Browsing by Author "Miranda, Silvana Spíndola de"

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    Avaliação do desempenho dos serviços de atenção primária à saúde no controle da tuberculose em metrópole do Sudeste do Brasil.
    (2021) Rabelo, Juliana Veiga Costa; Navarro, Pedro Daibert de; Carvalho, Wânia da Silva; Almeida, Isabela Neves de; Oliveira, Camila Stefânie Fonseca; Haddad, João Paulo Amaral; Miranda, Silvana Spíndola de
    A Organização Mundial da Saúde destaca a importância da organização e do desempenho dos serviços de saúde nas ações de controle da tuberculose. O objetivo deste estudo foi avaliar o desempenho dos serviços de atenção primaria à saúde em Belo Horizonte, Minas Gerais, Brasil, em relação às ações de controle da tuberculose nos eixos Estrutura e Processo, antes e após a utilização do instrumento validado denominado Estratificação por Grau de Risco Clínico e de Abandono do Tratamento da Tuberculose (ERTB). Estudo descritivo e prospectivo, no qual foram realizadas duas entrevistas (455 profissionais), tendo a segunda ocorrido após a ERTB. A classificação do desempenho seguiu os valores: ≤ 49,9%, críticos; entre 50% e 79,9%, insatisfatórios; e, ≥ 80%, satisfatórios. Na avaliação comparativa, foi utilizado o teste estatístico de McNemar, com p < 0,05. Após a estratificação de risco, a maior parte das variáveis de cada eixo melhorou significativamente. Nós concluímos que, por meio de um questionário padronizado, foi possível identificar o desempenho satisfatório dos serviços de atenção primária à saúde em Belo Horizonte em relação às ações de controle da tuberculose, na maioria das variáveis avaliadas nos eixos Estrutura e Processo.
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    Characterization of Mycobacterium tuberculosis heteroresistance by genotyping.
    (2020) Figueredo, Lida Jouca de Assis; Almeida, Isabela Neves de; Augusto, Claudio José; Soares, Valéria Martins; Suffys, Philip Noel; Carvalho, Wânia da Silva; Miranda, Silvana Spíndola de
    Background: Heteroresistance is the coexistence of susceptible and resistant strains in the same individual, considered the preliminary step for total resistance, and can stem from mixed infection or clonal heterogeneity. The aim of this study was to evaluate the heteroresistance of Mycobacterium tuberculosis to rifampicin and isoniazid and its characterization. Method: GenoType MTBDRplus®; Sanger sequencing of the rpoB, katG, and inhA genes; and Mycobacterial Interspersed Repetitive Unit – Variable Number Tandem Repeat (MIRU-VNTR) were performed. Results: In a total of 654 isolates, 530 were resistant, 124 were susceptible, and 29 were heteroresistant to a first-line drug. GenoType MTBDRplus® detected heteroresistance in the rpoB gene in 26/29 (89.6%), as compared to 5/29 (17.2%) in the katG gene and 2/29 (6.8%) in the inhA gene. Four isolates showed heteroresistance in these genes. The Sanger sequencing detected heteroresistance in the rpoB gene in 7/29 (24.1%), as compared to 3/29 (10.3%) in the katG gene. In one isolate, heteroresistance was concomitant in both the rpoB and katG genes. MIRU-VNTR detected mixed infection in three heteroresistant isolates, while four isolates showed clonal heterogeneity. Conclusions: GenoType MTBDRplus® detected more cases of heteroresistance when compared to sequencing. It was also possible to characterize mixed infection and clonal heterogeneity by MIRU-VNTR.
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    Cost analysis of smear microscopy and the Xpert assay for tuberculosis diagnosis : average turnaround time.
    (2020) Figueredo, Lida Jouca de Assis; Miranda, Silvana Spíndola de; Santos, Lucas Benício dos; Manso, Caroline Gontijo Gonçalves; Soares, Valéria Martins; Alves, Suely; Vater, Maria Cláudia; Kritski, Afrânio Lineu; Carvalho, Wânia da Silva; Pádua, Cristiane Menezes de; Almeida, Isabela Neves de
    Introduction: Rapid and accurate tuberculosis detection is critical for improving patient diagnosis and decreasing tuberculosis transmission. Molecular assays can significantly increase laboratory costs; therefore, the average time and economic impact should be evaluated before implementing a new technology. The aim of this study was to evaluate the cost and average turnaround time of smear microscopy and Xpert assay at a university hospital. Methods: The turnaround time and cost of the laboratory diagnosis of tuberculosis were calculated based on the mean cost and activity based costing (ABC). Results: The average turnaround time for smear microscopy was 16.6 hours while that for Xpert was 24.1 hours. The Xpert had a mean cost of USD 17.37 with an ABC of USD 10.86, while smear microscopy had a mean cost of USD 13.31 with an ABC of USD 6.01. The sensitivity of smear microscopy was 42.9% and its specificity was 99.1%, while the Xpert assay had a sensitivity of 100% and a specificity of 96.7%. Conclusions: The Xpert assay has high accuracy; however, the turnaround time and cost of smear microscopy were lower than those of Xpert.
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    Cost-effectiveness of Xpert®MTB/RIF in the diagnosis of tuberculosis : pragmatic study.
    (2021) Silva, Suely Conceição Alves da; Vater, Maria Cláudia; Ramalho, Daniela Maria de Paula; Almeida, Isabela Neves de; Miranda, Silvana Spíndola de; Kritski, Afrânio Lineu
    Introduction: The intensification of research and innovation with the creation of networks of rapid and effective molecular tests as strategies for the end of tuberculosis are essential to avoid late diagnosis and for the eradication of the disease. We aimed to evaluate the cost-effectiveness of Xpert®MTB/RIF (Xpert) in the diagnosis of drug-resistant tuberculosis in reference units, in scenarios with and without subsidies, and the respective cost adjustment for today. Methods: The analyses were performed considering as criterion of effectiveness, negative culture or clinical improvement in the sixth month of follow-up. The comparison was performed using two diagnostic strategies for the drug susceptibility test (DST), BactecTMMGITTM960 System, versus Xpert. The cost effectiveness and incremental cost-effectiveness ratio (ICER) were calculated and dollar-corrected for American inflation (US$ 1.00 = R$ 5,29). Results: Subsidized Xpert had the lowest cost of US$ 33.48 (R$67,52) and the highest incremental average efficiency (13.57), thus being a dominated analysis. After the inflation was calculated, the mean cost was DST-MGIT=US$ 74.85 (R$ 396,73) and Xpert = US$ 37.33 (R$197,86) with subsidies. Conclusions: The Xpert in the diagnosis of TB-DR in these reference units was cost-effective with subsidies. In the absence of a subsidy, Xpert in TB-DR is not characterized as cost effective. This factor reveals the vulnerability of countries dependent on international organizations’ subsidy policies.
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    Factors associated with tuberculosis and multidrug-resistant tuberculosis in patients treated at a tertiary referral hospital in the state of Minas Gerais, Brazil.
    (2020) Soares, Valéria Martins; Almeida, Isabela Neves de; Figueredo, Lida Jouca de Assis; Haddad, João Paulo Amaral; Oliveira, Camila Stefanie Fonseca de; Carvalho, Wânia da Silva; Miranda, Silvana Spíndola de
    Objective: To evaluate the risk factors for the development of tuberculosis and multidrugresistant tuberculosis (MDR-TB) in patients treated at a tertiary referral hospital. Methods: This was a cross-sectional study based on data obtained from patients treated at the Júlia Kubitschek Hospital, located in the city of Belo Horizonte, Brazil, between October of 2012 and October of 2014. We evaluated sociodemographic, behavioral, clinical, and radiological variables. The outcome considered to identify associations between tuberculosis and the explanatory variables was the treatment prescribed. To evaluate the associations between MDR-TB and the same explanatory variables, the change in MDR-TB treatment was considered. Results: The factors associated with tuberculosis were alcoholism, comorbidities, pulmonary cavitations, and a radiological pattern suggestive of tuberculosis. Cavitation and previous treatment for tuberculosis were associated with MDR-TB. Conclusions: Despite the significant progress made in the fight against tuberculosis, there is a need for coordinated actions that include social protection measures and patient support.
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    Pulmonary functional assessment : longitudinal study after treatment of pulmonary tuberculosis.
    (2021) Nishi, Marina Pires; Mancuzo, Eliane Viana; Sulmonett, Nara; Almeida, Isabela Neves de; César, Aina Liz Alves; Miranda, Silvana Spíndola de
    Even when treated adequately, pulmonary tuberculosis can lead to pulmonary sequelae. Patients treated for PTB between 2012 and 2016 answered a standardized questionnaire and underwent chest radiography and spirometry, measurement of absolute pulmonary volume, Diffusing Capacity for Carbon Monoxide (DLCO) and the 6-min walk test (6MWT) on two occasions: within the first year after the end of treatment (follow-up 1), and one and two years after follow-up 1 (follow-up 2). A total of 55 patients they underwent spirometry, 23 (41.82%) had obstructive ventilatory disorder (OVD) and eight (14.5%) had moderate OVD. In total, 29 patients underwent pulmonary function tests (PFTs) and 24 patients underwent the 6MWT on two occasions. The functional changes after PTB treatment appear not to have varied between one and two years of follow-up. There was a correlation between low FEV1 and low DLCO (p<0.001); low DLCO and low 6MWT (p<0.001) and radiographic abnormalities and low FEV1 (p=0.033). The most frequently observed change in spirometry was found in patients with OVD.
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    Rapid detection of Mycobacterium tuberculosis DNA and genetic markers for Isoniazid resistance in Ziehl-Neelsen stained slides.
    (2020) Bello, Graziele Lima; Morais, Franciele Costa Leite; Jesus, Sheile Pinheiro de; Wolf, Jonas Michel; Gehlen, Mirela; Almeida, Isabela Neves de; Figueiredo, Lida Jouca de Assis; Soares, Tainá dos Santos; Barcellos, Regina Bones; Costa, Elis Regina Dalla; Miranda, Silvana Spíndola de; Rossetti, Maria Lucia Rosa
    BACKGROUND Early diagnosis of tuberculosis (TB) and identification of strains of Mycobacterium tuberculosis resistant to anti- TB drugs are considered the main factors for disease control. OBJECTIVES To standardise a real-time polymerase chain reaction (qPCR) assay technique and apply it to identify mutations involved in M. tuberculosis resistance to Isoniazid (INH) directly in Ziehl-Neelsen (ZN) stained slides. METHODS Were analysed 55 independent DNA samples extracted from clinical isolates of M. tuberculosis by sequencing. For application in TB diagnosis resistance, 59 ZN-stained slides were used. The sensitivity, specificity and Kappa index, with a 95% confidence interval (CI95%), were determined. FINDINGS The agreement between the tests was, for the katG target, the Kappa index of 0.89 (CI95%: 0.7-1.0). The sensitivity and specificity were 97.6% (CI95%: 87.7-99.9) and 91.7% (CI95%: 61.5-99.5), respectively. For inhA, the Kappa index was 0.92 (CI95%: 0.8-1.0), the sensitivity and specificity were 94.4% (CI95%: 72.7-99.8) and 97.3% (CI95%: 85.8-99.9), respectively. The use of ZN- stained slides for drug-resistant TB detection showed significant results when compared to other standard tests for drug resistance. MAIN CONCLUSIONS qPCR genotyping proved to be an efficient method to detect genes that confer M. tuberculosis resistance to INH. Thus, qPCR genotyping may be an alternative instead of sequencing.
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    The activity-based cost of drug-susceptibility test of Mycobacterium tuberculosis through Kit SIRE Nitratase® plastlabor.
    (2020) Almeida, Isabela Neves de; Silva, Suely Conceição Alves da; Oliveira Junior, Haliton Alves de; Figueredo, Lida Jouca de Assis; Soares, Valéria Martins; Carvalho, Wânia da Silva; Kritski, Afrânio; Fiori, Maria Cláudia da Silva Vater da Costa; Miranda, Silvana Spíndola de
    Background: Drug‐resistant tuberculosis (TB) is an ongoing health threat, and the greatest challenge to adequate control of TB in many countries lies in the lack of proper laboratory drug‐susceptibility test. The aim of this study was to evaluate the activity‐based costs (ABC) of Kit SIRE Nitratase® (Kit SIRE) and compare its values with the conventional drug‐susceptibility test. Methods: The ABC was calculated for three different approaches: Kit SIRE (clinical samples and cultures), proportion methods in Lowenstein Jensen (PM‐LJ), and the BactecTM MGITTM 960 system based on Mycobacterial Research Laboratory’s routine. Results: The ABC of Kit SIRE from cultures was US$ 148.54, while from clinical samples was US$ 136.12. In the case of conventional tests, the ABC of BactecTM MGITTM 960 was US$ 227.63 and of the PM‐LJ was US$ 132.64. The Kit SIRE has a lower ABC when clinical samples are used instead of cultures. Compared to conventional tests, the ABC is similar to the PM‐LJ and lower the BactecTM MGITTM 960. Conclusion: The Kit SIRE should be used as a screening method in clinical specimens and in culture for laboratories that do not have BactecTM MGITTM 960. Therefore, it can be incorporated into the routine of laboratories in countries with low resources and a high burden of TB and drug‐resistant TB.
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    The impact of the stratification by degree of clinical severity and abandonment risk of tuberculosis treatment.
    (2021) Navarro, Pedro Daibert de; Haddad, João Paulo Amaral; Rabelo, Juliana Veiga Costa; Silva, Claudia Hermínia de Lima e; Almeida, Isabela Neves de; Carvalho, Wânia da Silva; Miranda, Silvana Spíndola de
    Objective: Evaluate the impact of the instrument of the “Stratification by Degree of Clinical Severity and Abandonment Risk of Tuberculosis Treatment” (SRTB) on the tuberculosis outcome. Methods: This study was a pragmatic clinical trial involving patients with a confirmed diagnosis of tuberculosis treated at one of the 152 primary health care units in the city of Belo Horizonte, Brazil, between May of 2016 and April of 2017. Cluster areas for tuberculosis were identified, and the units and their respective patients were divided into intervention (use of SRTB) and nonintervention groups. Results: The total sample comprised 432 participants, 223 and 209 of whom being allocated to the nonintervention and intervention groups, respectively. The risk of treatment abandonment in the nonintervention group was significantly higher than was that in the intervention group (OR = 15.010; p < 0.001), regardless of the number of risk factors identified. Kaplan-Meier curves showed a hazard ratio of 0.0753 (p < 0.001). Conclusions: The SRTB instrument was effective in reducing abandonment of tuberculosis treatment, regardless of the number of risk factors for that. This instrument is rapid and easy to use, and can be adapted to different realities. Its application showed characteristics predisposing to a non-adherence to the treatment and established bases to mitigate its impact.