ObjectiveTo produce pooled estimates of the global results of tuberculosis (TB) treatment and analyze the predictive factors of successful TB treatment.MethodsStudies published between 2014 and 2019 that reported the results of the treatment of pulmonary TB and the factors that influenced these results. The quality of the studies was evaluated according to the Newcastle-Ottawa quality assessment scale. A random effects model was used to calculate the pooled odds ratio (OR) and 95% confidence interval (CI). This review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) in February 2019 under number CRD42019121512.ResultsA total of 151 studies met the criteria for inclusion in this review. The success rate for the treatment of drug-sensitive TB in adults was 80.1% (95% CI: 78.4–81.7). America had the lowest treatment success rate, 75.9% (95% CI: 73.8–77.9), and Oceania had the highest, 83.9% (95% CI: 75.2–91.0). In children, the success rate was 84.8% (95% CI: 77.7–90.7); in patients coinfected with HIV, it was 71.0% (95% CI: 63.7–77.8), in patients with multidrug-resistant TB, it was 58.4% (95% CI: 51.4–64.6), in patients with and extensively drug-resistant TB it was 27.1% (12.7–44.5). Patients with negative sputum smears two months after treatment were almost three times more likely to be successfully treated (OR 2.7; 1.5–4.8), whereas patients younger than 65 years (OR 2.0; 1.7–2.4), nondrinkers (OR 2.0; 1.6–2.4) and HIV-negative patients (OR 1.9; 1.6–2.5 3) were two times more likely to be successfully treated.ConclusionThe success of TB treatment at the global level was good, but was still below the defined threshold of 85%. Factors such as age, sex, alcohol consumption, smoking, lack of sputum conversion at two months of treatment and HIV affected the success of TB treatment.
BackgroundThe Ministry of Health in Brazil included ethambutol in the intensive phase of sensible tuberculosis (TB) treatment in March 2010, due to the increasing drug resistance, and implemented the fixed dose combination in the TB treatment guidelines.MethodsA retrospective cohort study was performed to determine the impact of change from three to four drugs schemes on the TB cure and frequency of adverse drug reactions (ADRs) in TB patients. To answer this question, we used data from 730 randomly selected patients who received anti-TB treatment between January 2007 and December 2014 in a reference center from Salvador, Brazil.FindingsTB patients who received the RHEZ regimen (n = 365) developed ADRs more frequently than those treated with the RHZ (n = 365) (86 [23.6%] vs. 55 [15.1%]; p = 0.01). This difference in ADR incidence was even higher in patients above 30 years-old (64 [74.4%] vs. 36 [65.5%]; p = 0.01). The overall number of ADR episodes was greater in patients from the RHEZ group than in the group that received RHZ (170 [61.4%] vs. 107 [38.6%]; p = 0.03). Multivariable logistic regression analysis adjusted for age, alcohol use and diabetes demonstrated that patients receiving the RHEZ regimen had increased odds of developing ADRs than those undertaking the RHZ scheme (odds ratio [OR]: 1.61, 95% confidence interval [CI]: 1.10–2.35; p = 0.015). The overall cure rate was similar between the distinct treatment groups.ConclusionThe patients treated with the four-drug regimen exhibited increased risk of ADRs compared to those who received the three-drug regimen, and especially in patients older than 30 years of age.
Background Multidrug- and rifampicin (RMP)-resistant tuberculosis (MDR/RR-TB) requires prolonged and expensive treatment, which is difficult to sustain in the Colombian health system. This requires the joint action of different providers to provide timely health services to people with TB. Identifying factors associated with unfavorable treatment outcomes in patients with MDR/RR-TB who received drug therapy between 2013 and 2015 in Colombia can help guide the strengthening of the national TB control program. Method A retrospective cohort study was conducted with all patients who received treatment for MDR/RR-TB between January 2013 and December 2015 in Colombia who were registered and followed up by the national TB control program. A multivariate logistic regression model was used to estimate the associations between the exposure variables with the response variable (treatment outcome). Results A total of 511 patients with MDR/RR-TB were registered and followed up by the national TB control program in Colombia, of whom 16 (3.1%) had extensive drug resistance, 364 (71.2%) had multidrug resistance, and 131 (25.6%) had RMP monoresistance. The mean age was 39.9 years (95% confidence interval (CI): 38.5–41.3), most patients were male 285 (64.6%), and 299 (67.8%) were eligible for subsidized health services. The rate of unfavorable treatment outcomes in the RR-TB cohort was 50.1%, with rates of 85.7% for patients with extensive drug resistance, 47.6% for patients with multidrug resistance, and 52.6% for patients with RMP monoresistance. The 511 MDR/RR-TB patients were included in bivariate and multivariate analyses, patients age ≥ 60 years (crude odds ratio (ORc) = 2.4, 95% CI 1.1–5.8; adjusted odds ratio (ORa) = 2.7, 95% CI 1.1–6.8) and subsidized health regime affiliation (ORc = 3.6, 95% CI 2.3–5.6; ORa = 3.4, 95% CI 2.0–6.0) were associated with unfavorable treatment outcomes. Conclusion More than 50% of the patients with MDR/RR-TB in Colombia experienced unfavorable treatment outcomes. The patients who were eligible for subsidized care were more likely to experience unfavorable treatment outcomes. Those who were older than 60 years were also more likely to experience unfavorable treatment outcomes.
RESUMENIntroducción: Es importante proveer un adecuado y oportuno manejo a largo plazo de la ERC, por medio de estrategias farmacológicas y no farmacológicas, sin embargo, la baja adherencia de los pacientes al tratamiento farmacológico pone en riesgo la efectividad de la intervención.Objetivo: Traducir al español, validar y adaptar la escala de adherencia al tratamiento de Morisky de 8 items a pacientes con ERC. Materiales y Métodos:La traducción del MMAS-8 se realizó de acuerdo con las directrices para la traducción y la adaptación de instrumentos de medida para ser utilizados en investigación médica, se validó mediante juicio de expertos siguiendo el método Delphi. Se realizó un estudio piloto corte transversal, donde se encuesto a 30 pacientes que acudieron a consulta de predialisis de la unidad renal del hospital militar central en Bogotá Colombia.Resultados: La escala MMAS-8 traducida al español fue sometida a los jueces para su validación obteniéndose un porcentaje de acuerdo igual o mayor al 80% para todas las preguntas, se calculó el coeficiente de concordancia W de Kendall que en este caso fue 0,8 con un p valor de 0,0001 y se interpretó como un alto grado de concordancia entre las valoraciones hechas por los jueces a los diferentes ítems del cuestionario. Se aplicó el MMAS-8 a 30 pacientes con una media de edad de 75,9 años (+/-15), el nivel de adherencia al tratamiento se analizó según el puntaje de la escala de Morisky de 8 items, clasificándose como baja adherencia al tratamiento en el 62,5% de los casos con puntaje menor de 6, mediana adherencia 28,1% de los pacientes puntaje entre 6 y 7 y alta adherencia solo el 9,4% de los pacientes con puntaje mayor de 8.
Introducción: la dimensión fractal estadística ha sido de utilidad para la caracterización de diversos fenómenos, incluyendo la dinámica cardiaca fetal y del adulto, así como comportamientos asociados al sistema inmune. Las Infecciones Asociadas al Cuidado de la Salud son un problema de salud de alta importancia a nivel mundial.Objetivo: establecer el comportamiento fractal estadístico de la frecuencia de aparición de Infecciones Asociadas al Cuidado de la Salud.Material y métodos: Se aplicó la ley de Zipf-Mandelbrot a la distribución de frecuencias de aparición agrupadas por especialidad de Infecciones Asociadas al Cuidado de la Salud en el Hospital Meissen ESE II Nivel, para los años 2011, 2012 y 2013. Se calculó la dimensión fractal estadística para cada año, hallando los rangos en los que se desenvuelve la dinámica en estos años y posteriormente se realizaron simulaciones de estas dinámicas anuales.Resultados: Se observó un comportamiento a escala de la dinámica de aparición de Infecciones Asociadas al Cuidado de la Salud por especialidad, los valores de la dimensión fractal fue de 0,6104, 0,7560 y 0,4332 para los años 2011, 2012 y 2013 respectivamente.Conclusión: La ley de Zipf/Mandelbrot permite caracterizar de forma objetiva y reproducible el comportamiento de la frecuencia de aparición de las Infecciones Asociadas al Cuidado de la Salud en el tiempo; las dimensiones fractales acotadas consecutivas en el tiempo permitirían generar predicciones, constituyendo una herramienta de ayuda para la vigilancia epidemiológica y la clínica.
El objetivo de esta revisión fue sintetizar la información publicada en los últimos 10 años acerca de los biomarcadores de estrés empleados para medir esta condición en los estudiantes de ciencias de la salud y su relación con las escalas de estrés subjetivo agudo y crónico. Se realizaron búsquedas sistemáticas en Pubmed, Science Direct, Scopus y Lilacs, encontrado 112 artículos, de los cuales se incluyeron 17 que cumplieron con los criterios de inclusión. Los resultados muestran que el cortisol sérico y salival fue el biomarcador más utilizado y las escalas STAI, VASS y la escala de sucesos estresantes, son las que mejor se relacionan con niveles de cortisol en los estudios incluidos en esta revisión. Sim embargo consideramos que la información obtenida no es suficiente para establecer una correlación significativa entre los niveles de biomarcadores de estrés y de estrés percibido medido por escalas autoreferidas.
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