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        "resumen" => "<span id="as0005" class="elsevierStyleSection elsevierViewall"><p id="sp0005" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Introdu&#231;&#227;o&#58;</span> A tuberculose extensivamente resistente &#40;TBXDR&#41; define-se como uma forma de tuberculose multirresistente &#40;TBMR&#41; com resist&#234;ncias adicionais &#224;s fluoroquinolonas e&#44; pelo menos&#44; a um dos antibacilares inject&#225;veis seguintes&#58; amicacina&#44; canamicina e capreomicina&#46; Foi classificada pela OMS como uma amea&#231;a s&#233;ria ao controlo da tuberculose&#44; com consequ&#234;ncias &#224; escala mundial&#44; assumindo os contornos de uma aut&#234;ntica pandemia em algumas regi&#245;es do globo&#46;</p><p id="sp0010" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Objectivo&#58;</span> Comparar os doentes com TBXDR <span class="elsevierStyleItalic">versus</span> outros perfis de TBMR no que diz respeito &#224;s caracter&#237;sticas demogr&#225;ficas e epidemiol&#243;gicas&#44; factores etiopatog&#233;nicos e evolu&#231;&#227;o no internamento&#46;</p><p id="sp0015" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Material e m&#233;todos&#58;</span> Doentes internados no Servi&#231;o de Pneumologia III do Hospital de Pulido Valente no per&#237;odo compreendido entre Abril de 1999 e Junho de 2007&#44; com o diagn&#243;stico de TBMR microbiologicamente confirmado&#46; Foram analisadas as seguintes vari&#225;veis&#58; sexo&#44; distribui&#231;&#227;o et&#225;ria&#44; ra&#231;a&#44; formas de apresenta&#231;&#227;o da TB&#44; grupos de tratamento&#44; perfil de resist&#234;ncia aos antibacilares&#44; estatuto de imigrante&#44; n&#250;mero e dura&#231;&#227;o de tratamentos anteriores&#44; classifica&#231;&#227;o OMS&#44; co-infec&#231;&#227;o VIH&#44; alcoolismo e&#47;ou toxicodepend&#234;ncia&#44; demora m&#233;dia do internamento e mortalidade intra-hospitalar&#46; A an&#225;lise estat&#237;stica realizou-se no programa SPSS &#40;Statistical Package for the Social Sciences&#41;&#44; vers&#227;o 15&#46;0&#46; Nas vari&#225;veis categoriais&#44; as diferen&#231;as estat&#237;sticas entre os grupos foram avaliadas atrav&#233;s do teste qui-quadrado e as vari&#225;veis num&#233;ricas atrav&#233;s do teste <span class="elsevierStyleItalic">t</span>&#46; Para a constru&#231;&#227;o do modelo preditivo da presen&#231;a de TBXDR &#40;vari&#225;vel dependente&#41; foi utilizada a an&#225;lise de regress&#227;o log&#237;stica&#44; tendo sido inclu&#237;das as seguintes vari&#225;veis independentes&#58; classifica&#231;&#227;o OMS&#44; coinfec&#231;&#227;o VIH&#44; estatuto de imigrante&#44; alcoolismo e&#47;ou toxicodepend&#234;ncia e n&#250;mero e dura&#231;&#227;o de tratamentos anteriores&#46;</p><p id="sp0020" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Resultados&#58;</span> Foram contabilizados 132 doentes com TBMR&#44; dos quais 69 &#40;52&#44;3&#37;&#41; eram TBXDR&#46; Observaram-se diferen&#231;as estatisticamente significativas nas seguintes vari&#225;veis&#58; ra&#231;a &#40;a ra&#231;a negra esteve associada a TBXDR em 74&#37; dos casos <span class="elsevierStyleItalic">versus</span> 46&#37; da ra&#231;a caucasiana&#41;&#59; classifica&#231;&#227;o OMS &#40;doentes com retratamento por insucesso terap&#234;utico&#44; interrup&#231;&#227;o do tratamento ou recidiva constitu&#237;ram 69&#44;5&#37; dos casos de TBXDR <span class="elsevierStyleItalic">versus</span> 44&#44;5 &#37; dos casos n&#227;o TBXDR&#41;&#59; dura&#231;&#227;o m&#233;dia dos tratamentos anteriores &#40;4&#44;2 meses para os casos de TBXDR <span class="elsevierStyleItalic">versus</span> 2&#44;8 meses para os casos n&#227;o TBXDR&#41;&#59; coinfec&#231;&#227;o VIH&#47;SIDA &#40;doentes com coinfec&#231;&#227;o VIH constitu&#237;ram 65&#44;2&#37; dos casos de TB XDR <span class="elsevierStyleItalic">versus</span> 42&#44;9&#37; dos casos n&#227;o TBXDR&#41; e mortalidade &#40;33&#44;3&#37; nos doentes com TBXDR <span class="elsevierStyleItalic">versus</span> 14&#44;3&#37; nos doentes n&#227;o TBXDR&#41;&#46;</p><p id="sp0025" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Conclus&#245;es&#58;</span> As vari&#225;veis com valor preditivo para o diagn&#243;stico de TBXDR <span class="elsevierStyleItalic">versus</span> n&#227;o TBXDR foram&#58; presen&#231;a de infec&#231;&#227;o VIH &#40;risco relativo &#91;RR&#93; para TBXDR de 2&#44;5&#59; intervalo de confian&#231;a &#91;IC&#93;&#44; 1&#44;24 -5&#44;05&#41;&#59; maior dura&#231;&#227;o m&#233;dia dos tratamentos anteriores &#40;&#91;RR&#93; para TB XDR de 1&#44;2&#59; &#91;IC&#93;&#44; 1&#44;11-2&#44;30&#41;&#46;</p><p id="sp0030" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Rev Port Pneumol 2008&#59; XIV &#40;6&#41;&#58; 829-842</span></p></span>"
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Artigo Original/Original Article
Análise comparativa entre tuberculose multirresistente e tuberculose extensivamente resistente – Epidemiologia e factores preditivos
Comparative analysis of multidrug-resistant tuberculosis and extensively drug-resistant tuberculosis – Epidemiology and predictive factors
Ana Sofia Vilariça1, Carlos Gomes2, Jaime Pina3
1 Interna do Internato Complementar de Pneumologia, Serviço de Pneumologia III, Hospital de Pulido Valente, Centro Hospitalar Lisboa Norte, Lisboa, Alameda das Linhas de Torres, 117, 1769-001Lisboa / Pulmonology resident
2 Assistente Hospitalar Graduado de Pneumologia, Serviço de Pneumologia III, Hospital de Pulido Valente, Centro Hospitalar Lisboa Norte, Lisboa, Alameda das Linhas de Torres, 117, 1769-001Lisboa / Pulmonology consultant and specialist
3 Chefe de Serviço Hospitalar de Pneumologia e Director do Serviço de Pneumologia III do Hospital de Pulido Valente, Lisboa / Head, Hospital Pulmonology Service and Director, Hospital Pulmonology Service III, Pulido Valente Hospital, Lisbon
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        "autoresLista" => "Ana Sofia Vilari&#231;a, Carlos Gomes, Jaime Pina"
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            "nombre" => "Ana"
            "apellidos" => "Sofia Vilari&#231;a"
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            "entidad" => "Interna do Internato Complementar de Pneumologia&#44; Servi&#231;o de Pneumologia III&#44; Hospital de Pulido Valente&#44; Centro Hospitalar Lisboa Norte&#44; Lisboa&#44; Alameda das Linhas de Torres&#44; 117&#44; 1769-001Lisboa &#47; Pulmonology resident"
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        "titulo" => "Comparative analysis of multidrug-resistant tuberculosis and extensively drug-resistant tuberculosis &#8211; Epidemiology and predictive factors"
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            0 => "Tuberculose extensivamente resistente &#40;TBXDR&#41;"
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            0 => "Extensively drug-resistant tuberculosis &#40;XDR-TB&#41;"
            1 => "multidrug-resistant tuberculosis &#40;MDRTB&#41;"
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        "titulo" => "Resumo"
        "resumen" => "<span id="as0005" class="elsevierStyleSection elsevierViewall"><p id="sp0005" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Introdu&#231;&#227;o&#58;</span> A tuberculose extensivamente resistente &#40;TBXDR&#41; define-se como uma forma de tuberculose multirresistente &#40;TBMR&#41; com resist&#234;ncias adicionais &#224;s fluoroquinolonas e&#44; pelo menos&#44; a um dos antibacilares inject&#225;veis seguintes&#58; amicacina&#44; canamicina e capreomicina&#46; Foi classificada pela OMS como uma amea&#231;a s&#233;ria ao controlo da tuberculose&#44; com consequ&#234;ncias &#224; escala mundial&#44; assumindo os contornos de uma aut&#234;ntica pandemia em algumas regi&#245;es do globo&#46;</p><p id="sp0010" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Objectivo&#58;</span> Comparar os doentes com TBXDR <span class="elsevierStyleItalic">versus</span> outros perfis de TBMR no que diz respeito &#224;s caracter&#237;sticas demogr&#225;ficas e epidemiol&#243;gicas&#44; factores etiopatog&#233;nicos e evolu&#231;&#227;o no internamento&#46;</p><p id="sp0015" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Material e m&#233;todos&#58;</span> Doentes internados no Servi&#231;o de Pneumologia III do Hospital de Pulido Valente no per&#237;odo compreendido entre Abril de 1999 e Junho de 2007&#44; com o diagn&#243;stico de TBMR microbiologicamente confirmado&#46; Foram analisadas as seguintes vari&#225;veis&#58; sexo&#44; distribui&#231;&#227;o et&#225;ria&#44; ra&#231;a&#44; formas de apresenta&#231;&#227;o da TB&#44; grupos de tratamento&#44; perfil de resist&#234;ncia aos antibacilares&#44; estatuto de imigrante&#44; n&#250;mero e dura&#231;&#227;o de tratamentos anteriores&#44; classifica&#231;&#227;o OMS&#44; co-infec&#231;&#227;o VIH&#44; alcoolismo e&#47;ou toxicodepend&#234;ncia&#44; demora m&#233;dia do internamento e mortalidade intra-hospitalar&#46; A an&#225;lise estat&#237;stica realizou-se no programa SPSS &#40;Statistical Package for the Social Sciences&#41;&#44; vers&#227;o 15&#46;0&#46; Nas vari&#225;veis categoriais&#44; as diferen&#231;as estat&#237;sticas entre os grupos foram avaliadas atrav&#233;s do teste qui-quadrado e as vari&#225;veis num&#233;ricas atrav&#233;s do teste <span class="elsevierStyleItalic">t</span>&#46; Para a constru&#231;&#227;o do modelo preditivo da presen&#231;a de TBXDR &#40;vari&#225;vel dependente&#41; foi utilizada a an&#225;lise de regress&#227;o log&#237;stica&#44; tendo sido inclu&#237;das as seguintes vari&#225;veis independentes&#58; classifica&#231;&#227;o OMS&#44; coinfec&#231;&#227;o VIH&#44; estatuto de imigrante&#44; alcoolismo e&#47;ou toxicodepend&#234;ncia e n&#250;mero e dura&#231;&#227;o de tratamentos anteriores&#46;</p><p id="sp0020" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Resultados&#58;</span> Foram contabilizados 132 doentes com TBMR&#44; dos quais 69 &#40;52&#44;3&#37;&#41; eram TBXDR&#46; Observaram-se diferen&#231;as estatisticamente significativas nas seguintes vari&#225;veis&#58; ra&#231;a &#40;a ra&#231;a negra esteve associada a TBXDR em 74&#37; dos casos <span class="elsevierStyleItalic">versus</span> 46&#37; da ra&#231;a caucasiana&#41;&#59; classifica&#231;&#227;o OMS &#40;doentes com retratamento por insucesso terap&#234;utico&#44; interrup&#231;&#227;o do tratamento ou recidiva constitu&#237;ram 69&#44;5&#37; dos casos de TBXDR <span class="elsevierStyleItalic">versus</span> 44&#44;5 &#37; dos casos n&#227;o TBXDR&#41;&#59; dura&#231;&#227;o m&#233;dia dos tratamentos anteriores &#40;4&#44;2 meses para os casos de TBXDR <span class="elsevierStyleItalic">versus</span> 2&#44;8 meses para os casos n&#227;o TBXDR&#41;&#59; coinfec&#231;&#227;o VIH&#47;SIDA &#40;doentes com coinfec&#231;&#227;o VIH constitu&#237;ram 65&#44;2&#37; dos casos de TB XDR <span class="elsevierStyleItalic">versus</span> 42&#44;9&#37; dos casos n&#227;o TBXDR&#41; e mortalidade &#40;33&#44;3&#37; nos doentes com TBXDR <span class="elsevierStyleItalic">versus</span> 14&#44;3&#37; nos doentes n&#227;o TBXDR&#41;&#46;</p><p id="sp0025" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Conclus&#245;es&#58;</span> As vari&#225;veis com valor preditivo para o diagn&#243;stico de TBXDR <span class="elsevierStyleItalic">versus</span> n&#227;o TBXDR foram&#58; presen&#231;a de infec&#231;&#227;o VIH &#40;risco relativo &#91;RR&#93; para TBXDR de 2&#44;5&#59; intervalo de confian&#231;a &#91;IC&#93;&#44; 1&#44;24 -5&#44;05&#41;&#59; maior dura&#231;&#227;o m&#233;dia dos tratamentos anteriores &#40;&#91;RR&#93; para TB XDR de 1&#44;2&#59; &#91;IC&#93;&#44; 1&#44;11-2&#44;30&#41;&#46;</p><p id="sp0030" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Rev Port Pneumol 2008&#59; XIV &#40;6&#41;&#58; 829-842</span></p></span>"
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      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span id="as0010" class="elsevierStyleSection elsevierViewall"><p id="sp0035" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Introduction&#58;</span> Extensively drug-resistant tuberculosis &#40;XDR-TB&#41; is defined as a form of multidrug-resis-tant tuberculosis &#40;MDR-TB&#41; with additional resistance to fluoroquinolones and at least one of the injectable drugs used in tuberculosis treatment&#58; amikacin&#44; kanamycin and capreomycin&#46; It was classified by WHO as a serious threat to tuberculosis &#40;TB&#41; control&#44; with world-wide consequences&#44; taking on the proportions of a real pandemic in some regions&#46;</p><p id="sp0040" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Aim&#58;</span> To compare patients with XDR-TB <span class="elsevierStyleItalic">versus</span> other MDR-TB profiles with regard to epidemiological and demographic characteristics&#44; aetiopathogenic factors and inhospital outcomes&#46;</p><p id="sp0045" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Methods&#58;</span> Patients admitted to Pulido Valente Hospital &#40;Pulmonology Service III&#41; in the period ranging from April 1999 to June 2007 with MDR-TB diagnosis microbiologically confirmed&#46; The following variables were evaluated&#58; gender&#44; age&#44; race&#44; forms of TB presentation&#44; treatment groups&#44; resistance profile&#44; immigrant status&#44; number and duration of previous treatments&#44; WHO classification&#44; HIV co-infection&#44; alcoholism and&#47;or drug addiction&#44; average length of hospital stay and inhospital mortality&#46;</p><p id="sp0050" class="elsevierStyleSimplePara elsevierViewall">Statistical analysis was performed using the SPSS &#40;Statistical Package for the Social Sciences&#41;&#44; version 15&#46;0&#46; In categorical variables&#44; the statistical differences between groups were evaluated by the Chisquare test and numeric variables using the T-test&#46; Logistical regression analysis was used to build the predictive model of XDR-TB existence &#40;dependent variable&#41;&#44; which included the following independent variables&#58; WHO classification&#44; HIV co-infection&#44; immigrant status&#44; alcoholism and&#47;or drug addiction and number and duration of previous treatments&#46;</p><p id="sp0055" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Results&#58;</span> We recorded 132 patients with MDR-TB&#44; of which 69 &#40;52&#46;3&#37;&#41; were XDR-TB&#46; Statistically significant differences were observed in the following variables&#58; race &#40;black race was associated with XDRTB in 74&#37; of cases <span class="elsevierStyleItalic">versus</span> 46&#37; of the Caucasian race&#41;&#59; WHO classification &#40;patients with retreatment for therapeutic failure&#44; stopping treatment or relapse were 69&#46;5&#37; of XDR-TB cases versus 44&#46;5&#37; of Not XDR-TB cases&#59; average duration of previous treatments &#40;4&#46;2<span class="elsevierStyleHsp" style=""></span>months for XDR-TB cases <span class="elsevierStyleItalic">versus</span> 2&#46;8<span class="elsevierStyleHsp" style=""></span>months for Not XDR-TB cases&#41;&#59; HIV co-infection &#40;patients with HIV co-infection constituted 65&#46;2&#37; of XDR-TB cases <span class="elsevierStyleItalic">versus</span> 42&#46;9&#37; of Not XDR-TB cases&#41;&#44; mortality &#40;33&#46;3&#37; in patients with XDR-TB <span class="elsevierStyleItalic">versus</span> 14&#46;3&#37; in Not XDR-TB patients&#41;&#46;</p><p id="sp0060" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Conclusions&#58;</span> The variables with predictive value for the diagnosis of XDR-TB <span class="elsevierStyleItalic">vs</span>&#46; Not XDR-TB were presence of HIV co-infection &#40;odds ratio &#91;OR&#93; for XDRTB 2&#46;5&#59; 95&#37; confidence interval &#91;CI&#93;&#44; 1&#46;24<span class="elsevierStyleHsp" style=""></span>-<span class="elsevierStyleHsp" style=""></span>5&#46;05&#41; and increased average duration of previous treatments &#40;&#91;OR&#93; for XDR-TB 1&#46;2&#59; 95&#37; &#91;CI&#93;&#44; 1&#46;11 &#8211; 2&#46;30&#41;&#46;</p><p id="sp0065" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Rev Port Pneumol 2008&#59; XIV &#40;6&#41;&#58; 829-842</span></p></span>"
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                          "titulo" => "WHO Global Task Force outlines measures to combat XDR-TB worldwide"
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                          "tituloSerie" => "Int J Tuberc Lung Dis"
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                        "titulo" => "Extensively drug resistant tuberculosis in a high income country&#58; a report of four unrelated cases"
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                              1 => "R&#46; Mutterlein"
                              2 => "J&#46; Weig"
                              3 => "A&#46; Neher"
                              4 => "B&#46; Salzberger"
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                        "titulo" => "Extensively drug-resistant tuberculosis- California&#44; 1993-2006"
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                              0 => "R&#46; Banerjee"
                              1 => "J&#46; Allen"
                              2 => "J&#46; Westenhouse"
                              3 => "P&#46; Oh"
                              4 => "W&#46; Elms"
                              5 => "E&#46; Desmond"
                              6 => "A&#46; Nitta"
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Article information
ISSN: 08732159
Original language: Portuguese
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