Barriers faced by patients in the diagnosis of multidrug-resistant tuberculosis in Brazil

OBJECTIVE To understand patients’ narratives about the barriers they faced in the diagnosis and treatment of multidrug-resistant tuberculosis, and their consequences in Rio de Janeiro State, Brazil. METHODS This is a qualitative cross-sectional study with non-probabilistic sampling. A theoretical saturation criterion was considered for composing the number of interviewees. Semi-structured interviews were conducted from August to December 2019 with 31 patients undergoing treatment for multidrug-resistant tuberculosis at an outpatient referral center in Rio de Janeiro. Data were transcribed and processed with the aid of the NVIVO software. Interviews were evaluated by content analysis, and their themes, cross-referenced with participants’ characterization data. RESULTS Our main findings were: a) participants show a high proportion of primary drug resistance, b) patients experience delays in the diagnosis and effective treatment of multidrug-resistant tuberculosis ; c) healthcare providers fail to value or seek the diagnosis of drug-resistant tuberculosis, thus beginning the inadequate treatment for drug-susceptible tuberculosis, d) primary health units show low report rates of active case-finding and contact monitoring, and e) patients show poor knowledge about the disease. CONCLUSIONS We need to improve referral systems, and access to the diagnosis and effective treatment of multidrug-resistant tuberculosis; conduct an active investigation of contacts; intensify the training of healthcare providers, in collaboration with medical and nursing schools, in both public and private systems; and promote campaigns to educate the population on tuberculosis signs and symptoms

Coeficientes de atrito de forragens picadas em varias superficies

Orientador: Oscar Antonio BraunbeckDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Engenharia de Alimentos e AgricolaBibliografia: f. 67-70MestradoMestre em Engenharia Agrícol

The looming tide of nontuberculous mycobacterial infections in Portugal and Brazil

Nontuberculous mycobacteria (NTM) are widely disseminated in the environment and an emerging cause of infectious diseases worldwide. Their remarkable natural resistance to disinfectants and antibiotics and an ability to survive under low-nutrient conditions allows NTM to colonize and persist in man-made environments such as household and hospital water distribution systems. This overlap between human and NTM environments afforded new opportunities for human exposure, and for expression of their often neglected and underestimated pathogenic potential. Some risk factors predisposing to NTM disease have been identified and are mainly associated with immune fragilities of the human host. However, infections in apparently immunocompetent persons are also increasingly reported. The purpose of this review is to bring attention to this emerging health problem in Portugal and Brazil and to emphasize the urgent need for increased surveillance and more comprehensive epidemiological data in both countries, where such information is scarce and seriously thwarts the adoption of proper preventive strategies and therapeutic options.We acknowledge the support of FEDER through COMPETE and of National Funds through FCT - Fundacao para a Ciencia e a Tecnologia grants FCOMP-01-0124-FEDER-028359 [PTDC/BIA-MIC/2779/2012] and UID/NEU/04539/2013.info:eu-repo/semantics/publishedVersio

Tuberculose multirresistente no Brasil: histórico e medidas de controle

The article aimed at assessing multidrug-resistant tuberculosis control in Brazil, based on the experiences of reference institutions, and the most relevant studies carried out to determine local and national resistance rates. Control measures and the current situation of treatment and diagnoses after the implementation of the national guidelines, which were revised in 2004, are considered. The first national survey on resistance to anti-tuberculosis drugs was performed in the middle of last decade. From its outcomes, a regimen to treat all cases of multidrug-resistant tuberculosis was validated and adopted. Government measures enabled the implementation of a surveillance system, whose outcomes are also commented.O objetivo do artigo foi analisar o controle da tuberculose multirresistente no Brasil, com base nas experiências de instituições de referência e dos principais estudos de determinação das taxas locais e nacionais de resistência. Foram consideradas as medidas de controle e a situação atual de diagnóstico e tratamento, a partir da implementação das diretrizes nacionais, revisadas em 2004. O primeiro inquérito nacional de resistência aos medicamentos anti-tuberculose foi realizado em meados da década de 1990. A partir de seus resultados, foi validado e adotado um regime terapêutico nacional para todos os casos de tuberculose multirresistente. Medidas governamentais possibilitaram a implementação de um sistema de vigilância epidemiológica, cujos resultados também são comentados

Tuberculose : onde estamos?

Submitted by Fátima Lopes ([email protected]) on 2020-04-03T17:39:50Z No. of bitstreams: 1 Tuberculose.pdf: 158418 bytes, checksum: a96854426a4cbe5188c21d33b201e000 (MD5)Approved for entry into archive by Fátima Lopes ([email protected]) on 2020-04-03T18:28:54Z (GMT) No. of bitstreams: 1 Tuberculose.pdf: 158418 bytes, checksum: a96854426a4cbe5188c21d33b201e000 (MD5)Made available in DSpace on 2020-04-03T18:28:54Z (GMT). No. of bitstreams: 1 Tuberculose.pdf: 158418 bytes, checksum: a96854426a4cbe5188c21d33b201e000 (MD5) Previous issue date: 2018Universidade Federal do Rio de Janeiro. Faculdade de Medicina. Instituto de Doenças do Tórax. Rio de Janeiro, RJ, Brasil.Universidade Federal do Rio Grande do Sul. Faculdade de Medicina. Porto Alegre, RS, Brasil.Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública. Centro de Referência Hélio Fraga. Rio de Janeiro, RJ, Brasil.A tuberculose é a nona principal causa de morte em todo o mundo e a principal causa de morte por um único agente infeccioso, acima do HIV/AIDS. Os BRICS (Brasil, Rússia, Índia, China e África do Sul) são responsáveis por 53% de todos os casos de tuberculose no mundo. Estima-se que, em 2016, tenha havido 1,3 milhões de mortes por tuberculose entre indivíduos HIV negativos e outras 374.000 mortes entre indivíduos HIV positivos. Estima-se também que, em 2016, 10,4 milhões de pessoas (adultos: 90%; homens: 65%; pessoas com HIV: 10%) tenham apresentado tuberculose doença (isto é, foram casos incidentes). A tuberculose resistente é uma ameaça persistente; houve 490.000 casos de tuberculose multirresistente em 2016, além de 110.000 casos de tuberculose sensível à isoniazida e resistente à rifampicina

Atributos físicos do solo em diferentes sistemas de manejo de agroecossistemas no Território do Caparaó.

A compreensão do impacto do uso e manejo do solo em seus atributos físicos é fundamental no desenvolvimento de sistemas agrícolas sustentáveis. Objetivou-se avaliar o comportamento dos atributos físicos do solo sob oito tipos de uso e manejo no território do Caparaó (ES). O estudo foi conduzido em oito diferentes agroecossistemas: pastagem de capim gordura (PCG); pastagem de braquiária (PBR); horticultura (HOR); lavouras de café arábica (CA1 e CA2); fruticultura de citros (FRU); floresta de eucalipto (EUC) e vegetação nativa (VEN). Avaliou-se a umidade gravimétrica (UG), a densidade do solo (Ds), a densidade de partícula (DP), a porosidade total (PT) e a resistência do solo a penetração (RP) nas profundidades de 0-10 cm, 10-20 cm e 20-40 cm. A maior UG foi encontrada em HOR e VEN. As maiores Ds foram encontradas no sistema de manejo CA2, PCG e FRU. A menor PT ocorreu em PBR na camada superficial (0-10 cm), estatisticamente iguais a CA2 e FRU. Os maiores valores de RP foram observados em PBR para todas as profundidades avaliadas (5,28, 8,32 e 10,68 MPa). As médias da RP nos sistemas de manejo CA1 e CA2 foram iguais estatisticamente, mesmo situados em diferentes localidades. Nos sistemas PCG, PBR, FRU e EUC, os valores de RP, na profundidade de 20-40 cm, ficaram acima de 4,0 MPa, considerados uma limitante para o desenvolvimento radicular. Os resultados indicam que os diferentes manejos das culturas instaladas nos agroecossistemas causam variações significativas nos atributos físicos do solo avaliadosComprehending impacts of soil management and use on its physical attributes is essential to develop sustainable agricultural systems. This study evaluated the behavior of soil physical properties under different types of use and management in “Caparaó Capixaba” territory, state of Espírito Santo. This study was performed in eight different agroecosystems: Molasses grass pasture (PCG); Signalgrass pasture (PBR); Arabic coffee plantation (CA1 and CA2); Horticulture (HOR); Citrus culture (FRU); Eucalyptus forest (EUC) and Native vegetation (VEN). Gravimetric moisture (GM), bulk density (Bd), particle density (Pd), total porosity (Tp) and soil penetration resistance (PR) were evaluated at 0–10 cm, 10–20 cm and 20–40 cm depths. The highest GM was found in HOR and VEN. The highest Bd were found in the CA2, PCG and FRU management system. At a surface depth (0–10 cm), PBR presented the lowest PT value, statistically equal to CA2 and FRU. The highest values of RP were observed in PBR at all evaluated depths (5.28, 8.32 and 10.68 Mpa). CA1 and CA2 were similar in RP, even when in different places. PCG, PBR, FRU e EUC showed RP higher than 4.0 MPa, which is beyond the critical limit for root system growth. The results indicate that different soil management approaches for the existing crops and vegetation in the agroecosystems can cause significant changes in soil physical attributes

Pneumonia de repetição por aspiração de corpo estranho em adulto: Um relato de caso / Foreign-body aspiration recurrent pneumonia in an adult: A case report

INTRODUÇÃO: A pneumonia é uma infecção do parênquima pulmonar por proliferação de agentes infecciosos ou aspiração de conteúdo nocivo ao órgão, o quadro clínico pode ser variável. Quadros de pneumonia de repetição são graves e potencialmente fatais caso haja falha diagnóstica ou terapêutica, devendo sempre investigar causas secundárias. Acomete mais pacientes com doenças crônicas, imunodeprimidos e/ou com déficit neurológico, incidindo mais sobre os extremos de idade. OBJETIVO: Descrever um caso de pneumonia de repetição e sua conduta terapêutica fundamentada em evidências, assim como a causa da enfermidade. MÉTODO: Estudo de relato de caso do tipo retrospectivo fundamentando-se em análise de prontuário de paciente. RELATO DO CASO: Paciente adulto, asmático e com infecções frequentes de via aérea inferior, sem fatores de risco, porém a tosse, sibilância e dispneia eram recorrentes. Avaliando a história pregressa observavam-se pneumonias de repetição, a investigação complementar detalhada foi determinante para o seu caso, já que em lobo direito houve suspeita de presença de corpo estranho em imagem tomográfica, e pela broncoscopia o diagnóstico foi confirmado e o corpo estranho retirado (um caroço de laranja). O paciente foi investigado e após broncoscopia e extração de corpo estranho, passa bem e assintomático, sem novas crises e processos infecciosos

Is asthma control more than just an absence of symptoms? An expert consensus statement

Purpose: Definitions and measures of asthma control used in clinical trials and in clinical practice vary considerably. There is also misalignment between patients and healthcare professionals (HCPs) in terms of understanding and managing asthma control. This study aimed to progress towards a consensus definition of asthma control, and evaluate disparities between HCP and patient perspectives. Basic procedures: A two-stage Delphi questionnaire involving asthma specialists sought to identify areas of consensus on aspects of asthma control in clinical practice. Results were compared with those of a structured literature review to assess if existing guidance and measures of asthma control used in studies correlated with practice. Eighty-two panelists took part in the Delphi questionnaire. The structured literature review included 185 manuscripts and 31 abstracts. Main findings: Panelists agreed that there was no standard definition of asthma control, confirmed by a total of 19 different composite consensus/guideline definitions and/or validated measures of control being identified across the Delphi study and literature review. Panelists agreed on the positive associations of well-controlled asthma with patient outcomes, but not on the components or thresholds of a working definition of control. Principal conclusions: A universally accepted definition and measure of asthma control that is utilized and understood by patients, HCPs, and researchers is required