Objectives. To identify the risk factors that were associated with abandonment of treatment and mortality in tuberculosis (TB) patients. Methods. This study was a retrospective longitudinal cohort study involving tuberculosis patients treated between 2002 and 2008 in a TB reference center. Results. A total of 1,257 patients were evaluated, with 69.1% men, 54.4% under 40 years of age, 18.9% with extrapulmonary disease, and 9.3% coinfected with HIV. The risk factors that were associated with abandonment of treatment included male gender (OR = 2.05; 95% CI = 1.15–3.65) and nonadherence to previous treatment (OR = 3.14; 95% CI = 1.96–5.96). In addition, the presence of extrapulmonary TB was a protective factor (OR = 0.33, 95% CI = 0.14–0.76). The following risk factors were associated with mortality: age over 40 years (OR = 2.61, 95% CI = 1.76–3.85), coinfection with HIV (OR = 6.01, 95% CI = 3.78–9.56), illiteracy (OR = 1.88, 95% CI = 1.27–2.75), the presence of severe extrapulmonary TB (OR = 2.33, 95% CI = 1.24–4.38), and retreatment after relapse (OR = 1.95, 95% CI = 1.01–3.75). Conclusions. Male gender and retreatment after abandonment were independent risk factors for nonadherence to TB treatment. Furthermore, age over 40 years, coinfection with HIV, illiteracy, severe extrapulmonary TB, and retreatment after relapse were associated with higher TB mortality. Therefore, we suggest the implementation of direct measures that will control the identified risk factors to reduce the rates of treatment failure and TB-associated mortality.
Background:The Hospital Ferreira Machado, utilized, in part, as a clinical training center for graduate students from the Faculdade de Medicina de Campos, admitted 65 tuberculosis (TB) patients in 2001.Objective: To estimate the prevalence of positive tuberculin skin tests (TST) among medical students during distinct periods of their training and to identify and analyze correlated factors. To compare positivity rates, taking into account the booster effect, and estimate incidence of positive TST by class year. Methods:A cross-sectional study was conducted among 500 students registered in the first semester of 2002. Using a structured and validated questionnaire, data regarding demographics, BCG vaccination and potential exposure to TB patients were obtained. A professional licensed by the Health Department administered the TSTs, and the two-step Mantoux method (PPD Rt23) was used.Results: Of the 500 eligible subjects, 316 (63.2%) were excluded. Analysis showed increasing two-step TST positivity rates corresponding to extent of clinical experience (4%, 6.4% and 13.1%) and a tendency toward correlation with professional level. The highest percentage of positive TSTs was found during the period of clinical training, which corresponded to the time of greatest exposure to patients (1000 hours).Conclusions: a) the TST positivity rate was high (7.9%) among students; b) TST was correlated with in-hospital training stage; c) evaluation of the booster effect lead us to highly recommended boosters in order to reduce the number of falsenegative TST results.
Introdução: A obesidade é uma doença crônica considerada um problema de saúde pública, com etiologia multifatorial. Se caracteriza pelo acúmulo excessivo de gordura corporal e acomete indivíduos em qualquer faixa etária, incluindo a infância. A cirurgia bariátrica gera grande impacto no controle e no tratamento da obesidade mórbida e os seus benefícios incluem: resolução ou melhora de doenças crônicas como hipertensão, diabetes, dislipidemia, entre outras comorbidades, além de aspectos psicológicos e sociais. Objetivos: Identificar o perfil dos pacientes submetidos a cirurgia bariátrica para tratamento da obesidade. Métodos: Utilizou-se formulários do programa REDcap, contendo identificação, comorbidades associadas, tipo de técnica utilizada na cirurgia e data de sua realização, além das medidas antropométricas pré e pós operatórias, incluindo o índice de massa corpórea (IMC). Foi feita uma amostragem de 185 prontuários de pacientes num período de 2010 a 2016, no Hospital Escola Álvaro Alvim (HEAA), em Campos dos Goytacazes/RJ, Brasil. Resultados: Dos pacientes submetidos a cirurgia bariátrica, 84.4% eram do sexo feminino, 24.6% se declaravam de raça branca, 65.4% eram apresentados como solteiros, 5.6% relataram ter iniciado a obesidade entre 18 e 39 anos, 79.9% moravam em Campos dos Goytacazes na época da cirurgia, 88.8% dos indivíduos foram submetidos à técnica de gastroplastia com derivação intestinal (bypass gástrico), 38.0% não fumavam, 50.8% eram portadores de hipertensão arterial sistêmica (HAS) em tratamento ou não com anti-hipertensivos orais, 28.5% eram portadores de diabetes mellitus do tipo II (DM2), 21.2% eram dislipidêmicos, 15.1% eram eutireoideos e a média do IMC das pessoas antes da cirurgia foi de 44,76% kg/m². Discussão: Os achados sugerem uma atenção maior para a saúde das mulheres que estão na idade reprodutiva, visto a prevalência da obesidade nesse período. A investigação nessa faixa etária, direcionaria a triagem, possibilitaria diagnóstico e tratamento precoces, como a indicação para a cirurgia bariátrica. Foram identificadas limitações em relação às variáveis analisadas devido à falta de informações nos prontuários médicos por preenchimento inadequado. As informações ausentes, foram representadas nos formulários pela opção “não informado”. Sugere-se rigorosidade e padronização no preenchimento dos prontuários médicos para melhoria das análises. Conclusão: O perfil cirúrgico dos pacientes que buscaram a cirurgia bariátrica para correção da obesidade foi predominantemente de mulheres, com idade média de 39 anos que se declararam brancas, solteiras, com histórico de ter iniciado a obesidade entre os 18 aos 39 anos. As doenças relatadas com maior frequência foram HAS, DM2 e dislipidemia, demonstrando a importância da detecção e tratamento precoce.
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