Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 121
Filtrar
2.
Clin Infect Dis ; 2019 Mar 28.
Artigo em Inglês | MEDLINE | ID: mdl-30942853

RESUMO

BACKGROUND: We assessed multidrug-resistant tuberculosis (MDR-TB) cases and their household contacts (HHCs) to inform the development of an interventional clinical trial. METHODS: We conducted a cross-sectional study of adult MDR-TB cases and their HHCs in eight high-TB-burden countries. HHCs underwent symptom screening, chest radiography (CXR), sputum TB bacteriology, TB infection (TBI) testing (tuberculin skin test and interferon gamma release assay) and HIV testing. RESULTS: From October 2015 to April 2016, 1016 HHCs from 284 MDR-TB cases were enrolled. At diagnosis, 69% of MDR-TB cases were acid fast bacilli sputum smear-positive and 43% had cavitary disease; at study entry 35% remained smear-positive after a median MDR-TB treatment duration of 8.8 weeks. Nine HHCs were diagnosed with TB prior to entry and excluded. Of the remaining 1007 HHCs, 41% were male and the median age was 25 years. 121 (12%) HHC had new TB identified: 17 (2%) were confirmed; 33 (3%) probable; and 71 (7%) possible TB. TBI prevalence (defined as either TST or IGRA positivity) was 72% and varied by age, test used, and country. Of 1007 HHCs, 775 (77%) were considered high-risk per these mutually exclusive groups: 102 (10%) <5 years; 63 (6%) 5 and HIV-infected; and 610 (61%) 5 years, HIV-negative/unknown, and TBI positive. Only 21 (2%) HHCs were on preventive therapy. CONCLUSIONS: The majority of HHCs in these high-burden countries were at high risk of TB disease and infection, yet few were receiving routine preventive therapy. Trials of novel preventive therapies are urgently needed to inform treatment policy and practice.

3.
Humanidad. med ; 18(3): 521-531, set.-dic. 2018.
Artigo em Espanhol | LILACS-Express | ID: biblio-975458

RESUMO

RESUMEN El trabajo responde al desarrollo del Programa Nacional Formación Médica Integral Comunitaria (PNFMIC), dada la necesidad de consolidar el proceso formativo desde las potencialidades que brinda el trabajo comunitario integrado. Se reflexionó desde el tratamiento teórico metodológico en aspectos epistemológicos del tema, sus relaciones, que desde la acción práctico transformadora puede y debe lograr la entrada en las áreas de residencias de colectivos humanos identificados ya por estilos y formas de vida, por costumbres y cultura autóctonas. El objetivo está dirigido a establecer una aproximación a la problemática del trabajo comunitario integrado como escenario para fortalecer lo formativo, en tanto se resalta la importancia de reconstruir una comunidad y esbozar aspectos metodológicos para la acción concreta de transformación que garantiza su estabilidad y sostenibilidad y por tanto, dirigida a establecerse como tecnología social orientada a demostrar su impacto social y científico desde las condiciones de la construcción de una sociedad diferente.


ABSTRACT The work answers to the development of the National Program Community Integral Medical Education (PNFMIC), considering the need to consolidate the formative process from the potentialities that offers the integrated community work. It was reflected from the methodological theoretical treatment in epistemological aspects of the topic, its relations, that from the practical transforming action can and must achieve the entry in the areas of residences of human groups identified already by styles and forms of life, by native customs and culture. The objective is directed to establish an approach to the problems of the integrated community work like stage to strengthen the formative, meanwhile it is highlighted the importance of reconstructing a community and of outlining methodological aspects for the concrete action of transformation that guarantees its stability and sustainability and therefore, directed to settle like social technology faced to demonstrate its social and scientific impact from the conditions of the construction of a different society.

4.
J Clin Microbiol ; 56(8)2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29848566

RESUMO

Despite aggressive treatment, vascular pythiosis has a mortality rate of 40%. This is due to delays in diagnosis and a lack of effective monitoring tools. To overcome this drawback, serum beta-d-glucan (BG) and P. insidiosum-specific antibody (Pi-Ab) were examined as potential monitoring markers in vascular pythiosis. A prospective cohort study of vascular pythiosis patients was carried out from January 2010 to July 2016. Clinical information and blood samples were collected and evaluated by the BG and Pi-Ab assays. Linear mixed-effect models were used to compare BG and Pi-Ab levels. The in vitro susceptibility test was performed with all P. insidiosum isolates from culture-positive cases. A total of 50 patients were enrolled: 45 survived and 5 died during follow-up. The survivors had a significantly shorter time to medical care (P < 0.0001) and a significantly shorter waiting time to the first surgery (P < 0.0001). There were no differences in BG levels among the groups at diagnosis (P = 0.33); however, BG levels among survivors were significantly lower than those of the deceased group at 0.5 months (P < 0.0001) and became undetectable after 3 months. Survivors were able to maintain an enzyme-linked immunosorbent assay (ELISA) value (EV) of Pi-Ab above 8, whereas the EV among deceased patients was less than 4. In vitro susceptibility results revealed no synergistic effects between itraconazole and terbinafine. This study showed that BG and Pi-Ab are potentially valuable markers to monitor the disease after treatment initiation. An unchanged BG level at 2 weeks after surgery should prompt an evaluation for residual disease.

8.
Bol. venez. infectol ; 28(1): 41-50, ene-jun 2017.
Artigo em Espanhol | LILACS-Express | ID: biblio-876675

RESUMO

Introducción: En pediatría las enfermedades infecciosas constituyen la causa más frecuente de consulta a nivel de atención primaria en salud. La población del presente trabajo de investigación es predominantemente de la etnia Warao y nuestra línea de investigación pretende realizar diagnóstico clínico oportuno tanto de la gravedad del estado nutricional como de las enfermedades infecciosas, respetando la identidad, cultura y autonomía de dicha etnia. Objetivo: Identificar las enfermedades infecciosas más frecuentes por diagnóstico clínico en pacientes desnutridos con edades comprendidas entre 6 meses a 10 años de edad, habitantes de la Parroquia Curiapo, Municipio Antonio Díaz, Edo. Delta Amacuro en el período mayo-julio de 2016. Métodos: La recolección de datos se basó en la entrevista médico-paciente y en la utilización de equipos médicos como estetoscopio, otorrinolaringoscopio, balanza, cinta métrica, gráficas nutricionales de la Organización Mundial de la Salud y las del Estudio Transversal de Caracas. Resultados: De 608 pacientes en estudio, 296 (48,7 %) se encuentran en un estado de malnutrición por déficit, siendo la desnutrición subclínica la predominante con un total de 107 casos. Por otro lado de esos pacientes con malnutrición por déficit, la diarrea y el catarro común conforman las enfermedades infecciosas más frecuentes. Conclusión: El 50 % de la población en estudio presenta algún grado de desnutrición, y la enfermedad infecciosa más frecuente es la diarrea la cual deteriora el estado nutricional del paciente; generándose un círculo pobreza-enfermedad difícil de romper.


Introduction: Pediatric infectious diseases are the most frequent cause of consultation at the level of primary health care. The population of this research belongs to ethnic warao, and our research aims to make timely clinical diagnosis of the severity of the nutritional status and the infectious diseases, respecting the identity, culture and autonomy of this ethnic group. Objective: Our main objective is to identify the most common infectious diseases by clinical diagnosis in undernourished patients between 6 months and 10 years old inhabitants of the Curiapo Parish, Municipality Antonio Diaz, Edo. Delta Amacuro in the period May-July 2016. Methods: Data collection was based in Medical-patient interview, also using medical equipment such as stethoscope, tape measure, othorrinolaringoscope, scales, Nutritional charts of the World Health Organization and the Transversal Study of Caracas for a complete physical examination. Results: In our research we found out that, of 608 patients studied, 296 (48,7 %) are in undernourished deficit level, being subclinical malnutrition the most frequent with 107 cases. On the otherside, those patients with undernourished deficit level, Diarrhea and common cold make up the most frequent infectious diseases in our studied population. Conclusions: We conclude that in the population, about 50 %, have some kind of malnutrition and the most common infectious diseases is diarrhea which decrease the nutritional status of the patients, generating a poverty-disease circle, very difficult to break out.

9.
Fetal Diagn Ther ; 42(4): 262-270, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28384638

RESUMO

OBJECTIVE: Fetal aortic valvuloplasty (FAV) may avoid progression of critical aortic stenosis (CAS) to hypoplastic left ventricle, improving the options for biventricular circulation (BVC). We describe the results of FAV in 2 referral centers in Spain. METHODS: We analyzed all FAVs performed in the period 2007-2015. The selection of candidates, the technique, and postnatal management were made following an agreed protocol. A descriptive analysis of survival, type of circulation after birth, and complications was made, considering all deaths in the first 48 h after FAV as FAV-related. RESULTS: FAV was performed in 28 fetuses at a median gestational age (GA) of 23 weeks (range, 20-32). FAV was technically successful in 22 (78.6%), of whom 11 were born alive and with intention to treat. Eight (72.7%) resulted in BVC and 3 (27.3%) in univentricular circulation. The rate of FAV-related deaths was 32%. These patients underwent FAV earlier than live-born fetuses (median GA at FAV 22 weeks [range, 20.0-25.0] vs. 24.5 weeks [range, 21.0-32.0], respectively, p = 0.031). CONCLUSIONS: A significant proportion of fetuses with CAS who undergo technically successful FAV have BVC postnatally. However, FAV implies a high risk of fetal death, which highly depends on the GA at which this intervention is required.


Assuntos
Estenose da Valva Aórtica/terapia , Valvuloplastia com Balão/estatística & dados numéricos , Terapias Fetais/estatística & dados numéricos , Síndrome do Coração Esquerdo Hipoplásico/terapia , Feminino , Humanos , Gravidez , Estudos Retrospectivos , Espanha , Centros de Atenção Terciária
10.
Humanidad. med ; 17(1): 171-188, ene.-abr. 2017.
Artigo em Espanhol | LILACS-Express | ID: biblio-840717

RESUMO

Se presentan los resultados obtenidos en la tesis de maestría Sistema de talleres de trabajo educativo para la capacitación del profesor guía de Medicina en Nuevitas con el objetivo de demostrar el impacto a partir de su implementación en la brigada estudiantil. Se exponen las definiciones elaboradas y las contextualizaciones. Se concluye que el sistema contribuyó al adecuado desempeño del profesor guía y al desarrollo del modo de actuación de los estudiantes. La rapidez y la calidad que implicó en la praxis educativa constituyó el resultado más importante en el contexto de la carrera de Medicina en la Filial.


Results achieved through the master's thesis "Educational work workshops system for the Medicine degree guiding teacher training" in Nuevitas are presented, aimed at demonstrating its impact starting from its implementation on a class. Elaborate definitions and contexts are exposed. The conclusionreached through it was that the system contributed to the adequate guiding teacher's performance and to the development of students' behavior. The speed and quality it involved in educational praxis constituted the most important result in the context of the Medicine degree in La Filial town.

11.
Heart ; 103(16): 1244-1249, 2017 08.
Artigo em Inglês | MEDLINE | ID: mdl-28115472

RESUMO

OBJECTIVES: Paediatric pulmonary arterial hypertension (PAH) after neonatal arterial switch operation (ASO) for transposition of the great arteries (TGA) is a clinically recognised entity with an estimated incidence of 0.6%-1.0%. Nevertheless, a clinical characterisation is lacking. We present an international cohort of children with PAH after neonatal ASO for TGA and describe epidemiology and clinical course. METHODS: Data were collected of children with PAH after neonatal ASO (≤6 weeks after birth) for simple TGA without residual shunt defects, identified in four national paediatric PAH networks in Europe and one US referral centre. RESULTS: Twenty-five children were identified between 1989 and 2014. In 17 children (68%), PAH was detected <1 year after ASO. In the remaining children, PAH was detected after median 64 months (IQR 19.5, 94.5). Nineteen children (96%) received PAH-targeted therapies. During follow-up after ASO (median 5.2 years), eight children died, four underwent lung transplantation and two received a Potts shunt. 1-year and 5-year Potts shunt- and transplantation-free survival after ASO was 100% and 73%. From first PAH detection, this was 100% and 58%, respectively, which did not differ between children with early (<1 year after ASO) or late PAH detection. CONCLUSIONS: The occurrence of PAH after ASO for TGA represents a specific association. PAH onset may be early or late after ASO, with similar fatal course from first PAH detection. Mechanisms leading to PAH in this association are unknown, but may include abnormal prenatal pulmonary haemodynamics and/or genetic susceptibility. Routine, lifelong follow-up for children who undergo ASO for TGA should include screening for PAH.


Assuntos
Transposição das Grandes Artérias/efeitos adversos , Hipertensão Pulmonar/etiologia , Transposição dos Grandes Vasos/cirurgia , Pré-Escolar , Europa (Continente)/epidemiologia , Feminino , Seguimentos , Humanos , Hipertensão Pulmonar/epidemiologia , Hipertensão Pulmonar/fisiopatologia , Incidência , Lactente , Masculino , Estudos Retrospectivos , Fatores de Tempo , Estados Unidos/epidemiologia
12.
Rev Panam Salud Publica ; 39(1): 65-68, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-27754531

RESUMO

This study documented the number and results of mycobacterial culture and drug sensitivity testing (CDST) in Mexico from 2009-2013 and assessed whether states with a higher risk of multidrug-resistant tuberculosis (MDR-TB) performed more CDST and had more cultures showing MDR-TB. Data for this longitudinal, descriptive, operational research study came from the electronic records of 31 state public health laboratories in Mexico. The total number of CDSTs was 6 470, increasing from 2 143 in the first 2 years to 4 327 in the latter 3 years. There was a significant increase in the proportion of cultures showing sensitivity to all drugs, from 53.1% to 60.9% in 2011-2013 (P < 0.001) and a significant decrease in the proportion showing MDR-TB, from 28.2% in 2009 to 19.8% in 2013 (P < 0.001). Cases of extensively drug resistant tuberculosis were < 1% per year. In the 12 states with higher risk for MDR-TB, significantly more CDSTs (2 382 test) were done in 2011-2013 than in the other 19 states (1 945 tests). Also, for each year the proportion of cultures showing MDR-TB was significantly higher in high risk MDR-TB states than in lower risk ones (P < 0.001). During the 5-year study period, CDST was scaled up in Mexico, particularly in high-risk MDR-TB states where a higher proportion of cultures showed MDR-TB. Scale up and wider coverage of CDST should continue.


Assuntos
Tuberculose Pulmonar , Antituberculosos/uso terapêutico , Humanos , México , Testes de Sensibilidade Microbiana , Mycobacterium tuberculosis , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Tuberculose Pulmonar/tratamento farmacológico
13.
Rev Panam Salud Publica ; 39(1): 19-25, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-27754534

RESUMO

Objective To determine the use and performance of a line probe assay (LPA) compared with conventional culture and drug sensitivity testing (CDST) in patients registered with tuberculosis (TB) under routine program conditions in Peru in 2011-2013. Methods This was a descriptive, operational research, cross-sectional study of sputum specimens from patients with smear-positive pulmonary TB and mycobacterial cultures from patients with smear-negative or positive TB. Drug resistance to rifampicin and/or isoniazid detected by LPA was compared to CDST. Sensitivity, specificity, and predictive values were calculated and reliability for detecting drug resistance was assessed through kappa coefficient, with values 0.61-0.80 showing substantial correlation, and 0.81 or above showing almost-perfect correlation. Results In 2011-2013, there were 16 169 LPA tests performed, with the proportion of TB patients receiving the test increasing from 3.2% to 30.2%. In all, 2 905 LPA test results were compared to CDST. For LPA in sputum specimens, sensitivity for rifampicin was 92%; isoniazid, 94%; and MDR-TB, 88%; while specificity for rifampicin was 92%; isoniazid, 92%; and MDR-TB, 95%. For LPA in mycobacterial cultures, sensitivity for rifampicin was 95%; isoniazid, 96%; and MDR-TB, 90%; while specificity for rifampicin was 85%; isoniazid, 91%; and MDR-TB, 94%. Kappa coefficients were at 0.81 or above for all comparisons of LPA with CDST using sputum specimens and cultures, except for isoniazid in cultures, which was at 0.79. Conclusions This study suggests that LPA is a reliable and rapid screening test for drug-resistant TB and should be considered suitable for routine use and scale up in Peru.


Assuntos
Tuberculose , Antituberculosos , Estudos Transversais , Humanos , Testes de Sensibilidade Microbiana , Mycobacterium tuberculosis , Peru , Reprodutibilidade dos Testes , Rifampina/uso terapêutico , Escarro , Tuberculose/tratamento farmacológico , Tuberculose Resistente a Múltiplos Medicamentos/diagnóstico
14.
Fetal Diagn Ther ; 40(4): 268-276, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26943122

RESUMO

OBJECTIVE: To review our series of prenatally diagnosed transposition of the great arteries (TGA) to analyze the accuracy of fetal echocardiography for achieving a precise diagnosis of the TGA type (simple vs. complex) and to examine the short-term outcome. METHODS: A total of 94 cases of simple and complex TGA types (ventriculoarterial discordance with atrioventricular concordance) prenatally evaluated in our referral center between 1998 and 2014 were included. Fetuses with additional congenital anomalies and those with incomplete follow-up were excluded. Prenatal diagnostic accuracy and short-term survival were analyzed for the different types of TGA. RESULTS: The TGA type was correctly ascertained prenatally in 93.3%. Most fetuses were diagnosed with simple TGA (62.7%). There were 6 discrepancies: 5 fetuses with simple TGA had postnatally TGA + ventricular septal defect (VSD; n = 3) or TGA + VSD + coarctation of the aorta (n = 2), and 1 fetus with TGA + VSD postnatally showed severe left ventricular outflow tract obstruction. The mortality rate was 6.6%; it was higher in complex versus simple forms (12.8 vs. 1.9%, p = 0.038), and in cases with intramural coronary artery versus those without (60 vs. 3.5%, p < 0.001). We found no relationship between the arrangement of the great arteries and coronary arterial abnormalities. CONCLUSIONS: Simple TGA has a better outcome than the complex forms. A discrepancy rate of 7% with potential influence on the prognosis of survival between the prenatal diagnosis of the TGA type and the definitive diagnosis was found.


Assuntos
Transposição dos Grandes Vasos/diagnóstico por imagem , Ultrassonografia Pré-Natal , Adulto , Ecocardiografia , Feminino , Feto/diagnóstico por imagem , Idade Gestacional , Humanos , Recém-Nascido , Gravidez , Estudos Retrospectivos
15.
Rev. panam. salud pública ; 39(1): 19-25, Jan. 2016. tab, graf
Artigo em Inglês | LILACS | ID: lil-783027

RESUMO

ABSTRACT Objective To determine the use and performance of a line probe assay (LPA) compared with conventional culture and drug sensitivity testing (CDST) in patients registered with tuberculosis (TB) under routine program conditions in Peru in 2011–2013. Methods This was a descriptive, operational research, cross-sectional study of sputum specimens from patients with smear-positive pulmonary TB and mycobacterial cultures from patients with smear-negative or positive TB. Drug resistance to rifampicin and/or isoniazid detected by LPA was compared to CDST. Sensitivity, specificity, and predictive values were calculated and reliability for detecting drug resistance was assessed through kappa coefficient, with values 0.61–0.80 showing substantial correlation, and 0.81 or above showing almost-perfect correlation. Results In 2011–2013, there were 16 169 LPA tests performed, with the proportion of TB patients receiving the test increasing from 3.2% to 30.2%. In all, 2 905 LPA test results were compared to CDST. For LPA in sputum specimens, sensitivity for rifampicin was 92%; isoniazid, 94%; and MDR-TB, 88%; while specificity for rifampicin was 92%; isoniazid, 92%; and MDR-TB, 95%. For LPA in mycobacterial cultures, sensitivity for rifampicin was 95%; isoniazid, 96%; and MDR-TB, 90%; while specificity for rifampicin was 85%; isoniazid, 91%; and MDR-TB, 94%. Kappa coefficients were at 0.81 or above for all comparisons of LPA with CDST using sputum specimens and cultures, except for isoniazid in cultures, which was at 0.79. Conclusions This study suggests that LPA is a reliable and rapid screening test for drug-resistant TB and should be considered suitable for routine use and scale up in Peru.


RESUMEN Objetivo Definir la utilización de un ensayo con sondas en línea y evaluar su desempeño, en comparación con el método convencional de cultivo y antibiograma, en los pacientes registrados con tuberculosis en condiciones programáticas en el Perú del 2011 al 2013. Métodos Investigación operativa descriptiva con un estudio transversal de las muestras de esputo de los pacientes con diagnóstico de tuberculosis pulmonar y baciloscopia positiva y de los cultivos de micobacterias de los pacientes con tuberculosis y baciloscopia positiva o negativa. La farmacorresistencia a la rifampicina, la isoniacida o a ambas, detectada mediante el ensayo con sondas en línea, se comparó con los resultados obtenidos por el método de cultivo y antibiograma. Se calculó la sensibilidad, la especificidad y los valores predictivos del ensayo con sondas en línea y se evaluó su fiabilidad en la detección de la farmacorresistencia mediante el coeficiente k, cuyos valores de 0,61 a 0,80 correspondían a una fuerte correlación y los valores de 0,81 o superiores reflejaban una correlación casi perfecta. Resultados Del 2011 al 2013 se practicaron 16 169 ensayos con sondas en línea, y la proporción de pacientes con diagnóstico de tuberculosis en quienes se practicaba aumentó de 3,2% a 30,2%. En total, se compararon 2 905 resultados del ensayo molecular con el método convencional. En las muestras de esputo, el ensayo molecular ofreció una sensibilidad de 92% para la resistencia a la rifampicina, 94% a la isoniacida y 88% para la tuberculosis multirresistente; su especificidad fue 92% con respecto a la rifampicina, 92% a la isoniacida y 95% a la tuberculosis multirresistente. En los cultivos de micobacterias, el ensayo con sondas en línea mostró una sensibilidad de 95% para la resistencia a la rifampicina, 96% a la isoniacida y 90% para la tuberculosis multirresistente; la especificidad fue 85% para la rifampicina, 91% para la isoniacida y 94% para la tuberculosis multirresistente. El coeficiente k fue 0,81 o superior en todas las comparaciones del ensayo molecular con el método tradicional cuando se usaron muestras de esputo y cultivo, excepto con la isoniacida en cultivo, cuyo coeficiente fue 0,79. Conclusiones Los resultados del presente estudio indican que el ensayo con sondas en línea constituye una prueba de detección fiable y rápida para la tuberculosis multirresistente, y se debe considerar apropiada su utilización en la práctica de rutina y la ampliación de su empleo en el Perú.


Assuntos
Tuberculose/diagnóstico , Ensaio Clínico , Sonda , Peru
16.
Rev Panam Salud Publica ; 39(1),jan. 2016
Artigo em Inglês | PAHO-IRIS | ID: phr-28204

RESUMO

This study documented the number and results of mycobacterial culture and drug sensitivity testing (CDST) in Mexico from 2009–2013 and assessed whether states with a higher risk of multidrug-resistant tuberculosis (MDR-TB) performed more CDST and had more cultures showing MDR-TB. Data for this longitudinal, descriptive, operational research study came from the electronic records of 31 state public health laboratories in Mexico. The total number of CDSTs was 6 470, increasing from 2 143 in the first 2 years to 4 327 in the latter 3 years. There was a significant increase in the proportion of cultures showing sensitivity to all drugs, from 53.1% to 60.9% in 2011–2013 (P < 0.001) and a significant decrease in the proportion showing MDR-TB, from 28.2% in 2009 to 19.8% in 2013 (P < 0.001). Cases of extensively drug resistant tuberculosis were < 1% per year. In the 12 states with higher risk for MDR-TB, significantly more CDSTs (2 382 test) were done in 2011–2013 than in the other 19 states (1 945 tests). Also, for each year the proportion of cultures showing MDR-TB was significantly higher in high risk MDR-TB states than in lower risk ones (P < 0.001). During the 5-year study period, CDST was scaled up in Mexico, particularly in high-risk MDR-TB states where a higher proportion of cultures showed MDR-TB. Scale up and wider coverage of CDST should continue.


Se verificó el número y los resultados de los cultivos de micobacterias y antibiogramas realizados en México del 2009 al 2013 y se investigó si los estados con un mayor riesgo de tuberculosis multirresistente (MR) realizaban más pruebas de ambos estudios y obtenían más cultivos diagnósticos de tuberculosis MR. Los datos para este estudio longitudinal descriptivo de investigación operativa se tomaron de los registros electrónicos de 31 laboratorios estatales de salud pública en México. Se realizaron 6 470 pruebas; esta cifra aumentó de 2 143 en los dos primeros años a 4 327 en los últimos tres años estudiados. Se observó un incremento significativo de la proporción de cultivos con sensibilidad a todos los medicamentos, de 53,1% en el 2011 a 60,9% en el 2013 (p < 0,001) y una disminución significativa en la proporción de casos de tuberculosis MR, de 28,2% en el 2009 a 19,8% en el 2013 (p < 0,001). Los casos de tuberculosis extremadamente farmacorresistente fueron inferiores a 1% por año. En los 12 estados con mayor riesgo de tuberculosis MR, el número de cultivos y antibiogramas realizados del 2011 al 2013 (2 382 pruebas) fue significativamente más alto que en los otros 19 estados (1 945 pruebas). Asimismo, en cada año la proporción de cultivos que revelaban tuberculosis MR fue significativamente mayor en los estados con mayor riesgo de tuberculosis de este tipo, que en los estados con menor riesgo (p < 0,001). Durante el período de 5 años del estudio se amplió la aplicación de las pruebas de cultivo y antibiograma en México, sobre todo en los estados con un alto riesgo de tuberculosis MR, donde la proporción de cultivos que revelan multirresistencia es más alta. La aplicación y la cobertura de las pruebas de cultivo y antibiograma deben ampliarse.


Assuntos
Tuberculose , Técnicas de Cultura , Testes de Sensibilidade Microbiana , Tuberculose Resistente a Múltiplos Medicamentos , Pesquisa Operacional , Tuberculose Extensivamente Resistente a Medicamentos , México , Técnicas de Cultura , Testes de Sensibilidade Microbiana , Tuberculose Resistente a Múltiplos Medicamentos , Tuberculose Extensivamente Resistente a Medicamentos , Pesquisa Operacional
17.
Rev Panam Salud Publica ; 39(1),jan. 2016
Artigo em Inglês | PAHO-IRIS | ID: phr-28197

RESUMO

Objective. To determine the use and performance of a line probe assay (LPA) compared with conventional culture and drug sensitivity testing (CDST) in patients registered with tuberculosis (TB) under routine program conditions in Peru in 2011–2013. Methods. This was a descriptive, operational research, cross-sectional study of sputum specimens from patients with smear-positive pulmonary TB and mycobacterial cultures from patients with smear-negative or positive TB. Drug resistance to rifampicin and/or isoniazid detected by LPA was compared to CDST. Sensitivity, specificity, and predictive values were calculated and reliability for detecting drug resistance was assessed through kappa coefficient, with values 0.61–0.80 showing substantial correlation, and 0.81 or above showing almost-perfect correlation. Results. In 2011–2013, there were 16 169 LPA tests performed, with the proportion of TB patients receiving the test increasing from 3.2% to 30.2%. In all, 2 905 LPA test results were compared to CDST. For LPA in sputum specimens, sensitivity for rifampicin was 92%; isoniazid, 94%; and MDR-TB, 88%; while specificity for rifampicin was 92%; isoniazid, 92%; and MDR-TB, 95%. For LPA in mycobacterial cultures, sensitivity for rifampicin was 95%; isoniazid, 96%; and MDR-TB, 90%; while specificity for rifampicin was 85%; isoniazid, 91%; and MDR-TB, 94%. Kappa coefficients were at 0.81 or above for all comparisons of LPA with CDST using sputum specimens and cultures, except for isoniazid in cultures, which was at 0.79. Conclusions. This study suggests that LPA is a reliable and rapid screening test for drug-resistant TB and should be considered suitable for routine use and scale up in Peru.


Objetivo. Definir la utilización de un ensayo con sondas en línea y evaluar su desempeño, en comparación con el método convencional de cultivo y antibiograma, en los pacientes registrados con tuberculosis en condiciones programáticas en el Perú del 2011 al 2013. Métodos. Investigación operativa descriptiva con un estudio transversal de las muestras de esputo de los pacientes con diagnóstico de tuberculosis pulmonar y baciloscopia positiva y de los cultivos de micobacterias de los pacientes con tuberculosis y baciloscopia positiva o negativa. La farmacorresistencia a la rifampicina, la isoniacida o a ambas, detectada mediante el ensayo con sondas en línea, se comparó con los resultados obtenidos por el método de cultivo y antibiograma. Se calculó la sensibilidad, la especificidad y los valores predictivos del ensayo con sondas en línea y se evaluó su fiabilidad en la detección de la farmacorresistencia mediante el coeficiente k, cuyos valores de 0,61 a 0,80 correspondían a una fuerte correlación y los valores de 0,81 o superiores reflejaban una correlación casi perfecta. Resultados. Del 2011 al 2013 se practicaron 16 169 ensayos con sondas en línea, y la proporción de pacientes con diagnóstico de tuberculosis en quienes se practicaba aumentó de 3,2% a 30,2%. En total, se compararon 2 905 resultados del ensayo molecular con el método convencional. En las muestras de esputo, el ensayo molecular ofreció una sensibilidad de 92% para la resistencia a la rifampicina, 94% a la isoniacida y 88% para la tuberculosis multirresistente; su especificidad fue 92% con respecto a la rifampicina, 92% a la isoniacida y 95% a la tuberculosis multirresistente. En los cultivos de micobacterias, el ensayo con sondas en línea mostró una sensibilidad de 95% para la resistencia a la rifampicina, 96% a la isoniacida y 90% para la tuberculosis multirresistente; la especificidad fue 85% para la rifampicina, 91% para la isoniacida y 94% para la tuberculosis multirresistente. El coeficiente k fue 0,81 o superior en todas las comparaciones del ensayo molecular con el método tradicional cuando se usaron muestras de esputo y cultivo, excepto con la isoniacida en cultivo, cuyo coeficiente fue 0,79. Conclusiones. Los resultados del presente estudio indican que el ensayo con sondas en línea constituye una prueba de detección fiable y rápida para la tuberculosis multirresistente , y se debe considerar


Assuntos
Mycobacterium tuberculosis , Tuberculose , Tuberculose Resistente a Múltiplos Medicamentos , Sondas Moleculares , Técnicas de Sonda Molecular , Pesquisa Operacional , Peru , Tuberculose Resistente a Múltiplos Medicamentos , Sondas Moleculares , Técnicas de Sonda Molecular , Pesquisa Operacional
18.
Humanidad. med ; 15(3): 511-530, sep.-dic. 2015.
Artigo em Espanhol | LILACS-Express | ID: lil-769363

RESUMO

Se presenta un artículo con el objetivo de elaborar un sistema de talleres con la utilización de técnicas participativas para la autodirección estudiantil en la universidad médica, tema de gran relevancia en el desempeño del modelo del profesional. Este sistema contiene un conjunto de orientaciones teórico-metodológicas y herramientas de trabajo para ser implementadas por los estudiantes en la brigada, las cuales propician el fortalecimiento de su autodirección en analogía con el modelo del profesional.


An article is presented with the objective of elaborating a system of workshops with the use of collaborative techniques for the students’ self-direction in the medical university, issue of great relevance in the development of the future professional. This system contains a group of theoretical-methodological guidelines and working tools to be implemented by the students of the brigade, the ones that give the strength of its self-direction in analogy with the ideal professional.

19.
Humanidades Médicas ; 15(3)sep.-dic. 2015.
Artigo em Espanhol | CUMED | ID: cum-66365

RESUMO

Se presenta un artículo con el objetivo de elaborar un sistema de talleres con la utilización de técnicas participativas para la autodirección estudiantil en la universidad médica, tema de gran relevancia en el desempeño del modelo del profesional. Este sistema contiene un conjunto de orientaciones teórico-metodológicas y herramientas de trabajo para ser implementadas por los estudiantes en la brigada, las cuales propician el fortalecimiento de su autodirección en analogía con el modelo del profesional(AU)


An article is presented with the objective of elaborating a system of workshops with the use of collaborative techniques for the students' self-direction in the medical university, issue of great relevance in the development of the future professional. This system contains a group of theoretical-methodological guidelines and working tools to be implemented by the students of the brigade, the ones that give the strength of its self-direction in analogy with the ideal professional(AU)


Assuntos
Humanos , Planejamento Participativo , Pesquisa Participativa Baseada na Comunidade , Estudantes de Medicina
20.
Bioresour Technol ; 198: 634-41, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26433788

RESUMO

This study focuses on the evaluation of pecan nut shells as an alternative source of energy through pyrolysis and gasification. The physicochemical characteristics of the selected biomass that can influence the process efficiency, consumption rates, and the product yield, as well as create operational problems, were determined. In addition, the thermal decomposition kinetics necessary for prediction of consumption rates and yields were determined. Finally, the performance of a downdraft gasifier fed with pecan nut shells was analyzed in terms of process efficiency and exit gas characteristics. It was found that the pyrolytic decomposition of the nut shells can be modeled adequately using a single equation considering two independent parallel reactions. The performance of the gasification process can be influenced by the particle size and air flow rate, requiring a proper combination of these parameters for reliable operation and production of a valuable syngas.


Assuntos
Carya/química , Nozes/química , Termogravimetria/métodos , Biocombustíveis , Biomassa , Gases/química , Resíduos Industriais , Cinética , Modelos Teóricos , Nozes/anatomia & histologia , Tamanho da Partícula , Eliminação de Resíduos/métodos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA