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array:23 [ "pii" => "S2173511515000810" "issn" => "21735115" "doi" => "10.1016/j.rppnen.2015.03.003" "estado" => "S300" "fechaPublicacion" => "2015-07-01" "aid" => "1054" "copyright" => "Sociedade Portuguesa de Pneumologia" "copyrightAnyo" => "2015" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "cor" "cita" => "Rev Port Pneumol. 2015;21:223-4" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1135 "formatos" => array:3 [ "EPUB" => 187 "HTML" => 523 "PDF" => 425 ] ] "itemAnterior" => array:19 [ "pii" => "S2173511515000639" "issn" => "21735115" "doi" => "10.1016/j.rppnen.2015.03.001" "estado" => "S300" "fechaPublicacion" => "2015-07-01" "aid" => "1049" "copyright" => "Sociedade Portuguesa de Pneumologia" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "cor" "cita" => "Rev Port Pneumol. 2015;21:221-2" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1456 "formatos" => array:3 [ "EPUB" => 208 "HTML" => 678 "PDF" => 570 ] ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "A rare benign tumor of tracheobronchial tree: Endobronchial fibroepithelial polyp" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "221" "paginaFinal" => "222" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2309 "Ancho" => 2500 "Tamanyo" => 710003 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">(A and B) Low power view, hematoxylin and eosin staining showing a polypoid lesion with a fibrovascular connective tissue axis; (C and D) high-power view, hematoxylin and eosin staining, showing a ciliated cylindrical epithelium with an inflammatory infiltrate.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "R.C. Melo, C. Ribeiro, A. Sanches, A. Oliveira" "autores" => array:4 [ 0 => array:2 [ "nombre" => "R.C." "apellidos" => "Melo" ] 1 => array:2 [ "nombre" => "C." "apellidos" => "Ribeiro" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Sanches" ] 3 => array:2 [ "nombre" => "A." "apellidos" => "Oliveira" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173511515000639?idApp=UINPBA00004E" "url" => "/21735115/0000002100000004/v1_201507020213/S2173511515000639/v1_201507020213/en/main.assets" ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Tuberculosis in undiagnosed children: What are the criteria to start treatment in Portugal?" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "223" "paginaFinal" => "224" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "S. Martins, I. Carvalho, J.V. Santos, R. Duarte" "autores" => array:4 [ 0 => array:4 [ "nombre" => "S." "apellidos" => "Martins" "email" => array:2 [ 0 => "saracfv_21@hotmail.com" 1 => "up200901370@med.up.pt" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "I." "apellidos" => "Carvalho" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "J.V." "apellidos" => "Santos" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] 3 => array:3 [ "nombre" => "R." "apellidos" => "Duarte" "referencia" => array:4 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "aff0025" ] 3 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">f</span>" "identificador" => "aff0030" ] ] ] ] "afiliaciones" => array:6 [ 0 => array:3 [ "entidad" => "Medical School, Porto University, Portugal" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Hospital Centre of Vila Nova de Gaia/Espinho, Portugal" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Department of Health Information and Decision Science, Faculty of Medicine, University of Porto, Portugal" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "CINTESIS – Center for Health Technology and Services Research, Portugal" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Department of Clinical Epidemiology, Predictive Medicine and Public Health, Medical School, Porto University, Portugal" "etiqueta" => "e" "identificador" => "aff0025" ] 5 => array:3 [ "entidad" => "EPIUnit Institute of Public Health, Porto University, Portugal" "etiqueta" => "f" "identificador" => "aff0030" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Worldwide, about 9 million individuals per year are newly infected with tuberculosis (TB), 1 million of which are children under 15 years of age.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a> In Europe between 2000 and 2009, only 42.3% of patients with pediatric TB were assessed by culture, and only 39.9% of those tested were culture positive.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a> In fact, the confirmation rate among pediatric cases was 19.2% in Europe in 2009<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a> and 27.6% in Portugal from 2000 to 2009.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a> The variability and low specificity of clinical and radiological findings of TB in children indicate the need for a high level of suspicion in pediatric patients.</p><p id="par0010" class="elsevierStylePara elsevierViewall">In Portugal, TB is managed in the 67 tuberculosis outpatient centers. These centers are responsible for the management of all cases of TB and the screening of at-risk populations. The cases that are hospitalized are directed to these outpatient centers as soon as they are released from hospital.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Notification of all cases of TB to the National Tuberculosis Surveillance System (SVIG-TB) by the clinician is mandatory.</p><p id="par0020" class="elsevierStylePara elsevierViewall">This study was designed to identify the criteria leading to the empirical start of antibiotic treatment in Portugal, without diagnostic confirmation, in children age<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>6 years.</p><p id="par0025" class="elsevierStylePara elsevierViewall">This study was based on the implementation of a <span class="elsevierStyleItalic">web</span>-based survey, through Medquest<span class="elsevierStyleSup">®</span>, directed to doctors at the national level with experience in TB. Professionals’ experience with TB and specifically with TB in pediatric age was assessed. This survey included 30 multiple choice and simple answer questions, with all responses being anonymous.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The investigation was approved by the Ethics Committee of the EPIUnit-Institute of Public Health, University of Porto, Porto, Portugal.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The questionnaires were sent to all tuberculosis outpatient centers – two of them failed delivery. Of the 65 surveys sent, 29 (44.6%) were completed. Of the 29 responders, 20 (69%) were female. Mean age of the responders was 48.7 years, and mean clinical experience was 20 years (range, 2–38 years), including an average of 15.5 years of experience in TB management and 11.7 years in management of TB in children.</p><p id="par0040" class="elsevierStylePara elsevierViewall">When asked about their criteria to start treatment in children under 6 years of age without diagnostic confirmation, 72% cited epidemiological context, 62% mentioned radiological abnormalities, and 55% cited clinical history and the results of immunological tests, including tuberculin and gamma-interferon assays.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Factors associated with epidemiological context cited as the most important in the decision to start treatment included history of exposure (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>25, 86%), immunodeficiency (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>17, 59%) and country of origin with a high prevalence of TB (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>16, 55%). Radiological criteria included chest radiography, cited by 76% of responders, followed by computerized axial tomography (33%). The most valuable imaging findings were nodules and cavities (96%), adenopathies (41%), pleural effusion (41%) and “tree-in-bud” appearance (26%).</p><p id="par0050" class="elsevierStylePara elsevierViewall">Clinical determinants associated with the decision to start treatment included sustained fever (55%), respiratory symptoms (41%) and failure to thrive (34%). The average time window considered for these symptoms was 36.5 days (range, 7 days to 3 months).</p><p id="par0055" class="elsevierStylePara elsevierViewall">Immunological tests considered relevant to the decision to treat included tuberculin tests (41%) and interferon gamma assays (28%).</p><p id="par0060" class="elsevierStylePara elsevierViewall">History of exposure to a patient with active disease and the presence of clinical and radiological changes associated with disease progression were considered especially valuable in determining whether to treat. Although the radiological changes perceived as most suggestive of TB are not commonly presented under 6 years of age for TB, all findings are in agreement with proposed criteria for early treatment of TB in children under 6 years of age.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">3,4</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">One weakness of our study is that we only received 44.6% of the questionnaires sent. A wider study should be undertaken which includes hospital Pediatricians.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Author contributions</span><p id="par0070" class="elsevierStylePara elsevierViewall">Sara Martins initiated this research study and collaborated in all stages. Isabel Carvalho revised the questionnaire. João Vasco Santos facilitated the use Medquest for writing the questionnaire and gave support to putting it into practice. Raquel Duarte supervised all aspects of this work.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflict of interest</span><p id="par0075" class="elsevierStylePara elsevierViewall">There is no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Author contributions" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflict of interest" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:4 [ 0 => array:3 [ "identificador" => "bib0025" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Childhood tuberculosis in the European Union/European Economic Area, 2000 to 2009" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A. Sandgren" 1 => "V. Hollo" 2 => "C. Quinten" 3 => "D. Manissero" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Euro Surveillance: Bull Europeen sur les maladies transmissibles<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>Euro Commun Dis Bull" "fecha" => "2011" "volumen" => "16" "numero" => "12" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0030" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Confirming the diagnosis of tuberculosis in children in Northern Portugal" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "I. Ladeira" 1 => "A.M. Correia" 2 => "J. Dias" 3 => "R. Gaio" 4 => "I. Carvalho" 5 => "A. Carvalho" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Int J Tuberculosis Lung Dis: Off J Int Union Against Tuberculosis Lung Dis" "fecha" => "2014" "volumen" => "18" "numero" => "5" "paginaInicial" => "531" "paginaFinal" => "533" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0035" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Description of pediatric tuberculosis evaluated in a referral center in Istanbul Turkey" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "S.G. Gulec" 1 => "L. Telhan" 2 => "T. Kockaya" 3 => "E. Erdem" 4 => "B. Bayraktar" 5 => "A. Palanduz" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3349/ymj.2012.53.6.1176" "Revista" => array:7 [ "tituloSerie" => "Yonsei Med J" "fecha" => "2012" "volumen" => "53" "numero" => "6" "paginaInicial" => "1176" "paginaFinal" => "1182" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23074119" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0040" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Investigation and control of tuberculosis incidents affecting children in congregate settings" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "Control ECfDPa" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "2013" "editorial" => "ECDC" "editorialLocalizacion" => "Stockholm" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735115/0000002100000004/v1_201507020213/S2173511515000810/v1_201507020213/en/main.assets" "Apartado" => array:4 [ "identificador" => "20584" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735115/0000002100000004/v1_201507020213/S2173511515000810/v1_201507020213/en/main.pdf?idApp=UINPBA00004E&text.app=https://journalpulmonology.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173511515000810?idApp=UINPBA00004E" ]
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