ABSTRACT Introduction: tuberculous meningitis is the most serious form of extrapulmonary tuberculosis, this is due to the high mortality and morbidity in patients, its diagnosis is difficult and the majority of cases can be identified based on clinical criteria and characteristics of the cerebrospinal fluid that the majority Sometimes they are nonspecific. Objective: determine the clinical-epidemiological characteristics in patients with meningeal tuberculosis of patients admitted to the medical clinic area at the National Hospital in the period 2015-2023. Methodology: retrospective descriptive observational cross-sectional study of adult patients with meningeal tuberculosis admitted to the National Hospital in the period 2015-2023. Results: 32 patients between 20 and 80 years old (mean age: 39 years) were included; men 68.75 %, women 32.25 %. Mostly coming from the interior of the country. In most cases, patients presented an increase in proteins in the cerebrospinal fluid and predominantly mononuclear cellularity. The genxpert positivity of Mycobacterium from the cerebrospinal fluid was 62.5 %; in no case was AFB isolated. 37.5 % were seropositive for HIV and 43.75 % had pulmonary disease concomitant to meningitis. Mortality was 31.25 %. Conclusion: tuberculous meningitis in our research mainly affected middle-aged men from the interior, whose initial symptoms are fever in a higher percentage followed by headache, presenting a high mortality.

RESUMEN Introducción: la meningitis tuberculosa es la forma más grave de tuberculosis extrapulmonar, esto se debe a la gran mortalidad y morbilidad en los pacientes, con alta prevalencia en los países en desarrollo, lo que constituye un problema de salud pública. Su diagnóstico es difícil y la mayoría de casos se logran identificar a base de criterios clínicos y características del líquido cefalorraquídeo que la mayoría de veces son inespecíficos. Objetivo: determinar las características clínico-epidemiológicas en pacientes con tuberculosis meníngea de los pacientes internados en área de clínica médica en el Hospital Nacional en el periodo 2015-2023. Metodología: estudio observacional descriptivo de corte transversal de pacientes adultos con tuberculosis meníngea internados en el Centro Médico Nacional en el periodo 2015- 2023. Resultados: se incluyeron 32 pacientes entre 20 y 85 años (edad media: 39 años); varones 68,75 %, mujeres 32,25 %. Mayoría provenientes del interior del país. En la mayoría de los casos los pacientes presentaron un aumento de proteínas en el líquido cefalorraquídeo y celularidad predominio de mononucleares, la positividad de GeneXpert de Mycobacterium del líquido cefalorraquídeo fue 62,5 %, en ningún caso se aisló BAAR. Fueron seropositivos para VIH 37,5 % y tenían afección pulmonar concomitante a la meningitis 43,75 %. La mortalidad fue de 31,25 %. Conclusión: la meningitis tuberculosa en nuestra investigación afectó mayormente a hombres de mediana edad provenientes del interior, cuya clínica inicial es la fiebre en mayor porcentaje seguido de cefalea presentando una alta mortalidad.

ABSTRACT Paracoccidioidomycosis is a deep systemic mycosis, endemic in some Latin American countries, with an acute/subacute clinical presentation. In our country, it is the main differential diagnosis of pulmonary tuberculosis. We describe the clinical case of a 48-year-old man from a rural area, immunocompetent, who presented clinically with respiratory distress, progressive weight loss and lesions in the oral mucosa; as radiological findings, he presented bilateral reticular infiltrates. From a mycological point of view, the presence of the microorganism was evidenced in various biological samples: biopsies of oropharyngeal lesions and mycological study of sputum. Targeted treatment with intravenous antifungals was performed, presenting a good response to it with clinical improvement.

RESUMEN La paracoccidioidomicosis es una micosis profunda sistémica, endémica en algunos países de Latinoamérica, de presentación clínica es de evolución aguda/subaguda, en nuestro país es el principal diagnostico diferencial de la tuberculosis pulmonar. Se describe el caso clínico de un hombre de 48 años, procedente de zona rural, inmunocompetente, que se presentó clínicamente por dificultad respiratoria, pérdida de peso de forma progresiva y lesiones en mucosas oral; como hallazgos radiológicos presentó infiltrados reticulares bilaterales. Desde el punto de vista micológico se evidenció la presencia del microorganismo en diversas muestras biológicas: biopsias de lesiones orofaríngeas y estudio micológico del esputo. Se realizó tratamiento dirigido con antimicótico intravenoso presentando buena respuesta al mismo con mejoría clínica.

Resumen Introducción: la tuberculosis es una enfermedad infecciosa crónica causada por Mycobacterium tuberculosis, capaz de afectar cualquier órgano o tejido siendo la forma más común la enfermedad pulmonar. Objetivo: identificar los factores que afectan la adherencia al tratamiento antituberculoso en pacientes del Departamento de Boyacá durante los años 2017-2019. Metodología: estudio descriptivo retrospectivo que utilizó como fuentes de información datos registrados en la base del programa departamental de Tuberculosis y SIVIGILA. Se realizó análisis univariado, determinando la distribución de las variables y análisis bivariado en el que se exploró la asociación entre la adherencia al tratamiento de tuberculosis y las variables independientes, se utilizó la prueba de Chi cuadrado. Resultados: se incluyeron 402 pacientes, la adherencia al tratamiento antituberculoso fue 96,5% y la no adherencia de 3,5%. El 66,7% eran de sexo femenino; 55,7% vivián en zona urbana; 66,5% pertenecían al régimen subsidiado; 89,7% mestizos; 91,2% correspondían a otros grupos poblacionales, seguido del 7,5% de población privada de la libertad y 1,3% habitantes de calle. Dentro de las comorbilidades la coinfección con VIH con 4,2% fue la de mayor presencia. Entre las causas de no adherencia al tratamiento fueron desinterés, cambio frecuente de domicilio, contrato finalizado con la EPS y suspensión del tratamiento por toxicidad hepática. El paciente con mayor probabilidad de abandonar el tratamiento pertenece al sexo masculino, al grupo poblacional de migrantes o habitantes de calle y se encuentra afiliado al régimen subsidiado, se encontró una relación estadísticamente significativa entre estas variables y el resultado con la adherencia al tratamiento. Conclusiones: si bien el resultado obtenido en el presente trabajo no es elevado, es importante realizar vigilancia de la adherencia al tratamiento antituberculoso para disminuir el riesgo de complicaciones derivadas de su abandono como mayor mortalidad, desarrollo de resistencia bacteriana y un período de contagiosidad más prolongado.

Abstract Introduction: Tuberculosis is a chronic infectious disease caused by Mycobacterium tuberculosis, capable of affecting any organ or tissue, the most common form being lung disease. Objective: Identify the factors that affect adherence to tuberculosis treatment in patients from the Department of Boyacá during the years 2017-2019. Methodology: Retrospective descriptive study that used as information sources data registered in the database of the departmental Tuberculosis program and SIVIGILA. A univariate analysis was carried out, determining the distribution of the variables and a bivariate analysis in which the association between adherence to tuberculosis treatment and the independent variables was explored, using the Chi-square test. Results: 402 patients were included, adherence to anti-tuberculosis treatment was 96.5% and non-adherence 3.5%. 66.7% were female; 55.7% lived in an urban area; 66.5% belonged to the subsidized regime; 89.7% mestizo; 91.2% corresponded to other population groups, followed by 7.5% of the population deprived of liberty and 1.3% homeless. Within the comorbidities, coinfection with HIV 4.2% was the one with the greatest presence. Among the causes of non-adherence to treatment were lack of interest; frequent change of address; Terminated contract with the EPS and suspension of treatment due to liver toxicity. The patient with the highest probability of abandoning treatment belongs to the male sex, to the population group of migrants or street dwellers and is affiliated with the subsidized regime, a statistically significant relationship was found between these variables and the result with adherence to treatment. Conclusions: Although the result obtained in this study is not high, it is important to monitor adherence to tuberculosis treatment to reduce the risk of complications derived from its abandonment, such as increased mortality, development of bacterial resistance, and a longer period of contagiousness.

Abstract Introduction Aural polyps are a misnomer. Any lesion can present as a mass in the external auditory canal. Aural polyps are proliferation of the granulation tissue due to long standing inflammatory process with associated otalgia and otorrhea. Objectives To document the clinicoradiological presentations, intraoperative findings, and histopathological diagnosis of aural polyp, correlating them. Methods In our study 81 patients underwent treatment for aural polyps in the department of Ear, Nose, and Throat (ENT) from April 1997 to April 2022. Results were tabulated, a simple descriptive analysis was done using the Statistical Package Social Sciences software, and the results obtained were represented as percentages and presented in tables. Results The majority (38) of the patients presenting with aural polyps were diagnosed with mucosal and squamous type of CSOM, and 22 with simple granulation polyps. There were also 5 patients with malignant otitis externa, 3 patients had glomus tumors, 2 patients with retained foreign bodies, and 3 patients with brain herniation. We also identified aberrant internal carotid artery, high jugular bulb, one patient had facial nerve neuroma, one patient had polyp from the tragus diagnosed with tuberculosis, one patient with keratosis obturans, and one with exostosis. Conclusion A thorough detailed examination and mastoid exploration with radiological and histopathological evaluation is mandatory for better defining the definitive treatment. Utmost care and meticulousness are advised for the surgeons while dealing with aural polyps to avoid any complications. misnomer canal otorrhea presentations findings them 8 Ear Nose ENT (ENT 199 2022 tabulated software tables 38 (38 CSOM externa tumors bodies herniation artery bulb neuroma tuberculosis obturans exostosis complications 19 202 (3 1 20 (

Abstract Introduction. Proper management of multidrug-resistant tuberculosis is a prioritized strategy for tuberculosis control worldwide. Objective. To evaluate differences concerning demographic and clinical characteristics and programmatic indicators of Buenaventura patient cohort with confirmed diagnosis of multidrug-resistant tuberculosis, compared to those of the other municipalities from Valle del Cauca, Colombia, 2013-2016. Materials and methods. We conducted an analytical cohort study to compare records of patients older than 15 years with multidrug-resistant tuberculosis included in the Programa de Tuberculosis de Buenaventura (with para-aminosalicylic acid) versus the other municipalities of Valle del Cauca (without para-aminosalicylic). Results. Ninety-nine cases were recorded with a median age of 40 years (IQR = 26 - 53); in Buenaventura, 56% of the patients were women, while in the other municipalities, men predominated with 67%; 95% had health insurance. The most common comorbidity was diabetes (14%). Adverse reactions to antituberculosis medications in Buenaventura were 1.3 times more frequent than in the other municipalities (OR = 2.3; 95% CI = 0.993 - 5.568; p = 0.04). In Buenaventura, the mortality rate was 5% compared to the 15% reported in the other municipalities. Treatment failures were not reported in Buenaventura, but 35% did not continue with the follow-up. Treatment success was higher in Buenaventura (56 %). Conclusion. A strengthened program in Buenaventura presented better programmatic results than those from the other municipalities of Valle del Cauca. Access to molecular tests, availability of shortened treatments, and continuous monitoring to identify adverse reactions to antituberculosis medications are routes for all other control programs.

Resumen Introducción. El manejo adecuado de la tuberculosis multirresistente es una estrategia priorizada para el control de la tuberculosis en el mundo. Objetivo. Evaluar las diferencias entre las características demográficas y clínicas, y los indicadores programáticos de los pacientes con diagnóstico confirmado de tuberculosis pulmonar resistente a rifampicina o multirresistente en Buenaventura, frente a la cohorte de los demás municipios del Valle del Cauca entre 2013 y 2016. Materiales y métodos. Se desarrolló un estudio analítico de cohortes para comparar los registros de pacientes mayores de 15 años con tuberculosis multirresistente, del Programa de Tuberculosis de Buenaventura (con ácido paraaminosalicílico), frente a los demás municipios del Valle del Cauca (sin ácido paraaminosalicílico). Resultados. Se registraron 99 casos con una mediana de edad de 40 años (RIC = 26 - 53); en Buenaventura, el 56 % eran mujeres; en los demás municipios, predominaron los hombres (67 %); el 95 % de los evaluados tenía aseguramiento en salud. La comorbilidad más frecuente fue diabetes (14 %). Las reacciones adversas a medicamentos antituberculosos en Buenaventura fueron 1,3 veces más frecuentes que en los demás municipios (OR = 2,3; IC95 %: 0,993 - 5,568; p = 0,04). En Buenaventura falleció el 5 % de los casos frente al 15 % reportado en los demás municipios. No hubo fracasos con el tratamiento en Buenaventura, pero se reportó un 35 % de pérdida del seguimiento. El éxito del tratamiento fue mayor en Buenaventura en el 56 %. Conclusión. El programa fortalecido de Buenaventura presentó mejores resultados programáticos que los demás municipios del Valle del Cauca. El acceso a pruebas moleculares, la disponibilidad de tratamientos acortados y el seguimiento continuo para identificar reacciones adversas a medicamentos antituberculosos son un derrotero para todos los programas de control.

Abstract: At the end of the 19th century and during the first third of the 20th century, schools contributed to the spread of tuberculosis. The Modern School. Hispanic American Pedagogical Magazine (1892 to 1934) sought the prevention and overcoming of such a disease. And the aim of the analysis is to identify the measures to overcome the tuberculosis in childhood. The analysis indicates various types of actions. These could involve the school or not, but always giving prominence to childhood. This work is interesting because the source is revised for this purpose for the first time.

Resumen: A finales del siglo XIX y durante el primer tercio del siglo XX, los centros escolares tenían unas condiciones ambientales que contribuían con la expansión de la tuberculosis. La Escuela Moderna. Revista Pedagógica Hispano Americana es una publicación que destina varios de sus documentos a la prevención y superación de tal enfermedad. Es por ello por lo que se analizan sus impresiones desde 1892 hasta 1934, para identificar las medidas que se debían plantear para zanjar la presencia de la tuberculosis en la vida de la infancia. Desde tal análisis se han obtenido diferentes tipos de actuaciones que podían implicar o no a la escuela, pero tenían como protagonista a la salud infantil. Se considera de interés la revisión realizada al no haber sido planteada con anterioridad, poniendo la mirada en la fuente primaria seleccionada.

Resumen Introducción : En el consultorio de atención inmediata de clínica se concentra la atención de pacientes ambu latorios con enfermedades que requieren diagnóstico precoz, como la adenitis tuberculosa (AT). El objetivo fue describir las características clínicas, estudios com plementarios y procedimientos realizados a pacientes con diagnóstico confirmado por bacteriología o anatomía patológica de AT. Métodos : Estudio observacional, descriptivo, retros pectivo. Período: 2017-2023. Resultados : Se incluyeron 49 pacientes, con una mediana de edad de 31 años; 59% de sexo femenino, 22% con comorbilidades El 40% presentó adenopatías localizadas, la mayoría cervicales. La serología para HIV era positiva en 3 (6.1%). Al 73% se le ingresaron muestras para bacteriología, con aislamiento de M. tuberculosis en 71%. Al 79% se le realizó punción aspiración con aguja fina (PAAF) ganglionar; en el 48% los resultados de la citología fueron sugestivos de tuberculosis (TB). Al 77% se le realizó biopsia ganglionar, resultando en el 62% adenitis granulomatosa. Desde la primera consulta hasta el diagnóstico transcurrieron una mediana de 40 días. La mayoría de los tratamientos se iniciaron luego del resultado de la biopsia, seguido de cultivos, baciloscopia, PAAF y GeneXpert. Un paciente falleció. Discusión : La AT predominó en el sexo femenino en el grupo estudiado, coincidente con la experiencia local, la edad promedio de presentación fue 30 a 40 años. Puede afectar cualquier cadena ganglionar, aunque predomina la localización cervical, que coincide con los hallazgos de este trabajo. En nuestra serie, la demora diagnóstica desde la primera consulta fue menor a la referida en la bibliografía.

Abstract Introduction : In the clinical medicine’s immediate assistance unit, care is focused on outpatients with dis eases that require early diagnosis, such as tuberculous adenitis (TA). The aim was to describe clinical features, complementary studies and procedures performed in patients with a diagnosis confirmed by bacteriology or pathological anatomy of TA. Methods : Observational, descriptive, retrospective. Period: 2017-2023. Results : Fourty nine patients were included, with a median age of 31 years, 59% were female, 22% with comorbidities. 40% had localized lymphadenopathy, most of them cervical. HIV serology was positive in 3 cases (6.1%). Samples for bacteriology were submitted in 73%, with isolation of M. tuberculosis in 71%. Nodal fine needle aspiration (FNA) was performed in 79%, and in 48% the cytology results were suggestive of tuberculosis. Nodal biopsy was performed in 77%, with granulomatous adenitis as result in 62%. The term between admis sion and diagnosis ranged from a median of 40 days. Most treatments were started after the biopsy result, followed by culture, bacilloscopy, FNA, and GeneXpert. One patient died. Discussion : TA predominates in the female sex in the studied group, coinciding with the local experience, the average age of presentation is 30 to 40 years, can affect any lymph node region, although the cervical location predominates, which coincides with the findings of this work. In our series, the diagnostic delay from the first consultation was shorter than reported in the literature.

RESUMEN Introducción: La tuberculosis es una enfermedad de interés en salud laboral y existe una mayor probabilidad de infección y enfermedad en los trabajadores de la salud que en la población general. Esto sucede como consecuencia de la exposición a factores de riesgo ocupacionales y al déficit de implementación de las medidas de control de tuberculosis. Objetivo: Determinar la relación de los factores sociodemográficos, ocupacionales, conocimientos y prácticas sobre la tuberculosis con el uso adecuado del respirador N95 en los trabajadores de la salud de un hospital de la ciudad de Bogotá, Colombia. Métodos: Estudio de tipo cuantitativo y diseño transversal. Se realizó un muestreo aleatorio simple estratificado por ocupación y área de trabajo. Se utilizaron estadísticos descriptivos y pruebas no-paramétricas que se evaluaron a un nivel significancia del 5 % (P< 0,05). Resultados: Participaron 250 trabajadores de la salud. Los niveles educativos de universitario y posgradual (P< 0,001), las ocupaciones de enfermero, médico especialista, médico general y bacteriólogo (P< 0,001), las áreas de trabajo de hospitalización, cuidado intensivo adultos y urgencias (P= 0,034), se asociaron con el uso adecuado del respirador N95. Los conocimientos correctos sobre la tuberculosis (P< 0,001), se relacionaron con el uso adecuado del respirador N95. Conclusiones: Mediante acciones educativas se recomienda fortalecer los conocimientos y prácticas de los trabajadores de la salud sobre la tuberculosis y el uso adecuado del respirador N95, en especial hacia las ocupaciones de auxiliar de enfermería y otros auxiliares y tecnólogos de la salud, dado que estadísticamente mostraron un menor uso adecuado del respirador N95.

ABSTRACT Introduction: Tuberculosis is a disease of interest in occupational health and there is a greater probability of infection and disease in health workers than in the general population. This happens as a consequence of exposure to occupational risk factors and the lack of implementation of tuberculosis control measures. Objective: Determine the relationship of sociodemographic, occupational factors, knowledge and practices about tuberculosis with the appropriate use of the N95 respirator in health workers in a hospital in the city of Bogotá, Colombia. Methods: Quantitative study and cross-sectional design. A simple random sampling stratified by occupation and work area was carried out. Descriptive statistics and non-parametric tests were used and were evaluated at a significance level of 5% (P < 0.05). Results: 250 health workers participated. The educational levels of university and postgraduate (P < 0.001), the occupations of nurse, specialist doctor, general practitioner and bacteriologist (P < 0.001), the work areas of hospitalization, adult intensive care and emergencies (P = 0.034), were associated with the proper use of the N95 respirator. Correct knowledge about tuberculosis (P < 0.001) was related to the proper use of the N95 respirator. Conclusions: Through educational actions, it´s recommended to strengthen the knowledge and practices of health workers about tuberculosis and the proper use of the N95 respirator, especially towards the occupations of nursing assistant and other health assistants and technologists, given that statistically showed less adequate use of the N95 respirator.

Abstract Objectives: Identify potential barriers, delays, and missed opportunities in the prevention and diagnosis of childhood TB. Methods: Scoping review according to the PRISMA extension. The definitions considered for the selection followed the acronym PCC where the population (P) is children under 18years of age with TB disease, the concept (C) refers to missed opportunities for prevention and diagnosis, and context (C) is defined as a diagnosis of TB disease. The authors searched systematically in the databases; VHL/Lilacs, Medline via PubMed, Cochrane, Scopus, and Web of Science, without date or language limitation. Results: Seven studies were included. In developed countries, with low disease burden, the main shortcoming is the delay in diagnosing bacilliferous adults in contact with young children. This problem is concentrated in the portion of the population with socioeconomic vulnerability. In underdeveloped countries, with a high burden of disease, the biggest challenge is tracking children who come into contact with bacilliferous patients. Conclusions: There are still many missed opportunities in the prevention and diagnosis of childhood TB. The positive legacy of the COVID-19 pandemic should be taken advantage of and the encouragement of scientific development in the management of infectious diseases should be taken. Objectives barriers delays Methods extension P (P years C (C databases VHLLilacs VHL Lilacs VHL/Lilacs PubMed Cochrane Scopus Science limitation Results included countries vulnerability patients Conclusions COVID19 COVID 19 COVID-1 COVID1 1 COVID-

Primary ciliary dyskinesia (PCD) is an inherited ciliopathy that results in impaired mucous clearance and affects primarily the respiratory tract, causing upper airway disease, bronchial inflammation and bronchiectasis. The prevalence of PCD in low- and middle-income settings, including South Africa (SA), is unknown, largely owing to challenges with diagnosis, and identifying children or adults with PCD is challenging in a setting with a high prevalence of other infectious diseases, including lower respiratory tract infections and tuberculosis. No single test is diagnostic of PCD, and while some tests are costly, others are labour intensive and require highly specialised laboratory expertise. In the SA setting, awareness and opportunities for the diagnosis of PCD need to be created. In this commentary, we provide a pragmatic approach to identifying which children and adults require further investigations for PCD using a range of diagnostic tests or tools that are available. Furthermore, we recommend that designated centres of expertise for PCD diagnosis are created in SA. This would be an important step towards improving accessibility of diagnostic tests and developing local expertise to improving PCD diagnosis, especially in early childhood, to prevent long-term irreversible respiratory sequelae.

Ciara Goslett's account of childhood tuberculosis (TB) sheds light on the challenges faced by children diagnosed with TB in South Africa (SA). Children are particularly vulnerable to TB infection and to dangerous forms of disseminated TB such as TB meningitis, which can cause death or major lifelong disability. They have distinct challenges with diagnosis, and TB treatment for adults is not necessarily child-friendly. In the absence of a child-friendly formulation, adult tablets are broken into the correct dosage and used to treat children. Crushed and dissolved in water, the pieces are not very palatable for children. There are therefore issues that may be neglected if the voices of children are not included in the TB response in SA. These include delays in the development and accessibility of child-friendly medication, vaccine shortages and a lack of educational support for hospitalised children under school-going age. Some positive progress has been made through the establishment of the paediatric working group in the TB Think Tank, and SA's contribution to pivotal childhood TB research studies. Additional steps could be the inclusion of children's feedback in community-led monitoring efforts and engagement between child TB activists and the SA TB Caucus, a collective of parliamentarians.