Introducción: La tuberculosis es la causa principal de muerte a nivel mundial, siendo los países de ingresos medios y bajos los más afectados, principalmente a los adultos jóvenes quienes conforman la edad más productiva. La Organización Mundial de la Salud en el 2010 destacó que esta enfermedad es una de las tres causas principales de muerte en las mujeres entre la adolescencia y la adultez, incrementándose el riesgo si se tiene en cuenta que es la edad reproductiva y que los niños están bajo su cuidado, empeorando la situación sanitaria.Objetivo: Determinar el nivel de conocimientos de madres beneficiarias de comedores populares de Manchay sobre las medidas preventivas de la tuberculosis pulmonares. Metodología: El enfoque de la investigación fue de tipo cuantitativa, diseño descriptivo- correlacional, de corte trasversal. El estudio se realizó en 5 comedores populares de Pachacamac, donde la población fue de 85 madres y la muestra fue seleccionada por muestreo no probabilístico por conveniencia. El instrumento de recolección de datos fue un cuestionario sobre conocimientos de las madres elaborado por la investigadora y sometido a pruebas de validez y confiabilidad. El análisis de datos se realizó con el Programa Estadístico (SPSS) versión 19.0. Se tomó en cuenta los aspectos éticos, la autonomía, la confidencialidad de los datos que serán utilizados con fines de investigación. Resultados: De las madres de comedores populares de Manchay el 66% tienen un nivel de conocimiento medio, alto y bajo se encuentran casi en igual proporción 18 % y 16% respectivamente. Respecto a las medidas preventivas contra la TBP el 67% tienen un nivel de conocimiento medio, nivel bajo el 20% y alto 13%.

La tuberculosis (TB) es una enfermedad social por excelencia, multifactorial y está vinculada estrechamente a la pobreza, hacinamiento, tugurización, desnutrición, al hambre y demás determinantes sociales en nuestro país. La radiografía de tórax es suficiente en muchos casos para su detección, sin embargo aproximadamente en un 21% de los afectados estas sean normales, por ello se sugiriere que la Tomografía computada debe practicarse en los pacientes con sospecha de Tuberculosis pulmonar y radiografía normal o no concluyente. Para esto se incluyeron a 90 pacientes con diagnóstico de TBC confirmada por estudio bacteriológico, los cuales se realizaron una tomografía en el Hospital Nacional Hipólito Unanue entre los meses de julio y diciembre del 2014. En los cuales se evaluó las manifestaciones tomográficas en relación a Tuberculosis pulmonar activa e inactiva. Los hallazgos más frecuente de una tuberculosis pulmonar activa son la zona de consolidación, el patrón micronodular, las adenopatías mediastinales así como el patrón en vidrio esmerilado, con altas frecuencias. Además, vale mencionar la asociación que existe entre los distintos patrones de actividad con el derrame pleural. En caso de la tuberculosis inactiva es muy frecuentemente observar la fibrosis pulmonar asociada a adenopatías calcificadas, bronquiectasias, entre los más representativos. Por lo que se concluye que la Tomografía convencional de pulmones resulta ser una técnica de alta sensibilidad, superior a la radiografía para la detección de casos de tuberculosis activa como inactiva. Palabras clave. Tuberculosis pulmonar. TBC activa. TBC inactiva. Tomografía computada. Zona de consolidacion. Fibrosis. / --- The tuberculosis (TB) is a social excellent disease, multifactorial and is linked narrowly to the poverty, accumulation, tugurización, malnutrition, to the hunger and other social determinants in our country. The radiography of thorax is sufficient in many cases for his detection, nevertheless approximately, in 21 % of the affected ones, these are normal, by it will be suggested that the calculated Tomography must practice him in the patients with suspicion of pulmonary Tuberculosis and normal or not conclusive radiography. For this there were included to 90 patients by TBC's diagnosis confirmed by bacteriological study, which carried out a tomography in the National Hospital Hipólito Unanue between July and December 2014. In which the manifestations were evaluated tomografics in relation to pulmonary active and inactive Tuberculosis. The findings more frequent of a pulmonary active tuberculosis are the zone of consolidation, the micronodular boss, the mediastinal adenopatías as well as the boss in burnished glass, with high frequencies. In addition, it is worth mentioning the association that exists between the different bosses of activity with the pleural spillage. In case of the inactive Tuberculosis, it is very frequently to observe the pulmonary fibrosis associated to calcified adenopatías, bronquiectasias, between the most representative. For what concludes that the conventional Tomography of lungs turns out to be a technology of high sensibility, superior to the radiography for the detection of cases of active tuberculosis or inactive. Keywords: Pulmonary tuberculosis. Active TB. Inactive TB. Computed tomography. Consolidation zone. Fibrosis.

Es conocido a nivel mundial el riesgo de transmisión intrahospitalaria de la tuberculosis pulmonar (TBC), problema que afecta al personal de salud; es decir, residentes, internos y practicantes, extendiéndose a pacientes y visitantes del hospital. En áreas con elevada incidencia de casos de TB como en el Perú el riesgo de adquirir la infección en el PS puede llegar a ser tan alto como 40 veces más que en la población general, por ello es importante es importante prevenir el desarrollo de esta enfermedad. Algunas medidas para la prevención de la tuberculosis pulmonar son una buena alimentación, descanso y sueño adecuado, realización periódica del control médico y el uso de protectores respiratorios. Los estudiantes de enfermería al estar en contacto de manera casi permanente con los pacientes durante sus prácticas pre profesionales deben desarrollar diversas actividades preventivas, promocionales para evitar enfermedades en este caso la tuberculosis pulmonar, por lo que se formula la siguiente interrogante ¿Cuáles son las medidas que aplican los estudiantes de enfermería de una universidad nacional para la prevención de la tuberculosis pulmonar, Lima, 2015? teniendo como objetivo principal determinar las medidas que aplican los estudiantes de enfermería de la UNMSM para la prevención de la tuberculosis pulmonar. El tipo de estudio es descriptivo, la muestra fue de 47 estudiantes, se utilizó un cuestionario como instrumento de recolección de datos, después del análisis se llegó a la siguiente conclusión: Los estudiantes de enfermería no aplican medidas para la prevención de la tuberculosis en relación a la alimentación, descanso y sueño, y uso de los protectores respiratorios, lo que los pone en riesgo a padecer esta enfermedad. Palabras claves: Medidas de prevención, tuberculosis pulmonar. / --- It is known worldwide the risk of nosocomial transmission of pulmonary tuberculosis (TBC) problem affecting the health personnel; ie, residents, interns and practitioners, patients and hospital visitors spread. In areas with high incidence of TB and Peru the risk of acquiring infection in the PS can be as high as 40 times that of the general population, so it is important is important to prevent the development of this disease. Some measures for the prevention of pulmonary tuberculosis are good nutrition, adequate rest and sleep, regular conduct of medical control and use of respiratory protective devices. Nursing students to be in almost constant contact with patients during their pre professional practices must develop various preventive activities, promotional to prevent disease in this case pulmonary tuberculosis, so the next question is formulated what are the measures applying nursing students a national university for the prevention of pulmonary tuberculosis, Lima, 2015?, with the main objective to determine the measures they apply nursing students of San Marcos for the prevention of pulmonary tuberculosis. The type of study is descriptive, the sample was 47 students, a questionnaire was used as instrument of data collection, after the analysis has led to the following conclusion: nursing students do not apply measures for the prevention of tuberculosis in relation to food, rest and sleep, and use of respiratory protective devices, which puts them at risk for this disease. Keywords: Prevention, pulmonary tuberculosis.

RESUMEN La tuberculosis es una enfermedad de trascendencia social, que plantea serios problemas de salud pública, debido a las diferentes causas como el déficit de saneamiento ambiental, hacinamiento, deficiente nivel educativo para la salud, estrés social y deficiente alimentación. Sobre estos aspectos se concretiza el presente estudio, aplicando la relación entre el conocimiento de las medidas preventivas y las actitudes en el autocuidado de los pacientes con Tuberculosis Pulmonar, del Centro de Salud “Los Libertadores” del distrito de San Martín de Porres Lima. Que tiene como propósito brindar información, al sector interdisciplinario que labora en la Estrategia Sanitaria Control de la Tuberculosis, lo que permitirá desarrollar ideas innovadoras de educación e información y así favorecer un clima adecuado para la comunicación con el paciente. Se utilizó en el estudio de Investigación el Método Descriptivo Prospectivo Correlacional de corte transversal. La población considerada fue el universo de 40 pacientes, que cumplieron con el criterio de inclusión. Para la correlación de datos, se utilizó la Técnica de la entrevista y los Instrumentos fueron el cuestionario empleado para medir los conocimientos y la escala tipo Lickert para las actitudes. Los resultados que se obtuvieron nos llevaron a la siguiente conclusión: No existe relación entre conocimientos y actitudes que tiene los pacientes con Tuberculosis Pulmonar; el 80% (32) tiene conocimientos sobre las Medidas Preventivas y con respecto a las Actitudes en el Auto cuidado de los pacientes el 55% (20) muestran una actitud de Indiferencia.

Publicación a texto completo no autorizada por el autor / Produce un complejo de elongación ternario de la ARN polimerasa de Mycobacterium tuberculosis recombinante independiente del promotor transcripcionalmente activo. Para ello, prueba el efecto de las diferentes proporciones molares de las subunidades en la reconstitución in vitro de la ARN polimerasa de Mycobacterium tuberculosis, compara la coexpresión de la ARN polimerasa de Mycobacterium tuberculosis en Escherichia coli bajo dos temperaturas distintas: 25 y 37 °C y establece un método para la evaluación de la transcripción de dicha polimerasa independiente de promotor. / Tesis

Determina la relación existente entre el cuadro clínico y perfil epidemiológico de los niños con tuberculosis infantil drogo resistente con los resultados del tratamiento durante los años 2011 a 2015. El estudio es transversal, correlacional-causal, no experimental y retrospectivo. Se reportaron 96 casos, 82 ingresaron al estudio. Entre estos, 59% eran niños, con una edad media de 8 años y el 31% tuvo <5 años, 3 eran menores de 1 año. El caso índice (CI) se encontró en el 84% de la muestra. El 90% de casos no recibió tratamiento previo, 98% tuvo localización pulmonar y 49% se realizó la prueba de tuberculina (PPD), con ≥ 10 mm en el 73%. El 40% tuvieron frotis positivos, todos ellos tuvieron entre 5 a 14 años, y el 49% presentaron cultivos positivos. 28% tuvo Tuberculosis multidrogo resistente (TB-MDR) confirmada, 91% de ellos del grupo de edad de 10 a 14 años. Las drogas de segunda línea (DSL) para MDR / XDR-TB confirmada o probable se administró a 70 de 82 casos (85%) con una tasa de éxito del 88% y el 12% tuvo problemas durante el seguimiento. Existe una alta tasa de éxito del tratamiento y el tratamiento irregular es un factor importante para el fracaso terapéutico. Las áreas de El Agustino y Ate Vitarte, albergan el mayor número de pacientes con TB (DR) resistente a los medicamentos, sin embargo, vivir en el distrito de Santa Anita tiene una mayor correlación con el fracaso terapéutico. / Tesis

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in partial fulfillment of the requirements for the degree of Master of Medicine in Orthopaedic Surgery Johannesburg, 2017 / Background: The anterolateral approach to the spine for the surgical management of the Tuberculosis of the spine has been described. The surgical technique has evolved since the gold standard published by Hodgson et al. in 1956. The use of a Titanium Mesh Cage and the anterior instrumentation to construct the anterior column after adequate debridement defined the evolution. The aim of the study is to review the results of the patients that underwent this procedure between January 2012 and December 2015. Methods: The study was a retrospective study where 60 patients treated with this technique from 2012 – 2015 were reviewed. Sixty-one percent (61%) of the tested patients were HIV positive and 70.4% of the patients were female in the age group of 31-45 years. The surgical procedure was standardised for all the patients irrespective of their HIV status. The clinical and radiological outcomes measured consisted of the patients’ disability using the Oswestry Disability Index (ODI), the Frankel Neurological grading to measure neurological deficits and the Cobb angle to measure Kyphosis. The diagnosis of Tuberculosis of the Spine was confirmed in all the patients. Results: At a mean follow up period of 21.25 months, the ODI improved from a mean of 95.42% ± 6.57% before surgery to a mean of 8.00% ± 12.15% at the last follow up. There were 58 patients who were unable to walk independently before the surgery (Frankel A or B) but at the last follow up, 52 of the patients had achieved independent ambulation (Frankel D or E). The mean kyphosis was 33.90 ± 12.44 degrees before surgery, and in the immediate post-operative period, the mean kyphosis was 23.69 ± 10.31 degrees, and a mean of 26.27 ± 10.91 degrees was measured at the last follow up. There was a 30.12% correction achieved in the immediate post-operative period and an overall correction of 22.51% at the last follow up reflecting a loss of 7.61% in the kyphosis correction in the period between the immediate post-operative period and the last follow up. Complications were documented in six patients including two deaths unrelated to the procedure. Discussion: The ODI score showed an improvement as the mean value decreased by 87.42%. This is statistically and clinically significant (p=0.001). According to the work of Solberg et al. (2013) in degenerative spine, the threshold for a success is a mean change of 20% in the ODI scoring after lumbar disc surgery. Using this value as a proxy, an improvement of 87.42% is an excellent outcome. Before surgery, fifty-eight patients (96.7%) were non-ambulatory using the Frankel Neurological score. At the last follow up, 53 patients (91.4%) achieved a Frankel score of D or E and independent ambulation. This outcome compares favourably with ones published in the literature. The overall post-operative kyphosis correction achieved was 26.27 degrees (which translated to 22.51% correction) at the last follow up. This reflects a kyphosis correction loss of 7.61% that was not associated with any neurological deterioration and is therefore of no clinical significance. There were six cases of complications including two deaths unrelated to the procedure but the general debilitation of military Tuberculosis and Nosocomial infection. Conclusion: The anterior column reconstruction using the Titanium Mesh Cage and Anterior Instrumentation is safe and effective for the surgical management of the Tuberculosis of the Spine. There were good clinical outcomes as measured by the ODI score and the Frankel Neurological Grading system, and even though there was a loss of Kyphosis correction at the last follow up, this was not associated with a negative neurological outcome. Despite its limitation as a retrospective study, this study demonstrates that the procedure is safe and effective when used as an adjunct to the medical treatment of the Tuberculosis of the Spine. / MT2017

Introduction: The burden of disease due to HIV/AIDS and tuberculosis remains great for many countries around the world. Continuing attention must be devoted to these epidemics if we ever hope to one day contain their devastating effects on humankind. The objective of this study is to; to evaluate and compare cohort treatment outcomes of HIV infected TB patients and HIV infected non-TB patients treated with HAART at the Themba Lethu Clinic between 1st April 2004 and 1st April 2007. To measure outcomes in CD4, viral load, hemoglobin, liver function tests, weight, BMI, loss to follow up and death and to compare this outcomes between HIV patients who have had TB and HIV patients who have never had TB. Materials and Methods: information collected of patients for three years shall be used to carry out analysis. A total of 5818 patients were included in the cohort sample. 19.23% (1,048) of the patients had been diagnosed with TB at some point in time while 80.77% (4,770) had never been diagnosed with TB. Mean baseline CD4 cell counts were 113.47cells/mm3 for non TB patients and 88.85cells/mm3 for those who have ever had TB. This baseline CD4 counts are considered 2 months prior to ARV start and 1 month post the start of ARV. Baseline means for weight, BMI, AST and ALT were also taken into consideration by the two patient groups. Clinical out come was assessed and evaluated by comparing incidence of designated end points either as survival or failures. Incidence of deaths and loss to follow up was also compared in the two groups of patients. Results: Among HIV non TB patients, incidence rate of them having CD4 counts greater than 200 was at 36.47 persons per 10000 person days while for the patients who had been diagnosed with TB incidence of CD4 rising to above x 200 was lower at 34.19persons per 10000 person days. A rate ratio of 0.94 (95% CI 0.85 - 1.03) showed no true difference in the two groups. When looking at deaths in the two groups of patients, incidence in those who had TB was 3.84 deaths per 100 patient years and 4.16 deaths per 100 patient years for the non TB group with RR 0.93 and CI 0.66 - 1.28. Differences in incidence and outcomes were noticed in Hb gain, weight and BMI change, Liver function test changes over time and loss to follow up “defaulters”. Survival curves were modeled to show trend of change and log rank test were used to ascertain equality of survival curves. Where log rank p. values < 0.05 were noticed among survival curves of weight, BMI, AST, ALT, Hb and Loss to follow up. This again showed differences in weight, BMI, hemoglobin, AST, ALT and loss to follow up while no statistical differences were recognized between the two groups of patients when considering changes in CD4, deaths and Viral load over time as log rank test failed to reject the null hypothesis of similar curves. Conclusion: Data indicated that similarity and differences between HIV TB patients and HIV non TB patients could vary along certain outcomes. But one sure point is both groups of patients had an equal chance of staying alive when properly treated with ARV/HAART.

Thesis (M.Med.(Haematology)), Faculty of Health Sciences, University of the Witwatersrand, 2009 / Introduction Regulatory T cells (Tregs) are increasingly being recognized as key immunological players in immunosuppression and have been seen to be permissive for certain infections. Aim This study aimed to elucidate the role that Tregs play in symptomatic infection with Mycobacterium tuberculosis (TB), both with and without co-infection with human immunodeficiency virus type 1 (HIV 1) by quantification of these cells at ex vivo. It was then attempted to characterise the behaviour of FoxP3 positive cells in culture with stimulation. Methods Peripheral blood mononuclear cells were purified from uninfected controls, patients with active TB, patients with HIV infection and patients with HIV infection and active TB. The frequencies of Tregs were assessed by flow cytometry at ex vivo and again after four days of culture with stimulation with anti-CD3, Purified protein derivative, tetanus toxoid and HIV peptide superpools (gag and nef). These frequencies were compared between the four groups of patients. The ability of Tregs and effector T cells to proliferate was also assessed. Interferon-γ secretion was used as a measure of effector T cell response to stimulation. vi Results Frequencies of Tregs were significantly reduced in patients with active TB as compared with HIV infected patients and uninfected controls. Co-infected individuals showed a broad range of frequencies which were not significantly different from controls. These frequencies remained stable in culture with the exception of those individuals infected with HIV who showed a decline in the frequency of those cells expressing FoxP3 over the period. Cells expressing FoxP3 were not anergic and responded to stimulation. HIV specific proteins, in addition, resulted in specific effects on the Tregs with a positive interferon response to gag correlating with increased Treg frequencies and FoxP3 expression in CD4+ T cells correlated with the proliferative response of CD4+ T cells to Nef in HIV infected individuals. Conclusions This study shows significant differences of frequencies of FoxP3 positive producing cells in the peripheral blood at ex vivo in patients with active TB. The function of these cells in this population is uncertain and further functional data and long-term clinical follow-up is required. In addition, the frequencies of these cells remained constant over time and showed proliferative response to stimuli (most notably CD3) suggesting that these cells may be generated in the periphery.

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