array:19 [
  "pii" => "X0873215915339550"
  "issn" => "08732159"
  "doi" => "10.1016/j.rppnen.2015.03.003"
  "estado" => "S300"
  "fechaPublicacion" => "2015-07-01"
  "documento" => "article"
  "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
  "subdocumento" => "fla"
  "cita" => "Rev Port Pneumol. 2015;21:223-4"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 3258
    "formatos" => array:3 [
      "EPUB" => 212
      "HTML" => 2200
      "PDF" => 846
    ]
  ]
  "itemAnterior" => array:16 [
    "pii" => "X0873215915339542"
    "issn" => "08732159"
    "doi" => "10.1016/j.rppnen.2015.03.001"
    "estado" => "S300"
    "fechaPublicacion" => "2015-07-01"
    "documento" => "article"
    "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
    "subdocumento" => "fla"
    "cita" => "Rev Port Pneumol. 2015;21:221-2"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 5223
      "formatos" => array:3 [
        "EPUB" => 286
        "HTML" => 3924
        "PDF" => 1013
      ]
    ]
    "en" => array:9 [
      "idiomaDefecto" => true
      "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:8 [
          "identificador" => "fig1"
          "etiqueta" => "Figure 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "copyright" => "Elsevier España"
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "320v21n04-90433954fig1.jpg"
              "Alto" => 1250
              "Ancho" => 1667
              "Tamanyo" => 537714
            ]
          ]
          "descripcion" => array:1 [
            "en" => "A 2 cm pedunculated, glossy and lobulated bronchial fibroepithelial polyp obliterating the right main bronchus."
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "R.C. Melo, C. Ribeiro, A. Sanches, A. Oliveira"
          "autores" => array:4 [
            0 => array:2 [
              "Iniciales" => "R.C."
              "apellidos" => "Melo"
            ]
            1 => array:2 [
              "Iniciales" => "C."
              "apellidos" => "Ribeiro"
            ]
            2 => array:2 [
              "Iniciales" => "A."
              "apellidos" => "Sanches"
            ]
            3 => array:2 [
              "Iniciales" => "A."
              "apellidos" => "Oliveira"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0873215915339542?idApp=UINPBA00004E"
    "url" => "/08732159/0000002100000004/v0_201604141144/X0873215915339542/v0_201604141145/en/main.assets"
  ]
  "en" => array:9 [
    "idiomaDefecto" => true
    "titulo" => "Tuberculosis in undiagnosed children: What are the criteria to start treatment in Portugal?"
    "tieneTextoCompleto" => true
    "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 [
            "Iniciales" => "S."
            "apellidos" => "Martins"
            "email" => array:1 [
              0 => "up200901370@med.up.pt"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor1"
              ]
            ]
          ]
          1 => array:3 [
            "Iniciales" => "I."
            "apellidos" => "Carvalho"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "affb"
              ]
            ]
          ]
          2 => array:3 [
            "Iniciales" => "J.V."
            "apellidos" => "Santos"
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "affc"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">d</span>"
                "identificador" => "affd"
              ]
            ]
          ]
          3 => array:3 [
            "Iniciales" => "R."
            "apellidos" => "Duarte"
            "referencia" => array:4 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "affb"
              ]
              2 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">e</span>"
                "identificador" => "affe"
              ]
              3 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">f</span>"
                "identificador" => "afff"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:6 [
          0 => array:3 [
            "entidad" => "Medical School, Porto University, Portugal"
            "etiqueta" => "<span class="elsevierStyleSup">a</span>"
            "identificador" => "affa"
          ]
          1 => array:3 [
            "entidad" => "Hospital Centre of Vila Nova de Gaia/Espinho, Portugal"
            "etiqueta" => "<span class="elsevierStyleSup">b</span>"
            "identificador" => "affb"
          ]
          2 => array:3 [
            "entidad" => "Department of Health Information and Decision Science, Faculty of Medicine, University of Porto, Portugal"
            "etiqueta" => "<span class="elsevierStyleSup">c</span>"
            "identificador" => "affc"
          ]
          3 => array:3 [
            "entidad" => "CINTESIS &#x2013; Center for Health Technology and Services Research, Portugal"
            "etiqueta" => "<span class="elsevierStyleSup">d</span>"
            "identificador" => "affd"
          ]
          4 => array:3 [
            "entidad" => "Department of Clinical Epidemiology, Predictive Medicine and Public Health, Medical School, Porto University, Portugal"
            "etiqueta" => "<span class="elsevierStyleSup">e</span>"
            "identificador" => "affe"
          ]
          5 => array:3 [
            "entidad" => "EPIUnit Institute of Public Health, Porto University, Portugal"
            "etiqueta" => "<span class="elsevierStyleSup">f</span>"
            "identificador" => "afff"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor1"
            "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
            "correspondencia" => "Corresponding author. up200901370@med.up.pt"
          ]
        ]
      ]
    ]
    "textoCompleto" => "<p class="elsevierStylePara">Dear Editor&#44;</p><p class="elsevierStylePara">Worldwide&#44; about 9 million individuals per year are newly infected with tuberculosis &#40;TB&#41;&#44; 1 million of which are children under 15 years of age&#46;<a href="&#35;bib5" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">1</span></a> In Europe between 2000 and 2009&#44; only 42&#46;3&#37; of patients with pediatric TB were assessed by culture&#44; and only 39&#46;9&#37; of those tested were culture positive&#46;<a href="&#35;bib5" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">1</span></a> In fact&#44; the confirmation rate among pediatric cases was 19&#46;2&#37; in Europe in 2009<a href="&#35;bib5" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">1</span></a> and 27&#46;6&#37; in Portugal from 2000 to 2009&#46;<a href="&#35;bib6" class="elsevierStyleCrossRefs"><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&#46;</p><p class="elsevierStylePara">In Portugal&#44; TB is managed in the 67 tuberculosis outpatient centers&#46; These centers are responsible for the management of all cases of TB and the screening of at-risk populations&#46; The cases that are hospitalized are directed to these outpatient centers as soon as they are released from hospital&#46;</p><p class="elsevierStylePara">Notification of all cases of TB to the National Tuberculosis Surveillance System &#40;SVIG-TB&#41; by the clinician is mandatory&#46;</p><p class="elsevierStylePara">This study was designed to identify the criteria leading to the empirical start of antibiotic treatment in Portugal&#44; without diagnostic confirmation&#44; in children age&#160;&#60;&#160;6 years&#46;</p><p class="elsevierStylePara">This study was based on the implementation of a <span class="elsevierStyleItalic">web</span>-based survey&#44; through Medquest<span class="elsevierStyleSup">&#174;</span>&#44; directed to doctors at the national level with experience in TB&#46; Professionals&#8217; experience with TB and specifically with TB in pediatric age was assessed&#46; This survey included 30 multiple choice and simple answer questions&#44; with all responses being anonymous&#46;</p><p class="elsevierStylePara">The investigation was approved by the Ethics Committee of the EPIUnit-Institute of Public Health&#44; University of Porto&#44; Porto&#44; Portugal&#46;</p><p class="elsevierStylePara">The questionnaires were sent to all tuberculosis outpatient centers &#8211; two of them failed delivery&#46; Of the 65 surveys sent&#44; 29 &#40;44&#46;6&#37;&#41; were completed&#46; Of the 29 responders&#44; 20 &#40;69&#37;&#41; were female&#46; Mean age of the responders was 48&#46;7 years&#44; and mean clinical experience was 20 years &#40;range&#44; 2&#8211;38 years&#41;&#44; including an average of 15&#46;5 years of experience in TB management and 11&#46;7 years in management of TB in children&#46;</p><p class="elsevierStylePara">When asked about their criteria to start treatment in children under 6 years of age without diagnostic confirmation&#44; 72&#37; cited epidemiological context&#44; 62&#37; mentioned radiological abnormalities&#44; and 55&#37; cited clinical history and the results of immunological tests&#44; including tuberculin and gamma-interferon assays&#46;</p><p class="elsevierStylePara">Factors associated with epidemiological context cited as the most important in the decision to start treatment included history of exposure &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;25&#44; 86&#37;&#41;&#44; immunodeficiency &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;17&#44; 59&#37;&#41; and country of origin with a high prevalence of TB &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;16&#44; 55&#37;&#41;&#46; Radiological criteria included chest radiography&#44; cited by 76&#37; of responders&#44; followed by computerized axial tomography &#40;33&#37;&#41;&#46; The most valuable imaging findings were nodules and cavities &#40;96&#37;&#41;&#44; adenopathies &#40;41&#37;&#41;&#44; pleural effusion &#40;41&#37;&#41; and &#8220;tree-in-bud&#8221; appearance &#40;26&#37;&#41;&#46;</p><p class="elsevierStylePara">Clinical determinants associated with the decision to start treatment included sustained fever &#40;55&#37;&#41;&#44; respiratory symptoms &#40;41&#37;&#41; and failure to thrive &#40;34&#37;&#41;&#46; The average time window considered for these symptoms was 36&#46;5 days &#40;range&#44; 7 days to 3 months&#41;&#46;</p><p class="elsevierStylePara">Immunological tests considered relevant to the decision to treat included tuberculin tests &#40;41&#37;&#41; and interferon gamma assays &#40;28&#37;&#41;&#46;</p><p class="elsevierStylePara">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&#46; Although the radiological changes perceived as most suggestive of TB are not commonly presented under 6 years of age for TB&#44; all findings are in agreement with proposed criteria for early treatment of TB in children under 6 years of age&#46;<a href="&#35;bib7" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">3</span></a><span class="elsevierStyleSup">&#44; </span><a href="&#35;bib8" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">4</span></a></p><p class="elsevierStylePara">One weakness of our study is that we only received 44&#46;6&#37; of the questionnaires sent&#46; A wider study should be undertaken which includes hospital Pediatricians&#46;</p><a name="sec0005" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Author contributions</span><p class="elsevierStylePara">Sara Martins initiated this research study and collaborated in all stages&#46; Isabel Carvalho revised the questionnaire&#46; Jo&#227;o Vasco Santos facilitated the use Medquest for writing the questionnaire and gave support to putting it into practice&#46; Raquel Duarte supervised all aspects of this work&#46;</p><a name="sec0010" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Conflict of interest</span><p class="elsevierStylePara">There is no conflict of interest&#46;</p><p class="elsevierStylePara">Corresponding author&#46; up200901370&#64;med&#46;up&#46;pt</p>"
    "pdfFichero" => "320v21n04a90433955pdf001.pdf"
    "tienePdf" => true
    "bibliografia" => array:2 [
      "titulo" => "Bibliography"
      "seccion" => array:1 [
        0 => array:1 [
          "bibliografiaReferencia" => array:4 [
            0 => array:3 [
              "identificador" => "bib5"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Childhood tuberculosis in the European Union/European Economic Area, 2000 to 2009. Euro Surveillance: Bull Europeen sur les maladies transmissibles&#x000A0;=&#x000A0;Euro Commun Dis Bull. 2011; 16(12):. Available online: <inter&#x002D;ref>http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19825</inter&#x002D;ref>"
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Childhood tuberculosis in the European Union&#47;European Economic Area&#44; 2000 to 2009&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "Sandgren A"
                            1 => "Hollo V"
                            2 => "Quinten C"
                            3 => "Manissero D&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:3 [
                        "tituloSerie" => "Euro Surveillance: Bull Europeen sur les maladies transmissibles&#x000A0;=&#x000A0;Euro Commun Dis Bull. "
                        "fecha" => "2011"
                        "volumen" => "16"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib6"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Confirming the diagnosis of tuberculosis in children in Northern Portugal. Int J Tuberculosis Lung Dis: Off J Int Union Against Tuberculosis Lung Dis. 2014; 18(5):531&#x002D;3."
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Confirming the diagnosis of tuberculosis in children in Northern Portugal&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:7 [
                            0 => "Ladeira I"
                            1 => "Correia AM"
                            2 => "Dias J"
                            3 => "Gaio R"
                            4 => "Carvalho I"
                            5 => "Carvalho A"
                            6 => "et-al&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Int J Tuberculosis Lung Dis: Off J Int Union Against Tuberculosis Lung Dis. "
                        "fecha" => "2014"
                        "volumen" => "18"
                        "paginaInicial" => "531"
                        "paginaFinal" => "533"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib7"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Description of pediatric tuberculosis evaluated in a referral center in Istanbul Turkey. Yonsei Med J. 2012; 53(6):1176&#x002D;82."
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Description of pediatric tuberculosis evaluated in a referral center in Istanbul Turkey&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "Gulec SG"
                            1 => "Telhan L"
                            2 => "Kockaya T"
                            3 => "Erdem E"
                            4 => "Bayraktar B"
                            5 => "Palanduz A&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3349/ymj.2012.53.6.1176"
                      "Revista" => array:6 [
                        "tituloSerie" => "Yonsei Med J. "
                        "fecha" => "2012"
                        "volumen" => "53"
                        "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" => "bib8"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Investigation and control of tuberculosis incidents affecting children in congregate settings. Stockholm: ECDC; 2013. Available online: <inter&#x002D;ref>http://www.ecdc.europa.eu/en/publications/Publications/guidance&#x002D;investigation&#x002D;control&#x002D;tb&#x002D;incidents&#x002D;children&#x002D;in&#x002D;congregate&#x002D;settings.pdf</inter&#x002D;ref>"
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Investigation and control of tuberculosis incidents affecting children in congregate settings&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "Control ECfDPa&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:2 [
                        "titulo" => "Investigation and control of tuberculosis incidents affecting children in congregate settings&#46;"
                        "fecha" => "2013"
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/08732159/0000002100000004/v0_201604141144/X0873215915339550/v0_201604141145/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "50820"
    "tipo" => "SECCION"
    "es" => array:2 [
      "titulo" => "Letter to the editor"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "es"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/08732159/0000002100000004/v0_201604141144/X0873215915339550/v0_201604141145/en/320v21n04a90433955pdf001.pdf?idApp=UINPBA00004E&text.app=https://journalpulmonology.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0873215915339550?idApp=UINPBA00004E"
]
Share
Journal Information

Statistics

Follow this link to access the full text of the article

Tuberculosis in undiagnosed children: What are the criteria to start treatment in Portugal?
S.. Martinsa,
Corresponding author
up200901370@med.up.pt

Corresponding author. up200901370@med.up.pt
, I.. Carvalhob, J.V.. Santosc,d, R.. Duartea,b,e,f
a Medical School, Porto University, Portugal
b Hospital Centre of Vila Nova de Gaia/Espinho, Portugal
c Department of Health Information and Decision Science, Faculty of Medicine, University of Porto, Portugal
d CINTESIS – Center for Health Technology and Services Research, Portugal
e Department of Clinical Epidemiology, Predictive Medicine and Public Health, Medical School, Porto University, Portugal
f EPIUnit Institute of Public Health, Porto University, Portugal
Read
6590
Times
was read the article
2470
Total PDF
4120
Total HTML
Share statistics
 array:19 [
  "pii" => "X0873215915339550"
  "issn" => "08732159"
  "doi" => "10.1016/j.rppnen.2015.03.003"
  "estado" => "S300"
  "fechaPublicacion" => "2015-07-01"
  "documento" => "article"
  "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
  "subdocumento" => "fla"
  "cita" => "Rev Port Pneumol. 2015;21:223-4"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 3258
    "formatos" => array:3 [
      "EPUB" => 212
      "HTML" => 2200
      "PDF" => 846
    ]
  ]
  "itemAnterior" => array:16 [
    "pii" => "X0873215915339542"
    "issn" => "08732159"
    "doi" => "10.1016/j.rppnen.2015.03.001"
    "estado" => "S300"
    "fechaPublicacion" => "2015-07-01"
    "documento" => "article"
    "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
    "subdocumento" => "fla"
    "cita" => "Rev Port Pneumol. 2015;21:221-2"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 5223
      "formatos" => array:3 [
        "EPUB" => 286
        "HTML" => 3924
        "PDF" => 1013
      ]
    ]
    "en" => array:9 [
      "idiomaDefecto" => true
      "titulo" => "A rare benign tumor of tracheobronchial tree&#58; 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:8 [
          "identificador" => "fig1"
          "etiqueta" => "Figure 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "copyright" => "Elsevier Espa&#241;a"
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "320v21n04-90433954fig1.jpg"
              "Alto" => 1250
              "Ancho" => 1667
              "Tamanyo" => 537714
            ]
          ]
          "descripcion" => array:1 [
            "en" => "A 2&#160;cm pedunculated&#44; glossy and lobulated bronchial fibroepithelial polyp obliterating the right main bronchus&#46;"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "R.C. Melo, C. Ribeiro, A. Sanches, A. Oliveira"
          "autores" => array:4 [
            0 => array:2 [
              "Iniciales" => "R.C."
              "apellidos" => "Melo"
            ]
            1 => array:2 [
              "Iniciales" => "C."
              "apellidos" => "Ribeiro"
            ]
            2 => array:2 [
              "Iniciales" => "A."
              "apellidos" => "Sanches"
            ]
            3 => array:2 [
              "Iniciales" => "A."
              "apellidos" => "Oliveira"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0873215915339542?idApp=UINPBA00004E"
    "url" => "/08732159/0000002100000004/v0_201604141144/X0873215915339542/v0_201604141145/en/main.assets"
  ]
  "en" => array:9 [
    "idiomaDefecto" => true
    "titulo" => "Tuberculosis in undiagnosed children&#58; What are the criteria to start treatment in Portugal&#63;"
    "tieneTextoCompleto" => true
    "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 [
            "Iniciales" => "S."
            "apellidos" => "Martins"
            "email" => array:1 [
              0 => "up200901370&#64;med&#46;up&#46;pt"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor1"
              ]
            ]
          ]
          1 => array:3 [
            "Iniciales" => "I."
            "apellidos" => "Carvalho"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "affb"
              ]
            ]
          ]
          2 => array:3 [
            "Iniciales" => "J.V."
            "apellidos" => "Santos"
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "affc"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">d</span>"
                "identificador" => "affd"
              ]
            ]
          ]
          3 => array:3 [
            "Iniciales" => "R."
            "apellidos" => "Duarte"
            "referencia" => array:4 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "affb"
              ]
              2 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">e</span>"
                "identificador" => "affe"
              ]
              3 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">f</span>"
                "identificador" => "afff"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:6 [
          0 => array:3 [
            "entidad" => "Medical School, Porto University, Portugal"
            "etiqueta" => "<span class="elsevierStyleSup">a</span>"
            "identificador" => "affa"
          ]
          1 => array:3 [
            "entidad" => "Hospital Centre of Vila Nova de Gaia/Espinho, Portugal"
            "etiqueta" => "<span class="elsevierStyleSup">b</span>"
            "identificador" => "affb"
          ]
          2 => array:3 [
            "entidad" => "Department of Health Information and Decision Science, Faculty of Medicine, University of Porto, Portugal"
            "etiqueta" => "<span class="elsevierStyleSup">c</span>"
            "identificador" => "affc"
          ]
          3 => array:3 [
            "entidad" => "CINTESIS &#x2013; Center for Health Technology and Services Research, Portugal"
            "etiqueta" => "<span class="elsevierStyleSup">d</span>"
            "identificador" => "affd"
          ]
          4 => array:3 [
            "entidad" => "Department of Clinical Epidemiology, Predictive Medicine and Public Health, Medical School, Porto University, Portugal"
            "etiqueta" => "<span class="elsevierStyleSup">e</span>"
            "identificador" => "affe"
          ]
          5 => array:3 [
            "entidad" => "EPIUnit Institute of Public Health, Porto University, Portugal"
            "etiqueta" => "<span class="elsevierStyleSup">f</span>"
            "identificador" => "afff"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor1"
            "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
            "correspondencia" => "Corresponding author. up200901370@med.up.pt"
          ]
        ]
      ]
    ]
    "textoCompleto" => "<p class="elsevierStylePara">Dear Editor&#44;</p><p class="elsevierStylePara">Worldwide&#44; about 9 million individuals per year are newly infected with tuberculosis &#40;TB&#41;&#44; 1 million of which are children under 15 years of age&#46;<a href="&#35;bib5" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">1</span></a> In Europe between 2000 and 2009&#44; only 42&#46;3&#37; of patients with pediatric TB were assessed by culture&#44; and only 39&#46;9&#37; of those tested were culture positive&#46;<a href="&#35;bib5" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">1</span></a> In fact&#44; the confirmation rate among pediatric cases was 19&#46;2&#37; in Europe in 2009<a href="&#35;bib5" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">1</span></a> and 27&#46;6&#37; in Portugal from 2000 to 2009&#46;<a href="&#35;bib6" class="elsevierStyleCrossRefs"><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&#46;</p><p class="elsevierStylePara">In Portugal&#44; TB is managed in the 67 tuberculosis outpatient centers&#46; These centers are responsible for the management of all cases of TB and the screening of at-risk populations&#46; The cases that are hospitalized are directed to these outpatient centers as soon as they are released from hospital&#46;</p><p class="elsevierStylePara">Notification of all cases of TB to the National Tuberculosis Surveillance System &#40;SVIG-TB&#41; by the clinician is mandatory&#46;</p><p class="elsevierStylePara">This study was designed to identify the criteria leading to the empirical start of antibiotic treatment in Portugal&#44; without diagnostic confirmation&#44; in children age&#160;&#60;&#160;6 years&#46;</p><p class="elsevierStylePara">This study was based on the implementation of a <span class="elsevierStyleItalic">web</span>-based survey&#44; through Medquest<span class="elsevierStyleSup">&#174;</span>&#44; directed to doctors at the national level with experience in TB&#46; Professionals&#8217; experience with TB and specifically with TB in pediatric age was assessed&#46; This survey included 30 multiple choice and simple answer questions&#44; with all responses being anonymous&#46;</p><p class="elsevierStylePara">The investigation was approved by the Ethics Committee of the EPIUnit-Institute of Public Health&#44; University of Porto&#44; Porto&#44; Portugal&#46;</p><p class="elsevierStylePara">The questionnaires were sent to all tuberculosis outpatient centers &#8211; two of them failed delivery&#46; Of the 65 surveys sent&#44; 29 &#40;44&#46;6&#37;&#41; were completed&#46; Of the 29 responders&#44; 20 &#40;69&#37;&#41; were female&#46; Mean age of the responders was 48&#46;7 years&#44; and mean clinical experience was 20 years &#40;range&#44; 2&#8211;38 years&#41;&#44; including an average of 15&#46;5 years of experience in TB management and 11&#46;7 years in management of TB in children&#46;</p><p class="elsevierStylePara">When asked about their criteria to start treatment in children under 6 years of age without diagnostic confirmation&#44; 72&#37; cited epidemiological context&#44; 62&#37; mentioned radiological abnormalities&#44; and 55&#37; cited clinical history and the results of immunological tests&#44; including tuberculin and gamma-interferon assays&#46;</p><p class="elsevierStylePara">Factors associated with epidemiological context cited as the most important in the decision to start treatment included history of exposure &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;25&#44; 86&#37;&#41;&#44; immunodeficiency &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;17&#44; 59&#37;&#41; and country of origin with a high prevalence of TB &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;16&#44; 55&#37;&#41;&#46; Radiological criteria included chest radiography&#44; cited by 76&#37; of responders&#44; followed by computerized axial tomography &#40;33&#37;&#41;&#46; The most valuable imaging findings were nodules and cavities &#40;96&#37;&#41;&#44; adenopathies &#40;41&#37;&#41;&#44; pleural effusion &#40;41&#37;&#41; and &#8220;tree-in-bud&#8221; appearance &#40;26&#37;&#41;&#46;</p><p class="elsevierStylePara">Clinical determinants associated with the decision to start treatment included sustained fever &#40;55&#37;&#41;&#44; respiratory symptoms &#40;41&#37;&#41; and failure to thrive &#40;34&#37;&#41;&#46; The average time window considered for these symptoms was 36&#46;5 days &#40;range&#44; 7 days to 3 months&#41;&#46;</p><p class="elsevierStylePara">Immunological tests considered relevant to the decision to treat included tuberculin tests &#40;41&#37;&#41; and interferon gamma assays &#40;28&#37;&#41;&#46;</p><p class="elsevierStylePara">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&#46; Although the radiological changes perceived as most suggestive of TB are not commonly presented under 6 years of age for TB&#44; all findings are in agreement with proposed criteria for early treatment of TB in children under 6 years of age&#46;<a href="&#35;bib7" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">3</span></a><span class="elsevierStyleSup">&#44; </span><a href="&#35;bib8" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">4</span></a></p><p class="elsevierStylePara">One weakness of our study is that we only received 44&#46;6&#37; of the questionnaires sent&#46; A wider study should be undertaken which includes hospital Pediatricians&#46;</p><a name="sec0005" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Author contributions</span><p class="elsevierStylePara">Sara Martins initiated this research study and collaborated in all stages&#46; Isabel Carvalho revised the questionnaire&#46; Jo&#227;o Vasco Santos facilitated the use Medquest for writing the questionnaire and gave support to putting it into practice&#46; Raquel Duarte supervised all aspects of this work&#46;</p><a name="sec0010" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Conflict of interest</span><p class="elsevierStylePara">There is no conflict of interest&#46;</p><p class="elsevierStylePara">Corresponding author&#46; up200901370&#64;med&#46;up&#46;pt</p>"
    "pdfFichero" => "320v21n04a90433955pdf001.pdf"
    "tienePdf" => true
    "bibliografia" => array:2 [
      "titulo" => "Bibliography"
      "seccion" => array:1 [
        0 => array:1 [
          "bibliografiaReferencia" => array:4 [
            0 => array:3 [
              "identificador" => "bib5"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Childhood tuberculosis in the European Union/European Economic Area, 2000 to 2009. Euro Surveillance: Bull Europeen sur les maladies transmissibles&#x000A0;=&#x000A0;Euro Commun Dis Bull. 2011; 16(12):. Available online: <inter&#x002D;ref>http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19825</inter&#x002D;ref>"
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Childhood tuberculosis in the European Union&#47;European Economic Area&#44; 2000 to 2009&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "Sandgren A"
                            1 => "Hollo V"
                            2 => "Quinten C"
                            3 => "Manissero D&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:3 [
                        "tituloSerie" => "Euro Surveillance: Bull Europeen sur les maladies transmissibles&#x000A0;=&#x000A0;Euro Commun Dis Bull. "
                        "fecha" => "2011"
                        "volumen" => "16"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib6"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Confirming the diagnosis of tuberculosis in children in Northern Portugal. Int J Tuberculosis Lung Dis: Off J Int Union Against Tuberculosis Lung Dis. 2014; 18(5):531&#x002D;3."
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Confirming the diagnosis of tuberculosis in children in Northern Portugal&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:7 [
                            0 => "Ladeira I"
                            1 => "Correia AM"
                            2 => "Dias J"
                            3 => "Gaio R"
                            4 => "Carvalho I"
                            5 => "Carvalho A"
                            6 => "et-al&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Int J Tuberculosis Lung Dis: Off J Int Union Against Tuberculosis Lung Dis. "
                        "fecha" => "2014"
                        "volumen" => "18"
                        "paginaInicial" => "531"
                        "paginaFinal" => "533"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib7"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Description of pediatric tuberculosis evaluated in a referral center in Istanbul Turkey. Yonsei Med J. 2012; 53(6):1176&#x002D;82."
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Description of pediatric tuberculosis evaluated in a referral center in Istanbul Turkey&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "Gulec SG"
                            1 => "Telhan L"
                            2 => "Kockaya T"
                            3 => "Erdem E"
                            4 => "Bayraktar B"
                            5 => "Palanduz A&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3349/ymj.2012.53.6.1176"
                      "Revista" => array:6 [
                        "tituloSerie" => "Yonsei Med J. "
                        "fecha" => "2012"
                        "volumen" => "53"
                        "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" => "bib8"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Investigation and control of tuberculosis incidents affecting children in congregate settings. Stockholm: ECDC; 2013. Available online: <inter&#x002D;ref>http://www.ecdc.europa.eu/en/publications/Publications/guidance&#x002D;investigation&#x002D;control&#x002D;tb&#x002D;incidents&#x002D;children&#x002D;in&#x002D;congregate&#x002D;settings.pdf</inter&#x002D;ref>"
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Investigation and control of tuberculosis incidents affecting children in congregate settings&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "Control ECfDPa&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:2 [
                        "titulo" => "Investigation and control of tuberculosis incidents affecting children in congregate settings&#46;"
                        "fecha" => "2013"
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/08732159/0000002100000004/v0_201604141144/X0873215915339550/v0_201604141145/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "50820"
    "tipo" => "SECCION"
    "es" => array:2 [
      "titulo" => "Letter to the editor"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "es"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/08732159/0000002100000004/v0_201604141144/X0873215915339550/v0_201604141145/en/320v21n04a90433955pdf001.pdf?idApp=UINPBA00004E&text.app=https://journalpulmonology.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0873215915339550?idApp=UINPBA00004E"
]
Article information
ISSN: 08732159
Original language: English
The statistics are updated each day
Year/Month Html Pdf Total
2024 November 4 4 8
2024 October 25 23 48
2024 September 32 46 78
2024 August 41 44 85
2024 July 37 39 76
2024 June 39 45 84
2024 May 38 32 70
2024 April 43 27 70
2024 March 32 23 55
2024 February 25 22 47
2024 January 32 29 61
2023 December 18 30 48
2023 November 28 36 64
2023 October 31 41 72
2023 September 19 30 49
2023 August 20 24 44
2023 July 19 29 48
2023 June 22 16 38
2023 May 39 26 65
2023 April 27 22 49
2023 March 55 18 73
2023 February 40 20 60
2023 January 22 18 40
2022 December 46 24 70
2022 November 64 34 98
2022 October 46 42 88
2022 September 29 29 58
2022 August 42 42 84
2022 July 33 44 77
2022 June 26 32 58
2022 May 37 38 75
2022 April 30 46 76
2022 March 39 48 87
2022 February 28 26 54
2022 January 23 37 60
2021 December 28 41 69
2021 November 22 32 54
2021 October 29 49 78
2021 September 22 32 54
2021 August 29 23 52
2021 July 22 24 46
2021 June 15 21 36
2021 May 29 34 63
2021 April 61 54 115
2021 March 52 21 73
2021 February 47 21 68
2021 January 28 16 44
2020 December 26 6 32
2020 November 27 20 47
2020 October 31 17 48
2020 September 37 28 65
2020 August 31 18 49
2020 July 57 24 81
2020 June 38 18 56
2020 May 49 10 59
2020 April 49 13 62
2020 March 39 10 49
2020 February 43 31 74
2020 January 41 14 55
2019 December 45 20 65
2019 November 64 14 78
2019 October 39 23 62
2019 September 44 17 61
2019 August 92 12 104
2019 July 89 13 102
2019 June 81 11 92
2019 May 93 12 105
2019 April 90 22 112
2019 March 129 10 139
2019 February 80 8 88
2019 January 97 20 117
2018 December 64 5 69
2018 November 20 0 20
2018 October 14 6 20
2018 September 14 4 18
2018 August 30 21 51
2018 July 33 13 46
2018 June 39 15 54
2018 May 46 11 57
2018 April 70 23 93
2018 March 97 24 121
2018 February 41 4 45
2018 January 65 9 74
2017 December 45 12 57
2017 November 22 12 34
2017 October 14 9 23
2017 September 12 15 27
2017 August 19 20 39
2017 July 13 11 24
2017 June 12 15 27
2017 May 20 13 33
2017 April 4 0 4
2017 March 5 3 8
2017 February 5 4 9
2017 January 8 4 12
2016 December 5 2 7
2016 November 5 3 8
2016 October 2 3 5
2016 September 4 3 7
2016 August 6 2 8
2016 July 4 6 10
2016 June 0 5 5
2016 May 10 0 10
2016 April 11 28 39
2016 March 20 22 42
2016 February 30 23 53
2016 January 21 17 38
2015 December 22 20 42
2015 November 16 24 40
2015 October 24 20 44
2015 September 50 19 69
2015 August 137 85 222
2015 July 115 90 205
Show all

Follow this link to access the full text of the article

Pulmonology

Are you a health professional able to prescribe or dispense drugs?