Olena Oliveira

How much is too much alcohol in tuberculosis

About one-third of the population worldwide have Mycobacterium tuberculosis infections, although 90% of infected individuals never develop clinical disease [1, 2]. Heavy alcohol intake seems to increase risk of TB in males. New measures for alcohol abuse are needed http://ow.ly/2Esr304cDg4

Predictors of treatment outcome in multidrug-resistant tuberculosis in Portugal

Multidrug-resistant tuberculosis (MDR-TB) is a challenge to control programs.In these cases, treatment is more complex, more expensive and very often less successful. The purpose of this study was to analyze the factors that could influence (positively or negatively)the outcome. To examine this issue we used data from the National Tuberculosis Program in Portugal SVIG-TB.For the study,we included all MDR-TB cases reported from January 2000 to December 2008. To identify the predictive factors related to the outcome of treatment we used univariate and multiple logistic regression models with the clinical variables. During the studied period 130 patients with MDR-TB were notified, of these 94 (72,3%) were male and 36 (27,7%) female, mean age 42 years old (range 40-44). Forty-six patients (35,5%) had a previous treatment and 39 (30%) were HIV positive. Treatment success (cured or completed treatment) was observed in 80 (61,5%) patients. Susceptibility and use of pyrazinamide or ethambutol, susceptibility and use of a fluoroquinolone, the use of five or more drugs in the treatmant regimen, sputum culture conversion after 2 months of treatment were predictors of successful outcome of treatment. Treatment insucess (death, default and failure) was observed in 47 (36,1%) patients. Previous treatment, HIV co-infection, presence of cavitation on the chest radiograph, resistance of two more drugs than just isoniazid and rifampicin and positive cultures after 2 to 3 month of treatment were predictors of poor treatment outcome. Rapid diagnosis of drug resistance and an appropriate therapy for effective treatment are important conditions for the prevention of spread of resistant strains and control of MDR-TB.

Tuberculosis among the homeless: should we change the strategy?

BACKGROUND Tuberculosis (TB) is a major concern among high-risk populations such as the homeless. OBJECTIVES To evaluate TB incidence and treatment outcomes among homeless patients in Portugal and to identify predictors of unsuccessful TB treatment outcomes among the homeless. DESIGN This was a retrospective cohort study of all TB patients notified in Portugal from 2008 to 2014. Characteristics of homeless TB patients were assessed and predictors of unsuccessful TB treatment were determined using logistic regression. RESULTS TB incidence among the homeless was 122/100,000 homeless persons and was positively correlated with TB incidence among non-homeless persons. Homeless TB patients had a higher prevalence of alcohol and/or drug use, human immunodeficiency virus (HIV) co-infection, cavitary TB and smear positivity. The rate of unsuccessful treatment outcomes among the homeless was 28.6%, and was significantly associated with increased age, injection drug use (IDU) and HIV co-infection. CONCLUSION TB incidence among homeless persons was five times that among the non-homeless, and higher in regions with greater TB incidence among non-homeless persons. The successful treatment outcome rate was lower. Predictors of unsuccessful treatment were age, IDU and HIV co-infection. Integrated TB programmes targeting homeless and non-homeless patients, with measures targeting specific characteristics, may contribute to TB elimination in Portugal.

Effect of Isoniazid Resistance on the Tuberculosis Treatment Outcome

Tuberculosis (TB) remains a serious public health problem, and bout one-third of world’s population has active or latent TB. In urope, there are 49 new cases and 7 deaths from TB every hour.1 n Portugal, the incidence has been decreasing in recent years, and n 2014 the annual incidence was 20/1,00,000.2 Drug-resistant Mycobacterium tuberculosis has become a major hreat to the control of TB and, among all first-line drugs, resisance is greatest to isoniazid (INH).3,4 In Portugal, INH resistance as 10.5% in 2014 among TB cases in whom susceptibility testing as performed.2 In fact, there has been an increasing resistance to NH, despite the decreasing number of TB cases.2 INH is a first-line anti-TB drug because of its potent early bacteicidal activity against rapidly dividing cells.3,5 However, treatment f active TB requires multiple anti-TB drugs along with INH to revent selection and emergence of a drug-resistant population f M. tuberculosis. According to current World Health Organizaion (WHO) recommendations, INH mono-resistant TB should be reated with 6–9 months of rifampicin, ethambutol, and pyraznamide, plus or minus a fluoroquinolone.6 These are also the urrent treatment guidelines in Portugal. TB is a notifiable disease in Portugal, so clinicians report all cases o National-Tuberculosis-Surveillance-System (SVIG-TB) that has ata on patient demographics, comorbidities, risk behaviors, and linical, radiological, and microbiological information, as well as reatment outcomes.7 The objectives of this study were identify factors associated with NH mono-resistance, compare treatment outcomes of INH monoesistant patients with drug-susceptible patients and understand he causes of unsuccessful treatment among INH mono-resistance B cases. To achieve the goals, data from Portuguese SVIG-TB were retospectively analyzed from 1/January/2008 to 31/December/2014. NH mono-resistant cases were compared with drug-susceptible ases. Culture-confirmed cases tested against first-line anti-TB drugs ere included. INH mono-resistant TB cases were defined as having esistance to INH, but susceptibility to all other first-line anti-TB rugs. Drug-susceptible cases were those that had documented ensitivity to INH, rifampin, pyrazinamide, and ethambutol.

Prevalence and factors associated with diabetes mellitus among tuberculosis patients: a nationwide cohort.

The association between diabetes mellitus (DM) and tuberculosis (TB) has been a matter of study worldwide, since it is assumed that DM triples the risk of TB [1]. Recent studies have found discrepant prevalence of DM among TB patients, ranging from 5.3% in Denmark [2] to 44% in India [3]. There is an urgent need to control both epidemics in order to achieve the World Health Organization (WHO) TB elimination goal [4]. To reach this goal, an integrated approach between TB elimination strategies and control of noncommunicable diseases that perpetuate the risk for TB is fundamental [5]. In a Portuguese TB cohort, diabetes mellitus was associated with older age and no HIV infection or drug consumption http://ow.ly/10EoN1

Migration Flow and Its Impact on Tuberculosis Notification in Portugal

INTRODUCTION Tuberculosis notification in Portugal has decreased in the last few years. As a consequence of the economic crisis, emigration has increased and immigration has decreased. Immigrants are a risk group for tuberculosis. Most emigrants are 20-44 years old and belong to the age group most affected by tuberculosis. OBJECTIVE To describe the decrease in tuberculosis notification in Portugal over the last years from a demographical point of view. METHODS Mathematical analysis was performed to quantify the effect of the migration movements (separately and simultaneously) on tuberculosis notification in Portugal from 2008 to 2014. We calculated the estimated tuberculosis notification for each year during the period of study: 1) fixing immigration rate and tuberculosis rate in immigrants at 2008 values; 2) fixing emigration rate and tuberculosis rate in emigrants at 2008 values; 3) fixing both phenomenons at 2008 values. RESULTS The differences between the observed and the estimated numbers were small (≤0.5 cases/100000 inhabitants). DISCUSSION Impact of the migration movements on tuberculosis notification rate does not seem to be significant when analyzed for each phenomenon individually and simultaneously, by our model. This might mean that we have to concentrate our efforts in other risk factors for tuberculosis.

Tuberculosis incidence rate among the homeless population: The impact of socio-demographic and health-related variables

This work was supported by the contribution of Iceland, Liechtenstein and Norway, through the EEA Grants, under the Public Health Initiatives Programme (PT 06), grant number 138DT1. Olena Oliveira was supported by the project NORTE-08-5369-FSE-000041, financed by the Operational Program Norte 2020 and co-financed by the European Social Fund through a doctoral grant (UMINHO/BD/47/2016). Rita Gaio was partially supported by CMUP (UID/MAT/00144/2013), which is funded by FCT (Portugal) with national (MEC) and European structural funds (FEDER), under the partnership agreement PT2020

Immigrants’ access to health care: Problems identified in a high-risk tuberculosis population

INTRODUCTION Immigrants may utilize health care services differently than other residents and may also have a greater risk for tuberculosis (TB). OBJECTIVE Identify barriers to healthcare access by immigrants, factors associated with these barriers, and discuss strategies that may reduce these barriers. MATERIAL AND METHODS Anonymous questionnaires were given to immigrants at National Immigrant Support Centres between 2015 and 2016. Barriers to healthcare were identified using logistic regression. RESULTS One-hundred and nineteen questionnaires were administered to immigrants, 9 of whom (8%) presented with TB while in Portugal. Twenty-one percent of immigrants reported barriers to healthcare access, and 69% had general practitioners (GPs). The presence of barriers to healthcare access was negatively associated with having a GP and with being married or in a de facto union. CONCLUSIONS A considerable proportion of immigrants reported having difficulties accessing healthcare services in Portugal where legally these barriers are nonexistent. Certain factors were associated with these difficulties.

Diagnosis delay of tuberculosis in the Huambo province, Angola

INTRODUCTION Early diagnosis is necessary for the success of the tuberculosis (TB) program. GOAL To identify factors associated with diagnosis delay of TB in Huambo, Angola. MATERIAL AND METHODS Cross-sectional study carried out in patients diagnosed with TB at the Huambo Anti-Tuberculosis Dispensary (ATD) in the period between October 2015 and January 2016. RESULTS The 247 patients included in the analysis had a median age of 27 years and a median diagnosis delay of 64 days. In the univariate analysis, age, consumption of alcoholic beverages, living in a residence further than 10km from a healthcare unit, and looking for any other health unit than the emergency unit were associated with longer diagnosis delay. In the multivariate analysis model, to be between 30 and 44 years of age (p=0.018), to live in a residence more than 10km from a healthcare unit (p=0.006) and to turn to traditional medicine as the first healthcare option (p<0.001) were factors that led to greater time delay before diagnosis. CONCLUSIONS In the Huambo province, age, distance to healthcare facility and the first healthcare service consulted were associated with diagnosis delay of TB.

Tuberculosis and tobacco: is there any epidemiological association?

Tobacco smoking has been suspected to be a risk factor for tuberculosis (TB) for more than a century, but only recently has consistent epidemiological evidence between tobacco and TB been established [1, 2]. Smokers are more likely to be infected with TB, progress to active disease and die from TB [3–5]. However, there are few worldwide studies regarding a dose–response relationship between the number of smoked cigarettes per day (CPD) and TB risk. Excessive tobacco consumption in men (20 or more cigarettes per day) is a risk factor for tuberculosis http://ow.ly/AWdK30hdZOq