Estudo do perfil epidemiológico da tuberculose em Araraquara, SP, no período 2012 - 2017

Background: Tuberculosis (TB) affects 1/3 of the world’s population and about 10 million people develop TB each year, resulting in 2 million deaths. Objectives: The main goal of this work is to present a study of the epidemiological profile of TB in Araraquara, Brazil and to compare the epidemiological profile with the number of the diseases in the world,  Americas, Brazil and the State of São Paulo. Methods: Surveys and information were collected from World Health Organization (WHO ) annual report, Brazilian Ministry of Health, Secretary of the State of São Paulo, Municipal Health Department and the Special Healthcare Service of Araraquara (SESA). The period from 2012 to 2017 was analyzed considering the projections of the WHO goals to the end of TB from 2015 to 2035. Results: All data presented, except for the city of Araraquara, are above the projection required by OMS. Although slightly below the projection cited above, Araraquara is on track to reduce the incidence of TB to the point of eradicating the disease. Conclusions: Current low TB infection levels in Araraquara combined with factors such as one of the highest Human Development Index (HDI) in the country, the existence of a sanatorium specialized for treatment of the disease, public policies and an efficient information network about TB can explain the results and make Araraquara a model in the fight against the disease at national level. The city seems to be able to eradicate the disease within or even before OMS deadline.Introdução: A tuberculose (TB) afeta 1/3 da população mundial e cerca de 10 milhões de pessoas desenvolvem TB a cada ano, resultando em mais de dois milhões de mortes. Objetivos: O principal objetivo deste trabalho é apresentar um estudo do perfil epidemiológico da TB em Araraquara (SP) e comparar o perfil epidemiológico da TB em Araraquara com os padrões da doença no mundo, Américas, Brasil e Estado de São Paulo. Método: As pesquisas e informações foram coletadas do relatório anual da Organização Mundial da Saúde (OMS), do Ministério da Saúde do Brasil, da Secretaria do Estado de São Paulo, da Secretaria Municipal de Saúde e do Serviço Especial de Saúde de Araraquara (SESA). O período de 2012 a 2017 foi analisado considerando-se as projeções das metas da OMS para o fim da TB de 2015 a 2035. Resultados: Todos os dados apresentados, com exceção da cidade de Araraquara, estão acima da projeção requerida pela OMS. Embora ligeiramente abaixo da projeção citada, Araraquara está se encaminhando para reduzir a incidência de TB até o ponto de erradicar a doença. conclusões: Os baixos níveis atuais de infecção por TB em Araraquara podem ser explicados por fatores como, um dos maiores Índices de Desenvolvimento Humano (IDH) do País, a existência de um sanatório especializado no tratamento da doença, políticas públicas e uma eficiente rede de informações sobre TB . Araraquara pode ser um modelo no combate à doença no nível nacional e erradicar a doença  até antes do prazo estabelecido pela OMS

Tuberculose: história e evolução dos tratamentos da doença

A tuberculose (TB) é uma doença infectocontagiosa causada pela micobactéria do gênero Mycobacterium, sendo a espécie Mycobacterium tuberculosis (Mtb) a mais comum. A TB afeta principalmente os pulmões, mas pode afetar praticamente todos os órgãos do corpo. É uma das doenças que mais causa mortes no mundo, sendo a mais letal causada por um único agente infeccioso e acomete 1/3 da população mundial. Cerca de 10 milhões de pessoas desenvolvem a doença no mundo todo e dois milhões morrem anualmente. Os objetivos deste trabalho são apresentar o histórico da doença, desde seus primeiros registros até o aparecimento dos tipos multidrogas-resistentes, sua epidemiologia e imunologia, o mecanismo de ação do bacilo de Koch, a busca por novas drogas e vacinas, as principais formas de tratamento e atualizar as informações identificadas nos artigos publicados na literatura sobre o tema até o ano de 2018, através de extensa pesquisa bibliográfica em relatórios e bases de dados nacionais e internacionais. Os marcos da Estratégia para o Fim da TB no mundo até 2035 só poderão ser alcançados se serviços de diagnóstico, tratamento e prevenção da TB forem fornecidos em nível universal e se houver mobilização de vários setores da sociedade (em diferentes níveis: individual, comunitário e político) para diminuir fatores socioeconômicos que induzem a proliferação da doença. Um dos desafios para eliminar a progressão da TB no mundo é o surgimento de Mtb resistente aos fármacos tradicionais, sendo urgentemente necessário o desenvolvimento de drogas antiTB de ação mais potente e rápida com novos modos de ação para superar a resistência cruzada com a atual medicação

Calculated Drude weight and optical gap across the metal-insulator transition in the RVO3 series (R = Sr, Ca, La, Y)

We studied the changes in the optical properties of the RVO3 series (R = Sr, Ca, La, Y) using band structure calculations. These oxides present a transition from a non-magnetic metallic phase in SrVO3-CaVO3, to an antiferromagnetic insulator state in LaVO3-YVO3. The standard LDA and GGA approach to DFT fails to reproduce the observed band gap in the LaVO3-YVO3 insulating compounds. We show here that the use of the modified Becke-Johnson exchange potential in the calculation of the optical properties solves this problem. In particular, the optical conductivity of the metallic SrVO3-CaVO3 oxides exhibits a Drude contribution, whereas the insulating LaVO3-YVO3 materials reflects the opening of the optical gap. We also show that the calculated optical conductivity of these materials is in good agreement with previous experimental results

Risk factors for tuberculosis: diabetes, smoking, alcohol use, and the use of other drugs

ABSTRACT Tuberculosis continues to be a major public health problem. Although efforts to control the epidemic have reduced mortality and incidence, there are several predisposing factors that should be modified in order to reduce the burden of the disease. This review article will address some of the risk factors associated with tuberculosis infection and active tuberculosis, including diabetes, smoking, alcohol use, and the use of other drugs, all of which can also contribute to poor tuberculosis treatment results. Tuberculosis can also lead to complications in the course and management of other diseases, such as diabetes. It is therefore important to identify these comorbidities in tuberculosis patients in order to ensure adequate management of both conditions

Effectiveness and Safety of Imipenem-Clavulanate Added to an Optimized Background Regimen (OBR) Versus OBR Control Regimens in the Treatment of Multidrug-Resistant and Extensively Drug-Resistant Tuberculosis

SCOPUS: le.jinfo:eu-repo/semantics/publishe

Comparison of effectiveness and safety of imipenem/clavulanate-versus meropenem/clavulanate-containing regimens in the treatment of MDR- and XDR-TB

No large study to date has ever evaluated the effectiveness, safety and tolerability of imipenem/clavulanate versus meropenem/clavulanate to treat multidrug- and extensively drug-resistant tuberculosis (MDR- and XDR-TB). The aim of this observational study was to compare the therapeutic contribution of imipenem/clavulanate versus meropenem/clavulanate added to background regimens to treat MDR- and XDR-TB cases. 84 patients treated with imipenem/clavulanate-containing regimens showed a similar median number of antibiotic resistances (8 versus 8) but more fluoroquinolone resistance (79.0% versus 48.9%, p<0.0001) and higher XDR-TB prevalence (67.9% versus 49.0%, p=0.01) in comparison with 96 patients exposed to meropenem/clavulanate-containing regimens. Patients were treated with imipenem/clavulanate- and meropenem/clavulanate-containing regimens for a median (interquartile range) of 187 (60-428) versus 85 (49-156) days, respectively. Statistically significant differences were observed on sputum smear and culture conversion rates (79.7% versus 94.8%, p=0.02 and 71.9% versus 94.8%, p<0.0001, respectively) and on success rates (59.7% versus 77.5%, p=0.03). Adverse events to imipenem/clavulanate and meropenem/clavulanate were reported in 5.4% and 6.5% of cases only. Our study suggests that meropenem/clavulanate is more effective than imipenem/clavulanate in treating MDR/XDR-TB patients

Effectiveness and safety of meropenem/ clavulanate-containing regimens in the treatment of MDR- and XDR-TB

No large study has ever evaluated the efficacy, safety and tolerability of meropenem/ clavulanate to treat multidrug- and extensively drug-resistant tuberculosis (MDR- and XDR-TB). The aim of this observational study was to evaluate the therapeutic contribution, effectiveness, safety and tolerability profile of meropenem/clavulanate added to a background regimen when treating MDR- and XDR-TB cases. Patients treated with a meropenem/clavulanate-containing regimen (n=96) showed a greater drug resistance profile than those exposed to a meropenem/clavulanate-sparing regimen (n=168): in the former group XDR-TB was more frequent (49% versus 6.0%, p<0.0001) and the median (interquartile range (IQR)) number of antibiotic resistances was higher (8 (6-9) versus 5 (4-6)). Patients were treated with a meropenem/clavulanate-containing regimen for a median (IQR) of 85 (49-156) days. No statistically significant differences were observed in the overall MDR-TB cohort and in the subgroups with and without the XDR-TB patients; in particular, sputum smear and culture conversion rates were similar in XDR-TB patients exposed to meropenem/clavulanate-containing regimens (88.0% versus 100.0%, p=1.00 and 88.0% versus 100.0%, p=1.00, respectively). Only six cases reported adverse events attributable to meropenem/clavulanate (four of them then restarting treatment). The nondifferent outcomes and bacteriological conversion rate observed in cases who were more severe than controls might imply that meropenem/clavulanate could be active in treating MDR- and XDR-TB cases