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Resumo O artigo aborda as nuances mais básicas e as questões capitais envolvidas na alta mortalidade de médicos, enfermeiros, técnicos e auxiliares de enfermagem em decorrência da COVID-19 no Brasil. Trata-se de estudo realizado com base em dados dos conselhos federais de Medicina e Enfermagem (CFM e Cofen, respectivamente) e do estudo sobre o inventário de óbitos da Fundação Oswaldo Cruz (Fiocruz), e visa conhecer e analisar essa realidade à luz da sociologia das profissões. O trabalho presta contribuição relevante e inédita para a compreensão do passado, do presente e do futuro de seguimentos da classe trabalhadora que atuam na beira do leito, na linha de frente, prestando assistência direta a pacientes.

Background Adherence to tuberculosis preventive treatment (TPT) is an important determinant of clinical benefit. We assessed the association of participant behaviors early in TPT with subsequent discontinuation. Methods We used data from a phase 3 randomized trial and the preceding phase 2 trial to compare 4 months of rifampin to 9 months of isoniazid for TPT. We excluded participants whose providers discontinued TPT due to adverse events or tuberculosis disease. We analyzed 4 outcomes: discontinuing TPT within the first month of treatment, discontinuing TPT between the first and second month, discontinuing TPT after the second month, and completing treatment but not per protocol. We analyzed the association of outcomes with regimen and participant characteristics and 4 behavioral predictors of discontinuation recorded at the month 1 and month 2 follow-up visits: reporting symptoms of intolerance, missing >20% of doses, rescheduling appointments, and not bringing their medication bottle. Results Overall, 6656 participants were included (phase 3, 5848; phase 2, 808), of whom 4318 (64.9%) completed treatment per protocol. Participant characteristics were inconsistently associated with discontinuation. Phase 3 trial participants with 1, 2, or 3–4 behavioral predictors at the month 1 follow-up had 5.0 (95% confidence interval, 3.6–6.7), 18.6 (13.3–26.1), and 79.4 (38.2–165.0), respectively, higher odds of discontinuing before the second month. The corresponding number of predictors at the month 2 follow-up had 1.8 (1.4–2.2), 4.7 (3.6–6.2), and 7.4 (4.6–11.9) higher odds of discontinuing before completing treatment; phase 2 findings were similar. Conclusions Four behavioral predictors recorded early in therapy were more strongly associated with subsequent discontinuation than participant characteristics, particularly when more than 1 behavioral predictor was recorded. Clinical trials registration. NCT00170209; NCT00931736.

Introduction Tuberculosis contacts are candidates for active and latent tuberculosis infection screening and eventual treatment. However, many losses occur in the different steps of the contacts’ cascade of care. Reasons for this are poorly understood. Objective To describe the different steps where losses in the contact cascade occur and to explore knowledge and attitudes regarding tuberculosis transmission/prevention and perceptions about tuberculosis services in order to understand the reasons for losses from the tuberculosis service users’ perspective. Design We collected routine data from the index case and contact registry books and from patients’ records to build the cascade of care of contacts in 12 health facilities in three Brazilian cities with high tuberculosis incidence rates. During a knowledge, attitudes and practices (KAP) survey, trained interviewers administered a semi-structured questionnaire to 138 index cases and 98 contacts. Results Most of the losses in the cascade occurred in the first two steps (contact identification, 43% and tuberculin skin testing placement, 91% of the identified contacts). Among KAP-interviewed contacts, 67% knew how tuberculosis is transmitted, 87% knew its key symptoms and 81% declared they would take preventive therapy if prescribed. Among KAP-interviewed index cases, 67% knew they could spread tuberculosis, 70% feared for the health of their families and 88% would like their family to be evaluated in the same services. Conclusion Only a small proportion of contacts are evaluated for active and latent tuberculosis, despite their—and their index cases’—reasonable knowledge, positive attitudes towards prevention and satisfaction with tuberculosis services. In these services, education of service users would not be a sufficient solution. Healthcare workers’ and managers’ perspective, not explored in this study, may bring more light to this subject.

Setting Randomised trial comparing 9 months of isoniazid with 4 months of rifampicin for the treatment of high-risk tuberculin skin test positive subjects in Rio de Janeiro, Brazil. Objectives To compare QuantiFERON®-TB Gold In-Tube (QFT-GIT) responses before and 1, 4 and 9 months after starting treatment for latent tuberculous infection (LTBI) according to adherence to one of the two regimens. Design Participants in the trial were invited to undergo serial QFT-GIT. Within-subject differences at different time points were analysed as quantitative responses and categorised as positive or negative using different cut-off points. Results Of 215 participants, 118 completed treatment, of whom 58 underwent all three tests; and 97 did not complete treatment, of whom 10 underwent all tests. After 1 month of treatment, there was no significant difference in QFT-GIT response between the groups. After 4 and 9 months, reversions were more frequent in non-adherent subjects. Marked within-subject fluctuations were observed. No cut-off point could be established at which QFT-GIT responses were consistently positive or associated with adherence or type of treatment. Conclusion Frequent within-subject variability in QFT-GIT responses, not associated with LTBI treatment, makes it difficult for clinicians to interpret QFT-GIT conversions and reversions.

A prospective study was conducted to evaluate tuberculosis treatment outcomes according to socio-economic status (SES) using different classification criteria. Patients aged ≥18 years under treatment for ≤8 weeks were interviewed. Outcomes were classified as successful (cure/ completed) or unsuccessful (default/failure/death). The overall treatment default ratio was 20.9% and the unsuccessful outcome rate was 24.1%. Unsuccessful treatment was associated with SES according to any criteria used, except for the definition of poverty line. Poverty seems to be hampering the achievement of the World Health Organization targeted 90% cure rate in developing settings.

O objetivo deste estudo foi comparar diferenças entre os gêneros nos pacientes com tuberculose em uma cidade com alta incidência da doença. Este foi um estudo transversal com base em questionário envolvendo 560 pacientes com tuberculose (373 homens e 187 mulheres). Características sociodemográficas e clínicas, assim como critérios diagnósticos e desfecho do tratamento, foram coletados dos questionários e fichas médicas e posteriormente comparados entre os gêneros. A mediana do tempo do surgimento de sintomas até o diagnóstico foi de 90 dias. Não foram encontradas diferenças entre os gêneros relativas à apresentação clínica, critério diagnóstico, abandono prévio de tratamento, tempo do surgimento de sintomas, número de consultas antes do diagnóstico ou desfecho do tratamento. A abordagem diferenciada para os gêneros não é uma prioridade no Brasil. A demora no diagnóstico, no entanto, é um problema maior a despeito do gênero. The objective of this study was to compare gender differences among tuberculosis patients in a city with a high incidence of tuberculosis. This was a cross-sectional questionnaire-based study involving 560 tuberculosis patients (373 males and 187 females). Sociodemographic and clinical data, as well as data related to diagnostic criteria and treatment outcome, were collected (from the questionnaires and medical records) and subsequently compared between the genders. The median time from symptom onset to diagnosis was 90 days. There were no differences between the genders regarding the clinical presentation, diagnostic criteria, previous noncompliance with treatment, time from symptom onset, number of medical appointments prior to diagnosis, or treatment outcome. Gender-specific approaches are not a priority in Brazil. However, regardless of patient gender, the delay in diagnosis is a major concern.

OBJECTIVES: To describe knowledge, practices, and associated factors of medical students to prevent transmission of tuberculosis (TB) in five medical schools. METHODS: Cross-sectional survey of undergraduate medical students in preclinical and in early and late clinical years. Information was obtained on sociodemographic profile, previous lectures on TB, knowledge about TB transmission, exposure to patients with active pulmonary TB, and use of respiratory protective masks. RESULTS: Among 1 094 respondents, 575 (52.6%) correctly answered that coughing, speaking, and sneezing can transmit TB. Early [adjusted odds ratio = 4.0 (3.0, 5.5)] and late [adjusted odds ratio = 4.2 (3.1, 5.8)] clinical years were associated with correct answers, but having had previous lectures on TB was not. Among those who had previous lectures on TB, the rate of correct answers increased from 42.1% to 61.6%. Among 332 medical students who reported exposure to TB patients, 194 (58.4%) had not used protective masks. More years of clinical experience was associated with the use of masks [adjusted odds ratio = 2.9 (1.4, 6.1)], while knowledge was inversely associated with the use of masks [adjusted odds ratio = 0.4 (0.2, 0.6)]. CONCLUSIONS: Many medical students are not aware of the main routes of TB infection, and lectures on TB are not sufficient to change knowledge and practices. Regardless of knowledge about TB transmission, students engage in risky behaviors: more than two-thirds do not use a protective mask when examining an active TB case. We suggest innovative, effective active learning experiences to change this scenario.OBJETIVOS: Describir los conocimientos y las prácticas de los estudiantes de medicina para prevenir la transmisión de la tuberculosis (TB) en cinco escuelas de medicina y sus factores asociados. MÉTODOS: Estudio transversal mediante encuesta a estudiantes de medicina de cursos preclínicos, clínicos iniciales y clínicos avanzados. Se obtuvo información del perfil sociodemográfico, las conferencias recibidas sobre TB, el conocimiento sobre la transmisión de la TB, la exposición a pacientes con TB pulmonar activa y el uso de máscaras respiratorias de protección. RESULTADOS: De los 1 094 encuestados, 575 (52,6%) respondieron correctamente que toser, hablar y estornudar pueden transmitir la TB. Estar en los cursos clínicos iniciales (razón de posibilidades ajustada [ORa] = 4,0; intervalo de confianza de 95% [IC95%]: 3,0 a 5,5) y avanzados (ORa = 4,2; IC95%: 3,1 a 5,8) se asociaron con las respuestas correctas, no así haber recibido conferencias sobre TB. La tasa de respuestas correctas aumentó de 42,1% a 61,6% en los estudiantes que habían recibido conferencias sobre TB. De los 332 estudiantes de medicina que informaron haber estado expuestos a pacientes con TB, 194 (58,4%) no usaron máscaras protectoras. El mayor número de años de experiencia clínica se asoció con el uso de máscaras (ORa = 2,9; IC95%: 1,4 a 6,1), mientras que el conocimiento sobre el tema se asoció inversamente con el uso de máscaras (ORa = 0,4; IC95%: 0,2 a 0,6). CONCLUSIONES: Muchos estudiantes de medicina no conocen las vías principales de infección de la TB y las conferencias sobre TB no son suficientes para modificar sus conocimientos y actitudes. Independientemente del conocimiento sobre la transmisión de la TB, los estudiantes incurrieron en conductas de riesgo: más de dos terceras partes no usó máscaras protectoras al examinar casos activos de TB. Se recomienda establecer prácticas docentes innovadoras, efectivas y activas para cambiar este escenario.

INTRODUÇÃO: A solução de tuberculina é armazenada em frascos de diferentes tamanhos. Sua adsorção ao frasco pode influenciar o resultado da prova tuberculínica. OBJETIVO: Avaliar o efeito do tamanho do frasco de armazenamento da tuberculina nos resultados obtidos na prova tuberculínica. MÉTODO: Sessenta e três pacientes internados com diagnóstico de tuberculose ativa foram submetidos a duas provas tuberculínicas simultâneas, em ambos os antebraços. A técnica usada foi a de Mantoux e consistiu na aplicação de 0,1 ml de tuberculina armazenada em frascos de 5 ml ou de 1,5 ml, no antebraço direito e no antebraço esquerdo, de forma aleatória. A leitura da induração foi efetuada de forma cega por um único leitor treinado previamente. As leituras com diferenças de até 2 mm foram consideradas resultados concordantes. RESULTADOS: Vinte e um pacientes não tiveram induração e foram excluídos da análise. Entre os 42 pacientes restantes, a média dos diâmetros das indurações obtidas nas provas com tuberculina armazenada nos frascos grandes foi maior do que as obtidas com a armazenada em frascos pequenos. A concordância entre as leituras foi obtida em 40,5% delas (17/42), e a diferença foi negativa (frasco grande menor que frasco pequeno) em 16,7% (7/42) e positiva em 42,9% delas (18/42). CONCLUSÃO: O tamanho do frasco de armazenamento da tuberculina pode influenciar o resultado da prova tuberculínica. A adsorção da tuberculina à parede do frasco pode explicar o fenômeno. Os autores alertam para o impacto dessas variações nos estudos epidemiológicos e operacionais. BACKGROUND: Tuberculin purified protein derivative is stored in vials of various sizes. Its adsorption to the vial can influence the results of tuberculin tests. OBJECTIVE: To evaluate the effect of vial size on the results obtained in tuberculin tests. METHODS: Sixty-four inpatients with active tuberculosis were submitted to two simultaneous tuberculin tests using the Mantoux technique. Patients were randomly allocated to receive two 0.1-ml injections, either one in the right forearm from a 1.5-ml vial and one in the left forearm from a 5-ml vial or vice versa. Induration was determined in a blinded fashion by a single, previously trained observer. Right arm-left arm differences of 2 mm or less were considered concordant results. RESULTS: Twenty-one patients presented no induration and were excluded from analysis. Among the 42 remaining patients, mean induration diameters obtained in tuberculin tests using the larger vials were greater than those obtained in tests using the smaller vials. Concordance was achieved in 40.5% (17/42). The difference was negative (large-vial indurations smaller than small-vial indurations) in 16.7% (7/42) and positive in 42.9% (18/42). CONCLUSIONS: The size of the vial may influence tuberculin test results. Adsorption to the sides of the vial may explain this phenomenon. The authors caution others to be aware of the impact of these variations in epidemiological and operational studies.

The incidence of AIDS and other sexually transmitted diseases (STDs) is increasing among adolescents. In order to better understand high-risk sexual behavior among students, a cross-sectional study based on a self-answered anonymous questionnaire was conducted in 10 public and private high schools in Rio de Janeiro, Brazil. Data were obtained on sociodemographics, knowledge of STD/AIDS, and sexual behavior. Among 945 students aged 13-21, 59% were sexually initiated, and the median age at first sexual intercourse was 15 years (range: 7-19). Although 94% reported being aware of the need for condom use for protection, only 34% informed always using condoms during sex. Low family income was associated with unsatisfactory knowledge (OR = 9.40; 95% CI = 6.05-14.60) and inconsistent condom use (OR = 11.60; 95% CI = 5.54-24.30). However, unsatisfactory knowledge was not associated with inconsistent condom use. School-based educational programs should focus on sexual behavior more than on transmission of knowledge, as well as targeting low-income students. A incidência da AIDS e outras doenças sexualmente transmissíveis (DST) vem aumentando entre adolescentes. Com o objetivo de melhor conhecer o comportamento sexual de risco entre estudantes do ensino médio, foi realizado um estudo transversal baseado em um questionário anônimo e auto-aplicado em dez escolas do Rio de Janeiro. Obtivemos dados sócio-demográficos e informações sobre o conhecimento de DST/AIDS e sobre o comportamento sexual. Entre os 945 estudantes de 13 a 21 anos, 59% já haviam iniciado a sua vida sexual. A mediana de idade da primeira relação sexual foi de 15 anos (amplitude 7-19). Embora 94% conhecessem a proteção conferida pelo uso do preservativo, somente 34% declararam usá-lo sempre. Houve associação entre baixa renda familiar e conhecimento insatisfatório (OR = 9,40; IC95% = 6,05-14,60) e do uso inconstante de preservativos (OR = 11,60; IC95% = 5,54-24,30). Não houve entretanto associação entre conhecimento insatisfatório e uso inconstante de preservativo. Programas educacionais devem focalizar o comportamento mais do que a transmissão da informação e priorizar jovens de baixa renda familiar.

Objetivo: Avaliar o valor da punção-biópsia pleural no diagnóstico das doenças inflamatórias da pleura. Métodos: Foi feito um estudo retrospectivo de 82 toracocenteses realizadas durante um período de 42 meses em uma enfermaria de clínica médica no Rio de Janeiro. Os aspectos bioquímicos, citológicos e bacteriológicos do líquido pleural e o exame histopatológico do fragmento pleural foram correlacionados com o diagnóstico final. A sensibilidade, especificidade e os valores preditivos da concentração protéica e da percentagem de linfócitos no líquido pleural foram calculados utilizando diferentes valores de corte. Resultados: Dos 82 pacientes, 73 (89%) tinham tuberculose. Todos os pacientes com menos de 35 anos tinham tuberculose. O valor preditivo negativo para o diagnóstico de tuberculose aumentou de 17,1% para 66,7% utilizando 4,5g/dL e 2,5g/dL, respectivamente, como valores de corte para a concentração de proteínas no líquido pleural. O valor preditivo negativo do achado de 70% de linfócitos no líquido pleural foi de 100% e o seu valor preditivo positivo, de 94,2%. A pesquisa de BAAR no líquido pleural foi negativa nas 82 amostras. A sensibilidade do exame histopatológico da pleura foi de 69,2% para o diagnóstico de tuberculose. Conclusões: A tuberculose foi a causa mais comum de derrame pleural em todas as faixas etárias. O exame que mais contribuiu para confirmar este diagnóstico foi a análise histopatológica. Os autores sugerem que a punção pleural e a biópsia sejam realizadas simultaneamente nas populações em que a tuberculose tenha alta prevalência.Objective: To evaluate the efficacy of thoracentesis and pleural biopsy in the diagnosis of pleural inflammatory diseases. Methods: A retrospective study of 82 thoracenteses performed over a 42-month period in an internal medicine ward in Rio de Janeiro was conducted. Biochemical, cytological, and microbiological features of the pleural effusion, as well as the histopathological examination of the pleural tissue, were analyzed according to the final diagnosis. The sensitivity, sensibility, and predictive efficacy in the diagnosis of tuberculosis were calculated using different cut-off values of protein concentration and lymphocyte percentage. Results: Of the 82 patients, 73 (89%) had tuberculosis. This was the only diagnosis among patients aged 35 years or less. The negative predictive value (PV) raised from 17.1% to 66.7% when 4.5 and 2.5 g/dl, respectively, were used as cut-off values for protein concentration in the pleural fluid. Using 70% as the cut-off value for lymphocyte percentage in pleural fluid, negative PV was 100% and positive PV was 94.2%. Acid fast bacilli staining of the pleural fluid was negative in all samples. The sensitivity of the histopathological examination of the pleural tissue was 69.2% for the diagnosis of tuberculosis. Conclusions: Tuberculosis was the most common cause of pleural effusion in all age groups. Histopathological examination had the highest sensitivity to confirm tuberculosis. The authors suggest that, in populations with a high prevalence of tuberculosis, pleural tissue biopsy should be performed simultaneously with thoracentesis.

A formacao dos profissionais da saude deve visar a aquisicao de conhecimentos, atitudes e praticas de modo a capacitar o futuro profissional a promover a saude, prevenir doencas e lidar com as condicoes mais prevalentes no seu meio. As Diretrizes Curriculares Nacionais para os cursos da area da saude, publicadas a partir do final de 2001, recomendam como “eixo do desenvolvimento curricular as necessidades de saude mais frequentes” e sugerem que sejam utilizadas metodologias que privilegiem a integracao entre o ensino, a pesquisa, a extensao e a assistencia, desenvolvendo atitudes voltadas para a cidadania.

The objective of this study was to compare gender differences among tuberculosis patients in a city with a high incidence of tuberculosis. This was a cross-sectional questionnaire-based study involving 560 tuberculosis patients (373 males and 187 females). Sociodemographic and clinical data, as well as data related to diagnostic criteria and treatment outcome, were collected (from the questionnaires and medical records) and subsequently compared between the genders. The median time from symptom onset to diagnosis was 90 days. There were no differences between the genders regarding the clinical presentation, diagnostic criteria, previous noncompliance with treatment, time from symptom onset, number of medical appointments prior to diagnosis, or treatment outcome. Gender-specific approaches are not a priority in Brazil. However, regardless of patient gender, the delay in diagnosis is a major concern.

OBJECTIVES: To describe knowledge, practices, and associated factors of medical students to prevent transmission of tuberculosis (TB) in five medical schools. METHODS: Cross-sectional survey of undergraduate medical students in preclinical and in early and late clinical years. Information was obtained on sociodemographic profile, previous lectures on TB, knowledge about TB transmission, exposure to patients with active pulmonary TB, and use of respiratory protective masks. RESULTS: Among 1 094 respondents, 575 (52.6%) correctly answered that coughing, speaking, and sneezing can transmit TB. Early [adjusted odds ratio = 4.0 (3.0, 5.5)] and late [adjusted odds ratio = 4.2 (3.1, 5.8)] clinical years were associated with correct answers, but having had previous lectures on TB was not. Among those who had previous lectures on TB, the rate of correct answers increased from 42.1% to 61.6%. Among 332 medical students who reported exposure to TB patients, 194 (58.4%) had not used protective masks. More years of clinical experience was associated with the use of masks [adjusted odds ratio = 2.9 (1.4, 6.1)], while knowledge was inversely associated with the use of masks [adjusted odds ratio = 0.4 (0.2, 0.6)]. CONCLUSIONS: Many medical students are not aware of the main routes of TB infection, and lectures on TB are not sufficient to change knowledge and practices. Regardless of knowledge about TB transmission, students engage in risky behaviors: more than two-thirds do not use a protective mask when examining an active TB case. We suggest innovative, effective active learning experiences to change this scenario.

Tuberculosis (TB) treatment default is a major constraint of TB control, resulting in continued disease transmission and possibly the emergence of multidrug resistance. Marginalized populations may abandon treatment before being cured. The objective of this study was to evaluate the socioeconomic status (SES) of TB patients and identify potential incentives for improving treatment compliance by SES.A cross-sectional survey was conducted in a public health unit in Duque de Caxias, a county with one of the lowest per capita incomes in Rio de Janeiro state. From November 2003 to March 2004, 305 TB patients answered an anonymous questionnaire on socio-demographic aspects, household items and family income, history of previous treatment default, and on incentives for improving treatment adherence. Incentives were classified as economic, administrative, health service support, and habits, and scored as fundamental (3), important (2), desirable (1), or irrelevant (0).Health service support incentives had the highest scores overall. The aggregate economic incentive score correlated with SES (r = -0.191, p = 0.001). Among the 20% poorest patients, 16.7% had a previous history of default vs. 1.6% among the wealthiest (p = 0.004). Patients with a history of treatment default were significantly more likely to choose health service support incentives than other patients (r = -0.263, p = 0.039).Professional commitment will be needed to effect the necessary changes in health service support. Financial support for food and transportation subsidies may be required to improve treatment compliance among the poorest TB patients, i.e. those most likely to have previously defaulted from treatment.

INTRODUÇÃO:Em 1998, o Rio de Janeiro era o estado de maior incidência e mortalidade por tuberculose do Brasil. O Sistema de Informação de Agravos de Notificação em Tuberculose (SINAN-TB-RJ) não era confiável. OBJETIVO: Utilizar o estudo dos óbitos por tuberculose como instrumento de avaliação do programa de controle de tuberculose. MÉTODO: Foram realizados estudos descritivos do SINAN-TB-RJ e do Sistema de Informação de Mortalidade em tuberculose do Rio de Janeiro (SIM-TB-RJ) e os dois bancos de dados foram cruzados utilizando-se o programa Reclink. Foi também realizado um estudo baseado em prontuários dos cinco hospitais onde ocorreu o maior número de óbitos por tuberculose. RESULTADOS: Em 1998 foram registrados no SINAN-TB-RJ 16.567 casos de tuberculose em maiores de 14 anos. A forma pulmonar estava presente em 13.989 (84,5%) casos, dos quais 8.223 (56,8%) tiveram baciloscopia positiva. A sorologia anti-HIV, recomendada para todos os pacientes com tuberculose, foi solicitada em apenas 4.141 (25%) casos. No SIM-TB-RJ foram registrados 1.146 óbitos, dos quais 478 (41,7%) casos haviam sido notificados no SINAN-TB-RJ, entre 1995 e 1998. Dos 302 prontuários estudados, em 154 (50,9%) o período de internação foi inferior a 10 dias. O tempo entre o início dos sintomas e o diagnóstico foi superior a 60 dias em 143 (47,3%) pacientes. Dos 125 pacientes em re-tratamento, para apenas 43 (34,4%) foi prescrito o esquema RHZE recomendado pelo Ministério da Saúde. CONCLUSÃO: O estudo demonstra que a tuberculose é sub-notificada, o diagnóstico é tardio, a utilização dos exames laboratoriais recomendados é baixa e as normas do Ministério da Saúde não são cumpridas. BACKGROUND: In 1998, tuberculosis incidence and mortality rates in the state of Rio de Janeiro (RJ) were the highest in Brazil. However, the RJ tuberculosis database (SINAN-TB-RJ) has proven unreliable. OBJECTIVE: To evaluate the current tuberculosis control program by analyzing tuberculosis-attributed deaths. METHODS: Descriptive studies of the SINAN-TB-RJ and tuberculosis mortality (SIM-TB-RJ) databases were carried out. Both databases were linked using the Reclink program. A study based on medical records was performed in the five hospitals where the greatest numbers of tuberculosis deaths occurred. RESULTS: In the SINAN-TB-RJ database, 16,567 cases were registered in adults (> 14 years of age). Pulmonary disease was present in 13,989 (84.5%), of whom 8223 (56.8%) presented sputum smears that were positive for acid fast bacilli. Anti-HIV testing, recommended for all patients with tuberculosis, was performed in only 4141 (25%) of tuberculosis cases. The SIM-TB-RJ database showed 1146 deaths that were attributed to tuberculosis. Only 478 (41.7%) of those had been reported to the health care system (SINAN-TB-RJ). Among the 302 medical records analyzed, 154 (50.9%) recorded hospitalizations of up to 10 days and 143 (47.3%) had respiratory symptoms for more than 60 days before diagnosis. Among 125 cases of retreatment, the RHZE regimen recommended by the Brazilian Ministry of Health was prescribed for only 43 (34.4%). CONCLUSION: This study demonstrates weakness in the RJ tuberculosis control program, characterized by delayed diagnosis, limited use of the recommended tests, poor reporting, and non-compliance with the Ministry of Health guidelines.

Objetivo: Avaliar o valor da punção-biópsia pleural no diagnóstico das doenças inflamatórias da pleura. Métodos: Foi feito um estudo retrospectivo de 82 toracocenteses realizadas durante um período de 42 meses em uma enfermaria de clínica médica no Rio de Janeiro. Os aspectos bioquímicos, citológicos e bacteriológicos do líquido pleural e o exame histopatológico do fragmento pleural foram correlacionados com o diagnóstico final. A sensibilidade, especificidade e os valores preditivos da concentração protéica e da percentagem de linfócitos no líquido pleural foram calculados utilizando diferentes valores de corte. Resultados: Dos 82 pacientes, 73 (89%) tinham tuberculose. Todos os pacientes com menos de 35 anos tinham tuberculose. O valor preditivo negativo para o diagnóstico de tuberculose aumentou de 17,1% para 66,7% utilizando 4,5g/dL e 2,5g/dL, respectivamente, como valores de corte para a concentração de proteínas no líquido pleural. O valor preditivo negativo do achado de 70% de linfócitos no líquido pleural foi de 100% e o seu valor preditivo positivo, de 94,2%. A pesquisa de BAAR no líquido pleural foi negativa nas 82 amostras. A sensibilidade do exame histopatológico da pleura foi de 69,2% para o diagnóstico de tuberculose. Conclusões: A tuberculose foi a causa mais comum de derrame pleural em todas as faixas etárias. O exame que mais contribuiu para confirmar este diagnóstico foi a análise histopatológica. Os autores sugerem que a punção pleural e a biópsia sejam realizadas simultaneamente nas populações em que a tuberculose tenha alta prevalência.