Leticia Molino Guidoni

Smoking and 2-month culture conversion during anti-tuberculosis treatment.

OBJECTIVE To investigate risk factors for delayed sputum culture conversion to negative during anti-tuberculosis treatment, with an emphasis on smoking. DESIGN Nested case-control study of adults with non-cavitary, culture-confirmed pulmonary tuberculosis (TB) participating in an anti-tuberculosis treatment trial in Brazil. A case of delayed culture conversion was a patient who remained culture-positive after 2 months of treatment. Odds ratios with 95% confidence intervals were calculated. RESULTS Fifty-three cases and 240 control patients were analyzed. Smokers had three-fold greater odds of remaining culture-positive after 2 months of treatment (P = 0.007) than non-smokers, while smokers and ex-smokers who smoked >20 cigarettes a day had two-fold greater odds of remaining culture-positive after 2 months of treatment (P = 0.045). CONCLUSION Cigarette smoking adversely affects culture conversion during anti-tuberculosis treatment. Support for smoking cessation should be considered to improve outcomes in TB control programs.

Efeitos adversos causados pelo novo esquema de tratamento da tuberculose preconizado pelo Ministério da Saúde do Brasil

OBJECTIVE To determine the principal adverse effects of the tuberculosis treatment regimen recommended by the Brazilian Ministry of Health. METHODS A prospective descriptive study involving 79 tuberculosis patients treated at the Clinical Research Center of the Cassiano Antonio Moraes University Hospital, in the city of Vitória, Brazil, between 2003 and 2006. The treatment regimen consisted of isoniazid, rifampicin, pyrazinamide and ethambutol for four months, followed by rifampicin and isoniazid for two months. During the treatment period, the patients were clinically evaluated every week and had a monthly medical visit. RESULTS The overall incidence of adverse effects was 83.54%. Articular/bone/muscle involvement was the most common, followed by skin involvement (24.94% and 22.09%, respectively). Adverse effects were more common in the second month of treatment (41.59%). Modification of the treatment regimen was unnecessary. One patient required concomitant medication to counter the adverse effects. The cure rate was 100%. CONCLUSIONS The overall incidence of adverse effects related to the new treatment regimen recommended by the Brazilian Ministry of Health was high. However, none of those effects demanded a change in the regimen, which was effective in the patients evaluated.

Factors associated with nonadherence to TB chemoprophylaxis in Vitória, Brazil: a historical cohort study*

OBJECTIVE To describe the factors associated with nonadherence to TB chemoprophylaxis in patients older than 15 years of age treated via referral TB control programs. METHODS A historical cohort study was carried out based on medical charts related to cases treated via referral TB control programs in the city of Vitória, Brazil, between 2002 and 2007. Cases of infection with Mycobacterium tuberculosis were stratified into two groups: health care workers (HCW group); and individuals who were not health care workers (NHCW group). RESULTS A total of 395 patients were included in the study: 35 in the HCW group and 360 in the NHCW group. The mean age in the HCW and NHCW groups was 34.8 and 32.4 years, respectively (p = 0.36). Of the 35 patients in the HCW group, 29 (82.9%) were female, compared with 180 (50.0%) of the 360 patients in the NHCW group. In the HCW and NHCW groups, respectively, 15 (42.9%) and 169 (46.9%) of the patients were contacts of TB cases. In addition, 9 (25.7%) and 157 (78.5%) the HCW and NHCW group patients, respectively, were HIV-infected. Nonadherence to chemoprophylaxis was 37.1% and 21.9% in the HCW and NHCW groups, respectively (p = 0.045). In the multivariate analysis, the factors associated with nonadherence were being a health care worker (OR = 8.60; 95% CI: 2.09-35.41), being HIV-infected (OR = 4.57; 95% CI: 1.2-17.5) and having had contact with a TB patient (OR = 2.65; 95% CI: 1.15-6.12). CONCLUSIONS In order to improve adherence to TB chemoprophylaxis, new TB control program strategies are needed, especially for health care workers and HIV-infected patients.

DIFERENÇAS NAS CARACTERÍSTICAS CLÍNICAS E EPIDEMIOLÓGICAS ENTRE OS CASOS NOTIFICADOS POR TUBERCULOSE NA ATENÇÃO PRIMÁRIA E TERCIÁRIA

Objective: To compare, on the basis of clinical, radiological and epidemiological aspects, all cases of tuberculosis (TB) diagnosed in the tertiary healthcare services to those diagnosed at the primary healthcare providers in the municipality of Vitoria-ES. Methods: Cross- sectional, retrospective study, with analysis of the SINAN’s database, to identify all cases among residents of the municipality of Vitoria-ES and diagnosed with TB in 2006 and 2007. Patients were divided into two groups: cases diagnosed in Primary Health Care (PHC) and those diagnosed in Tertiary Health Care (THC). For statistical analysis, it was used the software STATA CORP 9.0. Results: 338 patients were identified; 207 (61.24%) of these were diagnosed in PHC and 131 (38.76%) in THC. The pulmonary form was predominant in both groups. However, the extrapulmonary form presented higher frequency in the THC group. When analyzing the results of sputum smear, the positivity was found in 114 (55.07%) patients of the PHC and in 57 (43.51%) of THC. Regarding the positive cultures, 119 (57.48%) patients diagnosed in PHC and only 38 (29%) in THC tested positive. Conclusion: There is evidence of high proportion of patients with TB communicated as “new cases” in THC in the city and it was observed a predominance of the pulmonary form in both groups - PHC and THC, although the extrapulmonary form was more frequent in the latter. doi:10.5020/18061230.2013.p251

Cross-cultural adaptation of the instrument "tool to estimate patient's costs" in priority municipalities of Brazil in tuberculosis control

Introduction: Tuberculosis is historically associated with poverty, generating costs that can influence treatment. Considering the impact of the costs of illness, the importance of adapting the instrument is highlighted. Objective: To adapt transculturally to Brazilian Portuguese the instrument Tool to Estimate Patients Costs. Methods: Study of the type transcultural adaptation of instrument. The translation followed the criteria described by Herdman, 1998, in order to preserve functional equivalence as much as possible. The questionnaire with cross-cultural adaptation was applied to 77 patients, with at least one full month of treatment for the disease. Results: Instrument was shown with Cronbach Alpha above 0.71 constituting a good tool for measuring the costs of the disease, being necessary modifications. Conclusions: This study suggests the creation of an instrument adapted for the treatment of TB in Brazil, for the evaluation of costs with the illness by tuberculosis.

Fatores que interferem na qualidade das amostras e dos procedimentos de coleta de escarro em sintomáticos respiratórios

RESUMO| Introdução: O êxito na identificação dos portadores de tuberculose está relacionado aos métodos diagnósticos utilizados e às boas práticas clínicas, sobretudo no que se refere aos procedimentos e orientações de coleta do escarro fornecidas pelos profissionais das Unidades Básicas de Saúde (UBS), ao transporte e ao armazenamento dos espécimes clínicos. Objetivo: Descrever a qualidade das amostras de escarro e dos procedimentos de coleta e seu impacto nas estratégias de busca de Sintomáticos Respiratórios (SR). Métodos: Trata-se de um corte transversal, realizado em UBS. Na primeira etapa, os SR foram entrevistados sobre procedimentos de orientação para coleta e percurso do material biológico até a entrega na Unidade. Na segunda etapa, os escarros dos SR foram analisados quanto à qualidade e correlacionados com resultados de baciloscopia e cultura. Foram realizadas análises de frequência relativa e absoluta, teste qui-quadrado e regressão logística. Resultados: Dos 182 pacientes entrevistados, 92,3% confirmaram ter recebido orientações quanto a procedimentos para realização da coleta de escarro. Entretanto, das nove variáveis estudadas sobre informações da coleta de escarro, em sete delas, mais da metade dos pacientes não realizaram os procedimentos informados de forma adequada. Com relação às informações sobre transporte e armazenamento do material coletado, observou-se que das seis variáveis estudadas, em quatro delas mais da metade dos pacientes não realizaram os procedimentos informados de forma adequada. Na análise da qualidade da amostra de acordo com a orientação, forma de coleta e armazenamento, observou-se que a qualidade da amostra é influenciada por cinco variáveis, com significância estatística. Conclusão: O fornecimento de educação em saúde sobre a importância do exame de escarro e da necessidade de produzir uma amostra de boa qualidade para o SR deve ser contínuo e prioridade do programa de tuberculose.

Membros familiares e profissionais de saúde na supervisão do tratamento da tuberculose

OBJETIVO: Comparar os resultados de cura por tuberculose entre pacientes supervisionados pelo membro familiar e pelo profissional de saude. METODOS: Estudo de coorte prospectiva de 171 pacientes de Vitoria, ES, no periodo de 2004 a 2007. Cada paciente foi acompanhado por seis meses ate a finalizacao do tratamento. Dos pacientes estudados, 59 pacientes tratados eram supervisionados por um membro familiar e 112 pelos profissionais de saude. Foram avaliados dados sociodemograficos e clinicos dos pacientes. Diferencas entre os grupos de estudo foram avaliadas utilizando o teste qui-quadrado ou teste t de Student ao nivel de significância de 5%. RESULTADOS: A maioria dos sujeitos do estudo apresentaram bacioscopia positiva e cultura confirmada para tuberculose. Dois pacientes tinham sorologia positiva para HIV. Um numero maior de pacientes no grupo supervisionado por profissionais de saude nao eram alfabetizados, comparado com aqueles pacientes do grupo supervisionado por membros familiares (p = 0,01). Todos os pacientes supervisionados por um familiar foram curados, frente a 90% dos pacientes supervisionados pelos profissionais de saude (p=0,024). CONCLUSOES: O sucesso do tratamento de tuberculose foi maior quando supervisionado por um familiar.

Miembros familiares y profesionales de salud en la supervisión del tratamiento de la tuberculosis

OBJETIVO: Comparar os resultados de cura por tuberculose entre pacientes supervisionados pelo membro familiar e pelo profissional de saude. METODOS: Estudo de coorte prospectiva de 171 pacientes de Vitoria, ES, no periodo de 2004 a 2007. Cada paciente foi acompanhado por seis meses ate a finalizacao do tratamento. Dos pacientes estudados, 59 pacientes tratados eram supervisionados por um membro familiar e 112 pelos profissionais de saude. Foram avaliados dados sociodemograficos e clinicos dos pacientes. Diferencas entre os grupos de estudo foram avaliadas utilizando o teste qui-quadrado ou teste t de Student ao nivel de significância de 5%. RESULTADOS: A maioria dos sujeitos do estudo apresentaram bacioscopia positiva e cultura confirmada para tuberculose. Dois pacientes tinham sorologia positiva para HIV. Um numero maior de pacientes no grupo supervisionado por profissionais de saude nao eram alfabetizados, comparado com aqueles pacientes do grupo supervisionado por membros familiares (p = 0,01). Todos os pacientes supervisionados por um familiar foram curados, frente a 90% dos pacientes supervisionados pelos profissionais de saude (p=0,024). CONCLUSOES: O sucesso do tratamento de tuberculose foi maior quando supervisionado por um familiar.