Impacto do teste Xpert MTB/RIF no diagnóstico da tuberculose

Introdução: O teste Xpert MTB / RIF está sendo cada vez mais utilizado em muitos países como diagnóstico inicial para a tuberculose (TB). Poucos estudos avaliaram o impacto do Xpert no diagnóstico em rotinas de programas de controle de TB no Brasil. O objetivo do presente estudo foi avaliar o impacto da introdução do Xpert MTB / RIF no diagnóstico de TB em uma cidade com alta incidência de TB no Brasil. Métodos: Incluímos pacientes avaliados com testes diagnósticos convencionais durante um ano antes da introdução do Xpert (grupo pré-Xpert) e pacientes avaliados usando Xpert durante um ano após a introdução do teste (grupo pós-Xpert). Resultados: 620 pacientes preencheram os critérios de inclusão (208 no grupo pré-Xpert e 412 no grupo pós-Xpert) e foram incluídos na análise. O tempo até o diagnóstico de TB foi menor no grupo pós-Xpert (0,7 dias, IQR: 0,5-1,0 dias) do que no grupo pré-Xpert (2,0 dias, IQR: 2,0-2,0 dias) (p <0,0001). Características atípicas da doença, como menor perda de peso, febre, dispneia, sudorese noturna e hemoptise; baciloscopia de escarro negativa; cultura negativa e radiografia de tórax atípica de TB foram mais comuns no grupo pós-Xpert do que no grupo pré-Xpert (p <0,0001 para todos). Conclusões: Observamos que a implementação do ensaio Xpert MTB / RIF, em rotinas de programas de controle de TB, melhora e facilita o diagnóstico de tuberculose, especialmente nos casos com manifestações da doença atípica. Esses resultados podem provavelmente ser generalizados para locais com incidência de TB similar.Introduction: The receptor for advanced glycation end products (RAGE) is expressed in normal lungs and is upregulated during inflammation and infection. The interaction between AGEs and RAGE on the plasma membrane causes oxidative stress and apoptosis in lung cells. The objective of this study is to evaluate plasma levels of AGEs and its soluble receptor (sRAGE) in patients with active TB and healthy controls, and to investigate their relationship with food intake and nutritional status. Methods: Case-control study. AGE (carboxymethil lysine, CML) and RAGE were measured by Elisa. Nutritional assessment was performed by body mass index, triceps skin-fold thickness, mid-arm circumference, mid-arm muscle circumference, bioelectrical impedance analysis, and food frequency questionnaire. Results: 35 TB patients and 35 controls were included in the study. The mean S-RAGE levels were higher in TB patients than in controls (68.5 ± 28.1 vs 57.5 ± 24.0, p=0.046). Among cases that were current smokers, lower S-RAGE levels were associated with mortality (S-RAGE levels= 58.0 ± 36.5 [non-survivors] vs 71.3 ± 25.6 [survivors], p=0.006), and with weight loss (S-RAGE levels= 65.6 ± 27.4 [weight loss] vs 98.6 ± 16.7 [no weight loss], p=0.034). There was no statistically significant difference in CML levels and diet CML content between cases and controls. Malnutrition was more frequent in cases than in controls, but there was no correlation between nutritional parameters and CML or S-RAGE levels. Conclusions: TB patients had higher S-RAGE levels than controls. S-RAGE may play a role in disease manifestations and outcomes, being associated with weight loss and mortality

Impacto do teste XPERT MTB/RIF Ultra no diagnóstico da tuberculose

Introdução: Desde 2018, a Organização Mundial da Saúde (OMS) recomendou o uso do Xpert MTB / RIF Ultra para o diagnóstico de TB pulmonar e extrapulmonar e sugeriu que o Xpert Ultra fosse testado em várias populações, com diferentes contextos geográficos e epidemiológicos. Métodos: Estudo transversal com coleta prospectiva de dados. Pacientes ambulatoriais com idade> 18 anos com sintomas respiratórios sugestivos de TB pulmonar foram convidados a participar. Sensibilidade, especificidade, valores preditivos positivos e negativos do teste foram calculados e comparados com o tradicional Xpert MTB / RIF. Resultados: No período do estudo, 180 pacientes foram incluídos na análise. O teste Xpert MTB / RIF Ultra foi positivo em 33 pacientes (18,3%) e a resistência RIF foi detectada em 1 (3,1%) paciente. Considerando a cultura como o padrão ouro, a sensibilidade, especificidade, valor preditivo positivo e valor preditivo negativo de Xpert MTB / RIF Ultra foram 100,0% (IC 95% 85,2–100,0), 93,6% (IC 95% 88,6–96,9), 69,7 % (IC de 95% 55,8–80,7) e 100,0% (IC de 95% 87,2–100,0), respectivamente. A área sob a curva ROC foi de 0,97 para o teste Xpert MTB / RIF Ultra (IC de 95% 0,93 a 0,99; p 0,05). Conclusões: Este é o primeiro estudo no Brasil a avaliar a acurácia do Xpert MTB / RIF Ultra em indivíduos com presunção de TB pulmonar. O teste apresentou excelente sensibilidade e alta especificidade, demonstrando ser uma ferramenta útil para o diagnóstico de TB pulmonar.Introduction: Since 2018, World Health Organization (WHO) recommended the Xpert MTB/RIF Ultra use for pulmonary and extrapulmonary TB diagnosis, and suggested that Xpert Ultra should be tested in various populations, with different geographical and epidemiological settings. Methods: Cross-sectional study with prospective data collection. Outpatients aged >18 years with respiratory symptoms suggestive of pulmonary TB were invited to participate. Sensitivity, specificity, positive and negative predictive values of the test were calculated and compared with the traditional Xpert MTB/RIF. Results: During the study period, 180 patients met the inclusion and were included in the analysis. Xpert MTB/ RIF Ultra test was positive in 33 patients (18.3%), and RIF resistance was detected in 1 (3.1%) patient. Considering culture as the gold standard, the sensitivity, specificity, positive predictive value, and negative predictive value of Xpert MTB/RIF Ultra were 100.0% (95% CI 85.2–100.0), 93.6% (95% CI 88.6–96.9), 69.7% (95% CI 55.8–80.7), and 100.0% (95% CI 87.2– 100.0) , respectively. The area under the ROC curve was 0.97 for the Xpert MTB/RIF Ultra test (95% CI 0.93 to 0.99; p 0.05). Conclusions: This is the first study in Brazil to evaluate the accuracy of Xpert MTB/RIF Ultra in individuals with presumptive pulmonary TB. The test showed an excellent sensitivity and a high specificity, demonstrating that it is a useful tool for pulmonary TB diagnosis

Anaerobic biodegradability of meat-processing wastes: effect of physical, chemical and enzymatic pre-treatments

Methane is produced during the anaerobic degradation of greaves and rinds, two by-products of pig slaughter and meat-processing industry. However, although values of 914±37 and 664±35 m3 CH4 ton-1 waste (wet weight) respectively were obtained, the degradation rate in batch assays was slow and lasted between 25 and 30 days. Therefore, in order to assess the potential increase in the biodegradation rate and biodegradability of these substrates, physical (temperature), chemical (alkali) and enzymatic (lipase) pre-treatments were tested. Partial hydrolysis was achieved for all the conditions applied but the efficiency was higher in alkaline and enzymatic treatments. These conditions produced hydrolysates with higher soluble+colloidal COD, long-chain fatty acids and ammonia concentrations, comparatively with the other treatments applied. Enzymatic hydrolysis increased 14% the methane production potential of the rinds, and this increase was even higher (80%) when rinds were thermally treated before addition of the enzyme. With all other pre-treatments, anaerobic biodegradability of both wastes was not improved comparatively to the raw materials. Alkaline conditions induced a severe decreased (89%) of rinds’ biodegradability. Enzymatic pre-treatment appears to be a promising strategy for increasing methane production from meat-processing wastes

Biochemical Methane Potential of raw and pre-treated meat-processing wastes

Raw and pre-treated greaves and rinds, two meat-processing wastes, were assessed for biochemical methane potential (BMP). Combinations of temperature (25, 55, 70 and 120°C), NaOH (0.3 g g-1 waste volatile solids) and lipase from Candida rugosa (10 U g-1 fat) were applied to promote wastes hydrolysis, and the effect on BMP was evaluated. COD solubilisation was higher (66% for greaves; 55% for rinds) when greaves were pre-treated with NaOH at 55°C and lipase was added to rinds after autoclaving. Maximum fat hydrolysis (52-54%) resulted from NaOH addition, at 55°C for greaves and 25°C for rinds. BMP of raw greaves and rinds was 707±46 and 756±56 L CH4 (at standard temperature and pressure) kg-1 VS, respectively. BMP of rinds improved 25% by exposure to 70ºC; all other strategies tested had no positive effect on BMP of both wastes, and anaerobic biodegradability was even reduced by the combined action of base and temperature.The authors thank Cristiana Goncalves for her help with the enzymatic pre-treatments. The financial support from Portuguese Innovation Agency (ADI), through the project FatValue (QREN no. 3491), is gratefully acknowledged. Professor Giovana Tommaso thanks the EMUNDUS15 - Erasmus Mundus External Cooperation Window (Lot15) that provided financial support for her stay in the University of Minho, Portugal

Severe acute respiratory syndrome coronavirus 2 seroprevalence among patients with pulmonary tuberculosis

Objective: The objective of this study was to estimate the seroprevalence of severe acute respiratory syndrome coronavirus 2 antibodies in patients with tuberculosis. Methods: This cross-sectional study was conducted at an outpatient tuberculosis clinic in Alvorada, RS, Brazil, with data collection between October and December 2020. Outpatients aged>18 years with active pulmonary tuberculosis, no prior history of coronavirus disease 2019, and no suspected coronavirus disease 2019 were included in the study. Whole blood samples were collected to perform the severe acute respiratory syndrome coronavirus 2 antibodies test. Results: During the study period, 52 patients met the inclusion and were included in the analysis. Severe acute respiratory syndrome coronavirus 2 antibodies were positive in 16 (30.8%) patients. Male sex was more frequent among patients with negative severe acute respiratory syndrome coronavirus 2 antibodies than in patients with positive severe acute respiratory syndrome coronavirus 2 antibodies (86.1 vs. 56.3%, p=0.031). Contact with coronavirus disease 2019 case was more common in patients with positive severe acute respiratory syndrome coronavirus 2 antibodies compared with patients with negative severe acute respiratory syndrome coronavirus 2 antibodies (87.5 vs. 8.3%, p<0.0001). In a multivariate analysis, in a model including the variables such as male sex and contact with coronavirus disease 2019 case, only contact with coronavirus disease 2019 was independently associated with positive severe acute respiratory syndrome coronavirus 2 antibodies (OR 77.0, 95%CI 11.5-512.4, p<0.0001). Conclusion: This study revealed a seroprevalence of 30.8% severe acute respiratory syndrome coronavirus 2 among patients with tuberculosis

A produção do conhecimento acerca da auditoria de enfermagem: aspectos teóricos e práticos

No âmbito da enfermagem, a auditoria apresenta crescente inserção no mercado de trabalho, tanto nas atividades desenvolvidas junto a instituições de saúde de ordem pública, privada, assim como nas operadoras de planos de saúde. Diante de tais considerações, este estudo tem como objetivo verificar o conhecimento produzido acerca da auditoria em enfermagem publicados nos últimos 5 anos em periódicos brasileiros de enfermagem. Trata-se de uma pesquisa bibliográfica, realizada nas seguintes bases da dados: Literatura Latino-Americana em Ciências da Saúde (LILACS) e Scientific Eletronic Library Online (SciELO), utilizando-se das seguintes palavras chaves segundo a classificação dos Descritores em Ciências da Saúde (DeCS): Auditoria de Enfermagem; Qualidade da Assistência à Saúde; Registros de Enfermagem. Os critérios de inclusão adotados foram: textos completos e acessíveis nas bases de dados descritas referentes a temática, textos de produção nacional com vistas a aproximar a discussão ao contexto brasileiro e por fim, textos publicados nos últimos 5 anos, pela preferência em abordar pesquisas recentes referentes a temática. Para a análise de dados utilizou-se a técnica de Análise Textual Discursiva. Os resultados apontam que o conhecimento produzido acerca da auditoria de enfermagem expressam conceitos teóricos e práticas; processos de implementação de auditoria de enfermagem em serviços de saúde; a auditoria como ferramenta para a avaliação de registros de enfermagem e qualidade da assistência e a auditoria e tecnologias em saúde. Conclui-se que o conhecimento produzido acerca da temática visa fortalecer e contribuir com as discussões e os processos de implementação de serviços de auditoria nos mais variados ambientes de saúde.

Impact of introduction of Xpert MTB/RIF test on tuberculosis (TB) diagnosis in a city with high TB incidence in Brazil

Background Xpert MTB/RIF is increasingly used in many countries as the initial diagnostic test for tuberculosis (TB). Few studies have evaluated the effect of Xpert on TB diagnosis under programmatic conditions in Brazil. The aim of the present study was to evaluate the impact of introduction of Xpert MTB/RIF on TB diagnosis in a city with high TB incidence in Brazil. Methods We included patients evaluated with conventional diagnostic tests during one year before Xpert introduction (pre-Xpert group) and patients evaluated using Xpert during one year after the test introduction (post-Xpert group). Results 620 patients met the inclusion criteria (208 in the pre-Xpert group and 412 in the postXpert group) and were included in the analysis. The time until TB diagnosis was shorter in post-Xpert group (0.7 day, IQR: 0.5–1.0 day) than in pre-Xpert group (2.0 days, IQR: 2.0– 2.0 days) (p<0.0001). Atypical disease characteristics, such as less weight loss, fever, dyspnea, night sweats, and hemoptysis; a negative sputum smear; a negative culture, and a chest X-ray atypical of TB were more common in post-Xpert group than in pre-Xpert group (p<0.0001 for all). Conclusions We found that the implementation of the Xpert MTB/RIF assay, under programmatic conditions, improve and facilitate TB diagnosis, especially in cases with atypical disease manifestations. These results are likely to be generalizable to settings with a similar high TB incidence

PROCESSO DE MORTE ENCEFÁLICA: SIGNIFICADO PARA ENFERMEIROS DE UMA UNIDADE DE TERAPIA INTENSIVA

Objetivo: compreender como os enfermeiros significam o cuidado prestado ao paciente no processo de morte encefálica em uma Unidade de Terapia Intensiva. Método: pesquisa qualitativa com aporte teórico-metodológico na Teoria Fundamentada nos Dados. A coleta de dados foi realizada em uma Unidade de Terapia Intensiva de um hospital no Sul do Brasil de setembro a novembro de 2014. Participaram do estudo 23 enfermeiros distribuídos em três grupos amostrais. A análise teve início com a codificação aberta, seguindo para a codificação axial e para a codificação seletiva, conforme a Teoria Fundamentada nos Dados. Resultados: emergiu da análise dos dados o fenômeno “Reconhecendo o trabalho multiprofissional como potencializador da doação de órgãos e tecidos para transplantes”, sustentado por cinco categorias. Conclusão: o cuidado prestado aos pacientes em processo de morte encefálica é significado pelos enfermeiros como gerador da oportunidade de uma nova vida aos múltiplos receptores.Descritores: Cuidados de Enfermagem. Morte Encefálica. Enfermeiros. Unidade de Terapia Intensiva