Brazilian Journal of Pulmonology

ISSN (on-line): 1806-3756 | ISSN (printed): 1806-3713

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Treatment compliance of patients with paracoccidioidomycosis in Central-West Brazil

Adesão ao tratamento de pacientes com paracoccidioidomicose na Região Centro-Oeste do Brasil

Ursulla Vilella Andrade1,a, Sandra Maria do Valle Leone de Oliveira1,b, Marilene Rodrigues Chang1,c, Edy Firmina Pereira1,d, Ana Paula da Costa Marques1,e, Lidia Raquel de Carvalho2,f, Rinaldo Poncio Mendes2,g, Anamaria Mello Miranda Paniago1,h

J Bras Pneumol.2019;45(2):e20180167-e20180167

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Objective: To evaluate the treatment compliance of patients with paracoccidioidomycosis. Methods: We studied 188 patients with paracoccidioidomycosis admitted to a tertiary referral hospital in the Central-West Region of Brazil from 2000 to 2010, to assess their compliance to treatment. In order to be considered compliant, patients needed to present two established criteria: (1) receive medicines from the pharmacy, and (2) achieve a self-reported utilization of at least 80% of the dispensed antifungal compounds prescribed since their previous appointment. Results: Most patients were male (95.7%), had the chronic form of the disease (94.2%), and were treated with cotrimoxazole (86.2%). Only 44.6% of patients were treatment compliant. The highest loss to follow-up was observed in the first 4 months of treatment (p < 0.02). Treatment compliance was higher for patients with than for those without pulmonary involvement (OR: 2.986; 95%CI 1.351-6.599), and higher for patients with than without tuberculosis as co-morbidity (OR: 2.763; 95%CI 1.004-7.604). Conclusions: Compliance to paracoccidioidomycosis treatment was low, and the period with the highest loss to follow-up corresponds to the first four months. Pulmonary paracoccidioidal involvement or tuberculosis comorbidity predicts a higher compliance to paracoccidioidomycosis therapy.

 


Keywords: Paracoccidioidomycosis; Treatment adherence and compliance; loss to follow-up; mycoses

 


Frequency of indeterminate results from an interferon-gamma release assay among HIV-infected individuals

Taxa de resultados indeterminados de ensaio de liberação de interferon-gama entre pessoas infectadas pelo HIV

Sandra Maria do Valle Leone de Oliveira1,2, Anete Trajman3,4, Anamaria Mello Miranda Paniago1, Ana Rita Coimbra Motta-Castro1,2, Antonio Ruffino-Netto5, Ethel Leonor Noia Maciel6, Julio Croda2,7, Maria da Gloria Bonecini-Almeida8

J Bras Pneumol.2017;43(3):215-218

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Objective: To evaluate the frequency of and factors associated with indeterminate interferon-gamma release assay (IGRA) results in people living with HIV/AIDS (PLWHA). Methods: We tested 81 PLWHA in the central-west region of Brazil, using the tuberculin skin test and an IGRA. Information on sociodemographic and clinical variables was gathered through the use of questionnaires and from medical records. The association of those variables with indeterminate results was analyzed by calculating the adjusted ORs in a multivariate logistic regression model. Concordance was evaluated by determining the kappa statistic. Results: Among the 81 patients evaluated, the tuberculin skin test results were positive in 18 (22.2%) of the patients, and the IGRA results were positive in 10 (12.3%), with a kappa of 0.62. The IGRA results were indeterminate in 22 (27.1%) of the patients (95% CI: 17.8-38.1%). The odds of obtaining indeterminate results were significantly higher in smokers (adjusted OR = 6.0; 95% CI: 1.4-26.7) and in samples stored for less than 35 days (adjusted OR = 14.0; 95% CI: 3.1-64.2). Patients with advanced immunosuppression (CD4+ T-cell count < 200 cells/mm3) were at a higher risk for indeterminate results (OR adjusted for smoking and inadequate duration of sample storage = 4.7; 95% CI: 0.91-24.0), although the difference was not significant. Conclusions: The high prevalence of indeterminate results can be a major limitation for the routine use of IGRAs in PLWHA. The need to repeat the test increases its costs and should be taken into account in cost-effectiveness studies. The processing of samples can significantly alter the results.

 


Keywords: Interferon-gamma release tests; Interferon-gamma; Tuberculosis; HIV; Latent tuberculosis; Tuberculin test.

 


 

 


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CNPq, Capes, Ministério da Educação, Ministério da Ciência e Tecnologia, Governo Federal, Brasil, País Rico é País sem Pobreza
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