ABSTRACT Introduction: The year 2015 constitutes the international time frame of reference to evaluate the actions of the "End tuberculosis" strategy. The elimination of the disease as a health problem requires the identification of populations and territories at greatest risk, and the determinants of their geographical distribution. Objective: Determine the influence of socio-economic, demographic and geospatial factors on the spatial distribution of tuberculosis in Havana in 2015. Methods: An ecological study was conducted. The spatial distribution of total TB cases, TB/HIV and TB/inmate cases at the municipality level was described; as well as socio-economic, demographic and geospatial variables with data available from all municipalities in the province. Thematic maps were made for each of the variables. Subsequently, a layer overlap analysis was performed. Results: A higher concentration of cases was observed in the center-south of the province; mainly in the municipalities of Centro Habana, Habana Vieja, Diez de Octubre and Boyeros ; with the exception of the latter, these municipalities are the most densely populated, those with the highest land occupation and the most unfavorable living conditions. Conclusions: The spatial distribution of tuberculosis in Havana is closely related to the behavior of socio-economic, demographic and geospatial variables in its different municipalities. These variables should be taken into account in health interventions aimed at eliminating the disease in the province.

RESUMEN Introducción: El año 2015 es el marco de referencia temporal internacional para evaluar las acciones de la estrategia “Fin a la tuberculosis”. La eliminación de la enfermedad como problema de salud requiere de la identificación de poblaciones y territorios en mayor riesgo, y de los determinantes de su distribución geográfica. Objetivo: Determinar la influencia de factores socioeconómicos, demográficos y geoespaciales en la distribución espacial de la tuberculosis en La Habana en el año 2015. Métodos: Se realizó un estudio ecológico. Se describió la distribución espacial del total de casos de tuberculosis, la confección TB/VIH y los casos TB/reclusos a nivel de municipio; así como de variables socioeconómicas, demográficas y geoespaciales con datos disponibles de todos los municipios de la provincia. Se realizaron mapas temáticos para cada una de las variables. Posteriormente, se realizó un análisis de superposición de capas. Resultados: Se observó una mayor concentración de casos en el centro-sur de la provincia; principalmente en los municipios Centro Habana, Habana Vieja, Diez de Octubre y Boyeros, a excepción de este último, estos municipios son los más densamente poblados, los que tienen mayor ocupación del suelo y condiciones de vida más desfavorables. Conclusiones: La distribución espacial de la tuberculosis en La Habana está estrechamente relacionada al comportamiento de variables socioeconómicas, demográficas y geoespaciales en sus diferentes municipios. Estas variables deben ser tomadas en cuenta en intervenciones de salud dirigidas a la eliminación de la enfermedad en la provincia.

Resumen Introducción: la tuberculosis es una de las enfermedades infecciosas de mayor distribución mundial y la tuberculosis meníngea es una de sus manifestaciones más devastadoras. Su diagnóstico y confirmación microbiológica no siempre es fácil. Objetivo: describir la experiencia en el diagnóstico de tuberculosis meníngea por pruebas moleculares comparado con cultivo, caracterizando las principales manifestaciones clínicas y determinar los factores asociados a mortalidad. Métodos: identificamos retrospectivamente a los pacientes adultos con diagnóstico de tuberculosis meníngea, mediante técnicas de pruebas moleculares y/o cultivo para M. tuberculosis, que ingresaron en nuestra institución entre enero de 2018 y marzo de 2020, se realizó un análisis estadístico descriptivo. Se excluyeron mujeres gestantes, pacientes que no contaran con prueba molecular para M. tuberculosis. Resultados: se obtuvo una muestra de 33 pacientes, los hallazgos más relevantes en el citoquímico de líquido cefalorraquídeo (LCR) fue la presencia de hipoglucorraquia, con una mediana de 34.2 mg/dL (RIQ 2.0-95.0 mg/dL) y de hiperproteinorraquia, con mediana de 265 mg/dL (RIQ 24.0-600 mg/dL). El resultado más significativo fue la presencia de proteína C reactiva elevada en suero en todos los casos, con una mediana de 53.3 mg/L (RIQ 22.9-89.6 mg/L) y neutrofilia en 75.8% (25). La mortalidad fue de 54.5% (18), la sensibilidad de la prueba molecular en LCR fue del 38.46% y el valor predictivo positivo de 58.82%. Conclusiones: el diagnóstico de TB meníngea sigue siendo todo un reto, aunque las pruebas moleculares pueden ayudar en el diagnóstico temprano, su sensibilidad es baja en formas extrapulmonares. (Acta Med Colomb 2022; 47. DOI:https://doi.org/10.36104/amc.2022.2115).

Abstract Introduction: tuberculosis is one of the most widely disseminated infectious diseases worldwide, and meningeal tuberculosis is one of its most devastating manifestations. Its diagnosis and microbiological confirmation is not always easy. Objective: to describe the experience in diagnosing meningeal tuberculosis through molecular tests compared to a culture, characterize the main clinical manifestations, and determine factors associated with mortality. Methods: we retrospectively identified adult patients diagnosed with meningeal tuberculosis through molecular and/or culture tests for M. tuberculosis who were admitted to our institution between January 2018 and March 2020. A descriptive analysis was performed. Pregnant women and patients who did not have a molecular test for M. tuberculosis were excluded. Results: a sample of 33 patients was obtained. The most relevant cerebrospinal fluid (CSF) cytochemical analysis findings were low glucose, with a median of 34.2 mg/dL (IQR 2.0-95.0 mg/ dL) and high protein, with a median of 265 mg/dL (IQR 24.0-600 mg/dL). The most significant result was elevated serum C-reactive protein in all cases, with a median of 53.3 mg/L (IQR 22.9 -89.6 mg/L) and neutrophilia in 75.8% (25). Mortality was 54.5% (18), the sensitivity of the CSF molecular test was 38.46% and the positive predictive value was 58.82%. Conclusions: the diagnosis of meningeal TB continues to be a challenge. While molecular tests can help provide an early diagnosis, their sensitivity is low in extrapulmonary forms. (Acta Med Colomb 2022; 47. DOI:https://doi.org/10.36104/amc.2022.2115).

RESUMO Objetivos: analisar o impacto dos programas de proteção social em pessoas adultas com diagnóstico de Tuberculose. Métodos: revisão sistemática conduzida pelo PRISMA, com registro PROSPERO n° CRD42019130884. Os estudos foram identificados nas bases de dados BVS, PubMed, Scielo, CINAHL e Scopus, a partir dos descritores “Proteção Social” e “Tuberculose”, em combinação com palavras-chave combinadas com operadores booleanos AND e OR. Incluíram-se estudos observacionais e de intervenção, publicados até o dia 23 de outubro de 2019, nos idiomas português, inglês e espanhol. Resultados: os programas de proteção social melhoram o tratamento da Tuberculose, as taxas de cura, a aderência ao tratamento, a prestação de serviços para o controle da TB, além de reduzirem a pobreza. Conclusões: os programas de proteção social impactam de forma positiva no tratamento e controle das pessoas com diagnóstico de Tuberculose.

ABSTRACT Objectives: to analyze the impact of social protection programs on adults diagnosed with Tuberculosis. Methods: systematic review conducted by PRISMA, with registration PROSPERO CRD42019130884. The studies were identified in the VHL, PubMed, Scielo, CINAHL and Scopus databases, using the descriptors “Social Protection” and “Tuberculosis”, in combination with keywords combined with Boolean operators AND and OR. Observational and interventional studies published until October 23, 2019, in Portuguese, English and Spanish, were included. Results: social protection programs improve the treatment of tuberculosis, cure rates, adherence to treatment, the provision of services for the control of TB and reduce poverty. Conclusions: social protection programs have a positive impact on the treatment and control of people diagnosed with Tuberculosis.

RESUMEN Objetivos: analizar el impacto de los programas sociales de adultos con diagnóstico de Tuberculosis. Métodos: se trata de una revisión sistemática conducida por PRISMA, con registro PROSPERO n° CRD42019130884. Los estudios se identificaron en las bases de datos BVS, PubMed, Scielo, CINAHL y Scopus, a partir de los descriptores “Protección Social” y “Tuberculosis”, y palabras clave combinadas con operadores booleanos AND y OR. Estaban incluidos los estudios observacionales y de intervención, publicados hasta el día 23 de octubre de 2019, en los idiomas portugués, inglés y español. Resultados: los programas de protección social mejoran el tratamiento de la tuberculosis, las tasas de curación, la adhesión al tratamiento, la prestación de servicios para el control de la TB, además de reducir la pobreza. Conclusiones: los programas sociales tienen un impacto positivo en el tratamiento y control de las personas diagnosticadas de tuberculosis.

Abstract Background: Tuberculosis (TB) is one of the ten leading causes of death worldwide. Aim: To characterize the clinical and epidemiological point of view of TB cases reported in the Department of Caaguazú-Paraguay, from 2014 to 2017. Methods: Observational, descriptive, retrospective study; Population: 659 cases of TB registered in the National Tuberculosis Control Program (NTCP); variables: age, sex, population group, type of TB, TB/HIV coinfection. We procesed database in Excel 2016 © using Stata 14.0®. Results: 63.3% were of male gender, average age: 35.8 years, 39.6% were indigenous and 85.4% were liberty deprived persons known as inmates (LDP), 89.6% had pulmonary TB and 2,4% had TB/HIV coinfection. Incidence rate exceed 21.6/100,000 inhabitants in 2014. Indigenous incidence was 76.5/100,000 inhabitants in 2017, LDP incidence was 2,272.1/ 100,000 inhabitants in 2017. Conclusion: The incidence of TB in the Department of Caaguazú is low, mainly affecting men, while TB incidence in indigenous people and LDP was high.

Resumen Introducción: La tuberculosis (TBC) es una de las diez principales causas de muerte en todo el mundo. Objetivo: Caracterizar clínica y epidemiológicamente los casos de TBC del Departamento de Caaguazú-Paraguay, entre los años 2014 y 2017. Pacientes y Métodos: Se realizó un estudio observacional, retrospectivo, utilizando datos secundarios del Programa Nacional de Control de la Tuberculosis (PNCT). La población: 659 casos de TBC registrados en el PNCT. Las variables: edad, sexo, grupo poblacional, tipo de TBC, co-infección TBC/VIH, y categoría de egreso. Procesamos la base de datos en Excel 2016 © usando Stata 14.0®. Resultado: El 63,3% de los participantes fue del género masculino. La edad promedio fue de 35,8 años. El 39,6% eran indígenas y 14,5% fueron personas privadas de libertad (PPL) conocidos como reclusos. El 89,6% tuvo TBC pulmonar, 2,4% tuvo co-infección TBC/VIH. La tasa de incidencia fue superior a 21,6/100.000 habts en 2014. La incidencia en indígenas fue de 76,5/100.000 habts en 2017. La incidencia en PPL fue de 2.272,1/100.000 habitantes en 2017. Conclusión: La incidencia de TBC en el Departamento de Caaguazú es baja en la población general afectando principalmente a hombres, mientras que en la población indígena y PPL es alta.

Background: Tuberculosis (TB), a disease caused by Mycobacterium tuberculosis, is a global public health emergency. No serological method is currently approved for the diagnosis of this infection. Objective: The objective of the study was to identify target antigens applicable to serological diagnostic methods for TB. Materials and methods: Sera of infected mice were analyzed by Western blot to detect M. tuberculosis antigens, during the acute and the progressive phases of the infection, and after antibiotic treatment. The 97 kDa antigen was then evaluated in the sera of 19 TB patients with positive baciloscopy and 12 healthy volunteers. Results: Mice infected with M. tuberculosis strain H37Rv had mycobacterial antigens in their sera from day 1 up to day 180 post-infection, including an antigen of 97 kDa. These circulating mycobacterial antigens decreased after treatment with isoniazid, rifampicin, and pyrazinamide in mice infected with antibiotic-susceptible M. tuberculosis. A 97 kDa antigen was also present in the sera of mice infected with a virulent Mycobacterium bovis strain, but not in the sera of mice infected with an avirulent strain. The sera of TB patients contained higher concentrations of the 97 kDa antigen than the sera of healthy volunteers. Conclusion: The 97 kDa antigen that we identified in mouse models of mycobacterial infection and in TB patients could be a target for serological diagnostic methods for TB.

Resumo O rastreio de grupos de risco para o desenvolvimento de tuberculose (TB) é uma prioridade para o controlo da doença. Uma vez que não existe um “gold-standard” para o diagnóstico de infeção latente (ITBL), o teste intradérmico da tuberculina (TST) e o teste de deteção de interferão-gama (IGRA) têm sido usados com esse propósito. O objetivo deste estudo foi determinar a proporção de ILTB através do TST e do teste IGRA e avaliar os fatores associados à discordância de resultados entre testes, considerando vários grupos de risco aconselhados para rastreio no Nordeste de Portugal. Os dados foram obtidos da base de dados de utentes de uma unidade local de saúde com suspeita de ILTB e orientados para rastreio (janeiro de 2014 a dezembro de 2015). Foi obtida a proporção de ILTB usando ambos os testes. Os modelos de regressão logística avaliaram os fatores de risco para um teste positivo e para resultados discordantes entre os testes. Obtiveram-se as estimativas de odds ratio (OR) e o respetivo intervalo de confiança de 95% (IC95%). Dos 367 pacientes incluídos na análise, 79,8% tiveram um TST positivo e 46,0% deles tiveram um IGRA positivo. Em comparação com contatos de casos de TB ativa, o risco de TST positivo foi maior em profissionais de saúde e presidiários (OR = 4.38; 95% CI: 1.59-12.09 e OR = 4.74 95% CI: 1.45-15.49, respetivamente) e menor em imunocomprometidos (OR = 0.14; 95% CI: 0.06-0.31). Por outro lado, os profissionais de saúde (OR = 0.44; 95% CI: 0.24-0.80) e imunocomprometidos (OR = 0.24; IC95%: 0.10-0.56) apresentaram menor risco de IGRA positivo. Houve 42.0% de resultados positivos concordantes, 16.1% de negativos concordantes e 41.9% de discordantes, com os profissionais de saúde a apresentarem maior risco de resultados discordantes (OR = 3.34; 95% CI: 1.84-6.05). A proporção de ILTB estimada pelo TST e IGRA nestes utentes aconselhados a fazer rastreio revelou-se alta, evidenciando a necessidade de estratégias preventivas. Entre os profissionais de saúde, os resultados do TST devem ser lidos com cautela, pois a maior proporção de resultados discordantes com um TST positivo sugere o impacto do efeito booster neste grupo.

Abstract The screening of groups with a high risk for developing tuberculosis (TB) is a priority in order to control this disease. Since there is no gold standard for the diagnosis of latent TB infection (LTBI), both the tuberculin skin test (TST) and the interferon-gamma release assays (IGRA) have been used for this purpose. The aim of this study was to determine the proportion of LTBI by using the TST and the IGRA tests, and to assess the risk factors related with discordant results between tests across several risk groups advised for screening in Northeast Portugal. Data were collected from the database of patients with suspected LTBI and advised for the screening in a public health unit (January 2014 to December 2015). The proportion of LTBI was computed using both tests. Logistic regression models assessed risk factors for a positive test and for discordant results between tests. The adjusted odds ratio (OR) and respective 95% confidence interval (95% CI) were obtained. Out of 367 patients included in the analysis, 79.8% had a positive TST and 46.0% of them had a positive IGRA. In comparison with contacts of active TB cases, healthcare workers and inmates presented higher odds of TST positivity (OR 4.38, 95% CI 1.59-12.09 and OR 4.74, 95% CI 1.45-15.49, respectively), but immunocompromised people presented lower odds of TST positivity (OR 0.14; 95% CI 0.06-0.31). Instead, healthcare workers (OR 0.44, 95% CI 0.24-0.80) and immunocompromised people (OR 0.24, 95% CI 0.10-0.56) presented lower odds of a positive IGRA. There were 42.0% concordant positive results, 16.1% concordant negative results, and 41.9% discordant results, with healthcare workers presenting higher odds of discordant results (OR 3.34, 95% CI 1.84-6.05). The proportion of LTBI estimated by TST and IGRA among people advised for screening in our setting is high, highlighting the need of preventive strategies. Among healthcare workers, TST results should be read with caution as the higher proportion of discordant results with a positive TST suggests the impact of the booster reaction in this group.

ABSTRAC Objective: To measure the level of knowledge about treatment of tuberculosis in doctors of the first level of care in the Lambayeque Region. Material and Methods: Descriptive, cross-sectional study. Data were collected in health facilities at the first level of care in September-October 2015. Sample size: EPIDAT v 3.1 was used: population size of 221 persons, 95% confidence level, 5 absolute precision %, An expected low level of knowledge in treatment of TB in physicians of 27%; A sample size of 97 participants was obtained. A total of 113 physicians selected for non-probabilistic sampling were included for convenience, excluding those who work only in private care and administrative activities. An instrument previously validated. Absolute and relative frequency analyzes were performed for qualitative and mean variables and standard deviation for quantitative variables. In addition, the inferential analysis with Chi2 and ANOVA with p <0.05. Results: 60.2% have a work experience of more than 5 years; 43.4% attended at least 1 patient in the last 6 months. When the level of knowledge was analyzed, it was obtained that of the 64/113 doctors surveyed obtained between 11 and 15 points (average level). Conclusions: The knowledge more frequent is medium and low level in doctors of first level care of the Lambayeque region.

RESUMEN Objetivo: Medir el nivel de conocimientos sobre tratamiento de tuberculosis en médicos del primer nivel de atención en la Región Lambayeque. Material y Métodos: Estudio descriptivo, trasversal. Se recolectaron datos en los establecimientos de salud del primer nivel de atención en septiembre-octubre 2015. Tamaño de muestra: se utilizó EPIDAT v 3.1; tamaño poblacional de 221 personas, nivel de confianza 95%, precisión absoluta 5%, proporción esperada de bajo nivel de conocimiento en tratamiento de TBC en médicos del 27%; se obtuvo un tamaño de muestra de 97 participantes. Se incluyeron a 113 médicos seleccionados por muestreo no probabilístico por conveniencia, excluyéndose los que laboren solamente en atención privada y actividades administrativas. Se aplicó un instrumento previamente validado. Se realizó análisis de frecuencias absolutas y relativas para variables cualitativas y media y desviación estándar para variables cuantitativas. Además, el análisis inferencial con Chi2 y ANOVA con p<0,05. Resultados: El 60.2% tienen una experiencia laboral mayor a 5 años; 43.4% atendieron al menos 1 paciente en los últimos 6 meses. Cuando se analizó el nivel de conocimiento se obtuvo como resultado que de los 64/113 médicos encuestados obtuvieron entre 11 y 15 puntos (nivel medio). Conclusiones: El conocimiento más frecuente es nivel medio y bajo en médicos de establecimiento de primer nivel de atención de la región Lambayeque.

Abstract (1) Background: The Commercial Kit SIRE Nitratase® PlastLabor, is a drug susceptibility test kit used to detect Mycobacterium tuberculosis resistance to first-line TB treatment drugs. The present study aimed at evaluating its performance in a multicenter study. (2) Methods: To determine its accuracy, the proportion methods in Lowenstein Jensen medium or the BACTECTMMGITTM960 system was used as a gold standard. (3) Results: The study revealed that the respective accuracies of the kit with 190 M. tuberculosis clinical isolates, using the proportion methods in Lowenstein Jensen medium or BACTECTMMGITTM960 system as a gold standard, were 93.9% and 94.6%, 96.9% and 94.6%, 98.0% and 97.8%, and 98.0% and 98.9%, for streptomycin, isoniazid, rifampicin, and ethambutol, respectively. (4) Conclusion: Thus, the kit can rapidly screen resistance to streptomycin, isoniazid, rifampicin, and ethambutol. Additionally, it does not require sophisticated equipment; hence, it can be easily used in the laboratories of low and middle income countries.

Abstract: Introduction: The emergence of tuberculosis (TB) and multidroresistant strains represents a problem for TB control. The objective was to evaluate the Xpert MTB/RIF (Xpert) in vulnerable groups (VG). Material and methods: We studied 82 pulmonary samples with Xpert indication, at the National Reference Laboratory, «Pedro Kourí» Institute, from May to October 2016. Sputum smear (AFB) and culture was performed, according to the laboratory procedures and Xpert according to the manufacturer’s standards. The results of the molecular assay were compared with the culture (detection of Mycobacterium tuberculosis) and proportions method (susceptibility to rifampicin). Results: The VG where most cases of TB were diagnosed was HIV positive (nine), followed by those previously treated (eight). Xpert detected TB in 21 cases, of which, eight was AFB negative. There was good agreement between Xpert and culture methods (greater than 92%) and excellent coincidence with the proportions method. Conclusions: The Xpert had a positive impact on the timely handling of cases. The excellent correlation between Xpert MTB/RIF and the proportions method demonstrates the utility of the system for the rapid assessment of rifampicin resistance as an indicator of TB - MDR.

Resumen: Introducción: La emergencia de la tuberculosis y de cepas multidrorresistentes representa un problema para el control de la tuberculosis. El objetivo fue evaluar el Xpert MTB/RIF en grupos vulnerables. Material y métodos: Se estudiaron 82 muestras pulmonares con indicación de Xpert, en el Laboratorio Nacional de Referencia del Instituto «Pedro Kourí» de mayo a octubre del 2016. Se realizó la baciloscopia y cultivo según los procedimientos del laboratorio, el Xpert de acuerdo con las normas del fabricante. Los resultados del ensayo molecular se compararon con el cultivo (detección de Mycobacterium tuberculosis) y método de las proporciones (susceptibilidad a rifampicina). Resultados: Los grupos vulnerables donde más se diagnosticaron casos de tuberculosis fueron los VIH positivos (nueve), seguido de los previamente tratados (ocho). El Xpert detectó tuberculosis en 21 casos, de los cuales ocho fueron baciloscopia negativa. Existió buena concordancia entre Xpert y los métodos de cultivo (mayor de 92%) y excelente coincidencia con el método de las proporciones. Conclusiones: El Xpert tuvo un efecto positivo en el manejo oportuno de casos. La excelente correlación entre Xpert MTB/RIF y el método de las proporciones demuestra la utilidad del sistema para la evaluación rápida de la resistencia a rifampicina como indicador de tuberculosis-multidrogorresistente.

Resumen Se evaluó el ácido úsnico (1), aislado del liquen Evernia prunastri (Cajamarca-Perú), producto natural conocido por sus actividades biológicas, y, del mismo modo, se evaluó la síntesis de su derivado acil-hidrazona (2), obtenido a partir de una reacción de condensación entre el ácido úsnico y la isoniazida en solución etanólica a reflujo, con un rendimiento global de 95%. Ambos compuestos fueron evaluados y comparados con la isoniazida según su actividad anti-Mycobacterium tuberculosis basada en el ensayo de susceptibilidad mediante el método TEMA. Los resultados mostraron que el compuesto 1 presenta valores de MIC de 16,0 μg/mL frente a las cepas H37Rv, TB DM 97 y MDR DM 1098, mientras que el compuesto 2 presenta valores de MIC de 2,0; 64,0 y 64,0 μg/mL respectivamente.

Abstract Compound usnic acid (1), isolated from lichen Evernia prunastri (Cajamarca-Peru) and the synthesis and characterization of its acyl-hydrazone (2), from the condensation reaction between usnic acid and isoniazid in an ethanol solution under reflux, giving an overall yield of 95%, were evaluated. Both compounds were evaluated and compared with isoniazid according to its anti-Mycobacterium tuberculosis activity based on the tetrazolium microplate assay (TEMA). Compound 1 had MIC (minimal inhibitory concentration) value of 16.0 μg/mL in each test of H37Rv (susceptible type), TB DM 97 (resistant wild type) and MDR DM 1098 (multi drug resistances type) strains. In similar tests, compound 2 MIC values were 2.0, 64.0 and 64.0 μg/mL respectively.

Resumo Foi avaliado o ácido úsnico (1), um produto natural conhecido pelas suas atividades biológicas, isolado a partir do líquen Evernia prunastri (Cajamarca-Peru), assim mesmo foi avaliada a síntese do seu derivado, a acil-hidrazona (2), obtido a partir de uma reação de condensação com refluxo entre o ácido úsnico e a isoniazida em solução etanólica, com um rendimento global de 95%. A atividade anti-Mycobacterium tuberculosis de ambos compostos foi avaliada e comparada com a isoniazida mediante testes de sensibilidade obtidos pelo método TEMA. Os resultados mostraram que o composto 1 apresenta o valor de MIC de 16,0 μg/mL contra variedades H37Rv, TB DM 97 e MDR DM 1098; enquanto que para o composto 2 os valores de MIC são de 2,0; 64,0 e 64,0 μg/mL, respectivamente.

Abstract Seven months after undergoing kidney transplantation, a 56-year-old woman presented with papules and ulcers in her right forearm. The patient received antibiotics for 8 months with limited improvement. Eleven months after symptom onset, she presented with acute arthritis in her left knee. Asynovial fluid culture yielded Mycobacterium tuberculosis, and a forearm ulcer biopsy showed granulomatous inflammation. After surgical fistulectomy and 12 months of tuberculosis treatment, she was cured. Chronic cutaneous ulcers and articular manifestations in TB are rare, but they should always be considered in the differential diagnosis for immunosuppressed patients. Surgical intervention and prolonged treatment might be necessary.

BACKGROUND To cope with the emergence of multidrug-resistant tuberculosis (MDR-TB), new molecular methods that can routinely be used to screen for a wide range of drug resistance related genetic markers in the Mycobacterium tuberculosis genome are urgently needed. OBJECTIVE To evaluate the performance of multiplex ligaton-dependent probe amplification (MLPA) against Genotype® MTBDRplus to detect resistance to isoniazid (INHr) and rifampicin (RIFr). METHOD 96 culture isolates characterised for identification, drug susceptibility testing (DST) and sequencing of rpoB, katG, and inhA genes were evaluated by the MLPA and Genotype®MTBDRplus assays. RESULTS With sequencing as a reference standard, sensitivity (SE) to detect INHr was 92.8% and 85.7%, and specificity (SP) was 100% and 97.5%, for MLPA and Genotype®MTBDRplus, respectively. In relation to RIFr, SE was 87.5% and 100%, and SP was 100% and 98.8%, respectively. Kappa value was identical between Genotype®MTBDRplus and MLPA compared with the standard DST and sequencing for detection of INHr [0.83 (0.75-0.91)] and RIFr [0.93 (0.88-0.98)]. CONCLUSION Compared to Genotype®MTBDRplus, MLPA showed similar sensitivity to detect INH and RIF resistance. The results obtained by the MLPA and Genotype®MTBDRplus assays indicate that both molecular tests can be used for the rapid detection of drug-resistant TB with high accuracy. MLPA has the added value of providing information on the circulating M. tuberculosis lineages.

Resumen Objetivo: determinar barreras asociadas a la adherencia al tratamiento acortado, estrictamente supervisado de tuberculosis (TB) en dos municipios de Colombia. Métodos: estudio de casos (128) y controles (182). Se realizó análisis univariado, bivariado y regresión logística. Resultados: los factores asociados a la no adherencia al tratamiento de TB son: no convivir con familiares (OR=4.54; IC95 % 1.45-14.22), inasistencia a reuniones religiosas (OR=28.17; IC95 % 4.37-181.75), no presentar antecedentes de manejo para una enfermedad mayor a dos semanas (OR=3.37; IC95 % 1.59-7.13), no reconocer que el tratamiento de TB dura hasta seis meses (OR=3.51; IC95 % 1.87-6.59), consumir drogas (OR=3.41; IC95 % 0.95-12.23), falta de suministro ocasional del tratamiento por parte de los servicios de salud (OR=5.53; IC95 % 1.20-5.52). Conclusiones: el diseño y desarrollo de estrategias para asegurar la adherencia al tratamiento de TB debe tener en cuenta, además de los factores individuales comportamentales de los pacientes, los factores sociales y administrativos que afectan su éxito.

Abstract Objective: to determine obstacles associated with the adherence to the strictly supervised treatment of tuberculosis (TB) in two municipalities of Colombia. Methods: case studies (128) and controls (182). Univariate, bivariate, and logistic regression analyzes were performed. Results: the factors associated with nonadherence to TB treatment were: no cohabitation with relatives (OR = 4.54, 95% CI 1.45-14.22), non-attendance to religious meetings (OR = 28.17, 95% CI 4.37-181.75), no antecedents regarding dealing with an illness lasting over two weeks (OR = 3.37, 95% CI 1.59-7.13), did not recognize that TB treatment lasts for up to six months (OR = 3.51, 95% CI 1.87-6.59), drug use (OR = 3.41 , 95% CI 0.95-12.23), occasional lack of treatment supplies by the health services (OR = 5.53, 95% CI 1.20-5.52). Conclusions: The design and development of strategies to ensure adherence to TB treatment must take into account, in addition to the individual behavioral factors of patients, the social and administrative factors that affect their success.

Resumo Objetivo: determinar barreiras associadas à aderência ao tratamento recortado, rigorosamente supervisionado de tuberculose (TB) em dois municípios da Colômbia. Métodos: estudo de casos (128) e controlos (182). Análise univariada, bivariada e regressão logística foram feitas. Resultados: os fatores associados à não aderência ao tratamento da TB são: não conviver com familiares (OR=4.54; IC95 % 1.45-14.22), não comparecimento a reuniões religiosas (OR=28.17; IC95 % 4.37-181.75), não apresentar antecedentes de manejo para doenças maiores do que duas semanas (OR=3.37; IC95 % 1.59-7.13), não reconhecer que o tratamento de TB dura até seis meses (OR=3.51; IC95 % 1.87-6.59), consumir drogas (OR=3.41; IC95 % 0.95-12.23), falta de fornecimento ocasional do tratamento por parte dos serviços de saúde (OR=5.53; IC95 % 1.20-5.52). Conclusões: a concepção e desenvolvimento de estratégias para garantir à adesão ao tratamento da TB deve levar em conta, além dos fatores individuais comportamentais dos pacientes, os fatores sociais e administrativos que afetam seu sucesso.

ABSTRACT Low thermal quality environments, such extreme latitudes or high elevation regions, are highly expensive for reptiles in terms of thermoregulation. Thus, physiological adaptations or behavioral adjustments to live in these habitats have evolved in some species. Anolis heterodermus (Duméril, 1851) is an anole lizard that lives at high elevations in the Andes region. In this paper, we attempted to elucidate the thermoregulation strategy of a population of this species from the eastern cordillera of Colombia during wet and dry seasons. We measured body temperatures (Tb), operative temperatures (Te) and preferred temperatures (Tpref). Based on these data, we obtained accuracy ( b ), environmental thermal quality ( e ) and efficiency of thermoregulation (E) indexes. There were no significant differences of Tb or b between seasons, sexes, ages, and for Tpref between sexes or ages, but we found differences in Te and e between seasons. The indexes suggested high thermoregulatory accuracy, low thermal environment quality and indicated that A. heterodermus was an active thermoregulator in both seasons. Broad ranges of Tb and the species association with microhabitats with high solar radiation suggest eurythermy and heliothermy. Anolis heterodermus lives in a low thermal quality habitat, using exposed perches, which seems the most efficient thermal microhabitats. We concluded that A. heterodermus performed behavioral adjustment for compensating seasonal variation in the environmental thermal costs.

RESUMEN Ambientes con baja calidad térmica, tales como las latitudes extremas o regiones en altas elevaciones, son altamente costosos para los reptiles en términos de termorregulación, por lo cual algunas especies han adquirido adaptaciones fisiológicas o ajustes conductuales para habitar estos ambientes. Anolis heterodermus (Duméril, 1851) es un lagarto que habita a altas elevaciones en la región andina. En el presente trabajo se evaluó la termorregulación de una población de esta especie en la cordillera oriental de Colombia durante las épocas húmeda y seca. Se midieron temperaturas corporales (Tb), operativas (Te) y de preferencia (Tpref). Con base en estas variables, se obtuvieron los índices de calidad térmica ambiental ( e ), exactitud ( b ) y eficiencia (E) de la termorregulación. No hubo diferencias significativas entre la Tb o b entre épocas, sexos o edades y tampoco de la Tpref entre sexos o edades, pero encontramos diferencias de Te y e entre épocas. Los índices sugieren alta exactitud termorreguladora y baja calidad térmica del ambiente, por lo tanto indican que A. heterodermus es un termorregulador activo para ambas épocas. El amplio intervalo de Tb y la asociación de la especie a microhábitats con alta radiación solar sugieren euritérmia y heliotermia. Anolis heterodermus habita en un ambiente de baja calidad térmica, usando perchas expuestas, las cuales parecen ser los microhábitats más eficientes para termorregular. Concluimos que A. heterodermus realiza ajustes conductuales para compensar la variación estacional en los costos térmicos del ambiente.

Resumo O objetivo deste trabalho foi identificar atributos dos solos e de sedimentos como instrumentos para determinação dos impactos decorrentes da erosão hídrica, bem como propor redução do sobreúso dos solos no Cerrado goiano. Solos e sedimentos da mata ciliar do Córrego Ponte Nova, bem como do cultivo de soja a montante foram avaliados por micromorfometria quanto à morfologia, à granulometria e à porosidade. Na encosta cultivada, o solo foi classificado como Latossolo Vermelho distroférrico, e, na mata ciliar de vereda, como Plintossolo Pétrico Concrecionário êutrico e Gleissolo Melânico Tb distrófico típico. Solos e sedimentos foram predominantemente argilosos, e a fração argila encontrava-se naturalmente agregada em partículas maiores, de tamanho silte e areia. Análises morfológicas, granulométricas e de porosidade, por micromorfometria, possibilitaram distinguir os sedimentos dos solos soterrados, pela diferenciação de coloração, textura e porosidade. Elevada concentração de agregados de argila tamanho areia no Gleissolo Melânico sugere a remoção seletiva de partículas finas, o que indica erosão no solo sob a mata ciliar. A elevada deposição de sedimentos sobre os solos da mata ciliar compromete a função de filtro do solo e também a perpetuidade e a regeneração da floresta por causa do soterramento de sementes e plântulas.

Abstract The objective of this work was to identify attributes of soil and of sediments as a tool to determine the impacts from water erosion, as well as to propose reducing the overuse of the soil in the Cerrado, in the state of Goiás, Brazil. Soils and sediments from the riparian forest of the Ponte Nova Stream and from upstream soybean crop areas were evaluated by micromorphometrics as to morphology, particle size, and porosity. Rhodic Oxisol was present in the cultivated hillside, and Petroferric Oxisol and Typic Eutraquox, in the riparian forest path. Soils and sediments were predominantly clayed, and the clay fraction was naturally aggregated into larger particles of silt and sand sizes. Analyses of morphological atributes, particle size, and porosity - by micromorphometrics - allowed to distinguish the sediment of buried soils by color, texture, and porosity differentiation. The high concentration of sandy-sized clay aggregates in Typic Eutraquox suggests the selective removal of fine particles, indicating soil erosion under the riparian forest. The high sediment deposition on the riparian forest soils is a risk to the soil filter function, and also to the perpetuity and regeneration of the forest because of the burial of seeds and seedlings.