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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Tumor necrosis factor-alpha &#40;TNF-&#945;&#41; is a pleomorphic cytokine involved in the pathogenesis of many rheumatic diseases&#46; Following anti-TNF therapy&#44; the relative risk for tuberculosis is increased by up to 25 times&#44; often as a rapidly progressive disease&#44; extra-pulmonary or disseminated&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;4</span></a> Aiming to evaluate compliance with guidelines for tuberculosis screening&#44; the authors conducted an enquiry among northern Portuguese hospitals which prescribe anti-TNF therapy&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">From all hospitals in northern Portugal the authors identified those that prescribed anti-TNF therapy&#44; and from them randomly selected from among the Internal Medicine medical doctors &#40;the specialty which most commonly prescribed biological therapy in these hospitals&#41; those who had at least&#44; one weekly consultation of autoimmune disease and were familiar with the hospital prescription procedures&#46; One hospital which had only one doctor prescribing was excluded&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The enquiry was carried out in September 2012&#46; The interview consisted of ten multiple-choice questions relating to each recommendation&#58; TB screening&#44; diagnostic exams&#44; preventive treatment&#44; when to start anti-TNF&#945; therapy and TB monitoring through the course of anti-TNF&#945; treatment&#46; Compliance rates were determined for each clinical recommendation and each guideline &#91;national&#44; international or European consensus&#93; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;1&#44;6&#44;7</span></a></p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Eleven hospitals were identified and ten were eligible&#46; They performed TB screening in all patients treated with anti-TNF therapy&#46; The screening method used by all hospitals was patient history and tuberculin skin test &#40;TST&#41;&#44; seven &#40;70&#37;&#41; used interferon-gamma-release-assay &#40;IGRA&#41; and six &#40;60&#37;&#41; used chest radiography &#40;CRX&#41;&#46; Compliance rate&#58; 60&#37; for UK guidelines and 50&#37; for European consensus&#44; USA and national guidelines &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">All hospitals performed TB screening prior to anti-TNF treatment &#40;compliance rate of 100&#37; with all guidelines&#41;&#59; seven &#40;70&#37;&#41; re-screened during anti-TNF treatment&#44; due to recent exposure to TB &#40;compliance rate of 70&#37; for USA&#44; national guidelines and European consensus&#44; UK guidelines do not give specific recommendations on this subject&#41; and eight hospitals &#40;80&#37;&#41; re-screened due to symptoms &#40;compliance rate of 80&#37; with all guidelines&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; Only one hospital &#40;10&#37;&#41; re-tested asymptomatic patients with a previous negative screening&#44; without recent exposure&#44; during anti-TNF treatment &#40;compliance rate 10&#37; with national&#44; American and European consensus&#44; not applicable to UK guidelines&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Three hospitals &#40;30&#37;&#41; screened in their own facilities&#44; 4 &#40;40&#37;&#41; in TB outpatient clinic&#44; 1 &#40;10&#37;&#41; in a primary care center and 2 &#40;20&#37;&#41; in elsewhere&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Eight hospitals &#40;80&#37;&#41; used TST cut-off of 5<span class="elsevierStyleHsp" style=""></span>mm&#44; one &#40;10&#37;&#41; 10<span class="elsevierStyleHsp" style=""></span>mm and one &#40;10&#37;&#41; 15<span class="elsevierStyleHsp" style=""></span>mm&#46; The compliance rate was 80&#37; percent with national&#44; UK and USA guidelines and 90&#37; with European consensus &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Seven hospitals &#40;70&#37;&#41; initiated preventive therapy&#44; if TST or IGRA were positive&#59; one &#40;10&#37;&#41; if both TST and IGRA were positive&#59; two &#40;20&#37;&#41; if TST was positive&#44; without IGRA result&#46; A compliance rate of 70&#37; with European consensus&#44; national and north-American guidelines was calculated&#46; No compliance for UK guidelines &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; All centers used isoniazid for preventive treatment&#46; Eight hospitals &#40;80&#37;&#41; treated their patients during nine months and two &#40;20&#37;&#41; during 6 months&#46; Compliance rates&#58; 80&#37; with national&#44; American and European consensus and 20&#37; with UK guidelines &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; Eight hospitals &#40;80&#37;&#41; initiated anti-TNF therapy 4 weeks after beginning LTBI treatment and two &#40;20&#37;&#41; 3 months after&#46; Compliance rate&#58; 80&#37; with national&#44; American and European consensus&#59; no compliance with UK guidelines &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">TB screening is performed routinely before anti-TNF treatment&#44; according to the individual physician&#39;s awareness of TB risk&#46; In our study&#44; the European consensus was the guideline with highest percentage of compliance&#44; presenting a medium rate of 69&#46;4&#37;&#37;&#44; followed closely by National and American Guidelines &#40;68&#46;1&#37;&#41;&#46; UK recommendations had a lower adherence&#44; with 64&#46;3&#37;&#46; This rate is similar to the compliance rate observed by Smith et al&#46; in the Gastroenterology and Dermatology G5 group &#40;including the five foremost industrialized economies &#8211; Germany&#44; France&#44; Italy&#44; Spain and the United Kingdom&#41;&#59; it was lower than the one observed in the non-G5 Rheumatology group&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Although this study has serious limitations&#44; as TB screening performance was based on self-reported actions of the physicians concerned&#44; we found that among the protocols followed by experienced anti-TNF prescribers&#44; the rate of compliance with the guidelines is low and there is excessive confidence in the TST&#46; Re-testing is neglected and is a something that needs to be improved&#46; The availability of facilities in Portugal such as the TB outpatient clinic can be considered a real asset but they are not used to their full potential&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0055" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">All&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">All&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">All&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">All&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">TST&#43; or IGRA&#43;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">All&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5<span class="elsevierStyleHsp" style=""></span>mm if IS10<span class="elsevierStyleHsp" style=""></span>mm if highrisk<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>15<span class="elsevierStyleHsp" style=""></span>mm in others&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">Who should receive prophylaxis&#63;</td><td class="td" title="table-entry  " align="left" valign="top">TST&#43; and&#47;or IGRA&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">TST&#43; and&#47;or IGRA&#43;&#59; Recent TB exposure&#59; CXR sequelae of non-treated TB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">TST&#43;&#59; Previous TB not treated&#59; CXR sequelae of non-treated TB&#59; IS and risk factors for TB exposure<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">d</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">TST&#43; and&#47;or IGRA&#43;&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">LTBI treatment &#40;months&#41;</td><td class="td" title="table-entry  " align="left" valign="top">9&#8211;12 H or 3HR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9 H&#44; 6 H&#44; 3HR&#44; 4 R&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6 H or 3 HR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9<span class="elsevierStyleHsp" style=""></span>H&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">Time delay before TNF antagonist therapy</td><td class="td" title="table-entry  " align="left" valign="top">LTBI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 weeks&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 weeks&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Abnormal CXR or previous TB&#58; complete prophylaxis&#59; Others&#58; no delay&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 weeks&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">Active TB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Full treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&#8211;8 weeks&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Full treatment&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="3" align="left" valign="middle">Time to screening</td><td class="td" title="table-entry  " align="left" valign="top">Before TNF antagonist therapy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">All&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">All<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">e</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">All&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">All&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">Re-testing&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Annual&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Annual&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">If symptoms of active TB&#59; until 6 months stopping anti-TNF&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Annual&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">Close contact with active TB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">All&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">All<a class="elsevierStyleCrossRef" href="#tblfn0030"><span class="elsevierStyleSup">f</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">All&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab699946.png"
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          "notaPie" => array:6 [
            0 => array:3 [
              "identificador" => "tblfn0005"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">History of prior TB infection and treatment&#44; close contacts of persons known or suspected to have active TB&#46;</p>"
            ]
            1 => array:3 [
              "identificador" => "tblfn0010"
              "etiqueta" => "b"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0010">TST will only become reliable once treatment has been stopped for 1 month in the case of steroids and for 3 months in the case of all other immunosuppressive drugs&#46;</p>"
            ]
            2 => array:3 [
              "identificador" => "tblfn0015"
              "etiqueta" => "c"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0015">New immigrant and drug users&#46;</p>"
            ]
            3 => array:3 [
              "identificador" => "tblfn0020"
              "etiqueta" => "d"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Risk factors for TB exposure are defined based on a publication from the US Centres for Disease Control and Prevention as&#58; close contacts of persons known or suspected to have active TB&#59; foreign-born persons from areas that have a high incidence of active TB &#40;e&#46;g&#46;&#44; Africa&#44; Asia&#44; Eastern Europe&#44; Latin America&#44; and Russia&#41;&#59; persons who visit areas with a high prevalence of active TB&#44; especially if the visits are frequent or prolonged&#59; residents and employees of congregate settings whose clients are at an increased risk for active TB &#40;e&#46;g&#46;&#44; correctional facilities&#44; long-term care facilities&#44; and homeless shelters&#41;&#59; health care workers who serve clients who are at an increased risk for active TB&#59; populations defined locally as having an increased incidence of latent <span class="elsevierStyleItalic">M&#46; tuberculosis</span> infection or active TB&#44; possibly including medically underserved&#44; low-income populations&#44; or persons who abuse drugs or alcohol&#59; and infants&#44; children&#44; and adolescents exposed to adults who are at an increased risk for latent <span class="elsevierStyleItalic">M&#46; tuberculosis</span> infection or active&#46;</p>"
            ]
            4 => array:3 [
              "identificador" => "tblfn0025"
              "etiqueta" => "e"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0025">Validated until 6 months prior initiation anti-TNF&#46;</p>"
            ]
            5 => array:3 [
              "identificador" => "tblfn0030"
              "etiqueta" => "f"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0030">Start chemoprophylaxis immediately&#44; at the same time as TB screening&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Comparison between TB screening guidelines and the 2010 European consensus&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
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              "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" 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">European&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">National&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">UK&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">American&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">Screen tools&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50&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">Screen time&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">75&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">75&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">75&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">TST &#8220;cut-off&#8221;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">80&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">Diagnosis methods of LTBI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">70&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">LTBI treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">80&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">Timing of initiation of anti-TNF if LTBI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">80&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">TB re-testing&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Summary of results and compliance to recommendations &#40;results in percentages&#41;&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:8 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
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                  "contribucion" => array:1 [
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                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
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                            0 => "I&#46; Solovic"
                            1 => "M&#46; Sester"
                            2 => "J&#46;J&#46; Gomez-Reino"
                            3 => "H&#46;L&#46; Rieder"
                            4 => "S&#46; Ehlers"
                            5 => "H&#46;J&#46; Milburn"
                          ]
                        ]
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                  ]
                  "host" => array:1 [
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                      "doi" => "10.1183/09031936.00028510"
                      "Revista" => array:6 [
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                            "web" => "Medline"
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            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
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                      "titulo" => "Risk and case characteristics of tuberculosis in rheumatoid arthritis associated with tumor necrosis factor antagonists in Sweden"
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                          "etal" => true
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                            1 => "C&#46;M&#46; Fored"
                            2 => "L&#46; Brandt"
                            3 => "E&#46; Baecklund"
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                      "doi" => "10.1002/art.21137"
                      "Revista" => array:6 [
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                            "web" => "Medline"
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            2 => array:3 [
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              "referencia" => array:1 [
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                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Treatment of rheumatoid arthritis with tumor necrosis factor inhibitors may predispose to significant increase in tuberculosis risk&#58; a multicenter active-surveillance report"
                      "autores" => array:1 [
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                          "etal" => false
                          "autores" => array:5 [
                            0 => "J&#46;J&#46; Gomez-Reino"
                            1 => "L&#46; Carmona"
                            2 => "V&#46;R&#46; Valverde"
                            3 => "E&#46;M&#46; Mola"
                            4 => "M&#46;D&#46; Montero"
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                      "doi" => "10.1002/art.11137"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arthritis Rheum"
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                            "web" => "Medline"
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                        ]
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            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Tumour necrosis factor antagonists&#58; structure&#44; function&#44; and tuberculosis risks"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
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                            0 => "R&#46;S&#46; Wallis"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S1473-3099(08)70227-5"
                      "Revista" => array:6 [
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                        "fecha" => "2008"
                        "volumen" => "8"
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                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18922482"
                            "web" => "Medline"
                          ]
                        ]
                      ]
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            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
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                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46; Duarte"
                            1 => "S&#46; Campainha"
                            2 => "J&#46; Cotter"
                            3 => "B&#46; Rosa"
                            4 => "P&#46; Varela"
                            5 => "A&#46; Correia"
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                      "Revista" => array:6 [
                        "tituloSerie" => "Acta Reumatol Port"
                        "fecha" => "2012"
                        "volumen" => "37"
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                          0 => array:2 [
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                            "web" => "Medline"
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                  ]
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            ]
            5 => array:3 [
              "identificador" => "bib0030"
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Letter to the Editor
Tuberculosis screening and compliance rate with guidelines among Northern Portuguese Hospitals prescribers of anti-TNF therapy
B.A. Ferreira
Corresponding author
betania_ferreira82@hotmail.com

Corresponding author.
, S. Ribeiro, J. Meireles, A. Correia, R. Duarte
Centro Hospitalar Porto-Hospital Santo António, Internal Medicine, Largo Professor Abel Salazar, Porto, Portugal
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Tumor necrosis factor-alpha &#40;TNF-&#945;&#41; is a pleomorphic cytokine involved in the pathogenesis of many rheumatic diseases&#46; Following anti-TNF therapy&#44; the relative risk for tuberculosis is increased by up to 25 times&#44; often as a rapidly progressive disease&#44; extra-pulmonary or disseminated&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;4</span></a> Aiming to evaluate compliance with guidelines for tuberculosis screening&#44; the authors conducted an enquiry among northern Portuguese hospitals which prescribe anti-TNF therapy&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">From all hospitals in northern Portugal the authors identified those that prescribed anti-TNF therapy&#44; and from them randomly selected from among the Internal Medicine medical doctors &#40;the specialty which most commonly prescribed biological therapy in these hospitals&#41; those who had at least&#44; one weekly consultation of autoimmune disease and were familiar with the hospital prescription procedures&#46; One hospital which had only one doctor prescribing was excluded&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The enquiry was carried out in September 2012&#46; The interview consisted of ten multiple-choice questions relating to each recommendation&#58; TB screening&#44; diagnostic exams&#44; preventive treatment&#44; when to start anti-TNF&#945; therapy and TB monitoring through the course of anti-TNF&#945; treatment&#46; Compliance rates were determined for each clinical recommendation and each guideline &#91;national&#44; international or European consensus&#93; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;1&#44;6&#44;7</span></a></p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Eleven hospitals were identified and ten were eligible&#46; They performed TB screening in all patients treated with anti-TNF therapy&#46; The screening method used by all hospitals was patient history and tuberculin skin test &#40;TST&#41;&#44; seven &#40;70&#37;&#41; used interferon-gamma-release-assay &#40;IGRA&#41; and six &#40;60&#37;&#41; used chest radiography &#40;CRX&#41;&#46; Compliance rate&#58; 60&#37; for UK guidelines and 50&#37; for European consensus&#44; USA and national guidelines &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">All hospitals performed TB screening prior to anti-TNF treatment &#40;compliance rate of 100&#37; with all guidelines&#41;&#59; seven &#40;70&#37;&#41; re-screened during anti-TNF treatment&#44; due to recent exposure to TB &#40;compliance rate of 70&#37; for USA&#44; national guidelines and European consensus&#44; UK guidelines do not give specific recommendations on this subject&#41; and eight hospitals &#40;80&#37;&#41; re-screened due to symptoms &#40;compliance rate of 80&#37; with all guidelines&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; Only one hospital &#40;10&#37;&#41; re-tested asymptomatic patients with a previous negative screening&#44; without recent exposure&#44; during anti-TNF treatment &#40;compliance rate 10&#37; with national&#44; American and European consensus&#44; not applicable to UK guidelines&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Three hospitals &#40;30&#37;&#41; screened in their own facilities&#44; 4 &#40;40&#37;&#41; in TB outpatient clinic&#44; 1 &#40;10&#37;&#41; in a primary care center and 2 &#40;20&#37;&#41; in elsewhere&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Eight hospitals &#40;80&#37;&#41; used TST cut-off of 5<span class="elsevierStyleHsp" style=""></span>mm&#44; one &#40;10&#37;&#41; 10<span class="elsevierStyleHsp" style=""></span>mm and one &#40;10&#37;&#41; 15<span class="elsevierStyleHsp" style=""></span>mm&#46; The compliance rate was 80&#37; percent with national&#44; UK and USA guidelines and 90&#37; with European consensus &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Seven hospitals &#40;70&#37;&#41; initiated preventive therapy&#44; if TST or IGRA were positive&#59; one &#40;10&#37;&#41; if both TST and IGRA were positive&#59; two &#40;20&#37;&#41; if TST was positive&#44; without IGRA result&#46; A compliance rate of 70&#37; with European consensus&#44; national and north-American guidelines was calculated&#46; No compliance for UK guidelines &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; All centers used isoniazid for preventive treatment&#46; Eight hospitals &#40;80&#37;&#41; treated their patients during nine months and two &#40;20&#37;&#41; during 6 months&#46; Compliance rates&#58; 80&#37; with national&#44; American and European consensus and 20&#37; with UK guidelines &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; Eight hospitals &#40;80&#37;&#41; initiated anti-TNF therapy 4 weeks after beginning LTBI treatment and two &#40;20&#37;&#41; 3 months after&#46; Compliance rate&#58; 80&#37; with national&#44; American and European consensus&#59; no compliance with UK guidelines &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">TB screening is performed routinely before anti-TNF treatment&#44; according to the individual physician&#39;s awareness of TB risk&#46; In our study&#44; the European consensus was the guideline with highest percentage of compliance&#44; presenting a medium rate of 69&#46;4&#37;&#37;&#44; followed closely by National and American Guidelines &#40;68&#46;1&#37;&#41;&#46; UK recommendations had a lower adherence&#44; with 64&#46;3&#37;&#46; This rate is similar to the compliance rate observed by Smith et al&#46; in the Gastroenterology and Dermatology G5 group &#40;including the five foremost industrialized economies &#8211; Germany&#44; France&#44; Italy&#44; Spain and the United Kingdom&#41;&#59; it was lower than the one observed in the non-G5 Rheumatology group&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Although this study has serious limitations&#44; as TB screening performance was based on self-reported actions of the physicians concerned&#44; we found that among the protocols followed by experienced anti-TNF prescribers&#44; the rate of compliance with the guidelines is low and there is excessive confidence in the TST&#46; Re-testing is neglected and is a something that needs to be improved&#46; The availability of facilities in Portugal such as the TB outpatient clinic can be considered a real asset but they are not used to their full potential&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0055" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">USA<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a>&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="4" align="left" valign="middle">How to screen&#63;</td><td class="td" title="table-entry  " align="left" valign="top">Clinical history<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">All&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">All&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">All&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">All&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">Chest radiograph&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">All&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">All&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">All&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">TST&#43; or IGRA&#43;&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">TST&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Without history of BCG vaccination&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">All&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Not for patients on IS as unreliable<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">All&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">IGRA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Negative TST&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">All&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Not used&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">All&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">TST &#8220;Cut-off&#8221; for treatment &#8805;</td><td class="td" title="table-entry  " align="left" valign="top">10 mm5 mm if&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5 mm if IS&#59; 10<span class="elsevierStyleHsp" style=""></span>mm in others&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Unvaccinated&#59; 15<span class="elsevierStyleHsp" style=""></span>mm in vaccinated&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5<span class="elsevierStyleHsp" style=""></span>mm if IS10<span class="elsevierStyleHsp" style=""></span>mm if highrisk<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>15<span class="elsevierStyleHsp" style=""></span>mm in others&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">Who should receive prophylaxis&#63;</td><td class="td" title="table-entry  " align="left" valign="top">TST&#43; and&#47;or IGRA&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">TST&#43; and&#47;or IGRA&#43;&#59; Recent TB exposure&#59; CXR sequelae of non-treated TB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">TST&#43;&#59; Previous TB not treated&#59; CXR sequelae of non-treated TB&#59; IS and risk factors for TB exposure<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">d</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">TST&#43; and&#47;or IGRA&#43;&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">LTBI treatment &#40;months&#41;</td><td class="td" title="table-entry  " align="left" valign="top">9&#8211;12 H or 3HR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9 H&#44; 6 H&#44; 3HR&#44; 4 R&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6 H or 3 HR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9<span class="elsevierStyleHsp" style=""></span>H&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">Time delay before TNF antagonist therapy</td><td class="td" title="table-entry  " align="left" valign="top">LTBI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 weeks&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 weeks&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Abnormal CXR or previous TB&#58; complete prophylaxis&#59; Others&#58; no delay&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 weeks&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">Active TB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Full treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&#8211;8 weeks&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Full treatment&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="3" align="left" valign="middle">Time to screening</td><td class="td" title="table-entry  " align="left" valign="top">Before TNF antagonist therapy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">All&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">All<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">e</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">All&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">All&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">Re-testing&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Annual&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Annual&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">If symptoms of active TB&#59; until 6 months stopping anti-TNF&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Annual&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">Close contact with active TB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">All&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">All<a class="elsevierStyleCrossRef" href="#tblfn0030"><span class="elsevierStyleSup">f</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">All&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab699946.png"
              ]
            ]
          ]
          "notaPie" => array:6 [
            0 => array:3 [
              "identificador" => "tblfn0005"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">History of prior TB infection and treatment&#44; close contacts of persons known or suspected to have active TB&#46;</p>"
            ]
            1 => array:3 [
              "identificador" => "tblfn0010"
              "etiqueta" => "b"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0010">TST will only become reliable once treatment has been stopped for 1 month in the case of steroids and for 3 months in the case of all other immunosuppressive drugs&#46;</p>"
            ]
            2 => array:3 [
              "identificador" => "tblfn0015"
              "etiqueta" => "c"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0015">New immigrant and drug users&#46;</p>"
            ]
            3 => array:3 [
              "identificador" => "tblfn0020"
              "etiqueta" => "d"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Risk factors for TB exposure are defined based on a publication from the US Centres for Disease Control and Prevention as&#58; close contacts of persons known or suspected to have active TB&#59; foreign-born persons from areas that have a high incidence of active TB &#40;e&#46;g&#46;&#44; Africa&#44; Asia&#44; Eastern Europe&#44; Latin America&#44; and Russia&#41;&#59; persons who visit areas with a high prevalence of active TB&#44; especially if the visits are frequent or prolonged&#59; residents and employees of congregate settings whose clients are at an increased risk for active TB &#40;e&#46;g&#46;&#44; correctional facilities&#44; long-term care facilities&#44; and homeless shelters&#41;&#59; health care workers who serve clients who are at an increased risk for active TB&#59; populations defined locally as having an increased incidence of latent <span class="elsevierStyleItalic">M&#46; tuberculosis</span> infection or active TB&#44; possibly including medically underserved&#44; low-income populations&#44; or persons who abuse drugs or alcohol&#59; and infants&#44; children&#44; and adolescents exposed to adults who are at an increased risk for latent <span class="elsevierStyleItalic">M&#46; tuberculosis</span> infection or active&#46;</p>"
            ]
            4 => array:3 [
              "identificador" => "tblfn0025"
              "etiqueta" => "e"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0025">Validated until 6 months prior initiation anti-TNF&#46;</p>"
            ]
            5 => array:3 [
              "identificador" => "tblfn0030"
              "etiqueta" => "f"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0030">Start chemoprophylaxis immediately&#44; at the same time as TB screening&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Comparison between TB screening guidelines and the 2010 European consensus&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:1 [
          "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" 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">European&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">National&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">UK&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">American&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">Screen tools&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50&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">Screen time&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">75&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">75&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">75&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">TST &#8220;cut-off&#8221;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">80&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">Diagnosis methods of LTBI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">70&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">LTBI treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">80&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">Timing of initiation of anti-TNF if LTBI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">80&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">TB re-testing&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab699945.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Summary of results and compliance to recommendations &#40;results in percentages&#41;&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:8 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The risk of tuberculosis related to tumour necrosis factor antagonist therapies&#58; aTBNET consensus statement"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "I&#46; Solovic"
                            1 => "M&#46; Sester"
                            2 => "J&#46;J&#46; Gomez-Reino"
                            3 => "H&#46;L&#46; Rieder"
                            4 => "S&#46; Ehlers"
                            5 => "H&#46;J&#46; Milburn"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1183/09031936.00028510"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Respir J"
                        "fecha" => "2010"
                        "volumen" => "36"
                        "paginaInicial" => "1185"
                        "paginaFinal" => "1206"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20530046"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Risk and case characteristics of tuberculosis in rheumatoid arthritis associated with tumor necrosis factor antagonists in Sweden"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46; Askling"
                            1 => "C&#46;M&#46; Fored"
                            2 => "L&#46; Brandt"
                            3 => "E&#46; Baecklund"
                            4 => "L&#46; Bertilsson"
                            5 => "L&#46; Coster"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/art.21137"
                      "Revista" => array:6 [
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ISSN: 21735115
Original language: English
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