Tuberculosis con resistencia a fármacos: nuevas definiciones de la OMS y su implicación en la Normativa de SEPAR / Drug Resistant Tuberculosis: New WHO Definitions and Their Implication in the SEPAR Guideline

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Exiguidade nas estratégias de enfrentamento à tuberculose na atenção primária no Sul do Brasil / Exiguity in strategies to combat tuberculosis in primary care in Southern Brazil / Exigüidaden las estrategias de combate a la tuberculosis en la atención primaria en el Sur de Brasil

Objetivo: descrever as ações de detecção de casos da tuberculose (TB) realizadas pela Atenção Básica de Saúde dos municípios de Uruguaiana, Pelotas e Santa Maria, no estado do Rio Grande do Sul. Método:transversal, quantitativo, realizado com 385 profissionais de saúde, utilizando um questionário estruturado autopreenchido sobre a organização e o planejamento das ações de detecção de sintomáticos respiratórios. Resultados:identificou-se que, em Uruguaiana, cerca de um quarto dos profissionais referem que sua unidade planejou ações de detecção de TB, enquanto a proporção nos demais municípios não alcançou um décimo dos profissionais. Observou-se, que a busca de casos na comunidade, assim como a orientação dos ACS sobre sinais e sintomas da TB foi considerada praticamente inexistente em Santa Maria. Conclusão:apesar dos municípios estudados serem prioritários para o controle da TB, os profissionais da unidade de saúde não são estimulados a manter um olhar diferenciado sobre essa problemática no seu território.

Objective: to describe the actions to detect tuberculosis (TB) cases carried out by Primary Health Care in the municipalities of Uruguaiana, Pelotas and Santa Maria, in the state of Rio Grande do Sul. Method: cross-sectional, quantitative, carried out with 385 health professionals, using a self-administered structured questionnaire on the organization and planning of actions to detect respiratory symptomatics.Results:it was identified that, in Uruguaiana, about a quarter of professionals reportthat their unit planned TB detection actions, while the proportion in the other municipalities did not reach one tenth of professionals. It was observed that the search for cases in the community, as well as the guidance of CHAs on signs and symptoms of TB was considered practically non-existent in Santa Maria. Conclusion:although the municipalities studied are priorities for TB control, health unit professionals are not encouraged to maintain a differentiated look at this problem in their territory.

Objetivo: describir las acciones para detectarcasos de tuberculosis (TB) llevadas a cabo por la Atención Primaria de Salud en los municipios de Uruguaiana, Pelotas y Santa María, en el estado de Rio Grande do Sul.Método: transversal, cuantitativo, realizado con 385 profesionales de la salud, utilizando un cuestionario estructurado autoadministrado sobre la organización y planificación de acciones para detectar la sintomática respiratoria.Resultados: se identificó que, en Uruguaiana, alrededor de una cuarta parte de los profesionales informan que su unidad planeaba acciones de detección de tuberculosis, mientras que la proporción en los otros municipios no llegó a una décima parte de los profesionales. Se observó que la búsqueda de casos en la comunidad, así como la orientación de CHA sobre signos y síntomas de tuberculosis, se consideró prácticamente inexistente en Santa María.Conclusión: aunque los municipios estudiados son prioridades para el control de la tuberculosis, no se alienta a losprofesionales de las unidades de salud a mantener una mirada diferenciada a este problema en su território.

24 de marzo. Hacia el fin de la tuberculosis sin dejar a nadie atrás / No disponible

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Vencendo a Tuberculose

Pôster apresentado no CRICS10, no eixo temático de Pesquisa e Comunicação. Apresenta as ações desenvolvidas pela equipe sobre contágio, diagnóstico e tratamento da Tuberculose: aumentar em 30% o número de interrogados em 2017, relação ao ano anterior; aumentar o número de coleta de baciloscopia em 50%, em relação a 2016; realizar ações de sensibilização e de promoção de saúde nas unidades e espaços do território.

El control de la tuberculosis en Cuba desde fines del siglo XIX hasta 1930 / Tuberculosis control in Cuba from the late 19th century to 1930

Introducción: la tuberculosis es una enfermedad infectocontagiosa de evolución aguda, subaguda o crónica, conocida antes del año 1000 a.n.e. Sobre la existencia de la tuberculosis en Cuba hay noticias desde 1630; el conocimiento de los médicos cubanos sobre el mal se presentó en las publicaciones especializadas. Objetivo: presentar los principales aspectos de la historia del control de la tuberculosis en Cuba. Métodos: se siguió le método histórico-lógico, apoyados en la revisión documental. Resultados: en Cuba la lucha contra la tuberculosis se inició a finales del siglo XIX; se presentan las acciones tomadas hasta el año 1930. A finales del siglo XIX se creó la Liga Antituberculosa, la cual a principios del siglo XX tomó carácter nacional; se construyeron dispensarios para el tratamiento ambulatorio de los enfermos; en 1907 el primer sanatorio para el tratamiento internado de los pacientes. Pero después de la segunda década los trabajos de la lucha tuvieron un decrecimiento. En la segunda mitad de la década del 20 se creó una cátedra específica para su enseñanza en la Escuela de Medicina e instituciones que reforzarían, al menos en teoría, el trabajo dirigido hacia la mejora de la situación de la enfermedad en la población. Conclusiones: durante los primeros años del siglo XX, se organizaron los primeros servicios para el tratamiento de la tuberculosis, se inició un incipiente control sobre la enfermedad. Aunque los servicios y acciones fueron insuficientes, constituyeron un intento de mejorar la situación enfermedad en la población(AU)

Introduction: tuberculosis is an infectious contagious disease of acute, subacute or chronic evolution. Known before the year 1 000 B.C., news about its presence in Cuba dates back to 1630. Cuban doctors' knowledge about the condition appeared in specialized publications. Objective: present the main aspects of the history of tuberculosis control in Cuba. Methods: the historical-logical method was applied, supported by document review. Results: the fight against tuberculosis started in Cuba in the late 19th century. A description is provided of the actions taken until the year 1930. The Anti-Tuberculosis League was founded at the end of the 19 th century, and acquired nationwide scope at the beginning of the 20th century. Dispensaries were built for ambulatory treatment. The first inpatient sanatorium was founded in 1907. However, after the second decade, the fight against tuberculosis witnessed a decline. In the second half of the 1920s, a specific professorship was created to be taught at the School of Medicine and institutions which would reinforce, at least theoretically, the work aimed at improving the status of the disease in the population. Conclusions: during the early years of the 20th century, the first services for the treatment of tuberculosis were created and incipient control of the disease was started. Insufficient as the services and actions were, they constituted an attempt to improve the status of the disease in the population(AU)

Beneficencia, caridad y poder en Barcelona. El enfrentamiento entre el patronato para la Lucha contra la tuberculosis y Jaime Queraltó y Ros por el modelo de asistencia sanitaria (1910-1916) / Welfare, charity and power in Barcelona. The conflict between the Board for the Fight against tuberculosis and Jaime Queraltó y Ros on the model for healthcare (1910-1916)

En el año 1910, como consecuencia de los preparativos para la celebración del primer Congreso Internacional de la Tuberculosis en Barcelona, las clases médicas de la ciudad escenificaron un duro enfrentamiento con respecto al modelo asistencial dirigido al tratamiento y prevención de la enfermedad fímica. A lo largo del conflicto, el ginecólogo Jaime Queraltó y Ros fue desterrado por acusar al Patronato de Cataluña para la Lucha contra la Tuberculosis, de fomentar el uso de prácticas asistenciales con el único fin de salvaguardar el alma de sus pacientes de la enfermedad, aun a costa de someterles a operaciones superfluas y cruentas, como fue la cauterización de un tatuaje anarquista que se le practicó a uno de los obreros que visitaban sus dispensarios. El interés que suscitó el llamado "caso del anarquista tatuado" traspasó en pocos meses las fronteras nacionales, convirtiendo al Patronato en objeto de las más duras críticas por parte de diversas instituciones extranjeras, y promoviendo a escala nacional un debate sobre las carencias o los beneficios de un modelo asistencial liberal en el que, lejos de fundarse en los principios de una ciencia secular, las prácticas sanitarias parecían seguir sujetas a una serie de valores higiénico-morales tradicionalmente vinculados con la caridad católica. Más allá de dar cuenta del conflicto entre los médicos, el propósito general de nuestro artículo pasa por analizar la forma en que las posturas enfrentadas respondieron a las distintas corrientes políticas de la ciudad, demostrando así la importancia que las prácticas asistenciales habían adquirido dentro las estrategias electorales de los distintos partidos a principios del siglo XX (AU)

In 1910, as a consequence of the preparations for the first International Congress on Tuberculosis in Barcelona, the city's medical community faced a grave confrontation with respect to the model of healthcare offered for the treatment and prevention of the phymic disease. During the conflict, the gynaecologist Jaime Queraltó I Ros was banished for accusing the Catalonian Board for the Fight Against Tuberculosis of promoting the use of a care practice whose sole objective was saving the patient's souls, even if this meant superfluous and bloody operations, like the cauterization of an anarchist tattoo on one of the workers who attended one of their free clinics. The interest arising from the case of the "tattooed anarchist" spread across the national borders in a few months, converting the Board into the object of harsh criticism from different foreign institutions and causing a nation-wide debate on the deficiencies or benefits of a liberal healthcare model that, far from being based on secular science, seemed to continue being tied to a series of hygienic-moral values traditionally linked to catholic charity. Beyond just giving an account of the conflict between physicians, the general aim of our article goes from analyzing the way in which the conflicting postures answered to different political currents in the city to showing the importance that healthcare had acquired within the electoral strategies of the different political parties in the XX century (AU)

La medicina de los niños en tiempos de Cervantes. Primeras monografías médicas pediátricas en España hace 400 años / Children's medicine in the times of Cervantes. First paediatric monographs in Spain four hundred years ago

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Comunicación efectiva para fortalecer la adherencia al tratamiento de las personas afectadas por la tuberculosis. Guía para el facilitador: Agente Comunitario de Salud / Effective communication to strengthen adherence to the treatment of people affected by tuberculosis. Facilitator's Guide: Community Health Agent

La publicación es el resultado de la participación de diversos actores sociales involucrados activamente en la lucha contra la tuberculosis, en el marco de la VIII Ronda del Fondo Mundial de lucha contra el SIDA, la tuberculosis y la malaria, que busca a través de una metodología participativa capacitar, e integrar los nuevos conocimientos y destrezas al uso cotidiano del personal facilitador como agente comunitario de salud a fin de sumar acciones de lucha en favor de la adherencia.

Comunicación efectiva para fortalecer la adherencia al tratamiento de las personas afectadas por la tuberculosis. Guía para el participante: Agente Comunitario de Salud. Material de apoyo / Effective communication to strengthen adherence to the treatment of people affected by tuberculosis. Participant Guide: Community Health Agent. Support material

La publicación es el resultado de la participación de diversos actores sociales involucrados activamente en la lucha contra la tuberculosis, en el marco de la VIII Ronda del Fondo Mundial de lucha contra el SIDA, la tuberculosis y la malaria, que busca a través de una metodología participativa capacitar, e integrar los nuevos conocimientos y destrezas al uso cotidiano del material de apoyo para el Agente Comunitario de Salud a fin de sumar acciones de lucha en favor de la adherencia.

Sistema de Información Gerencial de Tuberculosis SIGTB. Manual de usuario / SIGTB Tuberculosis Management Information System. User manual

La presente publicación describe la metodología que facilita al usuario la operación de las diferentes pantallas de captura y consulta de la información que se administra en el Sistema de Información Gerencial de Tuberculosis -SIGTB

Comunicación efectiva para fortalecer la adherencia al tratamiento de las personas afectadas por la tuberculosis. Guía para el facilitador: Personal de Salud / Effective communication to strengthen adherence to the treatment of people affected by tuberculosis. Facilitator's Guide: Health Personnel

La publicación es el resultado de la participación de diversos actores sociales involucrados activamente en la lucha contra la tuberculosis, en el marco de la VIII Ronda del Fondo Mundial de lucha contra el SIDA, la tuberculosis y la malaria, que busca a través de una metodología participativa capacitar, e integrar los nuevos conocimientos y destrezas al uso cotidiano del personal de salud a fin de sumar acciones de lucha en favor de la adherencia(

Comunicación efectiva para fortalecer la adherencia al tratamiento de las personas afectadas por la tuberculosis. Guía para el facilitador: Personal de Salud. Material de apoyo / Effective communication to strengthen adherence to the treatment of people affected by tuberculosis. Facilitator's Guide: Health Personnel. Support material

La publicación es el resultado de la participación de diversos actores sociales involucrados activamente en la lucha contra la tuberculosis, en el marco de la VIII Ronda del Fondo Mundial de lucha contra el SIDA, la tuberculosis y la malaria, que busca a través de una metodología participativa capacitar, e integrar los nuevos conocimientos y destrezas al uso cotidiano del personal de salud a fin de sumar acciones de lucha en favor de la adherencia

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)

Treatment guidelines for latent tuberculosis infection.

The treatment of latent tuberculosis infection (LTBI) has been established as valid for patients at high risk for developing active tuberculosis. Treatment of LTBI is also considered an important strategy for eliminating tuberculosis (TB) in Japan. In recent years, interferon-gamma release assays have come into widespread use; isoniazid (INH) preventive therapy for HIV patients has come to be recommended worldwide; and there have been increases in both types of biologics used in the treatment of immune diseases as well as the diseases susceptible to treatment. In light of the above facts, the Prevention Committee and the Treatment Committee of the Japanese Society for Tuberculosis have jointly drafted these guidelines. In determining subjects for LTBI treatment, the following must be considered: 1) risk of TB infection/ development; 2) infection diagnosis; 3) chest image diagnosis; 4) the impact of TB development; 5) the possible manifestation of side effects; and 6) the prospects of treatment completion. LTBI treatment is actively considered when relative risk is deemed 4 or higher, including risk factors such as the following: HIV/AIDS, organ transplants (immunosuppressant use), silicosis, dialysis due to chronic renal failure, recent TB infection (within 2 years), fibronodular shadows in chest radiographs (untreated old TB), the use of biologics, and large doses of corticosteroids. Although the risk is lower, the following risk factors require consideration of LTBI treatment when 2 or more of them are present: use of oral or inhaled corticosteroids, use of other immunosuppressants, diabetes, being underweight, smoking, gastrectomy, and so on. In principle, INH is administered for a period of 6 or 9 months. When INH cannot be used, rifampicin is administered for a period of 4 or 6 months. It is believed that there are no reasons to support long-term LTBI treatment for immunosuppressed patients in Japan, where the risk of infection is not considered markedly high. For pregnant women, HIV-positive individuals, heavy drinkers, and individuals with a history of liver injury, regular liver function tests are necessary when treatment is initiated and when symptoms are present. There have been reports of TB developing during LTBI treatment; therefore, attention should be paid to TB development symptoms. When administering LTBI treatment, patients must be educated about side effects, the risk of developing TB onset, and the risks associated with discontinuing medication. Treatment outcomes and support for continuation of treatment are evaluated in cooperation with health centers. As stipulated by the Infectious Diseases Control Law, doctors are required to notify a health center when an individual develops TB. Based on this notification, the health center registers the patient, sends a public health nurse to visit the patient and give instructions, and provides medication adherence support. The patient applies at a health center for public expenses for medical care at a designated TB care facility. Pending approval in a review by an infectious disease examination council, the patient's copayment is reduced.

[Prospects for the renovation of the medical system for tuberculosis and human resource development in the near future].

The status of tuberculosis (TB) in Japan was changed to decline and decreased dramatically after The World War II with the great nationwide efforts. Along with the decrease of TB people's attentions to tuberculosis has been reducing significantly, including the medical personnel. In the 1990s, TB returned to increase again, then Emergency Declaration against TB by Minister of Health and Welfare in 1999 drew the public attentions to TB again. Unfortunately, however, there have been many hospitals that cannot deal with TB properly. On the other hand, non-tuberculous mycobacteriosis (NTM) is increasing recently, which bothers many physicians or pulmonologists. "Japanese Respiratory Society" (JRS) was founded as "Japan Society of Chest Diseases" derived from "Japanese Society for Tuberculosis" (JSTB) in 1961, when almost all the members were the members of both the Societies. Now, after 50 years of JRS foundation, only one in four members of JRS may join to JSTB. However, the needs for training opportunities about TB and NTM do exist indeed, which is suggested by the fact that "Tuberculosis course", the joint program with JSTB, held in every annual JRS meeting has been filled with a lot of standing audience. In order to support these needs for training about TB, JSTB began the Certification System for TB and NTM in 2011. More than 1,000 certified physicians were born so far. In addition, the decreased number of JSTB members has returned to increase significantly. The most important challenge is to make a future countermeasure against TB and NTM, and also to promote the development of human resources based on the current situation and forecast of TB. This symposium was planned along the theme of this congress, "TB control for the next generation" in response to the wishes of the Congress President Dr. Yamagishi. On behalf of the Ministry of Health, Labour and Welfare, Dr. Yoshizawa talked about the future measures and challenges, and the human resource development for the future, based on the current situation of the medical system for tuberculosis. Dr. Fujita, the chairman of the committee of the certification system, talked about the JSTB Certification System, and the prospect of the human resource development. Dr. Nagai talked about the training opportunities for TB and NTM such as the "Educational seminar" in the annual meeting of JSTB or the "Tuberculosis course" in the annual meeting of JRS. Nurse and the Public health nurse are also the important members of the medical team for TB. Ms. Nagata talked about the human resources development of nurse responsible for tuberculosis care. Finally, Dr. Kudo, who originally proposed the JSTB Certification System as the chairman of the future planning committee, addressed the history and the foresights of the near future medical care system for TB as a special remark. We wish all the members may share the prospects of future medical care for TB and NTM, which may help for improving the future medical system.

Una perspectiva heterodoxa de la historia de los medicamentos. Dinámicas de inclusión-exclusión de los sueros antituberculosos Ravetllat-Pla en la España del primer tercio del siglo XX / A heterodox perspective on the history of drugs. Inclusionexclusion dynamics of the Ravetllat-Pla anti-tuberculosis serum in the first third of the 20th century

En 1924, momento histórico de auge de la tuberculosis en España, fue fundado el Instituto Ravetllat-Pla con el fin de producir y comercializar un suero antituberculoso fundamentado en una teoría propuesta por el veterinario Joaquim Ravetllat i Stech (1872-1923). La nueva teoría etiopatológica de la tuberculosis propuesta por Joaquim Ravetllat evidenciaba la variabilidad ontológica del bacilo de Koch proponiendo nuevas formas bacterianas que no habían sido descritas. El tisiólogo catalán Ramon Pla i Armengol (1880-1958) encontró en la teoría de Joaquim Ravetllat fundamento a los síntomas clínicos que observaba en sus pacientes por lo que continuó la investigación en alianza con el veterinario. Esta teoría científica fue considerada heterodoxa por la ciencia oficial de la época lo que condujo al establecimiento de un espacio de exclusión en el que el Instituto adoptó la identidad de heterodoxo. Como reacción a la exclusión el Instituto generó otro espacio de inclusión en el que, a través del éxito comercial de sus productos farmacéuticos, su refutada teoría científica fue legitimada y validada socialmente. En el presente artículo, se propone que la consideración de los medicamentos como productos comerciales permite evidenciar la participación activa de los distintos usuarios del suero Ravetllat-Pla en su construcción, reconceptualización y legitimación social. Además, desde las dinámicas de inclusión y exclusión, esta investigación contribuye al entendimiento de los procesos de legitimación del conocimiento desde de la heterodoxia científica (AU)

In 1924, a historically peak time for tuberculosis in Spain, the Ravetllat-Pla Institute was established with the aim of producing and commercializing an anti-tuberculosis serum and researching the variability of the bacteria implicated in this infection. This bacterial form, proposed by Joaquim Ravetllat in the first decade of the 20th century, led to the formulation of a new etiological-pathologic theory of tuberculosis, which upheld the drugs produced by the Institute and was considered heterodox by the official science of the time. The Catalan medical and political network established a space of exclusion leading to the marginalization of the Institute, which, by strengthening its heterodox identity, generated another space of inclusion. In this space, its refuted scientific theory could be socially legitimated and validated through the commercial success of its pharmaceutical products. In this paper, we suggest that the consideration of medicines as commercial products illustrates the active participation of the different users of the Ravetllat-Pla serum in its social construction, re-conceptualization and legitimization. Moreover, from the theoretical framework of inclusion-exclusion dynamics, this research contributes to understanding the processes of knowledge legitimatization by scientific heterodoxy