Se hizo un estudio de casos y controles ﷓ en 70 trabajadores de salud con diagnóstico de tuberculosis pulmonar (TBP) y 70 trabajadores sin antecedentes de esta enfermedad que laboraban en el mismo centro hospitalario durante el periodo 1995-2000. El objetivo del estudio fue demostrar la asociación entre los factores de riesgo ocupacionales y la TBP en estos trabajadores de salud de este centro hospitalario. De acuerdo al diseño, cada uno de los trabajadores fue entrevistado, se revisaron sus historias clínicas así como las bases de datos del Programa de Control de Tuberculosis, del área de Remuneraciones y del Servicio de Salud Ocupacional del HNGAI. El análisis multivariado demostró que el factor de riesgo significativo fue no usar respirador N95 (p=0.007, OR=7.9) y menor edad (p=0.017,0R=1.1). / A study of cases and controls of 70 healthcare workers with diagnostic of pulmonary tuberculosis (TBP) and 70 healthcare workers without antecedents of this illness, who worked in the same hospital center during the period 1995﷓2000. The objective of the study was to demonstrate the association between the occupational risk factors and TBP in these healthcare workers. Each one of them was interviewed, and clinical histories, the databases of the Program of Control of Tuberculosis, of the area of Remunerations and of the Service of Occupational Health of the HNGAI were revised. In the multivariate analysis, the risk factor with significant went to no use of mask respirator N95 (p=0.007, OR=7.9) and low age (p=0.017, OR=1.1).

Antecedentes: El control de la tuberculosis es un complejo reto para la salud pública en el mundo que involucra asegurar el acceso al diagnóstico, tratamiento y cura de los pacientes. Se sabe que el no cumplimiento del tratamiento puede llevar a complicaciones fatales y a la emergencia de cepas resistentes. La identificación y el entendimiento de los factores que determinan el no cumplimiento del tratamiento, proveerán información para aumentar la eficacia de los programas de control. Objetivo: Identificar factores de riesgo para el abandono del tratamiento antituberculosis en el Perú. Material y métodos: Se realizó un estudio de casos y controles en las provincias de mayor incidencia de abandono de tratamiento durante el año 2004. Se seleccionaron 295 casos y 590 controles y la relación de casos a controles fue de 1:2 los factores relacionados al abandono de tratamiento, se evaluaron mediante análisis de riesgo. Resultados: Se identificó como factores de riesgo para el abandono el presentar una edad entre 15 y 20 años (OR=1.78/1.02-3.13) o mayor de 40 años (OR=1.68/1.12-2.51),el presentar un nivel de educación inferior: secundaria (OR=1.88/1.09-3.26), primaria (OR=2.46/1.24-4.86), así como presentar al menos 1 Necesidad Básica Insatisfecha (NBI) (OR=1.67/1.09-2.54), el considerar al personal capacitado a medias (OR=1.63/1.06-2.52), así como el presentar el antecedente de abandono anterior (OR=7.06/4.32-11.53), así como manifestar disconformidad con la información recibida por el personal: considerar elemental (regular) la información recibida (OR=3.64/1.11-11.88), mostrarse insatisfecho o muy insatisfecho con la información recibida (OR=5.38/1.33-21.73). Conclusiones Es evidente que a pesar que existen muchos factores reconocidos en la bibliografía como factores de riesgo para el abandono de tratamiento, luego del análisis con la regresión logística, son solamente nueve los factores que podrían considerarse factores pronósticos de abandono de tratamiento. / Background: Tuberculosis control is a complex public health challenge in the world that involves ensuring access to diagnosis, treatment and cure of patients. It is known that no treatment compliance can lead to fatal complications and the emergence of resistant strains. The identification and understanding of the determinants of treatment noncompliance, provide information to enhance the effectiveness of control programs. Objective: To identify risk factors for noncompliance with tuberculosis treatment in Peru. Methods: We performed a case-control study in the provinces with the highest incidence of treatment noncompliance in 2004. We selected 295 cases and 590 controls and cases to controls ratio of 1:2 will be factors related to noncompliance of treatment were assessed by risk analysis. Results: We identified risk factors for noncompliance the present age from 15 to 20 years (OR = 1.78/1.02-3.13) or > 40 years (OR = 1.68/1.12-2.51), the present level of education Bottom: secondary (OR = 1.88/1.09-3.26), primary (OR = 2.46/1.24-4.86) and submit at least 1 unmet basic needs (NBI) (OR = 1.67/1.09-2.54), to consider personnel trained half (OR = 1.63/1.06-2.52) and presenting a history of previous of noncompliance (OR = 7.06/4.32-11.53), and to express disagreement with the information received by staff, to consider elementary (regular) information received (OR = 3.64/1.11-11.88), appear dissatisfied or very dissatisfied with the information received (OR = 5.38/1.33-21.73). Conclusions: It is evident that although there are many factors known in the literature as risk factors for discontinuing treatment after logistic regression analysis, are only nine factors that could be considered predictors of treatment dropout.

D.Cur. / Although tuberculosis is regarded as a curable disease, it still remains a health problem. The World Health Organization declared tuberculosis as a global emergency in 1993, and a global failure of health service providers to deal with the burden of tuberculosis in 1997. One of the factors that has a detrimental effect on the struggle against tuberculosis, is the fact that certain patients suffering from tuberculosis interrupt and/or stop taking their treatment before the scheduled period, thus, not adhering to their treatment. This non-compliance contributes to the increasing problem of chronic “halfcured and half-ill” patients with an increase of resistance against some of the first-linemedication. The problem with resistance is that second-line-medication must then be used. These medications are more toxic, the treatment is more expensive and takes longer, and, at the most, only half of the patients are cured. There are however other patients who comply with their treatment and complete it successfully. As a result of the above-mentioned problem the researcher has researched treatment compliance of tuberculosis within the context of the North West Province’s Southern District with the following objectives: ? to explore and describe the reasons why certain patients suffering from tuberculosis interrupt or prematurely stop their treatment; ? to explore and describe the reasons why certain patients suffering from tuberculosis comply with their treatment and complete it successfully; ? to develop and validate strategies in order to facilitate treatment compliance of the patient suffering from tuberculosis. Unstructured interviews were conducted with six patients who complied with their treatment, 11 patients who did not comply with their treatment (or defaulters), eight family members of non-compliant patients, and nine community health nurses. The following questions were asked in each respective group of participants: ? The treatment compliant patients and the defaulters were asked: “Tell me about your TB and treatment”. ? The family members were asked: “Tell me how his TB and treatment was for him”. ? The nurses were asked: “Why do you think some TB patients comply with their treatment and others are defaulters?” Interviews were recorded on tape and transcribed verbatim. Tesch’s (in Creswell, 1994:155) eight-step method of data-analysis was used in collaboration with an independent encoder to analyse the data. This research has proven that the treatment compliant patient is motivated and ready to comply with his treatment. Although the defaulter is also motivated he is not ready to comply with his treatment, because he does not accept tuberculosis as his problem nor the treatment thereof. This non-acceptance contributes to his misconceptions regarding tuberculosis and its treatment, and a negative attitude also develops towards the medicine, which becomes evident in the termination or adjustment of his treatment. The compliant patient on the other hand, within the same situation, when experiencing side effects, for example, still adheres to his treatment. Factors that contribute to the treatment compliance of the patient are: his motivation; his stage of behavioural change; the application of specific processes that will enable the patient to move from a nonready to a ready mode, where treatment compliance can be maintained; a patientcentred approach in the nurse-patient-relationship, where effective interpersonal skills are applied, where the patient is actively involved and where a member of his family is involved in the interaction process; and where cultural beliefs, stigmatisation and misconceptions with regard to tuberculosis and treatment are addressed. Strategies have been developed and validated that may enable the nurse to facilitate the patient’s treatment compliance. These strategies address the following aspects in order to promote the nurse’s knowledge and skills concerning: tuberculosis as problem and the treatment thereof; interpersonal skills within a patient-centred nursing approach; assessment of patient’s readiness to accept behavioural change within the patient’s cultural context; facilitation of the patient’s treatment compliance; facilitation of the community’s behavioural change in order to promote social support of the patient while cultural beliefs, stigmas and misconceptions are addressed.

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Medicine in the branch of Haematology. Johannesburg, 2015. / Introduction: The Gene Xpert MTB/Rif assay (Xpert) is a nucleic acid amplification technique that has been studied in the diagnosis of both pulmonary and, to a lesser extent, extrapulmonary tuberculosis (TB). This study was performed in the National Health Laboratory Services (NHLS) laboratory at Charlotte Maxeke Hospital which services a population with a high prevalence of Mycobacterium Tuberculosis Complex (MTBC) infection. The study aimed to develop a protocol for the processing of pleural and ascitic fluid samples to be run on Xpert for MTBC diagnosis, to evaluate the sensitivity and specificity of the Xpert assay as compared to the gold standard MTBC culture assays and to assess the utility of the Xpert assay as part of the diagnostic algorithm for fluid samples received in high prevalence MTBC laboratories. Materials and methods: A total of 392 pleural and ascitic fluid specimens were received for routine immunophenotypic analysis between August 2012 and February 2013 at the NHLS flow cytometry laboratory in Charlotte Maxeke hospital. Of these specimens, 229 had sufficient residual volume (>0.5ml) after routine immunophenotypic analysis to be tested on Xpert. Specimens were processed as per the manufacturer’s guidelines for pulmonary specimens and results were compared to the gold standard culture for Mycobacterium tuberculosis. Results: Xpert positivity was detected in 8.7% (20/229) of the total specimens. Only 43% (99/229) of these specimens were submitted for concurrent MTBC liquid culture (Mycobacterium Growth Indicator tube, MGIT) testing based on the laboratory information system history. Positivity on Xpert was shown in 9% (9/99) of specimens compared to 17% (17/99) on MGIT. One false positive was detected on Xpert. More than half of the specimens, 57% (130/229) were not referred for concurrent MTBC culture. The Xpert detected MTBC in 8.5% (11/130) of these specimens, with 1 Rifampicin resistant case identified. Xpert sensitivity and specificity in this study were 50% (CI:26-75%) and 99% (CI:91-100%) respectively Conclusion: The sensitivity and specificity of Xpert in this study was comparable to that found in other studies performed on fluid samples. Importantly, this study demonstrates that in a high burden HIV/TB setting like South Africa, more than 50% of fluid specimens referred for immunophenotypic analysis to exclude lymphoma are not referred for concurrent MTBC culture testing. Incorporation of Xpert into the laboratory diagnostic algorithm (LDA) in the immunophenotypic laboratory would, therefore, have a number of benefits, improving overall patient work-up and care. Implementation and policy uptake, however, would require a full costing analysis as Xpert testing would be performed in addition to, and not instead of, routine testing.

Thesis (M Med(Chemical Pathology))--University of Limpopo (Medunsa Campus), 2010. / Objectives: Tuberculosis (TB) is a major health problem in South Africa with disease rates more than double those observed in other developing countries and up to 60 times higher than those currently seen in the USA or Western Europe. Seventy years ago, it was demonstrated that approximately 70% of patients with primary adrenal insufficiency (PAI) was due to TB and this remains a major cause of PAI in developing countries. With these figures in mind it is of great concern that patients with TB are not screened for adrenal insufficiency more often. The aim of the study was to investigate the prevalence of adrenal insufficiency in patients diagnosed with TB. Study population: Seventy three patients at the Dr George Mukhari- and Kalafong hospitals in Gauteng, South Africa, aged 20-91 years, were included. 49 Females and 24 males were recruited. All patients had positive TB microscopy. Metods: High dose adrenocorticotropic hormone (ACTH) stimulation tests were done on all patients, a post stimulation cortisol concentration of > 500nmol/L was considered a normal response. Baseline ACTH determination was also done on all patients. ACTH determination was performed using the Siemens Immulite 2000 ACTH assay, whilst cortisol determination was done on a Beckman Coulter UniCel DxI 800 immunoassay system. Results: 68 patients had a normal response. 5 patients had a post ACTH stimulation cortisol of less than 500nmol/L. Conclusion: Five patients (6.85%) had a blunted response to the ACTH stimulation test which identifies some form of adrenal insufficiency. None of the patients had an increased ACTH concentration. This finding excludes PAI and the normal ACTH concentrations in these 5 patients are highly suggestive of secondary-or tertiary adrenal insufficiency.

Thesis (M Med(Family Medicine))--University of Limpopo (Medunsa Campus), 2010. / Background: In spite of the substantial progress made in the development and implementation of many strategies necessary for effective tuberculosis control, the disease continues to be the leading cause of death, and in Africa, because of the expanding HIV epidemic, there has been an increase of HIV associated TB. In 2005 African health ministers declared TB a regional emergency. Although TB treatment is free and Lesotho has 100% DOTS coverage, the country still reported an incidence of 485 per 100,000 population (2005) and a treatment success of 74%, which is still lower than 85% WHO target. Objective: This six-month study at Scott Hospital Health Service area in Lesotho was undertaken to assess the outcome measures of strategies instituted to improve the tuberculosis control programme and determine the effect on TB treatment outcome indicators and TB/HIV integration. xi Methodology: The study design was a quantitative, descriptive study. The principal researcher and a research assistant used a questionnaire to collect data from the outpatient, TB suspect and treatment registers. Study population and sample: The subjects of the study were all adult new sputum- smear positive TB patients enrolled and registered in the Scott Hospital Health Service area TB register from 1st January to 30 June 2006. Results and discussion: A total of 100 new sputum smear positive adult TB patients presenting at Scott Hospital during the research period formed the sample group of this study. This included 47 female and 53 male patients. Their ages ranged from 18 years to 84 years with the mean age of 42 years. Majority 52 (52%) were in the age group 20-39 years, followed by 27 (27%) in age group 40-59 years and 19 (19%) in the age group 60-79 years. There was a high TB/HIV co-infection of 40 (81.6%) among the 49 (49%) who accepted HIV counseling and testing. Active screening of patients for TB resulted in 378 (86.3%) of the 438 TB suspects having their sputa tested. Of these, 100 (26.5%) were new sputum smear positive. Good xii adherence and treatment supervision resulted in sputum conversion rate of 89 (89%). Rigorous implementation of the DOTS strategy showed increased treatment outcomes: cure rate of 76 (76%) and treatment success of 85 (85%). These results were similar to findings of other studies carried out in Cambodia, Tanzania and Rwanda to assess TB programme performance following introduction of improvements. Conclusion: This study demonstrates that implementation of activities consistent with new stop TB DOTS strategy to improve TB control is possible in a rural setting and leads to improvement in TB case detection and treatment success and a decrease in both defaulter and death rates.

Antecedentes: El control de la tuberculosis es un complejo reto para la salud pública en el mundo que involucra asegurar el acceso al diagnóstico, tratamiento y cura de los pacientes. Se sabe que el no cumplimiento del tratamiento puede llevar a complicaciones fatales y a la emergencia de cepas resistentes. La identificación y el entendimiento de los factores que determinan el no cumplimiento del tratamiento, proveerán información para aumentar la eficacia de los programas de control. Objetivo: Identificar factores de riesgo para el abandono del tratamiento antituberculosis en el Perú. Material y métodos: Se realizó un estudio de casos y controles en las provincias de mayor incidencia de abandono de tratamiento durante el año 2004. Se seleccionaron 295 casos y 590 controles y la relación de casos a controles fue de 1:2 los factores relacionados al abandono de tratamiento, se evaluaron mediante análisis de riesgo. Resultados: Se identificó como factores de riesgo para el abandono el presentar una edad entre 15 y 20 años (OR=1.78/1.02-3.13) o mayor de 40 años (OR=1.68/1.12-2.51),el presentar un nivel de educación inferior: secundaria (OR=1.88/1.09-3.26), primaria (OR=2.46/1.24-4.86), así como presentar al menos 1 Necesidad Básica Insatisfecha (NBI) (OR=1.67/1.09-2.54), el considerar al personal capacitado a medias (OR=1.63/1.06-2.52), así como el presentar el antecedente de abandono anterior (OR=7.06/4.32-11.53), así como manifestar disconformidad con la información recibida por el personal: considerar elemental (regular) la información recibida (OR=3.64/1.11-11.88), mostrarse insatisfecho o muy insatisfecho con la información recibida (OR=5.38/1.33-21.73). Conclusiones Es evidente que a pesar que existen muchos factores reconocidos en la bibliografía como factores de riesgo para el abandono de tratamiento, luego del análisis con la regresión logística, son solamente nueve los factores que podrían considerarse factores pronósticos de abandono de tratamiento. / Background: Tuberculosis control is a complex public health challenge in the world that involves ensuring access to diagnosis, treatment and cure of patients. It is known that no treatment compliance can lead to fatal complications and the emergence of resistant strains. The identification and understanding of the determinants of treatment noncompliance, provide information to enhance the effectiveness of control programs. Objective: To identify risk factors for noncompliance with tuberculosis treatment in Peru. Methods: We performed a case-control study in the provinces with the highest incidence of treatment noncompliance in 2004. We selected 295 cases and 590 controls and cases to controls ratio of 1:2 will be factors related to noncompliance of treatment were assessed by risk analysis. Results: We identified risk factors for noncompliance the present age from 15 to 20 years (OR = 1.78/1.02-3.13) or > 40 years (OR = 1.68/1.12-2.51), the present level of education Bottom: secondary (OR = 1.88/1.09-3.26), primary (OR = 2.46/1.24-4.86) and submit at least 1 unmet basic needs (NBI) (OR = 1.67/1.09-2.54), to consider personnel trained half (OR = 1.63/1.06-2.52) and presenting a history of previous of noncompliance (OR = 7.06/4.32-11.53), and to express disagreement with the information received by staff, to consider elementary (regular) information received (OR = 3.64/1.11-11.88), appear dissatisfied or very dissatisfied with the information received (OR = 5.38/1.33-21.73). Conclusions: It is evident that although there are many factors known in the literature as risk factors for discontinuing treatment after logistic regression analysis, are only nine factors that could be considered predictors of treatment dropout.

El presente estudio titulado “Factoresque Condicionan el Nivel de Adherencia al Tratamiento de los Pacientes de la E.S.N. de Prevención y Control de la Tuberculosis en el C.S. Fortaleza” tiene como objetivo general el determinar los factores que condicionan el Nivel de Adherencia al tratamiento Antituberculoso, identificando los factores propios del Paciente y los propios del servicio de salud. El estudio es de nivel aplicativo, tipo cuantitativo, método descriptivo de corte Transversal. La población estuvo conformada por todos los pacientes que se encontraban en la 2da. Fase del esquema I de tratamiento al momento de la recolección de los datos, siendo la población estudiada de 42 pacientes. Los resultados obtenidos fueron que los factores propios del paciente se encuentran presentes en el 100% de los pacientes pertenecientes al grupo de No Adherentes al tratamiento, mientras que estos mismos factores no se presentan en el grupo que tiene una buena adherencia al tratamiento. Respecto a los factores propios del Servicio de Salud están presentes en ambos grupos por lo que no se puede afirmar que condicionen el nivel de Adherencia en los Pacientes, en el grupo de No adherentes se encuentran presentes en un 100% y en el grupo de Adherentes en un 21.4%. Por lo que se concluye que los factores Propios del Paciente condicionan el Nivel de Adherencia al Tratamiento Antituberculoso. / The present titled study "Factors that Condition the Level of Adherence to the Treatment of the Patients of the E.S.N. of Prevention and Control of the Tuberculosis in the C.S. Strength" he/she has as general objective determining the factors that condition the Level of Adherence to the treatment against the tuberculosis identifying the factors characteristic of the Patient and those characteristic of the service of health. The study is of level applicative, quantitative type, descriptive method of cross section. The population was conformed by all the patients that were in 2da o'clock. Phase of the outline treatment I to the moment of the gathering of the data, being the studied population of 42 patients. The obtained results were that the factors characteristic of the patient are present in 100% of the patients belonging to the group of Not Adherent to the treatment, while these same factors are not presented in the group that has a good adherence to the treatment. Regarding the factors characteristic of the Service of Health they are present in both groups for what one cannot affirm that they condition the level of Adherence in the Patients, in the group of not adherent they are present in 100% and in the group of Adherent in 21.4%. For what you concludes that the factors Characteristic of the Patient condition the Level of Adherence to the Treatment against the tuberculosis.

Actualmente la tuberculosis sigue siendo una amenaza para la salud y el bienestar de las personas del Perú y del mundo. La Tuberculosis no sólo avanza en forma incontrolable, sino que en estas últimas décadas el bacilo de Kock se ha vuelto muy resistente al tratamiento primario, en este caso se dice que el paciente es multidrogorresistente. Perú es uno de los ocho países en el mundo con mayor número de pacientes afectados con Tuberculosis Multidrogorresistente (TB-MDR), la forma más grave de la tuberculosis, según un informe de la Organización Mundial de la Salud (OMS), además la aparición de un nuevo tipo de Tuberculosis multidrogorresistente conocido como Tuberculosis XDR, que es casi imposible de ser tratada en países en desarrollo y esta presente en 45 países. Las causa que producen este tipo de tuberculosis (TB-MDR) son diversas, siendo necesario conocer sobre la enfermedad. Por tal motivo esta investigación titulada “Conocimientos sobre Tuberculosis Multidrogorresistente de pacientes que asisten a la Estrategia Sanitaria Nacional de Prevención y Control de Tuberculosis del CS Madre Teresa de Calcuta. Lima-Perú.2008” tiene como objetivo general determinar el Nivel de conocimiento sobre Tuberculosis Multidrogorresistente de los pacientes que asisten a la ESN- PCT.y como objetivos específicos identificar el nivel de conocimientos sobre tuberculosis multidrogorresistente de los pacientes, del esquema I, Esquema II y Esquema MDR de tratamiento. El estudio es de nivel aplicativo, tipo cuantitativo, método descriptivo de corte transversal. La población estuvo conformada por todos los pacientes de la Estrategia Sanitaria Nacional de Prevención y Control de Tuberculosis (ESN-PCT) del CS “Madre Teresa de Calcuta”. Los resultados fueron que de un total de 95 (100%) pacientes con tuberculosis 51 (53,68%), tienen un conocimiento medio; 34 (35,79%), un conocimiento bajo y sólo 10 (10,53%) un conocimiento alto. Según esquemas de tratamiento: Esquema I, de un total de 54 (100%) pacientes 28(51,85%) cuentan con un conocimiento bajo, 25(46,30%) pacientes con conocimiento medio y sólo 1 (1.85%) con conocimiento alto. Esquema II, de un total de 21 (100%) pacientes 14(66,67%) cuentan con un conocimiento medio, seguido de 4(19,05%), con conocimiento bajo y sólo 3 (14,26%) con conocimiento alto. Esquema MDR, de un total de 20(100%) pacientes 12(60%) cuenta con un conocimiento medio, seguido de 6(30%), con conocimiento alto y 2 (10%) con conocimiento bajo. Por lo que se concluye que el nivel de conocimientos que predomina en los pacientes que asisten a la ESN-PCT del CS “Madre Teresa de Calcuta” predominantemente medio. / Today tuberculosis remains a threat to the health and welfare of the people of Peru and the world. Tuberculosis not only moving in an uncontrolled way, but in recent decades bacilli Kock has become highly resistant to primary treatment, in this case states that the patient is multidrug. Peru is one of the eight countries in the world with the largest number of patients with multidrug Tuberculosis (MDR-TB), the most serious form of tuberculosis, according to a report by the World Health Organization (WHO), plus the appearance a new type of multidrug tuberculosis known as XDR TB, which is almost impossible to be treated in developing countries and is present in 45 countries. The causes that produce this kind of tuberculosis (MDR-TB) are diverse, being necessary to know about the disease. Therefore this research entitled "Knowledge on Drug resistant Tuberculosis patients attending the National Health Strategy for Prevention and Control of Tuberculosis SC Mother Teresa of Calcutta. Lima-Perú.2008 "aims to determine the general level of knowledge about TB multidrug patients attending the PCT.y ESN-specific objectives identify the level of knowledge of multidrug tuberculosis patients, the scheme I outline Schedule II and MDR treatment. The study is application-level, quantitative, descriptive cross method. The population consisted of all patients in the National Health Strategy for Prevention and Control of Tuberculosis (ESN-PCT) of the CS "Mother Teresa of Calcutta." The results were that out of 95 (100%) patients with tuberculosis 51 (53.68%) have a knowledge environment; 34 (35.79%), knowledge, and only under 10 (10.53%) a knowledge high. According to treatment schemes: Scheme I, a total of 54 (100%) patients 28 (51.85%) have a low awareness, 25 (46.30%) patients and only half understanding 1 (1.85%) with knowledge high. Scheme II, a total of 21 (100%) patients 14 (66.67%) have a knowledge medium, followed by 4 (19.05%), with the knowledge and under only 3 (14.26%) with knowledge high. MDR Scheme, a total of 20 (100%) patients 12 (60%) has a knowledge medium, followed by 6 (30%), with high knowledge and 2 (10%) with low knowledge. It is therefore concluded that the prevailing level of knowledge in patients attending the ESN-PCT CS "Mother Teresa of Calcutta" predominantly middle.

La tuberculosis es una enfermedad infecciosa que constituye un grave problema de salud pública a nivel mundial principalmente en países en vías de desarrollo, como el Perú. Las limitaciones de los métodos clásicos de diagnostico (baciloscopía y cultivo) así como la alta frecuencia de ésta enfermedad han creado la necesidad de implementar nuevas estrategias para incrementar la sensibilidad de las pruebas y a su vez reducir el tiempo necesario para establecer el diagnostico confirmatorio. Considerando que los estudios correspondientes a la región del Tracto Respiratorio Inferior (TRI) son escasos, el objetivo de esta tesis fue determinar el perfil molecular de Mycobacterium tuberculosis en muestras biológicas del TRI de pacientes limeños con sospecha de tuberculosis. En el presente trabajo se evaluaron 43 muestras de pacientes limeños con sospecha clínica de tuberculosis las cuales fueron obtenidas a través de lavado bronquial, aspirado bronquial, secreción bronquial, lavado bronco-alveolar, aspirado bronco-alveolar y broncofibroscopía. De estas muestras se extrajo DNA y se realizó la prueba del PCR - Nested, para ello se empleó como secuencia diana el gen de la proteína A (65KDa) de Mycobacterium tuberculosis, los productos amplificados fueron evidenciados mediante electroforesis en gel de agarosa y tinción con bromuro de etidio. Los resultados obtenidos muestran que el 77% de las muestras procesadas poseen DNA de Mycobacterium tuberculosis, demostrándose la alta sensibilidad y especificidad del método empleado, el 82% de estas muestras correspondieron a la región del árbol bronquial superior, debido a que esta región es el punto de partida para la diseminación de esta micobacteria hacia otras regiones del tracto respiratorio y además, a que la mayoría de muestras fueron tomadas directamente de esta región. Asimismo, la aplicación de la prueba PCR- Nested incrementó la sensibilidad de detección 5.5 veces con respecto a un único evento de amplificación, lo cual demuestra la utilidad de esta prueba en el análisis de material biológico con baja carga micobacteriana como las empleadas en este trabajo. Finalmente, se concluye que la prueba PCR- Nested es un método altamente sensible y específico para detectar DNA de Mycobacterium tuberculosis a partir de muestras procedentes del TRI. / Tuberculosis is an infectious disease that constitutes a serious public health problem worldwide, mainly in developing countries such as Peru. The limitations of the traditional methods of diagnosis (smear and culture) as well as the high incidence of this disease have created the need to implement new strategies to increase the sensitivity of tests to reduce time to establish a confirmed diagnosis. Since there are not many researches at the region of the Lower Respiratory Tract (LRT), the objective of this study was to determine the molecular profile of Mycobacterium tuberculosis in biological samples taken from the LRT of patients with suspicion tuberculosis. In the present study, 43 samples from patients with clinical suspicion of tuberculosis were evaluated. The samples were obtained through bronchial lavage, bronchial aspirate, bronchial secretions, bronco-alveolar lavage, and sucked bronco-alveolar broncofibroscopy. DNA extraction was prepared from each sample, and it was used in a PCR- Nested test targeting the gene encoding the protein A (65KDa) from M. tuberculosis. The results showed that DNA from M. tuberculosis was detected in 77% of the processed samples, revealing a high sensitivity and specificity of this method. From the positive samples, 82% corresponded to those obtained from the bronchial tree top region. This last result is explained because of the fact that most of the samples were taken directly from this region, which is the starting point for the mycobacteria dissemination toward other regions of the respiratory tract. In addition, the application of the PCR-Nested test increased the sensitivity of detection by 5.5 fold compared to a single event amplification, demonstrating the usefulness of this test in the analysis of biological material with low mycobacterial load as those used in this work. Finally, we conclude that the PCR-Nested test is a highly sensitive and specific method for detecting DNA from Mycobacterium tuberculosis in samples from the LRT.