Drug-resistant tuberculosis (TB) is a growing global threat. Approximately 450,000 people developed multidrug-resistant TB worldwide in 2012 and an estimated 170,000 people died from the disease. This paper describes the sociodemographic, clinical-epidemiological and bacteriological aspects of TB and correlates these features with the distribution of anti-TB drug resistance. Mycobacterium tuberculosis (MT) cultures and drug susceptibility testing were performed according to the BACTEC MGIT 960 method. The results demonstrated that MT strains from individuals who received treatment for TB and people who were infected with human immunodeficiency virus were more resistant to TB drugs compared to other individuals (p < 0.05). Approximately half of the individuals received supervised treatment, but most drug-resistant cases were positive for pulmonary TB and exhibited positive acid-fast bacilli smears, which are complicating factors for TB control programs. Primary healthcare is the ideal level for early disease detection, but tertiary healthcare is the most common entry point for patients into the system. These factors require special attention from healthcare managers and professionals to effectively control and monitor the spread of TB drug-resistant cases.
RESUMOINTRODUÇÃO: Em 2013, no Sistema Único de Saúde, foi implantada uma ferramenta rápida para o diagnóstico da tuberculose (TB), o método GeneXpert MTB/RIF, que detecta a presença do material genético do complexo Mycobacterium tuberculosis e a resistência à rifampicina em uma única reação, fornecendo resultados dentro de 2 h. OBJETIVO: Analisar os resultados da utilização do método GeneXpert para o diagnóstico laboratorial da TB. METODOLOGIA: Realizou-se uma revisão de literatura sobre o método GeneXpert, com a utilização de manuais e artigos, em diferentes idiomas, das fontes MEDLINE, SciELO, LILACS e Google Acadêmico, na qual foram selecionados 60 artigos. RESULTADOS: Dos 49 artigos que relataram o uso de material clínico, 51,0% (N = 25) analisaram amostras provenientes de países considerados prioritários pela Organização Mundial da Saúde. Embora 63,2% (N = 31) dos artigos se reportem a amostras pulmonares, alguns estudos mostraram boa performance do método em amostras extrapulmonares. A sensibilidade do GeneXpert nos estudos analisados variou entre 46,0% e 100,0%. As pesquisas revelaram bom desempenho do método molecular GeneXpert para o diagnóstico da TB. A técnica é considerada simples, com baixos riscos biológicos, com custo equivalente ao de outras técnicas moleculares, e pode ser realizada com treinamento mínimo. CONCLUSÃO: Muitos estudos apontaram a rapidez, a boa sensibilidade e a especificidade desse método. O GeneXpert ainda não elimina a necessidade do uso de métodos bacteriológicos tradicionais. Trabalhos futuros poderão esclarecer algumas divergências entre as pesquisas consultadas, principalmente em relação à resistência à rifampicina.
These results show the importance of the bacteriological diagnosis, since identification of the species enables early and appropriate treatment.
Three mycobacterial isolates, one from the blood of an HIV-infected patient and two consecutive isolates from a woman with unknown HIV status, had been identified as belonging to the Mycobacterium avium complex by conventional procedures. In both patients, using genetic analysis procedures such as PCR–restriction enzyme analysis (PRA) of the hsp65 gene, a commercially available reverse hybridization-based assay (INNO-LiPA mycobacteria) and/or sequencing analysis of the 16S–23S internal transcribed spacer (ITS), the presence of Mycobacterium lentiflavum was also demonstrated. At the time of detection, both cases were also infected with M. avium, suggesting an underestimation of infection with M. lentiflavum and co-infection with different Mycobacterium species.
RESUMONeste trabalho foi averiguado o uso do geoprocessamento como ferramenta para realizar pesquisa e como subsídio para efetuar planejamento de ações em saúde pública. Diversos investigadores têm citado a construção de sistema de vigilância da saúde orientado por um modelo de análise de situações de risco, em substituição ao modelo de risco individual. Esta alternativa, que utiliza o espaço como referência, tem potencialmente mostrado maior poder explicativo por expressar diferentes acessos aos bens e aos serviços de infraestrutura urbana. Com o sistema de geoprocessamento, torna-se possível observar os fatores socioeconômicos, assim como a utilização e as formas de ocupação de áreas. Além disso, podem ser obtidos dados relevantes para efetuar o controle da vigilância em relação à saúde e ao meio ambiente construído e habitado. O uso do geoprocessamento constitui uma importante ferramenta para realizar a identificação, a localização e o acompanhamento de populações, principalmente nas periferias dos grandes centros urbanos. Este sistema contribui, ainda, para desenvolver os estudos de transmissão, de disseminação e, ainda, das ações de controle das doenças e dos agravos de saúde de uma determinada área de abrangência. Palavras-chave. saúde pública, distribuição espacial da população, vigilância epidemiológica, epidemiologia, geoprocessamento em saúde. ABSTRACTIn the present study is described the importance of the geographic information system (GIS) as a tool for performing research and as a subsidy for action planning in public health. Many investigators have described the construction of a health surveillance system based on a model to analyze the risk situations, aiming at replacing the individual risk model. This option employs the space as a reference, which potentially holds greater explanatory power for expressing different approaches to the profits and services for urban infrastructure. The geo-processing allows to observe the socioeconomic factors, the ways and the use of occupying the inhabited areas, to acquire relevant data for monitoring the sanitary surveillance, and also built and inhabited environment. The geo-processing works as an important tool for performing the identification, location and follow-up of populations. Therefore, the geo-processing contributes to the study on transmission, distribution and actions directed to the diseases and health problems control in a given scope area.
Conflito de interesses: NãoContribuição dos autores: TSS coleta, tabulação, delineamento do estudo e redação do manuscrito. FHAM delineamento do estudo. JTMP delineamento do estudo e elaboração do manuscrito. VDAP orientação do projeto, delineamento do estudo e elaboração do manuscrito. HSPP discussão dos achados, etapas de execução e elaboração do manuscrito. SMTN orientação do projeto, delineamento do estudo e elaboração do manuscrito. Contato para correspondência: Susilene Maria Tonelli Nardi E-mail: snardi@ial.sp.gov. O conteúdo teórico foi avaliado por especialistas da área, a fim de validá-lo, e a produção artística realizada por profissional da área, no estilo cartoon. Resultados: Produziu-se um GIBI colorido, com seis folhas impressas em frente e verso, em papel reciclável, com frases curtas e desenhos limpos intencionando uma leitura atrativa. Ao final do material acrescentou-se uma folha destacável com orientações sobre preparo, armazenamento e compra dos alimentos para que os estudantes possam levar para casa e multiplicar o conteúdo para amigos e familiares. Conclusão: A ampla utilização do gibi pode contribuir para a disseminação do conhecimento e prevenção das doenças transmitidas por alimentos, seja em sala de aula, como apoio pedagógico, ou em unidades de saúde, para que os profissionais trabalhem o tema em sua comunidade durante ações educativas.Descritores: Doenças Transmitidas por Alimentos; Educação em Saúde; Saúde Pública. AbstractIntroduction: Foodborne diseases occur worldwide and are a growing public health problem that requires new approaches aimed at control and prevention. The home environment is responsible for most outbreaks. The spread of information in the community about how to prevent foodborne diseases can be an effective tool in reducing risks. Objective: Develop a comic strip for children and teenagers about foodborne diseases, focusing on clinical aspects and preventive measures. Material and Methods: We conducted a literature review of the basic information that should be addressed in the comic strip. Subsequently, the main contaminants and related preventive measures were organized as a text with the themes that permeated information about the disease. Specialists in the field validated the theoretical content, and the text was sent to a professional artist for preparation as a comic strip. Results: A colorful cartoon of six double pages was printed on recyclable paper using short sentences and clean designs intended to make reading attractive. A detachable sheet was added at the end of the booklet with instructions on preparation, storage, and purchase of food to be taken home and the information disseminated to friends and family. Conclusion: The widespread use of the comic strip may contribute to the dissemination of knowledge and prevention of foodborne diseases, whether in the classroom as a teaching aid or in healthcare facilities for professionals to work with the issue in their communities during educational activities.
OBJECTIVE: To compare the performance of nested polymerase chain reaction (NPCR) with that of cultures in the detection of the Mycobacterium tuberculosis complex in pulmonary and extrapulmonary specimens. METHODS: We analyzed 20 and 78 pulmonary and extrapulmonary specimens, respectively, of 67 hospitalized patients suspected of having tuberculosis. An automated microbial system was used for the identification of Mycobacterium spp. cultures, and M. tuberculosis IS6110 was used as the target sequence in the NPCR. The kappa statistic was used in order to assess the level of agreement among the results. RESULTS: Among the 67 patients, 6 and 5, respectively, were diagnosed with pulmonary and extrapulmonary tuberculosis, and the NPCR was positive in all of the cases. Among the 98 clinical specimens, smear microscopy, culture, and NPCR were positive in 6.00%, 8.16%, and 13.26%, respectively. Comparing the results of NPCR with those of cultures (the gold standard), we found that NPCR had a sensitivity and specificity of 100% and 83%, respectively, in pulmonary specimens, compared with 83% and 96%, respectively, in extrapulmonary specimens, with good concordance between the tests (kappa, 0.50 and 0.6867, respectively). CONCLUSIONS: Although NPCR proved to be a very useful tool for the detection of M. tuberculosis complex, clinical, epidemiological, and other laboratory data should also be considered in the diagnosis and treatment of pulmonary and extrapulmonary tuberculosis.
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