RESUMO
SETTING: Arkansas, USA. OBJECTIVE: To investigate the relationship between an increase in the proportion of cases with advanced disease at first diagnosis and the recently observed slowing of the decline in tuberculosis (TB) incidence in low-incidence US states. DESIGN: We conducted descriptive statistical analyses of de-identified surveillance data of 1246 culture-confirmed TB patients reported in Arkansas during 1996-2013. We then fitted stepwise, multivariate logistic regression models to identify predictors for advanced disease at diagnosis, defined as having either smear-positive sputum or lung cavitation. RESULTS: From 1996 to 2013, the proportion of new cases with positive sputum smear and cases with lung cavitation increased from 51.6% to 75% and from 37.7% to 50%, respectively. Patients diagnosed during 2006-2013 were more likely to have positive sputum smears (adjusted odds ratio [aOR] 2.55, 95%CI 1.95-3.35) or lung cavitation (aOR 1.49, 95%CI 1.14-1.95) than those diagnosed during 1996-2005. During 1996-2013, age 15-64 years and excessive alcohol use were predictive of positive sputum smear or lung cavitation. CONCLUSION: Measures to reduce the proportion of cases with advanced disease at first diagnosis may be helpful to achieve further decline in TB incidence in low-incidence settings.
Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Mycobacterium tuberculosis/isolamento & purificação , Escarro/microbiologia , Tuberculose Pulmonar/diagnóstico , Adolescente , Adulto , Fatores Etários , Idoso , Arkansas/epidemiologia , Feminino , Humanos , Incidência , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Fatores de Risco , Tuberculose Pulmonar/epidemiologia , Tuberculose Pulmonar/patologia , Adulto JovemRESUMO
Subconjunctival injection of 10 mg of tobramycin provided therapeutic levels in the aqueous humor of 25 patients (ranging in age from 51 to 89 years) who underwent cataract surgery. The absorption from the subconjunctival tissue into the anterior chamber was fairly rapid, reaching a peak in approximately two hours. Peak levels were usually 20 times the minimum inhibitory concentration for Pseudomonas aeruginosa. The drug then gradually disappeared from the aqueous but still exceeded the minimum inhibitory concentration for Pseudomonas organisms after eight hours.
