Effectiveness of the implementation of a rapid molecular test on the outcome of treatment of pulmonary tuberculosis cases in Recife municipality

Submitted by Ana Beatriz Oliveira ([email protected]) on 2019-09-05T13:59:57Z No. of bitstreams: 1 Tese Clezio Leitão.pdf: 4875866 bytes, checksum: 784a22d0ee9b13bfa23a0535f5ff77b5 (MD5)Approved for entry into archive by Ana Beatriz Oliveira ([email protected]) on 2019-09-05T14:09:46Z (GMT) No. of bitstreams: 1 Tese Clezio Leitão.pdf: 4875866 bytes, checksum: 784a22d0ee9b13bfa23a0535f5ff77b5 (MD5)Made available in DSpace on 2019-09-05T14:09:46Z (GMT). No. of bitstreams: 1 Tese Clezio Leitão.pdf: 4875866 bytes, checksum: 784a22d0ee9b13bfa23a0535f5ff77b5 (MD5) Previous issue date: 2018Fundação Oswaldo Cruz. Instituto Aggeu Magalhães. Recife, PE, Brasil.O Brasil ocupa a 20ª posição em número de casos de tuberculose (TB) no mundo. Vulnerabilidade social, agravos associados e falhas na “linha de cuidados” na Atenção Básica à Saúde (ABS), contribuem para o atraso no diagnóstico e mortalidade por TB. A introdução do teste rápido molecular para TB (TRM-TB) de rápida execução, elevada acurácia, além de fornecer o perfil de sensibilidade à rifampicina, pode contribuir para a efetividade do Programa de controle da Tuberculose (PCT). Este estudo teve como objetivo principal analisar a efetividade do TRM-TB no desfecho do tratamento da TB pulmonar, associada ou não a formas extrapulmonares, após exclusão dos casos de abandono do tratamento, em unidades de saúde da ABS do Recife, entre 1º de junho de 2014 e 31 de maio de 2015. Realizou-se um estudo de caso-controle, considerando casos os indivíduos com desfecho desfavorável (óbito e falência ao tratamento) e controle os que tiveram desfecho favorável (cura), após tratamento. Para analisar o efeito independente da principal variável de exposição, o TRM-TB, sobre o desfecho, procedeu-se à regressão logística multivariada. Após ajuste dos potenciais fatores de confusão, permaneceram no modelo multivariado final associados ao desfecho desfavorável, de forma independente, faixa etária de 30 a 59 (OR 1,84; IC 95% 1,03-3,28; p=0,038) e > 60 anos (OR 3,53; IC 95% 1,83-6,81; p 60 years (OR 3.53, 95% CI 1.83-6.81, p < 0.001). Protection factors for the covariate Health Unit were care in prison units (OR 0.27, 95% CI 0.11-0.65, p = 0.004) and polyclinics (OR 0.40, 95% CI, 0.23-0.68, p = 0.001). The study suggests that although RMT-TB represents an effective diagnostic tool, it was not effective for a favorable treatment outcome in the TCP in the city of Recife in the study period

Exuberant bullous vasculitis associated with SARS-CoV-2 infection

We described a case of exuberant cutaneous small-vessel vasculitis in a 27-year-old male with mild CoVID-19 in Brazil. The patient presented painful purpuric papules and vesicobullous lesions with hemorrhagic content located in the larger amount in the lower limbs and, to a lesser extent in the region of the back and upper limbs, saving palms and soles of the feet. Influenza-like syndrome with anosmia and ageusia was reported seven days before the skin lesions. A real-time reverse transcription polymerase chain reaction was positive on a nasopharyngeal swab for SARS-CoV-2. Histopathological study showed leukocytoclastic cutaneous vasculitis affecting small vessels and microthrombi occluding some vessels. The patient presented an improvement in skin lesions by the fifth day of prednisone therapy. This case highlights the importance of the SARS-CoV-2 test in investigating the etiology of cutaneous vasculitis during this pandemic

Pharmacologic management of pain in patients with Chikungunya: a guideline

Abstract From the arrival of Chikungunya virus in the Americas in 2013 until March 2016, approximately two million cases of the disease have been reported. In Brazil, the virus was identified in 2014 and thousands of people have been affected. The disease has high attack rates, infecting 50% of a population within a few months. Approximately 50% of infected people develop chronic symptoms lasting for months or years. Joint involvement is the main clinical manifestation of Chikungunya. It is characterized by swelling and intense pain that is poorly responsive to analgesics, both in the acute and chronic phase of the disease. This significantly compromises quality of life and may have immeasurable psychosocial and economic repercussions, constituting therefore, a serious public health problem requiring a targeted approach. Physicians are often not familiar with how to approach the management of pain, frequently prescribing limited analgesics, such as dipyrone, in sub-therapeutic doses. In addition, there are few published studies or guidelines on the approach to the treatment of pain in patients with Chikungunya. Some groups of specialists from different fields have thus developed a protocol for the pharmacologic treatment of Chikungunya-associated acute and chronic joint pain; this will be presented in this review

Pharmacologic management of pain in patients with Chikungunya: a guideline

Abstract From the arrival of Chikungunya virus in the Americas in 2013 until March 2016, approximately two million cases of the disease have been reported. In Brazil, the virus was identified in 2014 and thousands of people have been affected. The disease has high attack rates, infecting 50% of a population within a few months. Approximately 50% of infected people develop chronic symptoms lasting for months or years. Joint involvement is the main clinical manifestation of Chikungunya. It is characterized by swelling and intense pain that is poorly responsive to analgesics, both in the acute and chronic phase of the disease. This significantly compromises quality of life and may have immeasurable psychosocial and economic repercussions, constituting therefore, a serious public health problem requiring a targeted approach. Physicians are often not familiar with how to approach the management of pain, frequently prescribing limited analgesics, such as dipyrone, in sub-therapeutic doses. In addition, there are few published studies or guidelines on the approach to the treatment of pain in patients with Chikungunya. Some groups of specialists from different fields have thus developed a protocol for the pharmacologic treatment of Chikungunya-associated acute and chronic joint pain; this will be presented in this review