Spatial analysis of tuberculosis and its relationship with socioeconomic indicators in a medium-sized city in Minas Gerais.

OBJECTIVE: To analyze the tuberculosis spatial pattern and its relationship with socioeconomic indicators, from 2008 to 2015, in a priority city for tuberculosis control by the National Tuberculosis Control Program, Juiz de Fora, Minas Gerais. METHODS: Ecological study in which the units of analysis were 81 urban regions of Juiz de Fora. Secondary data from Notifiable Diseases Information System and 2010 Demographic Census were used. Georeferenced data from 1,854 notifications were used to elaborate thematic maps in order to verify the distribution pattern of average tuberculosis rates and socioeconomic indicators within the city. Global spatial autocorrelation (Moran's I) and local (Local Indicator of Spatial Association) and multiple linear regression model were estimated to analyze the relationship between the average tuberculosis incidence rate and socioeconomic indicators. RESULTS: The average tuberculosis incidence rate was 48.3 cases/100,000 inhabitants/year. It was found that the urban regions corresponding to central regions of the city had lower rates with a progressive increase toward the urban regions representative of the most peripheral neighborhoods. All variables showed significant spatial autocorrelation. The regression model showed an association between the average tuberculosis incidence rate and the proportion of poor, household density, and aging index. CONCLUSION: The dynamics of tuberculosis transmission in Juiz de Fora may be explained by the maintenance of social inequality and urban space organization process.

Adjusting RT-qPCR conditions to avoid unspecific amplification in SARS-CoV-2 diagnosis.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in December 2019 and quickly spread around the world, forcing global health authorities to develop protocols for its diagnosis. Here we report dimer formation in the N2 primers-probe set (CDC 2019-nCoV Real-Time RT-PCR) used in the diagnostic routine, and propose alternatives to reduce dimerization events. Late unspecific amplifications were visualized in 56.4% of negative samples and 57.1% of no-template control, but not in positive samples or positive control. In silico analysis and gel electrophoresis confirmed the dimer formation. The RT-qPCR parameters were optimized and the late unspecific amplifications decreased to 11.5% in negative samples and no-template control. The adjustment of PCR parameters was essential to reduce the risk of false-positives results and to avoid inclusive results requiring repeat testing, which increases the costs and generates delays in results or even unnecessary requests for new samples.

Analysis of anti-tuberculosis drug resistance and sociodemographic and clinical aspects of patients admitted in a referral hospital.

OBJECTIVE: To determine the occurrence of anti-tuberculosis drug resistance and its association with sociodemographic and clinical characteristics of patients in a referral hospital. METHODS: This was a cross-sectional study based on data from patients who had mycobacterial culture identified and defined antimicrobials sensitivity profile (June 2014 to February 2016). The descriptive statistical analysis and Fisher's exact test were used to compare proportions. RESULTS: The study included 104 patients who had positive results for Mycobacterium tuberculosis . Bacilloscopy had high positivity (93.3%). A total of 15 patients (14.4%) had resistant strains and six (5.6%) multidrug-resistant. The sociodemographic and clinical characteristics were not related with resistance. CONCLUSION: This study contributed to further the understandings about the tuberculosis patients' profile, the study also served as a tool for development of specific public policies. Patients diagnosed with resistant tuberculosis must be under greater supervision.

Comparison between Ogawa-Kudoh and modified Petroff techniques for mycobacteria cultivation in the diagnosis of pulmonary tuberculosis.

OBJECTIVE: To compare the performance of the Ogawa-Kudoh method with the modified Petroff technique in diagnosis of pulmonary tuberculosis. METHODS: A total of 205 sputum samples from 166 patients with clinical suspicion or under pulmonary tuberculosis follow-up, seen at a public tertiary care hospital, from July 2014 to July 2016 were used. All samples were simultaneously processed using the Ogawa-Kudoh and modified Petroff decontamination methods, according to the recommendations of the Ministry of Health. In the statistical analysis, the McNemar test and the Kappa index were used, respectively, to compare proportions and verify agreement between data. RESULTS: The Ogawa-Kudoh and modified Petroff methods were efficient in mycobacteria detection, with no significant differences in results (p=0.549) and contamination rate of the cultures (p=0.065). The agreement between techniques was considered excellent (Kappa index of 0.877) and Ogawa-Kudoh, as compared to the modified Petroff technique, showed sensitivity of 90.4%, specificity of 96.6%, positive predictive value of 94.3% and negative predictive value of 94.2%. CONCLUSION: The Ogawa-Kudoh technique proved to be sufficiently sensitive and specific for diagnosis of pulmonary tuberculosis, and, therefore, suitable for routine laboratory application. Since it is simple, low-cost and has less technical requirements for biosafety and professional training, Ogawa-Kudoh is an alternative for managers and healthcare professionals to promote the expansion of bacteriological diagnostic coverage of pulmonary tuberculosis.

Spatial analysis of tuberculosis and its relationship with socioeconomic indicators in a medium-sized city in Minas Gerais / Análise espacial da tuberculose e sua relação com indicadores socioeconômicos em um município de médio porte em Minas Gerais

ABSTRACT: Objective: To analyze the tuberculosis spatial pattern and its relationship with socioeconomic indicators, from 2008 to 2015, in a priority city for tuberculosis control by the National Tuberculosis Control Program, Juiz de Fora, Minas Gerais. Methods: Ecological study in which the units of analysis were 81 urban regions of Juiz de Fora. Secondary data from Notifiable Diseases Information System and 2010 Demographic Census were used. Georeferenced data from 1,854 notifications were used to elaborate thematic maps in order to verify the distribution pattern of average tuberculosis rates and socioeconomic indicators within the city. Global spatial autocorrelation (Moran's I) and local (Local Indicator of Spatial Association) and multiple linear regression model were estimated to analyze the relationship between the average tuberculosis incidence rate and socioeconomic indicators. Results: The average tuberculosis incidence rate was 48.3 cases/100,000 inhabitants/year. It was found that the urban regions corresponding to central regions of the city had lower rates with a progressive increase toward the urban regions representative of the most peripheral neighborhoods. All variables showed significant spatial autocorrelation. The regression model showed an association between the average tuberculosis incidence rate and the proportion of poor, household density, and aging index. Conclusion: The dynamics of tuberculosis transmission in Juiz de Fora may be explained by the maintenance of social inequality and urban space organization process.

RESUMO: Objetivo: Analisar o padrão espacial da tuberculose e sua relação com indicadores socioeconômicos, entre 2008 e 2015, em um município considerado prioritário para o controle da tuberculose pelo Programa Nacional de Controle da Tuberculose, Juiz de Fora (MG). Métodos: Estudo ecológico no qual as unidades de análise foram as 81 regiões urbanas de Juiz de Fora. Foram usados dados secundários a partir do banco de dados de notificação do Sistema de Informação de Agravos de Notificação e dados do Censo Demográfico de 2010. Foram georreferenciadas 1.854 notificações e elaborados mapas temáticos para verificar o padrão da distribuição da taxa média de incidência de tuberculose e de indicadores socioeconômicos no município. Foram estimadas medidas de autocorrelação espacial global (coeficiente I de Moran) e local (Indicador Local de Associação Espacial) e modelo de regressão linear múltipla para verificar a relação entre a taxa média de incidência de tuberculose e os indicadores socioeconômicos. Resultados: A taxa média de incidência de tuberculose foi de 48,3 casos/100 mil habitantes/ano. As regiões urbanas correspondentes às regiões centrais do município tiveram taxas mais baixas, com aumento progressivo em direção às regiões urbanas representativas dos bairros mais periféricos. Todas as variáveis estudadas apresentaram autocorrelação espacial significativa. O modelo de regressão mostrou associação entre a taxa média de incidência de tuberculose e a Proporção de Pobres, Densidade Intradomiciliar e Índice de Envelhecimento. Conclusão: A dinâmica da transmissão da tuberculose em Juiz de Fora pode ser explicada pela manutenção da desigualdade social e pelo processo de organização do espaço urbano.

Analysis of anti-tuberculosis drug resistance and sociodemographic and clinical aspects of patients admitted in a referral hospital / Análise da resistência a medicamentos antituberculose e aspectos sociodemográficos e clínicos de pacientes atendidos em hospital referência

ABSTRACT Objective To determine the occurrence of anti-tuberculosis drug resistance and its association with sociodemographic and clinical characteristics of patients in a referral hospital. Methods This was a cross-sectional study based on data from patients who had mycobacterial culture identified and defined antimicrobials sensitivity profile (June 2014 to February 2016). The descriptive statistical analysis and Fisher's exact test were used to compare proportions. Results The study included 104 patients who had positive results for Mycobacterium tuberculosis . Bacilloscopy had high positivity (93.3%). A total of 15 patients (14.4%) had resistant strains and six (5.6%) multidrug-resistant. The sociodemographic and clinical characteristics were not related with resistance. Conclusion This study contributed to further the understandings about the tuberculosis patients' profile, the study also served as a tool for development of specific public policies. Patients diagnosed with resistant tuberculosis must be under greater supervision.

RESUMO Objetivo Verificar a ocorrência de resistência a fármacos antituberculose e a associação com características sociodemográficas e clínicas de pacientes de um hospital referência. Métodos Estudo transversal, com dados de pacientes que tiveram a cultura de micobactérias identificada e o respectivo perfil de sensibilidade aos antimicrobianos definido (junho de 2014 a fevereiro de 2016). Foram realizados a análise estatística descritiva e o teste exato de Fisher, para comparação de proporções. Resultados O estudo envolveu 104 pacientes, e todos tiveram resultados para Mycobacterium tuberculosis . A baciloscopia atingiu alta positividade (93,3%), e 15 pacientes (14,4%) apresentaram linhagens resistentes, sendo 6 (5,6%) multirresistentes. As características sociodemográficas e clínicas não foram associadas à resistência. Conclusão A pesquisa permitiu conhecer melhor o perfil dos pacientes com tuberculose e constitui ferramenta para elaboração de políticas públicas específicas. Os pacientes diagnosticados com tuberculose resistente devem ser submetidos à maior supervisão.

Comparison between Ogawa-Kudoh and modified Petroff techniques for mycobacteria cultivation in the diagnosis of pulmonary tuberculosis / Comparação entre os métodos de Ogawa-Kudoh e Petroff modificado para o cultivo de micobactérias no diagnóstico da tuberculose pulmonar

ABSTRACT Objective To compare the performance of the Ogawa-Kudoh method with the modified Petroff technique in diagnosis of pulmonary tuberculosis. Methods A total of 205 sputum samples from 166 patients with clinical suspicion or under pulmonary tuberculosis follow-up, seen at a public tertiary care hospital, from July 2014 to July 2016 were used. All samples were simultaneously processed using the Ogawa-Kudoh and modified Petroff decontamination methods, according to the recommendations of the Ministry of Health. In the statistical analysis, the McNemar test and the Kappa index were used, respectively, to compare proportions and verify agreement between data. Results The Ogawa-Kudoh and modified Petroff methods were efficient in mycobacteria detection, with no significant differences in results (p=0.549) and contamination rate of the cultures (p=0.065). The agreement between techniques was considered excellent (Kappa index of 0.877) and Ogawa-Kudoh, as compared to the modified Petroff technique, showed sensitivity of 90.4%, specificity of 96.6%, positive predictive value of 94.3% and negative predictive value of 94.2%. Conclusion The Ogawa-Kudoh technique proved to be sufficiently sensitive and specific for diagnosis of pulmonary tuberculosis, and, therefore, suitable for routine laboratory application. Since it is simple, low-cost and has less technical requirements for biosafety and professional training, Ogawa-Kudoh is an alternative for managers and healthcare professionals to promote the expansion of bacteriological diagnostic coverage of pulmonary tuberculosis.

RESUMO Objetivo Comparar o desempenho do método de Ogawa-Kudoh ao de Petroff modificado no diagnóstico da tuberculose pulmonar. Métodos Utilizaram-se 205 amostras de escarro de 166 pacientes com suspeita clínica ou controle de tuberculose pulmonar atendidos em um hospital público terciário, entre os meses de julho de 2014 a julho de 2016. Todas as amostras foram processadas simultaneamente pelos métodos de descontaminação Ogawa-Kudoh e Petroff modificado, seguindo as recomendações do Ministério da Saúde. Na análise estatística, foi empregado o teste de McNemar, para comparação de proporções, e o índice Kappa, para verificar o grau de concordância entre os dados. Resultados Os métodos Ogawa-Kudoh e Petroff modificado mostraram-se eficientes na detecção de micobactérias, não sendo verificadas discordâncias significativas tanto nas comparações de pares de resultados (p=0,549), como na taxa de contaminação das culturas (p=0,065). O grau de concordância das técnicas foi considerado excelente (índice Kappa de 0,877), e o Ogawa-Kudoh, em relação ao Petroff modificado, apresentou 90,4% de sensibilidade, 96,6% de especificidade, 94,3% de valor preditivo positivo e 94,2% de valor preditivo negativo. Conclusão O método de Ogawa-Kudoh revelou-se suficientemente sensível e específico para o diagnóstico da tuberculose pulmonar e, portanto, adequado para a aplicação na rotina laboratorial. Por ser mais simples, de baixo custo e com menores exigências técnicas de biossegurança e capacitação profissional, o Ogawa-Kudoh apresenta-se como alternativa para gestores e profissionais da área promoverem a ampliação da cobertura diagnóstica bacteriológica da tuberculose pulmonar.

Spatial Analysis of Tuberculosis and its Relatioship with Socioeconomic Indicators in a Medium-sized City in Minas Gerais / Análise Espacial da Tuberculose e sua Relação com Indicadores Socioeconômicos em um Município de Médio Porte em Minas Gerais

Objective: To analyze tuberculosis spatial pattern and its relationship with socioeconomic indicators, from 2008 to 2015, in a priority city for tuberculosis control by the National Tuberculosis Control Program, Juiz de Fora, Minas Gerais. Methods: Ecological study which units of analysis were 81 urban regions of Juiz de Fora. Secondary data from Notifiable Diseases Information System and 2010 Demographic Census were used. Georeferenced data from 1854 notifications were used to elaborate thematic maps in order to verify the distribution pattern of average tuberculosis rates and socioeconomic indicators within the city. Global spatial autocorrelation (Moran's I) and local (Local Indicator of Spatial Association) and multiple linear regression model were estimated to analyze the relationship between the average tuberculosis incidence rate and socioeconomic indicators. Results: The average tuberculosis incidence rate was 48.3 cases / 100 thousand inhabitants / year. It was found that the urban regions corresponding to central regions of the city had lower rates with a progressive increase towards the urban regions representative of the most peripheral neighborhoods. All variables showed significant spatial autocorrelation. The regression model showed an association between the average tuberculosis incidence rate and the proportion of poor, home density and aging index. Conclusions: The dynamics of tuberculosis transmission in Juiz de Fora may be explained by the maintenance of social inequality and urban space organization process.  

Objetivo: Analisar o padrão espacial da tuberculose e sua relação com indicadores socioeconômicos, entre 2008 e 2015, em um município considerado prioritário para o controle da tuberculose pelo Programa Nacional de Controle da Tuberculose, Juiz de Fora, Minas Gerais. Métodos: Estudo ecológico no qual as unidades de análise foram as 81 regiões urbanas de Juiz de Fora. Foram usados dados secundários, a partir do banco de dados de notificação do Sistema de Informação de Agravos de Notificação e dados do Censo Demográfico de 2010. Foram georreferenciadas 1854 notificações e elaborados mapas temáticos para verificar o padrão da distribuição da taxa média de incidência de tuberculose e de indicadores socioeconômicos no município. Foram estimadas medidas de autocorrelação espacial global (coeficiente I de Moran) e local (Indicador Local de Associação Espacial) e modelo de regressão linear múltipla para verificar a relação entre a Taxa média de incidência de tuberculose e os indicadores socioeconômicos. Resultados: A Taxa média de incidência de tuberculose foi de 48,3 casos/100 mil habitantes/ano. As regiões urbanas correspondentes às regiões centrais do município tiveram taxas mais baixas, com aumento progressivo em direção às regiões urbanas representativas dos bairros mais periféricos. Todas as variáveis estudadas apresentaram autocorrelação espacial significativa. O modelo de regressão mostrou associação entre a Taxa média de incidência de tuberculose e Proporção de Pobres, Densidade Intradomiciliar e Índice de Envelhecimento. Conclusões: A dinâmica da transmissão da tuberculose em Juiz de Fora pode ser explicada pela manutenção da desigualdade social e pelo processo de organização do espaço urbano.