Thesis (MSc (Community Health))--University of Stellenbosch. 1995. / Please refer to full text for abstract

Thesis (PhD)--Stellenbosch University, 2004 / ENGLISH ABSTRACT: It is estimated that about one third of the world's population is infected with Mycobacterium tuberculosis (M. tuberculosis). Of those infected, only 10 % will develop disease of which 3-5 % will relapse after completion of treatment. Susceptibility to M tuberculosis or relapse following treatment, may be due to environmental influences such as poverty-related factors including intestinal parasites (helminths), and/or genetic factors, all of which can influence the immune response to M. tuberculosis. In the current study, the epidemiology of mycobacterial infection and helminths was studied in two adjacent suburbs of Cape Town, South Africa. These communities had a tuberculosis notification rate of over 1 000/100 000 population with rampant infestations by helminths such as Ascaris lumbricoides and Trichuris trichiura. M. tuberculosis infection and Bacille Calmette Guerin (BCG) vaccination induce a Thl (type 1) immune response, while a Th2 (type 2) immune response is required for expulsion of intestinal parasites. Type 1 and type 2 responses negatively cross regulate each other in vitro and in experimental models. The interaction of these two immune responses in the study community, were investigated. It was hypothesised that susceptibility to M. tuberculosis and progression to disease may be increased in individuals mounting prominent type 2 immune responses, manifested by high serum IgE levels. Furthermore it is proposed that that poverty-related factors and intestinal parasites, specifically those trafficking through the lungs, could further augment the type 2 dominance in the study community. Results presented show that serum IgE concentrations, surrogate marker for type 2 activation, were high among healthy adults, confirming the dominance of type 2 responses. When characterised in census blocks or enumerator sub-districts (ESDs), IgE levels correlated with the tuberculosis notification rate per ESD. The notification rate of tuberculosis also correlated with the socio-economic status, female literacy and population density of the study population. Although these correlations do not necessarily imply a causal relationship, these factors are associated with susceptibility to M. tuberculosis. It was also shown that IgE concentrations decreased significantly after successful treatment of tuberculosis, showing that IgE concentrations in humans can be down-regulated under these circumstances, presumably due to enhancement of a type 1 response. Furthermore, as a reason for the high serum IgE concentrations in the study population, the helminth burden was subsequently measured in all primary school children in the study community. Results show that more than 50 % of the children recruited were infected with A. lumbricoides and/or T. trichiura. Schools situated in the poorest areas with the highest tuberculosis notification rates, presented with the highest prevalences of helminths. All the children, irrespective of their helminth status or their participation in the study, subsequently received ant-helminthic treatment. The BCG vaccination scar status and Mantoux skin test responses were available on a sub-sample of the above-mentioned school children. Although it is assumed that most children receive BCG vaccination in the neonatal period, only two thirds of the children had evidence of a BCG scar. The results show that the prevalence of BCG scar positivity, while independent of age, was lower in children around 11 years of age. In contrast to the broad constancy of BCG scar expression, the percentage of children showing Mantoux reactivity increased with age, from 13 % at 6 years to 65 % at mid teenage. The time course of Mantoux conversion with age indicated that any tuberculin sensitivity, induced by the BCG, waned within the first few years of life and that PPD responsiveness thereafter was induced by environmental exposure to M. tuberculosis. Contrary to the ThllTh2 paradigm, the prevalence of helminth infection in children with a BCG scar was marginally lower than in those without one. A relatively weak positive correlation was found between tuberculin responsiveness and helminth infection and this correlation was most marked in children without a BCG scar. In this subgroup, children who were infected with helminths were more likely to be PPD responsive than those who were not infected. The data showed that conversion to PPD sensitivity predisposed to helminth infection. The results suggest that the effect of helminth infection on the development of clinical tuberculosis is such that those with large worm burdens and who make good PPD responses are likely to be resistant whereas those who deal very effectively with these parasites and who make weaker PPD responses are more likely to be susceptible. The data also indicate that the BCG vaccine used in this study does not give rise to a latent infection whereas the pathogenic M. tuberculosis does so and repeatedly stimulates an immune response to it. In a separate study, it was demonstrated how the host response to M. tuberculosis differs in patients at risk for developing tuberculosis after successful completion of treatment, compared to those who have protective immunity. Individuals participating in the study were also interviewed to understand their social and economic background and how it relates to the disease. Purified protein derivative (PPD) and M. tuberculosis-induced cytokine responses were determined in the study groups. The results show that single immunological marker of susceptibility could not be distinguished, but rather immunological patterns of susceptibility were observéd. Individuals who have had tuberculosis once before and who had been cured, presented with an immuno-suppressive profile, which included high concentrations of IL-lO, TGF-13 as well as high IgE levels. This type of profile suggests that although these individuals have had tuberculosis once before, they have not acquired protective immunity and would be susceptible to reinfection and progression to disease. Furthermore, the interviews conducted showed that most of the people included in this study were poor, unemployed, undernourished and lived in overcrowded conditions. It seems inevitable that those individuals with the immuno-suppressed profile living in poverty would present with a second episode of tuberculosis in the near future. We conclude that in the study community, which has a typical third world setting, poverty-related factors including helminths, could contribute to a dominant type 2 immune response which in tum, would down-regulate the protective type I response, resulting in an enhanced susceptibility to M. tuberculosis and progression to disease. / AFRIKAANSE OPSOMMING: Dit word beraam dat ongeveer een derde van die wêreld se populasie geïnfekteer is met Mycobacterium tuberculosis (M. tuberculosis). Van diegene wat wel geïnfekteer is, sal slegs 10 % siekte ontwikkel met 3-5 % wat 'n relaps episode sal ervaar na voltooiing van behandeling. Vatbaarheid vir M. tuberculosis of 'n relaps episode gevolg na behandeling, mag toegeken word aan armoede-verwante faktore wat intestinale parasiete (helminte) asook genetiese faktore, insluit. Hierdie faktore het die vermoë om die immuun respons teen M. tuberculosis te beïnvloed. In die huidige studie, is die epidemiologie van die mikobakteriele infeksie en helminte bestudeer in twee aangrensende voorstede van Kaapstad, Suid Afrika. Hierdie gemeenskappe het 'n tuberkulose aanmeldings koers van 1 000/1 00 000 populasie met verpreide infestasies met helminte soos Ascaris lumbricoides and Trichuris trichiura. Infeksie met M tuberculosis en vaksinasie met Bacille Calmette Guerin (BeG), induseer 'n Th1 (tipe 1) immuun respons, terwyl 'n Th2 immuun respons benodig word vir die eliminasie van intestinale parasiete. Die interaksie tussen die twee immuun response was in die huidige studie populasie bestudeer. Dit word gepostuleer dat persone met 'n sterk tipe 2 immuun respons, gemanifesteer deur hoë serum IgE vlakke, vatbaar is vir infeksie met M. tuberculosis en progressie tot siekte. Verder was dit voorgestel dat armoede-verwante faktore en intestinal parasiete, veral parasiete wat deur die longe beweeg, 'n dominante tipe 2 respons verder kan versterk. Die resultate voorgestel, wys daarop dat serum IgE konsentrasies, 'n surrogaat merker vir tipe 2 aktivering, hoog was in gesonde volwassenenes. Dit het die siening van 'n dominante tipe 2 respons bevestig. IgE vlakke was bereken vir elke sensus blok of enumerator sub-distrik (ESD) en het gekorreleer met die tuberkulose annmeldings koers per ESD. Die aanmeldings koers het ook gekorreleer met die sosio-ekonomiese status, vroulike geletterdheid en populasie digtheid. Alhoewel hierdie korrelasies nie noodwending dui op 'n oorsaak en gevolg verhouding nie, is dit duidelik dat hierdie faktore kan bydra tot vatbaarheid vir M. tuberculosis. Dit was ook getoon dat IgE konsentrasies beduidend afneem na suksesvolle behandeling van tuberkulose. Dit wys daarop dat IgE konsentrasies in mense afgeruleer kan an waarskynlik dui op 'n verhoogde tipe 1 respons. Verder, as 'n rede vir die hoë IgE konsentrasies in die studie populasie, is die helmint ladings gevolglik in alle prim ere skool kinders in die studie populasie, gemeet. Die resultate dui daarop dat meer as 50 % van die kinders ingesluit, geïnfekteer was met A. lumbricoides en/of T. trichiura. Skole in areas met die hoogste armoede syfer en tuberkulose annmeldings koers, het ook die hoogste prevalensie van helminte gehad. Alle kinders, ongeag hulle helmint status of hulle deelname in die studie, het gevolglik anti-helmintiese behandeling ontvang. BeG vaksinasie littekens en Mantoux vel toets response was beskikbaar op 'n subpopulasie van die bogenoemde skool kinders. Alhoewel dit aanvaar word dat die meerderheid van kinders BeG vaksinasie in die neonatale periode ontvang het, het slegs twee derdes van die kinders 'n BeG litteken getoon. Die resulatate dui daarop dat die prevalensie van BeG litteken positiwiteit, onafhanklik van ouderdom, laer was in kinders rondom die ouderdom van 11 jaar. In kontras met die konstante uitdrukking van BeG littekens, het die persentasie van Mantoux reaktiwiteit verhoog met ouderdom vanaf 13 % by 6 jaar tot 65 % teen 15 jarige ouderdom. Die tyd koers van Mantoux omskakeling met ouderdom dui daarop dat tuberkulin sensitiwiteit, geïnduseer deur BeG, afneem binne die eerste paar jaar van lewe en dat PPD responsiwiteit daarna deinduseer word deur omgewings blootstelling aan M. tuberculosis. In kontras met die ThllTh2 paradigma, was die prevalensie van helmint infeksies in kinders met 'n BeG litteken marginaal laer teenoor hulle sonder 'n litteken. 'n Relatiewe swak posititiewe korrelasie was gevind tussen tuberkulin responsiwiteit en helmint infeksie. Hierdie korrelasie was meer beduidend in kinders sonder 'n litteken. In hierdie sub-groep, was die helmintgeïnfekteerde kinders meer geneig om PPD responsief te wees teenoor hulle wat nie geïnfekteer was nie. Die data wys daarop dat omskakeling na PPD sensiwiteit kan lei tot infeksie met helminte. Die resultate stel voor dat die effek van helmint infeksie op die ontwikkeling van kliniese tuberkulose van so 'n aard is dat diegene met groot wurm ladings en wat goeie PPD response toon, meer geneig sal wees om weerstandig te wees. Diegene egter wat die parasiete beter kan beheer and wat goeie PPD response toon, sal meer geneig wees om vatbaar te wees vir tuberkulose. Die data dui ook daarop dat die BeG vaksien wat in die studie gebruik was, nie lei tot latente infeksie nie, terwyl patogene M tuberculosis dit wel doen en herhaardelik die immuun respons sal stimuleer. In 'n aparte studie, was dit gedemonstreer dat die gasheer-respons teen M. tuberculosis in pasiënte wat die gevaar loop om na suksesvolle voltooiing van behandeling, weer tuberkulose te ontwikkel, verskil van diegene wat beskermende immuniteit het. Onderhoude was ook gevoer met indiwidue wat deelgeneem het aan die studie, om ten einde hul sosiale en ekonomiese agtergrond te verstaan en hoe dit gekoppel is aan die siekte. Purified protein derivative (PPD) en M. tuberculosis-geinduseerde sitokien response was in die studie groepe bepaal. Die resultate wys daarop dat alhoewel 'n enkele immunologiese merker nie geidentifiseer kon word nie, was immunologiese patrone vir vatbaarheid welopgemerk. Indiwidue wat reeds een episode van tuberkulose gehad het en suksesvolle behandeling ontvang het, het 'n onderdrukte immuun profiel getoon. Dit het ingesluit hoë vlakke van die sitokiene, IL-lO en TGF-J3 asook hoë vlakke van serum IgE. Hierdie tipe profiel stel voor dat ten spyte van die vorige tuberkulose episode, hierdie persone nie beskermende immunitiet ontwikkel nie en dus vatbaar is vir herinfeksie en progressie tot siekte. Die onderhoude het getoon dat die meerderheid van mense in die studie populasie onder armoedige oorbevolkte omstandighede lewe, wat werkloosheid en ondervoeding insluit. Die studie het verder getoon dat hierdie indiwidue met die onderdrukte immuun profiel en wat in armoede lewe, in die nabye toekoms vatbaar is vir 'n tweede episode van tuberkulose. In die studie gemeenskap, met 'n tipiese derde wêreld opset, is daar gewys dat armoedeverwante faktore en helminte, mag bydra tot 'n dominante tipe 2 immuun respons wat op sy beurt, die beskermende tipe 1 response sal af-reguleer. Dit sal uiteindelik lei tot verhoogde vatbaarheid vir M. tuberculosis en uiteindelik progressie tot siekte (tuberkulose).

La tuberculosis es un problema de salud pública con alto grado de transmisión que se incrementa en nuestra población. En este contexto, la presente investigación trabaja en un grupo de profesionales de enfermería, con el propósito de optimizar las medidas de protección respiratoria y así reducir el riesgo de transmisión. Como objetivo general fue determinar las medidas de protección respiratoria y la forma de aplicación para la prevención de tuberculosis en el profesional de enfermería del servicio de emergencia del Hospital Nacional Dos de Mayo, 2010. El presente estudio es de nivel aplicativo, tipo cuantitativo, método descriptivo, de corte transversal. La población estuvo conformada por 29 profesionales de enfermería. La técnica utilizada fue la observación, el instrumento la lista de chequeo. Los resultados fueron que el 100% de profesionales de enfermería aplica medidas de protección respiratoria, como medida directa, hacen uso del respirador y como medida indirecta, los pacientes utilizan las mascarillas. En cuanto a la forma de aplicación, ambas medidas son utilizadas inadecuadamente; puesto que, los profesionales inciden en el cuidado de los respiradores y en la educación al paciente sobre el uso de mascarillas. -- PALABRAS CLAVES: Medidas De Protección Respiratoria, Profesionales De Enfermería. / -- Tuberculosis is a public health problem with high transmission in our population increases. In this context, this research work in a group of nursing professionals in order to optimize the respiratory protection and reduce the risk of transmission. Its general objective is to determine the respiratory protection and the application form for the prevention of tuberculosis in nursing professional emergency service Hospital Dos de Mayo, 2010. The study is an application level, quantitative, descriptive, cross sectional study. The population consisted of 29 nurses. The technique used was the observation, the instrument checklist. The results were that 100% of nurses applied respiratory protection, as a direct measure, make use of the respirator and indirect measures, patients use the masks. Regarding the application form, both measures are used improperly; as professionals affect the care of respirators and patient education on the use of masks. -- KEY WORDS: Protective Respiratory, Nurses.

La tuberculosis es una enfermedad de trascendencia social que plantea serios problemas de salud pública, con el modelo de desarrollo económico del país, las consecuencias negativas han recaído en las clases más reprimidas social y económicamente, trayendo como resultado desempleo, bajos ingresos y extrema pobreza, los cuales son factores que permiten la permanencia del foco infeccioso de la enfermedad y su propagación, aunado a un déficit de saneamiento ambiental, hacinamiento, deficiente nivel educativo para la salud, estrés social y deficiente alimentación. El Ministerio de Salud enfrenta esta realidad mediante la Estrategia Sanitaria Control de la Tuberculosis cuyo objetivo es brindar atención integral a la persona y familia en riesgo a enfermar y morir por tuberculosis. Dentro de la aplicación de estrategias innovadoras que garanticen el logro de sus objetivos, recobra importancia el rol del paciente en su propia recuperación y la conservación de la salud de los miembros de su familia; en tanto el enfermero dentro de la Estrategia Sanitaria Control de la Tuberculosis requiere generar cambios en el usuario a través de la información, educación y comunicación para modificar la respuesta al proceso salud – enfermedad. Sobre estos aspectos se concretiza el presente estudio acerca de la relación entre el nivel de conocimientos sobre tuberculosis pulmonar y las actitudes hacia el tratamiento que tienen los pacientes registrados en la Estrategia Sanitaria Control de la Tuberculosis del Centro de Salud “San Luis”. Tiene como propósito brindar información válida y confiable al enfermero que labora en la Estrategia Sanitaria Control de la Tuberculosis, la cual le permita generar ideas innovadoras de educación e información y favorecer un clima adecuado para la comunicación con el paciente. La hipótesis de la investigación plantea la existencia de relación entre el nivel de conocimientos sobre tuberculosis pulmonar y las actitudes hacia el tratamiento que tienen los pacientes. Se utilizó en el estudio de investigación el método descriptivo correlacional de corte transversal. La población considerada fue de 60 pacientes, quienes cumplieron con los criterios de inclusión. Para la recolección de datos se utilizó el cuestionario para medir los conocimientos y la escala tipo Lickert para las actitudes. Los resultados que se obtuvieron demuestran que la mayoría de los pacientes con tuberculosis pulmonar presentan un nivel de conocimientos de medio o bajo sobre el tratamiento farmacológico, cuidados en el hogar y medidas preventivas, predisponiendo al agravamiento de la enfermedad, incremento del contagio a los demás miembros de la familia y comunidad ,y el mayor riesgo de mortalidad, así mismo se halló que la mayoría de pacientes con tuberculosis pulmonar tienen una actitud de indiferencia hacia el tratamiento, lo cual indica que están en mayor riesgo de recaer o abandonar el tratamiento. Además se pudo comprobar la relación entre el nivel de conocimientos sobre tuberculosis pulmonar y las actitudes hacia el tratamiento que tienen los pacientes registrados en la Estrategia Sanitaria Control de la Tuberculosis del Centro de Salud “San Luis”. / The tuberculosis is a disease of social importance that creates serious problems of public health, with the generation of adjustments in the economy, the consequences have fallen to the repressed classes more social and economically, bringing like result unemployment, low income and carries far poverty, which is factors that allow to the permanence of the infectious center of the disease and its propagation, in addition produce deficit of environmental cleaning, accumalation, deficient educative level for the health, social stress and deficient feeding. The Ministry of Health faces this reality by means of the Component Control of the Tuberculosis whose objective is to offer to integral attention to the person and family in risk to become ill and to die by tuberculosis. Within the effort to look for strategies that guarantee the profit of their objectives, it recovers importance the roll of the patient in his own recovery and the conservation of the health of the members of his family. The nurse within the Component Control of the Tuberculosis requires to generate changes in the user through the information, education and communication, to modify the answer to the process health - disease. On these aspects to concrete the present study about the relation between the level of knowledge on pulmonary tuberculosis and the attitudes towards the treatment that have the patients registered in the Component Control of the Tuberculosis of the Center of Health "San Luis". The intention is to stimulate the nurse to transform itself into a change agent that generates ideas innovating of education and information and favors a climate adapted for the communication with the patient doing emphasis in the importance of the continuity of the treatment, the cares in the home and the preventive measures. The hypothesis of the investigation raises the existence of direct relation between the level of knowledge on pulmonary tuberculosis and the attitudes towards the treatment that have the patients. The used method was descriptive the corelational one of cross section. The considered population was of 60 patients, who fulfilled the inclusion criteria. For the data collection the survey was used to measure the knowledge and the scale Lickert type for the attitudes. The results demonstrate that most of the patients with pulmonary tuberculosis they present/display a level of low means knowledge or on the farmacology treatment, taken care of in the home and preventive measures, having to the wrong the disease, increase of I infect to the other members of the family and community, y the greater risk of mortality, also was that most of patients with pulmonary tuberculosis they have an indifference attitude towards the treatment, which indicates that they are in greater risk of falling or of leaving the treatment. In addition the relation between the level of knowledge on pulmonary tuberculosis and the attitudes could be verified towards the treatment that have the patients registered in the Component Control of the Tuberculosis.

El presente trabajo tuvo como objetivo determinar la prevalencia de tuberculosis bovina en el distrito de Végueta, provincia de Huaura para los años 2001 y 2002 teniendo como base el Reglamento para el Control y Erradicación de la Tuberculosis Bovina, DS-31-2000 AG. El monitoreo se realizó a un total de 3240 y 3230 bovinos para los años 2001 y 2002 respectivamente, en animales mayores de cuatro semanas de edad. Las pruebas utilizadas fueron la de intradermoreacción tuberculina (PPD), tanto la prueba caudal como la doble comparativa en la tabla del cuello para la confirmación . Los resultados obtenidos fueron de cuatro casos positivos a la prueba caudal, 0.1235%, de los cuales un caso resultó positivo a la prueba doble comparativa, en el año 2001. En el año 2002 resultaron dos casos positivos a la prueba ano caudal, 0.0619%, de los cuales ambos resultaron positivos a la prueba doble comparativa. / This paper had the goal of determining the prevalence of bovine tuberculosis in the district of Végueta, province of Huaura, in the years 2001 and 2002, having as a base the regulations for the bovine tuberculosis control and eradication, D.S.-31-2000 AG. The monitoring was made among a total of 3240 and 3230 bovines in the years 2001 and 2002, respectively, of all ages older than 4 week old. The testing for bovine tuberculosis wade made using the PPD skin test, both the caudal tuberculin test (CFT) and the comparative cervical tuberculin test (CCT) for confirmation. About the results, in the year 2001 the caudal tuberculin test showed 4 positive cases, 0.1235%.One of these cases was positive to the comparative cervical tuberculin test, too. In the year 2002, the caudal fold tuberculin test showed 2 positive cases, that were positive to the comparative cervical tuberculin test, too.

La Tuberculosis Multidrogorresistente es un problema de salud pública que afecta al país. El consumo de alcohol se asocia frecuentemente a fracaso o abandono pero existen pocas investigaciones entre consumo de alcohol y TBMDR. El presente estudio tuvo por objetivo determinar si el consumo excesivo de alcohol es un factor de riesgo de tuberculosis multidrogorresistente secundaria. Metodología: Se realizó un estudio caso – control, denominando caso al paciente con TBMDR secundaria según criterios. Los controles fueron pacientes con TB no MDR que acudían a los mismos establecimientos en el mismo periodo que los casos. Se seleccionaron mínimamente 2 controles por caso. En total se reclutaron 44 casos y 125 controles, la muestra calculada fue de 43 casos y 86 controles. Resultados: El consumo excesivo de alcohol fue detectado con la prueba de screening AUDIT (Alcohol Use Disorders Identification Test). Existe asociación entre consumo excesivo de alcohol y TBMDR (p=0,018). El 54,55% de los casos presenta consumo excesivo, mientras que solo el 34,40% de los controles presenta el mismo tipo de consumo. El consumo perjudicial de alcohol está asociado a TBMDR (p=0,02), el consumo de riesgo y la dependencia no estuvieron asociados a TBMDR. Existen diferencias estadísticamente significativas entre las medias del puntaje del AUDIT entre casos y controles (p=0,01). La variable abandono al tratamiento no es variable confusora. La probabilidad de TBMDR incrementa si el paciente presenta consumo excesivo de alcohol y además abandona el tratamiento de 0,35 a 0,99. Conclusiones: El consumo excesivo de alcohol es un factor asociado a TBMDR secundaria, al igual que el consumo perjudicial. EL consumo de riesgo y la dependencia no estuvieron asociados a TB-MDR secundaria. / -- Background: Multidrug-Resistant Tuberculosis is a problem of public health goes affect country. The alcohol consumption is frequently associated to failure or abandonment but exist a few investigations between alcohol consumption and TBMDR. The present study had by objective to determine if the excessive alcohol consumption is a risk factor of secondary multidrogorresistente tuberculosis. Methods: A case – control study was development, denominating case to the patient with secondary TBMDR according to criteria. The controls were patient with TB non MDR that went to the same health services in the same period that the cases. 2 controls by case were selected. Altogether 44 cases were recruited and 125 controls, the calculated sample was of 43 cases and 86 controls. The excessive alcohol consumption was detected with the test of screening AUDIT (Alcohol Use Disorders Identification Test). Results: There was association between excessive alcohol consumption and TBMDR (p=0,018), 54.55% of the cases had excessive consumption, while 34.40% of the controls only had the same type of consumption. The detrimental alcohol consumption is associate to TBMDR (p=0,02), the risk consumption and the dependency was not associate to TBMDR. There was statistically significant differences between the averages of AUDIT between cases and controls (p=0,01). The variable abandonment of treatment is not confusor variable. TBMDR probability increases if the patient had excessive alcohol consumption and in addition leaves the treatment from 0.35 to 0,99. Conclusion: Excessive consumption of alcohol and harmful consumptions are factors associated to secondary TBMDR. Risk consumption and dependence were not associated with secondary MDRTB.

La tuberculosis representa una situación estresante tanto en el inicio de la enfermedad, diagnostico, tratamiento y recuperación del paciente. Al buscar entender las cogniciones y conductas que presentan los pacientes surge la necesidad de realizar un estudio con el objetivo de determinar las estrategias de afrontamiento del paciente que asiste a la ESN-PCT en el Centro de Salud Max Arias Schreiber. Material y Método. El estudio es de nivel aplicativo, tipo cuantitativo, método descriptivo simple de corte transversal..La población estuvo conformado por todos los pacientes asistentes a la ESNPCT en el mes de enero del 2013 conformado por 30 pacientes. La técnica fue la entrevista y el instrumento fue el (COPE) modificado , aplicado previo consentimiento informado. Resultados. Del 100 (30), el 50%(15) las estrategias de afrontamiento están presentes y en el 50%(15) están ausentes. Las estrategias centradas en el problema están presentes en 53 % (16) y en 47% (14) están ausentes. Dentro de las estrategias centradas en el problema del 100% (30), 53% (16) la supresión de actividades está presente y en 47% (14) ausente, la planificación está presente y en 57% (17) ausente. Sobre las estrategias centradas en la emoción en el 40% (12) están presentes y en el 60%(18) ausente. Dentro de las estrategias centradas en la emoción del 100%(30), 57%(17) está presente el acudir a la religión y en 43%(13) ausente; la negación está presente y en73% (22) ausente. Referente a las otras estrategias de afrontamiento en 43%(13) están presentes y en 57%(17) ausente .Dentro de las otras estrategias de afrontamiento del 100%(30), 60% (18) está presente el desentendimiento cognitivo y en 40%(12) ausente; en el 20%(15) el desentendimiento conductual esta presente y en 80%(24) ausente Conclusiones. Las estrategias de afrontamiento están presentes en la mitad de la población y ausentes en la otra mitad. Las estrategias de mayor uso en los pacientes fueron las centradas en el problema referida a concentrar sus fuerzas a seguir su tratamiento y las de menor uso fueron las centradas en la emoción que esta dada por aprender algo de estar enfermo Palabras clave: Estrategias de de afrontamiento, paciente asistente a la ESN-PCT. / --- Tuberculosis represents a stressful situation both the onset of the disease, diagnosis, treatment and recovery. In seeking to understand the cognitions and behaviors presented by patients raises the need for a study to determine the patient's coping strategies that attends ESN – PCT Health Center Max Arias Schreiber. Material and Methods. The study is level application, quantitative, descriptive method simple cross section. The population consisted of all patients attending the ESN-PCT in January 2013 consisted of 30 patients. The technique was the interview and the instrument was the (COPE) amended, applied prior informed consent. Results. 100% (30), 50% (15) coping strategies are present and in 50% (15) are absent. The problem centered strategies are present in 53% (16) and 47% (14) are absent. Among the strategies focused on the problem of 100% (30), 53% (16) suppression activities and is present in 47% (14) away, planning is present and in 57% (17) absent. On emotion-focused strategies in 40% (12) are present and in 60% (18) absent. Among the strategies focused on emotion than 100% (30), 57% (17) is going to present the religion and in 43% (13) absent denial is present and en73% (22) absent. Regarding the other coping strategies in 43% (13) are present and in 57% (17) absent. Among the other coping strategies of 100% (30), 60% (18) is present and cognitive disengagement 40% (12) absent in 20% (15) behavioral disengagement and is present in 80% (24) absent Conclusions. The coping strategies are present in half the population but absent in the other half. The most widely used strategies in patients were focused on the problem referred to concentrate their forces to continue their treatment and use were less focused on the emotion that is given to learn something about being sick Keywords: coping strategies, patient attendee ESN - PCT

A research report submitted to the Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, South Africa, in partial fulfilment of the requirements for the degree of Masters in Public Health-Social and Behaviour Change Communication.November 2012 / Aim of the study: The main aim of this study was to determine socio-demographic characteristics associated with being diagnosed with TB by a health care worker among adult males and females aged between18-49 years in Ntcheu district, Malawi. Method: This was a descriptive and analytical cross-sectional study. A total of 121 adult women and men were sampled using a three-stage simple sampling technique. The 2008 Population and Housing Census enumeration areas (EAs) were used as a sampling frame. The first stage involved simple sampling of two Traditional Authorities (TAs) out of nine (9). Stage two involved selection of ten villages in each sampled TA. The third level of sampling was a selection of six households from each selected village where the first dwelling was also sampled. A structured questionnaire was developed in English and translated into Chichewa. The questionnaire was administered by a trained interviewer at each respondent’s household. Three research assistants were employed to collect data. Results The awareness of TB was universal with every participant reporting that they had heard about TB. Of the 121 participants, more than half were male (53.7%; n=65).The median age of the respondents was 28 years (range 18-49 years) and approximately a third of the respondents (34.4%; n=31) had 1-2 children. The study found that higher education (p=0.01), higher ownership of household assets (p=0.01), higher average monthly household income (p=0.02) and higher socio-economic status of the respondents (p=0.01) were significantly associated with higher knowledge of causes of TB. It was found that education was also associated with knowledge of the transmission of TB (P=0.01). The lower the level of education the lower the knowledge level on the correct modes of TB transmission. There was also an association between knowledge of symptoms of TB and occupation (p=0.05). It was found that farmers were less likely to know symptoms of the disease compared to other forms of occupation namely: business persons, those participants who were employed and those not employed. The study found that women had significantly lower risk perceptions of the disease (p=0.01). No association was found between socio-economic and cultural factors of the respondent and self-reported TB diagnosis. Conclusion The findings of this study show that a comprehensive health promotion programme is required in order to address significant gaps on knowledge of causes of TB, transmission, symptoms and risk perceptions and other related socio-economic and cultural factors in Ntcheu district.

Dissertation Submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in the fulfillment of the requirement for the degree of Master of Science in Medicine by Research. Johannesburg, 2017 / Electron transport and respiration in Mycobacterium tuberculosis (Mtb), the causative agent of tuberculosis (TB) occurs through the use of the aa3 type cytochrome c oxidase (CcO) under normoxic conditions or cytochrome bd oxidase (CbdO) under microaerophillia. Using these oxidases, Mtb couples substrate level oxidation to generation of metabolic energy in the form of adenosine triphosphate (ATP) under aerobic conditions. The presence of the CbdO is expected to allow for growth and survival of Mtb in the oxygen restricted environment of the human TB granuloma, thus rendering it an important enzyme for further study. CbdO is comprised of two structural subunits, CydA (subunit I) and CydB (subunit II), which are encoded by the cydAB operon. Both subunits span the cytoplasmic membrane to form part of the mycobacterial electron transport chain. Notably, two other genes that are transcribed separately from the cydAB operon, the cydDC operon, have been proposed to be required for the synthesis of a functional CbdO. Based on amino acid sequence and structural predictions, the cydDC encode heterodimeric members of the ATP Binding Cassette ABC-type transporters. In other organisms, the cydDC functions to transport reducing agents to the periplasm, thus contributing to periplasmic redox homeostasis. In this study we aimed to analyze the function of the cydDC genes in Mycobacterium smegmatis. Through bioinformatics analyses, it was demonstrated that the CydDC subunits retain conserved residues associated with the ABC domain and adopt a three-dimensional fold that is similar to their counterparts in Escherichia coli. However, the published sequence of M. smegmatis suggests that cydC is a pseudogene, which was inconsistent with the demonstrated evidence of a functional CbdO in this organism. In this study, using standard DNA sequencing, it was demonstrated that the CBTBR laboratory strain of M. smegmatis does not harbor a cydC pseudogene but rather has a functional cydC gene. Next, we interrogated the function of the M. smegmatis and Mtb cydDC genes by heterologous expression in an E. coli cydD mutant. Heterologous expression of the Mtb cydDC genes restored CbdO biogenesis in the E. coli mutant. Using various microbiological approaches, we demonstrated that the mycobacterial cydDC was able to revert the stationary phase exit defect, high temperature sensitivity and increased oxidative stress susceptibility defects of the E. coli cydD mutant. Collectively, these data provided strong evidence that the mycobacterial cydDC genes encode a functional transporter that contributes to periplasmic redox homeostasis. Following this, we generated a double deletion mutant of the cydDC operon in M smegmatis. We confirmed the genetic integrity of the ΔcydDC strain by Southern Blot analysis and proved by absorption difference spectroscopy that this strain is defective in the ability to synthesize a functional CbdO, as measured by the lack of a heme d peak in membrane preparations from the mutant. In addition, the ΔcydDC mutant displayed increased sensitivity to oxidative stress and a reduced ability to exit stationary phase, phenotypic defects that were consistent with the lack of CbdO. In summary, this study provides the first evidence that loss of the M. smegmatis cydDC genes affects CbdO biogenesis. These data also confirm that the CydDC ABC-type transporter most likely transports reducing equivalents that allow for maturation of CbdO in the periplasm. Collectively, our observations advance the understanding of the mycobacterial electron transport chain and provide new evidence to assist in the development of CbdO as a TB drug target. / MT2017

A dissertation submitted to the Faculty of Medicine, University of the Witwatersrand, Johannesburg, in partial fulfillment of the requirements for the degree of Master of Medicine (Internal Medicine) Johannesburg 2001 / Introduction and Aim: The waxy outer cell wall of mycobacteria consists mainly of mycolic acids (MA). The unique immuno-stimulatory properties of MA via the CD 1-restricted antigen presentation pathway have been demonstrated in humans. Purification and isolation of M.tuberculosis (MTB) MA has allowed them to be applied as an antigen in an ELISA-based sero-diagnostic assay to detect specific antibodies in the sera of humans. The aim of the study was to measure the levels of antibody to MA in the sera of patients with culture proven pulmonary tuberculosis (PTB), and in control subjects without evidence of tuberculosis. / IT2018