with a mean age of 56.72±20.79 years. The average cost was €10,262.62±14,961.66, which increased significantly when associated with hospital admission, polymerase chain reaction, sputum smears and cultures, sensitvity testing, chest computed tomography, pleural biopsy, drug treatment longer than nine months, DOT and sick leave. In the multivariate analysis, hospitalization (OR=96.8; CI 29-472), sensitivity testing (OR=4.34; CI 1.71-12.1), chest CT (OR= 2.25; CI 1.08-4.77), DOT (OR=20.76; CI 4.11-148) and sick leave (OR=26,9; CI 8,51-122) showed an independent association with cost. CONCLUSION: Tuberculosis gives rise to significant health spending. In order to reduce these costs, more control of transmission, and fewer hospital admissions would be required.

Cumplimiento en España de la norma de prescribir cuatro fármacos en la fase intensiva del tratamiento estándar de la tuberculosis / Spanish Compliance With Guidelines for Prescribing Four Drugs in the Intensive Phase of Standard Tuberculosis Treatment

Introducción: Las normativas internacionales y españolas recomiendan el tratamiento intensivo de la tuberculosis (TB) con cuatro fármacos. El objetivo es determinar si en España se sigue esta recomendación y los factores asociados a utilizar tres fármacos (pauta estándar sin etambutol). Metodología: Estudio multicéntrico descriptivo, retrospectivo, en el que se analizaron los datos de los pacientes diagnosticados de TB en prácticamente todas las Comunidades Autónomas españolas entre 2007 y 2012. El estudio de factores asociados a prescribir tres fármacos se basó en regresión logística, calculándose las odds ratio (OR) y sus correspondientes intervalos de confianza del 95% (IC). Resultados: Se incluyeron 3.189 pacientes, de los que 1.413 (44,3%) fueron tratados con tres fármacos. Este porcentaje fue del 41,2% en los pacientes con baciloscopia positiva, del 36,1% en los que tenían al menos resistencia a un fármaco, del 31,4% en los que tenían infección por VIH y del 24,8% en los inmigrantes. Los factores asociados al uso de tres fármacos fueron: ser mujer (OR = 1,18; IC: 1,00-1,39); ser autóctono (OR = 3,09; IC: 2,58-3,70); estar jubilado (OR = 1,42; IC: 1,14-1,77); vivir sin techo (OR = 3,10; IC: 1,52-6,43), vivir solo (OR = 1,62; IC: 1,11-2,36) o en familia (OR = 1,97; IC: 1,48-2,65); ser atendido por especialistas de zona (OR = 1,37; IC: 1,10;1,70); no estar infectado por el VIH (OR = 1,63; IC: 1,09-2,48) y tener baciloscopia negativa con cultivo positivo (OR = 1,59; IC: 1,25-2,02). Conclusiones: Existe una proporción importante de tratamiento intensivo con tres fármacos. Se deben seguir las recomendaciones del tratamiento de la TB, tanto en la práctica clínica habitual como por parte del Plan para la Prevención y Control de la TB en España

Introduction: International and Spanish guidelines recommend a 4-drug regimen in the intensive treatment of tuberculosis (TB). The aim of our study was to determine if these recommendations are followed in Spain, and the factors associated with the use of 3 drugs (standard regimen without ethambutol). Methodology: Observational, multicenter, retrospective analysis of data from patients diagnosed with TB in practically all Spanish Autonomous Communities between 2007 and 2102. Factors associated with the use of 3 drugs were analyzed using logistic regression, and odds ratios (OR) and corresponding 95% confidence intervals (CI) were calculated. Results: A total of 3,189 patients were included, 1,413 (44.3%) of whom received 3 drugs. The percentage of 3-drug users among patients with positive sputum smear was 41.2%; among patients with resistance to at least 1 drug, 36.1%; among HIV-infected patients, 31.4%; and among immigrants, 24.8%. Factors associated with the use of 3 drugs were: female sex (OR = 1.18; CI: 1.00-1.39); native Spanish (OR = 3.09; CI: 2.58-3.70); retired (OR = 1.42; CI: 1.14-1.77); homeless (OR = 3.10; CI: 1.52-6.43); living alone (OR = 1.62; CI: 1.11-2.36); living in a family (OR = 1.97; CI: 1.48-2.65); seen by specialists in the region (OR = 1.37; CI: 1.10;1.70); no HIV infection (OR = 1.63; CI: 1.09-2.48); and negative sputum smear with positive culture (OR = 1.59; CI: 1.25-2.02). Conclusions: A large proportion of TB patients receive intensive treatment with 3 drugs. TB treatment recommendations should be followed, both in routine clinical practice and by the National Plan for Prevention and Control of Tuberculosis in Spain

Spanish Compliance With Guidelines for Prescribing Four Drugs in the Intensive Phase of Standard Tuberculosis Treatment. / Cumplimiento en España de la norma de prescribir cuatro fármacos en la fase intensiva del tratamiento estándar de la tuberculosis.

INTRODUCTION: International and Spanish guidelines recommend a 4-drug regimen in the intensive treatment of tuberculosis (TB). The aim of our study was to determine if these recommendations are followed in Spain, and the factors associated with the use of 3 drugs (standard regimen without ethambutol). METHODOLOGY: Observational, multicenter, retrospective analysis of data from patients diagnosed with TB in practically all Spanish Autonomous Communities between 2007 and 2102. Factors associated with the use of 3 drugs were analyzed using logistic regression, and odds ratios (OR) and corresponding 95% confidence intervals (CI) were calculated. RESULTS: A total of 3,189 patients were included, 1,413 (44.3%) of whom received 3 drugs. The percentage of 3-drug users among patients with positive sputum smear was 41.2%; among patients with resistance to at least 1 drug, 36.1%; among HIV-infected patients, 31.4%; and among immigrants, 24.8%. Factors associated with the use of 3 drugs were: female sex (OR=1.18; CI: 1.00-1.39); native Spanish (OR=3.09; CI: 2.58-3.70); retired (OR=1.42; CI: 1.14-1.77); homeless (OR=3.10; CI: 1.52-6.43); living alone (OR=1.62; CI: 1.11-2.36); living in a family (OR=1.97; CI: 1.48-2.65); seen by specialists in the region (OR=1.37; CI: 1.10;1.70); no HIV infection (OR=1.63; CI: 1.09-2.48); and negative sputum smear with positive culture (OR=1.59; CI: 1.25-2.02). CONCLUSIONS: A large proportion of TB patients receive intensive treatment with 3 drugs. TB treatment recommendations should be followed, both in routine clinical practice and by the National Plan for Prevention and Control of Tuberculosis in Spain.

Factors associated with unreported tuberculosis cases in Spanish hospitals.

BACKGROUND: Under-reporting of tuberculosis (TB) cases complicates disease control, hinders contact tracing and alters the accuracy of epidemiological data, including disease burden. The objective of the present study is to evaluate the proportion of unreported TB cases in Spanish healthcare facilities and to identify the associated factors. METHODS: A multi-center retrospective study design was employed. The study included TB cases diagnosed in 16 facilities during 2011-2012. These cases were compared to those reported to the corresponding public health departments. Demographic, microbiological and clinical data were analyzed to determine the factors associated with unreported cases. Associated factors were analyzed on a bivariate level using the x(2) test and on a multivariate level using a logistic regression. Odds ratios (OR) and 95 % confidence intervals (CI) were calculated. RESULTS: Of the 592 TB cases included in the study, 85 (14.4 %) were not reported. The percentage of unreported cases per healthcare center ranged from 0-45.2 %. The following variables were associated to under-reporting at a multivariate level: smear-negative TB (OR = 1.87; CI:1.07-3.28), extrapulmonary disease (OR = 2.07; CI:1.05-4.09) and retired patients (OR = 3.04; CI:1.29-7.18). A nurse case manager was present in all of the centers with 100 % reporting. The percentage of reported cases among the smear-positive cases was 9.4 % and 19.4 % (p = 0.001) among the rest of the study population. Smear-positive TB was no associated to under-reporting. CONCLUSIONS: It is important that TB Control Programs encourage thorough case reporting to improve disease control, contact tracing and accuracy of epidemiological data. The help from a TB nurse case manager could improve the rate of under-reporting.

Neuronal changes and oxidative stress in adolescent rats after repeated exposure to mephedrone.

Mephedrone is a new designer drug of abuse. We have investigated the neurochemical/enzymatic changes after mephedrone administration to adolescent rats (3×25 mg/kg, s.c. in a day, with a 2 h interval between doses, for two days) at high ambient temperature (26±2 °C), a schedule that intends to model human recreational abuse. In addition, we have studied the effect of mephedrone in spatial learning and memory. The drug caused a transient decrease in weight gain. After the first dose, animals showed hypothermia but, after the subsequent doses, temperature raised over the values of saline-treated group. We observed the development of tolerance to these thermoregulatory effects of mephedrone. Mephedrone induced a reduction of the densities of dopamine (30% in the frontal cortex) and serotonin (40% in the frontal cortex and the hippocampus and 48% in the striatum) transporters without microgliosis. These deficits were also accompanied by a parallel decrease in the expression of tyrosine hydroxylase and tryptophan hydroxylase 2. These changes matched with a down-regulation of D2 dopamine receptors in the striatum. Mephedrone also induced an oxidative stress evidenced by an increase of lipid peroxidation in the frontal cortex, and accompanied by a rise in glutathione peroxidase levels in all studied brain areas. Drug-treated animals displayed an impairment of the reference memory in the Morris water maze one week beyond the cessation of drug exposure, while the spatial learning process seems to be preserved. These findings raise concerns about the neuronal long-term effects of mephedrone.

Resistencia a fármacos antituberculosos de primera línea en Españna durante 2010-2011. Estudio RETUBES / Resistance to First-Line Antituberculosis Drugs in Spain, 2010-2011. RETUBES Study

Introducción: La magnitud de la resistencia actual a fármacos antituberculosos en España es desconocida. El objetivo del estudio es describir la resistencia a fármacos antituberculosos de primera línea y determinar sus factores asociados. Métodos: Estudio prospectivo multicéntrico de pacientes tuberculosos adultos con aislamiento de Mycobacterium tuberculosis y antibiograma de fármacos de primera línea en 32 hospitales y un centro extrahospitalario del sistema sanitario nacional durante los años 2010 y 2011. Resultados: Se estudió a 519 pacientes, 342 españoles y 177 (34,1%) extranjeros, 48 de ellos (9,2%) con resistencia a cualquier fármaco, de los que 35 (6,7%) eran resistentes a isoniacida. Hubo 10 casos multirresistentes (1,9%) y ninguno extremadamente resistente. Se detectó resistencia inicial a isoniacida en 28 de los 487 (5,7%) pacientes sin antecedentes de tratamiento antituberculoso previo, afectando más a los extranjeros (p < 0,01), y resistencia adquirida en 7 (22,6%) casos previamente tratados. La multirresistencia fue inicial en 6 casos (1,2%) y adquirida en otros 4 (12,9%). Los factores asociados a tener resistencia inicial a isoniacida fueron ser inmigrante y la convivencia en grupo (OR = 2,3; IC del 95%, 0,98- 5,67, y OR = 2,2; IC del 95%, 1,05-7,07, respectivamente). El factor asociado a la existencia de resistencia adquirida a isoniacida fue la edad inferior a 50 años (p = 0,03). Conclusiones: La tasa de resistencia inicial a isoniacida es superior a la estimada, probablemente debida al aumento de la inmigración durante los últimos años, lo que aconseja su vigilancia nacional sistemática. Los individuos inmigrantes y los que conviven en grupo tienen mayor riesgo de tener resistencia a isoniacida

Introduction: The magnitude of current resistance to antituberculosis drugs in Spain is unknown. The objective of this study is to describe resistance to first-line antituberculosis drugs and determine the associated factors. Methods: Prospective multicenter study of adult tuberculosis patients with positive Mycobacterium tuberculosis culture and antibiogram including first-line drugs in 32 hospitals and one out-patient center of the Spanish Health System between 2010 and 2011. Results: A total of 519 patients, 342 Spanish nationals and 177 (34.1%) foreigners were studied. Drug resistance was found in 48 (9.2%), of which 35 (6.7%) were isoniazid-resistant. There were 10 (1.9%) multiresistant cases and no strain was extremely resistant. Initial isoniazid resistance was detected in 28 of the 487 (5.7%) antituberulosis-naïve patients, most of whom were foreigners (P<.01). Acquired resistance was seen in 7 (22.6%) previously treated cases. Multiresistance was initial in 6 cases (1.2%) and acquired in another 4 (12.9%). Factors associated with initial isoniazid resistance were immigrant status and group cohabitation OR = 2.3; 95%CI: .98-5.67 and OR = 2.2; 95%CI: 1.05-7.07 respectively). The factor associated with acquired resistance to isoniazid was age below 50 years (P=.03). Conclusions: The rate of initial isoniazid resistance is greater than estimated, probably due to the increase in immigration during recent years, suggesting that systematic national monitoring is required. Immigrants and those who cohabit in groups have a higher risk of isoniazid resistance

Resistance to first-line antituberculosis drugs in Spain, 2010-2011. RETUBES Study.

INTRODUCTION: The magnitude of current resistance to antituberculosis drugs in Spain is unknown. The objective of this study is to describe resistance to first-line antituberculosis drugs and determine the associated factors. METHODS: Prospective multicenter study of adult tuberculosis patients with positive Mycobacterium tuberculosis culture and antibiogram including first-line drugs in 32 hospitals and one out-patient center of the Spanish Health System between 2010 and 2011. RESULTS: A total of 519 patients, 342 Spanish nationals and 177 (34.1%) foreigners were studied. Drug resistance was found in 48 (9.2%), of which 35 (6.7%) were isoniazid-resistant. There were 10 (1.9%) multiresistant cases and no strain was extremely resistant. Initial isoniazid resistance was detected in 28 of the 487 (5.7%) antituberulosis-naïve patients, most of whom were foreigners (P<.01). Acquired resistance was seen in 7 (22.6%) previously treated cases. Multiresistance was initial in 6 cases (1.2%) and acquired in another 4 (12.9%). Factors associated with initial isoniazid resistance were immigrant status and group cohabitation OR=2.3; 95%CI: .98-5.67 and OR=2.2; 95%CI: 1.05-7.07 respectively). The factor associated with acquired resistance to isoniazid was age below 50 years (P=.03). CONCLUSIONS: The rate of initial isoniazid resistance is greater than estimated, probably due to the increase in immigration during recent years, suggesting that systematic national monitoring is required. Immigrants and those who cohabit in groups have a higher risk of isoniazid resistance.

Tuberculosis e inmigración en España. Revisión bibliográfica / Tuberculosis and immigration in Spain. Scoping review

Fundamentos: La inmigración es un fenómeno bastante reciente en España y aún existen pocas publicaciones científicas sobre tuberculosis (TB) e inmigración. El objetivo de este estudio fue describir las características diferenciales de la tuberculosis en inmigrantes respecto a los sujetos autóctonos. Métodos: Revisión bibliográfica de artículos originales escritos en español o inglés y publicados entre 1998-2012, sobre TB en poblaciones inmigrantes. Se incluyeron las publicaciones con las palabras clave tuberculosis, inmigrante y España. La búsqueda bibliográfica se realizó en las bases de datos Medline y MEDES. Resultados: Se encontró un total de 72.087 artículos publicados sobre TB a escala mundial y en el 6% de éstos se trataba el tema inmigración. En relación a España se encontraron 2.917 artículos, que representaban el 4% de los publicados a escala mundial, y 219 (7,5%) consideraban además la inmigración. De los 219 artículos, el 48% fueron publicados en revistas españolas y el 52% restante en revistas anglosajonas. El 93,5% de las personas inmigrantes con TB tenían menos de 51 años, mientras que en los nativos este porcentaje es del 64,9%. Las resistencias al tratamiento se da en el 7,8% de la población inmigrante frente al 3,8 de la autóctona. Conclusiones: Los inmigrantes con tuberculosis se caracterizan por ser más jóvenes que los autóctonos con tuberculosis, presentan más resistencias farmacológicas y proceden sobretodo de América Latina, Europa del Este, África y Asia. La no disponibilidad de la tarjeta sanitaria puede ser un problema (AU)

Background: Immigration is a fairly recent phenomenon in Spain and there are still few scientific publications on tuberculosis (TB) and immigration. Therefore, the aim of this study is to describe the differential characteristics of TB in the immigrant population with respect to natives in Spain. Methods: Literature review of original articles written in Spanish or English and published 1998-2012 about TB among immigrant population. The articles with the key words "Tuberculosis", "immigrants" and "Spain" were included. Literature search was performed in Medline and MEDES. Results:Atotal of 72,087 articles on TBwere detectedworldwide, 6% of themdealt with the immigration issue. Regarding Spain we found 2,917 articles representing 4% of the papers published worldwide, and in 219 (7.5%) immigration was considered. Of the 219 articles, 48%were published in Spanish journals and the 52% remaining in Anglo-Saxon journals. 93.5% of immigrants with TB were younger than 51, whereas this percentage was 64.9% in natives. Drug resistance can be seen in 7.8% of the immigrant population but in only 3.8%of natives. It was also detected that the unavailability of a health card could be a problem. Conclusion: Immigrants with TB were characterized by being younger and having more drug resistance and coming mostly from LatinAmerica, Eastern Europe,Africa andAsia. It was also detected that the unavailability of a health card could be a problem (AU)

[Tuberculosis and immigration in Spain: scoping review]. / Tuberculosis e inmigración en España: revisión bibliográfica.

BACKGROUND: Immigration is a fairly recent phenomenon in Spain and there are still few scientific publications on tuberculosis (TB) and immigration. Therefore, the aim of this study is to describe the differential characteristics of TB in the immigrant population with respect to natives in Spain. METHODS: Literature review of original articles written in Spanish or English and published 1998-2012 about TB among immigrant population. The articles with the key words "Tuberculosis", "immigrants" and "Spain" were included. Literature search was performed in Medline and MEDES. RESULTS: A total of 72,087 articles on TB were detected worldwide, 6% of them dealt with the immigration issue. Regarding Spain we found 2,917 articles representing 4% of the papers published worldwide, and in 219 (7.5%) immigration was considered. Of the 219 articles, 48% were published in Spanish journals and the 52% remaining in Anglo-Saxon journals. 93.5% of immigrants with TB were younger than 51, whereas this percentage was 64.9% in natives. Drug resistance can be seen in 7.8% of the immigrant population but in only 3.8% of natives. It was also detected that the unavailability of a health card could be a problem. CONCLUSION: Immigrants with TB were characterized by being younger and having more drug resistance and coming mostly from Latin America, Eastern Europe, Africa and Asia. It was also detected that the unavailability of a health card could be a problem.

Navigation with two landmarks in rats (Rattus norvegicus): the role of landmark salience.

In two experiments, male and female rats were trained in a Morris pool in the presence of 1 (Experiment 1) or 2 (Experiment 2) landmarks, which were placed relatively close in relation to a hidden platform. Experiment 1 established the relative salience of 3 landmarks. Two of them revealed a similar salience, and smaller than a third one, the most salient landmark, both in training and on a test trial without the platform. Then in Experiment 2 rats were extensively trained to find a hidden platform in the presence of a configuration formed by 2 landmarks and the effects of varying the salience of one of the landmarks were studied. Subsequent test trials without the platform revealed that finding the platform was controlled by different strategies and that the rats were taking advantage of this redundancy depending on the nature of the test trials. Surprisingly, in Experiment 2 a clear sex difference was found on escape trials only, with males reaching the platform faster than females.

A predictive scoring instrument for tuberculosis lost to follow-up outcome.

BACKGROUND: Adherence to tuberculosis (TB) treatment is troublesome, due to long therapy duration, quick therapeutic response which allows the patient to disregard about the rest of their treatment and the lack of motivation on behalf of the patient for improved. The objective of this study was to develop and validate a scoring system to predict the probability of lost to follow-up outcome in TB patients as a way to identify patients suitable for directly observed treatments (DOT) and other interventions to improve adherence. METHODS: Two prospective cohorts, were used to develop and validate a logistic regression model. A scoring system was constructed, based on the coefficients of factors associated with a lost to follow-up outcome. The probability of lost to follow-up outcome associated with each score was calculated. Predictions in both cohorts were tested using receiver operating characteristic curves (ROC). RESULTS: The best model to predict lost to follow-up outcome included the following characteristics: immigration (1 point value), living alone (1 point) or in an institution (2 points), previous anti-TB treatment (2 points), poor patient understanding (2 points), intravenous drugs use (IDU) (4 points) or unknown IDU status (1 point). Scores of 0, 1, 2, 3, 4 and 5 points were associated with a lost to follow-up probability of 2,2% 5,4% 9,9%, 16,4%, 15%, and 28%, respectively. The ROC curve for the validation group demonstrated a good fit (AUC: 0,67 [95% CI; 0,65-0,70]). CONCLUSION: This model has a good capacity to predict a lost to follow-up outcome. Its use could help TB Programs to determine which patients are good candidates for DOT and other strategies to improve TB treatment adherence.