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To assess the spatial distribution of TB and malaria incidence, as well as their spatial association with each other, regardless of environmental and socio-economic factors commonly reported as determinants of both disease rates among the municipalities of Amazonas State, Brazil between 2012 and 2015.Through an ecological approach considering municipalities of Amazonas, Brazil, as unit of analysis, a negative binomial regression model was used to assess association between malaria and TB rates, in which the dependent variable was the average municipal tuberculosis incidence rate.Positive associations of overall malaria (β = 0.100 [CI = 0.032, 0.168], P = 0.004), P. vivax malaria (β = 0.115 [CI = 0.036, 0.195], P = 0.005), and P. falciparum malaria (β = 0.389 [CI = -0.0124, 0.791], P = 0.057) with TB rates were found, regardless of the sociodemographic factors included in the study.In the Brazilian Amazon, TB and malaria are spatially associated. Therefore, it is very likely that co-infections also occur in this region, regardless of the HIV status.Evaluer la distribution spatiale de l'incidence de la tuberculose (TB) et du paludisme, ainsi que leur association spatiale, indépendamment des facteurs environnementaux et socioéconomiques communément rapportés comme déterminants des taux des deux maladie dans les municipalités de l'Etat d'Amazonas, au Brésil, entre 2012 et 2015. MÉTHODES: Dans le cadre d'une approche écologique prenant en considération les municipalités d'Amazonas, au Brésil, comme unité d'analyse, un modèle de régression binomiale négatif a été utilisé pour évaluer l'association entre les taux de paludisme et de TB, dans laquelle la variable dépendante était le taux moyen d'incidence municipale de la TB. RÉSULTATS: Des associations positives entre le paludisme en général (β = 0,100 [IC= 0,032 à 0,168], p = 0,004), le paludisme à P. vivax (β = 0,115 [IC: 0,036 à 0,195], p = 0,005) et le paludisme à P. falciparum (β = 0,389 [IC: - 0,0124 à 0,791], p = 0,057) avec des taux de TB ont été retrouvées quels que soient les facteurs sociodémographiques inclus dans l’étude.En Amazonie brésilienne, la TB et le paludisme sont associés spatialement. Par conséquent, il est très probable que des coinfections se produisent également dans cette région, quel que soit le statut VIH.

Objetivo: Relatar a experiencia de enfermeiros na utilizacao de uma tecnologia movel para o cuidado de enfermagem a usuarios na atencao primaria e especializada durante a pandemia da COVID-19. Metodologia: Utilizou-se o metodo de sistematizacao de experiencias proposto por Holliday, que possibilitou a reconstrucao reflexiva da experiencia coletiva vivida, por meio de cinco etapas para a explanacao da experiencia. Resultados: Possibilitou a elaboracao de novas ferramentas para o acompanhamento de usuarios atendidos pelos servicos de saude por meio de tecnologias remotas que mediaram a assistencia de enfermagem. Conclusoes: O uso de tecnologia movel possibilitou a continuidade da assistencia de enfermagem durante a pandemia da COVID-19, de modo que o cuidado pode ser levado aos usuarios vulneraveis, sem que houvesse o comprometimento da saude no atual contexto epidemiologico em que a doenca esta em pleno processo de propagacao e disseminacao. Descritores: Tecnologia da Informacao; Cuidados de Enfermagem; Pandemias; Infeccoes por Coronavirus. MOBILE TECHNOLOGY FOR NURSING CARE DURING THE COVID-19 PANDEMIC: EXPERIENCE REPORT Objective: To report the experience of nurses in the use of mobile technology for nursing care for users in primary and special care during the COVID-19 pandemic. Methodology: Use the method of systematization of experiments studied by Holliday, which enabled the reflexive reconstruction of the collective experience lived, through five steps for an explanation of the experience. Results: It enabled the development of new tools for monitoring users served by health services through remote technologies that mediate nursing care. Conclusions: The use of mobile technology makes it possible to recover nursing care during a COVID-19 pandemic, the way care can be taken to vulnerable users, without interruption or health compromise in the current epidemiological context in which the disease is in progress full process of propagation and dissemination. Descriptors: Information technology; Nursing care; Pandemics; Coronavirus infections. TECNOLOGIA MOVIL PARA LA ATENCION DE ENFERMERIA DURANTE LA PANDEMIA COVID-19: INFORME DE EXPERIENCIA Objetivo: Informar sobre la experiencia de enfermeros en el uso de una tecnologia movil para la atencion de enfermeria para los usuarios de atencion primaria y especial durante la pandemia de COVID-19. Metodologia: utilice el metodo de sistematizacion de experimentos estudiados por Holliday, que permitio la reconstruccion reflexiva de la experiencia colectiva vivida, a traves de cinco pasos para una explicacion de la experiencia. Resultados: permitio el desarrollo de nuevas herramientas para monitorear a los usuarios atendidos por los servicios de salud a traves de tecnologias remotas que median la atencion de enfermeria. Conclusiones: El uso de una tecnologia movil permite recuperar la atencion de enfermeria durante una pandemia de COVID-19, la forma en que se puede prestar atencion a los usuarios vulnerables, sin interrupcion o compromiso de salud em el contexto epidemiologico actual em el que la enfermedad esta en progreso proceso completo de propagacion y difusion. Descriptores: Tecnologia de la informacion; Cuidado de enfermeria; Pandemias; Infecciones por coronavirus.

Objetivo: Pesquisar as evidências na literatura científica, referentes às principais orientações e ao acompanhamento dos portadores de tuberculose drogarresistente na atenção primária à saúde. Métodos: Revisão integrativa da literatura com busca nas bases de dados MEDLINE/PubMed, CINAHL, LILACS e Scopus, de onde foram selecionados nove artigos científicos, incluídos nesta pesquisa. Resultados: Todos os artigos apresentaram orientações e acompanhamento do tratamento dos portadores de tuberculose drogarresistente. Destes, cinco destacaram a importância da adesão e do fortalecimento do regime terapêutico. Como acompanhamento, os artigos ressaltaram o tratamento diretamente observado, a participação de um conselheiro, o rastreamento ativo dos doentes e dos seus contatos domiciliares. Considerações finais: A pesquisa evidenciou orientações e acompanhamento efetivos para os casos de tuberculose drogarresistentena atenção primária à saúde, reforçando a importância do trabalho em equipe, incluindo o apoio psicológico, social e nutricional para a adesão ao tratamento e prevenção da transmissão de cepas resistentes na comunidade.

Objective: To report the perception of the nursing team of a hospital in the municipality of Coari in the interior of the state of Amazonas, in the face of the coronavirus pandemic, exposing the main fears and anxieties in view of the uncertainties of the new world scenario and the challenges to come. Experience report: This epor tis based on the experience of the nursing team in the face of the coronavirus pandemic, demonstrating their fears and anxieties and how the current events in Brazil and in the world can significantly affect the psychological conditions of health professionals, since they have increased risk of contamination due to direct contact with infected patients. Thus, it was observed that the nursing teams have acted with constant psychological pressure, which can cause anxiety and even depression. Final considerations: professionals suffer the same psychological pressures, mainly due to fear in view of the uncertainty of future conditions, in view of the proportion of the pandemic. Therefore, it is necessary that health professionals are attended to in their concerns and helplessness, since the regression of the pandemic depends on it.

Tuberculosis (TB) is one of the infectious diseases that contributes most to the morbidity and mortality of millions of people worldwide. Brazil is one of 22 countries that accounts for 80% of the tuberculosis global burden. The highest incidence rates in Brazil occur in the States of Amazonas and Rio de Janeiro. The aim of this study was to describe the temporal distribution of TB in the State of Amazonas. Between 2001 and 2011, 28,198 cases of tuberculosis were reported in Amazonas, distributed among 62 municipalities, with the capital Manaus reporting the highest (68.7%) concentration of cases. Tuberculosis was more prevalent among males (59.3%) aged 15 to 34 years old (45.5%), whose race/color was predominantly pardo (64.7%) and who had pulmonary TB (84.3%). During this period, 81 cases of multidrug-resistant TB were registered, of which the highest concentration was reported from 2008 onward (p = 0.002). The municipalities with the largest numbers of indigenous individuals affected were Sao Gabriel da Cachoeira (93%), Itamarati (78.1%), and Santa Isabel do Rio Negro (70.1%). The future outlook for this region includes strengthening the TB control at the primary care level, by expanding diagnostic capabilities, access to treatment, research projects developed in collaboration with the Dr. Heitor Vieira Dourado Tropical Medicine Foundation .;Fundacao de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD).; and financing institutions, such as the project for the expansion of the Clinical Research Center and the creation of a hospital ward for individuals with transmissible respiratory diseases, including TB.

Os treinamentos militares na selva amazônica constituem importantes fatores na incidência de leishmaniose tegumentar americana na região. Este trabalho descreve 48 casos de leishmaniose tegumentar americana em pacientes militares nos quais a doença se manifestou após operação de treinamento na Amazônia. O período de incubação médio foi de 27,6 dias. Houve predomínio de lesões nos membros superiores, face e pescoço. A maioria dos indivíduos apresentou duas lesões, sendo as úlceras as manifestações mais freqüentes. O diagnóstico foi realizado pelo exame de escarificação das lesões, sendo confirmado pela demonstração do parasito em 43 (89,6%) casos.

The occurrence of tuberculosis with first-line multidrug resistance leads to the use of alternative medications, often at higher costs, longer treatment periods, and greater clinical complexity. Here, we report 3 patients with multidrug-resistant tuberculosis. One patient with human immunodeficiency virus died before the sensitivity test was performed. The early diagnosis of multidrug-resistant tuberculosis and appropriate treatment should be priorities of the National Tuberculosis Control Program in order to break the chain of transmission. In addition, the possibility of substituting the proportion method with more modern and faster techniques should be urgently evaluated.

Objective: This study evaluated the performance of the Tuberculin Skin Test (TST) and Quantiferon-TB Gold in-Tube (QFT) and the possible association of factors which may modify their results in young children (0–6 years) with recent contact with an index tuberculosis case. Materials and Methods: A cross-sectional study including 135 children was conducted in Manaus, Amazonas-Brazil. The TST and QFT were performed and the tests results were analyzed in relation to the personal characteristics of the children studied and their relationship with the index case. Results: The rates of positivity were 34.8% (TST) and 26.7% (QFT), with 14.1% of indeterminations by the QFT. Concordance between tests was fair (Kappa = 0.35 P,0.001). Both the TST and QFT were associated with the intensity of exposure (Linear OR = 1.286, P = 0.005; Linear OR = 1.161, P = 0.035 respectively) with only the TST being associated with the time of exposure (Linear OR = 1.149, P = 0.009). The presence of intestinal helminths in the TST+ group was associated with negative QFT results (OR = 0.064, P = 0.049). In the TST2 group lower levels of ferritin were associated with QFT+ results (Linear OR = 0.956, P = 0.036). Conclusions: Concordance between the TST and QFT was lower than expected. The factors associated with the discordant results were intestinal helminths, ferritin levels and exposure time to the index tuberculosis case. In TST+ group, helminths were associated with negative QFT results suggesting impaired cell-mediated immunity. The TST2&QFT+ group had a shorter exposure time and lower ferritin levels, suggesting that QFT is faster and ferritin may be a potential biomarker of early stages of tuberculosis infection.

BACKGROUND In young children, underdiagnosis and diagnostic delay have an adverse effect on morbidity and mortality of tuberculosis (TB). This study evaluated new strategies for early TB diagnosis using an outpatient protocol in children between 0 and 5 years of age, with a recent household TB contact. METHODS Case recruitment was performed in Manaus, Amazonas, Brazil, from 2008 to 2009. Epidemiologic and clinical data, tuberculin test, chest radiograph and 2 induced sputum respiratory samples from each participant were obtained. Laboratory diagnosis was based on Lowenstein-Jensen (LJ) culture, mycobacteria growth indicator tube (MGIT) and polymerase chain reaction. We conducted a study of comparison of diagnostic tests and a study of cases and controls to identify the clinical characteristics of the population with positive culture and polymerase chain reaction results. RESULTS A total of 102 children were evaluated. Thirty-two fulfilled criteria of suspicion of TB. MGIT was more sensitive (P = 0.035) and faster (P < 0.001) than LJ. Clinical score, MGIT, LJ and polymerase chain reaction presented no concordance or slight concordance. A positive MGIT culture was only associated with a strong tuberculin test reaction (P = 0.026). The combination of MGIT with the clinical score allowed the diagnosis of 33% more cases with little or no symptomatology compared with the exclusive use of the clinical classification. CONCLUSIONS The sensitivity and speed of MGIT demonstrate the utility of liquid cultures for the diagnosis in children. Furthermore, these results suggest that the use of MGIT in children presenting recent household TB contact and a strong tuberculin test reaction may be a strategy to improve early TB diagnosis.

SETTING: Treatment default is a serious problem in tuberculosis control because it implies persistence of infection source, increased mortality, increased relapse rates and facilitates the development of resistant strains. OBJECTIVE: This study analyzed tuberculosis treatment default determinants in the Amazonas State to contribute in planning appropriate control interventions. DESIGN: Observational study with a retrospective cohort using Brazilian Disease Notification System data from 2005 to 2010. A nested case control study design was used. Patients defaulting from treatment were considered as 'cases' and those completing treatment as 'controls'. In the analysis, 11,312 tuberculosis patients were included, 1,584 cases and 9,728 controls. RESULTS: Treatment default was observed to be associated to previous default (aOR 3.20; p