Treatment of pulmonary and extrapulmonary tuberculosis. / Tratamiento de la enfermedad tuberculosa pulmonar y extrapulmonar.

The purpose of tuberculosis treatment is twofold: to provide an individual benefit centred on healing the patient with TB, and to provide a collective benefit to the community in which the patient resides. The different treatment regimens for tuberculosis sensitive to first-line antituberculosis drugs as well as resistant tuberculosis are examined and the peculiarities in the management of pulmonary and extrapulmonary tuberculosis are discussed.

Directly observed therapy for chronic hepatitis C: a randomized clinical trial in the prison setting.

BACKGROUND: The diagnosis and treatment of chronic hepatitis C are major concerns in prisons. OBJECTIVES: The aim of this randomized clinical trial was to determine the extent to which directly observed therapy (DOT) improved the efficacy of the standard treatment for chronic hepatitis C in the prison setting. PATIENTS AND METHODS: A randomized clinical trial was carried out to evaluate the efficacy of a DOT compared with a self-administered therapy in prison inmates who underwent standard treatment for chronic hepatitis C (based on pegylated interferon alpha-2a and ribavirin). RESULTS: A total of 252 inmates were randomized, of which 244 were analyzed: 109 in the DOT group and 135 in the non-DOT group. The mean age was 35.88 years (SD 6.54), 94.3% were men, 72.1% reported intravenous drug use, 21.3% were HIV co-infected, and 55.3% had genotype 1 or 4. The patients received the study treatment for a median time of 33.9 weeks in the overall sample. Sustained virological response was achieved in 60.6% (95% CI, 51.17-69.22) of the DOT group and in 65.9% (95% CI, 57.59-73.38) of the standard therapy group (risk ratio=0.92; 95% CI, 0.76-1.12). The mean proportion of patients continuing the treatment was 83% (SD=31). Adverse events were reported in 93.4% of the patients, and serious adverse events were reported in 8.2%, with no significant differences between groups. CONCLUSIONS: Sustained virological response was remarkably high, although there were no differences between groups, probably due to high treatment adherence.

Tratamento diretamente observado da tuberculose: processos de aprendizagem em uma instituição de ensino superior / Directly observed treatment of tuberculosis: learning process in a highereducation institution / Tratamiento directamente observado de la tuberculosis: procesos de aprendizajeen una institución de enseñanza superior

O presente estudo objetivou analisar os processos de aprendizagem teórico-práticos relacionados ao Tratamento Diretamente Observado da tuberculose entre graduandos de enfermagem de uma instituição pública de ensino superior em Ribeirão Preto, São Paulo. Trabalho com abordagem quantiqualitativa, cuja coleta foi realizada em 2011. Utilizou-se instrumento autoaplicável contendo cinco questões, de forma que as análises se deram, respectivamente, por meio da estatística descritiva e da fundamentação teórico-analítica do Discurso do Sujeito Coletivo. Observou-se que a maioria dos 72 entrevistados não teve contato com a temática durante o curso e que o limitado conhecimento apresentado fora pautado no modelo hegemônico de atuação em saúde. Entende-se que se faz necessária maior articulação das práticas educacionais relacionadas à tuberculose e ao tratamento diretamente observado na formação do enfermeiro generalista, haja vista que este possui atributos específicos na gestão do cuidado e da assistência ao doente por tuberculose, família e demais comunicantes.

This quanti-qualitative study examined theoretical and practical learning processes among undergraduate nursing students at a public institution in Ribeirao Preto, Sao Paulo, as regards the Directly Observed Treatment oftuberculosis. Data were collected in 2011 using a self-administered questionnaire of five questions and were analyzed, respectively, using descriptive statistics and the analytical theory of Collective Subject Discourse. It was observed that most of the 72 respondents had no contact with DOTS during the course and that the limited knowledge displayed was shaped by the hegemonic model of health care. It was concluded that better coordination between education activities relating to tuberculosis and to directly-observed treatmentis needed in the training process for generalist nurses, giventhat they have specific attributes in care management and care for tuberculosis patients, relatives and other contacts.

El presente estudio tuvo como objetivo analizar los procesos de aprendizaje teóricos y prácticos relacionados con el Tratamiento Directamente Observado entre graduandos del curso de enfermería de una institución públicade enseñanza superior de Ribeirao Preto, Sao Paulo-Brasil. Trabajo con abordaje cuanticualitativo, cuya colección fue hecha en 2011. Se utilizó un instrumento auto-aplicable conteniendo cinco cuestiones, cuyos análisis se dieron, respectivamente, por medio de estadística descriptiva y de la fundamentación teórico-analítica del discurso del sujeto colectivo. Se observó que la gran mayoría de los 72 entrevistados no tuvo contacto con la temática durante el curso y, que el poco conocimiento presentado fuera pautado en el modelo hegemónico de actuación en salud. Los resultados revelaron la necesidad de una mayor articulación de las prácticas educacionales relacionadas a la tuberculosis y al tratamiento irectamente observado en la formación del enfermero generalista, teniendo en vista que este pose e atributos específicos en la gestión del cuidado y de la asistencia al enfermo por tuberculosis, familia y otros comunicantes.