Statistics

 array:25 [
  "pii" => "S0873215912000037"
  "issn" => "08732159"
  "doi" => "10.1016/j.rppneu.2011.12.005"
  "estado" => "S300"
  "fechaPublicacion" => "2012-03-01"
  "aid" => "69"
  "copyright" => "Sociedade Portuguesa de Pneumologia"
  "copyrightAnyo" => "2011"
  "documento" => "article"
  "crossmark" => 0
  "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
  "subdocumento" => "fla"
  "cita" => "Rev Port Pneumol. 2012;18:72-9"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 6830
    "formatos" => array:3 [
      "EPUB" => 244
      "HTML" => 5235
      "PDF" => 1351
    ]
  ]
  "Traduccion" => array:1 [
    "en" => array:20 [
      "pii" => "S217351151200005X"
      "issn" => "21735115"
      "doi" => "10.1016/j.rppnen.2012.01.004"
      "estado" => "S300"
      "fechaPublicacion" => "2012-03-01"
      "aid" => "69"
      "copyright" => "Sociedade Portuguesa de Pneumologia"
      "documento" => "article"
      "crossmark" => 0
      "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
      "subdocumento" => "fla"
      "cita" => "Rev Port Pneumol. 2012;18:72-9"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 7913
        "formatos" => array:3 [
          "EPUB" => 242
          "HTML" => 5722
          "PDF" => 1949
        ]
      ]
      "en" => array:12 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>"
        "titulo" => "Predictors of delayed sputum smear and culture conversion among a Portuguese population with pulmonary tuberculosis"
        "tienePdf" => "en"
        "tieneTextoCompleto" => "en"
        "tieneResumen" => array:2 [
          0 => "en"
          1 => "pt"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "72"
            "paginaFinal" => "79"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "pt" => array:1 [
            "titulo" => "Preditores de convers&#227;o tardia dos exames micobacteriol&#243;gicos direto e cultural de expetora&#231;&#227;o numa popula&#231;&#227;o portuguesa com tuberculose pulmonar"
          ]
        ]
        "contieneResumen" => array:2 [
          "en" => true
          "pt" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "en" => true
        ]
        "contienePdf" => array:1 [
          "en" => true
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "P&#46; Caetano Mota, A&#46; Carvalho, I&#46; Valente, R&#46; Braga, R&#46; Duarte"
            "autores" => array:5 [
              0 => array:2 [
                "nombre" => "P&#46;"
                "apellidos" => "Caetano Mota"
              ]
              1 => array:2 [
                "nombre" => "A&#46;"
                "apellidos" => "Carvalho"
              ]
              2 => array:2 [
                "nombre" => "I&#46;"
                "apellidos" => "Valente"
              ]
              3 => array:2 [
                "nombre" => "R&#46;"
                "apellidos" => "Braga"
              ]
              4 => array:2 [
                "nombre" => "R&#46;"
                "apellidos" => "Duarte"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "en"
      "Traduccion" => array:1 [
        "pt" => array:9 [
          "pii" => "S0873215912000037"
          "doi" => "10.1016/j.rppneu.2011.12.005"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => true
            "ES2" => true
            "LATM" => true
          ]
          "gratuito" => true
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "pt"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0873215912000037?idApp=UINPBA00004E"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S217351151200005X?idApp=UINPBA00004E"
      "url" => "/21735115/0000001800000002/v1_201305151558/S217351151200005X/v1_201305151558/en/main.assets"
    ]
  ]
  "itemSiguiente" => array:20 [
    "pii" => "S0873215912000049"
    "issn" => "08732159"
    "doi" => "10.1016/j.rppneu.2012.01.001"
    "estado" => "S300"
    "fechaPublicacion" => "2012-03-01"
    "aid" => "70"
    "copyright" => "Sociedade Portuguesa de Pneumologia"
    "documento" => "article"
    "crossmark" => 0
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "fla"
    "cita" => "Rev Port Pneumol. 2012;18:80-5"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 9410
      "formatos" => array:3 [
        "EPUB" => 290
        "HTML" => 6957
        "PDF" => 2163
      ]
    ]
    "pt" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Artigo original</span>"
      "titulo" => "Estudo multic&#234;ntrico de oxigenoterapia &#8211; uma auditoria nacional aos procedimentos de oxigenoterapia em enfermarias de medicina interna"
      "tienePdf" => "pt"
      "tieneTextoCompleto" => "pt"
      "tieneResumen" => array:2 [
        0 => "pt"
        1 => "en"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "80"
          "paginaFinal" => "85"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "en" => array:1 [
          "titulo" => "Oxygen Therapy Multicentric Study &#8211; A Nationwide Audit to Oxygen Therapy Procedures in Internal Medicine Wards"
        ]
      ]
      "contieneResumen" => array:2 [
        "pt" => true
        "en" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "pt" => true
      ]
      "contienePdf" => array:1 [
        "pt" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Figura 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 1875
              "Ancho" => 3174
              "Tamanyo" => 270937
            ]
          ]
          "descripcion" => array:1 [
            "pt" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Fluxograma dos resultados do estudo&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "J&#46;T&#46; Neves, M&#46;J&#46; Lob&#227;o"
          "autores" => array:3 [
            0 => array:2 [
              "nombre" => "J&#46;T&#46;"
              "apellidos" => "Neves"
            ]
            1 => array:2 [
              "nombre" => "M&#46;J&#46;"
              "apellidos" => "Lob&#227;o"
            ]
            2 => array:1 [
              "colaborador" => "Grupo de trabalho EMO"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "pt"
    "Traduccion" => array:1 [
      "en" => array:9 [
        "pii" => "S2173511512000048"
        "doi" => "10.1016/j.rppnen.2012.01.003"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "en"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173511512000048?idApp=UINPBA00004E"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0873215912000049?idApp=UINPBA00004E"
    "url" => "/08732159/0000001800000002/v2_201509041409/S0873215912000049/v2_201509041409/pt/main.assets"
  ]
  "itemAnterior" => array:20 [
    "pii" => "S0873215912000025"
    "issn" => "08732159"
    "doi" => "10.1016/j.rppneu.2011.10.004"
    "estado" => "S300"
    "fechaPublicacion" => "2012-03-01"
    "aid" => "68"
    "copyright" => "Sociedade Portuguesa de Pneumologia"
    "documento" => "article"
    "crossmark" => 0
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "fla"
    "cita" => "Rev Port Pneumol. 2012;18:64-71"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 9164
      "formatos" => array:3 [
        "EPUB" => 221
        "HTML" => 7016
        "PDF" => 1927
      ]
    ]
    "pt" => array:12 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Artigo original</span>"
      "titulo" => "Disfun&#231;&#227;o er&#233;til na s&#237;ndrome de apneia obstrutiva do sono &#8211; Preval&#234;ncia e determinantes"
      "tienePdf" => "pt"
      "tieneTextoCompleto" => "pt"
      "tieneResumen" => array:2 [
        0 => "pt"
        1 => "en"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "64"
          "paginaFinal" => "71"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "en" => array:1 [
          "titulo" => "Erectile dysfunction in obstructive sleep apnea syndrome &#8211; Prevalence and determinants"
        ]
      ]
      "contieneResumen" => array:2 [
        "pt" => true
        "en" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "pt" => true
      ]
      "contienePdf" => array:1 [
        "pt" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "T&#46; Santos, M&#46; Drummond, F&#46; Botelho"
          "autores" => array:3 [
            0 => array:2 [
              "nombre" => "T&#46;"
              "apellidos" => "Santos"
            ]
            1 => array:2 [
              "nombre" => "M&#46;"
              "apellidos" => "Drummond"
            ]
            2 => array:2 [
              "nombre" => "F&#46;"
              "apellidos" => "Botelho"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "pt"
    "Traduccion" => array:1 [
      "en" => array:9 [
        "pii" => "S2173511512000036"
        "doi" => "10.1016/j.rppnen.2012.01.002"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "en"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173511512000036?idApp=UINPBA00004E"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0873215912000025?idApp=UINPBA00004E"
    "url" => "/08732159/0000001800000002/v2_201509041409/S0873215912000025/v2_201509041409/pt/main.assets"
  ]
  "pt" => array:18 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Artigo original</span>"
    "titulo" => "Preditores de convers&#227;o tardia dos exames micobacteriol&#243;gicos direto e cultural de expetora&#231;&#227;o numa popula&#231;&#227;o portuguesa com tuberculose pulmonar"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "72"
        "paginaFinal" => "79"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "P&#46; Caetano Mota, A&#46; Carvalho, I&#46; Valente, R&#46; Braga, R&#46; Duarte"
        "autores" => array:5 [
          0 => array:4 [
            "nombre" => "P&#46;"
            "apellidos" => "Caetano Mota"
            "email" => array:1 [
              0 => "patmota&#64;net&#46;sapo&#46;pt"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "A&#46;"
            "apellidos" => "Carvalho"
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "I&#46;"
            "apellidos" => "Valente"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">d</span>"
                "identificador" => "aff0020"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "R&#46;"
            "apellidos" => "Braga"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">d</span>"
                "identificador" => "aff0020"
              ]
            ]
          ]
          4 => array:3 [
            "nombre" => "R&#46;"
            "apellidos" => "Duarte"
            "referencia" => array:3 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
              2 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">e</span>"
                "identificador" => "aff0025"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:5 [
          0 => array:3 [
            "entidad" => "Servi&#231;o de Pneumologia&#44; Centro Hospitalar de S&#227;o Jo&#227;o&#44; Porto&#44; Portugal"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Centro de Diagn&#243;stico Pneumol&#243;gico de Vila Nova de Gaia&#44; Vila Nova de Gaia&#44; Portugal"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
          2 => array:3 [
            "entidad" => "Servi&#231;o de Pneumologia&#44; Centro Hospitalar de Vila Nova de Gaia&#47;Espinho&#44; Vila Nova de Gaia&#44; Portugal"
            "etiqueta" => "c"
            "identificador" => "aff0015"
          ]
          3 => array:3 [
            "entidad" => "Servi&#231;o de Patologia&#44; Centro Hospitalar de Vila Nova de Gaia&#47;Espinho&#44; Vila Nova de Gaia&#44; Portugal"
            "etiqueta" => "d"
            "identificador" => "aff0020"
          ]
          4 => array:3 [
            "entidad" => "Departamento de Epidemiologia&#44; Faculdade de Medicina&#44; Universidade do Porto&#44; Porto&#44; Portugal"
            "etiqueta" => "e"
            "identificador" => "aff0025"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Autor para correspond&#234;ncia&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "en" => array:1 [
        "titulo" => "Predictors of delayed sputum smear and culture conversion among a Portuguese population with pulmonary tuberculosis"
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introdu&#231;&#227;o</span><p id="par0005" class="elsevierStylePara elsevierViewall">O sucesso do controlo da tuberculose &#40;TB&#41; depende de uma preven&#231;&#227;o precoce e eficaz da transmiss&#227;o do <span class="elsevierStyleItalic">Mycobacterium tuberculosis</span> &#40;MT&#41; a partir de doentes infeciosos&#46; A esteriliza&#231;&#227;o da expetora&#231;&#227;o constitui um ponto cardinal para o sucesso terap&#234;utico e baixa infeciosidade do doente&#44; sendo usada para melhor determinar o tempo de dura&#231;&#227;o do isolamento da via a&#233;rea em contexto hospitalar e de ambulat&#243;rio&#46; Nos pa&#237;ses de maiores recursos&#44; a documenta&#231;&#227;o da convers&#227;o do exame cultural &#233; atualmente recomendada antes do t&#233;rmino do tratamento antibacilar<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a>&#46; Apesar da discord&#226;ncia entre os resultados dos exames direto e cultural &#40;abaixo referida&#41;&#44; o exame direto &#233; mais r&#225;pido&#44; simples e econ&#243;mico do que o cultural&#44; sendo por isso largamente utilizado para o diagn&#243;stico e a monitoriza&#231;&#227;o terap&#234;utica em &#225;reas de recursos mais limitados<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Alguns estudos reportaram que o n&#250;mero de bacilos &#225;lcool-&#225;cido resistentes &#40;BAAR&#41; diminui rapidamente ap&#243;s o in&#237;cio da terap&#234;utica e que 80-85&#37; dos doentes com TB tornam-se n&#227;o infeciosos cerca de 2 semanas depois<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#8211;5</span></a>&#46; Contudo&#44; Wang et al&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> estimou que mais de 50&#37; dos doentes com TB provavelmente mant&#234;m-se contagiosos ap&#243;s 2 semanas de tratamento&#46; Tal salienta a import&#226;ncia de uma monitoriza&#231;&#227;o regular do resultado dos exames direto e cultural de expetora&#231;&#227;o at&#233; &#224; obten&#231;&#227;o de 3 amostras negativas consecutivas de forma a estabelecer o tempo necess&#225;rio para o isolamento respirat&#243;rio e providenciar a prote&#231;&#227;o adequada dos contactos n&#227;o infetados&#44; situa&#231;&#227;o j&#225; reportada previamente por Clancy<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a>&#46; Estudos epidemiol&#243;gicos indicaram que a propor&#231;&#227;o de doentes com TB que permanecem com exames diretos de expetora&#231;&#227;o positivos ap&#243;s 2 meses de tratamento pode ser superior a 20&#37; &#40;3&#44;3-25&#44;3&#37;&#41;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#8211;13</span></a>&#46; Outros estudos indicam que a aus&#234;ncia de convers&#227;o do exame direto e&#47;ou cultural ao 2&#176; m&#234;s de tratamento constitui um preditor de infeciosidade do doente e da fal&#234;ncia do tratamento<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;8&#8211;11&#44;14</span></a>&#46; Portanto&#44; a identifica&#231;&#227;o dos seus fatores de risco &#233; muito importante para as pol&#237;ticas de controlo da TB e aloca&#231;&#227;o dos recursos de sa&#250;de p&#250;blica&#46; Muitos estudos<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;13&#44;15&#8211;18</span></a> revelaram que o g&#233;nero masculino&#44; a diabetes mellitus&#44; o tabagismo&#44; a doen&#231;a radiol&#243;gica extensa&#44; a cavita&#231;&#227;o&#44; a carga bacilar&#44; bem como outros fatores aumentam o risco de infeciosidade da TB&#46; Contudo&#44; alguns dos resultados destes estudos eram inconsistentes devido a diferen&#231;as metodol&#243;gicas&#44; como a aplica&#231;&#227;o da convers&#227;o do exame direto em detrimento do exame cultural&#46; Em particular&#44; de acordo com investiga&#231;&#245;es pr&#233;vias&#44; pode haver uma discord&#226;ncia entre os resultados dos exames direto e cultural aos 2 meses&#44; e cerca de 30&#37; dos doentes com TB com negativa&#231;&#227;o do exame cultural permanecem com exame direto positivo<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">19&#8211;21</span></a>&#46; Tal deve-se &#224; presen&#231;a de BAAR n&#227;o vi&#225;veis&#44; coloniza&#231;&#227;o por micobact&#233;rias n&#227;o tuberculosas&#44; ou resultados falso-positivos<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">19&#8211;21</span></a>&#46; Uma revis&#227;o sistem&#225;tica e meta-an&#225;lise recente realizada por Horne et al&#46; concluiu que tanto o exame direto quanto o cultural t&#234;m baixa sensibilidade e especificidade para <span class="elsevierStyleItalic">outcomes</span> como fal&#234;ncia terap&#234;utica e recidiva<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a>&#46; Esta posi&#231;&#227;o foi argumentada por alguns autores<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> no que se refere a quest&#245;es metodol&#243;gicas&#44; contudo&#44; Su et al&#46; demonstrou que o limitado valor preditivo do exame direto aos 2 meses para a convers&#227;o da cultura era devido ao significativo impacto cl&#237;nico de alguns fatores&#44; para al&#233;m do estado do exame direto&#44; como cavita&#231;&#227;o&#44; resist&#234;ncia &#224; rifampicina&#44; e aplica&#231;&#227;o da terap&#234;utica observada diretamente &#40;TOD&#41;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">O desaparecimento de BAAR dos exames direto e cultural consiste no determinante mais amplamente aceite do tempo de isolamento e tratamento de doentes com TB&#44; apesar de alguma precau&#231;&#227;o e ju&#237;zo cl&#237;nico deverem ser aplicados na interpreta&#231;&#227;o dos seus resultados&#44; sobretudo relativamente ao exame direto&#46; O presente estudo foi elaborado de forma a determinar o tempo de convers&#227;o dos exames direto e cultural e a identificar os potenciais preditores de convers&#227;o tardia dos mesmos em doentes com TB pulmonar&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Material e m&#233;todos</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Desenho do estudo e popula&#231;&#227;o</span><p id="par0020" class="elsevierStylePara elsevierViewall">Coorte retrospetiva de doentes adultos com o diagn&#243;stico de TB pulmonar&#44; confirmado por exame cultural de expetora&#231;&#227;o&#44; referenciados a um Centro de Diagn&#243;stico Pneumol&#243;gico urbano &#40;Vila Nova de Gaia&#44; Portugal&#41;&#44; entre janeiro de 2006 a junho de 2009&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Dados s&#243;cio-demogr&#225;ficos&#44; cl&#237;nicos&#44; microbiol&#243;gicos&#44; radiol&#243;gicos e relacionados com a terap&#234;utica foram obtidos atrav&#233;s dos processos dos doentes e das bases do Plano Nacional de Luta contra a Tuberculose&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Foram estabelecidos como crit&#233;rios de exclus&#227;o&#58; multirresist&#234;ncia&#44; incapacidade de obter expetora&#231;&#227;o para an&#225;lise&#44; abandono&#44; transfer&#234;ncia para outra institui&#231;&#227;o&#44; ou morte durante o tratamento&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Exames micobacteriol&#243;gicos de expetora&#231;&#227;o &#8211; direto e cultural</span><p id="par0035" class="elsevierStylePara elsevierViewall">A an&#225;lise do exame direto para dete&#231;&#227;o de BAAR foi feita por microscopia de fluoresc&#234;ncia e&#47;ou colora&#231;&#227;o de Ziehl-Neelsen e a respetiva quantifica&#231;&#227;o por categorias padr&#227;o e equivalentes&#58; 1-9 BAAR&#47;100 campos &#40;1&#43;&#41;&#59; 1-9 BAAR&#47;10 campos &#40;2&#43;&#41;&#59; 1-9 BAAR&#47;campo &#40;3&#43;&#41;&#59; e &#62; 9 BAAR&#47;campo &#40;4&#43;&#41;<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">25&#44;26</span></a>&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">As amostras foram cultivadas em meio l&#237;quido BACTEC MGIT 960 &#40;Becton Dickinson&#41; e&#47;ou em meio s&#243;lido Lowenstein-Jensen &#40;Bio-Rad&#41; e a quantifica&#231;&#227;o do n&#250;mero de col&#243;nias foi realizada da seguinte forma&#58; &#60; 10 col&#243;nias &#40;1&#43;&#41;&#59; 10-100 col&#243;nias &#40;2&#43;&#41;&#59; &#62; 100 col&#243;nias &#40;3&#43;&#41;&#59; e conflu&#234;ncia &#40;4&#43;&#41;&#44; de acordo com os crit&#233;rios laboratoriais de refer&#234;ncia&#46; Todas as primeiras culturas positivas foram submetidas a estes de identifica&#231;&#227;o do MT e testes de sensibilidade aos antimicrobianos &#40;TSA&#41; &#40;m&#233;todo da concentra&#231;&#227;o inibit&#243;ria m&#237;nima&#41;&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Caracter&#237;sticas radiol&#243;gicas</span><p id="par0045" class="elsevierStylePara elsevierViewall">As telerradiografias tor&#225;cicas foram caracterizadas de acordo com extens&#227;o da doen&#231;a &#40;unilateral&#44; bilateral&#41; e presen&#231;a de cavita&#231;&#227;o&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Tratamento e monitoriza&#231;&#227;o</span><p id="par0050" class="elsevierStylePara elsevierViewall">O esquema terap&#234;utico cl&#225;ssico com dura&#231;&#227;o de 6 meses&#44; de acordo com os consensos internacionais&#44; foi aplicado &#40;fase inicial &#40;2 meses&#41;&#58; isoniazida &#40;H&#41;&#44; rifampicina &#40;R&#41;&#44; pirazinamida &#40;Z&#41;&#44; e etambutol &#40;E&#41;&#44; diariamente&#59; fase de continua&#231;&#227;o &#40;4 meses&#41;&#58; H e R diariamente&#41;&#44; e alterado nos doentes com doen&#231;a hep&#225;tica e&#47;ou renal concomitante&#44; na presen&#231;a de efeitos adversos&#44; e de acordo com os resultados do TSA&#44; se necess&#225;rio&#46; A estrat&#233;gia terap&#234;utica TOD foi assegurada durante todo o per&#237;odo de tratamento&#46; Os exames direto e cultural de expetora&#231;&#227;o foram realizados no in&#237;cio&#44; aos 2 meses&#44; e no fim do tratamento&#46; Contudo&#44; o exame direto foi realizado a cada 2 semanas at&#233; &#224; obten&#231;&#227;o de 3 amostras negativas consecutivas e o exame cultural mensalmente at&#233; &#224; obten&#231;&#227;o de 2 amostras negativas consecutivas<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a>&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Defini&#231;&#245;es</span><p id="par0055" class="elsevierStylePara elsevierViewall">A convers&#227;o do exame direto foi definida na presen&#231;a de 3 amostras negativas consecutivas&#46; O tempo de convers&#227;o dos exames direto e cultural foi calculado desde a data de in&#237;cio de tratamento at&#233; &#224; data da primeira amostra negativa&#46; A convers&#227;o tardia dos exames direto e cultural foi definida perante a positividade persistente desses exames ap&#243;s 2 meses de tratamento antibacilar&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">An&#225;lise estat&#237;stica</span><p id="par0060" class="elsevierStylePara elsevierViewall">A an&#225;lise estat&#237;stica foi feita atrav&#233;s do programa SPSS vers&#227;o 17 &#40;<span class="elsevierStyleItalic">SPSS Inc&#46;&#44; Chicago&#44; Illinois&#44; USA</span>&#41;&#46; Todas as probabilidades foram bicaudais e os valores de p &#60; 0&#44;05 foram considerados significativos&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Os dados foram descritos em mediana e intervalo interquartil &#40;IIQ&#41; para as vari&#225;veis quantitativas &#40;distribui&#231;&#227;o n&#227;o normal&#41; e como contagens e propor&#231;&#245;es para as vari&#225;veis qualitativas&#46; A compara&#231;&#227;o de vari&#225;veis quantitativas foi feita atrav&#233;s do teste <span class="elsevierStyleItalic">Mann-Whitney</span>&#46; O teste Qui-quadrado ou teste exato de <span class="elsevierStyleItalic">Fisher</span> foram usados para comparar vari&#225;veis categ&#243;ricas sempre que apropriado&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">A convers&#227;o tardia dos exames direto e cultural foi considerada uma vari&#225;vel dicot&#243;mica dependente&#46; As vari&#225;veis com significado estat&#237;stico e com significado biol&#243;gico plaus&#237;vel na an&#225;lise univariada foram introduzidas num modelo de regress&#227;o log&#237;stica &#40;m&#233;todo <span class="elsevierStyleItalic">forward stepwise</span>&#41; de forma a identificar os fatores independentemente associados com o <span class="elsevierStyleItalic">outcome</span> de convers&#227;o tardia&#46; Os odds ratios &#40;OR&#41; e intervalos de confian&#231;a de 95&#37; &#40;IC 95&#37;&#41; foram determinados&#46;</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Resultados</span><p id="par0075" class="elsevierStylePara elsevierViewall">Foram analisados retrospetivamente um total de 136 doentes&#46; A mediana de idades foi 41&#44;0 &#40;IIQ 18&#44;0&#41; anos&#44; e 75&#44;0&#37; dos doentes eram do g&#233;nero masculino&#46; As caracter&#237;sticas s&#243;cio-demogr&#225;ficas e as co-morbilidados dos doentes inclu&#237;dos est&#227;o representadas na <a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#46; Todos os doentes tinham TB pulmonar confirmada por exame cultural de expetora&#231;&#227;o e 118 doentes &#40;86&#44;8&#37;&#41; apresentavam simultaneamente exame direto positivo&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">O tempo mediano de convers&#227;o dos exames direto e cultural foi 46 &#40;1-343&#41; dias e 46 &#40;1-127&#41; dias&#44; respetivamente&#46; Ap&#243;s 2 meses de tratamento&#44; 25&#44;4&#37; &#40;30&#47;118&#41; e 27&#44;2&#37; &#40;37&#47;136&#41; dos doentes permaneciam com exame direto e cultural positivo&#44; respetivamente&#46; Entre os 30 doentes com convers&#227;o tardia do exame direto&#44; 6 atingiram convers&#227;o do exame cultural aos 2 meses&#46; Na <a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a> est&#227;o representados alguns dados dos doentes inclu&#237;dos relacionados com a TB&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Fatores associados com a convers&#227;o do exame direto de expetora&#231;&#227;o</span><p id="par0085" class="elsevierStylePara elsevierViewall">O g&#233;nero masculino &#91;55&#44;0 &#40;IIQ 53&#44;0&#41; dias vs 34&#44;0 &#40;IIQ 24&#44;5&#41; dias&#59; p &#61; 0&#44;028&#93;&#44; o tabagismo ativo &#91;54&#44;0 &#40;IIQ 48&#44;0&#41; dias vs 28&#44;0 &#40;IIQ 33&#44;5&#41; dias&#59; p &#61; 0&#44;004&#93;&#44; e as cargas bacilares mais elevadas &#91;1&#43;&#58; 24&#44;0 &#40;IIQ 14&#44;0&#41; dias vs 2&#43;&#58; 35&#44;0 &#40;IIQ 36&#44;3&#41; dias vs 3&#43;&#58; 53&#44;0 &#40;IIQ 54&#44;5&#41; dias vs 4&#43;&#58; 62&#44;0 &#40;IIQ 62&#44;5&#41; dias&#59; p &#61; 0&#44;001&#93; estiveram associados a um maior tempo de convers&#227;o do exame direto&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Pela an&#225;lise univariada&#44; o risco de um exame direto permanecer positivo aos 2 meses de tratamento foi superior nos doentes com idade &#8805; 50 anos&#44; do g&#233;nero masculino&#44; e com carga bacilar &#62; 3&#43; &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabela 3</a>&#41;&#46; N&#227;o foram encontradas diferen&#231;as estatisticamente significativas relativamente &#224;s outras vari&#225;veis analisadas&#44; nomeadamente&#44; imigra&#231;&#227;o&#44; reclus&#227;o&#44; sem-abrigo&#44; resid&#234;ncia comunit&#225;ria&#44; h&#225;bitos alco&#243;licos e toxif&#237;licos&#44; diabetes mellitus&#44; neoplasias&#44; TB pr&#233;via&#44; extens&#227;o TB &#40;pulmonar ou extra-pulmonar&#41;&#44; tratamento antibacilar alternativo&#44; e toxicidade terap&#234;utica&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">A an&#225;lise de regress&#227;o log&#237;stica multivariada indicou que todas estas 3 vari&#225;veis significativas na an&#225;lise univariada estavam independentemente associadas com a convers&#227;o tardia do exame direto &#40;idade &#8805; 50 anos&#58; OR 4&#44;4&#44; IC 95&#37; 1&#44;5-13&#44;3&#59; g&#233;nero masculino&#58; OR 10&#44;8&#44; IC 95&#37; 1&#44;3-91&#44;1&#59; carga bacilar &#62; 3&#43;&#58; OR 11&#44;7&#44; IC 95&#37; 1&#44;4-100&#44;6&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabela 4</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Fatores associados com a convers&#227;o do exame cultural de expetora&#231;&#227;o</span><p id="par0100" class="elsevierStylePara elsevierViewall">O desemprego &#91;56&#44;0 &#40;IIQ 55&#44;0&#41; dias vs 41&#44;5 &#40;IIQ 46&#44;3&#41; dias&#59; p &#61; 0&#44;046&#93;&#44; o tabagismo ativo &#91;58&#44;0 &#40;IIQ 47&#44;0&#41; dias vs 33&#44;5 &#40;IIQ 40&#44;3&#41; dias&#59; p &#61; 0&#44;022&#93;&#44; o envolvimento radiol&#243;gico bilateral &#91;59&#44;5 &#40;IIQ 64&#44;8&#41; dias vs 41&#44;0 &#40;IIQ 43&#44;0&#41; dias&#59; p &#61; 0&#44;011&#93;&#44; a doen&#231;a cavit&#225;ria &#91;57&#44;0 &#40;IIQ 49&#44;8&#41; dias vs 35&#44;0 &#40;IIQ 42&#44;3&#41; dias&#59; p &#61; 0&#44;006&#93;&#44; e as contagens de col&#243;nias mais elevadas &#91;1&#43;&#58; 20&#44;5 &#40;IIQ 28&#44;5&#41; dias vs 2&#43;&#58; 27&#44;0 &#40;IIQ 26&#44;0&#41; dias vs 3&#43;&#58; 39&#44;0 &#40;IIQ 33&#44;0&#41; dias vs 4&#43;&#58; 66&#44;0 &#40;IIQ 54&#44;0&#41; dias&#59; p &#60; 0&#44;001&#93; estiveram associadas a um maior tempo de convers&#227;o do exame cultural&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Pela an&#225;lise univariada&#44; o risco de um exame cultural permanecer positivo aos 2 meses de tratamento foi superior nos doentes desempregados&#44; com infe&#231;&#227;o pelo v&#237;rus da imunodefici&#234;ncia humana &#40;VIH&#41;&#44; com envolvimento radiol&#243;gico bilateral&#44; doen&#231;a cavit&#225;ria&#44; e com contagem de col&#243;nias &#62; 3&#43; &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabela 3</a>&#41;&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">A an&#225;lise de regress&#227;o log&#237;stica multivariada revelou que s&#243; o envolvimento radiol&#243;gico bilateral &#40;OR 3&#44;7&#44; IC 95&#37; 1&#44;5- 9&#44;0&#41; e a contagem de col&#243;nias &#62; 3&#43; &#40;OR 5&#44;8&#44; IC 95&#37; 1&#44;2-27&#44;4&#41; estavam independentemente associados com a convers&#227;o tardia do exame cultural &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabela 4</a>&#41;&#46;</p></span></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discuss&#227;o</span><p id="par0115" class="elsevierStylePara elsevierViewall">Uma monitoriza&#231;&#227;o regular dos exames micobacteriol&#243;gicos direto e cultural de expetora&#231;&#227;o durante o tratamento antibacilar permite avaliar a convers&#227;o desses exames&#44; evento importante para o planeamento terap&#234;utico e aconselhamento dos doentes com TB<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a>&#44; sobretudo nos pa&#237;ses com incid&#234;ncia interm&#233;dia de TB&#44; como Portugal<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a>&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">No presente estudo&#44; os autores analisaram&#44; de forma independente&#44; os resultados dos exames direto e cultural de doentes com TB pulmonar&#46; Os tempos medianos de convers&#227;o dos exames direto e cultural foram superiores a um m&#234;s&#44; apesar dos respetivos intervalos serem amplos e vari&#225;veis podendo demonstrar a influ&#234;ncia de diferentes fatores&#46; O tabagismo ativo e a carga bacilar global &#40;representada atrav&#233;s da quantifica&#231;&#227;o do n&#250;mero de BAAR e contagem de col&#243;nias&#41; estiveram associadas a um maior tempo de convers&#227;o para ambos os exames&#46; O g&#233;nero masculino esteve associado a um tempo de convers&#227;o do exame direto maior e o desemprego&#44; o envolvimento radiol&#243;gico bilateral&#44; e a doen&#231;a cavit&#225;ria estiveram associados a tempo de convers&#227;o do exame cultural maior&#46; O intervalo do tempo de convers&#227;o do exame direto foi superior ao do exame cultural&#44; provavelmente devido &#224; presen&#231;a de bacilos n&#227;o vi&#225;veis<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">20&#44;24</span></a>&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Os resultados deste estudo revelaram uma convers&#227;o tardia dos exames direto e cultural em 25&#44;4&#37; e 27&#44;2&#37; dos doentes com TB&#44; respetivamente&#46; Estudos previamente realizados relataram tempos de convers&#227;o variados entre os doentes com TB&#44; o que est&#225; relacionado com diferen&#231;as geogr&#225;ficas&#44; estado inicial do exame direto&#44; metodologias e an&#225;lise estat&#237;stica aplicadas<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;8&#8211;16&#44;18&#44;24&#44;30&#8211;32</span></a>&#46; No presente estudo&#44; a convers&#227;o tardia do exame direto esteve independentemente associada a uma idade superior a 50 anos&#44; ao g&#233;nero masculino&#44; e a uma carga bacilar pr&#233;-tratamento elevada&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Estudos pr&#233;vios demonstraram que a aus&#234;ncia de convers&#227;o do exame direto &#233; mais frequente nos doentes mais idosos<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#44;15&#44;18&#44;33&#44;34</span></a>&#44; situa&#231;&#227;o explicada pela maior incid&#234;ncia de limita&#231;&#245;es f&#237;sicas&#44; <span class="elsevierStyleItalic">clearance</span> ineficaz dos bacilos devido a uma resposta imunol&#243;gica mais deficit&#225;ria&#44; e atraso no acesso ao diagn&#243;stico e tratamento neste grupo de doentes&#46; Potencialmente&#44; algumas das suas co-morbilidades&#44; como as que possam afetar a absor&#231;&#227;o e metabolismo de determinados f&#225;rmacos antibacilares&#44; podem tamb&#233;m desempenhar um papel&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Os estudos relativos ao efeito do g&#233;nero na convers&#227;o da expetora&#231;&#227;o s&#227;o contradit&#243;rios&#46; No presente estudo&#44; os autores verificaram que o g&#233;nero masculino esteve associado a convers&#227;o tardia do exame direto&#46; Estes resultados est&#227;o de acordo com os apresentados por Rekha et al&#46;&#44; que especulou que tal estava relacionado com a maior preval&#234;ncia de h&#225;bitos alco&#243;licos e tab&#225;gicos nos homens<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a>&#46; Contudo&#44; no presente estudo&#44; n&#227;o foi encontrado qualquer efeito do g&#233;nero no consumo de &#225;lcool e de tabaco &#40;dados n&#227;o apresentados&#41;&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Os doentes com cargas bacilares pr&#233;-tratamento superiores &#40;3&#43;&#47;4&#43;&#41; negativaram menos frequentemente em compara&#231;&#227;o com os doentes com cargas bacilares inferiores &#40;1&#43;&#47;2&#43;&#41;&#46; Estudos pr&#233;vios reportaram resultados semelhantes<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;8&#44;11&#44;35</span></a>&#46; Rieder mostrou que a convers&#227;o do exame direto aos 2 meses foi 90&#44;9&#37;&#44; 77&#44;9&#37;&#44; e 61&#44;7&#37; nos doentes com carga bacilar inicial baixa&#44; moderada&#44; e intensa&#44; respetivamente<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a>&#46; Outros estudos tamb&#233;m demonstraram que a positividade persistente do exame direto esteve associada a graus mais elevados de BAAR pr&#233;-tratamento reflexo de uma carga inicial de micobact&#233;rias elevada<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">36&#44;37</span></a>&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">A an&#225;lise univariada mostrou que a positividade do exame cultural aos 2 meses esteve associada com o desemprego&#44; a infe&#231;&#227;o pelo VIH&#44; o envolvimento radiol&#243;gico bilateral&#44; a cavita&#231;&#227;o e contagem de col&#243;nias mais elevada&#46; Contudo&#44; a an&#225;lise multivariada mostrou que s&#243; o envolvimento radiol&#243;gico bilateral e as contagens de col&#243;nias mais elevadas estiveram independentemente relacionadas com esse resultado&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Nos doentes com TB desempregados&#44; o consumo de &#225;lcool&#44; de tabaco e a infe&#231;&#227;o pelo VIH foram mais frequentes &#40;dados n&#227;o apresentados&#41;&#44; os quais poderiam constituir potenciais confundidores&#46; A evid&#234;ncia pr&#233;via mostrou que os fumadores ativos e passivos apresentam maior risco de contrair TB ativa comparativamente com os n&#227;o fumadores<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">38&#8211;41</span></a>&#44; contudo os dados sobre a associa&#231;&#227;o entre tabagismo e outros <span class="elsevierStyleItalic">outcomes</span>&#44; como a convers&#227;o do exame cultural&#44; ainda s&#227;o insuficientes<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">38&#8211;41</span></a>&#46; A an&#225;lise univariada revelou que a infe&#231;&#227;o pelo VIH esteve associada com a convers&#227;o tardia do exame cultural&#44; contudo o estado de infe&#231;&#227;o pelo VIH n&#227;o constituiu um resultado significativo na an&#225;lise multivariada&#46; Tal est&#225; de acordo com alguns estudos anteriores que mostraram que o estado de infe&#231;&#227;o pelo VIH n&#227;o influencia negativamente a convers&#227;o do exame cultural&#44; na medida em que a sua positividade tem sido associada a uma carga bacilar inferior&#44; expressa&#44; tal como no presente estudo&#44; por uma baixa preval&#234;ncia de doen&#231;a cavit&#225;ria neste grupo de doentes &#40;dados n&#227;o apresentados&#41;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">18&#44;30&#44;33&#44;35&#44;42</span></a>&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">O envolvimento radiol&#243;gico bilateral e uma contagem de col&#243;nias elevada constitu&#237;ram fatores de risco independentes para a convers&#227;o tardia do exame cultural&#44; devido &#224; elevada carga bacilar basal destes doentes&#46; Contrariamente a outros estudos<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;11&#44;24&#44;28</span></a>&#44; os presentes resultados n&#227;o revelaram qualquer rela&#231;&#227;o entre a presen&#231;a de cavita&#231;&#227;o e a convers&#227;o tardia dos exames direto e cultural de expetora&#231;&#227;o&#44; apesar da mesma estar significativamente associada a um maior tempo de convers&#227;o do exame cultural&#46; Esta discrep&#226;ncia pode ter estado relacionada com diferen&#231;as metodol&#243;gicas e relacionadas com as popula&#231;&#245;es&#44; o reduzido tamanho da amostra&#44; e&#47;ou o desenho retrospetivo do estudo&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Neste estudo&#44; os fatores que influenciaram a convers&#227;o dos exames direto e cultural foram diferentes&#46; Consequentemente&#44; pode-se especular sobre a import&#226;ncia de avaliar separadamente cada tipo de exame micobacteriol&#243;gico&#46; Su et al&#46; realizou uma an&#225;lise prospetiva que incluiu 371 doentes com TB e mostrou que o valor preditivo do exame direto aos 2 meses na convers&#227;o do exame cultural era limitado devido &#224; consider&#225;vel influ&#234;ncia de fatores cl&#237;nicos&#44; como exame direto inicial&#44; cavita&#231;&#227;o&#44; resist&#234;ncia &#224; rifampicina&#44; multirresist&#234;ncia&#44; e TOD<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a>&#46; &#192; semelhan&#231;a&#44; nem todos os doentes do presente estudo apresentaram simultaneamente convers&#227;o tardia dos exames direto e cultural&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">O conhecimento dos fatores de risco associados a uma convers&#227;o tardia do exame cultural permite a identifica&#231;&#227;o dos doentes altamente infeciosos&#44; os quais necessitam de mais recursos m&#233;dicos e maior tempo de isolamento respirat&#243;rio&#44; para al&#233;m de necessitarem de uma interpreta&#231;&#227;o cautelosa dos exames diretos de expetora&#231;&#227;o&#46; Consequentemente&#44; alguns autores<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">22&#44;24</span></a> advogam o uso de uma nova medida&#44; como um biomarcador de elevada precis&#227;o e de resultado imediato&#44; contrariamente ao exame cultural&#44; para avalia&#231;&#227;o da resposta ao tratamento e grau de infeciosidade durante o tratamento antibacilar&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">As principais limita&#231;&#245;es do presente estudo s&#227;o o seu pequeno tamanho amostral&#44; o seu desenho retrospetivo&#44; com a consequente falta de alguns dados e avalia&#231;&#227;o subjetiva de algumas caracter&#237;sticas&#46; Os autores tentaram minimizar tais limita&#231;&#245;es atrav&#233;s de uma revis&#227;o cuidadosa de todos os ficheiros cl&#237;nicos e resultados de exames auxiliares de diagn&#243;stico dispon&#237;veis&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">Em conclus&#227;o&#44; a convers&#227;o tardia dos exames direto e cultural de expetora&#231;&#227;o ocorreu em cerca de um ter&#231;o dos doentes&#46; A idade avan&#231;ada&#44; o g&#233;nero masculino&#44; e uma carga bacilar mais elevada estiveram independentemente associados com a convers&#227;o tardia do exame direto&#59; o envolvimento radiol&#243;gico bilateral e uma contagem de col&#243;nias mais elevada estiveram independentemente associados com a convers&#227;o tardia do exame cultural&#46; Os autores sugerem que a intensifica&#231;&#227;o do tratamento e medidas adequadas de precau&#231;&#227;o de transmiss&#227;o do MT devem ser especialmente aplicadas nos doentes com TB e estes fatores de risco&#44; permitindo a optimiza&#231;&#227;o das medidas nacionais de controlo da TB&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflitos de interesses</span><p id="par0180" class="elsevierStylePara elsevierViewall">Os autores declaram n&#227;o haver conflito de interesses&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:10 [
        0 => array:2 [
          "identificador" => "xres547690"
          "titulo" => array:5 [
            0 => "Resumo"
            1 => "Introdu&#231;&#227;o"
            2 => "Material e m&#233;todos"
            3 => "Resultados"
            4 => "Conclus&#245;es"
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec565571"
          "titulo" => "Palavras-chave"
        ]
        2 => array:2 [
          "identificador" => "xres547691"
          "titulo" => array:5 [
            0 => "Abstract"
            1 => "Introduction"
            2 => "Material and methods"
            3 => "Results"
            4 => "Conclusions"
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec565570"
          "titulo" => "Keywords"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introdu&#231;&#227;o"
        ]
        5 => array:3 [
          "identificador" => "sec0010"
          "titulo" => "Material e m&#233;todos"
          "secciones" => array:6 [
            0 => array:2 [
              "identificador" => "sec0015"
              "titulo" => "Desenho do estudo e popula&#231;&#227;o"
            ]
            1 => array:2 [
              "identificador" => "sec0020"
              "titulo" => "Exames micobacteriol&#243;gicos de expetora&#231;&#227;o &#8211; direto e cultural"
            ]
            2 => array:2 [
              "identificador" => "sec0025"
              "titulo" => "Caracter&#237;sticas radiol&#243;gicas"
            ]
            3 => array:2 [
              "identificador" => "sec0030"
              "titulo" => "Tratamento e monitoriza&#231;&#227;o"
            ]
            4 => array:2 [
              "identificador" => "sec0035"
              "titulo" => "Defini&#231;&#245;es"
            ]
            5 => array:2 [
              "identificador" => "sec0040"
              "titulo" => "An&#225;lise estat&#237;stica"
            ]
          ]
        ]
        6 => array:3 [
          "identificador" => "sec0045"
          "titulo" => "Resultados"
          "secciones" => array:2 [
            0 => array:2 [
              "identificador" => "sec0050"
              "titulo" => "Fatores associados com a convers&#227;o do exame direto de expetora&#231;&#227;o"
            ]
            1 => array:2 [
              "identificador" => "sec0055"
              "titulo" => "Fatores associados com a convers&#227;o do exame cultural de expetora&#231;&#227;o"
            ]
          ]
        ]
        7 => array:2 [
          "identificador" => "sec0060"
          "titulo" => "Discuss&#227;o"
        ]
        8 => array:2 [
          "identificador" => "sec0065"
          "titulo" => "Conflitos de interesses"
        ]
        9 => array:1 [
          "titulo" => "Bibliografia"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2011-07-08"
    "fechaAceptado" => "2011-12-07"
    "PalabrasClave" => array:2 [
      "pt" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palavras-chave"
          "identificador" => "xpalclavsec565571"
          "palabras" => array:5 [
            0 => "Tuberculose"
            1 => "Expetora&#231;&#227;o"
            2 => "Exame direto"
            3 => "Exame cultural"
            4 => "Convers&#227;o tardia"
          ]
        ]
      ]
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec565570"
          "palabras" => array:5 [
            0 => "Tuberculosis"
            1 => "Sputum"
            2 => "Smear"
            3 => "Culture"
            4 => "Delayed conversion"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "pt" => array:2 [
        "titulo" => "Resumo"
        "resumen" => "<span><span class="elsevierStyleSectionTitle">Introdu&#231;&#227;o</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A aus&#234;ncia de convers&#227;o dos exames micobacteriol&#243;gicos direto e&#47;ou cultural de expetora&#231;&#227;o ap&#243;s 2 meses de tratamento para a tuberculose &#40;TB&#41; tem sido considerado um preditor do grau de infeciosidade do doente e de fal&#234;ncia terap&#234;utica&#46; Os autores estabeleceram por objetivo a identifica&#231;&#227;o dos fatores associados com a convers&#227;o tardia dos exames direto e cultural de expetora&#231;&#227;o num grupo de doentes com TB pulmonar sob tratamento antibacilar&#46;</p></span> <span><span class="elsevierStyleSectionTitle">Material e m&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Coorte retrospetiva de 136 doentes adultos com TB pulmonar&#44; confirmada por exame cultural de expetora&#231;&#227;o&#44; referenciados a um Centro de Diagn&#243;stico Pneumol&#243;gico urbano&#46; Foram analisadas vari&#225;veis s&#243;cio-demogr&#225;ficas&#44; cl&#237;nicas&#44; radiol&#243;gicas&#44; microbiol&#243;gicas e relacionadas com a terap&#234;utica&#46;</p></span> <span><span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A mediana de idades foi 41&#44;0 &#40;intervalo interquartil &#91;IIQ&#93; 18&#44;0&#41; anos e 75&#44;0&#37; dos doentes eram do g&#233;nero masculino&#46; A convers&#227;o tardia dos exames de expetora&#231;&#227;o direto e cultural ocorreu em 25&#44;4&#37; &#40;30&#47;118&#41; e 27&#44;2&#37; &#40;37&#47;136&#41; dos doentes&#44; respetivamente&#46; Pela an&#225;lise multivariada&#44; a idade &#8805; 50 anos &#40;odds ratio &#91;OR&#93; 4&#44;4&#44; intervalo de confian&#231;a &#91;IC&#93; 95&#37; 1&#44;5-13&#44;3&#41;&#44; o g&#233;nero masculino &#40;OR 10&#44;8&#44; IC 95&#37; 1&#44;3-91&#44;1&#41;&#44; e a carga bacilar &#62; 1-9 bacilos &#225;lcool-&#225;cido resistentes &#40;BAAR&#41;&#47;campo &#40;3&#43;&#41; &#40;OR 11&#44;7&#44; IC 95&#37; 1&#44;4-100&#44;6&#41; estiveram significativamente associados com a positividade persistente do exame direto&#44; ap&#243;s 2 meses de tratamento&#46; O envolvimento radiol&#243;gico bilateral &#40;OR 3&#44;7&#44; IC 95&#37; 1&#44;5-9&#44;0&#41; e a contagem de col&#243;nias &#62; 100 &#40;3&#43;&#41; &#40;OR 5&#44;8&#44; IC 95&#37; 1&#44;2-27&#44;4&#41; estiveram significativamente associados com a positividade persistente do exame cultural&#46;</p></span> <span><span class="elsevierStyleSectionTitle">Conclus&#245;es</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A convers&#227;o tardia dos exames direto e cultural de expetora&#231;&#227;o ocorreu em cerca de um ter&#231;o dos doentes&#46; A idade mais avan&#231;ada&#44; o g&#233;nero masculino e a elevada carga bacilar estiveram independentemente associados com a convers&#227;o tardia do exame direto de expetora&#231;&#227;o&#46; O envolvimento radiol&#243;gico bilateral e a contagem de col&#243;nias mais elevada estiveram independentemente associados com a convers&#227;o tardia do exame cultural&#46;</p></span>"
      ]
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span><span class="elsevierStyleSectionTitle">Introduction</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Failure of sputum smear and&#47;or culture conversion after 2 months of tuberculosis &#40;TB&#41; treatment has been considered a predictor of patient infectivity and treatment failure&#46; We aimed to identify the factors associated with delayed sputum smear and culture conversion in patients with pulmonary TB who were given anti-TB treatment&#46;</p></span> <span><span class="elsevierStyleSectionTitle">Material and methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Retrospective cohort of 136 adult patients with sputum culture-proven pulmonary TB referred to an urban Chest Disease Centre&#46; Socio-demographic&#44; clinical&#44; radiological&#44; microbiological&#44; and therapeutic data were evaluated&#46;</p></span> <span><span class="elsevierStyleSectionTitle">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">The median age was 41&#46;0 &#40;interquartile range &#91;IQR&#93; 18&#46;0&#41; years and 75&#46;0&#37; of patients were male&#46; Delayed sputum smear and culture conversion occurred in 25&#46;4&#37; &#40;30&#47;118&#41; and 27&#46;2&#37; &#40;37&#47;136&#41; of patients&#44; respectively&#46; Multivariate analysis indicated that age &#8805; 50 years &#40;odds ratio &#91;OR&#93; 4&#46;4&#44; 95&#37; confidence interval &#91;CI&#93; 1&#46;5-13&#46;3&#41;&#44; male gender &#40;OR 10&#46;8&#44; 95&#37; CI 1&#46;3-91&#46;1&#41;&#44; and smear grade &#62; 1-9 acid fast bacilli &#40;AFB&#41;&#47;field &#40;3&#43;&#41; &#40;OR 11&#46;7&#44; 95&#37; CI 1&#46;4-100&#46;6&#41; were significantly associated with persistent smear positivity after 2 months of treatment&#46; Bilateral radiological involvement &#40;OR 3&#46;7&#44; 95&#37; CI 1&#46;5-9&#46;0&#41; and colony count &#62; 100 &#40;3&#43;&#41; &#40;OR 5&#46;8&#44; 95&#37; CI 1&#46;2-27&#46;4&#41; were significantly associated with persistent culture positivity&#46;</p></span> <span><span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Delayed sputum smear and culture conversion occurred in about one third of patients&#46; Older age&#44; male gender&#44; and higher bacillary load were independently associated with delayed smear conversion&#46; Bilateral radiological involvement and higher colony count were independently associated with delayed culture conversion&#46;</p></span>"
      ]
    ]
    "multimedia" => array:4 [
      0 => array:7 [
        "identificador" => "tbl0005"
        "etiqueta" => "Tabela 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">As vari&#225;veis quantitativas s&#227;o expressas em mediana e intervalo interquartil &#40;IIQ&#41;&#46;</p><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">DM&#58; diabetes mellitus&#59; TB&#58; tuberculose&#59;VIH&#58; v&#237;rus da imunodefici&#234;ncia humana&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Caracter&#237;sticas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Todos os doentes &#40;n &#61; 136&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Idade &#40;anos&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">41&#44;0 &#40;IIQ 18&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">G&#233;nero&#44; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Feminino &#47; Masculino&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">34 &#40;25&#44;0&#41; &#47; 102 &#40;75&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Desemprego&#44; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Sim &#47; N&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50 &#40;36&#44;8&#41; &#47; 86 &#40;63&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Imigrante&#44; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Sim &#47; N&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6 &#40;4&#44;4&#41; &#47; 130 &#40;95&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Reclus&#227;o&#44; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Sim &#47; N&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 &#40;1&#44;5&#41; &#47; 134 &#40;98&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Sem-abrigo&#44; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Sim &#47; N&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6 &#40;4&#44;4&#41; &#47; 130 &#40;95&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Resid&#234;ncia comunit&#225;ria&#44; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Sim &#47; N&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 &#40;2&#44;2&#41; &#47; 133 &#40;97&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Tabagismo ativo&#44; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Sim &#47; N&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">75 &#40;72&#44;8&#41; &#47; 28 &#40;27&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Alcoolismo&#44; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Sim &#47; N&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21 &#40;15&#44;4&#41; &#47; 115 &#40;84&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Utilizadores de drogas&#44; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Sim &#47; N&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15 &#40;11&#44;0&#41; &#47; 121 &#40;89&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Infe&#231;&#227;o pelo VIH&#44; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Sim &#47; N&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15 &#40;11&#44;0&#41; &#47; 121 &#40;89&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">DM&#44; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Sim &#47; N&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10 &#40;7&#44;4&#41; &#47; 126 &#40;92&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Neoplasia&#44; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Sim &#47; N&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5 &#40;3&#44;7&#41; &#47; 131 &#40;96&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">TB pr&#233;via&#44; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Sim &#47; N&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12 &#40;8&#44;8&#41; &#47; 124 &#40;91&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Peso&#44; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#60; 60 Kg &#47; &#8805; 60 Kg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">72 &#40;57&#44;1&#41; &#47; 54 &#40;42&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab884642.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "pt" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Caracter&#237;sticas s&#243;cio-demogr&#225;ficas e co-morbilidades da popula&#231;&#227;o</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "tbl0010"
        "etiqueta" => "Tabela 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">BAAR&#58; bacilos &#225;lcool-&#225;cido resistentes&#59;TB&#58; tuberculose&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Caracter&#237;sticas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Todos os doentes &#40;n &#61; 136&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">TB pulmonar &#47; extra-pulmonar&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">128 &#40;94&#44;1&#41; &#47; 8 &#40;5&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Envolvimento radiol&#243;gico&#44; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Unilateral &#47; Bilateral&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">79 &#40;61&#44;2&#41; &#47; 50 &#40;38&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Cavita&#231;&#227;o&#44; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Sim &#47; N&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">92 &#40;67&#44;6&#41; &#47; 44 &#40;32&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Carga bacilar&#44; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>1-9 BAAR&#47;100 campos &#40;1&#43;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6 &#40;6&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>1-9 BAAR&#47;10 campos &#40;2&#43;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14 &#40;15&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>1-9 BAAR&#47;campo &#40;3&#43;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24 &#40;25&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#62; 9 BAAR&#47;campo &#40;4&#43;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">49 &#40;52&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Contagem de col&#243;nias&#44; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#60; 10 &#40;1&#43;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8 &#40;7&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>10-100 &#40;2&#43;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15 &#40;13&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#62; 100 &#40;3&#43;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">27 &#40;24&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>conflu&#234;ncia &#40;4&#43;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">59 &#40;54&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Teste sensibilidade antimicrobiana&#44; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Sens&#237;vel&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">126 &#40;92&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Resist&#234;ncia &#224; isoniazida&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;0&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Resist&#234;ncia &#224; estreptomicina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7 &#40;5&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Resist&#234;ncia &#224; isoniazida e estreptomicina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 &#40;1&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Toxicidade terap&#234;utica&#44; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Sim &#47; N&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">17 &#40;14&#44;4&#41; &#47; 101 &#40;85&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab884645.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "pt" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Caracter&#237;sticas da TB e tratamento antibacilar</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "tbl0015"
        "etiqueta" => "Tabela 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:3 [
          "leyenda" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">VIH&#58; v&#237;rus da imunodefici&#234;ncia humana&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Convers&#227;o tardia exame direto</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Convers&#227;o tardia exame cultural</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">Valor p</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">Valor p</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Idade &#40;anos&#41;</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#60; 50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15 &#40;17&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;003&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24 &#40;25&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;371&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#8805; 50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15 &#40;44&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13 &#40;32&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">G&#233;nero</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Feminino&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;6&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;008&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;20&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;317&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Masculino&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">28 &#40;31&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30 &#40;29&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Desemprego</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Sim&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14 &#40;29&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;439&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19 &#40;38&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;031&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>N&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16 &#40;22&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18 &#40;20&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Tabagismo ativo</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Sim&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21 &#40;30&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;065&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25 &#40;33&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;124&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>N&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;12&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;17&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Infe&#231;&#227;o VIH</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Sim&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;36&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;468&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;53&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;028&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>N&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26 &#40;24&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">29 &#40;24&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Peso &#40;Kg&#41;</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#60; 60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12 &#40;19&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;082&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17 &#40;23&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;228&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#8805; 60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16 &#40;34&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18 &#40;33&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Envolvimento radiol&#243;gico</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Unilateral&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15 &#40;23&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;613&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15 &#40;19&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;005&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Bilateral&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13 &#40;27&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21 &#40;42&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Cavita&#231;&#227;o</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Sim&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22 &#40;25&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;856&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30 &#40;32&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;041&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>N&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;26&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;15&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Carga bacilar</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>1&#43; &#47; 2&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;5&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;010&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;15&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;078&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>3&#43; &#47; 4&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25 &#40;34&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26 &#40;35&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Contagem de col&#243;nias</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>1&#43; &#47; 2&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;9&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;278&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;8&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;018&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>3&#43; &#47; 4&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24 &#40;28&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">29 &#40;33&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Sensibilidade f&#225;rmacos</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Sens&#237;vel&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">28 &#40;25&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;27&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Resistente &#62; 1 f&#225;rmaco&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;22&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;30&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab884643.png"
              ]
            ]
          ]
          "notaPie" => array:1 [
            0 => array:3 [
              "identificador" => "tblfn0005"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara">Convers&#227;o tardia dos exames direto e cultural de expetora&#231;&#227;o&#58; exame direto e cultural de expetora&#231;&#227;o persistentemente positivo ao fim de 2 meses de tratamento antibacilar&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "pt" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Fatores associados com a convers&#227;o tardia dos exames micobacteriol&#243;gicos direto e cultural de expetora&#231;&#227;o<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> &#40;an&#225;lise univariada&#41;</p>"
        ]
      ]
      3 => array:7 [
        "identificador" => "tbl0020"
        "etiqueta" => "Tabela 4"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">OR&#58; odds ratio&#59; IC 95&#37;&#58; intervalo de confian&#231;a de 95&#37;&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Vari&#225;vel dependente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Vari&#225;vel independente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">OR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">IC 95&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">Valor p</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " rowspan="3" align="left" valign="top">Convers&#227;o exame direto</td><td class="td" title="table-entry  " align="left" valign="top">Idade &#8805; 50 anos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;5-13&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;008&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">G&#233;nero masculino&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;3-91&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;029&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Carga bacilar &#40;3&#43; &#47; 4&#43;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;4-100&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;025&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">Convers&#227;o exame cultural</td><td class="td" title="table-entry  " align="left" valign="top">Envolvimento radiol&#243;gico bilateral&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;5-9&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;005&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Contagem de col&#243;nias &#40;3&#43; &#47; 4&#43;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;2-27&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;027&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab884644.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "pt" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Regress&#227;o log&#237;stica multivariada das vari&#225;veis significativamente associadas com a convers&#227;o tardia dos exames micobacteriol&#243;gicos direto e cultural da expetora&#231;&#227;o</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "Bibliografia"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:42 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "World Health Organization&#46; Treatment of Tuberculosis&#46; Guidelines for National Programmes&#44; 4<span class="elsevierStyleSup">th</span> ed&#46; World Health Organization Document 2010&#59;WHO&#47;HTM&#47;TB&#47;2009&#46;420&#58;1-147&#46;"
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Time to detection of Mycobacterium tuberculosis in sputum culture correlates with outcome in patients receiving treatment for pulmonary tuberculosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "M&#46;D&#46; Epstein"
                            1 => "N&#46;W&#46; Schluger"
                            2 => "A&#46;L&#46; Davidow"
                            3 => "S&#46; Bonk"
                            4 => "W&#46;N&#46; Rom"
                            5 => "B&#46; Hanna"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "1998"
                        "volumen" => "113"
                        "paginaInicial" => "379"
                        "paginaFinal" => "386"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9498955"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Infectivity of patients with pulmonary tuberculosis during chemotherapy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "D&#46;A&#46; Mitchison"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Respir J"
                        "fecha" => "1990"
                        "volumen" => "3"
                        "paginaInicial" => "385"
                        "paginaFinal" => "386"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2114306"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The early bactericidal activity of drugs in patients with pulmonary tuberculosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "A&#46; Jindani"
                            1 => "V&#46;R&#46; Aber"
                            2 => "E&#46;A&#46; Edwards"
                            3 => "D&#46;A&#46; Mitchison"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/arrd.1980.121.6.939"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am Rev Respir Dis"
                        "fecha" => "1980"
                        "volumen" => "121"
                        "paginaInicial" => "939"
                        "paginaFinal" => "949"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6774638"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A pilot study concerning the infection risk of sputum positive tuberculosis patients on chemotherapy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "S&#46;M&#46; Brooks"
                            1 => "N&#46;L&#46; Lassiter"
                            2 => "E&#46;C&#46; Young"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/arrd.1973.108.4.799"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am Rev Respir Dis"
                        "fecha" => "1973"
                        "volumen" => "108"
                        "paginaInicial" => "799"
                        "paginaFinal" => "804"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/4741874"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Factors influencing time to smear conversion in patients with smear-positive pulmonary tuberculosis"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "Tami Group"
                          "etal" => false
                          "autores" => array:5 [
                            0 => "J&#46;Y&#46; Wang"
                            1 => "L&#46;N&#46; Lee"
                            2 => "C&#46;J&#46; Yu"
                            3 => "Y&#46;J&#46; Chien"
                            4 => "P&#46;C&#46; Yang"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1440-1843.2009.01598.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Respirology"
                        "fecha" => "2009"
                        "volumen" => "14"
                        "paginaInicial" => "1012"
                        "paginaFinal" => "1019"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19659516"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Infectiousness of tuberculosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "L&#46; Clancy"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Bull Int Union Tuberc Lung Dis"
                        "fecha" => "1990"
                        "volumen" => "65"
                        "paginaInicial" => "70"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2257364"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Sputum smear conversion during directly observed treatment for tuberculosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "H&#46;L&#46; Rieder"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Tuber Lung Dis"
                        "fecha" => "1996"
                        "volumen" => "77"
                        "paginaInicial" => "124"
                        "paginaFinal" => "129"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8762846"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Factors determining the outcome of treatment of adult smear-positive tuberculosis cases in The Gambia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "C&#46; Lienhardt"
                            1 => "K&#46; Manneh"
                            2 => "V&#46; Bouchier"
                            3 => "G&#46; Lahai"
                            4 => "P&#46;J&#46; Milligan"
                            5 => "K&#46;P&#46; McAdam"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Tuberc Lung Dis"
                        "fecha" => "1998"
                        "volumen" => "2"
                        "paginaInicial" => "712"
                        "paginaFinal" => "718"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9755924"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Bacteriological follow-up of tuberculosis treatment&#58; a comparative study of smear microscopy and culture results at the second month of treatment"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "H&#46; Ramarokoto"
                            1 => "H&#46; Randriamiharisoa"
                            2 => "A&#46; Rakotoarisaonina"
                            3 => "T&#46; Rasolovavalona"
                            4 => "V&#46; Rasolofo"
                            5 => "S&#46; Chanteau"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Tuberc Lung Dis"
                        "fecha" => "2002"
                        "volumen" => "6"
                        "paginaInicial" => "909"
                        "paginaFinal" => "912"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12365578"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Factors predicting persistent sputum smear positivity among pulmonary tuberculosis patients 2 months after treatment"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "R&#46; Singla"
                            1 => "M&#46;M&#46; Osman"
                            2 => "N&#46; Khan"
                            3 => "N&#46; Al-Sharif"
                            4 => "M&#46;O&#46; Al-Sayegh"
                            5 => "M&#46;A&#46; Shaikh"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Tuberc Lung Dis"
                        "fecha" => "2003"
                        "volumen" => "7"
                        "paginaInicial" => "58"
                        "paginaFinal" => "64"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12701836"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effect of cigarette smoking on sputum smear conversion in adults with active pulmonary tuberculosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "A&#46;T&#46; Abal"
                            1 => "B&#46; Jayakrishnan"
                            2 => "S&#46; Parwer"
                            3 => "A&#46; El Shamy"
                            4 => "E&#46; Abahussain"
                            5 => "P&#46;N&#46; Sharma"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.rmed.2004.08.016"
                      "Revista" => array:6 [
                        "tituloSerie" => "Respir Med"
                        "fecha" => "2005"
                        "volumen" => "99"
                        "paginaInicial" => "415"
                        "paginaFinal" => "420"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15763447"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Association of conversion &#38; cure with initial smear grading among new smear positive pulmonary tuberculosis patients treated with Category I regimen"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "P&#46;G&#46; Gopi"
                            1 => "V&#46; Chandrasekaran"
                            2 => "R&#46; Subramani"
                            3 => "T&#46; Santha"
                            4 => "A&#46; Thomas"
                            5 => "N&#46; Selvakumar"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Indian J Med Res"
                        "fecha" => "2006"
                        "volumen" => "123"
                        "paginaInicial" => "807"
                        "paginaFinal" => "814"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16885603"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Sputum smear status at two months and subsequent treatment outcome in new patients with smear-positive pulmonary tuberculosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "F&#46;M&#46; Salaniponi"
                            1 => "J&#46;J&#46; Christensen"
                            2 => "F&#46; Gausi"
                            3 => "J&#46;J&#46; Kwanjana"
                            4 => "A&#46;D&#46; Harries"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Tuberc Lung Dis"
                        "fecha" => "1999"
                        "volumen" => "3"
                        "paginaInicial" => "1047"
                        "paginaFinal" => "1048"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10587328"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Factors influencing sputum smear and culture conversion time among patients with new case pulmonary tuberculosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "M&#46; G&#252;ler"
                            1 => "E&#46; Unsal"
                            2 => "B&#46; Dursun"
                            3 => "O&#46; Aydln"
                            4 => "N&#46; Capan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1742-1241.2006.01131.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Clin Pract"
                        "fecha" => "2007"
                        "volumen" => "61"
                        "paginaInicial" => "231"
                        "paginaFinal" => "235"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17166185"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Time to culture conversion in smokers with pulmonary tuberculosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;A&#46; Gull&#243;n"
                            1 => "I&#46; Su&#225;rez"
                            2 => "M&#46; Lecuona"
                            3 => "R&#46; Fern&#225;ndez"
                            4 => "G&#46; Rubinos"
                            5 => "A&#46; Medina"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.4081/monaldi.2009.358"
                      "Revista" => array:6 [
                        "tituloSerie" => "Monaldi Arch Chest Dis"
                        "fecha" => "2009"
                        "volumen" => "71"
                        "paginaInicial" => "127"
                        "paginaFinal" => "131"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19999959"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Time to sputum culture conversion in multidrug-resistant tuberculosis&#58; predictors and relationship to treatment outcome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "T&#46;H&#46; Holtz"
                            1 => "M&#46; Sternberg"
                            2 => "S&#46; Kammerer"
                            3 => "K&#46;F&#46; Laserson"
                            4 => "V&#46; Riekstina"
                            5 => "E&#46; Zarovska"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Ann Intern Med"
                        "fecha" => "2006 2"
                        "volumen" => "144"
                        "paginaInicial" => "650"
                        "paginaFinal" => "659"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16670134"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0016508506025637"
                          "estado" => "S300"
                          "issn" => "00165085"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Sputum conversion at the end of intensive phase of Category-1 regimen in the treatment of pulmonary tuberculosis patients with diabetes mellitus or HIV infection&#58; An analysis of risk factors"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "V&#46;V&#46; Banu Rekha"
                            1 => "R&#46; Balasubramanian"
                            2 => "S&#46; Swaminathan"
                            3 => "R&#46; Ramachandran"
                            4 => "F&#46; Rahman"
                            5 => "V&#46; Sundaram"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Indian J Med Res"
                        "fecha" => "2007"
                        "volumen" => "126"
                        "paginaInicial" => "452"
                        "paginaFinal" => "458"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18160750"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Incidence and significance of acid-fast bacilli in sputum smears at the end of antituberculous treatment"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "R&#46; Vidal"
                            1 => "N&#46; Martin-Casabona"
                            2 => "A&#46; Juan"
                            3 => "T&#46; Falgueras"
                            4 => "M&#46; Miravitlles"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "1996"
                        "volumen" => "109"
                        "paginaInicial" => "1562"
                        "paginaFinal" => "1565"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8769512"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The significance of the persistent presence of acid-fast bacilli in sputum smears in pulmonary tuberculosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "M&#46;S&#46; Al-Moamary"
                            1 => "W&#46; Black"
                            2 => "E&#46; Bessuille"
                            3 => "R&#46;K&#46; Elwood"
                            4 => "S&#46; Vedal"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "1999"
                        "volumen" => "116"
                        "paginaInicial" => "726"
                        "paginaFinal" => "731"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10492279"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0105"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The incidence and clinical implication of sputum with positive acid-fast bacilli smear but negative in mycobacterial culture in a tertiary referral hospital in South Korea"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;S&#46; Lee"
                            1 => "E&#46;C&#46; Kim"
                            2 => "S&#46;I&#46; Joo"
                            3 => "S&#46;M&#46; Lee"
                            4 => "C&#46;G&#46; Yoo"
                            5 => "Y&#46;W&#46; Kim"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3346/jkms.2008.23.5.767"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Korean Med Sci"
                        "fecha" => "2008"
                        "volumen" => "23"
                        "paginaInicial" => "767"
                        "paginaFinal" => "771"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18955779"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Sputum monitoring during tuberculosis treatment for predicting outcome&#58; systematic review and meta-analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "D&#46;J&#46; Horne"
                            1 => "S&#46;E&#46; Royce"
                            2 => "L&#46; Gooze"
                            3 => "M&#46; Narita"
                            4 => "P&#46;C&#46; Hopewell"
                            5 => "P&#46; Nahid"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S1473-3099(10)70071-2"
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet Infect Dis"
                        "fecha" => "2010"
                        "volumen" => "10"
                        "paginaInicial" => "387"
                        "paginaFinal" => "394"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20510279"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0115"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Sputum monitoring during tuberculosis treatment for predicting outcome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "J&#46;B&#46; Humbwavali"
                            1 => "N&#46;J&#46; Trujillo"
                            2 => "B&#46;S&#46; Paim"
                            3 => "F&#46;H&#46; Wolff"
                            4 => "N&#46;T&#46; Barcellos"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S1473-3099(11)70043-3"
                      "Revista" => array:5 [
                        "tituloSerie" => "Lancet Infect Dis"
                        "fecha" => "2011"
                        "volumen" => "11"
                        "paginaInicial" => "160"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21371650"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0120"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Role of 2-month sputum smears in predicting culture conversion in pulmonary tuberculosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "W&#46;J&#46; Su"
                            1 => "J&#46;Y&#46; Feng"
                            2 => "Y&#46;C&#46; Chiu"
                            3 => "S&#46;F&#46; Huang"
                            4 => "Y&#46;C&#46; Lee"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1183/09031936.00007410"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Respir J"
                        "fecha" => "2011"
                        "volumen" => "37"
                        "paginaInicial" => "376"
                        "paginaFinal" => "383"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20516049"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0125"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Diagnostic Standards and Classification of Tuberculosis in Adults and Children&#46; This official statement of the American Thoracic Society and the Centers for Disease Control and Prevention was adopted by the ATS Board of Directors&#44; July 1999&#46; This statement was endorsed by the Council of the Infectious Disease Society of America&#44; September 1999&#46; Am J Respir Crit Care Med&#46; 2000&#59;161&#40;4 Pt 1&#41;&#58;1376&#8211;95&#46;"
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0130"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Mycobacteria&#46; Em&#58; Bailey &#38; Scott&#39;s Diagnostic Microbiology"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "B&#46;A&#46; Forbes"
                            1 => "D&#46;F&#46; Sahm"
                            2 => "A&#46;S&#46; Weissfeld"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:4 [
                        "edicion" => "11&#170; ed&#46;"
                        "fecha" => "2002"
                        "editorial" => "Mosby"
                        "editorialLocalizacion" => "St&#46; Louis&#44; MO"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0135"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Tuberculosis treatment and management of some problems related to the medication"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46; Duarte"
                            1 => "A&#46; Carvalho"
                            2 => "D&#46; Ferreira"
                            3 => "S&#46; Saleiro"
                            4 => "R&#46; Lima"
                            5 => "M&#46; Mota"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Port Pneumol"
                        "fecha" => "2010"
                        "volumen" => "16"
                        "paginaInicial" => "559"
                        "paginaFinal" => "572"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20700555"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib0140"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "How soon should patients with smear-positive tuberculosis be released from inpatient isolation&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "D&#46;J&#46; Horne"
                            1 => "C&#46;O&#46; Johnson"
                            2 => "E&#46; Oren"
                            3 => "C&#46; Spitters"
                            4 => "M&#46; Narita"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1086/649022"
                      "Revista" => array:6 [
                        "tituloSerie" => "Infect Control Hosp Epidemiol"
                        "fecha" => "2010"
                        "volumen" => "31"
                        "paginaInicial" => "78"
                        "paginaFinal" => "84"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19968490"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib0145"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Programa Nacional de Luta contra a Tuberculose&#46; Ponto da Situa&#231;&#227;o Epidemiol&#243;gica e de desempenho&#46; Ano 2010 &#40;vers&#227;o Mar&#231;o 2011&#41;&#46; 2&#8211;33&#46;"
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib0150"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Sputum conversion among patients with pulmonary tuberculosis&#58; are there implications for removal of respiratory isolation&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46; Fort&#250;n"
                            1 => "P&#46; Mart&#237;n-D&#225;vila"
                            2 => "A&#46; Molina"
                            3 => "E&#46; Navas"
                            4 => "J&#46;M&#46; Hermida"
                            5 => "J&#46; Cobo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/jac/dkm025"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Antimicrob Chemother"
                        "fecha" => "2007"
                        "volumen" => "59"
                        "paginaInicial" => "794"
                        "paginaFinal" => "798"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17392354"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib0155"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Non conversion of sputum smears in new smear positive pulmonary tuberculosis patients in Yaound&#233;&#44; Cameroon"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "C&#46; Kuaban"
                            1 => "R&#46; Bame"
                            2 => "L&#46; Mouangue"
                            3 => "S&#46; Djella"
                            4 => "C&#46; Yomgni"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "East Afr Med J"
                        "fecha" => "2009"
                        "volumen" => "86"
                        "paginaInicial" => "219"
                        "paginaFinal" => "225"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20084990"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            31 => array:3 [
              "identificador" => "bib0160"
              "etiqueta" => "32"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Acid-fast bacilli in sputum smears of patients with pulmonary tuberculosis&#46; Prevalence and significance of negative smears pretreatment and positive smears post-treatment"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "T&#46;C&#46; Kim"
                            1 => "R&#46;S&#46; Blackman"
                            2 => "K&#46;M&#46; Heatwole"
                            3 => "T&#46; Kim"
                            4 => "D&#46;F&#46; Rochester"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Am Rev Respir Dis"
                        "fecha" => "1984"
                        "volumen" => "129"
                        "paginaInicial" => "264"
                        "paginaFinal" => "268"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6421211"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            32 => array:3 [
              "identificador" => "bib0165"
              "etiqueta" => "33"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Factors associated with time to sputum smear conversion in active pulmonary tuberculosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Dom&#237;nguez-Castellano"
                            1 => "M&#46;A&#46; Muniain"
                            2 => "J&#46; Rodriguez-Ba&#241;o"
                            3 => "M&#46; Garcia"
                            4 => "M&#46;J&#46; Rios"
                            5 => "J&#46; Galvez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Tuberc Lung Dis"
                        "fecha" => "2003"
                        "volumen" => "7"
                        "paginaInicial" => "432"
                        "paginaFinal" => "438"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12757043"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            33 => array:3 [
              "identificador" => "bib0170"
              "etiqueta" => "34"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Predictors of sputum culture conversion among patients with tuberculosis in the era of tuberculosis resurgence"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "Z&#46; Liu"
                            1 => "K&#46;L&#46; Shilkret"
                            2 => "H&#46;M&#46; Ellis"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Intern Med"
                        "fecha" => "1999"
                        "volumen" => "159"
                        "paginaInicial" => "1110"
                        "paginaFinal" => "1116"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10335689"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            34 => array:3 [
              "identificador" => "bib0175"
              "etiqueta" => "35"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Factors influencing time to sputum conversion among patients with smear-positive pulmonary tuberculosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "E&#46;E&#46; Telzak"
                            1 => "B&#46;A&#46; Fazal"
                            2 => "C&#46;L&#46; Pollard"
                            3 => "G&#46;S&#46; Turett"
                            4 => "J&#46;E&#46; Justman"
                            5 => "S&#46; Blum"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Infect Dis"
                        "fecha" => "1997"
                        "volumen" => "25"
                        "paginaInicial" => "666"
                        "paginaFinal" => "670"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9314458"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            35 => array:3 [
              "identificador" => "bib0180"
              "etiqueta" => "36"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Present aspects of bacterial resistance in tuberculosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "G&#46; Canetti"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/arrd.1965.92.5.687"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am Rev Respir Dis"
                        "fecha" => "1965"
                        "volumen" => "92"
                        "paginaInicial" => "687"
                        "paginaFinal" => "703"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/5321145"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            36 => array:3 [
              "identificador" => "bib0185"
              "etiqueta" => "37"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Enumeration of tubercle bacilli in sputum of patients with pulmonary tuberculosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "G&#46;L&#46; Hobby"
                            1 => "A&#46;P&#46; Holman"
                            2 => "M&#46;D&#46; Iseman"
                            3 => "J&#46;M&#46; Jones"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Antimicrob Agents Chemother"
                        "fecha" => "1973"
                        "volumen" => "4"
                        "paginaInicial" => "94"
                        "paginaFinal" => "104"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/4208508"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            37 => array:3 [
              "identificador" => "bib0190"
              "etiqueta" => "38"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Tobacco and tuberculosis&#58; a qualitative systematic review and meta-analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "K&#46; Slama"
                            1 => "C&#46;Y&#46; Chiang"
                            2 => "D&#46;A&#46; Enarson"
                            3 => "K&#46; Hassmiller"
                            4 => "A&#46; Fanning"
                            5 => "P&#46; Gupta"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Tuberc Lung Dis"
                        "fecha" => "2007"
                        "volumen" => "11"
                        "paginaInicial" => "1049"
                        "paginaFinal" => "1061"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17945060"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            38 => array:3 [
              "identificador" => "bib0195"
              "etiqueta" => "39"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Tobacco smoke&#44; indoor air pollution and tuberculosis&#58; a systematic review and meta-analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "H&#46;H&#46; Lin"
                            1 => "M&#46; Ezzati"
                            2 => "M&#46; Murray"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1371/journal.pmed.0040020"
                      "Revista" => array:5 [
                        "tituloSerie" => "PLoS Med"
                        "fecha" => "2007"
                        "volumen" => "4"
                        "paginaInicial" => "e20"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17227135"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            39 => array:3 [
              "identificador" => "bib0200"
              "etiqueta" => "40"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Tobacco and tuberculosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "J&#46;P&#46; Zellweger"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.4081/monaldi.2008.403"
                      "Revista" => array:6 [
                        "tituloSerie" => "Monaldi Arch Chest Dis"
                        "fecha" => "2008"
                        "volumen" => "69"
                        "paginaInicial" => "83"
                        "paginaFinal" => "85"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18837424"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            40 => array:3 [
              "identificador" => "bib0205"
              "etiqueta" => "41"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Passive smoking and tuberculosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46;C&#46; Leung"
                            1 => "T&#46;H&#46; Lam"
                            2 => "K&#46;S&#46; Ho"
                            3 => "W&#46;W&#46; Yew"
                            4 => "C&#46;M&#46; Tam"
                            5 => "W&#46;M&#46; Chan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/archinternmed.2009.506"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Intern Med"
                        "fecha" => "2010"
                        "volumen" => "170"
                        "paginaInicial" => "287"
                        "paginaFinal" => "292"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20142576"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            41 => array:3 [
              "identificador" => "bib0210"
              "etiqueta" => "42"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Smear microscopy and culture conversion rates among smear positive pulmonary tuberculosis patients by HIV status in Dar es Salaam&#46; Tanzania"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "M&#46; Senkoro"
                            1 => "S&#46;G&#46; Mfinanga"
                            2 => "O&#46; M&#248;rkve"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/1471-2334-10-210"
                      "Revista" => array:5 [
                        "tituloSerie" => "BMC Infect Dis"
                        "fecha" => "2010"
                        "volumen" => "10"
                        "paginaInicial" => "210"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20637077"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "pt"
  "url" => "/08732159/0000001800000002/v2_201509041409/S0873215912000037/v2_201509041409/pt/main.assets"
  "Apartado" => array:4 [
    "identificador" => "9575"
    "tipo" => "SECCION"
    "pt" => array:2 [
      "titulo" => "Artigos originais"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "pt"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/08732159/0000001800000002/v2_201509041409/S0873215912000037/v2_201509041409/pt/main.pdf?idApp=UINPBA00004E&text.app=https://journalpulmonology.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0873215912000037?idApp=UINPBA00004E"
]