Objetivos: Principalmente nas regiÃes com maior carga de TB no mundo, ainda existe grande demora no recebimento dos exames diagnÃsticos de TB pelos pacientes. Pesquisadores da Rede Brasileira de Tuberculose desenvolveram e avaliaram o desempenho de um teste diagnÃstico para TB pulmonar: escore clÃnico Neural TB. O objetivo desse trabalho foi avaliar a efetividade do escore clÃnico Neural TB no diagnÃstico rÃpido de tuberculose pulmonar em unidade de referÃncia. MÃtodos: Foi realizado um ensaio clÃnico pragmÃtico, que recebeu intervenÃÃo diagnÃstica na segunda metade do projeto. Foram recrutados 351 pacientes com 18 anos de idade ou mais, com suspeita de TB pulmonar e aplicado o escore clÃnico Neural TB. Na primeira fase do estudo, os pacientes seguiram a rotina do Hospital. Na segunda fase, os pacientes tinham a coleta do escarro para baciloscopia antecipada de acordo com a classificaÃÃo pelo escore clÃnico. Para comparaÃÃo entre duas subpopulaÃÃes independentes foram utilizados o teste T-Student e o teste de Mann Whitney. Os resultados foram considerados significantes para um valor de p < 0,05. Foi calculada RazÃo de prevalÃncia e intervalo de confianÃa de 95%. A concordÃncia entre Escore e diagnÃstico de TB pulmonar foi realizada pelo Ãndice de Kappa. Resultados: Quando comparado ao diagnÃstico realizado atravÃs da baciloscopia do escarro, cultura do escarro ou diagnÃstico clÃnico-radiolÃgico em conjunto, o escore clÃnico Neural TB apresentou sensibilidade de 75,9%, especificidade de 48,8% e acurÃcia de 55%. O uso do escore clÃnico Neural TB foi capaz de diminuir o tempo entre a triagem e a leitura da lÃmina por baciloscopia em 1 dia (de 3,2 para 2,6 dias; p < 0,001). Apesar de diminuir o tempo para inÃcio do tratamento em mÃdia 4 dias com relaÃÃo ao grupo baseline (de 8,2 para 4 dias), essa diferenÃa nÃo foi estatisticamente significante (p = 0,166). ConclusÃes: O escore clÃnico pode ser uma ferramenta Ãtil na detecÃÃo de casos de TB pulmonar. Por sua simplicidade, nÃo necessita de equipamentos caros e complexos para sua execuÃÃo. Ao ser utilizado por um profissional treinado, o questionÃrio poderà gerar informaÃÃes sobre encaminhamentos ou pedidos de exames na abordagem do paciente sintomÃtico respiratÃrio, ou ainda ajudar na decisÃo sobre inÃcio do tratamento. / Objectives: Mainly in regions with the greatest TB burden in the world, there is still a delay for patients to receive the results of the diagnostic exams. Researchers from Rede Brasileira de Tuberculose developed and evaluated the performance of a diagnostic test for pulmonary TB: Neural TB clinical score. The objective of the present work is to evaluate the effectiveness of the Neural TB clinical score in the rapid diagnose of pulmonary tuberculosis in a reference unit. Methods: A pragmatic clinical essay with diagnostic intervention in the second half of the project was conducted. We recruited 351 patients aged 18 years or older, suspected of having pulmonary TB, and we applied the Neural TB clinical score to them. In the first phase of the essay, patients followed the routine of the Hospital. In the second phase, patients had collection of sputum samples for baciloscopy anticipated according to their classification by the score. T-Student test and Mann Whitney test were used to compare two independent subpopulations. Results were considered significant if p value < 0,05. Prevalence ratio and 95% confidence interval were calculated. Kappa index was used to measure conformity between the clinical score and pulmorary TB diagnostic. Results: Neural TB clinical score showed sensitivity of 75,9%, specificity of 48,8% and accuracy of 55% when compared to the diagnostic realised through sputum baciloscopy, sputum culture or clinical-radiological diagnostic altogether. The use of Neural TB clinical score was able to reduce time between patient screening and detection of organisms in a sputum sample slide in 1 day (from 3.2 to 2.6 days; p < 0.001). Although time until beginning the treatment was reduced 4 days in average when compared to the baseline group (from 8.2 to 4 days), this difference was not statistically significant (p = 0.166). Conclusion: The clinical score may be a useful tool for the detection of pulmonary tuberculosis cases. Because it is simple, it does not require expensive or complex equipment for its execution. As it is used by a trained professional, the questionnaire may produce information about referrals or test requests for the respiratory symptomatic patient, or even help in the decision of starting treatment.

Study objective: The standard daily dose of rifampin in directly observed treatment of Mycobacterium tuberculosis (TB) is 600 mg, taken orally. The purpose of this study was to assess the efficacy of standard dose rifampin therapy in patients who were slow to respond to routine directly observed therapy (DOT). Methods: Patients with non-drug-resistant pulmonary TB who were receiving 600 mg of oral rifampin by DOT were eligible for inclusion. Patients were deemed slow to respond if their sputum smears and cultures remained positive for M tuberculosis and if the patient’s condition did not improve clinically or radiographically after 3 months of treatment. Serum rifampin levels were ascertained to determine the adequacy of the standard rifampin dosing. Patients with subtherapeutic blood levels had their rifampin dose increased to 900 mg, and rifampin levels were repeated. Rifampin dosage was increased again if blood levels were still subtherapeutic. No antitubercular medications were added to the treatment regimen. The total weekly dose of the other standard treatment drugs was not increased. Results: Of 124 new patients with active pulmonary TB, 6 patients were identified as slow to respond to the standard antitubercular DOT. All six patients had subtherapeutic serum rifampin levels. All six patients responded clinically, radiographically, and mycobacteriologically after an increase in rifampin dosage to reach target drug blood level. Conclusions: Standard dosing with rifampin resulted in a poor clinical response and subtherapeutic serum levels in six patients. Increasing the dosage of rifampin improved the outcome without additional side effects. In TB patients who are slow to respond to standard treatment, an inadequate dose of rifampin should be suspected. Current antituberculer drug administration does not include adjusted dosage for rifampin.

Philosophiae Doctor - PhD / Background: Tuberculosis (TB) is a major cause of morbidity and mortality among children (<15 years) in resource-limited countries. The World Health Organization (WHO) identified active contact screening and isoniazid preventive therapy (IPT) as essential actions for detecting and preventing childhood TB. Despite their benefits and inclusion in the policy of most National TB Programme (NTP) guidelines of the resource-limited countries, there is still a wide gap between policy and implementation. The implementation of contact screening for active case finding might be improved by the decentralised use of the Xpert MTB/RIF test in gastric lavage (GL) specimens, but this has not been previously assessed. Furthermore, although the provision of IPT to eligible child contacts has been a focus for implementation by the NTP of Rwanda since 2005, implementation has not previously been evaluated. The assessment of IPT uptake and adherence as well as associated factors could be informative for the programme. Therefore, we aimed to assess the diagnostic yield of Xpert MTB/RIF in GL among child contacts with suspected pulmonary tuberculosis (PTB) and the uptake of and adherence to IPT by eligible child contacts to make recommendations towards strengthening TB diagnostic and prevention in children in Kigali, Rwanda. Methods: The proposed study setting Kigali, the capital city of Rwanda, was the location for 30% of the national PTB case notifications in 2013-14.A conceptual framework based on ecological theory was used in this study. Quantitative, qualitative and mixed (using both quantitative and qualitative research methods in one study) research methods were applied, and various research designs were used depending on the research questions. The study involved a cross-sectional analysis of the diagnostic yield of Xpert MTB/RIF in GL among all child contacts with suspected TB. Across-sectional and prospective cohort study design was used to assess the uptake and adherence of IPT among eligible child contacts.

Student Number : 0413807K - MSc research report - School of Public Health - Faculty of Health Sciences / Tuberculosis ranks among the top ten causes of global mortality. Globally it kills nearly 2 million people each year and is the second leading cause of death after Human Immune Deficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS).Tuberculosis (TB) is primarily an illness of the respiratory system, and is spread by coughing and sneezing from an infectious person. Nearly a third of the world’s population is infected with the bacilli that causes TB and are at risk of developing tuberculosis (TB).1, 2 Left untreated, each person with active TB disease will infect on average between 10 and 15 people every year. In 2004, estimated per capita TB incidence was stable or falling in five out of six World Health Organization (WHO regions, but growing at 0.6% per year globally. The exception is the African region, where TB incidence was still rising.3, 4 HIV increases the risk of developing TB and accounts for much of the increase in countries where prevalence is high. 4 Co-infection is common and could be as high as 70% in high-burdened countries. Gains made in global TB control in the 1970 and 80s are being dramatically reversed by the effect of HIV/AIDS. HIV is the main reason for failure to meet Tuberculosis (TB) control targets in high HIV settings.3 Drug-resistant TB is a major problem. Resistance to single anti-tuberculosis drugs have been reported in almost every country surveyed. To make the situation worse, drugs resistant to all the major anti-TB drugs have emerged. 4 Drug-resistant TB is caused by inconsistent or partial treatment, when patients do not take all their medicines regularly for the required period because they start to feel better, because doctors and health workers prescribe the wrong treatment regimens, or because the drug supply is unreliable. A particularly dangerous form of drug-resistant TB is multidrug-resistant TB (MDR-TB), which is defined as the disease caused by TB bacilli resistant to at least isoniazid and rifampicin, the two most powerful anti-TB drugs.4, 5

Este trabalho apresenta o resultado do estudo das causas que interferem na busca passiva de casos de tuberculose pulmonar na população. Entrevistaram-se 350 indivíduos, bacilíferos e não bacilíferos, que procuraram o Centro de Saúde de Pinheiros-SP, durante o ano de 1985. Foram estudadas as informações obtidas referentes ao tempo decorrido desde a percepção de alguma sintomatologia pela população de estudo até a sua chegada ao Centro de Saúde. Os resultados obtidos permitem supor que boa parte da responsabilidade pela demora no atendimento correto da população pode ser atribuída aos profissionais das instâncias anteriores à procura do Centro de Saúde. Outros fatores relacionados à àrea do comportamento humano e a aspectos sócio-econômicos foram identificados como causa provável de demora para a procura de assistência adequada à saúde. Concluiu-se que a população não conhece ou conhece pouco as características da função assistencial do centro de saúde, com exceção da gratuidade dos serviços oferecidos. Este conjunto de fatores resultou num tempo de sintomatologia que variou de menos de 3 semanas até mais de 24 meses, com maior concentração de casos no espaço de tempo compreendido entre 3 semanas ate 12 meses, significando maior risco de disseminação da infecção na comunidade. / This work presents the results of the study of causes that interfere with the passive search of pulmonary tuberculosis cases in the population. Three hundred and fifty infection spreading and non infection spreading subjects who looked up the Pinheiros Public Health Center in the city of São Paulo throughout 1985 were interviewed. Information obtained regarding intervening time between perception of any symptom by the study population and its arrival at the Health Center was studied. The results obtained point ot to the fact that a good deal of responsability for the delay in the provision of correct care lies with the professionals of the anterior instances attended by the population before looking up the Health Center. Other factors related to the area of human behaviour and socio-economic aspects were also identified as probable causes of the delay in obtaining adequate health care. It is concluded that the population has little or no knowledge whatsoever regarding the health care function of the Health Center, save it being free of charge. This group of factors resulted in a symptomatology time span that varied from less than three weeks to twenty-four months with a higher concentration rate comprised between three weeks and twelve months meaning a larger infection spreading risk in the community.

Introdução: A tuberculose, nos dias atuais, tem diagnóstico efetuado de modo preciso, em bases etiológicas, através da microbiologia; pode ser prevenido, o tratamento é específico e altamente efetivo em condições ideais. Todavia, diversos problemas ocorrem na condução rotineira dos casos, o que implica em sérios prejuízos para a população, podendo-se observar elevadas taxas de morbimortalidade pela doença, em especial nos países menos desenvolvidos. Objetivos: Estudar uma série de pacientes que tiveram o diagnóstico de tuberculose pulmonar, e que foram tratados em uma Unidade Sanitária especializada de Porto Alegre (RS), relacionando os desfechos (cura/não cura) com variáveis diversas: situação bacteriológica inicial dos casos (bacilíferos e não-bacilíferos), dados demográficos, coinfecção pelo HIV, e alcoolismo. Métodos: Foi arrolada uma série de pacientes consecutivos com o diagnóstico de tuberculose pulmonar (microbiológicamente comprovada ou não), os quais foram tratados basicamente com Rifampicina, Isoniazida e Pirazinamida – RHZ, de junho de 2005 a junho de 2007. Casos tuberculose extrapulmonar, de mudança de diagnóstico, transferência, e com dados incompletos, foram excluídos. Os desfechos considerados foram “cura” e “não cura” (esta por abandono ou óbito). Os dados foram coletados nos Prontuários e Fichas (SINAN-TB). Os programas EXCEL e SPSS foram usados para tabulação e tratamento estatístico dos dados. Resultados: De 292 casos de tuberculose, em geral, 117 (40,0%) tinham formas extrapulmonares da doença, e 175 (60,0%) eram casos de tuberculose pulmonar, 131 (74,8%) dos quais microbiologicamente confirmados (123 por bacterioscopia, 8 por cultura do escarro), e 44 (25,2%) sem confirmação. Dos 175 pacientes, 60,0% eram homens, 69,0% brancos, 84,0% com idade entre 20 e 59 anos, e 61,1% com escolaridade de 1º e 2º graus; 16,6% eram alcoolistas, e de 166 que foram testados, 42,7% eram HIV+. “Cura” ocorreu em 133 (76,0%) pacientes, 95 (71,4%) dos quais haviam tido confirmação bacteriológica. “Não cura” verificou-se em 42 (24,0%) pacientes, 37 deles por abandono do tratamento (33 dos quais, sendo de casos microbiologicamente confirmados – 21,1% de 131). Conclusões: O número de casos de tuberculose pulmonar excedeu o de outras formas da doença. O desfecho CURA ocorreu em 76,0% dos 175 pacientes com tuberculose pulmonar; a NÃO CURA associou-se significativamente com a presença de HIV+ (X2=30 P 0,001) e com os níveis mais baixos de escolaridade (X2 = 21,18 P < 0, 001). Condição bacteriológica inicial (X2=1,63 P=0,44), sexo (X2 = 0,67 P = 0,71), faixas etárias (X2 = 7,5 P = 0, 27) e hábito alcoólico (X2 = 1,6 P = 0,43) não se revelaram significativamente relacionados com os desfechos. / Introduction: Tuberculosis, today, has a right diagnosis in microbiologic grounds; it may be prevented , and its treatment is specific and effective in ideal conditions. However, several troubles may occur in daily conduction of the clinical cases, resulting in serious consequences to the population, as raised morbidity and mortality taxes, mainly in under developed countries. Objectives: To study a series of patients with diagnosis of pulmonary tuberculosis, who were treated in a Sanitary Unity, reference for the disease, in Porto Alegre (RS-Brazil), aiming to relate outcomes “cure” and “no cure” to variables as initial bacteriological situation (presence of the tubercle bacillus or not), demographic data, association to HIV and alcoholic habits. Methods: A series of consecutive patients with diagnosis of pulmonary tuberculosis (microbiologically proved or not), who were treated basically with Riphampicin, Isoniazid and Pyrazinamide from june/2005 to june/2007, were enrolled. Cases of extra-pulmonary tuberculosis change of diagnosis, transference, and those with non complete data, were excluded. The outcomes were “cure” and “no cure” (by desertion or death). Data were collected from the charts (SINAN-TB). The programs EXCEL and SPSS were used for classification and statistical treatment of the data. Results: Of 292 cases of tuberculosis, 117 (40.0%) had extra pulmonary forms of the disease, and 175 (60,0%) were cases of pulmonary tuberculosis, 131 (74,8%) of them microbiologically confirmed (123 by bacterioscopy, 8 by culture of sputum), and 44 (25,2%) were not confirmed. There were 60.0% of males, 69.0% white, 84.0% with 20-59 years, and 61.1% with primary or secondary school completed. Of all 175 patients, 16.6% had alcoholic habits, and of 166 patients that were tested, 42.7% were HIV+. “Cure” occurred in 133 (76.0%) patients, 95 of them with bacteriological confirmation. “Non cure” occurred in 42 patientes (24.0%), 37 of them by desertion of the treatment (33 of which were cases microbiologically confirmed – 21.1% of 131). Conclusions: The number of pulmonary tuberculosis cases exceeded the non pulmonary forms of the disease. “Cure” occurred 76.0 of 175 patients with pulmonary tuberculosis.IIt was observed significant association between the outcome “non cure” of pulmonary tuberculosis patients with HIV presence (X2=30 P 0,001) and with lower school levels (X2 = 21,18 P < 0, 001). Initial bacteriological condition (X2=1,63/P=0,44), sex (X2 = 0,67/P = 0,71), age (X2 = 7,5 /P = 0, 27) and alcoholic habits (X2 = 1,6 P = 0,43) were not significantly related to outcomes.

Introdução: A tuberculose, nos dias atuais, tem diagnóstico efetuado de modo preciso, em bases etiológicas, através da microbiologia; pode ser prevenido, o tratamento é específico e altamente efetivo em condições ideais. Todavia, diversos problemas ocorrem na condução rotineira dos casos, o que implica em sérios prejuízos para a população, podendo-se observar elevadas taxas de morbimortalidade pela doença, em especial nos países menos desenvolvidos. Objetivos: Estudar uma série de pacientes que tiveram o diagnóstico de tuberculose pulmonar, e que foram tratados em uma Unidade Sanitária especializada de Porto Alegre (RS), relacionando os desfechos (cura/não cura) com variáveis diversas: situação bacteriológica inicial dos casos (bacilíferos e não-bacilíferos), dados demográficos, coinfecção pelo HIV, e alcoolismo. Métodos: Foi arrolada uma série de pacientes consecutivos com o diagnóstico de tuberculose pulmonar (microbiológicamente comprovada ou não), os quais foram tratados basicamente com Rifampicina, Isoniazida e Pirazinamida – RHZ, de junho de 2005 a junho de 2007. Casos tuberculose extrapulmonar, de mudança de diagnóstico, transferência, e com dados incompletos, foram excluídos. Os desfechos considerados foram “cura” e “não cura” (esta por abandono ou óbito). Os dados foram coletados nos Prontuários e Fichas (SINAN-TB). Os programas EXCEL e SPSS foram usados para tabulação e tratamento estatístico dos dados. Resultados: De 292 casos de tuberculose, em geral, 117 (40,0%) tinham formas extrapulmonares da doença, e 175 (60,0%) eram casos de tuberculose pulmonar, 131 (74,8%) dos quais microbiologicamente confirmados (123 por bacterioscopia, 8 por cultura do escarro), e 44 (25,2%) sem confirmação. Dos 175 pacientes, 60,0% eram homens, 69,0% brancos, 84,0% com idade entre 20 e 59 anos, e 61,1% com escolaridade de 1º e 2º graus; 16,6% eram alcoolistas, e de 166 que foram testados, 42,7% eram HIV+. “Cura” ocorreu em 133 (76,0%) pacientes, 95 (71,4%) dos quais haviam tido confirmação bacteriológica. “Não cura” verificou-se em 42 (24,0%) pacientes, 37 deles por abandono do tratamento (33 dos quais, sendo de casos microbiologicamente confirmados – 21,1% de 131). Conclusões: O número de casos de tuberculose pulmonar excedeu o de outras formas da doença. O desfecho CURA ocorreu em 76,0% dos 175 pacientes com tuberculose pulmonar; a NÃO CURA associou-se significativamente com a presença de HIV+ (X2=30 P 0,001) e com os níveis mais baixos de escolaridade (X2 = 21,18 P < 0, 001). Condição bacteriológica inicial (X2=1,63 P=0,44), sexo (X2 = 0,67 P = 0,71), faixas etárias (X2 = 7,5 P = 0, 27) e hábito alcoólico (X2 = 1,6 P = 0,43) não se revelaram significativamente relacionados com os desfechos. / Introduction: Tuberculosis, today, has a right diagnosis in microbiologic grounds; it may be prevented , and its treatment is specific and effective in ideal conditions. However, several troubles may occur in daily conduction of the clinical cases, resulting in serious consequences to the population, as raised morbidity and mortality taxes, mainly in under developed countries. Objectives: To study a series of patients with diagnosis of pulmonary tuberculosis, who were treated in a Sanitary Unity, reference for the disease, in Porto Alegre (RS-Brazil), aiming to relate outcomes “cure” and “no cure” to variables as initial bacteriological situation (presence of the tubercle bacillus or not), demographic data, association to HIV and alcoholic habits. Methods: A series of consecutive patients with diagnosis of pulmonary tuberculosis (microbiologically proved or not), who were treated basically with Riphampicin, Isoniazid and Pyrazinamide from june/2005 to june/2007, were enrolled. Cases of extra-pulmonary tuberculosis change of diagnosis, transference, and those with non complete data, were excluded. The outcomes were “cure” and “no cure” (by desertion or death). Data were collected from the charts (SINAN-TB). The programs EXCEL and SPSS were used for classification and statistical treatment of the data. Results: Of 292 cases of tuberculosis, 117 (40.0%) had extra pulmonary forms of the disease, and 175 (60,0%) were cases of pulmonary tuberculosis, 131 (74,8%) of them microbiologically confirmed (123 by bacterioscopy, 8 by culture of sputum), and 44 (25,2%) were not confirmed. There were 60.0% of males, 69.0% white, 84.0% with 20-59 years, and 61.1% with primary or secondary school completed. Of all 175 patients, 16.6% had alcoholic habits, and of 166 patients that were tested, 42.7% were HIV+. “Cure” occurred in 133 (76.0%) patients, 95 of them with bacteriological confirmation. “Non cure” occurred in 42 patientes (24.0%), 37 of them by desertion of the treatment (33 of which were cases microbiologically confirmed – 21.1% of 131). Conclusions: The number of pulmonary tuberculosis cases exceeded the non pulmonary forms of the disease. “Cure” occurred 76.0 of 175 patients with pulmonary tuberculosis.IIt was observed significant association between the outcome “non cure” of pulmonary tuberculosis patients with HIV presence (X2=30 P 0,001) and with lower school levels (X2 = 21,18 P < 0, 001). Initial bacteriological condition (X2=1,63/P=0,44), sex (X2 = 0,67/P = 0,71), age (X2 = 7,5 /P = 0, 27) and alcoholic habits (X2 = 1,6 P = 0,43) were not significantly related to outcomes.

Introdução: A tuberculose, nos dias atuais, tem diagnóstico efetuado de modo preciso, em bases etiológicas, através da microbiologia; pode ser prevenido, o tratamento é específico e altamente efetivo em condições ideais. Todavia, diversos problemas ocorrem na condução rotineira dos casos, o que implica em sérios prejuízos para a população, podendo-se observar elevadas taxas de morbimortalidade pela doença, em especial nos países menos desenvolvidos. Objetivos: Estudar uma série de pacientes que tiveram o diagnóstico de tuberculose pulmonar, e que foram tratados em uma Unidade Sanitária especializada de Porto Alegre (RS), relacionando os desfechos (cura/não cura) com variáveis diversas: situação bacteriológica inicial dos casos (bacilíferos e não-bacilíferos), dados demográficos, coinfecção pelo HIV, e alcoolismo. Métodos: Foi arrolada uma série de pacientes consecutivos com o diagnóstico de tuberculose pulmonar (microbiológicamente comprovada ou não), os quais foram tratados basicamente com Rifampicina, Isoniazida e Pirazinamida – RHZ, de junho de 2005 a junho de 2007. Casos tuberculose extrapulmonar, de mudança de diagnóstico, transferência, e com dados incompletos, foram excluídos. Os desfechos considerados foram “cura” e “não cura” (esta por abandono ou óbito). Os dados foram coletados nos Prontuários e Fichas (SINAN-TB). Os programas EXCEL e SPSS foram usados para tabulação e tratamento estatístico dos dados. Resultados: De 292 casos de tuberculose, em geral, 117 (40,0%) tinham formas extrapulmonares da doença, e 175 (60,0%) eram casos de tuberculose pulmonar, 131 (74,8%) dos quais microbiologicamente confirmados (123 por bacterioscopia, 8 por cultura do escarro), e 44 (25,2%) sem confirmação. Dos 175 pacientes, 60,0% eram homens, 69,0% brancos, 84,0% com idade entre 20 e 59 anos, e 61,1% com escolaridade de 1º e 2º graus; 16,6% eram alcoolistas, e de 166 que foram testados, 42,7% eram HIV+. “Cura” ocorreu em 133 (76,0%) pacientes, 95 (71,4%) dos quais haviam tido confirmação bacteriológica. “Não cura” verificou-se em 42 (24,0%) pacientes, 37 deles por abandono do tratamento (33 dos quais, sendo de casos microbiologicamente confirmados – 21,1% de 131). Conclusões: O número de casos de tuberculose pulmonar excedeu o de outras formas da doença. O desfecho CURA ocorreu em 76,0% dos 175 pacientes com tuberculose pulmonar; a NÃO CURA associou-se significativamente com a presença de HIV+ (X2=30 P 0,001) e com os níveis mais baixos de escolaridade (X2 = 21,18 P < 0, 001). Condição bacteriológica inicial (X2=1,63 P=0,44), sexo (X2 = 0,67 P = 0,71), faixas etárias (X2 = 7,5 P = 0, 27) e hábito alcoólico (X2 = 1,6 P = 0,43) não se revelaram significativamente relacionados com os desfechos. / Introduction: Tuberculosis, today, has a right diagnosis in microbiologic grounds; it may be prevented , and its treatment is specific and effective in ideal conditions. However, several troubles may occur in daily conduction of the clinical cases, resulting in serious consequences to the population, as raised morbidity and mortality taxes, mainly in under developed countries. Objectives: To study a series of patients with diagnosis of pulmonary tuberculosis, who were treated in a Sanitary Unity, reference for the disease, in Porto Alegre (RS-Brazil), aiming to relate outcomes “cure” and “no cure” to variables as initial bacteriological situation (presence of the tubercle bacillus or not), demographic data, association to HIV and alcoholic habits. Methods: A series of consecutive patients with diagnosis of pulmonary tuberculosis (microbiologically proved or not), who were treated basically with Riphampicin, Isoniazid and Pyrazinamide from june/2005 to june/2007, were enrolled. Cases of extra-pulmonary tuberculosis change of diagnosis, transference, and those with non complete data, were excluded. The outcomes were “cure” and “no cure” (by desertion or death). Data were collected from the charts (SINAN-TB). The programs EXCEL and SPSS were used for classification and statistical treatment of the data. Results: Of 292 cases of tuberculosis, 117 (40.0%) had extra pulmonary forms of the disease, and 175 (60,0%) were cases of pulmonary tuberculosis, 131 (74,8%) of them microbiologically confirmed (123 by bacterioscopy, 8 by culture of sputum), and 44 (25,2%) were not confirmed. There were 60.0% of males, 69.0% white, 84.0% with 20-59 years, and 61.1% with primary or secondary school completed. Of all 175 patients, 16.6% had alcoholic habits, and of 166 patients that were tested, 42.7% were HIV+. “Cure” occurred in 133 (76.0%) patients, 95 of them with bacteriological confirmation. “Non cure” occurred in 42 patientes (24.0%), 37 of them by desertion of the treatment (33 of which were cases microbiologically confirmed – 21.1% of 131). Conclusions: The number of pulmonary tuberculosis cases exceeded the non pulmonary forms of the disease. “Cure” occurred 76.0 of 175 patients with pulmonary tuberculosis.IIt was observed significant association between the outcome “non cure” of pulmonary tuberculosis patients with HIV presence (X2=30 P 0,001) and with lower school levels (X2 = 21,18 P < 0, 001). Initial bacteriological condition (X2=1,63/P=0,44), sex (X2 = 0,67/P = 0,71), age (X2 = 7,5 /P = 0, 27) and alcoholic habits (X2 = 1,6 P = 0,43) were not significantly related to outcomes.

Este trabalho apresenta o resultado do estudo das causas que interferem na busca passiva de casos de tuberculose pulmonar na população. Entrevistaram-se 350 indivíduos, bacilíferos e não bacilíferos, que procuraram o Centro de Saúde de Pinheiros-SP, durante o ano de 1985. Foram estudadas as informações obtidas referentes ao tempo decorrido desde a percepção de alguma sintomatologia pela população de estudo até a sua chegada ao Centro de Saúde. Os resultados obtidos permitem supor que boa parte da responsabilidade pela demora no atendimento correto da população pode ser atribuída aos profissionais das instâncias anteriores à procura do Centro de Saúde. Outros fatores relacionados à àrea do comportamento humano e a aspectos sócio-econômicos foram identificados como causa provável de demora para a procura de assistência adequada à saúde. Concluiu-se que a população não conhece ou conhece pouco as características da função assistencial do centro de saúde, com exceção da gratuidade dos serviços oferecidos. Este conjunto de fatores resultou num tempo de sintomatologia que variou de menos de 3 semanas até mais de 24 meses, com maior concentração de casos no espaço de tempo compreendido entre 3 semanas ate 12 meses, significando maior risco de disseminação da infecção na comunidade. / This work presents the results of the study of causes that interfere with the passive search of pulmonary tuberculosis cases in the population. Three hundred and fifty infection spreading and non infection spreading subjects who looked up the Pinheiros Public Health Center in the city of São Paulo throughout 1985 were interviewed. Information obtained regarding intervening time between perception of any symptom by the study population and its arrival at the Health Center was studied. The results obtained point ot to the fact that a good deal of responsability for the delay in the provision of correct care lies with the professionals of the anterior instances attended by the population before looking up the Health Center. Other factors related to the area of human behaviour and socio-economic aspects were also identified as probable causes of the delay in obtaining adequate health care. It is concluded that the population has little or no knowledge whatsoever regarding the health care function of the Health Center, save it being free of charge. This group of factors resulted in a symptomatology time span that varied from less than three weeks to twenty-four months with a higher concentration rate comprised between three weeks and twelve months meaning a larger infection spreading risk in the community.

El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado. / Background: Pulmonary tuberculosis is a highly prevalent disease in low-income countries; clinical prediction tools allow healthcare personnel to catalog patients with a higher risk of death in order to prioritize medical attention. Methodology: We conducted a literature search on prognostic models aimed to predict mortality in patients diagnosed with pulmonary tuberculosis. We included prospective and retrospective studies where prognostic models predicting mortality were either developed or validated in patients diagnosed with pulmonary tuberculosis. Three reviewers independently assessed the quality of the included studies using the PROBAST tool (Prediction model study Risk of Bias Assessment Tool). A narrative review of the characteristics of each model was conducted. Results: Six articles (n = 3553 patients) containing six prediction models were included in the review. Most studies (5 out of 6) were retrospective cohorts, only one study was a prospective case-control study. All the studies had a high risk of bias according to the PROBAST tool in the overall assessment. Regarding the applicability of the prediction models, three studies had a low concern of applicability, two high concern and one unclear concern. Five studies developed new prediction rules. In general, the presented models had a good discriminatory ability, with areas under the curve fluctuating between 0.65 up to 0.91. Conclusion: None of the prognostic models included in the review accurately predict mortality in patients with pulmonary tuberculosis, due to great heterogeneity in the population and a high risk of bias. / Revisión por pares