Incorporação de atores da Rede Brasileira de Pesquisa em TB nas atividades do Jornal Brasileiro de Pneumologia da Sociedade Brasileira de Pneumologia e Tisiologia
01 Aug 2004-Jornal Brasileiro De Pneumologia (Sociedade Brasileira de Pneumologia e Tisiologia)-Vol. 30, Iss: 4, pp 303-306
TL;DR: This issue of the Jornal Brasileiro dePneumonologia (JBP, Brazilian Journal of Pulmonary Medicine) is a collection of articles concerning tuberculosis (TB), conceived as a companion to the publication of the proceedings and conclusions of the I Encontro Nacional deTuberculose (1st National Tuberculosis Forum), to be held in Brasilia from June 30 to July 3, 2004.
Abstract: This issue of the Jornal Brasileiro dePneumonologia (JBP, Brazilian Journal ofPulmonary Medicine) is a collection of articlesregarding tuberculosis (TB). It was conceived as acompanion to the publication of the proceedingsand conclusions of the I Encontro Nacional deTuberculose (1st National Tuberculosis Forum), tobe held in Brasilia from June 30 to July 3, 2004.The forum represents a milestone in the history ofPhthisiology in Brazil and is the culmination ofefforts by the think tank known as the InteligenciaNacional em TB (National TB Knowledge Base),which is composed of representatives of variousentities. The Secretaria de Vigilancia em Saude doMinisterio da Saude (Ministry of Health, Departmentof Health Oversight), the Sociedade Brasileira dePulmonologia e Tisiologia (SBPT, Brazilian Societyof Pulmonology and Phthisiology) and the RedeBrasileira de Pesquisa em Tuberculose (Rede-TB,Brazilian Tuberculosis Research Network) are allrepresented. The impact of their actions, agreedupon in a transparent and cordial way, can be seenas much in the content of the event as in thenature of the articles published in this issue of thejournal. These articles provide unequivocal evidenceof the interdisciplinary and horizontal quality ofRede-TB activities. When the position of JPBassociate editor for TB was created, there were onlytwo TB-related articles under review. On May 14,2004, Rede-TB researchers were invited, and readilyagreed, to work in collaboration with the JBP. Sincethen, 20 original articles, 3 review articles and 2case reports have been submitted for publication.These 25 articles address various spheres ofknowledge: epidemiology (4), diagnosis (6), clinicalmedicine and treatment (7), operational research(4), molecular epidemiology (1), genetics (1),immunology(1) and chemoprophylaxis(1). Thereviewers should be complimented on their agility,which made it possible to have a sufficient numberof TB-related articles approved for publicationbefore the deadline for this issue. Although it wasnot possible, in the current issue, to publish all ofthe TB-related manuscripts submitted, many ofthese extremely relevant and high-quality articleswill appear in subsequent issues of the JBP.In response to a joint proposal put forth bythe governmental projects Polos de EducacaoPermanente (Poles of Continuing Education) andParque Produtivo (Productivity Estate), a re-evaluation of the functions and interrelationshipsamong the various entities affecting TB control iscurrently underway. This re-assessment involves thefederal Ministries of Health, Science andTechnology, and Education, as well as public andprivate medical schools. In addition, state andmunicipal administrations, health councils, medicalsocieties such as the SBPT, professionalorganizations such as the Conselho Regional deMedicina do Rio de Janeiro (CREMERJ) andnongovernmental organizations dealing with TBor HIV, as well as research networks such as theRede-TB, were included in this project. Conferenceshave been held on the subjects of scientifictechnology and technological innovation, theaccreditation status of university hospitals has beenscrutinized, and the subject of university reformhas been discussed in depth. The Rede-TBresearchers have been working in cooperation withthe SBPT, using the JBP as a communicationvehicle. Their objectives are to identifyshortcomings and challenges yet to be met in thefields of science, technology and technologicalinnovation, propose directives that encourage the
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TL;DR: Male gender and PPD > 10 mm were significantly more frequent in the tuberculosis group and among the continuous variables, adenosine deaminase (ADA), percentile of cells, protein and age performed better as isolated diagnostic criteria.
Abstract: INTRODUCAO: A tuberculose e a causa mais frequente de derrame pleural no Brasil. Em mais de 50% dos casos o tratamento tem sido instituido sem a confirmacao do diagnostico. Nosso objetivo e identificar variaveis que possam contribuir para este diagnostico. METODO: Estudamos 215 pacientes subsequentes com derrame pleural, 104 com tuberculose (TB) e 111 com outras causas (NTB): 41 neoplasias, 29 transudatos, 28 parapneumomicos e 13 de outras etiologias. Variaveis clinicas, radiologicas e laboratoriais foram avaliadas quanto ao poder em discriminar os dois grupos de modo isolado ou em associacao. RESULTADOS: O sexo masculino e a reacao ao PPD maior do que 10mm foram significantemente mais frequentes no grupo da tuberculose. Dentre as variaveis continuas, a adenosina desaminase (ADA), o percentual de celulas, a proteina e a idade mostraram melhor desempenho isolado para o diagnostico, com uma area abaixo da curva ROC maior do que 0,7 e razao de chance superior a 5. As caracteristicas radiologicas, a desidrogenase latica, os leucocitos e o tempo de doenca nao foram capazes, isoladamente, de diferenciar o grupo TB do NTB. A associacao da ADA com qualquer uma das demais variaveis continuas, de melhor desempenho isolado, possui uma LR+ maior do que 10 e uma LR- menor do que 0,1, o que praticamente confirma a presenca ou ausencia da tuberculose pleural. CONCLUSOES: Em pacientes com ADA maior do que 39U/L, a sensibilidade foi de 95%. A especificidade pode ser aumentada, para mais de 90%, se considerarmos os derrames nao purulentos ou com predominio de linfocitos (>50%).
17 citations
TL;DR: The appropriate combination of conventional epidemiology and genotyping of M. tuberculosis contributes to a better understanding of the dynamics of tuberculosis transmission even when such a study is performed in a single, isolated health clinic.
Abstract: BACKGROUND: Tuberculosis is an ancient disease, which still remains one of the major ills faced by mankind in the 21st century. In recent decades, new technologies employing the knowledge gained from molecular biology studies have allowed for more accurate detection of tuberculosis and increased investigation of the etiology and epidemiology of the disease. AIM: Evaluating the degree of similarity among strains of Mycobacterium tuberculosis provided by the Phthisiology Sector of Centro de Saude Navegantes (Navegantes Health Clinic) in Porto Alegre, RS, Brazil. METHOD: A retrospective study was performed involving RFLP typing of 55 sputum samples from outpatients examined at the Centro de Saude Navegantes. The results of the genotyping were correlated to the conventional epidemiology data. RESULTS: A single pattern was seen in 39 (70.9%) of the isolates, whereas 16 isolates (29.1%) showed clustering patterns and were grouped into 8 clusters of 2 patients each. An epidemiological link was found for 6 (37.5%) of the 16 patients in the clusters. CONCLUSION: The appropriate combination of conventional epidemiology and genotyping of M. tuberculosis contributes to a better understanding of the dynamics of tuberculosis transmission even when such a study is performed in a single, isolated health clinic.
13 citations
TL;DR: The dynamics of tuberculosis cannot be fully understood without also taking a qualitative approach, and there is a real need for queries such as “Why?” and “How”, representing the targets of qualitative methodology, which is an in-depth, holistic approach and encompasses interdisciplinary thinking, abstract meanings and subtle implications.
Abstract: Pathogenic organisms, as part of a natural process, interact with the environment, searching for dynamic stability as well as for their ecological niches, whether internal or external to other organisms. Elucidat ing the complexity of these interrelationships poses a real challenge for epidemiologists. Quantitative theoretical analysis has been insufficient because of the limitation imposed by questions such as “How much?” “Where?” and “Which one?” Although they succeed in quantifying, categorizing and correlating, the answers to these questions do not always provide a satisfactory explanation of the process. There is a real need for queries such as “Why?” and “How?”, representing the targets of qualitative methodology, which is an in-depth, hol ist ic approach and encompasses interdisciplinary thinking, abstract meanings and subtle implications. Answers to many questions related to the pathogenicity of tuberculosis may be found in quantitative analysis. Nevertheless, the dynamics of tuberculosis cannot be fully understood without also taking a qualitative approach. As an exercise, let us examine the disease and its dynamics. The pathogenic power of an infectious disease has long been defined as a function of microbe virulence (V) and the resistance (R) of the infected organism, interrelated as follows:
12 citations
TL;DR: Investigating whether polymorphisms within the promoter region of the TNF-a (-238/-308) coding genes are associated to the occurrence of active TB found that the presence of the -238A allele was associated with susceptibility to TB disease occurrence and severity, while the -308A allelewas associated with protection to the occurrences of another pulmonary diseases.
Abstract: BACKGROUND: Host genetic factors may play a role in the susceptibility to active tuberculosis (TB), and several polymorphisms in different cytokine coding genes have been described and associated with diseases to date. OBJECTIVES: To investigate whether polymorphisms within the promoter region of the TNF-a (-238/-308) coding genes are associated to the occurrence of active TB. METHODS: SNPs within the TNF-a gene were analyzed by PCR-RFLP among two groups of individuals: patients with TB (n = 234, and patients non TB (n = 113). RESULTS: In this study, the presence of the -238A allele was associated with susceptibility to TB disease occurrence and severity (p = 0,00002; OR = 0,15; IC = 0,06-0,36. On the contrary, the -308A allele was associated with protection to the occurrence of another pulmonary diseases. CONCLUSIONS: These results suggest the importance of genetics studies on TB occurrence. Further studies are needed pursuing a better understanding of the human pathogenesis of M. tb.
11 citations
TL;DR: Assays to determine minimal inhibition concentrations in liquid medium and employing oxidation-reduction indicators proved to be rapid and inexpensive and has the potential to become a faster, alternative method for determining susceptibility of M. tuberculosis strains in developing countries.
Abstract: BACKGROUND: Knowledge of the rates of drug resistance is one of the pillars of tuberculosis control program evaluation. Data from low-resource countries are scarce and results are delayed due to the techniques employed. There is therefore an urgent need for evaluation of faster and less onerous testing methods. OBJECTIVE: To compare the performance of rapid colorimetric assays for phenotyping that employ oxidation-reduction indicators to determine the susceptibility profile of Mycobacterium tuberculosis with the gold-standard proportion method on Lowenstein-Jensen Medium. METHOD: We analyzed 166 M. tuberculosis strains of known susceptibility. Minimal inhibition concentrations for isoniazid and rifampicin were determined in microplates, using a liquid medium and Alamar Blue and tetrazolium bromide indicators. To measure agreement the Kappa value was used. Cutoff values between sensitive and resistant strains were defined as 0.2mg/mL and 1.0mg/mL for isoniazid and rifampicin, respectively. RESULTS: There was 100% concordance between Alamar Blue and tetrazolium bromide methods in the determination of minimal inhibition concentrations. Agreement between the colorimetric method and the Lowenstein-Jensen was 95% for isoniazid and rifampicin. Using the colorimetric method, results were obtained within 7 days, in contrast to the 28 days required for the conventional method. CONCLUSIONS: Assays to determine minimal inhibition concentrations in liquid medium and employing oxidation-reduction indicators proved to be rapid and inexpensive. This method has the potential to become a faster, alternative method for determining susceptibility of M. tuberculosis strains in developing countries.
10 citations