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Your search keyword '"Mello, Fernanda Carvalho de Queiroz"' showing total 7 results
Start Over Author "Mello, Fernanda Carvalho de Queiroz" Topic tuberculosis, multidrug-resistant
7 results on '"Mello, Fernanda Carvalho de Queiroz"'

1. Bedaquiline, pretomanid, linezolid, and moxifloxacin (BPaLM) for multidrug- or rifampin-resistant tuberculosis: a systematic review.

Author

Silva DR, Fernandes FF, Ferreira JC, Bernando W, Dalcolmo MMP, Johansen FDC, and Mello FCQ

Subjects
Humans, Treatment Outcome, Drug Therapy, Combination, Tuberculosis, Multidrug-Resistant drug therapy, Linezolid therapeutic use, Moxifloxacin therapeutic use, Moxifloxacin administration & dosage, Diarylquinolines therapeutic use, Antitubercular Agents therapeutic use, Antitubercular Agents adverse effects, Antitubercular Agents administration & dosage, Nitroimidazoles therapeutic use, Nitroimidazoles adverse effects, Rifampin therapeutic use
Abstract

Objective: To evaluate the available evidence comparing the use of the bedaquiline, pretomanid, linezolid, and moxifloxacin (BPaLM) regimen for 6 months with that of standard-of-care regimens for patients with multidrug-resistant or rifampin-resistant tuberculosis (MDR/RR-TB)., Methods: This was a systematic review of clinical trials comparing the use of the BPaLM regimen with the standard of care in patients with MDR/RR-TB. The main outcome measure was an unfavorable endpoint (a composite of death, treatment failure, treatment discontinuation, loss to follow-up, and recurrence), and secondary outcome measures included adverse events and serious adverse events. We searched the MEDLINE, EMBASE, Google Scholar, LILACS, and ClinicalTrials.gov databases, from their inception to January 31, 2024, with no limitation as to language or year of publication. The risk of bias was assessed by using the Cochrane risk-of-bias tool, and the quality of evidence was based on the Grading of Recommendations Assessment, Development and Evaluation approach., Results: A total of 3,668 studies were retrieved; only one (a randomized clinical trial) met the inclusion criteria and was included. In patients with MDR/RR-TB, treatment with the BPaLM regimen, when compared with the standard of care, reduced the risk of an unfavorable outcome (composite, number needed to treat [NNT] = 7); early treatment discontinuation (NNT = 8); adverse events and discontinuation (NNT = 12); and serious adverse events (NNT = 5)., Conclusions: This systematic review of the use of BPaLM in patients with MDR/RR-TB, although it included only one study, showed that BPaLM is more effective than is the standard of care and has a better safety profile. That has major implications for guidelines on the treatment of MDR/RR-TB.

Published
2025
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2. Analysis of catastrophic costs incurred by patients with multidrug-resistant tuberculosis in an outpatient clinic in the state of Rio de Janeiro.

Author

Medeiros RL, Moreira ADSR, Neves ACOJ, Leite VJ, Almeida IN, Mello FCQ, and Kritski A

Subjects
Humans, Brazil epidemiology, Prospective Studies, Poverty, Ambulatory Care Facilities, Tuberculosis, Multidrug-Resistant diagnosis, Tuberculosis, Multidrug-Resistant drug therapy
Abstract

Background: Multidrug-resistant tuberculosis (MDR-TB) is a serious global public health concern associated with social vulnerability. In Brazil, the Unified Health System (SUS, Portuguese) provides free diagnosis and treatment for MDR-TB; however, other expenses may still be incurred for patients and their families which, according to the World Health Organization (WHO), can be catastrophic when these costs surpass 20.0% of the annual household income. This study aimed to assess the extent of catastrophic costs related to the diagnostic and therapeutic aspects of MDR-TB among patients receiving care at an outpatient clinic in Rio de Janeiro., Methods: This prospective study used convenience sampling from July 2019 to June 2021. Data regarding direct and indirect costs were collected using a standardized questionnaire endorsed by the WHO. To analyze any impoverishment occurred from MDR-TB, a threshold established by the Brazilian Institute of Geography and Statistics for 2019 and 2020 of US$ 79,562 and US$ 94,5273, respectively, was applied. Descriptive statistics were used for data analysis, including mean; standard deviation; variation coefficient; median; and maximum, minimum, and interquartile ranges., Results: A total of 65 patients were interviewed. Among the participants, 73.8% experienced catastrophic costs, with indirect costs exerting the most significant impact (median: US$ 3,825.9), in contrast to direct costs (median: US$ 542.7). When comparing the periods before and after diagnosis, the prevalence of poverty increased from 12.0% to 28.0%., Conclusions: Despite the support from the SUS in Brazil, diagnostic and therapeutic cascades incur additional costs, exacerbating social vulnerability among patients with MDR-TB.

Published
2023
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3. Shortened tuberculosis treatment regimens: what is new?

Author

Silva DR, Mello FCQ, and Migliori GB

Subjects
Clinical Protocols, Clinical Trials as Topic, Clofazimine therapeutic use, Humans, Linezolid therapeutic use, Rifampin therapeutic use, Antitubercular Agents therapeutic use, Tuberculosis drug therapy, Tuberculosis, Multidrug-Resistant drug therapy
Abstract

Given the global burden of tuberculosis, shortened treatment regimens with existing or repurposed drugs are needed to contribute to tuberculosis control. The long duration of treatment of drug-susceptible tuberculosis (DS-TB) is associated with nonadherence and loss to follow up, and the treatment success rate of multidrug-resistant tuberculosis (MDR-TB) is low (approximately 50%) with longer regimens. In this review article, we report recent advances and ongoing clinical trials aimed at shortening regimens for DS-TB and MDR-TB. We discuss the role of high-dose rifampin, as well as that of clofazimine and linezolid in regimens for DS-TB. There are at least 5 ongoing clinical trials and 17 observational studies and clinical trials evaluating shorter regimens for DS-TB and MDR-TB, respectively. We also report the results of observational studies and clinical trials evaluating a standardized nine-month moxifloxacin-based regimen for MDR-TB. Further studies, especially randomized clinical trials, are needed to evaluate regimens including newer drugs, drugs proven to be or highly likely to be efficacious, and all-oral drugs in an effort to eliminate the need for injectable drugs.

Published
2020
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4. Prevalence of primary drug resistance in pulmonary tuberculosis patients with no known risk factors for such.

Author

Bastos GM, Cezar MC, Mello FC, and Conde MB

Subjects
Adult, Brazil epidemiology, Cross-Sectional Studies, Female, Humans, Male, Medical Records, Microbial Sensitivity Tests, Middle Aged, Prevalence, Risk Factors, Tuberculosis, Multidrug-Resistant epidemiology, Young Adult, Antitubercular Agents therapeutic use, Drug Resistance, Multiple, Bacterial, Mycobacterium tuberculosis drug effects, Tuberculosis, Multidrug-Resistant drug therapy
Abstract

Objective: To estimate the prevalence of primary resistance to the drugs in the basic treatment regimen for tuberculosis in treatment-naïve patients with pulmonary tuberculosis and no known risk factors for such resistance, as well as to identify factors potentially associated with drug resistance., Methods: This was an exploratory cross-sectional study. We analyzed the medical records of the subjects enrolled in two clinical trials of treatments for drug-susceptible tuberculosis between November 1, 2004 and March 31, 2011 at the Prof. Newton Bethlem Outpatient Clinic of the Federal University of Rio de Janeiro Thoracic Diseases Institute, located in the city of Rio de Janeiro, Brazil. The inclusion criteria were being > 18 years of age, testing positive for AFB in the first sputum sample, having a positive culture for Mycobacterium tuberculosis, having undergone drug susceptibility testing, and being treatment-naïve. Patients with a history of imprisonment or hospitalization were excluded, as were those who had been in contact with drug-resistant tuberculosis patients., Results: We included 209 patients. The overall prevalence of primary drug resistance was 16.3%. The overall prevalence of resistance to isoniazid and streptomycin was, respectively, 9.6% and 9.1%, compared with 5.8% and 6.8% for single-drug resistance to isoniazid and streptomycin, respectively. The prevalence of resistance to two or more drugs was 3.8%, and the prevalence of multidrug resistance was 0.5%. No statistically significant associations were found between the variables studied and drug susceptibility testing results., Conclusions: In this sample, the prevalence of primary drug resistance was high despite the absence of known risk factors.

Published
2012
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5. Esquemas mais curtos de tratamento da tuberculose : o que há de novo?

Author

Silva, Denise Rossato, Mello, Fernanda Carvalho de Queiroz, and Migliori, Giovanni Battista

Subjects
medicine.medical_specialty, Tuberculosis, Antitubercular Agents, Review Article, Clofazimine, law.invention, Tuberculose/tratamento farmacológico, Tuberculose resistente a múltiplos medicamentos, Diseases of the respiratory system, Clinical Protocols, Randomized controlled trial, Moxifloxacin, law, Tuberculosis, Multidrug-Resistant, Humans, Medicine, Tuberculose, Intensive care medicine, Tuberculosis/drug therapy, Clinical Trials as Topic, Drug resistance, bacterial, Tuberculose resistente a múltiplos medicamentos/tratamento farmacológico, RC705-779, business.industry, Linezolid, medicine.disease, Review article, Clinical trial, Regimen, Farmacorresistência bacteriana, Observational study, Rifampin, business, medicine.drug, Tratamento farmacológico, Tuberculosis, multidrug-resistant/drug therapy
Abstract

Given the global burden of tuberculosis, shortened treatment regimens with existing or repurposed drugs are needed to contribute to tuberculosis control. The long duration of treatment of drug-susceptible tuberculosis (DS-TB) is associated with nonadherence and loss to follow up, and the treatment success rate of multidrug-resistant tuberculosis (MDR-TB) is low (approximately 50%) with longer regimens. In this review article, we report recent advances and ongoing clinical trials aimed at shortening regimens for DS-TB and MDR-TB. We discuss the role of high-dose rifampin, as well as that of clofazimine and linezolid in regimens for DS-TB. There are at least 5 ongoing clinical trials and 17 observational studies and clinical trials evaluating shorter regimens for DS-TB and MDR-TB, respectively. We also report the results of observational studies and clinical trials evaluating a standardized nine-month moxifloxacin-based regimen for MDR-TB. Further studies, especially randomized clinical trials, are needed to evaluate regimens including newer drugs, drugs proven to be or highly likely to be efficacious, and all-oral drugs in an effort to eliminate the need for injectable drugs. RESUMO Em virtude da carga global da tuberculose, esquemas mais curtos de tratamento com medicamentos já existentes ou reaproveitados são necessários para contribuir para o controle da doença. A longa duração do tratamento da tuberculose sensível (TBS) está relacionada com não adesão e perda de seguimento, e a taxa de sucesso do tratamento da tuberculose multirresistente (TBMR) é baixa (de aproximadamente 50%) com esquemas mais longos. Neste artigo de revisão, relatamos avanços recentes e ensaios clínicos em andamento cujo objetivo é encurtar os esquemas de tratamento de TBS e TBMR. Discutimos o papel da rifampicina em altas doses, assim como o da clofazimina e linezolida em esquemas de tratamento de TBS. Relatamos também os resultados de estudos observacionais e ensaios clínicos de avaliação de um esquema padronizado de nove meses à base de moxifloxacina para o tratamento de TBMR. Mais estudos, especialmente ensaios clínicos randomizados, são necessários para avaliar esquemas que incluam medicamentos mais novos, medicamentos comprovadamente ou provavelmente eficazes e medicamentos exclusivamente orais na tentativa de dispensar o uso de medicamentos injetáveis.

Published
2020

6. Prevalência de resistência primária em pacientes com tuberculose pulmonar sem fatores de risco conhecidos para resistência primária

Author

Bastos, Giselle Mota, Cezar, Michelle Cailleaux, Mello, Fernanda Carvalho de Queiroz, and Conde, Marcus Barreto

Subjects
Fatores de Risco, Tuberculose pulmonar, Tuberculose resistente a múltiplos medicamentos, Tuberculosis, pulmonary, Risk factors, Tuberculosis, multidrug-resistant
Abstract

OBJETIVO: Estimar a prevalência de resistência primária aos medicamentos do esquema básico de tratamento antituberculose em pacientes com tuberculose pulmonar virgens de tratamento sem fatores de risco conhecidos para resistência primária, e identificar os possíveis fatores associados à resistência medicamentosa. MÉTODOS: Estudo transversal exploratório com a análise de prontuários de pacientes que participaram de dois ensaios clínicos de tuberculose sensível entre 1&º de novembro de 2004 e 31 de março de 2011 no Ambulatório Prof. Newton Bethlem do Instituto de Doenças do Tórax da Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ). Os critérios de inclusão foram ter idade > 18 anos, ter pesquisa direta de BAAR positiva na primeira amostra de escarro, ter cultura positiva para Mycobacterium tuberculosis, ter realizado testes de sensibilidade aos fármacos, ser virgem de tratamento para tuberculose e não ter história de prisão, hospitalização ou contato com caso de tuberculose resistente. RESULTADOS: Foram incluídos 209 pacientes. A prevalência de resistência primária geral foi de 16,3%. A prevalência geral de resistência à isoniazida e à estreptomicina foi, respectivamente, 9,6% e 9,1%, enquanto a prevalência de monorresistência à isoniazida e à estreptomicina foi de, respectivamente, 5,8% e 6,8%. A prevalência de resistência a dois ou mais fármacos foi de 3,8%, e a prevalência de tuberculose multirresistente foi de 0,5%. Não foram observadas associações estatisticamente significativas entre as variáveis estudadas e resultados do teste de sensibilidade aos fármacos. CONCLUSÕES: Na amostra estudada, a prevalência de resistência primária foi elevada apesar da ausência de fatores de risco conhecidos. OBJECTIVE: To estimate the prevalence of primary resistance to the drugs in the basic treatment regimen for tuberculosis in treatment-naïve patients with pulmonary tuberculosis and no known risk factors for such resistance, as well as to identify factors potentially associated with drug resistance. METHODS: This was an exploratory cross-sectional study. We analyzed the medical records of the subjects enrolled in two clinical trials of treatments for drug-susceptible tuberculosis between November 1, 2004 and March 31, 2011 at the Prof. Newton Bethlem Outpatient Clinic of the Federal University of Rio de Janeiro Thoracic Diseases Institute, located in the city of Rio de Janeiro, Brazil. The inclusion criteria were being > 18 years of age, testing positive for AFB in the first sputum sample, having a positive culture for Mycobacterium tuberculosis, having undergone drug susceptibility testing, and being treatment-naïve. Patients with a history of imprisonment or hospitalization were excluded, as were those who had been in contact with drug-resistant tuberculosis patients. RESULTS: We included 209 patients. The overall prevalence of primary drug resistance was 16.3%. The overall prevalence of resistance to isoniazid and streptomycin was, respectively, 9.6% and 9.1%, compared with 5.8% and 6.8% for single-drug resistance to isoniazid and streptomycin, respectively. The prevalence of resistance to two or more drugs was 3.8%, and the prevalence of multidrug resistance was 0.5%. No statistically significant associations were found between the variables studied and drug susceptibility testing results. CONCLUSIONS: In this sample, the prevalence of primary drug resistance was high despite the absence of known risk factors.

Published
2012

7. III Brazilian Thoracic Association Guidelines on tuberculosis

Author

Conde, Marcus Barreto, Melo, Fernando Augusto Fiuza de, Marques, Ana Maria Campos, Cardoso, Ninarosa Calzavara, Pinheiro, Valeria Goes Ferreira, Dalcin, Paulo de Tarso Roth, Machado Junior, Almério, Lemos, Antonio Carlos Moreira, Netto, Antônio Ruffino, Durovni, Betina, Sant'Anna, Clemax Couto, Lima, Dinalva, Capone, Domenico, Barreira, Draurio, Matos, Eliana Dias, Mello, Fernanda Carvalho de Queiroz, David, Fernando Cezar, Marsico, Giovanni, Afiune, Jorge Barros, Silva, José Roberto Lapa e, Jamal, Leda Fátima, Telles, Maria Alice da Silva, Hirata, Mário Hiroyuki, Dalcolmo, Margareth Pretti, Rabahi, Marcelo Fouad, Cailleaux-Cesar, Michelle, Palaci, Moises, Morrone, Nelson, Guerra, Renata Leborato, Dietze, Reynaldo, Miranda, Silvana Spíndola de, Cavalcante, Solange Cesar, Nogueira, Susie Andries, Nonato, Tatiana Senna Galvão, Martire, Terezinha, Galesi, Vera Maria Nader, and Dettoni, Valdério do Valle

Subjects
Adult, Tuberculose resistente a múltiplos medicamentos, Evidence-Based Medicine, Infecções por Mycobacterium, Diagnóstico, Diagnosis, Mycobacterium infections, Tuberculose, Humans, Tuberculosis, Tuberculosis, multidrug-resistant, Child, Brazil
Abstract

Diariamente novos artigos científicos sobre tuberculose (TB) são publicados em todo mundo. No entanto, é difícil para o profissional sobrecarregado na rotina de trabalho acompanhar a literatura e discernir o que pode e deve ser aplicado na prática diária juntos aos pacientes com TB. A proposta das "III Diretrizes para TB da Sociedade Brasileira de Pneumologia e Tisiologia (SBPT)" é revisar de forma crítica o que existe de mais recente na literatura científica nacional e internacional sobre TB e apresentar aos profissionais da área de saúde as ferramentas mais atuais e úteis para o enfrentamento da TB no nosso país. As atuais "III Diretrizes para TB da SBPT" foram desenvolvidas pela Comissão de TB da SBPT e pelo Grupo de Trabalho para TB a partir do texto das "II Diretrizes para TB da SBPT" (2004). As bases de dados consultadas foram LILACS (SciELO) e PubMed (Medline). Os artigos citados foram avaliados para determinação do nível de evidência científica, e 24 recomendações sobre TB foram avaliadas, discutidas por todo grupo e colocadas em destaque. A primeira versão das "III Diretrizes para TB da SBPT" foi colocada no website da SBPT para consulta pública durante três semanas, e as sugestões, críticas e o nível de evidência da referência científica que as embasavam foram avaliados e discutidos antes de serem incorporadas ou não ao texto final. New scientific articles about tuberculosis (TB) are published daily worldwide. However, it is difficult for health care workers, overloaded with work, to stay abreast of the latest research findings and to discern which information can and should be used in their daily practice on assisting TB patients. The purpose of the III Brazilian Thoracic Association (BTA) Guidelines on TB is to critically review the most recent national and international scientific information on TB, presenting an updated text with the most current and useful tools against TB to health care workers in our country. The III BTA Guidelines on TB have been developed by the BTA Committee on TB and the TB Work Group, based on the text of the II BTA Guidelines on TB (2004). We reviewed the following databases: LILACS (SciELO) and PubMed (Medline). The level of evidence of the cited articles was determined, and 24 recommendations on TB have been evaluated, discussed by all of the members of the BTA Committee on TB and of the TB Work Group, and highlighted. The first version of the present Guidelines was posted on the BTA website and was available for public consultation for three weeks. Comments and critiques were evaluated. The level of scientific evidence of each reference was evaluated before its acceptance for use in the final text.

Published
2009

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