Showing papers by "Afrânio Lineu Kritski published in 2018"
TL;DR: A high early mortality rate was observed among TB/HIV coinfected ICU patients in the Manaus, Amazon Region and the factors predictive of mortality were IMV, hypoalbuminemia, and severe immunosuppression.
Abstract: Objective: To identify factors predictive of mortality in patients admitted to the ICU with tuberculosis (TB)/HIV coinfection in the Manaus, Amazon Region. Methods: This was a retrospective cohort study of TB/HIV coinfected patients over 18 years of age who were admitted to an ICU in the city of Manaus, Brazil, between January of 2011 and December of 2014. Sociodemographic, clinical, and laboratory variables were assessed. To identify factors predictive of mortality, we employed a Cox proportional hazards model. Results: During the study period, 120 patients with TB/HIV coinfection were admitted to the ICU. The mean age was 37.0 ± 11.7 years. Of the 120 patients evaluated, 94 (78.3%) died and 62 (66.0%) of those deaths having occurred within the first week after admission. Data on invasive mechanical ventilation (IMV) and ARDS were available for 86 and 67 patients, respectively Of those 86, 75 (87.2%) underwent IMV, and, of those 67, 48 (71.6%) presented with ARDS. The factors found to be independently associated with mortality were IMV (p = 0.002), hypoalbuminemia (p = 0.013), and CD4 count < 200 cells/mm3 (p = 0.002). Conclusions: A high early mortality rate was observed among TB/HIV coinfected ICU patients. The factors predictive of mortality in this population were IMV, hypoalbuminemia, and severe immunosuppression.
18 citations
TL;DR: The proposed DST provides a quick and low-cost pretest for presumptive PTB patients, which is useful to guide confirmatory testing and patient management, especially in settings with limited resources in low and middle-incoming countries.
14 citations
TL;DR: This study highlights the need to understand more fully the rationale behind the continued use of these devices, as well as their applications in the treatment and prevention of tuberculosis.
Abstract: 1. Serviço de Pneumologia, Centro Hospitalar de Vila Nova de Gaia-Espinho, Porto, Portugal. 2. Epidemiology Research Unit – EpiUNIT – Instituto de Saúde Pública, Universidade do Porto, Portugal. 3. Faculdade de Medicina, Universidade do Porto, Porto, Portugal. 4. Faculdade de Medicina, Universidade Federal do Rio Grande do Sul – UFRGS – Porto Alegre (RS) Brasil. 5. Centro de Investigación, Prevención y Tratamiento de Infecciones Respiratorias, Hospital Universitario, Universidad Autonoma de Nuevo Leon, Monterrey, México. 6. Serviço de Pneumologia, Hospital Especializado Octávio Mangabeira, Secretaria de Saúde do Estado da Bahia, Salvador (BA) Brasil. 7. Faculdade de Medicina, Universidade Federal de Goiás – UFG – Goiânia (GO) Brasil. 8. WHO Collaborating Centre for TB and Lung Diseases, Fondazione Salvatore Maugeri, Istituto di Ricovero e Cura a Carattere Scientifico – IRCCS – Tradate, Italia. 9. Programa Acadêmico de Tuberculose, Hospital Universitário Clementino Fraga Filho – HUCFF – Instituto de Doenças do Tórax – IDT – Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ) Brasil. a. http://orcid.org/0000-0003-2257-3099; b. http://orcid.org/0000-0003-0230-2734; c. http://orcid.org/0000-0001-8973-4024; d. http://orcid.org/0000-0002-3038-7715; e. http://orcid.org/0000-0002-4050-5906; f. http://orcid.org/0000-0002-8551-3598; g. http://orcid.org/0000-0002-5900-6007; h. http://orcid.org/0000-0002-2597-574X In 2015, the World Health Organization (WHO) launched the End TB strategy, which has three pillars—integrated, patient-centered care and prevention; bold policies and supportive systems; and intensified research and innovation—and has the inbuilt concept of the elimination of tuberculosis.(1-4) The elimination of tuberculosis has been defined as < 1 case per million population, preelimination having been defined as < 10 cases per million. Since then, the three pillars have been officially adopted by a number of countries(5): in 2015, by Brazil, Ethiopia, the Russian Federation, South Africa, and Vietnam; and in 2016, by India, Indonesia, Swaziland, and Thailand.
11 citations
TL;DR: Compared with SSM, Xpert test showed a greater sensitivity, but it also had a time delay with respect to treatment initiation and a higher mean cost per examination.
Abstract: INTRODUCTION: The molecular test Xpert MTB/RIF (Xpert) has been recommended for use in the diagnosis of pulmonary tuberculosis (PTB); however, data on the cost of incorporating it under routine conditions in high-burden countries are scarce. The clinical impact and costs incurred in adopting the Xpert test in routine PTB diagnosis was evaluated in a prospective study conducted from November 2012 to November of 2013, in the City of Rio de Janeiro, Brazil. METHODS: The diagnostic and therapeutic cascade for TB treatment was evaluated using Xpert in the first stage (S1), and sputum smear microscopy (SSM) in the second stage (S2). The mean costs associated with each diagnostic test were calculated including equipment, human resources, supplies, and infrastructure. RESULTS: We included 232 subjects with probable TB (S1 = 87; S2 = 145). The sensitivities of Xpert and SSM were 91.7% (22/24) and 79.1% (34/43), respectively. The median time between triage and TB treatment initiation in S1 (n = 24) was 14.5 days (IQR 8-28.0) and in S2 (n = 43) it was 8 days [interquartile range (IQR) 6-12.0]. The estimated mean costs per examination in S1 and S2 were US$24.61 and US$6.98, respectively. CONCLUSIONS: Compared with SSM, Xpert test showed a greater sensitivity, but it also had a time delay with respect to treatment initiation and a higher mean cost per examination.
7 citations
TL;DR: The statistical method used in this study makes it possible to conclude that, over the six-month period, amikacin-associated hearing threshold shifts were detected by HFA and PTA, and that DPOAE testing was not efficient in detecting such shifts.
Abstract: Objective: To investigate early detection of amikacin-induced ototoxicity in a population treated for multidrug-resistant tuberculosis (MDR-TB), by means of three different tests: pure-tone audiometry (PTA); high-frequency audiometry (HFA); and distortion-product otoacoustic emission (DPOAE) testing. Methods: This was a longitudinal prospective cohort study involving patients aged 18-69 years with a diagnosis of MDR-TB who had to receive amikacin for six months as part of their antituberculosis drug regimen for the first time. Hearing was assessed before treatment initiation and at two and six months after treatment initiation. Sequential statistics were used to analyze the results. Results: We included 61 patients, but the final population consisted of 10 patients (7 men and 3 women) because of sequential analysis. Comparison of the test results obtained at two and six months after treatment initiation with those obtained at baseline revealed that HFA at two months and PTA at six months detected hearing threshold shifts consistent with ototoxicity. However, DPOAE testing did not detect such shifts. Conclusions: The statistical method used in this study makes it possible to conclude that, over the six-month period, amikacin-associated hearing threshold shifts were detected by HFA and PTA, and that DPOAE testing was not efficient in detecting such shifts.
4 citations
DOI•
University of Lisbon1, Universidade Federal do Rio Grande do Sul2, Universidade Nova de Lisboa3, Instituto Nacional de Saúde Dr. Ricardo Jorge4, Instituto Superior de Ciências da Saúde Egas Moniz5, Federal University of Rio de Janeiro6, Pasteur Institute7, King Abdullah University of Science and Technology8, University of Cape Town9, University of London10, Universidade Luterana do Brasil11
TL;DR: CPLP-TB, the largest CPLP M. tuberculosis molecular and drug susceptibility dataset, is assembled and analyzed, comprised of a total of 1447 clinical isolates, including 423 multidrug-resistant isolates from five C PLP countries, supporting the risk assessment of strain-specific trends.
Abstract: Tuberculosis (TB) remains a major health problem within the Community of Portuguese Language Speaking Countries (CPLP). Despite the marked variation in TB incidence across its member-states and continued human migratory flux between countries, a considerable gap in the knowledge on the Mycobacterium tuberculosis population structure and strain circulation between the countries still exists. To address this, we have assembled and analyzed the largest CPLP M. tuberculosis molecular and drug susceptibility dataset, comprised by a total of 1447 clinical isolates, including 423 multidrug-resistant isolates, from five CPLP countries. To make this data available to the scientific community and public health authorities we developed CPLP-TB (available at http://cplptb. ff.ulisboa.pt), an online database coupled with web-based tools for exploratory data analysis. As a public health tool, it is expected to contribute to improved knowledge on the M. tuberculosis population structure and strain circulation within the CPLP, thus supporting the risk assessment of strain-specific trends.