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\fs12 \cf0 11.� Congreso ALAT \par
}
{\phpg\posx850\pvpg\posy1101\absw5020\absh2825 \b \f20 \fs15 \cf0 \b \f20 \fs15
\cf0 Material y m�todos:{\b0 Estudio}{\b0 observacional,}{\b0 retrospectivo,}
{\b0 descripti- }
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\par}{\phpg\posx850\pvpg\posy1101\absw5020\absh2825 \sl-210 \b \f20 \fs15 \cf0 {\b0
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\par}{\phpg\posx850\pvpg\posy1101\absw5020\absh2825 \sl-210 \b \f20 \fs15 \cf0
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tratamiento.}{\b0 Examen}{\b0 f�sico:}{\b0 Ap. }
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flog�sticos.}{\b0 Ecograf�a}{\b0 TD: }
\par}{\phpg\posx850\pvpg\posy1101\absw5020\absh2825 \sl-210 \b \f20 \fs15 \cf0 {\b0
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del}{\b0 pereneo}{\b0 y }
\par}{\phpg\posx850\pvpg\posy1101\absw5020\absh2825 \sl-210 \b \f20 \fs15 \cf0 {\b0
tibial}{\b0 posterior.}{\b0 TAC}{\b0 TD:}{\b0 descartar}{\b0 foco}{\b0 de}
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\par}{\phpg\posx850\pvpg\posy1101\absw5020\absh2825 \sl-210 \b \f20 \fs15 \cf0 {\b0
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{\b0 �sea?}{\b0 Artrocentesis:}{\b0 l�q.}{\b0 ar- }
\par}{\phpg\posx850\pvpg\posy1101\absw5020\absh2825 \sl-210 \b \f20 \fs15 \cf0 {\b0
ticular:}{\b0 5}{\b0 BAAR/100}{\b0 campos;}{\b0 c�psula}{\b0 articular:}{\b0
BAAR}{\b0 +.}{\b0 Gene}{\b0 xpert}{\b0 l�q. }
\par}{\phpg\posx850\pvpg\posy1101\absw5020\absh2825 \sl-210 \b \f20 \fs15 \cf0 {\b0
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\par}{\phpg\posx850\pvpg\posy1101\absw5020\absh2825 \sl-210 \b \f20 \fs15 \cf0 {\b0
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complicaciones}{\b0 posteriores. }\par
}
{\phpg\posx6207\pvpg\posy1108\absw4852\absh452 \f20 \fs12 \cf0 \f20 \fs12 \cf0
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antituberculoso del personal militar con antecedente de tuberculosis pulmonar de
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}
{\phpg\posx11079\pvpg\posy711\absw145\absh142 \f20 \fs12 \cf0 \f20 \fs12 \cf0 97
\par
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{\phpg\posx850\pvpg\posy8346\absw5019\absh1880 \b \f20 \fs15 \cf0 \b \f20 \fs15
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\par}{\phpg\posx850\pvpg\posy8346\absw5019\absh1880 \sl-210 \b \f20 \fs15 \cf0 {\b0
toso. }\par
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{\phpg\posx850\pvpg\posy10946\absw5019\absh3604 \b \f20 \fs15 \cf0 \b \f20 \fs15
\cf0 226. PATR�N FUNCIONAL RESPIRATORIO EN MILITARES CON
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ANTECEDENTE DE TUBERCULOSIS PULMONAR
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{\b0 M.C.}{\b0 Hern�ndez}{\b0 y}{\b0 A.}{\b0 Riboty }
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{\b0\i Marina}{\b0\i de}{\b0\i Guerra}{\b0\i del}{\b0\i Per�. }
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{\b0 programa}{\b0 SPSS}{\b0 v.23. }\par
}
{\phpg\posx6207\pvpg\posy7492\absw5017\absh3594 \b\i \f20 \fs15 \cf0 \b\i \f20
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{\b0 el}{\b0 tiempo}{\b0 de}{\b0 tratamineto }
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\par}{\phpg\posx6207\pvpg\posy7492\absw5017\absh3594 \sl-210 \b\i \f20 \fs15 \cf0
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28a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a
28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a
0028a28a0028a28a0028a28a0028a28a0028a28
a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a00
28a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a
28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a
0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a002
8a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a2
8a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0
028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028
a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28
a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a00
28a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a
28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a
0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a002
8a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a2
8a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0
028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028
a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28
a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a00
28a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a
28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a
0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a002
8a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a2
8a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0
028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028
a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28
a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a00
28a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a
28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a
0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a002
8a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a2
8a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0
028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028
a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28
a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a00
28a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a
28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a
0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a002
8a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a2
8a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0
028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028
a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28
a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a00
28a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a
28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a
0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a002
8a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a2
8a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0
028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028
a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28
a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a00
28a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a
28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a
0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a002
8a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a2
8a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0
028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028
a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28
a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a00
28a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a
28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a
0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a002
8a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a2
8a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0
028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028
a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28
a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a00
28a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a
28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a
0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a002
8a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a2
8a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0
028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028
a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28
a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a00
28a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a
28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a
0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a002
8a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a2
8a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a00ffd9
}}\par}{\phpg\posx680\pvpg\posy711\absw149\absh142 \f20 \fs12 \cf0 \f20 \fs12 \cf0
98 \par
}
{\phpg\posx5258\pvpg\posy713\absw1048\absh138 \i \f20 \fs12 \cf0 \i \f20 \fs12 \cf0
11.� Congreso ALAT \par
}
{\phpg\posx680\pvpg\posy1103\absw5019\absh6604 \f20 \fs15 \cf0 \f20 \fs15 \cf0 xico
(EdoM�x), y las comorbilidades asociadas a la enfermedad as�
\par}{\phpg\posx680\pvpg\posy1103\absw5019\absh6604 \sl-210 \f20 \fs15 \cf0 mismo,
identificar las variantes de Mycobacterium spp aisladas, y
\par}{\phpg\posx680\pvpg\posy1103\absw5019\absh6604 \sl-210 \f20 \fs15 \cf0
establecer los patrones de comportamiento ante los antibi�ticos.
\par}{\phpg\posx680\pvpg\posy1103\absw5019\absh6604 \sl-210 \f20 \fs15 \cf0 {\b
Material}{\b y}{\b m�todos:} Durante el 2017 se recibieron 1.176 muestras
\par}{\phpg\posx680\pvpg\posy1103\absw5019\absh6604 \sl-210 \f20 \fs15 \cf0
acompa�adas de una historia cl�nica. Las muestras fueron procesadas
\par}{\phpg\posx680\pvpg\posy1103\absw5019\absh6604 \sl-210 \f20 \fs15 \cf0 y
diagnosticadas siguiendo el algoritmo de diagn�stico (baciloscopia,
\par}{\phpg\posx680\pvpg\posy1103\absw5019\absh6604 \sl-210 \f20 \fs15 \cf0
aislamiento, caracterizaci�n molecular y drogo-sensibilidad). Para el
\par}{\phpg\posx680\pvpg\posy1103\absw5019\absh6604 \sl-210 \f20 \fs15 \cf0
an�lisis estad�stico se realiz� la prueba de la prueba de {\field{\*\fldinst SYMBOL
99 \\f Symbol }} {\up006 \fs8 2}, con un In-
\par}{\phpg\posx680\pvpg\posy1103\absw5019\absh6604 \sl-210 \f20 \fs15 \cf0 tervalo
de confianza al 95% (IC95%) y resultados significativos p {\field{\*\fldinst SYMBOL
163 \\f Symbol }}
\par}{\phpg\posx680\pvpg\posy1103\absw5019\absh6604 \sl-210 \f20 \fs15 \cf0 0,05.
\par}{\phpg\posx680\pvpg\posy1103\absw5019\absh6604 \sl-210 \f20 \fs15 \cf0 {\b
Resultados:} Se procesaron 1.176 muestras, de las cuales se present�
\par}{\phpg\posx680\pvpg\posy1103\absw5019\absh6604 \sl-210 \f20 \fs15 \cf0 una
prevalencia del 31% de muestras positivas, la edad promedio es
\par}{\phpg\posx680\pvpg\posy1103\absw5019\absh6604 \sl-210 \f20 \fs15 \cf0 de 45
a�os, el 84% (988/1.176 muestras) son expectoraciones. As� mis-
\par}{\phpg\posx680\pvpg\posy1103\absw5019\absh6604 \sl-210 \f20 \fs15 \cf0 mo,
362/1.176 (30,8%) de las muestras presentan comorbilidad con
\par}{\phpg\posx680\pvpg\posy1103\absw5019\absh6604 \sl-210 \f20 \fs15 \cf0
diabetes mellitus, mientras que el 7,7% (91/1.176 muestras) presentan
\par}{\phpg\posx680\pvpg\posy1103\absw5019\absh6604 \sl-210 \f20 \fs15 \cf0 la
comorbilidad relacionada con VIH positivo. Muestras negativas por
\par}{\phpg\posx680\pvpg\posy1103\absw5019\absh6604 \sl-210 \f20 \fs15 \cf0
baciloscopias, es 67,17%. 10 Muestras fueron positivas a Mycobacte-
\par}{\phpg\posx680\pvpg\posy1103\absw5019\absh6604 \sl-210 \f20 \fs15 \cf0 riun no
tuberculoso (MNTB: M. kansassi, M. marinum, M. gordonae,
\par}{\phpg\posx680\pvpg\posy1103\absw5019\absh6604 \sl-210 \f20 \fs15 \cf0 M.
fortitum, M. intracelluare, M. scrofulaceum y M. avium). El resul-
\par}{\phpg\posx680\pvpg\posy1103\absw5019\absh6604 \sl-210 \f20 \fs15 \cf0 tado de
los factores de riesgo asociados a la prevalencia de TB que
\par}{\phpg\posx680\pvpg\posy1103\absw5019\absh6604 \sl-210 \f20 \fs15 \cf0 fueron
significativos en el estudio son: causa del estudio p = 0,0001;
\par}{\phpg\posx680\pvpg\posy1103\absw5019\absh6604 \sl-210 \f20 \fs15 \cf0
comorbilidad p = 0,017, Mientras que los momios de los factores de
\par}{\phpg\posx680\pvpg\posy1103\absw5019\absh6604 \sl-210 \f20 \fs15 \cf0 riesgo
asociados a la prevalencia son: causa del estudio: pacientes que
\par}{\phpg\posx680\pvpg\posy1103\absw5019\absh6604 \sl-210 \f20 \fs15 \cf0 env�an
muestras para control tienen (OR = 1,617; IC95% 1,373 a 1,917),
\par}{\phpg\posx680\pvpg\posy1103\absw5019\absh6604 \sl-210 \f20 \fs15 \cf0 En la
variable de comorbilidad: los pacientes que presentan HIV po-
\par}{\phpg\posx680\pvpg\posy1103\absw5019\absh6604 \sl-210 \f20 \fs15 \cf0 sitivo
tienen OR = 1,742; IC95% 1,048 a 2,89. Para la variable de resis-
\par}{\phpg\posx680\pvpg\posy1103\absw5019\absh6604 \sl-210 \f20 \fs15 \cf0 tencia
a f�rmacos se observ�: pacientes DM y positivos a MTB presen-
\par}{\phpg\posx680\pvpg\posy1103\absw5019\absh6604 \sl-210 \f20 \fs15 \cf0 taron
resistencia a estreptomicina (7), isoniazida (3), rifampizina (2),
\par}{\phpg\posx680\pvpg\posy1103\absw5019\absh6604 \sl-210 \f20 \fs15 \cf0
etambutol (1) y pirazidamida (10), mientras la resistencia a f�rmacos
\par}{\phpg\posx680\pvpg\posy1103\absw5019\absh6604 \sl-210 \f20 \fs15 \cf0
observada en pacientes con VIH solo son estreptomicina (2) y pirazi-
\par}{\phpg\posx680\pvpg\posy1103\absw5019\absh6604 \sl-210 \f20 \fs15 \cf0 damida
(2).
\par}{\phpg\posx680\pvpg\posy1103\absw5019\absh6604 \sl-210 \f20 \fs15 \cf0 {\b
Conclusiones:} Los pacientes que env�an muestras para control tienen
\par}{\phpg\posx680\pvpg\posy1103\absw5019\absh6604 \sl-210 \f20 \fs15 \cf0 m�s
posibilidades de re-infectarse con MTB. Sin embargo los an�lisis
\par}{\phpg\posx680\pvpg\posy1103\absw5019\absh6604 \sl-210 \f20 \fs15 \cf0
arrojaron que los pacientes con DM presentan mayor n�mero en la
\par}{\phpg\posx680\pvpg\posy1103\absw5019\absh6604 \sl-210 \f20 \fs15 \cf0
resistencia a f�rmacos. \par
}
{\phpg\posx6037\pvpg\posy1103\absw5019\absh3202 \f20 \fs15 \cf0 \f20 \fs15 \cf0
fragmentos con similar significado y se analizaron de acuerdo al mo-
\par}{\phpg\posx6037\pvpg\posy1103\absw5019\absh3202 \sl-210 \f20 \fs15 \cf0 delo
propuesto.
\par}{\phpg\posx6037\pvpg\posy1103\absw5019\absh3202 \sl-210 \f20 \fs15 \cf0 {\b
Resultados:} Despu�s de triangular la informaci�n de la encuesta con
\par}{\phpg\posx6037\pvpg\posy1103\absw5019\absh3202 \sl-210 \f20 \fs15 \cf0 la
informaci�n de los grupos focales. Se identificaron como barreras
\par}{\phpg\posx6037\pvpg\posy1103\absw5019\absh3202 \sl-210 \f20 \fs15 \cf0 de
acceso al servicio en la dimensi�n disponibilidad (18%): horarios
\par}{\phpg\posx6037\pvpg\posy1103\absw5019\absh3202 \sl-210 \f20 \fs15 \cf0 de
atenci�n, infraestructura y suministro de informaci�n. En la di-
\par}{\phpg\posx6037\pvpg\posy1103\absw5019\absh3202 \sl-210 \f20 \fs15 \cf0
mensi�n accesibilidad (29%): distancia entre la residencia y el lugar
\par}{\phpg\posx6037\pvpg\posy1103\absw5019\absh3202 \sl-210 \f20 \fs15 \cf0 de
atenci�n, tiempos de espera y costos del traslado al centro de aten-
\par}{\phpg\posx6037\pvpg\posy1103\absw5019\absh3202 \sl-210 \f20 \fs15 \cf0 ci�n.
En la dimensi�n aceptabilidad (28%): temor o verg�enza al aten-
\par}{\phpg\posx6037\pvpg\posy1103\absw5019\absh3202 \sl-210 \f20 \fs15 \cf0 derse
en un servicio de salud, estigma social. En la dimensi�n contac-
\par}{\phpg\posx6037\pvpg\posy1103\absw5019\absh3202 \sl-210 \f20 \fs15 \cf0 to
(25%): percepci�n de mala calidad de atenci�n y efectos secundarios
\par}{\phpg\posx6037\pvpg\posy1103\absw5019\absh3202 \sl-210 \f20 \fs15 \cf0 de la
enfermedad.
\par}{\phpg\posx6037\pvpg\posy1103\absw5019\absh3202 \sl-210 \f20 \fs15 \cf0 {\b
Conclusiones:} Estos hallazgos son consistentes con la literatura y su-
\par}{\phpg\posx6037\pvpg\posy1103\absw5019\absh3202 \sl-210 \f20 \fs15 \cf0 gieren
la necesidad de dise�ar y ejecutar pol�ticas sanitarias que re-
\par}{\phpg\posx6037\pvpg\posy1103\absw5019\absh3202 \sl-210 \f20 \fs15 \cf0 duzcan
o eliminen las barreras para la atenci�n de los pacientes con
\par}{\phpg\posx6037\pvpg\posy1103\absw5019\absh3202 \sl-210 \f20 \fs15 \cf0 TBMDR,
con el fin de lograr la adherencia al tratamiento y garantizar
\par}{\phpg\posx6037\pvpg\posy1103\absw5019\absh3202 \sl-210 \f20 \fs15 \cf0 del
acceso equitativo y eficiente a los servicios de salud. \par
}
{\phpg\posx680\pvpg\posy8861\absw5040\absh5480 \b \f20 \fs15 \cf0 \b \f20 \fs15
\cf0 228. ACCESO A LOS SERVICIOS DE SALUD: AN�LISIS DE BARRERAS
\par}{\phpg\posx680\pvpg\posy8861\absw5040\absh5480 \sl-200 \b \f20 \fs15 \cf0 Y
ESTRATEGIAS EN PACIENTES CON TUBERCULOSIS
\par}{\phpg\posx680\pvpg\posy8861\absw5040\absh5480 \sl-200 \b \f20 \fs15 \cf0
MULTIDROGORRESISTENTE EN UNA REGI�N DEL PER�
\par}{\phpg\posx680\pvpg\posy8861\absw5040\absh5480 \sl-170 \par\b \f20 \fs15 \cf0
{\b0 O.}{\b0 Rivera,}{\b0 S.}{\b0 Benites}{\b0 y}{\b0 C.}{\b0 Bonilla }
\par}{\phpg\posx680\pvpg\posy8861\absw5040\absh5480 \sl-156 \par\b \f20 \fs15 \cf0
{\b0\i Universidad}{\b0\i C�sar}{\b0\i Vallejo.}{\b0\i Lima.}{\b0\i
Universidad}{\b0\i Privada}{\b0\i Norbert}{\b0\i Wiener. }
\par}{\phpg\posx680\pvpg\posy8861\absw5040\absh5480 \sl-200 \b \f20 \fs15 \cf0
{\b0\i Lima.}{\b0\i Hospital}{\b0\i Nacional}{\b0\i Daniel}{\b0\i Alcides}
{\b0\i Carri�n.}{\b0\i Callao. }
\par}{\phpg\posx680\pvpg\posy8861\absw5040\absh5480 \sl-217 \par\b \f20 \fs15 \cf0
Introducci�n:{\b0 El}{\b0 acceso}{\b0 a}{\b0 servicios}{\b0 de}{\b0 salud}
{\b0 es}{\b0 un}{\b0 tema}{\b0 de}{\b0 preocupa- }
\par}{\phpg\posx680\pvpg\posy8861\absw5040\absh5480 \sl-210 \b \f20 \fs15 \cf0 {\b0
ci�n,}{\b0 en}{\b0 la}{\b0 regi�n}{\b0 de}{\b0 las}{\b0 Am�ricas.}{\b0 A}
{\b0 partir}{\b0 de}{\b0 los}{\b0 a�os}{\b0 80}{\b0 muchos }
\par}{\phpg\posx680\pvpg\posy8861\absw5040\absh5480 \sl-210 \b \f20 \fs15 \cf0 {\b0
pa�ses,}{\b0 incluyendo}{\b0 el}{\b0 Per�,}{\b0 iniciaron}{\b0 reformas}{\b0
en}{\b0 los}{\b0 sistemas}{\b0 de}{\b0 salud }
\par}{\phpg\posx680\pvpg\posy8861\absw5040\absh5480 \sl-210 \b \f20 \fs15 \cf0 {\b0
con}{\b0 el}{\b0 fin}{\b0 de}{\b0 garantizar}{\b0 acceso,}{\b0 equidad}{\b0
y}{\b0 eficiencia}{\b0 en}{\b0 la}{\b0 atenci�n. }
\par}{\phpg\posx680\pvpg\posy8861\absw5040\absh5480 \sl-210 \b \f20 \fs15 \cf0 {\b0
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{\phpg\posx11076\pvpg\posy711\absw148\absh142 \f20 \fs11 \cf0 \f20 \fs11 \cf0 99
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{\phpg\posx6207\pvpg\posy1101\absw5020\absh6416 \b \f20 \fs14 \cf0 \b \f20 \fs14
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diagn�stico}{\b0 bacteriol�gico}{\b0 de }
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{\b0 rias}{\b0 y}{\b0 extrapulmonares,}{\b0 entre}{\b0 2011}{\b0 y}{\b0
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{\b0 lidades}{\b0 fueron:}{\b0 bronquiectasias}{\b0 (35%),}{\b0 tabaquismo}{\b0
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{\b0 directo}{\b0 y}{\b0 el}{\b0 68%}{\b0 restante}{\b0 por}{\b0 cultivo.}
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{\b0 etambutol}{\b0 (45%). }
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{\b0 hallada.}{\b0 El}{\b0 predominio}{\b0 aislamientos}{\b0 de}{\b0 M.}{\b0
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}
{\phpg\posx850\pvpg\posy11801\absw5017\absh2834 \b \f20 \fs14 \cf0 \b \f20 \fs14
\cf0 231. MICOBACTERIAS NO TUBERCULOSAS: UNA INFECCI�N
\par}{\phpg\posx850\pvpg\posy11801\absw5017\absh2834 \sl-200 \b \f20 \fs14 \cf0
PULMONAR EN EXPANSI�N
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{\b0 M.M.}{\b0 Perin,}{\b0 M.L.}{\b0 Canteros,}{\b0 N.}{\b0 Rolan,}{\b0 M.}
{\b0 Bentancourt,}{\b0 A.}{\b0 Famiglietti, }
\par}{\phpg\posx850\pvpg\posy11801\absw5017\absh2834 \sl-200 \b \f20 \fs14 \cf0
{\b0 C.}{\b0 Vay,}{\b0 R.}{\b0 G�mez}{\b0 Tejada,}{\b0 L.}{\b0 Limongi}{\b0
y}{\b0 A.M.}{\b0 Putruele }
\par}{\phpg\posx850\pvpg\posy11801\absw5017\absh2834 \sl-156 \par\b \f20 \fs14 \cf0
{\b0\i Hospital}{\b0\i de}{\b0\i Cl�nicas}{\b0\i Jos�}{\b0\i de}{\b0\i San}
{\b0\i Mart�n.}{\b0\i Facultad}{\b0\i de}{\b0\i Medicina. }
\par}{\phpg\posx850\pvpg\posy11801\absw5017\absh2834 \sl-200 \b \f20 \fs14 \cf0
{\b0\i Universidad}{\b0\i de}{\b0\i Buenos}{\b0\i Aires. }
\par}{\phpg\posx850\pvpg\posy11801\absw5017\absh2834 \sl-217 \par\b \f20 \fs14 \cf0
Introducci�n:{\b0 Las}{\b0 micobacterias}{\b0 no}{\b0 tuberculosas}{\b0 (MNT)}
{\b0 han}{\b0 adquirido }
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{\b0 relevancia}{\b0 en}{\b0 los}{\b0 �ltimos}{\b0 a�os}{\b0 debido}{\b0 al}
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{\b0 nosupresoras}{\b0 y}{\b0 corticoides}{\b0 inhalados.}{\b0 En}{\b0
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{\b0 escasos}{\b0 por}{\b0 ser}{\b0 infecciones}{\b0 de}{\b0 declaraci�n}{\b0
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\par}{\phpg\posx850\pvpg\posy11801\absw5017\absh2834 \sl-210 \b \f20 \fs14 \cf0
{\b0 describir}{\b0 caracter�sticas}{\b0 demogr�ficas}{\b0 y}{\b0 cl�nicas}{\b0
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}}\par}{\phpg\posx680\pvpg\posy711\absw217\absh142 \f20 \fs12 \cf0 \f20 \fs12 \cf0
100 \par
}
{\phpg\posx5258\pvpg\posy713\absw1048\absh138 \i \f20 \fs12 \cf0 \i \f20 \fs12 \cf0
11.� Congreso ALAT \par
}
{\phpg\posx1394\pvpg\posy1122\absw2647\absh142 \f20 \fs12 \cf0 \f20 \fs12 \cf0
Tabla 1 p�ster 232. Resumen de casos con TB \par
}
{\phpg\posx680\pvpg\posy4673\absw5020\absh2068 \f20 \fs15 \cf0 \f20 \fs15 \cf0 vada
en los pacientes tratados fue 16,5 veces mayor que la incidencia
\par}{\phpg\posx680\pvpg\posy4673\absw5020\absh2068 \sl-210 \f20 \fs15 \cf0
calculada en la poblaci�n general en 2016 (25,4/100.000). En la si-
\par}{\phpg\posx680\pvpg\posy4673\absw5020\absh2068 \sl-210 \f20 \fs15 \cf0 guiente
tabla se resumen los casos de TB, la enfermedad de base, el
\par}{\phpg\posx680\pvpg\posy4673\absw5020\absh2068 \sl-210 \f20 \fs15 \cf0 anti-
TNF{\field{\*\fldinst SYMBOL 97 \\f Symbol }} y el cribado y tratamiento de
infecci�n tuberculosa laten-
\par}{\phpg\posx680\pvpg\posy4673\absw5020\absh2068 \sl-210 \f20 \fs15 \cf0 te
(ITBL).
\par}{\phpg\posx680\pvpg\posy4673\absw5020\absh2068 \sl-210 \f20 \fs15 \cf0 {\b
Conclusiones:} La incidencia de TB en el grupo de pacientes estudia-
\par}{\phpg\posx680\pvpg\posy4673\absw5020\absh2068 \sl-210 \f20 \fs15 \cf0 dos fue
significativamente superior al de la poblaci�n general, con
\par}{\phpg\posx680\pvpg\posy4673\absw5020\absh2068 \sl-210 \f20 \fs15 \cf0
frecuencia elevada de presentaciones extra-pulmonares. El cribado
\par}{\phpg\posx680\pvpg\posy4673\absw5020\absh2068 \sl-210 \f20 \fs15 \cf0 de ITBL
con un algoritmo pre-establecido deber�a ser indispensable
\par}{\phpg\posx680\pvpg\posy4673\absw5020\absh2068 \sl-210 \f20 \fs15 \cf0 para
disminuir la incidencia de TB en la poblaci�n que recibe estos
\par}{\phpg\posx680\pvpg\posy4673\absw5020\absh2068 \sl-210 \f20 \fs15 \cf0
f�rmacos. \par
}
{\phpg\posx680\pvpg\posy7601\absw5021\absh6614 \b \f20 \fs15 \cf0 \b \f20 \fs15
\cf0 233. TUBERCULOSIS CONG�NITA: UN RETO DE DIAGN�STICO
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TEMPRANO
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{\b0 C.}{\b0 Alvitez}{\b0 Luna,}{\b0 I.}{\b0 Morocho}{\b0 Ore}{\b0 y}{\b0
N.}{\b0 Lovat�n}{\b0 Gudiel }
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{\b0\i Servicio}{\b0\i de}{\b0\i Neumolog�a}{\b0\i Pedi�trica.}{\b0\i Hospital}
{\b0\i Cayetano}{\b0\i Heredia. }
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\fs15 \cf0 Introducci�n:{\b0 La}{\b0 tuberculosis}{\b0 es}{\b0 una}{\b0
enfermedad}{\b0 prevalente}{\b0 a}{\b0 nivel }
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Material y m�todos:{\b0 Reporte}{\b0 de}{\b0 caso. }
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Resultados:{\b0 Prematuro}{\b0 de}{\b0 33}{\b0 semanas,}{\b0 nacido}{\b0 en}
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�tero}{\b0 a}{\b0 patolog�a.}{\b0 Madre}{\b0 continua}{\b0 febril}{\b0 y}{\b0
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radiograf�a}{\b0 y}{\b0 tomograf�a}{\b0 de}{\b0 t�rax}{\b0 que}{\b0 reporta}
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\par}{\phpg\posx680\pvpg\posy7601\absw5021\absh6614 \sl-210 \b \f20 \fs15 \cf0 {\b0
tratamiento}{\b0 antituberculoso,}{\b0 la}{\b0 fiebre}{\b0 cae}{\b0 al}{\b0
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tado}{\b0 de}{\b0 patolog�as}{\b0 reportan}{\b0 granulomas}{\b0 en}{\b0
endometrio}{\b0 y}{\b0 placenta; }
\par}{\phpg\posx680\pvpg\posy7601\absw5021\absh6614 \sl-210 \b \f20 \fs15 \cf0 {\b0
estudios}{\b0 en}{\b0 neonato}{\b0 en}{\b0 busca}{\b0 de}{\b0 tuberculosis,}
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\par}{\phpg\posx680\pvpg\posy7601\absw5021\absh6614 \sl-210 \b \f20 \fs15 \cf0 {\b0
veces)}{\b0 y}{\b0 ecograf�a}{\b0 abdominal}{\b0 no}{\b0 contributorios}{\b0
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\par}{\phpg\posx680\pvpg\posy7601\absw5021\absh6614 \sl-210 \b \f20 \fs15 \cf0 {\b0
neonato}{\b0 en}{\b0 ese}{\b0 momento}{\b0 (16}{\b0 d�as)}{\b0 estable.}{\b0
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\par}{\phpg\posx680\pvpg\posy7601\absw5021\absh6614 \sl-210 \b \f20 \fs15 \cf0 {\b0
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\par}{\phpg\posx680\pvpg\posy7601\absw5021\absh6614 \sl-210 \b \f20 \fs15 \cf0 {\b0
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\par}{\phpg\posx680\pvpg\posy7601\absw5021\absh6614 \sl-210 \b \f20 \fs15 \cf0 {\b0
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}
{\phpg\posx6037\pvpg\posy8871\absw5019\absh1313 \b \f20 \fs15 \cf0 \b \f20 \fs15
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{\b0 prevalente}{\b0 pero}{\b0 la }
\par}{\phpg\posx6037\pvpg\posy8871\absw5019\absh1313 \sl-210 \b \f20 \fs15 \cf0
{\b0 infecci�n}{\b0 cong�nita}{\b0 es}{\b0 raramente}{\b0 diagnosticada}{\b0
y}{\b0 requiere}{\b0 un}{\b0 alto }
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es}{\b0 favorable. }\par
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{\phpg\posx6037\pvpg\posy10751\absw5020\absh3779 \b \f20 \fs15 \cf0 \b \f20
\fs15 \cf0 234. COHORTE DE TRATAMIENTO DE TBPFP PANSENSIBLE Y
\par}{\phpg\posx6037\pvpg\posy10751\absw5020\absh3779 \sl-200 \b \f20 \fs15 \cf0
NUEVOS COMPARANDO 2.� FASE 2 VS. 3 VECES POR SEMANA
\par}{\phpg\posx6037\pvpg\posy10751\absw5020\absh3779 \sl-200 \b \f20 \fs15 \cf0 EN
PER�
\par}{\phpg\posx6037\pvpg\posy10751\absw5020\absh3779 \sl-170 \par\b \f20 \fs15
\cf0 {\b0 S.}{\b0 Pecho,}{\b0 O.}{\b0 Jave}{\b0 y}{\b0 J.C.}{\b0 Saravia }
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\cf0 {\b0\i Hospital}{\b0\i Edgardo}{\b0\i Rebagliati}{\b0\i Martins.}{\b0\i
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\cf0 Introducci�n:{\b0 Seg�n}{\b0 OPS/OMS}{\b0 Per�}{\b0 presenta}{\b0 una}
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{\b0 de}{\b0 TB}{\b0 de}{\b0 96,9}{\b0 �}{\b0 100.000}{\b0 siendo}{\b0 el}
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\i \f20 \fs12 \cf0 11.� Congreso ALAT
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{\b\i0 \fs15 Material}{\b\i0 \fs15 y}{\b\i0 \fs15 m�todos:}{\i0 \fs15 Estudio}
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y}{\i0 \fs15 2HREZ/4(HR)2}{\i0 \fs15 en }
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{\i0 \fs15 sibles.}{\i0 \fs15 Se}{\i0 \fs15 evidencia}{\i0 \fs15 mejores}{\i0
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con}{\i0 \fs15 segunda}{\i0 \fs15 fase}{\i0 \fs15 4(HR)2}{\i0 \fs15 y}{\i0
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a}{\i0 \fs15 pansensibles.}{\i0 \fs15 Adicionalmente,}{\i0 \fs15 seg�n}{\i0
\fs15 el }
\par}{\phpg\posx850\pvpg\posy713\absw5626\absh3806 \sl-210 \i \f20 \fs12 \cf0
{\i0 \fs15 PCT}{\i0 \fs15 en}{\i0 \fs15 el}{\i0 \fs15 2013}{\i0 \fs15 hubo}{\i0
\fs15 1657}{\i0 \fs15 reca�das}{\i0 \fs15 a}{\i0 \fs15 nivel}{\i0 \fs15
nacional,}{\i0 \fs15 y}{\i0 \fs15 el}{\i0 \fs15 2016}{\i0 \fs15 el}{\i0 \fs15
n�- }
\par}{\phpg\posx850\pvpg\posy713\absw5626\absh3806 \sl-210 \i \f20 \fs12 \cf0
{\i0 \fs15 mero}{\i0 \fs15 de}{\i0 \fs15 reca�das}{\i0 \fs15 aument�}{\i0 \fs15
a}{\i0 \fs15 2517. }
\par}{\phpg\posx850\pvpg\posy713\absw5626\absh3806 \sl-144 \par\i \f20 \fs12 \cf0
{\i0 Tabla.}{\i0 Resultado}{\i0 de}{\i0 Cohortes}{\i0 Per�}{\i0 y}{\i0 Comas}
{\i0 seg�n}{\i0 Tratamiento}{\i0 recibido}{\i0 por}{\i0 per�odo }\par
}
{\phpg\posx11015\pvpg\posy711\absw209\absh142 \f20 \fs12 \cf0 \f20 \fs12 \cf0
101 \par
}
{\phpg\posx850\pvpg\posy6561\absw5017\absh1313 \b \f20 \fs15 \cf0 \b \f20 \fs15
\cf0 Conclusiones:{\b0 No}{\b0 se}{\b0 hall�}{\b0 diferencias}{\b0 en}{\b0
cuanto}{\b0 a}{\b0 �xito}{\b0 o}{\b0 fracaso}{\b0 en- }
\par}{\phpg\posx850\pvpg\posy6561\absw5017\absh1313 \sl-210 \b \f20 \fs15 \cf0 {\b0
tre}{\b0 ambos}{\b0 esquemas.}{\b0 No}{\b0 se}{\b0 ha}{\b0 demostrado}{\b0
ning�n}{\b0 beneficio}{\b0 adicional }
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reportado}{\b0 un}{\b0 incremento}{\b0 no}{\b0 significativo}{\b0 de}{\b0
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pansensibles. }\par
}
{\phpg\posx850\pvpg\posy8861\absw5017\absh5480 \b \f20 \fs15 \cf0 \b \f20 \fs15
\cf0 235. TUBERCULOSIS PULMONAR EN UN HOSPITAL REGIONAL
\par}{\phpg\posx850\pvpg\posy8861\absw5017\absh5480 \sl-170 \par\b \f20 \fs15 \cf0
{\b0 E.}{\b0 Cepeda,}{\b0 O.}{\b0 Granados,}{\b0 E.}{\b0 Reyes}{\b0 y}{\b0
L.}{\b0 Hern�ndez }
\par}{\phpg\posx850\pvpg\posy8861\absw5017\absh5480 \sl-156 \par\b \f20 \fs15 \cf0
{\b0\i Servicio}{\b0\i M�dico}{\b0\i Petr�leos}{\b0\i Mexicanos. }
\par}{\phpg\posx850\pvpg\posy8861\absw5017\absh5480 \sl-202 \par\b \f20 \fs15 \cf0
Introducci�n:{\b0 Una}{\b0 tercera}{\b0 parte}{\b0 de}{\b0 la}{\b0 poblaci�n}
{\b0 mundial}{\b0 se}{\b0 encuen- }
\par}{\phpg\posx850\pvpg\posy8861\absw5017\absh5480 \sl-210 \b \f20 \fs15 \cf0 {\b0
tra}{\b0 infectado}{\b0 por}{\b0 M.}{\b0 tuberculosis,}{\b0 existen}{\b0
factores}{\b0 del}{\b0 hu�sped}{\b0 que }
\par}{\phpg\posx850\pvpg\posy8861\absw5017\absh5480 \sl-210 \b \f20 \fs15 \cf0 {\b0
incrementan}{\b0 el}{\b0 riesgo}{\b0 de}{\b0 progresi�n,}{\b0 activaci�n}{\b0
y}{\b0 reactivaci�n}{\b0 de}{\b0 la }
\par}{\phpg\posx850\pvpg\posy8861\absw5017\absh5480 \sl-210 \b \f20 \fs15 \cf0 {\b0
tuberculosis;}{\b0 como}{\b0 son}{\b0 enfermedades}{\b0 sist�micas}{\b0
cr�nico}{\b0 degenerati- }
\par}{\phpg\posx850\pvpg\posy8861\absw5017\absh5480 \sl-210 \b \f20 \fs15 \cf0 {\b0
vas,}{\b0 estatus}{\b0 nutricional}{\b0 y}{\b0 estados}{\b0 de}{\b0
inmunocompromiso.}{\b0 Objetivo: }
\par}{\phpg\posx850\pvpg\posy8861\absw5017\absh5480 \sl-210 \b \f20 \fs15 \cf0 {\b0
conocer}{\b0 las}{\b0 caracter�sticas}{\b0 cl�nicas}{\b0 y}{\b0 patolog�as}
{\b0 asociadas}{\b0 a}{\b0 tubercu- }
\par}{\phpg\posx850\pvpg\posy8861\absw5017\absh5480 \sl-210 \b \f20 \fs15 \cf0 {\b0
losis}{\b0 pulmonar}{\b0 en}{\b0 un}{\b0 hospital}{\b0 regional;}{\b0 as�}
{\b0 como}{\b0 los}{\b0 m�todos}{\b0 por}{\b0 los }
\par}{\phpg\posx850\pvpg\posy8861\absw5017\absh5480 \sl-210 \b \f20 \fs15 \cf0 {\b0
cuales}{\b0 fueron}{\b0 diagnosticados. }
\par}{\phpg\posx850\pvpg\posy8861\absw5017\absh5480 \sl-210 \b \f20 \fs15 \cf0
Material y m�todos:{\b0 Se}{\b0 hizo}{\b0 un}{\b0 estudio,}{\b0 que}{\b0
inclu�an}{\b0 pacientes}{\b0 hos- }
\par}{\phpg\posx850\pvpg\posy8861\absw5017\absh5480 \sl-210 \b \f20 \fs15 \cf0 {\b0
pitalizados}{\b0 y}{\b0 de}{\b0 la}{\b0 consulta}{\b0 externa}{\b0 que}{\b0
comprendi�}{\b0 del}{\b0 2004}{\b0 al}{\b0 2015. }
\par}{\phpg\posx850\pvpg\posy8861\absw5017\absh5480 \sl-210 \b \f20 \fs15 \cf0 {\b0
Se}{\b0 registr�}{\b0 un}{\b0 total}{\b0 de}{\b0 124}{\b0 pacientes;}{\b0
los}{\b0 cuales}{\b0 se}{\b0 distribuyeron}{\b0 78 }
\par}{\phpg\posx850\pvpg\posy8861\absw5017\absh5480 \sl-210 \b \f20 \fs15 \cf0 {\b0
hombres,}{\b0 62,9%,}{\b0 46}{\b0 mujeres,}{\b0 37,1%,}{\b0 donde}{\b0 la}
{\b0 edad}{\b0 promedio}{\b0 fue}{\b0 de }
\par}{\phpg\posx850\pvpg\posy8861\absw5017\absh5480 \sl-210 \b \f20 \fs15 \cf0 {\b0
56,9}{\b0 �}{\b0 19,5}{\b0 a�os,}{\b0 con}{\b0 una}{\b0 edad}{\b0 m�nima}
{\b0 de}{\b0 18}{\b0 a�os}{\b0 y}{\b0 edad}{\b0 m�xima}{\b0 de }
\par}{\phpg\posx850\pvpg\posy8861\absw5017\absh5480 \sl-210 \b \f20 \fs15 \cf0 {\b0
98}{\b0 a�os.}{\b0 Se}{\b0 utiliz�}{\b0 el}{\b0 programa}{\b0 estad�stico}
{\b0 SPSS}{\b0 versi�n}{\b0 24}{\b0 para}{\b0 Win- }
\par}{\phpg\posx850\pvpg\posy8861\absw5017\absh5480 \sl-210 \b \f20 \fs15 \cf0 {\b0
dows. }
\par}{\phpg\posx850\pvpg\posy8861\absw5017\absh5480 \sl-210 \b \f20 \fs15 \cf0
Resultados:{\b0 La}{\b0 comorbilidad}{\b0 m�s}{\b0 frecuente}{\b0 fue}{\b0
s�ndrome}{\b0 metab�lico }
\par}{\phpg\posx850\pvpg\posy8861\absw5017\absh5480 \sl-210 \b \f20 \fs15 \cf0 {\b0
en}{\b0 35,5%}{\b0 de}{\b0 los}{\b0 casos,}{\b0 seguido}{\b0 de}{\b0
diabetes}{\b0 mellitus,}{\b0 hipertensi�n}{\b0 ar- }
\par}{\phpg\posx850\pvpg\posy8861\absw5017\absh5480 \sl-210 \b \f20 \fs15 \cf0 {\b0
terial,}{\b0 y}{\b0 solo}{\b0 2,4%}{\b0 con}{\b0 serolog�a}{\b0 positiva}{\b0
para}{\b0 VIH.}{\b0 De}{\b0 los}{\b0 a�os}{\b0 inclui- }
\par}{\phpg\posx850\pvpg\posy8861\absw5017\absh5480 \sl-210 \b \f20 \fs15 \cf0 {\b0
dos}{\b0 en}{\b0 el}{\b0 estudio}{\b0 el}{\b0 mayor}{\b0 n�mero}{\b0 de}{\b0
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\par}{\phpg\posx850\pvpg\posy8861\absw5017\absh5480 \sl-210 \b \f20 \fs15 \cf0 {\b0
2006,}{\b0 seguidos}{\b0 de}{\b0 2011,}{\b0 2009}{\b0 y}{\b0 2010}{\b0
respectivamente.}{\b0 El}{\b0 diagn�stico }
\par}{\phpg\posx850\pvpg\posy8861\absw5017\absh5480 \sl-210 \b \f20 \fs15 \cf0 {\b0
se}{\b0 realiz�}{\b0 el}{\b0 58,1%}{\b0 mediante}{\b0 estudio}{\b0 BAAR,}{\b0
78}{\b0 pacientes;}{\b0 seguido}{\b0 por }
\par}{\phpg\posx850\pvpg\posy8861\absw5017\absh5480 \sl-210 \b \f20 \fs15 \cf0 {\b0
cl�nica/imagen}{\b0 en}{\b0 13,7%,}{\b0 17}{\b0 pacientes,}{\b0 biopsia}{\b0
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\par}{\phpg\posx850\pvpg\posy8861\absw5017\absh5480 \sl-210 \b \f20 \fs15 \cf0 {\b0
resto}{\b0 por}{\b0 toracoscopia,}{\b0 cultivo,}{\b0 PCR.}{\b0 Todos}{\b0
los}{\b0 pacientes}{\b0 recibieron }
\par}{\phpg\posx850\pvpg\posy8861\absw5017\absh5480 \sl-210 \b \f20 \fs15 \cf0 {\b0
tratamiento}{\b0 est�ndar}{\b0 con}{\b0 buena}{\b0 respuesta. }\par
}
{\phpg\posx6207\pvpg\posy10656\absw5017\absh935 \b \f20 \fs15 \cf0 \b \f20 \fs15
\cf0 Conclusiones:{\b0 En}{\b0 comparaci�n}{\b0 con}{\b0 otros}{\b0 estudios}
{\b0 en}{\b0 donde}{\b0 los}{\b0 pa- }
\par}{\phpg\posx6207\pvpg\posy10656\absw5017\absh935 \sl-210 \b \f20 \fs15 \cf0
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{\b0 berculosis}{\b0 activa,}{\b0 en}{\b0 nuestro}{\b0 centro}{\b0 las}{\b0
enfermedades}{\b0 cr�nico}{\b0 dege- }
\par}{\phpg\posx6207\pvpg\posy10656\absw5017\absh935 \sl-210 \b \f20 \fs15 \cf0
{\b0 nerativas}{\b0 en}{\b0 este}{\b0 caso}{\b0 el}{\b0 s�ndrome}{\b0
metab�lico}{\b0 tiene}{\b0 un}{\b0 mayor}{\b0 peso; }
\par}{\phpg\posx6207\pvpg\posy10656\absw5017\absh935 \sl-210 \b \f20 \fs15 \cf0
{\b0 por}{\b0 lo}{\b0 tanto,}{\b0 su}{\b0 importancia}{\b0 para}{\b0 incidir}
{\b0 en}{\b0 la}{\b0 prevenci�n}{\b0 y}{\b0 su}{\b0 control. }\par
}
{\phpg\posx6207\pvpg\posy12206\absw5019\absh2470 \b \f20 \fs15 \cf0 \b \f20
\fs15 \cf0 236. SINGULTO INCOERCIBLE SECUNDARIO A TUBERCULOSIS:
\par}{\phpg\posx6207\pvpg\posy12206\absw5019\absh2470 \sl-200 \b \f20 \fs15 \cf0
PRESENTACI�N DE UN CASO
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\cf0 {\b0 E.}{\b0 Cepeda,}{\b0 G.}{\b0 Santander,}{\b0 A.}{\b0 Salas}{\b0 y}
{\b0 D.}{\b0 Molina }
\par}{\phpg\posx6207\pvpg\posy12206\absw5019\absh2470 \sl-156 \par\b \f20 \fs15
\cf0 {\b0\i Hospital}{\b0\i Regional}{\b0\i de}{\b0\i PEMEX}{\b0\i Cd.}{\b0\i
Madero.}{\b0\i Tamaulipas.}{\b0\i Hospital}{\b0\i Central }
\par}{\phpg\posx6207\pvpg\posy12206\absw5019\absh2470 \sl-200 \b \f20 \fs15 \cf0
{\b0\i Sur}{\b0\i de}{\b0\i Alta}{\b0\i Especialidad}{\b0\i PEMEX.}{\b0\i
Ciudad}{\b0\i de}{\b0\i M�xico. }
\par}{\phpg\posx6207\pvpg\posy12206\absw5019\absh2470 \sl-219 \par\b \f20 \fs15
\cf0 Introducci�n:{\b0 Se}{\b0 trata}{\b0 de}{\b0 un}{\b0 enfermo}{\b0 con}
{\b0 singulto}{\b0 rebelde}{\b0 al}{\b0 trata- }
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{\b0 miento}{\b0 sin}{\b0 s�ntomas}{\b0 broncopulmonares,}{\b0 p�rdida}{\b0
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\par}{\phpg\posx6207\pvpg\posy12206\absw5019\absh2470 \sl-210 \b \f20 \fs15 \cf0
{\b0 de}{\b0 t�rax}{\b0 anormal,}{\b0 demostr�ndose}{\b0 tuberculosis}{\b0
activa}{\b0 como}{\b0 causa}{\b0 del }
\par}{\phpg\posx6207\pvpg\posy12206\absw5019\absh2470 \sl-210 \b \f20 \fs15 \cf0
{\b0 s�ntoma}{\b0 por}{\b0 invasi�n}{\b0 a}{\b0 pleura}{\b0 diafragm�tica}{\b0
y}{\b0 al}{\b0 diafragma. }
\par}{\phpg\posx6207\pvpg\posy12206\absw5019\absh2470 \sl-210 \b \f20 \fs15 \cf0
Material y m�todos:{\b0 Paciente}{\b0 del}{\b0 sexo}{\b0 masculino}{\b0 75}
{\b0 a�os}{\b0 de}{\b0 edad, }
\par}{\phpg\posx6207\pvpg\posy12206\absw5019\absh2470 \sl-210 \b \f20 \fs15 \cf0
{\b0 hernia}{\b0 hiatal}{\b0 y}{\b0 reflujo}{\b0 gastroesof�gico}{\b0 en}{\b0
2015}{\b0 mediante}{\b0 panendos- }\par
}
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}}\par}{\phpg\posx680\pvpg\posy711\absw213\absh142 \f20 \fs12 \cf0 \f20 \fs12 \cf0
102 \par
}
{\phpg\posx5258\pvpg\posy713\absw1048\absh138 \i \f20 \fs12 \cf0 \i \f20 \fs12 \cf0
11.� Congreso ALAT \par
}
{\phpg\posx680\pvpg\posy1103\absw5020\absh6226 \f20 \fs15 \cf0 \f20 \fs15 \cf0
copia, enfermedad diverticular no complicada y enfermedad hemo-
\par}{\phpg\posx680\pvpg\posy1103\absw5020\absh6226 \sl-210 \f20 \fs15 \cf0
rroidal, no toxicoman�as, no diabetes ni otras cr�nicodegenerativas.
\par}{\phpg\posx680\pvpg\posy1103\absw5020\absh6226 \sl-210 \f20 \fs15 \cf0 {\b
Resultados:} P�rdida de peso de 2 a�os de evoluci�n y Rx de t�rax
\par}{\phpg\posx680\pvpg\posy1103\absw5020\absh6226 \sl-210 \f20 \fs15 \cf0
anormal, sin s�ntomas broncopulmonares, radiol�gicamente im�ge-
\par}{\phpg\posx680\pvpg\posy1103\absw5020\absh6226 \sl-210 \f20 \fs15 \cf0 nes
sugestivas de tuberculosis, baciloscopias de flemas negativas,
\par}{\phpg\posx680\pvpg\posy1103\absw5020\absh6226 \sl-210 \f20 \fs15 \cf0 enviado
a neumolog�a, ante la ausencia de cuadro cl�nico se le propu-
\par}{\phpg\posx680\pvpg\posy1103\absw5020\absh6226 \sl-210 \f20 \fs15 \cf0 so
broncoscopia para b�squeda de etiolog�a, no acept�; baciloscopias
\par}{\phpg\posx680\pvpg\posy1103\absw5020\absh6226 \sl-210 \f20 \fs15 \cf0
posteriores negativas, continu� perdida ponderal, amerit� hospitali-
\par}{\phpg\posx680\pvpg\posy1103\absw5020\absh6226 \sl-210 \f20 \fs15 \cf0 zaci�n
en 3 ocasiones, estancias prolongadas por singulto, sometido
\par}{\phpg\posx680\pvpg\posy1103\absw5020\absh6226 \sl-210 \f20 \fs15 \cf0 a
broncoscopia la cual fue normal, citolog�as, baciloscopias y cultivos
\par}{\phpg\posx680\pvpg\posy1103\absw5020\absh6226 \sl-210 \f20 \fs15 \cf0
negativos a Baar hongos, se aisl� Klebsiella pneumoniae, recibi� tra-
\par}{\phpg\posx680\pvpg\posy1103\absw5020\absh6226 \sl-210 \f20 \fs15 \cf0
tamiento. Tomograf�a opacidad heterog�nea en l�bulo superior dere-
\par}{\phpg\posx680\pvpg\posy1103\absw5020\absh6226 \sl-210 \f20 \fs15 \cf0 cho,
sugestivas de bronquiectasias y cavitaci�n, patr�n reticulonodu-
\par}{\phpg\posx680\pvpg\posy1103\absw5020\absh6226 \sl-210 \f20 \fs15 \cf0 lar
bilateral que no exist�a; nueva broncoscopia cultivos negativos PCR
\par}{\phpg\posx680\pvpg\posy1103\absw5020\absh6226 \sl-210 \f20 \fs15 \cf0 para
Mycobacterium tuberculosis negativo, marcadores tumorales
\par}{\phpg\posx680\pvpg\posy1103\absw5020\absh6226 \sl-210 \f20 \fs15 \cf0
negativos, continu� perdida ponderal sin diagn�stico, se llev� a tora-
\par}{\phpg\posx680\pvpg\posy1103\absw5020\absh6226 \sl-210 \f20 \fs15 \cf0
coscopia diagn�stica encontr�ndose lesiones granulomatosas en pul-
\par}{\phpg\posx680\pvpg\posy1103\absw5020\absh6226 \sl-210 \f20 \fs15 \cf0 m�n
derecho y pleura visceral. Reporte de anatom�a patol�gica: lesio-
\par}{\phpg\posx680\pvpg\posy1103\absw5020\absh6226 \sl-210 \f20 \fs15 \cf0 nes
granulomatosas caseosas, complic�ndose con fistula
\par}{\phpg\posx680\pvpg\posy1103\absw5020\absh6226 \sl-210 \f20 \fs15 \cf0
broncopleural, neumot�rax hipertensivo y enfisema subcut�neo pro-
\par}{\phpg\posx680\pvpg\posy1103\absw5020\absh6226 \sl-210 \f20 \fs15 \cf0 gresivo
post operatorio que requiri� de segunda sonda con lo que se
\par}{\phpg\posx680\pvpg\posy1103\absw5020\absh6226 \sl-210 \f20 \fs15 \cf0
controlaron el enfisema y el neumot�rax no as� la fistula. Fue necesa-
\par}{\phpg\posx680\pvpg\posy1103\absw5020\absh6226 \sl-210 \f20 \fs15 \cf0 rio
enviarlo a cirug�a de t�rax para tratamiento quir�rgico, a Hospital
\par}{\phpg\posx680\pvpg\posy1103\absw5020\absh6226 \sl-210 \f20 \fs15 \cf0 de
especialidades, ah� se obtuvo Barr de esputo positivos y se inici�
\par}{\phpg\posx680\pvpg\posy1103\absw5020\absh6226 \sl-210 \f20 \fs15 \cf0
tratamiento antituberculoso: desapareci� el singulto.
\par}{\phpg\posx680\pvpg\posy1103\absw5020\absh6226 \sl-210 \f20 \fs15 \cf0 {\b
Conclusiones:} En un principio se consider� el RGE como causa del
\par}{\phpg\posx680\pvpg\posy1103\absw5020\absh6226 \sl-210 \f20 \fs15 \cf0
singulto, pero no de la caquexia, la demostraci�n de necrosis caseosa
\par}{\phpg\posx680\pvpg\posy1103\absw5020\absh6226 \sl-210 \f20 \fs15 \cf0 en el
diafragma, el Barr positivo, la desaparici�n del hipo despu�s del
\par}{\phpg\posx680\pvpg\posy1103\absw5020\absh6226 \sl-210 \f20 \fs15 \cf0
tratamiento antituberculoso, fundament� el diagn�stico de tubercu-
\par}{\phpg\posx680\pvpg\posy1103\absw5020\absh6226 \sl-210 \f20 \fs15 \cf0 losis
como causa. La fistula broncopleural es una complicaci�n grave
\par}{\phpg\posx680\pvpg\posy1103\absw5020\absh6226 \sl-210 \f20 \fs15 \cf0 en
cirug�a pleuropulmonar cuando hay actividad tuberculosa como
\par}{\phpg\posx680\pvpg\posy1103\absw5020\absh6226 \sl-210 \f20 \fs15 \cf0 en el
caso que se trata y requiere de un cirujano de t�rax experimen-
\par}{\phpg\posx680\pvpg\posy1103\absw5020\absh6226 \sl-210 \f20 \fs15 \cf0 tado
para resolver esta complicaci�n. \par
}
{\phpg\posx6037\pvpg\posy1103\absw5020\absh2635 \f20 \fs15 \cf0 \f20 \fs15 \cf0 se
encontr� epidermis con espongiosis moderada con infiltrado infla-
\par}{\phpg\posx6037\pvpg\posy1103\absw5020\absh2635 \sl-210 \f20 \fs15 \cf0
matorio linfocitario con presencia de eosin�filos. Por caracter�sticas
\par}{\phpg\posx6037\pvpg\posy1103\absw5020\absh2635 \sl-210 \f20 \fs15 \cf0
cl�nicas radiol�gicas y criterios de la escala regiSCAR de 8 puntos se
\par}{\phpg\posx6037\pvpg\posy1103\absw5020\absh2635 \sl-210 \f20 \fs15 \cf0
establece el diagn�stico de s�ndrome de DRESS con da�o de �rgano
\par}{\phpg\posx6037\pvpg\posy1103\absw5020\absh2635 \sl-210 \f20 \fs15 \cf0
hep�tico y pulmonar. Cuadro cl�nico mejora luego de suspender tra-
\par}{\phpg\posx6037\pvpg\posy1103\absw5020\absh2635 \sl-210 \f20 \fs15 \cf0
tamiento antituberculoso, agregar adrenalina endovenosa (0,01 cc/Kg
\par}{\phpg\posx6037\pvpg\posy1103\absw5020\absh2635 \sl-210 \f20 \fs15 \cf0
peso/d�a), corticoides sist�micos endovenoso y antihistam�nicos en-
\par}{\phpg\posx6037\pvpg\posy1103\absw5020\absh2635 \sl-210 \f20 \fs15 \cf0
dovenoso.
\par}{\phpg\posx6037\pvpg\posy1103\absw5020\absh2635 \sl-210 \f20 \fs15 \cf0 {\b
Conclusiones:} El s�ndrome de DRESS tiene car�cter multisist�mico
\par}{\phpg\posx6037\pvpg\posy1103\absw5020\absh2635 \sl-210 \f20 \fs15 \cf0 con
alta morbimortalidad. Los casos relacionados al tratamiento an-
\par}{\phpg\posx6037\pvpg\posy1103\absw5020\absh2635 \sl-210 \f20 \fs15 \cf0
tituberculoso son poco reportados en la literatura. Conocer las carac-
\par}{\phpg\posx6037\pvpg\posy1103\absw5020\absh2635 \sl-210 \f20 \fs15 \cf0
ter�sticas cl�nicas y criterios diagn�sticos del s�ndrome de DRESS en
\par}{\phpg\posx6037\pvpg\posy1103\absw5020\absh2635 \sl-210 \f20 \fs15 \cf0 el
contexto de pacientes recibiendo tratamiento antituberculoso per-
\par}{\phpg\posx6037\pvpg\posy1103\absw5020\absh2635 \sl-210 \f20 \fs15 \cf0 mitir�
un adecuado manejo de estos casos. \par
}
{\phpg\posx680\pvpg\posy8441\absw5021\absh5858 \b \f20 \fs15 \cf0 \b \f20 \fs15
\cf0 237. PULM�N EOSINOF�LICO EN EL CONTEXTO DEL S�NDROME
\par}{\phpg\posx680\pvpg\posy8441\absw5021\absh5858 \sl-200 \b \f20 \fs15 \cf0 DE
DRESS POR TRATAMIENTO ANTITUBERCULOSO
\par}{\phpg\posx680\pvpg\posy8441\absw5021\absh5858 \sl-170 \par\b \f20 \fs15 \cf0
{\b0 D.}{\b0 Le�n,}{\b0 M.}{\b0 Paredes}{\b0 y}{\b0 J.}{\b0 de}{\b0 los}{\b0
R�os }
\par}{\phpg\posx680\pvpg\posy8441\absw5021\absh5858 \sl-156 \par\b \f20 \fs15 \cf0
{\b0\i Servicio}{\b0\i de}{\b0\i Neumolog�a.}{\b0\i Centro}{\b0\i de}{\b0\i
Excelencia}{\b0\i Ni�o}{\b0\i Jes�s.}{\b0\i Hospital }
\par}{\phpg\posx680\pvpg\posy8441\absw5021\absh5858 \sl-200 \b \f20 \fs15 \cf0
{\b0\i Mar�a}{\b0\i Auxiliadora. }
\par}{\phpg\posx680\pvpg\posy8441\absw5021\absh5858 \sl-212 \par\b \f20 \fs15 \cf0
Introducci�n:{\b0 El}{\b0 s�ndrome}{\b0 de}{\b0 DRESS}{\b0 (Drug}{\b0
Reaction}{\b0 with}{\b0 Eosinophi- }
\par}{\phpg\posx680\pvpg\posy8441\absw5021\absh5858 \sl-210 \b \f20 \fs15 \cf0 {\b0
lia}{\b0 and}{\b0 Systemic}{\b0 Symptons)}{\b0 es}{\b0 potencialmente}{\b0
letal,}{\b0 las}{\b0 manifestacio- }
\par}{\phpg\posx680\pvpg\posy8441\absw5021\absh5858 \sl-210 \b \f20 \fs15 \cf0 {\b0
nes}{\b0 cl�nicas}{\b0 son}{\b0 variables}{\b0 lo}{\b0 que}{\b0 dificulta}
{\b0 su}{\b0 diagn�stico.}{\b0 Se}{\b0 presenta }
\par}{\phpg\posx680\pvpg\posy8441\absw5021\absh5858 \sl-210 \b \f20 \fs15 \cf0 {\b0
el}{\b0 caso}{\b0 de}{\b0 una}{\b0 paciente}{\b0 que}{\b0 desarrolla}{\b0
pulm�n}{\b0 eosinofilico}{\b0 en}{\b0 el}{\b0 con- }
\par}{\phpg\posx680\pvpg\posy8441\absw5021\absh5858 \sl-210 \b \f20 \fs15 \cf0 {\b0
texto}{\b0 de}{\b0 s�ndrome}{\b0 de}{\b0 DRESS}{\b0 por}{\b0 tratamiento}{\b0
antituberculoso.}{\b0 Objeti- }
\par}{\phpg\posx680\pvpg\posy8441\absw5021\absh5858 \sl-210 \b \f20 \fs15 \cf0 {\b0
vos:}{\b0 1.}{\b0 Reportar}{\b0 un}{\b0 caso}{\b0 poco}{\b0 com�n}{\b0 de}
{\b0 pulm�n}{\b0 eosinofilico}{\b0 en}{\b0 s�n- }
\par}{\phpg\posx680\pvpg\posy8441\absw5021\absh5858 \sl-210 \b \f20 \fs15 \cf0 {\b0
drome}{\b0 de}{\b0 DRESS}{\b0 por}{\b0 tratamiento}{\b0 antituberculoso.}{\b0
2.}{\b0 Conocer}{\b0 formas }
\par}{\phpg\posx680\pvpg\posy8441\absw5021\absh5858 \sl-210 \b \f20 \fs15 \cf0 {\b0
severas}{\b0 del}{\b0 s�ndrome}{\b0 de}{\b0 DRESS. }
\par}{\phpg\posx680\pvpg\posy8441\absw5021\absh5858 \sl-210 \b \f20 \fs15 \cf0
Material y m�todos:{\b0 Estudio}{\b0 descriptivo,}{\b0 revisi�n}{\b0 de}{\b0
historia}{\b0 cl�nica }
\par}{\phpg\posx680\pvpg\posy8441\absw5021\absh5858 \sl-210 \b \f20 \fs15 \cf0 {\b0
y}{\b0 bibliograf�a. }
\par}{\phpg\posx680\pvpg\posy8441\absw5021\absh5858 \sl-210 \b \f20 \fs15 \cf0
Resultados:{\b0 Paciente}{\b0 mujer}{\b0 de}{\b0 19}{\b0 a�os}{\b0 con}{\b0
diagn�stico}{\b0 de}{\b0 tuberculo- }
\par}{\phpg\posx680\pvpg\posy8441\absw5021\absh5858 \sl-210 \b \f20 \fs15 \cf0 {\b0
sis}{\b0 pulmonar}{\b0 baciloscopia}{\b0 positiva}{\b0 que}{\b0 inicia}{\b0
tratamiento}{\b0 antituber- }
\par}{\phpg\posx680\pvpg\posy8441\absw5021\absh5858 \sl-210 \b \f20 \fs15 \cf0 {\b0
culoso}{\b0 de}{\b0 primera}{\b0 l�nea}{\b0 (isoniciada,}{\b0 rifampicina,}
{\b0 pirazinamida,}{\b0 etam- }
\par}{\phpg\posx680\pvpg\posy8441\absw5021\absh5858 \sl-210 \b \f20 \fs15 \cf0 {\b0
butol)}{\b0 y}{\b0 en}{\b0 la}{\b0 dosis}{\b0 25}{\b0 presenta}{\b0
lesiones}{\b0 d�rmicas}{\b0 maculo}{\b0 papulares }
\par}{\phpg\posx680\pvpg\posy8441\absw5021\absh5858 \sl-210 \b \f20 \fs15 \cf0 {\b0
morbiliformes}{\b0 pruriginosas}{\b0 en}{\b0 miembros}{\b0 inferiores}{\b0 de}
{\b0 forma}{\b0 ascen- }
\par}{\phpg\posx680\pvpg\posy8441\absw5021\absh5858 \sl-210 \b \f20 \fs15 \cf0 {\b0
dente,}{\b0 fiebre;}{\b0 adenopat�as}{\b0 dolorosas}{\b0 axilares,}{\b0
cervicales,}{\b0 inguinales; }
\par}{\phpg\posx680\pvpg\posy8441\absw5021\absh5858 \sl-210 \b \f20 \fs15 \cf0 {\b0
n�useas}{\b0 y}{\b0 v�mitos,}{\b0 por}{\b0 lo}{\b0 que}{\b0 acude}{\b0 a}
{\b0 consulta}{\b0 de}{\b0 neumolog�a}{\b0 y}{\b0 se }
\par}{\phpg\posx680\pvpg\posy8441\absw5021\absh5858 \sl-210 \b \f20 \fs15 \cf0 {\b0
decide}{\b0 su}{\b0 hospitalizaci�n.}{\b0 Durante}{\b0 su}{\b0 estancia}{\b0
desarrolla}{\b0 angioedema }
\par}{\phpg\posx680\pvpg\posy8441\absw5021\absh5858 \sl-210 \b \f20 \fs15 \cf0 {\b0
facial,}{\b0 las}{\b0 lesiones}{\b0 d�rmicas}{\b0 confluyen}{\b0 y}{\b0
presenta}{\b0 insuficiencia}{\b0 respi- }
\par}{\phpg\posx680\pvpg\posy8441\absw5021\absh5858 \sl-210 \b \f20 \fs15 \cf0 {\b0
ratoria.}{\b0 Se}{\b0 realizan}{\b0 estudios}{\b0 diagn�sticos}{\b0 que}{\b0
revelan}{\b0 leucocitosis, }
\par}{\phpg\posx680\pvpg\posy8441\absw5021\absh5858 \sl-210 \b \f20 \fs15 \cf0 {\b0
linfocitos}{\b0 at�picos,}{\b0 e}{\b0 hipereosinofilia,}{\b0 elevaci�n}{\b0
de}{\b0 transaminasas}{\b0 con }
\par}{\phpg\posx680\pvpg\posy8441\absw5021\absh5858 \sl-210 \b \f20 \fs15 \cf0 {\b0
patr�n}{\b0 colest�sico,}{\b0 adem�s}{\b0 de}{\b0 trastorno}{\b0 de}{\b0
coagulaci�n,}{\b0 relaci�n}{\b0 PO2/ }
\par}{\phpg\posx680\pvpg\posy8441\absw5021\absh5858 \sl-210 \b \f20 \fs15 \cf0 {\b0
FiO2:}{\b0 213;}{\b0 radiograf�a}{\b0 de}{\b0 t�rax}{\b0 con}{\b0 patr�n}{\b0
alveolo}{\b0 intersticial}{\b0 difuso }
\par}{\phpg\posx680\pvpg\posy8441\absw5021\absh5858 \sl-210 \b \f20 \fs15 \cf0 {\b0
bilateral}{\b0 con}{\b0 lesiones}{\b0 cavitarias}{\b0 en}{\b0 �pice}{\b0
derecho.}{\b0 En}{\b0 biopsia}{\b0 de}{\b0 piel }\par
}
{\phpg\posx6037\pvpg\posy4451\absw5020\absh5291 \b \f20 \fs15 \cf0 \b \f20 \fs15
\cf0 238.{\i MYCOBACTERIUM}{\i TUBERCULOSIS} SIMULANDO PROCESO
\par}{\phpg\posx6037\pvpg\posy4451\absw5020\absh5291 \sl-200 \b \f20 \fs15 \cf0
NEOPL�SICO
\par}{\phpg\posx6037\pvpg\posy4451\absw5020\absh5291 \sl-170 \par\b \f20 \fs15 \cf0
{\b0 C.}{\b0 Barboza,}{\b0 E.}{\b0 Gonz�lez,}{\b0 A.}{\b0 Ortega,}{\b0 F.}
{\b0 Coronel,}{\b0 F.}{\b0 Gonz�lez,}{\b0 L.}{\b0 Acosta }
\par}{\phpg\posx6037\pvpg\posy4451\absw5020\absh5291 \sl-200 \b \f20 \fs15 \cf0
{\b0 y}{\b0 R.}{\b0 Coronel }
\par}{\phpg\posx6037\pvpg\posy4451\absw5020\absh5291 \sl-156 \par\b \f20 \fs15 \cf0
{\b0\i Instituto}{\b0\i Nacional}{\b0\i de}{\b0\i Enfermedades}{\b0\i
Respiratorias}{\b0\i y}{\b0\i del}{\b0\i Ambiente- }
\par}{\phpg\posx6037\pvpg\posy4451\absw5020\absh5291 \sl-200 \b \f20 \fs15 \cf0
{\b0\i INERAM. }
\par}{\phpg\posx6037\pvpg\posy4451\absw5020\absh5291 \sl-217 \par\b \f20 \fs15 \cf0
Introducci�n:{\b0 La}{\b0 tuberculosis}{\b0 (TB)}{\b0 es}{\b0 una}{\b0
enfermedad}{\b0 con}{\b0 alta}{\b0 pre- }
\par}{\phpg\posx6037\pvpg\posy4451\absw5020\absh5291 \sl-210 \b \f20 \fs15 \cf0
{\b0 valencia}{\b0 en}{\b0 el}{\b0 mundo,}{\b0 y}{\b0 puede}{\b0 presentarse}
{\b0 de}{\b0 distintas}{\b0 formas;}{\b0 en }
\par}{\phpg\posx6037\pvpg\posy4451\absw5020\absh5291 \sl-210 \b \f20 \fs15 \cf0
{\b0 ocasiones}{\b0 mimetizando}{\b0 procesos}{\b0 neo}{\b0 proliferativos.}
{\b0 Presentamos}{\b0 dos }
\par}{\phpg\posx6037\pvpg\posy4451\absw5020\absh5291 \sl-210 \b \f20 \fs15 \cf0
{\b0 casos}{\b0 interesantes}{\b0 de}{\b0 TB}{\b0 simulando}{\b0 c�ncer}{\b0
de}{\b0 pulm�n. }
\par}{\phpg\posx6037\pvpg\posy4451\absw5020\absh5291 \sl-210 \b \f20 \fs15 \cf0
Material y m�todos:{\b0 Estudio}{\b0 observacional,}{\b0 reporte}{\b0 de}{\b0
dos}{\b0 casos}{\b0 de }
\par}{\phpg\posx6037\pvpg\posy4451\absw5020\absh5291 \sl-210 \b \f20 \fs15 \cf0
{\b0 TB}{\b0 simulando}{\b0 proceso}{\b0 neopl�sico. }
\par}{\phpg\posx6037\pvpg\posy4451\absw5020\absh5291 \sl-210 \b \f20 \fs15 \cf0
Resultados:{\b0 Cuadro}{\b0 cl�nico}{\b0 1:}{\b0 masculino}{\b0 81}{\b0
a�os,}{\b0 tabaquista}{\b0 por}{\b0 40 }
\par}{\phpg\posx6037\pvpg\posy4451\absw5020\absh5291 \sl-210 \b \f20 \fs15 \cf0
{\b0 a�os,}{\b0 �ndice}{\b0 tab�quico}{\b0 (IT):}{\b0 96}{\b0 paquetes/a�os}
{\b0 (p/a).}{\b0 Dos}{\b0 meses}{\b0 con }
\par}{\phpg\posx6037\pvpg\posy4451\absw5020\absh5291 \sl-210 \b \f20 \fs15 \cf0
{\b0 disnea}{\b0 progresiva,}{\b0 tos}{\b0 productiva,}{\b0 p�rdida}{\b0 de}
{\b0 10}{\b0 kilos,}{\b0 no}{\b0 otros}{\b0 s�nto- }
\par}{\phpg\posx6037\pvpg\posy4451\absw5020\absh5291 \sl-210 \b \f20 \fs15 \cf0
{\b0 mas.}{\b0 Examen}{\b0 f�sico}{\b0 (EF):}{\b0 murmullo}{\b0 vesicular}{\b0
(MV)}{\b0 disminuido}{\b0 en }
\par}{\phpg\posx6037\pvpg\posy4451\absw5020\absh5291 \sl-210 \b \f20 \fs15 \cf0
{\b0 campos}{\b0 pulmonares}{\b0 (ACP).}{\b0 Esputo}{\b0 seriado}{\b0 y}{\b0
GeneXpert}{\b0 negativos; }
\par}{\phpg\posx6037\pvpg\posy4451\absw5020\absh5291 \sl-210 \b \f20 \fs15 \cf0
{\b0 toracotom�a}{\b0 posterolateral}{\b0 con}{\b0 biopsia:}{\b0 proceso}{\b0
granulomatoso}{\b0 com- }
\par}{\phpg\posx6037\pvpg\posy4451\absw5020\absh5291 \sl-210 \b \f20 \fs15 \cf0
{\b0 patible}{\b0 con}{\b0 TB.}{\b0 Inicia}{\b0 tratamiento}{\b0 para}{\b0
TB}{\b0 Pulmonar.}{\b0 Paciente}{\b0 con }
\par}{\phpg\posx6037\pvpg\posy4451\absw5020\absh5291 \sl-210 \b \f20 \fs15 \cf0
{\b0 mejor�a}{\b0 cl�nica}{\b0 y}{\b0 buena}{\b0 adherencia}{\b0 al}{\b0
antibacilar.}{\b0 Cuadro}{\b0 cl�nico}{\b0 2: }
\par}{\phpg\posx6037\pvpg\posy4451\absw5020\absh5291 \sl-210 \b \f20 \fs15 \cf0
{\b0 masculino}{\b0 58}{\b0 a�os,}{\b0 tabaquista}{\b0 por}{\b0 40}{\b0 a�os}
{\b0 IT:}{\b0 100}{\b0 p/y.}{\b0 Dos}{\b0 meses}{\b0 con }
\par}{\phpg\posx6037\pvpg\posy4451\absw5020\absh5291 \sl-210 \b \f20 \fs15 \cf0
{\b0 dolor}{\b0 tor�cico}{\b0 izquierdo}{\b0 de}{\b0 moderada}{\b0
intensidad,}{\b0 p�rdida}{\b0 de}{\b0 peso}{\b0 no }
\par}{\phpg\posx6037\pvpg\posy4451\absw5020\absh5291 \sl-210 \b \f20 \fs15 \cf0
{\b0 cuantificable}{\b0 y}{\b0 disnea}{\b0 a}{\b0 m�nimos}{\b0 esfuerzos.}{\b0
EF:}{\b0 M/V}{\b0 disminuido}{\b0 en }
\par}{\phpg\posx6037\pvpg\posy4451\absw5020\absh5291 \sl-210 \b \f20 \fs15 \cf0
{\b0 ACP.}{\b0 Esputo}{\b0 seriado}{\b0 y}{\b0 GeneXpert}{\b0 negativos;}{\b0
3}{\b0 estudios}{\b0 de}{\b0 fibrobron- }
\par}{\phpg\posx6037\pvpg\posy4451\absw5020\absh5291 \sl-210 \b \f20 \fs15 \cf0
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96be32bad06fed748f156a177aa69fe0eb8d3575b9f5887c29fda3a8dfb699a5ebba9ebd2dd1d2adbc8
b6d2b4fd3744d12d04d65a4dbbd697c65bdf1be83f0f7c43af7c3d861bcd7bc39a1ebde2087455d29f5
7bed79347d22ef521a1685611dcdb2cfafead2db258e911492c71cd7f3dbc4cc8afb93f3224ff829bfe
d88c180ff00821c7fc14a1816dca24b0f850718395520789b04a9c7cf80491b82a9c01247ff000535fd
af76a99bfe0877ff00052ef31463f77a7fc272981d080de2a041fc33ee68baeebfaff875f781f437c25
93f6c1f8ad6171e23d43c7d0fc35b1d3fc5575a24fa178a7e136a7a4ea3ad5958d968f7efab6976dafc
ba5ea7069d7c355934d8ae2eac2068355d2b56b478e46b4dcdf3d7ed570cf6ff00f05b9ff837860bbb9
379770b7fc15862b9bc65546bb953f633f0787b
868e34448da57dce55514658e00029cbff000534fdad848929ff00821d7fc14c8b202a09d3be1296087
92a18f8ac90a59509038f940181907c5bc27e2cfdaebf6d0ff82bcffc1247e33ebbff0004d6fdb03f65
5f84ff00b23dc7edf12fc4ff00883f1e34af080f0e63e3efecb72783fc142daf3c2bacea4d687fe125f
08c3a34e6fd105c5f788f4786d4b66e0c63d53b6ba3fcbfe0afbc0feb013a1faff414fa620201c8c73f
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51400514514005145140051451400514514005145140051451400514514005145140051451400514514
00514514005145140051451400514514005145140051451400514514005145140051451400514514005
14514005145140051451400514514005145140051451400514514005145140051451400514514005145
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05145140051451400514514005145140051451400514514005145140051451400514514005145140051
45140051451400514514005145140051451400514514005145140051451400514514005145140051451
40051451400514514005145140051451400514514005145140051451400514514005145140051451400
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00514514005145140051451400514514005145140051451400514514005145140051451400514514005
14514005145140051451400514514005145140051451400514514005145140051451400514514005145
14005145140051451400514514005145140051451400514514005145140051451400514514005145140
05145140051451400514514005145140051451400514514005145140051451400514514005145140051
45140051451400514514005145140051451400514514005145140051451400514514005145140051451
40051451400514514005145140051451400514514005145140051451400514514005145140051451400
51451400514514005145140051451400514514005145140051451400514514005145140051451400514
51400514514005145140051451400514514005145140051451400514514005145140051451400514514
00514514005145140051451400514514005145140051451400514514005145140051451400514514005
14514005145140051451400514514005145140051451400514514005145140051451400514514005145
14005145140051451400514514005145140051451400514514005145140051451400514514005145140
05145140051451400514514005145140051451400514514005145140051451400514514005145140051
45140051451400514514005145140051451400514514005145140051451400514514005145140051451
40051451400514514005145140051451400514514005145140051451400514514005145140051451400
51451400514514005145140051451400514514005145140051451400514514005145140051451400514
51400514514005145140051451400514514005145140051451400514514005145140051451400514514
00514514005145140051451400514514005145140051451400514514005145140051451400514514005
14514005145140051451400514514005145140051451400514514005145140051451400514514005145
14005145140051451400514514005145140051451400514514005145140051451400514514005145140
05145140051451400514514005145140051451400514514005145140051451400514514005145140051
45140051451400514514005145140051451400514514005145140051451400514514005145140051451
40051451400514514005145140051451400514514005145140051451400514514005145140051451400
51451400514514005145140051451400514514005145140051451400514514005145140051451400514
51400514514005145140051451400514514005145140051451400514514005145140051451400514514
00514514005145140051451400514514005145140051451400514514005145140051451400514514005
14514005145140051451400514514005145140051451400514514005145140051451400514514005145
14005145140051451400514514005145140051451400514514005145140051451400514514005145140
05145140051451400514514005145140051451400514514005145140051451400514514005145140051
45140051451400514514005145140051451400514514005145140051451400514514005145140051451
40051451400514514005145140051451400514514005145140051451401fffd9
}}\par}{\phpg\posx5428\pvpg\posy713\absw1048\absh138 \i \f20 \fs12 \cf0 \i \f20
\fs12 \cf0 11.� Congreso ALAT \par
}
{\phpg\posx850\pvpg\posy1103\absw5017\absh1690 \f20 \fs15 \cf0 \f20 \fs15 \cf0
raci�n de Zhiel Neelsen en l�quido pleural: 9 BAAR en 200 campos.
\par}{\phpg\posx850\pvpg\posy1103\absw5017\absh1690 \sl-210 \f20 \fs15 \cf0 Inicia
tratamiento para TB extra-pulmonar. Paciente actualmente en
\par}{\phpg\posx850\pvpg\posy1103\absw5017\absh1690 \sl-210 \f20 \fs15 \cf0 2�
fase, con mejor�a cl�nica y adherencia al tratamiento.
\par}{\phpg\posx850\pvpg\posy1103\absw5017\absh1690 \sl-210 \f20 \fs15 \cf0 {\b
Conclusiones:} A pesar de que la TB es una enfermedad muy com�n
\par}{\phpg\posx850\pvpg\posy1103\absw5017\absh1690 \sl-210 \f20 \fs15 \cf0 y
ampliamente estudiada, en algunas oportunidades representa un
\par}{\phpg\posx850\pvpg\posy1103\absw5017\absh1690 \sl-210 \f20 \fs15 \cf0
verdadero desaf�o diagn�stico debido a su habilidad para simular
\par}{\phpg\posx850\pvpg\posy1103\absw5017\absh1690 \sl-210 \f20 \fs15 \cf0 otras
enfermedades. Las fallas en el diagn�stico promueven el ina-
\par}{\phpg\posx850\pvpg\posy1103\absw5017\absh1690 \sl-210 \f20 \fs15 \cf0 decuado
tratamiento y la progresi�n hacia complicaciones de la
\par}{\phpg\posx850\pvpg\posy1103\absw5017\absh1690 \sl-210 \f20 \fs15 \cf0
misma. \par
}
{\phpg\posx11011\pvpg\posy711\absw213\absh142 \f20 \fs12 \cf0 \f20 \fs12 \cf0
103 \par
}
{\phpg\posx850\pvpg\posy3401\absw5020\absh7748 \b \f20 \fs15 \cf0 \b \f20 \fs15
\cf0 239. EVALUACI�N DE LAS CARACTER�STICAS OPERATIVAS
\par}{\phpg\posx850\pvpg\posy3401\absw5020\absh7748 \sl-200 \b \f20 \fs15 \cf0 DEL
GENEXPERT {\up006 \fs8 �} MTB/RIF EN UN CENTRO NACIONAL DE
\par}{\phpg\posx850\pvpg\posy3401\absw5020\absh7748 \sl-200 \b \f20 \fs15 \cf0
REFERENCIA
\par}{\phpg\posx850\pvpg\posy3401\absw5020\absh7748 \sl-170 \par\b \f20 \fs15 \cf0
{\b0 M.J.}{\b0 Fern�ndez,}{\b0 J.I.}{\b0 Lasso,}{\b0 A.}{\b0 Ca�as,}{\b0 C.}
{\b0 Morantes,}{\b0 G.}{\b0 Cortes,}{\b0 C.}{\b0 Ruiz, }
\par}{\phpg\posx850\pvpg\posy3401\absw5020\absh7748 \sl-200 \b \f20 \fs15 \cf0 {\b0
L.}{\b0 Aguiar,}{\b0 A.}{\b0 G�mez}{\b0 y}{\b0 C.A.}{\b0 Celis }
\par}{\phpg\posx850\pvpg\posy3401\absw5020\absh7748 \sl-156 \par\b \f20 \fs15 \cf0
{\b0\i Pontificia}{\b0\i Universidad}{\b0\i Javeriana.}{\b0\i Hospital}{\b0\i
Universitario}{\b0\i San}{\b0\i Ignacio. }
\par}{\phpg\posx850\pvpg\posy3401\absw5020\absh7748 \sl-144 \par\par\b \f20
\fs15 \cf0 Introducci�n:{\b0 La}{\b0 detecci�n}{\b0 temprana}{\b0 es}{\b0
esencial}{\b0 para}{\b0 disminuir}{\b0 la }
\par}{\phpg\posx850\pvpg\posy3401\absw5020\absh7748 \sl-210 \b \f20 \fs15 \cf0 {\b0
transmisi�n}{\b0 de}{\b0 tuberculosis}{\b0 (TB)}{\b0 globalmente.}{\b0 En}{\b0
Colombia,}{\b0 la}{\b0 prueba }
\par}{\phpg\posx850\pvpg\posy3401\absw5020\absh7748 \sl-210 \b \f20 \fs15 \cf0 {\b0
de}{\b0 GeneXpert }{\b0\up006 \fs8 �}{\b0 MTB/RIF}{\b0 podr�a}{\b0 constituir}
{\b0 una}{\b0 estrategia}{\b0 para}{\b0 la}{\b0 detec- }
\par}{\phpg\posx850\pvpg\posy3401\absw5020\absh7748 \sl-210 \b \f20 \fs15 \cf0 {\b0
ci�n}{\b0 o}{\b0 descarte}{\b0 tempranos}{\b0 de}{\b0 la}{\b0 infecci�n.}{\b0
Este}{\b0 estudio}{\b0 eval�a}{\b0 las}{\b0 ca- }
\par}{\phpg\posx850\pvpg\posy3401\absw5020\absh7748 \sl-210 \b \f20 \fs15 \cf0 {\b0
racter�sticas}{\b0 operativas}{\b0 del}{\b0 GeneXpert}{\b0\up006 \fs8 �}{\b0
MTB/RIF}{\b0 en}{\b0 pacientes}{\b0 sinto- }
\par}{\phpg\posx850\pvpg\posy3401\absw5020\absh7748 \sl-210 \b \f20 \fs15 \cf0 {\b0
m�ticos}{\b0 respiratorios,}{\b0 reclutados}{\b0 entre}{\b0 mayo/2013}{\b0 y}
{\b0 mayo/2016}{\b0 en}{\b0 el }
\par}{\phpg\posx850\pvpg\posy3401\absw5020\absh7748 \sl-210 \b \f20 \fs15 \cf0 {\b0
Hospital}{\b0 Universitario}{\b0 San}{\b0 Ignacio. }
\par}{\phpg\posx850\pvpg\posy3401\absw5020\absh7748 \sl-210 \b \f20 \fs15 \cf0
Material y m�todos:{\b0 Estudio}{\b0 retrospectivo,}{\b0 de}{\b0 evaluaci�n}
{\b0 de}{\b0 pruebas }
\par}{\phpg\posx850\pvpg\posy3401\absw5020\absh7748 \sl-210 \b \f20 \fs15 \cf0 {\b0
diagn�sticas,}{\b0 con}{\b0 an�lisis}{\b0 seg�n}{\b0 resultado}{\b0 de}{\b0
las}{\b0 baciloscopias}{\b0 y}{\b0 esta- }
\par}{\phpg\posx850\pvpg\posy3401\absw5020\absh7748 \sl-210 \b \f20 \fs15 \cf0 {\b0
do}{\b0 de}{\b0 inmunosupresi�n}{\b0 de}{\b0 los}{\b0 sujetos,}{\b0 teniendo}
{\b0 como}{\b0 referencia}{\b0 los }
\par}{\phpg\posx850\pvpg\posy3401\absw5020\absh7748 \sl-210 \b \f20 \fs15 \cf0 {\b0
cultivos}{\b0 y}{\b0 las}{\b0 pruebas}{\b0 de}{\b0 susceptibilidad}{\b0 en}
{\b0 relaci�n}{\b0 con}{\b0 los}{\b0 resultados }
\par}{\phpg\posx850\pvpg\posy3401\absw5020\absh7748 \sl-210 \b \f20 \fs15 \cf0 {\b0
del}{\b0 GeneXpert. }
\par}{\phpg\posx850\pvpg\posy3401\absw5020\absh7748 \sl-210 \b \f20 \fs15 \cf0
Resultados:{\b0 Se}{\b0 incluyeron}{\b0 468}{\b0 pacientes}{\b0 a}{\b0
quienes}{\b0 se}{\b0 les}{\b0 realiz�}{\b0 en }
\par}{\phpg\posx850\pvpg\posy3401\absw5020\absh7748 \sl-210 \b \f20 \fs15 \cf0 {\b0
alguna}{\b0 secreci�n}{\b0 respiratoria}{\b0 la}{\b0 prueba}{\b0 GeneXpert}
{\b0\up006 \fs8 �}{\b0 MTB/RIF}{\b0 y}{\b0 cultivo }
\par}{\phpg\posx850\pvpg\posy3401\absw5020\absh7748 \sl-210 \b \f20 \fs15 \cf0 {\b0
para}{\b0 TB.}{\b0 Las}{\b0 caracter�sticas}{\b0 operativas}{\b0 de}{\b0 la}
{\b0 prueba}{\b0 se}{\b0 resumen}{\b0 en}{\b0 la }
\par}{\phpg\posx850\pvpg\posy3401\absw5020\absh7748 \sl-210 \b \f20 \fs15 \cf0 {\b0
tabla.}{\b0 Para}{\b0 la}{\b0 resistencia}{\b0 a}{\b0 RIF}{\b0 S,}{\b0 E,}
{\b0 VPP}{\b0 y}{\b0 VPN}{\b0 fueron}{\b0 100%,}{\b0 96%,}{\b0 50%}{\b0 y }
\par}{\phpg\posx850\pvpg\posy3401\absw5020\absh7748 \sl-210 \b \f20 \fs15 \cf0 {\b0
100%,}{\b0 respectivamente.}{\b0 El}{\b0 AUC-ROC}{\b0 fue}{\b0 0,93}{\b0 en}
{\b0 forma}{\b0 general,}{\b0 0,93 }
\par}{\phpg\posx850\pvpg\posy3401\absw5020\absh7748 \sl-210 \b \f20 \fs15 \cf0 {\b0
para}{\b0 sujetos}{\b0 con}{\b0 baciloscopias}{\b0 negativas}{\b0 sin}{\b0
VIH}{\b0 y}{\b0 0,94}{\b0 para}{\b0 sujetos }
\par}{\phpg\posx850\pvpg\posy3401\absw5020\absh7748 \sl-210 \b \f20 \fs15 \cf0 {\b0
con}{\b0 baciloscopias}{\b0 negativas}{\b0 con}{\b0 VIH. }
\par}{\phpg\posx850\pvpg\posy3401\absw5020\absh7748 \sl-210 \b \f20 \fs15 \cf0
Conclusiones:{\b0 La}{\b0 validez}{\b0 operativa}{\b0 del}{\b0 GeneXpert }
{\b0\up006 \fs8 �}{\b0 MTB/RIF}{\b0 es}{\b0 similar }
\par}{\phpg\posx850\pvpg\posy3401\absw5020\absh7748 \sl-210 \b \f20 \fs15 \cf0 {\b0
a}{\b0 la}{\b0 reportada}{\b0 por}{\b0 el}{\b0 fabricante,}{\b0 nacional}{\b0
e}{\b0 internacionalmente}{\b0 y}{\b0 cum- }
\par}{\phpg\posx850\pvpg\posy3401\absw5020\absh7748 \sl-210 \b \f20 \fs15 \cf0 {\b0
ple}{\b0 con}{\b0 las}{\b0 recomendaciones}{\b0 de}{\b0 la}{\b0 OMS}{\b0
para}{\b0 la}{\b0 implementaci�n}{\b0 de}{\b0 su }
\par}{\phpg\posx850\pvpg\posy3401\absw5020\absh7748 \sl-210 \b \f20 \fs15 \cf0 {\b0
uso.}{\b0 Su}{\b0 utilidad}{\b0 es}{\b0 superior}{\b0 a}{\b0 la}{\b0
reportada}{\b0 internacionalmente}{\b0 en}{\b0 pa- }
\par}{\phpg\posx850\pvpg\posy3401\absw5020\absh7748 \sl-210 \b \f20 \fs15 \cf0 {\b0
cientes}{\b0 con}{\b0 VIH.}{\b0 En}{\b0 el}{\b0 caso}{\b0 particular}{\b0
de}{\b0 Colombia,}{\b0 la}{\b0 prevalencia}{\b0 de }
\par}{\phpg\posx850\pvpg\posy3401\absw5020\absh7748 \sl-210 \b \f20 \fs15 \cf0 {\b0
TB}{\b0 reportada}{\b0 es}{\b0 de}{\b0 39}{\b0 casos/100.000}{\b0
habitantes,}{\b0 con}{\b0 las}{\b0 caracter�sti- }
\par}{\phpg\posx850\pvpg\posy3401\absw5020\absh7748 \sl-210 \b \f20 \fs15 \cf0 {\b0
cas}{\b0 operativas}{\b0 encontradas}{\b0 en}{\b0 el}{\b0 grupo}{\b0 general}
{\b0 de}{\b0 pacientes,}{\b0 un}{\b0 resul- }
\par}{\phpg\posx850\pvpg\posy3401\absw5020\absh7748 \sl-210 \b \f20 \fs15 \cf0 {\b0
tado}{\b0 positivo}{\b0 del}{\b0 GeneXpert}{\b0\up006 \fs8 �}{\b0 MTB/RIF}
{\b0 resultar�a}{\b0 en}{\b0 una}{\b0 probabilidad }
\par}{\phpg\posx850\pvpg\posy3401\absw5020\absh7748 \sl-210 \b \f20 \fs15 \cf0 {\b0
post-prueba}{\b0 de}{\b0 infecci�n}{\b0 por}{\b0 tuberculosis}{\b0 del}{\b0
80%}{\b0 (IC95%}{\b0 65-86%)}{\b0 lo }
\par}{\phpg\posx850\pvpg\posy3401\absw5020\absh7748 \sl-210 \b \f20 \fs15 \cf0 {\b0
que}{\b0 implicar�a}{\b0 la}{\b0 necesidad}{\b0 de}{\b0 inicio}{\b0 de}{\b0
tratamiento}{\b0 y}{\b0 un}{\b0 resultado }
\par}{\phpg\posx850\pvpg\posy3401\absw5020\absh7748 \sl-210 \b \f20 \fs15 \cf0 {\b0
negativo}{\b0 resultar�a}{\b0 en}{\b0 una}{\b0 probabilidad}{\b0 post-prueba}
{\b0 de}{\b0 0,7%}{\b0 (IC95% }
\par}{\phpg\posx850\pvpg\posy3401\absw5020\absh7748 \sl-210 \b \f20 \fs15 \cf0 {\b0
0,2-0,9%),}{\b0 lo}{\b0 que}{\b0 indicar�a}{\b0 que}{\b0 se}{\b0 podr�a}{\b0
no}{\b0 dar}{\b0 inicio}{\b0 al}{\b0 tratamiento }
\par}{\phpg\posx850\pvpg\posy3401\absw5020\absh7748 \sl-210 \b \f20 \fs15 \cf0 {\b0
antituberculoso}{\b0 y}{\b0 explorar}{\b0 diagn�sticos}{\b0 alternos}{\b0 m�s}
{\b0 probables}{\b0 en }
\par}{\phpg\posx850\pvpg\posy3401\absw5020\absh7748 \sl-210 \b \f20 \fs15 \cf0 {\b0
espera}{\b0 de}{\b0 los}{\b0 resultados}{\b0 de}{\b0 los}{\b0 cultivos. }\par
}
{\phpg\posx6207\pvpg\posy1103\absw5020\absh3769 \f20 \fs15 \cf0 \f20 \fs15 \cf0 el
principal causante de las adenopat�as cervicales, sin embargo las
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh3769 \sl-210 \f20 \fs15 \cf0
micobacterias no tuberculosas son relativamente frecuentes en el
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh3769 \sl-210 \f20 \fs15 \cf0 ni�o y
raras en adultos. El objetivo de este estudio fue identificar y
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh3769 \sl-210 \f20 \fs15 \cf0
establecer la frecuencia de la etiolog�a infecciosa por micobacterias
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh3769 \sl-210 \f20 \fs15 \cf0 no
tuberculosas en pacientes adultos mexicanos con linfadenopatias
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh3769 \sl-210 \f20 \fs15 \cf0
cervicales.
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh3769 \sl-210 \f20 \fs15 \cf0 {\b
Material}{\b y}{\b m�todos:} Se estudiaron 85 pacientes mayores de 18 a�os,
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh3769 \sl-210 \f20 \fs15 \cf0 con
linfadenopat�a cervical, 45 VIH positivos y 40 VIH negativos sin
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh3769 \sl-210 \f20 \fs15 \cf0
antecedentes de tratamiento anti-tuberculoso, seleccionados en un
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh3769 \sl-210 \f20 \fs15 \cf0
hospital de concentraci�n de especialidad de tercer nivel. Se realiz�
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh3769 \sl-210 \f20 \fs15 \cf0
biopsia de nodo linf�tico para estudio histopatol�gico, b�squeda de
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh3769 \sl-210 \f20 \fs15 \cf0
bacilos �cido-alcohol resistentes, cultivo en el tubo indicador del cre-
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh3769 \sl-210 \f20 \fs15 \cf0
cimiento de Mycobacterium BACTEC (MGIT-960) y la identificaci�n de
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh3769 \sl-210 \f20 \fs15 \cf0 cepa
micobacteriana por PCR-RFLP (Restriction Fragment Lenght Po-
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh3769 \sl-210 \f20 \fs15 \cf0
lymorfism) de hsp65.
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh3769 \sl-210 \f20 \fs15 \cf0 {\b
Resultados:} En pacientes VIH positivos 42 (93%) cepas correspondie-
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh3769 \sl-210 \f20 \fs15 \cf0 ron al
Complejo Mycobacterium tuberculosis, dos (4,4%) a M. intrace-
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh3769 \sl-210 \f20 \fs15 \cf0
llulare y una (2,2%) a M. gordonae; en los pacientes VIH negativos 39
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh3769 \sl-210 \f20 \fs15 \cf0
(97,5%) cepas correspondieron al Complejo M. tuberculosis y una
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh3769 \sl-210 \f20 \fs15 \cf0 (2,5%)
a M. fortuitum. \par
}
{\phpg\posx6260\pvpg\posy5618\absw1839\absh142 \f20 \fs12 \cf0 \f20 \fs12 \cf0
Tabla 1. Linfadenopatia cervical \par
}
{\phpg\posx850\pvpg\posy12641\absw5017\absh2078 \b \f20 \fs15 \cf0 \b \f20 \fs15
\cf0 240. TIPIFICACI�N DE MICOBACTERIAS NO TUBERCULOSAS EN
\par}{\phpg\posx850\pvpg\posy12641\absw5017\absh2078 \sl-200 \b \f20 \fs15 \cf0
CULTIVOS DE PACIENTES CON DIAGN�STICO DE TUBERCULOSIS
\par}{\phpg\posx850\pvpg\posy12641\absw5017\absh2078 \sl-200 \b \f20 \fs15 \cf0
GANGLIONAR
\par}{\phpg\posx850\pvpg\posy12641\absw5017\absh2078 \sl-170 \par\b \f20 \fs15 \cf0
{\b0 E.}{\b0 Meneses,}{\b0 M.}{\b0 Hern�ndez,}{\b0 A.}{\b0 Hern�ndez,}{\b0
M.}{\b0 Gonz�lez,}{\b0 E.}{\b0 Ram�rez, }
\par}{\phpg\posx850\pvpg\posy12641\absw5017\absh2078 \sl-200 \b \f20 \fs15 \cf0
{\b0 H.}{\b0 Gonz�lez}{\b0 y}{\b0 R.}{\b0 Cicero }
\par}{\phpg\posx850\pvpg\posy12641\absw5017\absh2078 \sl-156 \par\b \f20 \fs15 \cf0
{\b0\i Hospital}{\b0\i General}{\b0\i de}{\b0\i M�xico}{\b0\i Dr.}{\b0\i
Eduardo}{\b0\i Liceaga.}{\b0\i Instituto}{\b0\i de }
\par}{\phpg\posx850\pvpg\posy12641\absw5017\absh2078 \sl-200 \b \f20 \fs15 \cf0
{\b0\i Diagn�stico}{\b0\i y}{\b0\i Referencia}{\b0\i Epidemiol�gicos}{\b0\i
(InDRE). }
\par}{\phpg\posx850\pvpg\posy12641\absw5017\absh2078 \sl-222 \par\b \f20 \fs15 \cf0
Introducci�n:{\b0 La}{\b0 tuberculosis}{\b0 es}{\b0 un}{\b0 problema}{\b0 de}
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\par}{\phpg\posx6037\pvpg\posy1300\absw5018\absh6049 \sl-210 \b \f20 \fs14 \cf0
{\b0 neamente,}{\b0 febril.}{\b0 T�rax:}{\b0 Fr�mito}{\b0 vocal}{\b0 y}{\b0
murmullo}{\b0 vesicular}{\b0 dismi- }
\par}{\phpg\posx6037\pvpg\posy1300\absw5018\absh6049 \sl-210 \b \f20 \fs14 \cf0
{\b0 nu�dos,}{\b0 submatidez}{\b0 en}{\b0 ambos}{\b0 hemit�rax.}{\b0 Ex�menes}
{\b0 auxiliares:}{\b0 BAAR }
\par}{\phpg\posx6037\pvpg\posy1300\absw5018\absh6049 \sl-210 \b \f20 \fs14 \cf0
{\b0 en}{\b0 esputo}{\b0 (�}{\b0 10):}{\b0 negativas.}{\b0 HIV}{\b0 Elisa:}
{\b0 No}{\b0 Reactivo.}{\b0 Procedimientos: }
\par}{\phpg\posx6037\pvpg\posy1300\absw5018\absh6049 \sl-210 \b \f20 \fs14 \cf0
{\b0 videofibrobroncoscopia:}{\b0 signos}{\b0 inflamatorios}{\b0 en}{\b0 LID}
{\b0 y}{\b0 en}{\b0 segmentos }
\par}{\phpg\posx6037\pvpg\posy1300\absw5018\absh6049 \sl-210 \b \f20 \fs14 \cf0
{\b0 lingulares,}{\b0 BAAR}{\b0 de}{\b0 aspirado}{\b0 bronquial}{\b0
negativo.}{\b0 Se}{\b0 env�a}{\b0 muestra }
\par}{\phpg\posx6037\pvpg\posy1300\absw5018\absh6049 \sl-210 \b \f20 \fs14 \cf0
{\b0 para}{\b0 MODS.}{\b0 Evoluci�n:}{\b0 prueba}{\b0 MODS,}{\b0 informa}{\b0
positivo,}{\b0 con}{\b0 resisten- }
\par}{\phpg\posx6037\pvpg\posy1300\absw5018\absh6049 \sl-210 \b \f20 \fs14 \cf0
{\b0 cia}{\b0 a}{\b0 isoniacida}{\b0 y}{\b0 rifampicina,}{\b0 (TB}{\b0 MDR)}
{\b0 inicia}{\b0 tratamiento}{\b0 con}{\b0 etam- }
\par}{\phpg\posx6037\pvpg\posy1300\absw5018\absh6049 \sl-210 \b \f20 \fs14 \cf0
{\b0 butol,}{\b0 pirazinamida,}{\b0 levofloxacino,}{\b0 kanamicina,}{\b0
etionamida,}{\b0 ciclose- }
\par}{\phpg\posx6037\pvpg\posy1300\absw5018\absh6049 \sl-210 \b \f20 \fs14 \cf0
{\b0 rina.}{\b0 Paciente}{\b0 presenta}{\b0 mejor�a}{\b0 cl�nica,}{\b0
siguiendo}{\b0 tratamiento}{\b0 en}{\b0 su }
\par}{\phpg\posx6037\pvpg\posy1300\absw5018\absh6049 \sl-210 \b \f20 \fs14 \cf0
{\b0 centro}{\b0 penitenciario. }\par
}
{\phpg\posx6037\pvpg\posy11531\absw2741\absh179 \b\i \f20 \fs14 \cf0 \b\i \f20
\fs14 \cf0 Figura.{\b0 Radiograf�a}{\b0 de}{\b0 t�rax}{\b0 al}{\b0
ingreso. }\par
}
{\phpg\posx680\pvpg\posy13071\absw5018\absh1691 \b \f20 \fs14 \cf0 \b \f20 \fs14
\cf0 Resultados:{\b0 De}{\b0 los}{\b0 390}{\b0 pacientes}{\b0 con}{\b0
tuberculosis}{\b0 pulmonar }
\par}{\phpg\posx680\pvpg\posy13071\absw5018\absh1691 \sl-210 \b \f20 \fs14 \cf0
{\b0 MDR.}{\b0 El}{\b0 11,28%}{\b0 (44)}{\b0 resultaron}{\b0 pre-XDR.}{\b0
El}{\b0 80%}{\b0 (35)}{\b0 de}{\b0 ellos}{\b0 pre- }
\par}{\phpg\posx680\pvpg\posy13071\absw5018\absh1691 \sl-210 \b \f20 \fs14 \cf0
{\b0 sent�}{\b0 resistencia}{\b0 a}{\b0 inyectables}{\b0 de}{\b0 segunda}{\b0
l�nea}{\b0 y}{\b0 el}{\b0 20%}{\b0 a}{\b0 quino- }
\par}{\phpg\posx680\pvpg\posy13071\absw5018\absh1691 \sl-210 \b \f20 \fs14 \cf0
{\b0 lonas}{\b0 (9). }
\par}{\phpg\posx680\pvpg\posy13071\absw5018\absh1691 \sl-210 \b \f20 \fs14 \cf0
Conclusiones:{\b0 Existe}{\b0 un}{\b0 porcentaje}{\b0 importante}{\b0 de}{\b0
pacientes}{\b0 con}{\b0 tu- }
\par}{\phpg\posx680\pvpg\posy13071\absw5018\absh1691 \sl-210 \b \f20 \fs14 \cf0
{\b0 berculosis}{\b0 pulmonar}{\b0 pre}{\b0 XDR}{\b0 entre}{\b0 los}{\b0
pacientes}{\b0 catalogados}{\b0 con }
\par}{\phpg\posx680\pvpg\posy13071\absw5018\absh1691 \sl-210 \b \f20 \fs14 \cf0
{\b0 tuberculosis}{\b0 pulmonar}{\b0 MDR.}{\b0 La}{\b0 importancia}{\b0 de}
{\b0 identificarlos}{\b0 deter- }
\par}{\phpg\posx680\pvpg\posy13071\absw5018\absh1691 \sl-210 \b \f20 \fs14 \cf0
{\b0 minar�}{\b0 un}{\b0 manejo}{\b0 terap�utico}{\b0 diferenciado}{\b0 y}{\b0
mejores}{\b0 �xitos}{\b0 en}{\b0 su }
\par}{\phpg\posx680\pvpg\posy13071\absw5018\absh1691 \sl-210 \b \f20 \fs14 \cf0
{\b0 tratamiento. }\par
}
{\phpg\posx6037\pvpg\posy13809\absw5017\absh366 \b\i \f20 \fs14 \cf0 \b\i \f20
\fs14 \cf0 Figura.{\b0 TAC}{\b0 de}{\b0 t�rax:}{\b0 Hallazgos}{\b0 en}{\b0
relaci�n}{\b0 con}{\b0 proceso}{\b0 gramulomatoso }
\par}{\phpg\posx6037\pvpg\posy13809\absw5017\absh366 \sl-210 \b\i \f20 \fs14 \cf0
{\b0 en}{\b0 actividad}{\b0 tuberculomas}{\b0 abscedados,}{\b0 en}{\b0
asociaci�n}{\b0 con}{\b0 aspergilomas. }\par
}
{\phpg\posx6037\pvpg\posy14541\absw5017\absh368 \b \f20 \fs14 \cf0 \b \f20 \fs14
\cf0 Conclusiones:{\b0 La}{\b0 prueba}{\b0 MODS}{\b0 fue}{\b0 muy}{\b0 �til}
{\b0 en}{\b0 el}{\b0 diagn�stico}{\b0 de}{\b0 un }
\par}{\phpg\posx6037\pvpg\posy14541\absw5017\absh368 \sl-210 \b \f20 \fs14 \cf0
{\b0 caso}{\b0 de}{\b0 tuberculosis}{\b0 resistente}{\b0 complicada. }\par
}
\sect\sectd\pard\plain
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}}\par}{\phpg\posx5428\pvpg\posy713\absw1048\absh138 \i \f20 \fs12 \cf0 \i \f20
\fs12 \cf0 11.� Congreso ALAT \par
}
{\phpg\posx850\pvpg\posy1100\absw5020\absh6607 \b \f20 \fs15 \cf0 \b \f20 \fs15
\cf0 243. TUBERCULOSIS PULMONAR Y EXTRAPULMONAR EN
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INERAM CON LA NARIZ ELECTR�NICA (PULEX ENOSE)
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{\b0 R.}{\b0 Coronel}{\b0\up006 \fs8 1}{\b0 ,}{\b0 E.}{\b0 Gonz�lez }{\b0\up006
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{\b0 , }
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{\b0\up006 \fs8 1}{\b0 y}{\b0 C.}{\b0 Magis-Escurra}{\b0\up006 \fs8 4 }
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{\b0\i\up006 \fs8 1}{\b0\i Instituto}{\b0\i Nacional}{\b0\i de}{\b0\i
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{\b0\i INERAM.}{\b0\i Asunci�n.}{\b0\i Paraguay.}{\b0\i\up006 \fs8 2}{\b0\i
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{\b0\i Tuberculosis-PNCT.}{\b0\i Asunci�n.}{\b0\i Paraguay.}{\b0\i\up006 \fs8
3}{\b0\i eNose}{\b0\i Company.}{\b0\i Zutphen. }
\par}{\phpg\posx850\pvpg\posy1100\absw5020\absh6607 \sl-200 \b \f20 \fs15 \cf0
{\b0\i Pa�ses}{\b0\i Bajos.}{\b0\i\up006 \fs8 4}{\b0\i Radboud}{\b0\i
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\par}{\phpg\posx850\pvpg\posy1100\absw5020\absh6607 \sl-200 \b \f20 \fs15 \cf0
{\b0\i Bajos. }
\par}{\phpg\posx850\pvpg\posy1100\absw5020\absh6607 \sl-228 \par\b \f20 \fs15 \cf0
Introducci�n:{\b0 Un}{\b0 estudio}{\b0 reci�n}{\b0 publicado}{\b0 con}{\b0
una}{\b0 nariz}{\b0 electr�nica }
\par}{\phpg\posx850\pvpg\posy1100\absw5020\absh6607 \sl-210 \b \f20 \fs15 \cf0 {\b0
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{\b0 sintom�- }
\par}{\phpg\posx850\pvpg\posy1100\absw5020\absh6607 \sl-210 \b \f20 \fs15 \cf0 {\b0
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TB,}{\b0 con }
\par}{\phpg\posx850\pvpg\posy1100\absw5020\absh6607 \sl-210 \b \f20 \fs15 \cf0 {\b0
previa}{\b0 firma}{\b0 del}{\b0 consentimiento}{\b0 informado.}{\b0 El}{\b0
diagn�stico}{\b0 de}{\b0 TB}{\b0 fue }
\par}{\phpg\posx850\pvpg\posy1100\absw5020\absh6607 \sl-210 \b \f20 \fs15 \cf0 {\b0
establecido}{\b0 con}{\b0 el}{\b0 gold}{\b0 est�ndar}{\b0 (cultivo}{\b0 del}
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losis).}{\b0 Fue}{\b0 realizado}{\b0 examen}{\b0 f�sico,}{\b0 Rx}{\b0 de}{\b0
t�rax}{\b0 y}{\b0 el}{\b0 an�lisis}{\b0 del}{\b0 aire }
\par}{\phpg\posx850\pvpg\posy1100\absw5020\absh6607 \sl-210 \b \f20 \fs15 \cf0 {\b0
exhalado}{\b0 por}{\b0 cinco}{\b0 minutos}{\b0 con}{\b0 el}{\b0 eNose}{\b0
a}{\b0 todos}{\b0 los}{\b0 participantes;}{\b0 las }
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\par}{\phpg\posx850\pvpg\posy1100\absw5020\absh6607 \sl-210 \b \f20 \fs15 \cf0
Resultados:{\b0 Resultados}{\b0 preliminares:}{\b0 107}{\b0 sintom�ticos}{\b0
respiratorios }
\par}{\phpg\posx850\pvpg\posy1100\absw5020\absh6607 \sl-210 \b \f20 \fs15 \cf0 {\b0
fueron}{\b0 evaluados}{\b0 desde}{\b0 noviembre}{\b0 de}{\b0 2016}{\b0 hasta}
{\b0 diciembre}{\b0 de}{\b0 2017. }
\par}{\phpg\posx850\pvpg\posy1100\absw5020\absh6607 \sl-210 \b \f20 \fs15 \cf0 {\b0
Cuatro}{\b0 personas}{\b0 VIH}{\b0 positivos;}{\b0 11}{\b0 contactos}{\b0
cercanos}{\b0 TB.}{\b0 Los}{\b0 partici- }
\par}{\phpg\posx850\pvpg\posy1100\absw5020\absh6607 \sl-210 \b \f20 \fs15 \cf0 {\b0
pantes}{\b0 que}{\b0 obtuvieron}{\b0 resultados}{\b0 bacteriol�gicos}{\b0
negativos,}{\b0 pero}{\b0 con }
\par}{\phpg\posx850\pvpg\posy1100\absw5020\absh6607 \sl-210 \b \f20 \fs15 \cf0 {\b0
alta}{\b0 sospecha/riesgo}{\b0 de}{\b0 TB}{\b0 fueron}{\b0 tratados}{\b0 con}
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\par}{\phpg\posx850\pvpg\posy1100\absw5020\absh6607 \sl-210 \b \f20 \fs15 \cf0 {\b0
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{\b0 extrapulmonar}{\b0 el}{\b0 diagn�sti- }
\par}{\phpg\posx850\pvpg\posy1100\absw5020\absh6607 \sl-210 \b \f20 \fs15 \cf0 {\b0
co}{\b0 tambi�n}{\b0 fue}{\b0 hecho}{\b0 a}{\b0 trav�s}{\b0 de}{\b0 biopsia}
{\b0 del}{\b0 tejido}{\b0 afectado.}{\b0 Los}{\b0 pa- }
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externo}{\b0 y}{\b0 el}{\b0 PNCT. }
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presentar}{\b0 en}{\b0 junio}{\b0 2018. }\par
}
{\phpg\posx11011\pvpg\posy711\absw213\absh142 \f20 \fs12 \cf0 \f20 \fs12 \cf0
105 \par
}
{\phpg\posx6207\pvpg\posy1103\absw5020\absh7171 \f20 \fs15 \cf0 \f20 \fs15 \cf0
palmente en los ni�os, contribuyen al aumento de la misma. La po-
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh7171 \sl-210 \f20 \fs15 \cf0
blaci�n pedi�trica en nuestro pa�s, es altamente vulnerable a la TB que
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh7171 \sl-210 \f20 \fs15 \cf0 suele
ser de contagio intrafamiliar y presenta formas m�s graves que
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh7171 \sl-210 \f20 \fs15 \cf0 en el
adulto. La TB drogorresistente (DR) es un emergente de esta
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh7171 \sl-210 \f20 \fs15 \cf0
problem�tica. Objetivos: cuantificar el n�mero de pacientes adultos
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh7171 \sl-210 \f20 \fs15 \cf0 y
pedi�tricos y su evoluci�n en el quinquenio 2013/2017. Evidenciar
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh7171 \sl-210 \f20 \fs15 \cf0 el
aumento del n�mero de pacientes pedi�tricos asistidos en la insti-
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh7171 \sl-210 \f20 \fs15 \cf0
tuci�n, tanto sensibles como DR. Cuantificar los abandonos de trata-
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh7171 \sl-210 \f20 \fs15 \cf0
miento.
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh7171 \sl-210 \f20 \fs15 \cf0 {\b
Material}{\b y}{\b m�todos:} Estudio descriptivo, retrospectivo, observacional
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh7171 \sl-210 \f20 \fs15 \cf0 de
2162 tratamientos anti TB efectuados desde el 1 de enero 2013 al
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh7171 \sl-210 \f20 \fs15 \cf0 31 de
diciembre 2017.Los casos adultos consultan en su gran mayor�a
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh7171 \sl-210 \f20 \fs15 \cf0 como
sintom�ticos respiratorios. Los pacientes pedi�tricos evaluados
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llegaron a la instituci�n en su totalidad, para estudio de contacto con-
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh7171 \sl-210 \f20 \fs15 \cf0
viviente, generalmente asintom�ticos o con s�ntomas leves de recien-
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh7171 \sl-210 \f20 \fs15 \cf0 te
comienzo. Poblaci�n y muestra: pacientes en tratamiento anti TB
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh7171 \sl-210 \f20 \fs15 \cf0
durante el quinquenio 2013-2017, pertenecientes a la poblaci�n am-
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bulatoria del Instituto Vaccarezza, Facultad de Medicina. UBA.
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh7171 \sl-210 \f20 \fs15 \cf0 {\b
Resultados:} Se iniciaron 2.162 tratamientos, de los cuales 2.044
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh7171 \sl-210 \f20 \fs15 \cf0
(94,54%) fueron TB sensibles y 118 (5,45%) TB-DR.1957 adultos (90%);
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh7171 \sl-210 \f20 \fs15 \cf0 205
pedi�tricos (10,4%). Los casos TBMDR aumentaron en los �ltimos
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh7171 \sl-210 \f20 \fs15 \cf0 2
a�os, duplic�ndose en los pacientes pedi�tricos. Los abandonos dis-
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh7171 \sl-210 \f20 \fs15 \cf0
minuyeron notoriamente con la incorporaci�n en el 2010, de acciones
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh7171 \sl-210 \f20 \fs15 \cf0
institucionales interdisciplinarias. Logramos un alto grado de adhe-
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh7171 \sl-210 \f20 \fs15 \cf0 rencia
y los abandonos de los pacientes adultos se mantienen en va-
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh7171 \sl-210 \f20 \fs15 \cf0 lores
bajos, sin abandonos en los DR.
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh7171 \sl-210 \f20 \fs15 \cf0 {\b
Conclusiones:} Observamos en nuestra instituci�n, un aumento signi-
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh7171 \sl-210 \f20 \fs15 \cf0
ficativo y progresivo, del n�mero de casos sensibles como la duplica-
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh7171 \sl-210 \f20 \fs15 \cf0 ci�n
de los DR en pediatr�a, correlacionado con el aumento de la inci-
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh7171 \sl-210 \f20 \fs15 \cf0 dencia
de TB en la poblaci�n general. Es importante la disminuci�n
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh7171 \sl-210 \f20 \fs15 \cf0
significativa de los abandonos en los �ltimos a�os, llegando a cero en
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh7171 \sl-210 \f20 \fs15 \cf0 los
casos pedi�tricos. A partir de la implementaci�n de una nueva
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh7171 \sl-210 \f20 \fs15 \cf0
estrategia institucional, centrada en la b�squeda sistem�tica y activa
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh7171 \sl-210 \f20 \fs15 \cf0 de los
contactos, principalmente DR pedi�tricos, conduciendo a una
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh7171 \sl-210 \f20 \fs15 \cf0 mejor
capacidad de detecci�n y seguimiento. Ponemos �nfasis en la
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh7171 \sl-210 \f20 \fs15 \cf0
importancia de un equipo de trabajo interdisciplinario para obtener
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh7171 \sl-210 \f20 \fs15 \cf0 mayor
�xito en la adherencia de una enfermedad cr�nica y emergen-
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh7171 \sl-210 \f20 \fs15 \cf0 te
como es la TBC. \par
}
{\phpg\posx850\pvpg\posy11286\absw5017\absh557 \b \f20 \fs15 \cf0 \b \f20 \fs15
\cf0 Conclusiones:{\b0 Con}{\b0 los}{\b0 resultados}{\b0 finales}{\b0 de}{\b0
cultivo}{\b0 y}{\b0 el}{\b0 procesamien- }
\par}{\phpg\posx850\pvpg\posy11286\absw5017\absh557 \sl-210 \b \f20 \fs15 \cf0 {\b0
to}{\b0 de}{\b0 datos}{\b0 del}{\b0 AeoNose}{\b0 podemos}{\b0 evaluar}{\b0
la}{\b0 utilidad}{\b0 de}{\b0 este}{\b0 'point}{\b0 of }
\par}{\phpg\posx850\pvpg\posy11286\absw5017\absh557 \sl-210 \b \f20 \fs15 \cf0 {\b0
care'}{\b0 dispositivo}{\b0 en}{\b0 un}{\b0 ambiente}{\b0 hospitalario. }\par
}
{\phpg\posx850\pvpg\posy12473\absw5017\absh2230 \b \f20 \fs15 \cf0 \b \f20 \fs15
\cf0 244. EVOLUCI�N DE LA TUBERCULOSIS EN UN CENTRO
\par}{\phpg\posx850\pvpg\posy12473\absw5017\absh2230 \sl-200 \b \f20 \fs15 \cf0
UNIVERSITARIO DE REFERENCIA
\par}{\phpg\posx850\pvpg\posy12473\absw5017\absh2230 \sl-170 \par\b \f20 \fs15 \cf0
{\b0 S.}{\b0 Inwentarz,}{\b0 V.L.}{\b0 Lagrutta}{\b0 Mart�n,}{\b0 M.}{\b0
Medin,}{\b0 D.}{\b0 Mart�nez,}{\b0 R.}{\b0 Estevan, }
\par}{\phpg\posx850\pvpg\posy12473\absw5017\absh2230 \sl-199 \b \f20 \fs15 \cf0
{\b0 J.}{\b0 Falco,}{\b0 M.}{\b0 Vescovo,}{\b0 J.L.}{\b0 Vi�a,}{\b0 L.}{\b0
Alves,}{\b0 I.}{\b0 Palma,}{\b0 M.}{\b0 Natiello,}{\b0 M.}{\b0 Souto, }
\par}{\phpg\posx850\pvpg\posy12473\absw5017\absh2230 \sl-200 \b \f20 \fs15 \cf0
{\b0 S.}{\b0 Ag�ero,}{\b0 N.}{\b0 Huergo,}{\b0 L.}{\b0 Castro}{\b0 Zorrilla}
{\b0 y}{\b0 D.}{\b0 Palmero }
\par}{\phpg\posx850\pvpg\posy12473\absw5017\absh2230 \sl-156 \par\b \f20 \fs15 \cf0
{\b0\i Instituto}{\b0\i de}{\b0\i Tisioneumonolog�a}{\b0\i Dr.}{\b0\i Ra�l}
{\b0\i Vaccarezza.}{\b0\i Facultad}{\b0\i de }
\par}{\phpg\posx850\pvpg\posy12473\absw5017\absh2230 \sl-200 \b \f20 \fs15 \cf0
{\b0\i Medicina-UBA. }
\par}{\phpg\posx850\pvpg\posy12473\absw5017\absh2230 \sl-201 \par\b \f20 \fs15 \cf0
Introducci�n:{\b0 La}{\b0 tuberculosis}{\b0 (TB)}{\b0 es}{\b0 un}{\b0 grave}
{\b0 problema}{\b0 de}{\b0 Salud }
\par}{\phpg\posx850\pvpg\posy12473\absw5017\absh2230 \sl-210 \b \f20 \fs15 \cf0
{\b0 P�blica}{\b0 en}{\b0 Argentina.}{\b0 Los}{\b0 abandonos}{\b0 reiterados,}
{\b0 los}{\b0 problemas}{\b0 de}{\b0 ac- }
\par}{\phpg\posx850\pvpg\posy12473\absw5017\absh2230 \sl-210 \b \f20 \fs15 \cf0
{\b0 cesibilidad,}{\b0 el}{\b0 abuso}{\b0 de}{\b0 drogas}{\b0 y}{\b0 las}{\b0
dificultades}{\b0 diagn�sticas}{\b0 princi- }\par
}
{\phpg\posx6207\pvpg\posy9491\absw5020\absh4913 \b \f20 \fs15 \cf0 \b \f20 \fs15
\cf0 245. DESENLACES DE CASOS GRAVES DE TUBERCULOSIS
\par}{\phpg\posx6207\pvpg\posy9491\absw5020\absh4913 \sl-200 \b \f20 \fs15 \cf0 EN
AM�RICA LATINA Y EUROPA
\par}{\phpg\posx6207\pvpg\posy9491\absw5020\absh4913 \sl-170 \par\b \f20 \fs15 \cf0
{\b0 M.}{\b0 Munoz,}{\b0 S.}{\b0 Tiberi,}{\b0 R.}{\b0 G�mez,}{\b0 A.}{\b0
Carvalho,}{\b0 M.}{\b0 Cordeiro}{\b0 dos}{\b0 Santos, }
\par}{\phpg\posx6207\pvpg\posy9491\absw5020\absh4913 \sl-199 \b \f20 \fs15 \cf0
{\b0 D.}{\b0 Ferreira,}{\b0 C.}{\b0 Hern�ndez,}{\b0 A.}{\b0 Kritski,}{\b0 A.}
{\b0 Mar��a,}{\b0 A.}{\b0 Mendoza, }
\par}{\phpg\posx6207\pvpg\posy9491\absw5020\absh4913 \sl-200 \b \f20 \fs15 \cf0
{\b0 A.}{\b0 Rahman,}{\b0 O.}{\b0 Akkerman,}{\b0 J.W.}{\b0 Alffenaar,}{\b0
J.}{\b0 Barrett,}{\b0 J.}{\b0 Bruchfeld, }
\par}{\phpg\posx6207\pvpg\posy9491\absw5020\absh4913 \sl-200 \b \f20 \fs15 \cf0
{\b0 R.}{\b0 Centis,}{\b0 L.}{\b0 D'Ambrosio,}{\b0 R.}{\b0 Duarte,}{\b0 M.}
{\b0 Duenser,}{\b0 L.}{\b0 Davies}{\b0 Forsman, }
\par}{\phpg\posx6207\pvpg\posy9491\absw5020\absh4913 \sl-200 \b \f20 \fs15 \cf0
{\b0 N.}{\b0 Jayasekera,}{\b0 L.}{\b0 John,}{\b0 E.}{\b0 Johnson,}{\b0 W.}
{\b0 Lynn,}{\b0 J.}{\b0 Martin,}{\b0 N.}{\b0 Sabir, }
\par}{\phpg\posx6207\pvpg\posy9491\absw5020\absh4913 \sl-200 \b \f20 \fs15 \cf0
{\b0 L.}{\b0 Saderi,}{\b0 K.}{\b0 Shah,}{\b0 L.}{\b0 Wagrell,}{\b0 V.}{\b0
White,}{\b0 P.}{\b0 Zolfaghari,}{\b0 A.}{\b0 Zumla, }
\par}{\phpg\posx6207\pvpg\posy9491\absw5020\absh4913 \sl-199 \b \f20 \fs15 \cf0
{\b0 H.}{\b0 Kunst,}{\b0 G.}{\b0 Sotgiu}{\b0 y}{\b0 G.B.}{\b0 Migliori }
\par}{\phpg\posx6207\pvpg\posy9491\absw5020\absh4913 \sl-184 \par\b \f20 \fs15 \cf0
Introducci�n:{\b0 El}{\b0 objetivo}{\b0 del}{\b0 estudio}{\b0 es}{\b0
describir}{\b0 el}{\b0 desenlace}{\b0 de}{\b0 una }
\par}{\phpg\posx6207\pvpg\posy9491\absw5020\absh4913 \sl-210 \b \f20 \fs15 \cf0
{\b0 cohorte}{\b0 de}{\b0 casos}{\b0 TB}{\b0 grave}{\b0 reclutados}{\b0 en}
{\b0 11}{\b0 centros,}{\b0 en}{\b0 7}{\b0 pa�ses}{\b0 de }
\par}{\phpg\posx6207\pvpg\posy9491\absw5020\absh4913 \sl-210 \b \f20 \fs15 \cf0
{\b0 Am�rica}{\b0 Latina}{\b0 (Brasil,}{\b0 M�xico,}{\b0 Paraguay)}{\b0 y}{\b0
Europa}{\b0 (Reino}{\b0 Unido,}{\b0 Ho- }
\par}{\phpg\posx6207\pvpg\posy9491\absw5020\absh4913 \sl-210 \b \f20 \fs15 \cf0
{\b0 landa,}{\b0 Portugal,}{\b0 Suecia). }
\par}{\phpg\posx6207\pvpg\posy9491\absw5020\absh4913 \sl-210 \b \f20 \fs15 \cf0
Material y m�todos:{\b0 Estudio}{\b0 observacional}{\b0 multic�ntrico.}{\b0 Se}
{\b0 estrati- }
\par}{\phpg\posx6207\pvpg\posy9491\absw5020\absh4913 \sl-210 \b \f20 \fs15 \cf0
{\b0 fic�}{\b0 por}{\b0 tratamiento}{\b0 IV}{\b0 vs}{\b0 oral.}{\b0 Se}{\b0
realiz�}{\b0 el}{\b0 an�lisis}{\b0 de}{\b0 regresi�n}{\b0 lo- }
\par}{\phpg\posx6207\pvpg\posy9491\absw5020\absh4913 \sl-210 \b \f20 \fs15 \cf0
{\b0 g�stica}{\b0 para}{\b0 identificar}{\b0 las}{\b0 variables}{\b0
asociadas}{\b0 a}{\b0 mortalidad. }
\par}{\phpg\posx6207\pvpg\posy9491\absw5020\absh4913 \sl-210 \b \f20 \fs15 \cf0
Resultados:{\b0 De}{\b0 175}{\b0 casos}{\b0 de}{\b0 TB}{\b0 grave,}{\b0 76}
{\b0 en}{\b0 Am�rica}{\b0 Latina,}{\b0 70,9% }
\par}{\phpg\posx6207\pvpg\posy9491\absw5020\absh4913 \sl-210 \b \f20 \fs15 \cf0
{\b0 fueron}{\b0 hombres}{\b0 (mediana}{\b0 de}{\b0 edad}{\b0 44,5}{\b0 (IQR}
{\b0 33,0-58,0)}{\b0 a�os);}{\b0 29,1% }
\par}{\phpg\posx6207\pvpg\posy9491\absw5020\absh4913 \sl-210 \b \f20 \fs15 \cf0
{\b0 inmunocomprometidos}{\b0 (22,5%}{\b0 co-infecci�n}{\b0 por}{\b0 TB/VIH).}
{\b0 80,3%}{\b0 de}{\b0 los }
\par}{\phpg\posx6207\pvpg\posy9491\absw5020\absh4913 \sl-210 \b \f20 \fs15 \cf0
{\b0 pacientes}{\b0 fueron}{\b0 casos}{\b0 nuevos,}{\b0 63,9%}{\b0 con}{\b0
TB}{\b0 pulmonar,}{\b0 13,3%}{\b0 TB}{\b0 mi- }
\par}{\phpg\posx6207\pvpg\posy9491\absw5020\absh4913 \sl-210 \b \f20 \fs15 \cf0
{\b0 liar,}{\b0 y}{\b0 9%}{\b0 meningitis.163}{\b0 (95,3%)}{\b0 ingresaron}
{\b0 a}{\b0 la}{\b0 UCI}{\b0 y}{\b0 recibieron}{\b0 tra- }
\par}{\phpg\posx6207\pvpg\posy9491\absw5020\absh4913 \sl-210 \b \f20 \fs15 \cf0
{\b0 tamiento}{\b0 IV}{\b0 (mediana}{\b0 de}{\b0 2}{\b0 (IQR}{\b0 0-14)}{\b0
d�as);}{\b0 126}{\b0 (78,3%)}{\b0 requirieron }
\par}{\phpg\posx6207\pvpg\posy9491\absw5020\absh4913 \sl-210 \b \f20 \fs15 \cf0
{\b0 de}{\b0 intubaci�n}{\b0 orotraqueal}{\b0 y}{\b0 ventilaci�n}{\b0
mec�nica}{\b0 (mediana}{\b0 de}{\b0 4}{\b0 (IQR }
\par}{\phpg\posx6207\pvpg\posy9491\absw5020\absh4913 \sl-210 \b \f20 \fs15 \cf0
{\b0 1-11)}{\b0 d�as).}{\b0 Mas}{\b0 casos}{\b0 requirieron}{\b0 de}{\b0
ventilaci�n}{\b0 mec�nica}{\b0 invasiva }
\par}{\phpg\posx6207\pvpg\posy9491\absw5020\absh4913 \sl-210 \b \f20 \fs15 \cf0
{\b0 en}{\b0 Am�rica}{\b0 Latina,}{\b0 pero}{\b0 menos}{\b0 pacientes}{\b0
fueron}{\b0 ingresados}{\b0 en}{\b0 UCI.}{\b0 El }\par
}
\sect\sectd\pard\plain
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a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a00
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0028a28a0028a28a0028a28a0028a28a0028a28
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8a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0
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0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a002
8a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a2
8a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0
028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028
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a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a00
28a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a
28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a
0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a002
8a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a2
8a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0
028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028
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a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a00
28a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a
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0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a002
8a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a2
8a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0
028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028
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a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a00
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8a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a2
8a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0
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28a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a
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0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a002
8a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a2
8a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0
028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028
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a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a00
28a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a
28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a
0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a002
8a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a2
8a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0
028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028
a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28
a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a00
28a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a
28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a
0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a002
8a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a2
8a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0
028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028
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a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a00
28a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a
28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a
0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a002
8a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a2
8a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0
028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028
a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28
a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a00
28a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a
28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a
0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a002
8a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a2
8a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a00ffd9
}}\par}{\phpg\posx680\pvpg\posy711\absw215\absh142 \f20 \fs12 \cf0 \f20 \fs12 \cf0
106 \par
}
{\phpg\posx5258\pvpg\posy713\absw1048\absh138 \i \f20 \fs12 \cf0 \i \f20 \fs12 \cf0
11.� Congreso ALAT \par
}
{\phpg\posx680\pvpg\posy1103\absw5020\absh4336 \f20 \fs15 \cf0 \f20 \fs15 \cf0
tiempo desde el inicio de los s�ntomas hasta el ingreso hospitalario
\par}{\phpg\posx680\pvpg\posy1103\absw5020\absh4336 \sl-210 \f20 \fs15 \cf0 fue de
29 (IQR 9,5-60) meses y las indicaciones: falla org�nica m�lti-
\par}{\phpg\posx680\pvpg\posy1103\absw5020\absh4336 \sl-210 \f20 \fs15 \cf0 ple
(27,7%), meningitis (10,3%) y obstrucci�n de la v�a a�rea (7,1%);
\par}{\phpg\posx680\pvpg\posy1103\absw5020\absh4336 \sl-210 \f20 \fs15 \cf0 48,4%
inici� tratamiento anti-TB en la UCI. Se confirm� malabsorci�n
\par}{\phpg\posx680\pvpg\posy1103\absw5020\absh4336 \sl-210 \f20 \fs15 \cf0 en el
17,1% de los casos. 75 (45,8%) recibieron tratamiento anti-TB IV,
\par}{\phpg\posx680\pvpg\posy1103\absw5020\absh4336 \sl-210 \f20 \fs15 \cf0 sin
diferencias significativas entre los tratados IV vs oral, en cuanto la
\par}{\phpg\posx680\pvpg\posy1103\absw5020\absh4336 \sl-210 \f20 \fs15 \cf0
prevalencia de TB-MDR, edad, estado bacteriol�gico y factores de ries-
\par}{\phpg\posx680\pvpg\posy1103\absw5020\absh4336 \sl-210 \f20 \fs15 \cf0 go. El
88,9% de los pacientes con tratamiento IV vs 83,3% oral lograron
\par}{\phpg\posx680\pvpg\posy1103\absw5020\absh4336 \sl-210 \f20 \fs15 \cf0 la
conversi�n bacteriol�gica, con tasas de �xito de 36,1% vs 41,5%, res-
\par}{\phpg\posx680\pvpg\posy1103\absw5020\absh4336 \sl-210 \f20 \fs15 \cf0
pectivamente (p: ns). En Am�rica Latina, la tasa de �xito de los pacien-
\par}{\phpg\posx680\pvpg\posy1103\absw5020\absh4336 \sl-210 \f20 \fs15 \cf0 tes
tratados IV vs oral fue del 22,7% vs 32,4%, y en Europa 40,5% vs
\par}{\phpg\posx680\pvpg\posy1103\absw5020\absh4336 \sl-210 \f20 \fs15 \cf0 50,0%
respectivamente. La mortalidad fue de 61,8% y 45,2% (p: 0,04)
\par}{\phpg\posx680\pvpg\posy1103\absw5020\absh4336 \sl-210 \f20 \fs15 \cf0 en
Am�rica Latina y Europa. En general, los �ndices de Charlson (OR
\par}{\phpg\posx680\pvpg\posy1103\absw5020\absh4336 \sl-210 \f20 \fs15 \cf0 1,2, p:
0,003), SAPS II (OR 1,1, p: 0,03) y la escala de coma de Glasgow
\par}{\phpg\posx680\pvpg\posy1103\absw5020\absh4336 \sl-210 \f20 \fs15 \cf0 (OR
0,9, p: 0,02) se asociaron con mayor mortalidad, mientras que la
\par}{\phpg\posx680\pvpg\posy1103\absw5020\absh4336 \sl-210 \f20 \fs15 \cf0 escala
de SOFA no (OR 1,3, p: 0,11). En Europa, las mismas escalas, se
\par}{\phpg\posx680\pvpg\posy1103\absw5020\absh4336 \sl-210 \f20 \fs15 \cf0
asociaron significativamente con mayor mortalidad (OR 1,2, p: 0,007;
\par}{\phpg\posx680\pvpg\posy1103\absw5020\absh4336 \sl-210 \f20 \fs15 \cf0 OR 1,1,
p: 0,03; OR 0,9, p: 0,02 respectivamente), pero no as� en Am�-
\par}{\phpg\posx680\pvpg\posy1103\absw5020\absh4336 \sl-210 \f20 \fs15 \cf0 rica
Latina.
\par}{\phpg\posx680\pvpg\posy1103\absw5020\absh4336 \sl-210 \f20 \fs15 \cf0 {\b
Conclusiones:} Los casos graves de TB en Am�rica Latina y Europa
\par}{\phpg\posx680\pvpg\posy1103\absw5020\absh4336 \sl-210 \f20 \fs15 \cf0 tienen
diferentes caracter�sticas cl�nicas y por lo tanto desaf�os y
\par}{\phpg\posx680\pvpg\posy1103\absw5020\absh4336 \sl-210 \f20 \fs15 \cf0
desenlaces diferentes, siendo la mortalidad mayor en Am�rica La-
\par}{\phpg\posx680\pvpg\posy1103\absw5020\absh4336 \sl-210 \f20 \fs15 \cf0
tina. \par
}
{\phpg\posx680\pvpg\posy6341\absw5020\absh7748 \b \f20 \fs15 \cf0 \b \f20 \fs15
\cf0 246. DIFERENCIAS RADIOL�GICAS EN PACIENTES CON
\par}{\phpg\posx680\pvpg\posy6341\absw5020\absh7748 \sl-200 \b \f20 \fs15 \cf0
TUBERCULOSIS PULMONAR SEG�N EL TIPO DE
\par}{\phpg\posx680\pvpg\posy6341\absw5020\absh7748 \sl-200 \b \f20 \fs15 \cf0
INMUNOSUPRESI�N: EXPERIENCIA EN EL HOSPITAL
\par}{\phpg\posx680\pvpg\posy6341\absw5020\absh7748 \sl-200 \b \f20 \fs15 \cf0
UNIVERSITARIO DE CARACAS 2000-2016
\par}{\phpg\posx680\pvpg\posy6341\absw5020\absh7748 \sl-170 \par\b \f20 \fs15 \cf0
{\b0 A.}{\b0 Maldonado,}{\b0 E.}{\b0 S�nchez-Angarita,}{\b0 A.}{\b0 Mata,}{\b0
J.}{\b0 Catar�, }
\par}{\phpg\posx680\pvpg\posy6341\absw5020\absh7748 \sl-200 \b \f20 \fs15 \cf0 {\b0
A.}{\b0 Acu�a-Izcaray}{\b0 y}{\b0 M.}{\b0 Laucho-Contreras }
\par}{\phpg\posx680\pvpg\posy6341\absw5020\absh7748 \sl-156 \par\b \f20 \fs15 \cf0
{\b0\i C�tedra}{\b0\i y}{\b0\i Servicio}{\b0\i de}{\b0\i Neumonolog�a}{\b0\i
y}{\b0\i Cirug�a}{\b0\i de}{\b0\i T�rax.}{\b0\i Hospital }
\par}{\phpg\posx680\pvpg\posy6341\absw5020\absh7748 \sl-200 \b \f20 \fs15 \cf0
{\b0\i Universitario}{\b0\i de}{\b0\i Caracas.}{\b0\i Universidad}{\b0\i
Central}{\b0\i de}{\b0\i Venezuela. }
\par}{\phpg\posx680\pvpg\posy6341\absw5020\absh7748 \sl-227 \par\b \f20 \fs15 \cf0
Introducci�n:{\b0 La}{\b0 TB}{\b0 pulmonar}{\b0 (TB-P)}{\b0 suele}{\b0 tener}
{\b0 manifestaciones }
\par}{\phpg\posx680\pvpg\posy6341\absw5020\absh7748 \sl-210 \b \f20 \fs15 \cf0 {\b0
radiol�gicas}{\b0 que}{\b0 sugieren}{\b0 su}{\b0 diagn�stico;}{\b0 sin}{\b0
embargo,}{\b0 el}{\b0 grado}{\b0 de }
\par}{\phpg\posx680\pvpg\posy6341\absw5020\absh7748 \sl-210 \b \f20 \fs15 \cf0 {\b0
compromiso}{\b0 inmunol�gico}{\b0 del}{\b0 paciente,}{\b0 puede}{\b0 inducir}
{\b0 a}{\b0 presentacio- }
\par}{\phpg\posx680\pvpg\posy6341\absw5020\absh7748 \sl-210 \b \f20 \fs15 \cf0 {\b0
nes}{\b0 at�picas.}{\b0 El}{\b0 objetivo}{\b0 de}{\b0 este}{\b0 estudio}{\b0
es}{\b0 comparar}{\b0 diferentes}{\b0 pato- }
\par}{\phpg\posx680\pvpg\posy6341\absw5020\absh7748 \sl-210 \b \f20 \fs15 \cf0 {\b0
log�as}{\b0 que}{\b0 est�n}{\b0 asociadas}{\b0 a}{\b0 inmunosupresi�n,}{\b0
con}{\b0 las}{\b0 formas}{\b0 radio- }
\par}{\phpg\posx680\pvpg\posy6341\absw5020\absh7748 \sl-210 \b \f20 \fs15 \cf0 {\b0
l�gicas}{\b0 de}{\b0 presentaci�n}{\b0 de}{\b0 la}{\b0 TB-P}{\b0 en}{\b0
pacientes}{\b0 de}{\b0 la}{\b0 consulta}{\b0 de }
\par}{\phpg\posx680\pvpg\posy6341\absw5020\absh7748 \sl-210 \b \f20 \fs15 \cf0 {\b0
tuberculosis}{\b0 del}{\b0 Hospital}{\b0 Universitario}{\b0 de}{\b0 Caracas. }
\par}{\phpg\posx680\pvpg\posy6341\absw5020\absh7748 \sl-210 \b \f20 \fs15 \cf0
Material y m�todos:{\b0 Es}{\b0 un}{\b0 estudio}{\b0 retrospectivo,}{\b0 en}
{\b0 el}{\b0 que}{\b0 se}{\b0 inclu- }
\par}{\phpg\posx680\pvpg\posy6341\absw5020\absh7748 \sl-210 \b \f20 \fs15 \cf0 {\b0
yeron}{\b0 5.186}{\b0 pacientes}{\b0 con}{\b0 diagn�stico}{\b0 de}{\b0 TB}
{\b0 de}{\b0 la}{\b0 consulta}{\b0 de}{\b0 TB}{\b0 del }
\par}{\phpg\posx680\pvpg\posy6341\absw5020\absh7748 \sl-210 \b \f20 \fs15 \cf0 {\b0
Hospital}{\b0 Universitario}{\b0 de}{\b0 Caracas}{\b0 en}{\b0 un}{\b0
per�odo}{\b0 comprendido}{\b0 entre }
\par}{\phpg\posx680\pvpg\posy6341\absw5020\absh7748 \sl-210 \b \f20 \fs15 \cf0 {\b0
2000-2016.}{\b0 2.852}{\b0 pacientes}{\b0 ten�an}{\b0 diagn�stico}{\b0 de}{\b0
TB-P.}{\b0 Se}{\b0 compara- }
\par}{\phpg\posx680\pvpg\posy6341\absw5020\absh7748 \sl-210 \b \f20 \fs15 \cf0 {\b0
ron}{\b0 los}{\b0 distintos}{\b0 hallazgos}{\b0 radiol�gicos}{\b0 en}{\b0
pacientes}{\b0 patolog�as}{\b0 inmu- }
\par}{\phpg\posx680\pvpg\posy6341\absw5020\absh7748 \sl-210 \b \f20 \fs15 \cf0 {\b0
nosupresoras}{\b0 [desnutrici�n,}{\b0 VIH}{\b0 SIDA,}{\b0 diabetes}{\b0
mellitus}{\b0 (DM),}{\b0 uso}{\b0 de }
\par}{\phpg\posx680\pvpg\posy6341\absw5020\absh7748 \sl-210 \b \f20 \fs15 \cf0 {\b0
drogas}{\b0 il�citas,}{\b0 uso}{\b0 de}{\b0 alcohol}{\b0 y}{\b0 drogas}{\b0
inmunosupresoras].}{\b0 Se}{\b0 anali- }
\par}{\phpg\posx680\pvpg\posy6341\absw5020\absh7748 \sl-210 \b \f20 \fs15 \cf0 {\b0
zaron}{\b0 los}{\b0 datos}{\b0 con}{\b0 estad�stica}{\b0 descriptiva}{\b0 y}
{\b0 regresi�n}{\b0 log�stica}{\b0 biva- }
\par}{\phpg\posx680\pvpg\posy6341\absw5020\absh7748 \sl-210 \b \f20 \fs15 \cf0 {\b0
riada. }
\par}{\phpg\posx680\pvpg\posy6341\absw5020\absh7748 \sl-210 \b \f20 \fs15 \cf0
Resultados:{\b0 De}{\b0 2.852}{\b0 pacientes}{\b0 con}{\b0 diagn�stico}{\b0
de}{\b0 TB-P,}{\b0 61,2%}{\b0 pre- }
\par}{\phpg\posx680\pvpg\posy6341\absw5020\absh7748 \sl-210 \b \f20 \fs15 \cf0 {\b0
sentaban}{\b0 cavitaciones}{\b0 en}{\b0 la}{\b0 radiolog�a}{\b0 pulmonar.}{\b0
La}{\b0 presencia}{\b0 de}{\b0 ca- }
\par}{\phpg\posx680\pvpg\posy6341\absw5020\absh7748 \sl-210 \b \f20 \fs15 \cf0 {\b0
vitaciones}{\b0 estaba}{\b0 relacionada}{\b0 con}{\b0 el}{\b0 diagn�stico}{\b0
de}{\b0 HIV-SIDA}{\b0 (OR}{\b0 = }
\par}{\phpg\posx680\pvpg\posy6341\absw5020\absh7748 \sl-210 \b \f20 \fs15 \cf0 {\b0
1,27,}{\b0 IC}{\b0 =}{\b0 1,20-1,34),}{\b0 mientras}{\b0 que}{\b0 la}{\b0
ausencia}{\b0 de}{\b0 cavernas}{\b0 se}{\b0 relacio- }
\par}{\phpg\posx680\pvpg\posy6341\absw5020\absh7748 \sl-210 \b \f20 \fs15 \cf0 {\b0
naba}{\b0 con}{\b0 el}{\b0 diagn�stico}{\b0 de}{\b0 DM}{\b0 (OR}{\b0 =}{\b0
1,48;}{\b0 IC}{\b0 =}{\b0 1,18-1,86),}{\b0 desnutrici�n }
\par}{\phpg\posx680\pvpg\posy6341\absw5020\absh7748 \sl-210 \b \f20 \fs15 \cf0 {\b0
(OR}{\b0 =}{\b0 1,90;}{\b0 IC}{\b0 =}{\b0 1,55-2,32),}{\b0 alcohol}{\b0 (OR}
{\b0 =}{\b0 1,58;}{\b0 IC}{\b0 =}{\b0 1,21-2,05)}{\b0 y}{\b0 con}{\b0 uso }
\par}{\phpg\posx680\pvpg\posy6341\absw5020\absh7748 \sl-210 \b \f20 \fs15 \cf0 {\b0
de}{\b0 drogas}{\b0 il�citas}{\b0 (OR}{\b0 =}{\b0 2,22;}{\b0 IC}{\b0 =}{\b0
1,50-3,20).}{\b0 En}{\b0 cuanto}{\b0 a}{\b0 la}{\b0 distribu- }
\par}{\phpg\posx680\pvpg\posy6341\absw5020\absh7748 \sl-210 \b \f20 \fs15 \cf0 {\b0
ci�n}{\b0 radiol�gica,}{\b0 tener}{\b0 diagn�stico}{\b0 de}{\b0 HIV-SIDA}{\b0
o}{\b0 desnutrici�n,}{\b0 se }
\par}{\phpg\posx680\pvpg\posy6341\absw5020\absh7748 \sl-210 \b \f20 \fs15 \cf0 {\b0
asoci�}{\b0 con}{\b0 presencia}{\b0 de}{\b0 lesiones}{\b0 unilaterales}{\b0
(OR}{\b0 =}{\b0 1,28;}{\b0 IC}{\b0 =}{\b0 1,15-1,43 }
\par}{\phpg\posx680\pvpg\posy6341\absw5020\absh7748 \sl-210 \b \f20 \fs15 \cf0 {\b0
y}{\b0 OR}{\b0 =}{\b0 1,38;}{\b0 IC}{\b0 =}{\b0 1,12-1,70). }
\par}{\phpg\posx680\pvpg\posy6341\absw5020\absh7748 \sl-210 \b \f20 \fs15 \cf0
Conclusiones:{\b0 La}{\b0 inmunosupresi�n}{\b0 est�}{\b0 ligada}{\b0 a}{\b0
patrones}{\b0 at�picos}{\b0 en }
\par}{\phpg\posx680\pvpg\posy6341\absw5020\absh7748 \sl-210 \b \f20 \fs15 \cf0 {\b0
la}{\b0 radiolog�a}{\b0 tor�cica}{\b0 de}{\b0 las}{\b0 TB,}{\b0 excepto}{\b0
los}{\b0 pacientes}{\b0 con}{\b0 diagn�stico }
\par}{\phpg\posx680\pvpg\posy6341\absw5020\absh7748 \sl-210 \b \f20 \fs15 \cf0 {\b0
de}{\b0 VIH-SIDA}{\b0 en}{\b0 los}{\b0 que}{\b0 estuvo}{\b0 asociada}{\b0
con}{\b0 la}{\b0 presencia}{\b0 de}{\b0 cavitacio- }
\par}{\phpg\posx680\pvpg\posy6341\absw5020\absh7748 \sl-210 \b \f20 \fs15 \cf0 {\b0
nes}{\b0 pulmonares.}{\b0 Esto}{\b0 probablemente}{\b0 se}{\b0 deba}{\b0 al}
{\b0 grado}{\b0 de}{\b0 control}{\b0 pre- }
\par}{\phpg\posx680\pvpg\posy6341\absw5020\absh7748 \sl-210 \b \f20 \fs15 \cf0 {\b0
vio}{\b0 de}{\b0 estos}{\b0 pacientes}{\b0 y}{\b0 sus}{\b0 niveles}{\b0 de}
{\b0 inmunosupresi�n. }\par
}
{\phpg\posx6037\pvpg\posy1100\absw5020\absh8875 \b \f20 \fs15 \cf0 \b \f20 \fs15
\cf0 247. LA DIABETES MELLITUS SE ASOCIA CON MAYOR RIESGO DE
\par}{\phpg\posx6037\pvpg\posy1100\absw5020\absh8875 \sl-200 \b \f20 \fs15 \cf0
TUBERCULOSIS EXTRAPULMONAR: EXPERIENCIA EN LA
\par}{\phpg\posx6037\pvpg\posy1100\absw5020\absh8875 \sl-200 \b \f20 \fs15 \cf0
CONSULTA DE TUBERCULOSIS DEL HOSPITAL UNIVERSITARIO
\par}{\phpg\posx6037\pvpg\posy1100\absw5020\absh8875 \sl-200 \b \f20 \fs15 \cf0 DE
CARACAS 2000-2016
\par}{\phpg\posx6037\pvpg\posy1100\absw5020\absh8875 \sl-170 \par\b \f20 \fs15 \cf0
{\b0 A.}{\b0 Maldonado,}{\b0 E.}{\b0 S�nchez-Angarita,}{\b0 A.}{\b0 Mata,}{\b0
J.}{\b0 Catar�, }
\par}{\phpg\posx6037\pvpg\posy1100\absw5020\absh8875 \sl-200 \b \f20 \fs15 \cf0
{\b0 A.}{\b0 Acu�a-Izcaray}{\b0 y}{\b0 M.}{\b0 Laucho-Contreras }
\par}{\phpg\posx6037\pvpg\posy1100\absw5020\absh8875 \sl-156 \par\b \f20 \fs15 \cf0
{\b0\i C�tedra}{\b0\i y}{\b0\i Servicio}{\b0\i de}{\b0\i Neumonolog�a}{\b0\i
y}{\b0\i Cirug�a}{\b0\i de}{\b0\i T�rax.}{\b0\i Hospital }
\par}{\phpg\posx6037\pvpg\posy1100\absw5020\absh8875 \sl-200 \b \f20 \fs15 \cf0
{\b0\i Universitario}{\b0\i de}{\b0\i Caracas.}{\b0\i Universidad}{\b0\i
Central}{\b0\i de}{\b0\i Venezuela. }
\par}{\phpg\posx6037\pvpg\posy1100\absw5020\absh8875 \sl-223 \par\b \f20 \fs15 \cf0
Introducci�n:{\b0 La}{\b0 tuberculosis}{\b0 pulmonar}{\b0 (TB-P)}{\b0 es}{\b0
una}{\b0 enfermedad }
\par}{\phpg\posx6037\pvpg\posy1100\absw5020\absh8875 \sl-210 \b \f20 \fs15 \cf0
{\b0 limitante,}{\b0 que}{\b0 afecta}{\b0 a}{\b0 millones}{\b0 de}{\b0
personas}{\b0 anualmente.}{\b0 Sin}{\b0 em- }
\par}{\phpg\posx6037\pvpg\posy1100\absw5020\absh8875 \sl-210 \b \f20 \fs15 \cf0
{\b0 bargo}{\b0 la}{\b0 patog�nesis}{\b0 asociada}{\b0 a}{\b0 la}{\b0
tuberculosis}{\b0 sigue}{\b0 siendo}{\b0 dif�cil }
\par}{\phpg\posx6037\pvpg\posy1100\absw5020\absh8875 \sl-210 \b \f20 \fs15 \cf0
{\b0 de}{\b0 explicar,}{\b0 teniendo}{\b0 en}{\b0 cuenta}{\b0 que}{\b0 solo}
{\b0 un}{\b0 peque�o}{\b0 porcentaje}{\b0 de }
\par}{\phpg\posx6037\pvpg\posy1100\absw5020\absh8875 \sl-210 \b \f20 \fs15 \cf0
{\b0 los}{\b0 pacientes}{\b0 desarrollan}{\b0 la}{\b0 forma}{\b0 cl�nica}{\b0
de}{\b0 la}{\b0 enfermedad.}{\b0 La}{\b0 tu- }
\par}{\phpg\posx6037\pvpg\posy1100\absw5020\absh8875 \sl-210 \b \f20 \fs15 \cf0
{\b0 berculosis}{\b0 extrapulmonar}{\b0 (TB-EP)}{\b0 es}{\b0 m�s}{\b0
frecuente}{\b0 en}{\b0 los}{\b0 pacien- }
\par}{\phpg\posx6037\pvpg\posy1100\absw5020\absh8875 \sl-210 \b \f20 \fs15 \cf0
{\b0 tes}{\b0 con}{\b0 alg�n}{\b0 tipo}{\b0 de}{\b0 inmunosupresi�n.}{\b0 El}
{\b0 objetivo}{\b0 de}{\b0 este}{\b0 estudio }
\par}{\phpg\posx6037\pvpg\posy1100\absw5020\absh8875 \sl-210 \b \f20 \fs15 \cf0
{\b0 es}{\b0 comparar}{\b0 diferentes}{\b0 patolog�as}{\b0 y}{\b0 h�bitos}{\b0
de}{\b0 vida}{\b0 que}{\b0 causan }
\par}{\phpg\posx6037\pvpg\posy1100\absw5020\absh8875 \sl-210 \b \f20 \fs15 \cf0
{\b0 inmunosupresi�n}{\b0 y}{\b0 determinar}{\b0 el}{\b0 riesgo}{\b0 de}{\b0
desarrollar}{\b0 TB-EP}{\b0 en }
\par}{\phpg\posx6037\pvpg\posy1100\absw5020\absh8875 \sl-210 \b \f20 \fs15 \cf0
{\b0 pacientes}{\b0 de}{\b0 la}{\b0 consulta}{\b0 de}{\b0 tuberculosis}{\b0
del}{\b0 Hospital}{\b0 Universitario }
\par}{\phpg\posx6037\pvpg\posy1100\absw5020\absh8875 \sl-210 \b \f20 \fs15 \cf0
{\b0 de}{\b0 Caracas. }
\par}{\phpg\posx6037\pvpg\posy1100\absw5020\absh8875 \sl-210 \b \f20 \fs15 \cf0
Material y m�todos:{\b0 Estudio}{\b0 retrospectivo,}{\b0 que}{\b0 incluy�}{\b0
5.186}{\b0 pacien- }
\par}{\phpg\posx6037\pvpg\posy1100\absw5020\absh8875 \sl-210 \b \f20 \fs15 \cf0
{\b0 tes}{\b0 tratados}{\b0 por}{\b0 tuberculosis}{\b0 en}{\b0 un}{\b0
per�odo}{\b0 comprendido}{\b0 entre}{\b0 los }
\par}{\phpg\posx6037\pvpg\posy1100\absw5020\absh8875 \sl-210 \b \f20 \fs15 \cf0
{\b0 a�os}{\b0 2000-2016}{\b0 del}{\b0 Hospital}{\b0 Universitario}{\b0 de}
{\b0 Caracas.}{\b0 Se}{\b0 compar�}{\b0 el }
\par}{\phpg\posx6037\pvpg\posy1100\absw5020\absh8875 \sl-210 \b \f20 \fs15 \cf0
{\b0 diagn�stico}{\b0 de}{\b0 TB-EP}{\b0 y}{\b0 diferentes}{\b0 formas}{\b0
de}{\b0 inmunosupresi�n}{\b0 [des- }
\par}{\phpg\posx6037\pvpg\posy1100\absw5020\absh8875 \sl-210 \b \f20 \fs15 \cf0
{\b0 nutrici�n,}{\b0 VIH}{\b0 SIDA,}{\b0 diabetes}{\b0 mellitus}{\b0 (DM),}
{\b0 uso}{\b0 de}{\b0 drogas}{\b0 il�citas,}{\b0 uso }
\par}{\phpg\posx6037\pvpg\posy1100\absw5020\absh8875 \sl-210 \b \f20 \fs15 \cf0
{\b0 de}{\b0 alcohol].}{\b0 Se}{\b0 analizaron}{\b0 los}{\b0 datos}{\b0 con}
{\b0 estad�sticas}{\b0 descriptivas}{\b0 y }
\par}{\phpg\posx6037\pvpg\posy1100\absw5020\absh8875 \sl-210 \b \f20 \fs15 \cf0
{\b0 regresi�n}{\b0 log�stica}{\b0 bivariada. }
\par}{\phpg\posx6037\pvpg\posy1100\absw5020\absh8875 \sl-210 \b \f20 \fs15 \cf0
Resultados:{\b0 En}{\b0 la}{\b0 poblaci�n}{\b0 total}{\b0 la}{\b0 edad}{\b0
promedio}{\b0 fue}{\b0 de}{\b0 31,4}{\b0 �}{\b0 18 }
\par}{\phpg\posx6037\pvpg\posy1100\absw5020\absh8875 \sl-210 \b \f20 \fs15 \cf0
{\b0 a�os,}{\b0 58,8%}{\b0 eran}{\b0 masculinos.}{\b0 VIH-SIDA}{\b0 25,6%,}
{\b0 diabetes}{\b0 mellitus}{\b0 4,1%, }
\par}{\phpg\posx6037\pvpg\posy1100\absw5020\absh8875 \sl-210 \b \f20 \fs15 \cf0
{\b0 desnutrici�n}{\b0 7,3%,}{\b0 consumo}{\b0 de}{\b0 alcohol}{\b0 3,4%,}{\b0
uso}{\b0 de}{\b0 drogas}{\b0 il�citas }
\par}{\phpg\posx6037\pvpg\posy1100\absw5020\absh8875 \sl-210 \b \f20 \fs15 \cf0
{\b0 2,3%.}{\b0 La}{\b0 proporci�n}{\b0 de}{\b0 TB-P}{\b0 y}{\b0 TB-EP}{\b0
fue}{\b0 de}{\b0 55%}{\b0 y}{\b0 45%,}{\b0 respectivamen- }
\par}{\phpg\posx6037\pvpg\posy1100\absw5020\absh8875 \sl-210 \b \f20 \fs15 \cf0
{\b0 te.}{\b0 La}{\b0 DM}{\b0 es}{\b0 la}{\b0 inmunosupresi�n}{\b0 que}{\b0
aumenta}{\b0 m�s}{\b0 el}{\b0 riesgo}{\b0 de}{\b0 tener }
\par}{\phpg\posx6037\pvpg\posy1100\absw5020\absh8875 \sl-210 \b \f20 \fs15 \cf0
{\b0 TB-EP}{\b0 (OR}{\b0 =}{\b0 2,32,}{\b0 IC}{\b0 =}{\b0 1,79-3,1)}{\b0 en}
{\b0 comparaci�n}{\b0 con}{\b0 la}{\b0 desnutrici�n }
\par}{\phpg\posx6037\pvpg\posy1100\absw5020\absh8875 \sl-210 \b \f20 \fs15 \cf0
{\b0 [OR}{\b0 1,34,}{\b0 (1,16-1,55)],}{\b0 uso}{\b0 de}{\b0 alcohol}{\b0
[OR}{\b0 =}{\b0 1,33}{\b0 (1,08-1,64)]}{\b0 o}{\b0 drogas }
\par}{\phpg\posx6037\pvpg\posy1100\absw5020\absh8875 \sl-210 \b \f20 \fs15 \cf0
{\b0 il�citas}{\b0 [OR}{\b0 =}{\b0 1,66}{\b0 (1,24-2,23)].}{\b0 No}{\b0 hubo}
{\b0 asociaci�n}{\b0 entre}{\b0 el}{\b0 uso}{\b0 de }
\par}{\phpg\posx6037\pvpg\posy1100\absw5020\absh8875 \sl-210 \b \f20 \fs15 \cf0
{\b0 inmunosupresores}{\b0 o}{\b0 el}{\b0 diagn�stico}{\b0 de}{\b0 VIH-SIDA}
{\b0 con}{\b0 el}{\b0 diagn�stico}{\b0 de }
\par}{\phpg\posx6037\pvpg\posy1100\absw5020\absh8875 \sl-210 \b \f20 \fs15 \cf0
{\b0 TB-EP.}{\b0 Sin}{\b0 embargo,}{\b0 al}{\b0 evaluar}{\b0 los}{\b0
diferentes}{\b0 tipos}{\b0 de}{\b0 TB-EP,}{\b0 el}{\b0 diag- }
\par}{\phpg\posx6037\pvpg\posy1100\absw5020\absh8875 \sl-210 \b \f20 \fs15 \cf0
{\b0 n�stico}{\b0 de}{\b0 HIV-SIDA}{\b0 se}{\b0 correlaciona}{\b0 con}{\b0
aumento}{\b0 del}{\b0 riesgo}{\b0 para}{\b0 TB }
\par}{\phpg\posx6037\pvpg\posy1100\absw5020\absh8875 \sl-210 \b \f20 \fs15 \cf0
{\b0 pleural}{\b0 [OR}{\b0 =}{\b0 2,63}{\b0 (2,12-3,26)].}{\b0 La}{\b0
vacunaci�n}{\b0 con}{\b0 BCG}{\b0 no}{\b0 tuvo}{\b0 efecto }
\par}{\phpg\posx6037\pvpg\posy1100\absw5020\absh8875 \sl-210 \b \f20 \fs15 \cf0
{\b0 protector}{\b0 para}{\b0 el}{\b0 desarrollo}{\b0 de}{\b0 TB-EP. }
\par}{\phpg\posx6037\pvpg\posy1100\absw5020\absh8875 \sl-210 \b \f20 \fs15 \cf0
Conclusiones:{\b0 El}{\b0 factor}{\b0 de}{\b0 riesgo}{\b0 m�s}{\b0 frecuente}
{\b0 para}{\b0 TB-EP}{\b0 es}{\b0 la}{\b0 DM. }
\par}{\phpg\posx6037\pvpg\posy1100\absw5020\absh8875 \sl-210 \b \f20 \fs15 \cf0
{\b0 Aunque}{\b0 el}{\b0 HIV-SIDA}{\b0 no}{\b0 se}{\b0 correlaciona}{\b0 con}
{\b0 el}{\b0 diagn�stico}{\b0 de}{\b0 TB-EP,}{\b0 se }
\par}{\phpg\posx6037\pvpg\posy1100\absw5020\absh8875 \sl-210 \b \f20 \fs15 \cf0
{\b0 observa}{\b0 que}{\b0 la}{\b0 susceptibilidad}{\b0 a}{\b0 desarrollar}
{\b0 TB}{\b0 pleural}{\b0 es}{\b0 mayor}{\b0 en }
\par}{\phpg\posx6037\pvpg\posy1100\absw5020\absh8875 \sl-210 \b \f20 \fs15 \cf0
{\b0 esta}{\b0 poblaci�n.}{\b0 El}{\b0 conocimiento}{\b0 de}{\b0 los}{\b0
factores}{\b0 de}{\b0 riesgo}{\b0 para}{\b0 TB-EP }
\par}{\phpg\posx6037\pvpg\posy1100\absw5020\absh8875 \sl-210 \b \f20 \fs15 \cf0
{\b0 es}{\b0 importante}{\b0 para}{\b0 el}{\b0 diagn�stico}{\b0 y}{\b0
tratamiento}{\b0 oportuno}{\b0 de}{\b0 esta}{\b0 pa- }
\par}{\phpg\posx6037\pvpg\posy1100\absw5020\absh8875 \sl-210 \b \f20 \fs15 \cf0
{\b0 tolog�a. }\par
}
{\phpg\posx6037\pvpg\posy11471\absw5017\absh3131 \b \f20 \fs15 \cf0 \b \f20
\fs15 \cf0 248. C�LULAS NK EN LA RESISTENCIA A LA DISEMINACI�N
\par}{\phpg\posx6037\pvpg\posy11471\absw5017\absh3131 \sl-200 \b \f20 \fs15 \cf0
EXTRAPULMONAR DE LA TUBERCULOSIS Y SUS PROPIEDADES
\par}{\phpg\posx6037\pvpg\posy11471\absw5017\absh3131 \sl-200 \b \f20 \fs15 \cf0 DE
MEMORIA INMUNOL�GICA COMO POTENCIALES BLANCOS
\par}{\phpg\posx6037\pvpg\posy11471\absw5017\absh3131 \sl-200 \b \f20 \fs15 \cf0
TERAP�UTICOS
\par}{\phpg\posx6037\pvpg\posy11471\absw5017\absh3131 \sl-170 \par\b \f20 \fs15
\cf0 {\b0 A.}{\b0 Chore�o-Parra,}{\b0 L.}{\b0 Jim�nez-�lvarez,}{\b0 D.}{\b0
Maldonado-D�az, }
\par}{\phpg\posx6037\pvpg\posy11471\absw5017\absh3131 \sl-200 \b \f20 \fs15 \cf0
{\b0 A.}{\b0 Cruz-Lagunas,}{\b0 G.}{\b0 Ram�rez-Mart�nez,}{\b0 E.}{\b0
M�rquez-Garc�a, }
\par}{\phpg\posx6037\pvpg\posy11471\absw5017\absh3131 \sl-200 \b \f20 \fs15 \cf0
{\b0 C.}{\b0 Mendoza-Milla,}{\b0 F.}{\b0 Urrea-Ram�rez,}{\b0 E.}{\b0 Soto-
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mediante}{\i0 \fs15 ELISA}{\i0 \fs15 y}{\i0 \fs15 citometr�a}{\i0 \fs15 de}{\i0
\fs15 flujo.}{\i0 \fs15 Las}{\i0 \fs15 dife- }
\par}{\phpg\posx850\pvpg\posy713\absw5626\absh3742 \sl-210 \i \f20 \fs12 \cf0
{\i0 \fs15 rencias}{\i0 \fs15 entre}{\i0 \fs15 grupos}{\i0 \fs15 de}{\i0 \fs15
individuos}{\i0 \fs15 y}{\i0 \fs15 animales}{\i0 \fs15 fueron}{\i0 \fs15
analizadas}{\i0 \fs15 con }
\par}{\phpg\posx850\pvpg\posy713\absw5626\absh3742 \sl-210 \i \f20 \fs12 \cf0
{\i0 \fs15 la}{\i0 \fs15 prueba}{\i0 \fs15 U}{\i0 \fs15 de}{\i0 \fs15 Mann-
Whitney. }
\par}{\phpg\posx850\pvpg\posy713\absw5626\absh3742 \sl-210 \i \f20 \fs12 \cf0
{\b\i0 \fs15 Resultados:}{\i0 \fs15 Los}{\i0 \fs15 pacientes}{\i0 \fs15 con}{\i0
\fs15 TB}{\i0 \fs15 men�ngea}{\i0 \fs15 tienen}{\i0 \fs15 menor}{\i0 \fs15
cantidad }
\par}{\phpg\posx850\pvpg\posy713\absw5626\absh3742 \sl-210 \i \f20 \fs12 \cf0
{\i0 \fs15 de}{\i0 \fs15 c�lulas}{\i0 \fs15 NK}{\i0 \fs15 CD56bright}{\i0 \fs15
circulantes}{\i0 \fs15 (p}{\i0 \fs15 <}{\i0 \fs15 0,05)}{\i0 \fs15 y}{\i0 \fs15
�stas}{\i0 \fs15 expresan }
\par}{\phpg\posx850\pvpg\posy713\absw5626\absh3742 \sl-210 \i \f20 \fs12 \cf0
{\i0 \fs15 menos}{\i0 \fs15 mol�culas}{\i0 \fs15 del}{\i0 \fs15 receptor}{\i0
\fs15 de}{\i0 \fs15 activaci�n}{\i0 \fs15 NKp46}{\i0 \fs15 (p}{\i0 \fs15 <}
{\i0 \fs15 0,05)}{\i0 \fs15 y}{\i0 \fs15 del }\par
}
{\phpg\posx850\pvpg\posy4883\absw5018\absh2257 \f20 \fs15 \cf0 \f20 \fs15 \cf0
marcador de memoria inmunol�gica CD45RO (p < 0,01) comparadas
\par}{\phpg\posx850\pvpg\posy4883\absw5018\absh2257 \sl-210 \f20 \fs15 \cf0 con las
c�lulas NK de pacientes con TB pulmonar. La vacunaci�n en
\par}{\phpg\posx850\pvpg\posy4883\absw5018\absh2257 \sl-210 \f20 \fs15 \cf0 ratones
con ant�genos de MtbH37Rv induce una expansi�n in vivo
\par}{\phpg\posx850\pvpg\posy4883\absw5018\absh2257 \sl-210 \f20 \fs15 \cf0 de
c�lulas NK hep�ticas CXCR6+ con capacidad incrementada para
\par}{\phpg\posx850\pvpg\posy4883\absw5018\absh2257 \sl-210 \f20 \fs15 \cf0
producir IFN-{\field{\*\fldinst SYMBOL 103 \\f Symbol }}. en respuesta a la
exposici�n in vitro a ant�genos de
\par}{\phpg\posx850\pvpg\posy4883\absw5018\absh2257 \sl-210 \f20 \fs15 \cf0 Mtb
H37Rv.
\par}{\phpg\posx850\pvpg\posy4883\absw5018\absh2257 \sl-210 \f20 \fs15 \cf0 {\b
Conclusiones:} Las deficiencias en el fenotipo de c�lulas NK observa-
\par}{\phpg\posx850\pvpg\posy4883\absw5018\absh2257 \sl-210 \f20 \fs15 \cf0 das en
los pacientes con TB diseminada apoyan la participaci�n de
\par}{\phpg\posx850\pvpg\posy4883\absw5018\absh2257 \sl-210 \f20 \fs15 \cf0 estas
c�lulas en el control de la infecci�n pulmonar por Mtb. Las c�-
\par}{\phpg\posx850\pvpg\posy4883\absw5018\absh2257 \sl-210 \f20 \fs15 \cf0 lulas
NK ejercen respuestas de memoria contra los ant�genos de Mtb
\par}{\phpg\posx850\pvpg\posy4883\absw5018\absh2257 \sl-210 \f20 \fs15 \cf0 lo que
las coloca como potenciales blancos terap�uticos para mejorar
\par}{\phpg\posx850\pvpg\posy4883\absw5018\absh2257 \sl-210 \f20 \fs15 \cf0 el
control de la TB. \par
}
{\phpg\posx6207\pvpg\posy4813\absw2739\absh179 \b\i \f20 \fs15 \cf0 \b\i \f20 \fs15
\cf0 Figura 1.{\b0 Drenaje}{\b0 de}{\b0 quilot�rax}{\b0 en}{\b0 HTI. }\par
}
{\phpg\posx11014\pvpg\posy711\absw211\absh142 \f20 \fs12 \cf0 \f20 \fs12 \cf0
107 \par
}
{\phpg\posx850\pvpg\posy8021\absw5020\absh6236 \b \f20 \fs15 \cf0 \b \f20 \fs15
\cf0 249. QUILOT�RAX TUBERCULOSO. PRESENTACI�N EXCEPCIONAL
\par}{\phpg\posx850\pvpg\posy8021\absw5020\absh6236 \sl-170 \par\b \f20 \fs15 \cf0
{\b0 H.}{\b0 Rodr�guez }{\b0\up006 \fs9 1,2}{\b0 ,}{\b0 P.}{\b0 Cornejo }
{\b0\up006 \fs9 1,2}{\b0 ,}{\b0 H.}{\b0 Alquizar }{\b0\up006 \fs9 1,2}{\b0 ,}
{\b0 U.}{\b0 Concepci�n }{\b0\up006 \fs9 1,2}{\b0 y}{\b0 C.}{\b0 Ruiz}
{\b0\up006 \fs9 3 }
\par}{\phpg\posx850\pvpg\posy8021\absw5020\absh6236 \sl-156 \par\b \f20 \fs15 \cf0
{\b0\i\up006 \fs9 1}{\b0\i CENEX}{\b0\i TB}{\b0\i Luz}{\b0\i Caviedes}{\b0\i
Rojas.}{\b0\i Hospital}{\b0\i Regional}{\b0\i Docente}{\b0\i de}{\b0\i
Trujillo. }
\par}{\phpg\posx850\pvpg\posy8021\absw5020\absh6236 \sl-200 \b \f20 \fs15 \cf0
{\b0\i\up006 \fs9 2}{\b0\i Facultad}{\b0\i de}{\b0\i Medicina.}{\b0\i
Universidad}{\b0\i Nacional}{\b0\i de}{\b0\i Trujillo.}{\b0\i\up006 \fs9 3}
{\b0\i UCV.}{\b0\i Hospital }
\par}{\phpg\posx850\pvpg\posy8021\absw5020\absh6236 \sl-200 \b \f20 \fs15 \cf0
{\b0\i Regional}{\b0\i Docente}{\b0\i de}{\b0\i Trujillo. }
\par}{\phpg\posx850\pvpg\posy8021\absw5020\absh6236 \sl-212 \par\b \f20 \fs15 \cf0
Introducci�n:{\b0 El}{\b0 quilot�rax}{\b0 es}{\b0 un}{\b0 derrame}{\b0
pleural}{\b0 causado}{\b0 por}{\b0 el }
\par}{\phpg\posx850\pvpg\posy8021\absw5020\absh6236 \sl-210 \b \f20 \fs15 \cf0 {\b0
ac�mulo}{\b0 de}{\b0 quilo}{\b0 por}{\b0 lesi�n}{\b0 o}{\b0 bloqueo}{\b0
del}{\b0 conducto}{\b0 tor�cico.}{\b0 Pre- }
\par}{\phpg\posx850\pvpg\posy8021\absw5020\absh6236 \sl-210 \b \f20 \fs15 \cf0 {\b0
sentamos}{\b0 el}{\b0 caso}{\b0 de}{\b0 un}{\b0 paciente}{\b0 con}{\b0
quilot�rax}{\b0 tuberculoso}{\b0 cuyo }
\par}{\phpg\posx850\pvpg\posy8021\absw5020\absh6236 \sl-210 \b \f20 \fs15 \cf0 {\b0
diagn�stico}{\b0 se}{\b0 realiz�}{\b0 mediante}{\b0 una}{\b0 muestra}{\b0 de}
{\b0 aspirado}{\b0 bron- }
\par}{\phpg\posx850\pvpg\posy8021\absw5020\absh6236 \sl-210 \b \f20 \fs15 \cf0 {\b0
quial. }
\par}{\phpg\posx850\pvpg\posy8021\absw5020\absh6236 \sl-210 \b \f20 \fs15 \cf0
Material y m�todos:{\b0 Anamnesis:}{\b0 paciente}{\b0 var�n}{\b0 de}{\b0 55}
{\b0 a�os}{\b0 sin }
\par}{\phpg\posx850\pvpg\posy8021\absw5020\absh6236 \sl-210 \b \f20 \fs15 \cf0 {\b0
comorbilidades.}{\b0 Present�}{\b0 tos}{\b0 seca,}{\b0 dolor}{\b0 pleur�tico}
{\b0 en}{\b0 hemit�rax }
\par}{\phpg\posx850\pvpg\posy8021\absw5020\absh6236 \sl-210 \b \f20 \fs15 \cf0 {\b0
izquierdo,}{\b0 disnea}{\b0 al}{\b0 reposo.}{\b0 Acudi�}{\b0 a}{\b0
emergencia}{\b0 del}{\b0 HRDT.}{\b0 Estu- }
\par}{\phpg\posx850\pvpg\posy8021\absw5020\absh6236 \sl-210 \b \f20 \fs15 \cf0 {\b0
dio}{\b0 radiogr�fico}{\b0 mostr�}{\b0 derrame}{\b0 pleural}{\b0 en}{\b0
HTI.}{\b0 Toracocentesis: }
\par}{\phpg\posx850\pvpg\posy8021\absw5020\absh6236 \sl-210 \b \f20 \fs15 \cf0 {\b0
l�quido}{\b0 "lechoso",}{\b0 con}{\b0 triglic�ridos}{\b0 de}{\b0 3.006}
{\b0 mg/dl,}{\b0 colesterol }
\par}{\phpg\posx850\pvpg\posy8021\absw5020\absh6236 \sl-210 \b \f20 \fs15 \cf0 {\b0
127,9}{\b0 mg/dl.}{\b0 Con}{\b0 diagn�stico}{\b0 de}{\b0 quilot�rax,}{\b0 se}
{\b0 hospitaliz�}{\b0 en}{\b0 Neu- }
\par}{\phpg\posx850\pvpg\posy8021\absw5020\absh6236 \sl-210 \b \f20 \fs15 \cf0 {\b0
molog�a.}{\b0 Examen}{\b0 cl�nico}{\b0 preferencial:}{\b0 pulmones:}{\b0
fr�mito}{\b0 vocal }
\par}{\phpg\posx850\pvpg\posy8021\absw5020\absh6236 \sl-210 \b \f20 \fs15 \cf0 {\b0
abolido,}{\b0 matidez}{\b0 y}{\b0 murmullo}{\b0 vesicular}{\b0 ausente}{\b0
en}{\b0 2/3}{\b0 inferiores }
\par}{\phpg\posx850\pvpg\posy8021\absw5020\absh6236 \sl-210 \b \f20 \fs15 \cf0 {\b0
de}{\b0 HTI. }
\par}{\phpg\posx850\pvpg\posy8021\absw5020\absh6236 \sl-210 \b \f20 \fs15 \cf0
Resultados:{\b0 Procedimientos:}{\b0 baciloscopias}{\b0 en}{\b0 esputo}{\b0
(2)}{\b0 negativos. }
\par}{\phpg\posx850\pvpg\posy8021\absw5020\absh6236 \sl-210 \b \f20 \fs15 \cf0 {\b0
Cultivo}{\b0 en}{\b0 proceso.}{\b0 TAC}{\b0 de}{\b0 t�rax}{\b0 y}{\b0
abdominal:}{\b0 L�quido}{\b0 pleural}{\b0 poste- }
\par}{\phpg\posx850\pvpg\posy8021\absw5020\absh6236 \sl-210 \b \f20 \fs15 \cf0 {\b0
robasal}{\b0 �reas}{\b0 de}{\b0 aneumatosis}{\b0 inhomog�neas}{\b0 en}{\b0
LII}{\b0 e}{\b0 intersticiopat�a }
\par}{\phpg\posx850\pvpg\posy8021\absw5020\absh6236 \sl-210 \b \f20 \fs15 \cf0 {\b0
inespec�fica.}{\b0 No}{\b0 se}{\b0 observa}{\b0 adenopat�as.}{\b0
Videobroncoscopia:}{\b0 mostr� }
\par}{\phpg\posx850\pvpg\posy8021\absw5020\absh6236 \sl-210 \b \f20 \fs15 \cf0 {\b0
signos}{\b0 inflamatorios}{\b0 en}{\b0 S6}{\b0 izquierdo,}{\b0 resultados}{\b0
de}{\b0 baciloscopia}{\b0 en }
\par}{\phpg\posx850\pvpg\posy8021\absw5020\absh6236 \sl-210 \b \f20 \fs15 \cf0 {\b0
aspirado}{\b0 bronquial}{\b0 mostraron}{\b0 de}{\b0 1-3}{\b0 BAAR}{\b0
(paucibacilar).}{\b0 Evoluci�n: }
\par}{\phpg\posx850\pvpg\posy8021\absw5020\absh6236 \sl-210 \b \f20 \fs15 \cf0 {\b0
se}{\b0 coloc�}{\b0 tubo}{\b0 de}{\b0 drenaje}{\b0 pleural.}{\b0 Recibi�}{\b0
octreotide}{\b0 y}{\b0 nutrici�n}{\b0 pa- }
\par}{\phpg\posx850\pvpg\posy8021\absw5020\absh6236 \sl-210 \b \f20 \fs15 \cf0 {\b0
renteral.}{\b0 Durante}{\b0 hospitalizaci�n}{\b0 paciente}{\b0 present�}{\b0
fiebre;}{\b0 cultivos}{\b0 de }
\par}{\phpg\posx850\pvpg\posy8021\absw5020\absh6236 \sl-210 \b \f20 \fs15 \cf0 {\b0
secreciones}{\b0 y}{\b0 hemocultivos}{\b0 fueron}{\b0 negativos.}{\b0
Disminuci�n}{\b0 del}{\b0 quilo- }
\par}{\phpg\posx850\pvpg\posy8021\absw5020\absh6236 \sl-210 \b \f20 \fs15 \cf0 {\b0
t�rax}{\b0 a}{\b0 la}{\b0 tercera}{\b0 semana}{\b0 de}{\b0 tratamiento;}{\b0
present�}{\b0 plaquetopenia }
\par}{\phpg\posx850\pvpg\posy8021\absw5020\absh6236 \sl-210 \b \f20 \fs15 \cf0 {\b0
como}{\b0 reacci�n}{\b0 adversa}{\b0 a}{\b0 nutrici�n}{\b0 parenteral.}{\b0
Inici�}{\b0 tratamiento}{\b0 para }
\par}{\phpg\posx850\pvpg\posy8021\absw5020\absh6236 \sl-210 \b \f20 \fs15 \cf0 {\b0
tuberculosis}{\b0 sensible}{\b0 el}{\b0 24/03/2018. }\par
}
{\phpg\posx6207\pvpg\posy9065\absw5017\absh1989 \b\i \f20 \fs15 \cf0 \b\i \f20
\fs15 \cf0 Figura 2.{\b0 TAC}{\b0 de}{\b0 t�rax-derrame}{\b0 pleural+}{\b0
Interciopat�a}{\b0 inespec�fica}{\b0 en}{\b0 LII. }
\par}{\phpg\posx6207\pvpg\posy9065\absw5017\absh1989 \sl-210 \b\i \f20 \fs15 \cf0
{\b0 No}{\b0 adenopat�as. }
\par}{\phpg\posx6207\pvpg\posy9065\absw5017\absh1989 \sl-165 \par\b\i \f20 \fs15
\cf0 {\i0 Conclusiones:}{\b0\i0 Ante}{\b0\i0 el}{\b0\i0 diagn�stico}{\b0\i0 de}
{\b0\i0 quilot�rax}{\b0\i0 se}{\b0\i0 debe}{\b0\i0 investigar}{\b0\i0 la }
\par}{\phpg\posx6207\pvpg\posy9065\absw5017\absh1989 \sl-210 \b\i \f20 \fs15 \cf0
{\b0\i0 etiolog�a}{\b0\i0 tuberculosa}{\b0\i0 cuando}{\b0\i0 no}{\b0\i0 existe}
{\b0\i0 antecedente}{\b0\i0 de}{\b0\i0 traumatismo }
\par}{\phpg\posx6207\pvpg\posy9065\absw5017\absh1989 \sl-210 \b\i \f20 \fs15 \cf0
{\b0\i0 o}{\b0\i0 cirug�a}{\b0\i0 tor�cica,}{\b0\i0 a}{\b0\i0 pesar}{\b0\i0
de}{\b0\i0 la}{\b0\i0 ausencia}{\b0\i0 de}{\b0\i0 afectaci�n}{\b0\i0 pulmonar}
{\b0\i0 y/o }
\par}{\phpg\posx6207\pvpg\posy9065\absw5017\absh1989 \sl-210 \b\i \f20 \fs15 \cf0
{\b0\i0 mediast�nica}{\b0\i0 en}{\b0\i0 las}{\b0\i0 im�genes.}{\b0\i0 En}
{\b0\i0 estos}{\b0\i0 casos,}{\b0\i0 la}{\b0\i0 aplicaci�n}{\b0\i0 de}{\b0\i0
las}{\b0\i0 t�c- }
\par}{\phpg\posx6207\pvpg\posy9065\absw5017\absh1989 \sl-210 \b\i \f20 \fs15 \cf0
{\b0\i0 nicas}{\b0\i0 microbiol�gicas}{\b0\i0 habituales}{\b0\i0 para}{\b0\i0
la}{\b0\i0 identificaci�n}{\b0\i0 del}{\b0\i0 Mycobac- }
\par}{\phpg\posx6207\pvpg\posy9065\absw5017\absh1989 \sl-210 \b\i \f20 \fs15 \cf0
{\b0\i0 terium}{\b0\i0 tuberculosis}{\b0\i0 puede}{\b0\i0 retrasar}{\b0\i0 el}
{\b0\i0 diagn�stico}{\b0\i0 o}{\b0\i0 resultar}{\b0\i0 negativas, }
\par}{\phpg\posx6207\pvpg\posy9065\absw5017\absh1989 \sl-210 \b\i \f20 \fs15 \cf0
{\b0\i0 lo}{\b0\i0 que}{\b0\i0 generalmente}{\b0\i0 obliga}{\b0\i0 a}{\b0\i0
la}{\b0\i0 pr�ctica}{\b0\i0 de}{\b0\i0 procedimientos}{\b0\i0 invasivos }
\par}{\phpg\posx6207\pvpg\posy9065\absw5017\absh1989 \sl-210 \b\i \f20 \fs15 \cf0
{\b0\i0 como}{\b0\i0 el}{\b0\i0 uso}{\b0\i0 de}{\b0\i0 la}{\b0\i0
videobroncoscopia. }\par
}
{\phpg\posx6207\pvpg\posy11786\absw5019\absh2848 \b \f20 \fs15 \cf0 \b \f20
\fs15 \cf0 250. TUBERCULOSIS PLEURAL: HALLAZGOS EN ULTRASONIDO
\par}{\phpg\posx6207\pvpg\posy11786\absw5019\absh2848 \sl-200 \b \f20 \fs15 \cf0
TOR�CICO Y NIVELES DE ADENOSINA DESAMINASA
\par}{\phpg\posx6207\pvpg\posy11786\absw5019\absh2848 \sl-170 \par\b \f20 \fs15
\cf0 {\b0 A.E.}{\b0 Garc�a}{\b0 Calvette,}{\b0 J.}{\b0 Castillo}{\b0 Pichardo}
{\b0 y}{\b0 Z.M.}{\b0 Fuentes}{\b0 Alcal� }
\par}{\phpg\posx6207\pvpg\posy11786\absw5019\absh2848 \sl-156 \par\b \f20 \fs15
\cf0 {\b0\i Hospital}{\b0\i Dr.}{\b0\i Jos�}{\b0\i Ignacio}{\b0\i Baldo.}{\b0\i
El}{\b0\i Algodonal. }
\par}{\phpg\posx6207\pvpg\posy11786\absw5019\absh2848 \sl-143 \par\par\b \f20 \fs15
\cf0 Introducci�n:{\b0 El}{\b0 derrame}{\b0 pleural}{\b0 tuberculoso}{\b0
constituye}{\b0 una}{\b0 las}{\b0 pri- }
\par}{\phpg\posx6207\pvpg\posy11786\absw5019\absh2848 \sl-210 \b \f20 \fs15 \cf0
{\b0 meras}{\b0 causas}{\b0 de}{\b0 exudados}{\b0 pleurales}{\b0 y}{\b0 uno}
{\b0 de}{\b0 los}{\b0 principales}{\b0 motivos }
\par}{\phpg\posx6207\pvpg\posy11786\absw5019\absh2848 \sl-210 \b \f20 \fs15 \cf0
{\b0 de}{\b0 consulta,}{\b0 La}{\b0 mayor�a}{\b0 de}{\b0 los}{\b0 pacientes}
{\b0 con}{\b0 TB}{\b0 pleural}{\b0 no}{\b0 presentan }
\par}{\phpg\posx6207\pvpg\posy11786\absw5019\absh2848 \sl-210 \b \f20 \fs15 \cf0
{\b0 manifestaciones}{\b0 cl�nicas}{\b0 que}{\b0 los}{\b0 distingan}{\b0 de}
{\b0 aquellos}{\b0 de}{\b0 diferente }
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{\b0 etiolog�a,}{\b0 describir}{\b0 la}{\b0 utilidad}{\b0 de}{\b0 la}{\b0
combinaci�n}{\b0 de}{\b0 los}{\b0 hallazgos}{\b0 US }
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{\b0 tor�cicos}{\b0 y}{\b0 la}{\b0 determinaci�n}{\b0 de}{\b0 ADA}{\b0 como}
{\b0 m�todo}{\b0 auxiliar}{\b0 o}{\b0 comple- }
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{\b0 mentario}{\b0 en}{\b0 el}{\b0 diagn�stico}{\b0 de}{\b0 TB}{\b0 pleural,}
{\b0 con}{\b0 la}{\b0 finalidad}{\b0 de}{\b0 iniciar}{\b0 un }
\par}{\phpg\posx6207\pvpg\posy11786\absw5019\absh2848 \sl-210 \b \f20 \fs15 \cf0
{\b0 tratamiento}{\b0 oportuno}{\b0 y}{\b0 minimizar}{\b0 complicaciones}{\b0
tales}{\b0 como}{\b0 empie- }
\par}{\phpg\posx6207\pvpg\posy11786\absw5019\absh2848 \sl-210 \b \f20 \fs15 \cf0
{\b0 ma}{\b0 tuberculosos,}{\b0 derrame}{\b0 pleural}{\b0 tabicado}{\b0 y}{\b0
engrosamiento}{\b0 pleural }\par
}
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}}\par}{\phpg\posx680\pvpg\posy711\absw213\absh142 \f20 \fs11 \cf0 \f20 \fs11 \cf0
108 \par
}
{\phpg\posx5258\pvpg\posy713\absw1048\absh138 \i \f20 \fs11 \cf0 \i \f20 \fs11 \cf0
11.� Congreso ALAT \par
}
{\phpg\posx680\pvpg\posy1103\absw5020\absh5848 \f20 \fs14 \cf0 \f20 \fs14 \cf0
residual al importante n�mero de pacientes que se atienden en este
\par}{\phpg\posx680\pvpg\posy1103\absw5020\absh5848 \sl-210 \f20 \fs14 \cf0 centro.
El objetivo es evaluar la relaci�n entre los hallazgos del US
\par}{\phpg\posx680\pvpg\posy1103\absw5020\absh5848 \sl-210 \f20 \fs14 \cf0
tor�cico y los niveles de ADA en l�quido pleural (LP) en pacientes con
\par}{\phpg\posx680\pvpg\posy1103\absw5020\absh5848 \sl-210 \f20 \fs14 \cf0 TB
pleural.
\par}{\phpg\posx680\pvpg\posy1103\absw5020\absh5848 \sl-210 \f20 \fs14 \cf0 {\b
Material}{\b y}{\b m�todos:} Estudio de enfoque cuantitativo, descriptivo,
\par}{\phpg\posx680\pvpg\posy1103\absw5020\absh5848 \sl-210 \f20 \fs14 \cf0
transversal que incluy� pacientes mayores de 18 a�os de cualquier
\par}{\phpg\posx680\pvpg\posy1103\absw5020\absh5848 \sl-210 \f20 \fs14 \cf0 sexo,
con diagn�stico de exudado pleural linfoc�tico de etiolog�a tu-
\par}{\phpg\posx680\pvpg\posy1103\absw5020\absh5848 \sl-210 \f20 \fs14 \cf0
berculosa, basado en estudio histol�gico o microbiol�gico de la biop-
\par}{\phpg\posx680\pvpg\posy1103\absw5020\absh5848 \sl-210 \f20 \fs14 \cf0 sia
pleural con aguja de Abrams. Se realiz� ultrasonograf�a (US) tor�-
\par}{\phpg\posx680\pvpg\posy1103\absw5020\absh5848 \sl-210 \f20 \fs14 \cf0 cica a
los pacientes y determinaci�n de ADA en LP mediante el
\par}{\phpg\posx680\pvpg\posy1103\absw5020\absh5848 \sl-210 \f20 \fs14 \cf0 m�todo
de Giusti, y se correlacionaron con los hallazgos ultrasono-
\par}{\phpg\posx680\pvpg\posy1103\absw5020\absh5848 \sl-210 \f20 \fs14 \cf0
gr�ficos. El an�lisis estad�stico se calcul� la media y la desviaci�n es-
\par}{\phpg\posx680\pvpg\posy1103\absw5020\absh5848 \sl-210 \f20 \fs14 \cf0 t�ndar
de las variables contin�as; en el caso de las variables discretas,
\par}{\phpg\posx680\pvpg\posy1103\absw5020\absh5848 \sl-210 \f20 \fs14 \cf0 se
calcul� su mediana e identific� valores m�nimos y m�ximos; a las
\par}{\phpg\posx680\pvpg\posy1103\absw5020\absh5848 \sl-210 \f20 \fs14 \cf0
variables nominales u ordinales, se les calcul� sus frecuencias y por-
\par}{\phpg\posx680\pvpg\posy1103\absw5020\absh5848 \sl-210 \f20 \fs14 \cf0
centajes. La relaci�n de ADA respecto a las variables continuas se bas�
\par}{\phpg\posx680\pvpg\posy1103\absw5020\absh5848 \sl-210 \f20 \fs14 \cf0 en la
prueba ANOVA de una v�a, se aplic� la prueba chi-cuadrado de
\par}{\phpg\posx680\pvpg\posy1103\absw5020\absh5848 \sl-210 \f20 \fs14 \cf0
Pearson. Se consider� un contraste estad�sticamente significativo si p
\par}{\phpg\posx680\pvpg\posy1103\absw5020\absh5848 \sl-210 \f20 \fs14 \cf0 < 0,05.
Los datos fueron analizados con JMP-SAS versi�n 12.
\par}{\phpg\posx680\pvpg\posy1103\absw5020\absh5848 \sl-210 \f20 \fs14 \cf0 {\b
Resultados:} Se incluyeron 68 pacientes, con edades comprendidas
\par}{\phpg\posx680\pvpg\posy1103\absw5020\absh5848 \sl-210 \f20 \fs14 \cf0 entre
18 y 71 a�os (X = 36,02 � 15,05 DE), 72% de sexo masculino.
\par}{\phpg\posx680\pvpg\posy1103\absw5020\absh5848 \sl-210 \f20 \fs14 \cf0
Diecinueve pacientes tuvieron niveles de ADA en Lp < 40 UI/L (G1),
\par}{\phpg\posx680\pvpg\posy1103\absw5020\absh5848 \sl-210 \f20 \fs14 \cf0
diecis�is entre 40 y 80 UI/L (G2), y treinta y tres > 80 UI/L (G3). En el
\par}{\phpg\posx680\pvpg\posy1103\absw5020\absh5848 \sl-210 \f20 \fs14 \cf0 US
tor�cico se encontraron los siguientes hallazgos: El patr�n ultra-
\par}{\phpg\posx680\pvpg\posy1103\absw5020\absh5848 \sl-210 \f20 \fs14 \cf0
sonogr�fico complejo septado se observ� en 50% de los exudados tu-
\par}{\phpg\posx680\pvpg\posy1103\absw5020\absh5848 \sl-210 \f20 \fs14 \cf0
berculosos; en el G3 la presencia de part�culas y el patr�n utrasono-
\par}{\phpg\posx680\pvpg\posy1103\absw5020\absh5848 \sl-210 \f20 \fs14 \cf0 gr�fico
complejo septado en LP fueron significativamente observados
\par}{\phpg\posx680\pvpg\posy1103\absw5020\absh5848 \sl-210 \f20 \fs14 \cf0 con m�s
frecuencia (p = 0,001)).
\par}{\phpg\posx680\pvpg\posy1103\absw5020\absh5848 \sl-210 \f20 \fs14 \cf0 {\b
Conclusiones:} Niveles de ADA mayores a 80 UI/L estuvieron signifi-
\par}{\phpg\posx680\pvpg\posy1103\absw5020\absh5848 \sl-210 \f20 \fs14 \cf0
cativamente asociados al patr�n ultrasonografico complejo septado y
\par}{\phpg\posx680\pvpg\posy1103\absw5020\absh5848 \sl-210 \f20 \fs14 \cf0 a la
presencia de part�culas en el derrame pleural tuberculoso. \par
}
{\phpg\posx6037\pvpg\posy1101\absw5020\absh2636 \b \f20 \fs14 \cf0 \b \f20 \fs14
\cf0 Resultados:{\b0 Se}{\b0 incluyeron}{\b0 120}{\b0 casos}{\b0 y}{\b0 240}
{\b0 controles,}{\b0 la}{\b0 mediana}{\b0 de }
\par}{\phpg\posx6037\pvpg\posy1101\absw5020\absh2636 \sl-210 \b \f20 \fs14 \cf0
{\b0 n�mero}{\b0 de}{\b0 d�as}{\b0 entre}{\b0 la}{\b0 aparici�n}{\b0 de}{\b0
s�ntomas}{\b0 respiratorios}{\b0 y}{\b0 el}{\b0 co- }
\par}{\phpg\posx6037\pvpg\posy1101\absw5020\absh2636 \sl-210 \b \f20 \fs14 \cf0
{\b0 mienzo}{\b0 de}{\b0 tratamiento}{\b0 fue}{\b0 de}{\b0 93}{\b0 d�as}{\b0
en}{\b0 los}{\b0 casos}{\b0 y}{\b0 24}{\b0 d�as}{\b0 en}{\b0 los }
\par}{\phpg\posx6037\pvpg\posy1101\absw5020\absh2636 \sl-210 \b \f20 \fs14 \cf0
{\b0 controles}{\b0 respectivamente.}{\b0 En}{\b0 la}{\b0 regresi�n}{\b0
log�stica,}{\b0 se}{\b0 evidenciaron }
\par}{\phpg\posx6037\pvpg\posy1101\absw5020\absh2636 \sl-210 \b \f20 \fs14 \cf0
{\b0 como}{\b0 factores}{\b0 relacionados}{\b0 con}{\b0 el}{\b0 retraso:}{\b0
horarios}{\b0 poco}{\b0 flexibles }
\par}{\phpg\posx6037\pvpg\posy1101\absw5020\absh2636 \sl-210 \b \f20 \fs14 \cf0
{\b0 para}{\b0 la}{\b0 recepci�n}{\b0 de}{\b0 la}{\b0 muestra}{\b0 (ORaj}{\b0
=}{\b0 1,86,}{\b0 IC95%:}{\b0 1,25-2,98),}{\b0 falta }
\par}{\phpg\posx6037\pvpg\posy1101\absw5020\absh2636 \sl-210 \b \f20 \fs14 \cf0
{\b0 de}{\b0 informaci�n}{\b0 al}{\b0 paciente}{\b0 sobre}{\b0 la}{\b0
obtenci�n}{\b0 de}{\b0 muestra}{\b0 (ORaj}{\b0 =}{\b0 1,61, }
\par}{\phpg\posx6037\pvpg\posy1101\absw5020\absh2636 \sl-210 \b \f20 \fs14 \cf0
{\b0 IC95%:}{\b0 1,32-2,53),}{\b0 poca}{\b0 accesibilidad}{\b0 para}{\b0
recepci�n}{\b0 de}{\b0 la}{\b0 muestra }
\par}{\phpg\posx6037\pvpg\posy1101\absw5020\absh2636 \sl-210 \b \f20 \fs14 \cf0
{\b0 (ORaj}{\b0 =}{\b0 1,22,}{\b0 IC95%:}{\b0 1,12-2,18),}{\b0 serolog�a}{\b0
positiva}{\b0 para}{\b0 VIH}{\b0 (ORaj}{\b0 =}{\b0 1,47, }
\par}{\phpg\posx6037\pvpg\posy1101\absw5020\absh2636 \sl-210 \b \f20 \fs14 \cf0
{\b0 IC95%:}{\b0 1,21-1,89)}{\b0 y}{\b0 percepci�n}{\b0 errada}{\b0 del}{\b0
costo}{\b0 del}{\b0 tratamiento}{\b0 (ORaj }
\par}{\phpg\posx6037\pvpg\posy1101\absw5020\absh2636 \sl-210 \b \f20 \fs14 \cf0
{\b0 =}{\b0 2,17,}{\b0 IC95%:}{\b0 1,45-3,89). }
\par}{\phpg\posx6037\pvpg\posy1101\absw5020\absh2636 \sl-210 \b \f20 \fs14 \cf0
Conclusiones:{\b0 Estos}{\b0 hallazgos}{\b0 sugieren}{\b0 la}{\b0 necesidad}
{\b0 de}{\b0 dise�ar}{\b0 y}{\b0 eje- }
\par}{\phpg\posx6037\pvpg\posy1101\absw5020\absh2636 \sl-210 \b \f20 \fs14 \cf0
{\b0 cutar}{\b0 pol�ticas}{\b0 sanitarias}{\b0 que}{\b0 reduzcan}{\b0 el}{\b0
retraso,}{\b0 facilitando}{\b0 el}{\b0 acceso }
\par}{\phpg\posx6037\pvpg\posy1101\absw5020\absh2636 \sl-210 \b \f20 \fs14 \cf0
{\b0 a}{\b0 los}{\b0 servicios}{\b0 de}{\b0 salud}{\b0 y}{\b0 la}{\b0
satisfacci�n}{\b0 de}{\b0 los}{\b0 pacientes. }\par
}
{\phpg\posx680\pvpg\posy8021\absw5020\absh6236 \b \f20 \fs14 \cf0 \b \f20 \fs14
\cf0 251. TRATAMIENTO TARD�O DE LA TUBERCULOSIS PULMONAR EN
\par}{\phpg\posx680\pvpg\posy8021\absw5020\absh6236 \sl-200 \b \f20 \fs14 \cf0 UN
�REA URBANA DE ALTO RIESGO DE TRANSMISI�N EN EL PER�
\par}{\phpg\posx680\pvpg\posy8021\absw5020\absh6236 \sl-170 \par\b \f20 \fs14 \cf0
{\b0 O.}{\b0 Rivera,}{\b0 J.}{\b0 Mendigure}{\b0 y}{\b0 C.}{\b0 Bonilla }
\par}{\phpg\posx680\pvpg\posy8021\absw5020\absh6236 \sl-156 \par\b \f20 \fs14 \cf0
{\b0\i Universidad}{\b0\i C�sar}{\b0\i Vallejo.}{\b0\i Lima.}{\b0\i
Universidad}{\b0\i Privada}{\b0\i Norbert}{\b0\i Wiener. }
\par}{\phpg\posx680\pvpg\posy8021\absw5020\absh6236 \sl-200 \b \f20 \fs14 \cf0
{\b0\i Lima.}{\b0\i Hospital}{\b0\i Nacional}{\b0\i Daniel}{\b0\i Alcides}
{\b0\i Carri�n.}{\b0\i Callao. }
\par}{\phpg\posx680\pvpg\posy8021\absw5020\absh6236 \sl-212 \par\b \f20 \fs14 \cf0
Introducci�n:{\b0 El}{\b0 diagn�stico}{\b0 precoz}{\b0 y}{\b0 el}{\b0 inicio}
{\b0 oportuno}{\b0 del}{\b0 trata- }
\par}{\phpg\posx680\pvpg\posy8021\absw5020\absh6236 \sl-210 \b \f20 \fs14 \cf0 {\b0
miento,}{\b0 son}{\b0 la}{\b0 piedra}{\b0 angular}{\b0 para}{\b0 el}{\b0
control}{\b0 de}{\b0 la}{\b0 tuberculosis}{\b0 (TB). }
\par}{\phpg\posx680\pvpg\posy8021\absw5020\absh6236 \sl-210 \b \f20 \fs14 \cf0 {\b0
El}{\b0 retraso}{\b0 del}{\b0 inicio}{\b0 del}{\b0 tratamiento,}{\b0 puede}
{\b0 llevar}{\b0 al}{\b0 progreso}{\b0 de}{\b0 la }
\par}{\phpg\posx680\pvpg\posy8021\absw5020\absh6236 \sl-210 \b \f20 \fs14 \cf0 {\b0
enfermedad,}{\b0 aumento}{\b0 de}{\b0 la}{\b0 transmisi�n}{\b0 y}{\b0
mortalidad.}{\b0 En}{\b0 Per�,}{\b0 el}{\b0 a�o }
\par}{\phpg\posx680\pvpg\posy8021\absw5020\absh6236 \sl-210 \b \f20 \fs14 \cf0 {\b0
2016}{\b0 se}{\b0 han}{\b0 examinado}{\b0 1.907.085}{\b0 sintom�ticos}{\b0
respiratorios}{\b0 de}{\b0 los }
\par}{\phpg\posx680\pvpg\posy8021\absw5020\absh6236 \sl-210 \b \f20 \fs14 \cf0 {\b0
cuales}{\b0 27.217}{\b0 fueron}{\b0 casos}{\b0 nuevos}{\b0 de}{\b0 TB}{\b0
bacil�feros}{\b0 (1,4%),}{\b0 expresado }
\par}{\phpg\posx680\pvpg\posy8021\absw5020\absh6236 \sl-210 \b \f20 \fs14 \cf0 {\b0
en}{\b0 una}{\b0 tasa}{\b0 de}{\b0 incidencia}{\b0 de}{\b0 TB}{\b0 pulmonar}
{\b0 BK}{\b0 positivo}{\b0 de}{\b0 88,4}{\b0 � }
\par}{\phpg\posx680\pvpg\posy8021\absw5020\absh6236 \sl-210 \b \f20 \fs14 \cf0 {\b0
100.000}{\b0 habitantes.}{\b0 Desde}{\b0 hace}{\b0 m�s}{\b0 de}{\b0 una}{\b0
d�cada,}{\b0 a}{\b0 pesar}{\b0 de}{\b0 las }
\par}{\phpg\posx680\pvpg\posy8021\absw5020\absh6236 \sl-210 \b \f20 \fs14 \cf0 {\b0
intervenciones}{\b0 implementadas,}{\b0 este}{\b0 indicador}{\b0 no}{\b0
disminuye}{\b0 m�s}{\b0 del }
\par}{\phpg\posx680\pvpg\posy8021\absw5020\absh6236 \sl-210 \b \f20 \fs14 \cf0 {\b0
2%}{\b0 anual.}{\b0 Una}{\b0 de}{\b0 las}{\b0 explicaciones,}{\b0 podr�a}{\b0
ser}{\b0 inicio}{\b0 de}{\b0 tratamiento }
\par}{\phpg\posx680\pvpg\posy8021\absw5020\absh6236 \sl-210 \b \f20 \fs14 \cf0 {\b0
tard�o,}{\b0 que}{\b0 permite}{\b0 se}{\b0 perpet�e}{\b0 la}{\b0
transmisi�n.}{\b0 Es}{\b0 por}{\b0 ello,}{\b0 el}{\b0 inter�s }
\par}{\phpg\posx680\pvpg\posy8021\absw5020\absh6236 \sl-210 \b \f20 \fs14 \cf0 {\b0
de}{\b0 medir}{\b0 el}{\b0 lapso}{\b0 transcurrido}{\b0 entre}{\b0 la}{\b0
aparici�n}{\b0 de}{\b0 los}{\b0 s�ntomas}{\b0 res- }
\par}{\phpg\posx680\pvpg\posy8021\absw5020\absh6236 \sl-210 \b \f20 \fs14 \cf0 {\b0
piratorios}{\b0 y}{\b0 el}{\b0 comienzo}{\b0 eficiente}{\b0 del}{\b0
tratamiento,}{\b0 determinando}{\b0 los }
\par}{\phpg\posx680\pvpg\posy8021\absw5020\absh6236 \sl-210 \b \f20 \fs14 \cf0 {\b0
factores}{\b0 asociados}{\b0 al}{\b0 retraso. }
\par}{\phpg\posx680\pvpg\posy8021\absw5020\absh6236 \sl-210 \b \f20 \fs14 \cf0
Material y m�todos:{\b0 Se}{\b0 llev�}{\b0 a}{\b0 cabo}{\b0 un}{\b0 estudio}
{\b0 de}{\b0 casos}{\b0 y}{\b0 controles, }
\par}{\phpg\posx680\pvpg\posy8021\absw5020\absh6236 \sl-210 \b \f20 \fs14 \cf0 {\b0
entre}{\b0 los}{\b0 meses}{\b0 de}{\b0 enero}{\b0 a}{\b0 diciembre}{\b0 del}
{\b0 2016;}{\b0 los}{\b0 casos,}{\b0 fueron}{\b0 pa- }
\par}{\phpg\posx680\pvpg\posy8021\absw5020\absh6236 \sl-210 \b \f20 \fs14 \cf0 {\b0
cientes}{\b0 nuevos}{\b0 con}{\b0 TB}{\b0 pulmonar}{\b0 BK}{\b0 positivo,}
{\b0 ingresados}{\b0 a}{\b0 tratamien- }
\par}{\phpg\posx680\pvpg\posy8021\absw5020\absh6236 \sl-210 \b \f20 \fs14 \cf0 {\b0
to}{\b0 despu�s}{\b0 de}{\b0 30}{\b0 d�as}{\b0 de}{\b0 iniciados}{\b0 los}
{\b0 s�ntomas}{\b0 respiratorios;}{\b0 los}{\b0 con- }
\par}{\phpg\posx680\pvpg\posy8021\absw5020\absh6236 \sl-210 \b \f20 \fs14 \cf0 {\b0
troles,}{\b0 fueron}{\b0 pacientes}{\b0 nuevos}{\b0 con}{\b0 TB}{\b0
pulmonar}{\b0 BK}{\b0 positivo, }
\par}{\phpg\posx680\pvpg\posy8021\absw5020\absh6236 \sl-210 \b \f20 \fs14 \cf0 {\b0
ingresados}{\b0 a}{\b0 tratamiento}{\b0 dentro}{\b0 de}{\b0 los}{\b0 30}{\b0
d�as}{\b0 de}{\b0 iniciados}{\b0 los}{\b0 s�nto- }
\par}{\phpg\posx680\pvpg\posy8021\absw5020\absh6236 \sl-210 \b \f20 \fs14 \cf0 {\b0
mas}{\b0 respiratorios.}{\b0 Mediante}{\b0 una}{\b0 ficha}{\b0 de}{\b0
recolecci�n}{\b0 de}{\b0 informaci�n }
\par}{\phpg\posx680\pvpg\posy8021\absw5020\absh6236 \sl-210 \b \f20 \fs14 \cf0 {\b0
de}{\b0 los}{\b0 expedientes}{\b0 cl�nicos}{\b0 y}{\b0 una}{\b0 encuesta}{\b0
dirigida}{\b0 a}{\b0 los}{\b0 pacientes;}{\b0 se }
\par}{\phpg\posx680\pvpg\posy8021\absw5020\absh6236 \sl-210 \b \f20 \fs14 \cf0 {\b0
recolectaron:}{\b0 datos}{\b0 sociodemogr�ficos,}{\b0 cl�nico-laboratoriales}
{\b0 y}{\b0 de}{\b0 los }
\par}{\phpg\posx680\pvpg\posy8021\absw5020\absh6236 \sl-210 \b \f20 \fs14 \cf0 {\b0
servicios}{\b0 de}{\b0 salud.}{\b0 Se}{\b0 calcularon}{\b0 los}{\b0 tiempos}
{\b0 transcurridos}{\b0 entre}{\b0 la }
\par}{\phpg\posx680\pvpg\posy8021\absw5020\absh6236 \sl-210 \b \f20 \fs14 \cf0 {\b0
aparici�n}{\b0 de}{\b0 los}{\b0 s�ntomas}{\b0 respiratorios,}{\b0 solicitud}
{\b0 de}{\b0 la}{\b0 primera}{\b0 y}{\b0 se- }
\par}{\phpg\posx680\pvpg\posy8021\absw5020\absh6236 \sl-210 \b \f20 \fs14 \cf0 {\b0
gunda}{\b0 baciloscopia}{\b0 y}{\b0 el}{\b0 comienzo}{\b0 del}{\b0
tratamiento. }\par
}
{\phpg\posx6037\pvpg\posy4451\absw5030\absh9449 \b \f20 \fs14 \cf0 \b \f20 \fs14
\cf0 252. DEPRESI�N Y ADHERENCIA AL TRATAMIENTO EN PACIENTES
\par}{\phpg\posx6037\pvpg\posy4451\absw5030\absh9449 \sl-200 \b \f20 \fs14 \cf0 CON
TUBERCULOSIS MULTIDROGORRESISTENTE EN UNA REGI�N
\par}{\phpg\posx6037\pvpg\posy4451\absw5030\absh9449 \sl-200 \b \f20 \fs14 \cf0 DEL
PER�
\par}{\phpg\posx6037\pvpg\posy4451\absw5030\absh9449 \sl-170 \par\b \f20 \fs14 \cf0
{\b0 O.}{\b0 Rivera,}{\b0 F.}{\b0 Quiroz,}{\b0 E.}{\b0 Crespo,}{\b0 J.}{\b0
Mendigure,}{\b0 I.}{\b0 Huaylla}{\b0 y}{\b0 C.}{\b0 Bonilla }
\par}{\phpg\posx6037\pvpg\posy4451\absw5030\absh9449 \sl-156 \par\b \f20 \fs14 \cf0
{\b0\i Universidad}{\b0\i C�sar}{\b0\i Vallejo.}{\b0\i Lima.}{\b0\i Per�.}
{\b0\i Universidad}{\b0\i del}{\b0\i Valle.}{\b0\i Cali. }
\par}{\phpg\posx6037\pvpg\posy4451\absw5030\absh9449 \sl-200 \b \f20 \fs14 \cf0
{\b0\i Colombia.}{\b0\i Universidad}{\b0\i Privada}{\b0\i Norbert}{\b0\i
Wiener.}{\b0\i Lima.}{\b0\i Per�.}{\b0\i Hospital }
\par}{\phpg\posx6037\pvpg\posy4451\absw5030\absh9449 \sl-200 \b \f20 \fs14 \cf0
{\b0\i Nacional}{\b0\i Daniel}{\b0\i Alcides}{\b0\i Carri�n.}{\b0\i Callao.}
{\b0\i Per�. }
\par}{\phpg\posx6037\pvpg\posy4451\absw5030\absh9449 \sl-222 \par\b \f20 \fs14 \cf0
Introducci�n:{\b0 La}{\b0 Organizaci�n}{\b0 Mundial}{\b0 de}{\b0 la}{\b0
Salud,}{\b0 define}{\b0 la}{\b0 adhe- }
\par}{\phpg\posx6037\pvpg\posy4451\absw5030\absh9449 \sl-210 \b \f20 \fs14 \cf0
{\b0 rencia,}{\b0 "como}{\b0 el}{\b0 grado}{\b0 en}{\b0 el}{\b0 que}{\b0 la}
{\b0 conducta}{\b0 de}{\b0 un}{\b0 paciente,}{\b0 en}{\b0 re- }
\par}{\phpg\posx6037\pvpg\posy4451\absw5030\absh9449 \sl-210 \b \f20 \fs14 \cf0
{\b0 laci�n}{\b0 con}{\b0 la}{\b0 toma}{\b0 de}{\b0 medicaci�n,}{\b0 el}{\b0
seguimiento}{\b0 de}{\b0 una}{\b0 dieta}{\b0 o}{\b0 la }
\par}{\phpg\posx6037\pvpg\posy4451\absw5030\absh9449 \sl-210 \b \f20 \fs14 \cf0
{\b0 modificaci�n}{\b0 de}{\b0 h�bitos}{\b0 de}{\b0 vida,}{\b0 se}{\b0
corresponde}{\b0 con}{\b0 las}{\b0 recomenda- }
\par}{\phpg\posx6037\pvpg\posy4451\absw5030\absh9449 \sl-210 \b \f20 \fs14 \cf0
{\b0 ciones}{\b0 acordadas}{\b0 con}{\b0 el}{\b0 profesional}{\b0 sanitario".}
{\b0 La}{\b0 falta}{\b0 de}{\b0 adherencia }
\par}{\phpg\posx6037\pvpg\posy4451\absw5030\absh9449 \sl-210 \b \f20 \fs14 \cf0
{\b0 al}{\b0 tratamiento,}{\b0 es}{\b0 uno}{\b0 de}{\b0 los}{\b0 principales}
{\b0 impedimentos}{\b0 para}{\b0 el}{\b0 con- }
\par}{\phpg\posx6037\pvpg\posy4451\absw5030\absh9449 \sl-210 \b \f20 \fs14 \cf0
{\b0 trol}{\b0 de}{\b0 la}{\b0 tuberculosis,}{\b0 contribuyendo}{\b0 a}{\b0
profundas}{\b0 consecuencias }
\par}{\phpg\posx6037\pvpg\posy4451\absw5030\absh9449 \sl-210 \b \f20 \fs14 \cf0
{\b0 cl�nico-epidemiol�gicas}{\b0 (progresi�n}{\b0 de}{\b0 enfermedad,}{\b0
aparici�n}{\b0 de }
\par}{\phpg\posx6037\pvpg\posy4451\absw5030\absh9449 \sl-210 \b \f20 \fs14 \cf0
{\b0 cepas}{\b0 resistentes,}{\b0 contagiosidad,}{\b0 muerte)}{\b0 y}{\b0
econ�micas.}{\b0 En}{\b0 Per�,}{\b0 el }
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\par}{\phpg\posx850\pvpg\posy1100\absw5040\absh7345 \sl-210 \b \f20 \fs15 \cf0 {\b0
n�sticas}{\b0 que}{\b0 buscan}{\b0 resolver}{\b0 este}{\b0 problema}{\b0 con}
{\b0 el}{\b0 fin}{\b0 de}{\b0 iniciar}{\b0 trata- }
\par}{\phpg\posx850\pvpg\posy1100\absw5040\absh7345 \sl-210 \b \f20 \fs15 \cf0 {\b0
miento}{\b0 precoz,}{\b0 mientras}{\b0 se}{\b0 esperan}{\b0 los}{\b0
resultados}{\b0 del}{\b0 cultivo.}{\b0 En}{\b0 este }
\par}{\phpg\posx850\pvpg\posy1100\absw5040\absh7345 \sl-210 \b \f20 \fs15 \cf0 {\b0
estudio}{\b0 se}{\b0 describen}{\b0 los}{\b0 hallazgos}{\b0 de}{\b0
tomograf�a}{\b0 de}{\b0 t�rax}{\b0 obtenidos }
\par}{\phpg\posx850\pvpg\posy1100\absw5040\absh7345 \sl-210 \b \f20 \fs15 \cf0 {\b0
en}{\b0 una}{\b0 poblaci�n}{\b0 con}{\b0 TB}{\b0 pulmonar}{\b0 y}{\b0 su}
{\b0 relaci�n}{\b0 con}{\b0 la}{\b0 cantidad}{\b0 de }
\par}{\phpg\posx850\pvpg\posy1100\absw5040\absh7345 \sl-210 \b \f20 \fs15 \cf0 {\b0
ADN}{\b0 detectado}{\b0 en}{\b0 la}{\b0 prueba}{\b0 genot�pica}{\b0
GENEXPERT}{\b0 MTB/RIF. }
\par}{\phpg\posx850\pvpg\posy1100\absw5040\absh7345 \sl-210 \b \f20 \fs15 \cf0
Material y m�todos:{\b0 Estudio}{\b0 retrospectivo,}{\b0 observacional,}{\b0
descriptivo }
\par}{\phpg\posx850\pvpg\posy1100\absw5040\absh7345 \sl-210 \b \f20 \fs15 \cf0 {\b0
en}{\b0 una}{\b0 poblaci�n}{\b0 de}{\b0 31}{\b0 pacientes}{\b0 mayores}{\b0
de}{\b0 18}{\b0 a�os,}{\b0 internados}{\b0 en }
\par}{\phpg\posx850\pvpg\posy1100\absw5040\absh7345 \sl-210 \b \f20 \fs15 \cf0 {\b0
el}{\b0 Hospital}{\b0 Universitario}{\b0 San}{\b0 Jorge}{\b0 de}{\b0 Pereira}
{\b0 (Colombia),}{\b0 durante}{\b0 el }
\par}{\phpg\posx850\pvpg\posy1100\absw5040\absh7345 \sl-210 \b \f20 \fs15 \cf0 {\b0
2016;}{\b0 a}{\b0 los}{\b0 cuales}{\b0 se}{\b0 les}{\b0 realiz�}{\b0
tomograf�a}{\b0 de}{\b0 t�rax,}{\b0 prueba}{\b0 genot�pi- }
\par}{\phpg\posx850\pvpg\posy1100\absw5040\absh7345 \sl-210 \b \f20 \fs15 \cf0 {\b0
ca}{\b0 y}{\b0 se}{\b0 les}{\b0 confirm�}{\b0 TB}{\b0 con}{\b0 cultivo}{\b0
en}{\b0 medio}{\b0 Owaga/Kudoh}{\b0 o}{\b0 Lowens- }
\par}{\phpg\posx850\pvpg\posy1100\absw5040\absh7345 \sl-210 \b \f20 \fs15 \cf0 {\b0
tein-Jensen.}{\b0 Para}{\b0 describir}{\b0 la}{\b0 frecuencia}{\b0 de}{\b0
los}{\b0 hallazgos}{\b0 tomogr�ficos }
\par}{\phpg\posx850\pvpg\posy1100\absw5040\absh7345 \sl-210 \b \f20 \fs15 \cf0 {\b0
y}{\b0 su}{\b0 relaci�n}{\b0 con}{\b0 la}{\b0 cantidad}{\b0 de}{\b0 ADN}{\b0
detectado}{\b0 en}{\b0 la}{\b0 prueba}{\b0 genot�- }
\par}{\phpg\posx850\pvpg\posy1100\absw5040\absh7345 \sl-210 \b \f20 \fs15 \cf0 {\b0
pica,}{\b0 se}{\b0 evalu�}{\b0 la}{\b0 significancia}{\b0 estad�stica}{\b0
de}{\b0 las}{\b0 variables}{\b0 cualitativas }
\par}{\phpg\posx850\pvpg\posy1100\absw5040\absh7345 \sl-210 \b \f20 \fs15 \cf0 {\b0
a}{\b0 trav�s}{\b0 del}{\b0 test}{\b0 exacto}{\b0 de}{\b0 Fisher.}{\b0
Estos}{\b0 an�lisis}{\b0 se}{\b0 realizaron}{\b0 en}{\b0 STATA. }
\par}{\phpg\posx850\pvpg\posy1100\absw5040\absh7345 \sl-210 \b \f20 \fs15 \cf0
Resultados:{\b0 El}{\b0 promedio}{\b0 de}{\b0 edad}{\b0 de}{\b0 los}{\b0
pacientes}{\b0 analizados}{\b0 fue}{\b0 de }
\par}{\phpg\posx850\pvpg\posy1100\absw5040\absh7345 \sl-210 \b \f20 \fs15 \cf0 {\b0
48,3}{\b0 a�os,}{\b0 el}{\b0 74,2%}{\b0 fueron}{\b0 hombres,}{\b0 el}{\b0
87%}{\b0 de}{\b0 los}{\b0 casos}{\b0 fueron}{\b0 diag- }
\par}{\phpg\posx850\pvpg\posy1100\absw5040\absh7345 \sl-210 \b \f20 \fs15 \cf0 {\b0
nosticados}{\b0 de}{\b0 primera}{\b0 vez.}{\b0 Los}{\b0 resultados}{\b0 de}
{\b0 las}{\b0 baciloscopias}{\b0 fueron }
\par}{\phpg\posx850\pvpg\posy1100\absw5040\absh7345 \sl-210 \b \f20 \fs15 \cf0 {\b0
negativos}{\b0 en}{\b0 el}{\b0 54,8%,}{\b0 menos}{\b0 del}{\b0 20%}{\b0
presentaban}{\b0 baciloscopias}{\b0 in- }
\par}{\phpg\posx850\pvpg\posy1100\absw5040\absh7345 \sl-210 \b \f20 \fs15 \cf0 {\b0
formadas}{\b0 con}{\b0 m�s}{\b0 de}{\b0 (+++).}{\b0 La}{\b0 coinfecci�n}{\b0
por}{\b0 VIH}{\b0 fue}{\b0 del}{\b0 16%.}{\b0 Con }
\par}{\phpg\posx850\pvpg\posy1100\absw5040\absh7345 \sl-210 \b \f20 \fs15 \cf0 {\b0
respecto}{\b0 a}{\b0 los}{\b0 hallazgos}{\b0 tomogr�ficos}{\b0 y}{\b0 la}{\b0
presencia}{\b0 de}{\b0 ADN}{\b0 en}{\b0 la }
\par}{\phpg\posx850\pvpg\posy1100\absw5040\absh7345 \sl-210 \b \f20 \fs15 \cf0 {\b0
prueba}{\b0 genot�pica,}{\b0 el}{\b0 65%}{\b0 de}{\b0 los}{\b0 pacientes}{\b0
con}{\b0 cantidad}{\b0 alta}{\b0 y}{\b0 media }
\par}{\phpg\posx850\pvpg\posy1100\absw5040\absh7345 \sl-210 \b \f20 \fs15 \cf0 {\b0
presentaban}{\b0 �rbol}{\b0 en}{\b0 gemaci�n,}{\b0 seguido}{\b0 de}{\b0
patr�n}{\b0 en}{\b0 vidrio}{\b0 esmeri- }
\par}{\phpg\posx850\pvpg\posy1100\absw5040\absh7345 \sl-210 \b \f20 \fs15 \cf0 {\b0
lado.}{\b0 La}{\b0 resistencia}{\b0 a}{\b0 rifampicina}{\b0 (rpoB)}{\b0 fue}
{\b0 detectada}{\b0 en}{\b0 dos}{\b0 pacien- }
\par}{\phpg\posx850\pvpg\posy1100\absw5040\absh7345 \sl-210 \b \f20 \fs15 \cf0 {\b0
tes}{\b0 (6,45%). }
\par}{\phpg\posx850\pvpg\posy1100\absw5040\absh7345 \sl-237 \b \f20 \fs15 \cf0 {\b0
\fs12 Tabla.}{\b0 \fs12 Relaci�n}{\b0 \fs12 de}{\b0 \fs12 hallazgos}{\b0 \fs12
tomogr�ficos}{\b0 \fs12 con}{\b0 \fs12 cantidad}{\b0 \fs12 de}{\b0 \fs12 ADN}
{\b0 \fs12 reportada}{\b0 \fs12 en}{\b0 \fs12 prueba }
\par}{\phpg\posx850\pvpg\posy1100\absw5040\absh7345 \sl-171 \b \f20 \fs15 \cf0 {\b0
\fs12 genot�pica }\par
}
{\phpg\posx11011\pvpg\posy711\absw213\absh142 \f20 \fs12 \cf0 \f20 \fs12 \cf0
109 \par
}
{\phpg\posx6207\pvpg\posy1103\absw5020\absh6415 \f20 \fs15 \cf0 \f20 \fs15 \cf0
Objetivos espec�ficos: determinar incidencia hospitalaria de reaccio-
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh6415 \sl-210 \f20 \fs15 \cf0 nes
adversas Identificar el predominio de sexo de las reacciones ad-
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh6415 \sl-210 \f20 \fs15 \cf0 versas
Conocer el tipo de rafa m�s frecuente que se presentan en los
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh6415 \sl-210 \f20 \fs15 \cf0
pacientes internados. Establecer el grupo etario de mayor presenta-
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh6415 \sl-210 \f20 \fs15 \cf0 ci�n
de las reacciones Caracterizar el tipo de rafas seg�n eritema po-
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh6415 \sl-210 \f20 \fs15 \cf0
limorfo mayor, menor, hep�tica, g�strica. Analizar el momento de
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh6415 \sl-210 \f20 \fs15 \cf0
aparici�n de las rafas, con respecto al inicio del tratamiento antituber-
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh6415 \sl-210 \f20 \fs15 \cf0 culoso
esquema I. Identificar los f�rmacos responsables de diversas
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh6415 \sl-210 \f20 \fs15 \cf0
reacciones adversas Establecer si existe relaci�n entre sexo, f�rmaco
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh6415 \sl-210 \f20 \fs15 \cf0 y tipo
de las reacciones adversas.
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh6415 \sl-210 \f20 \fs15 \cf0 {\b
Material}{\b y}{\b m�todos:} El estudio es de tipo observacional descriptivo
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh6415 \sl-210 \f20 \fs15 \cf0
anal�tico. Se realiza el an�lisis estad�stico en SSP 22.0.
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh6415 \sl-210 \f20 \fs15 \cf0 {\b
Resultados:} La incidencia de rafa es de 264 por cada 1.000. Las rafas
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh6415 \sl-210 \f20 \fs15 \cf0
predominan varones 61% mujeres 39%. El grupo etario con m�s rafa
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh6415 \sl-210 \f20 \fs15 \cf0 es <
30 a�os 48%. El tipo de rafa m�s frecuente es eritema polimorfo
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh6415 \sl-210 \f20 \fs15 \cf0 menor
con 44%. Tambi�n destaca el tipo de la hepatitis 36%.de los
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh6415 \sl-210 \f20 \fs15 \cf0 cuales
son varones 23% mujeres 12%. Se demuestra que en 3� semana
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh6415 \sl-210 \f20 \fs15 \cf0 de
tratamiento predomina la aparici�n de rafa 82% destaca el tipo
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh6415 \sl-210 \f20 \fs15 \cf0
hepatitis con 43%. Y en rafa eritema polimorfo menor la aparici�n en
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh6415 \sl-210 \f20 \fs15 \cf0 2�
semana 30,4% y 3� semana con 26,8%. El f�rmaco que produce reac-
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh6415 \sl-210 \f20 \fs15 \cf0 ci�n
adversa del tipo hepatitis en mujeres es pirazinamida 21% segui-
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh6415 \sl-210 \f20 \fs15 \cf0 da de
isoniacida con 4%. A diferencia de varones la rifampicina 17%
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh6415 \sl-210 \f20 \fs15 \cf0
seguida de pirazinamida 8%. En relaci�n al f�rmaco identificado en
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh6415 \sl-210 \f20 \fs15 \cf0
eritema polimorfo menor en varones destaca la rifampicina con 17%
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh6415 \sl-210 \f20 \fs15 \cf0
seguido del etambutol en 13% en mujeres es la pirazinamida con 8%
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh6415 \sl-210 \f20 \fs15 \cf0
seguido del etambutol e isoniacida en igual proporci�n 4%.
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh6415 \sl-210 \f20 \fs15 \cf0 {\b
Conclusiones:} Hay incidencia hospitalaria elevada de rafas 264 casos
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh6415 \sl-210 \f20 \fs15 \cf0 por
cada 1.000 predomina en varones. La aparici�n de la reacciones
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh6415 \sl-210 \f20 \fs15 \cf0
adversas es entre la 2� y 3� semana la hepatitis y el eritema polimorfo
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh6415 \sl-210 \f20 \fs15 \cf0 menor
siendo reacciones de hipersensibilidad de tipo III relacionado
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh6415 \sl-210 \f20 \fs15 \cf0 con
inmunocomplejos se trata con dosis alta de corticoide y plasma-
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh6415 \sl-210 \f20 \fs15 \cf0
f�resis con respuesta adecuada. Los f�rmacos identificados para rafa
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh6415 \sl-210 \f20 \fs15 \cf0
hepatitis y eritema polimorfo menor son rifampicina, pirazinamida
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh6415 \sl-210 \f20 \fs15 \cf0
existiendo asociaci�n estad�stica significativa (p: 0,03). \par
}
{\phpg\posx850\pvpg\posy10551\absw5018\absh935 \b \f20 \fs15 \cf0 \b \f20 \fs15
\cf0 Conclusiones:{\b0 En}{\b0 TB}{\b0 los}{\b0 hallazgos}{\b0 tomogr�ficos}
{\b0 como}{\b0 �rbol}{\b0 en}{\b0 gema- }
\par}{\phpg\posx850\pvpg\posy10551\absw5018\absh935 \sl-210 \b \f20 \fs15 \cf0 {\b0
ci�n,}{\b0 cavitaciones,}{\b0 consolidaci�n}{\b0 y}{\b0 vidrio}{\b0
esmerilado}{\b0 pueden}{\b0 estar }
\par}{\phpg\posx850\pvpg\posy10551\absw5018\absh935 \sl-210 \b \f20 \fs15 \cf0 {\b0
relacionados}{\b0 con}{\b0 mayor}{\b0 cantidad}{\b0 de}{\b0 ADN}{\b0
reportado}{\b0 en}{\b0 la}{\b0 prueba}{\b0 ge- }
\par}{\phpg\posx850\pvpg\posy10551\absw5018\absh935 \sl-210 \b \f20 \fs15 \cf0 {\b0
not�pica,}{\b0 sin}{\b0 embargo,}{\b0 en}{\b0 este}{\b0 estudio}{\b0 no}{\b0
se}{\b0 alcanz�}{\b0 significancia}{\b0 es- }
\par}{\phpg\posx850\pvpg\posy10551\absw5018\absh935 \sl-210 \b \f20 \fs15 \cf0 {\b0
tad�stica.}{\b0 Se}{\b0 requieren}{\b0 estudios}{\b0 con}{\b0 mayor}{\b0
tama�o}{\b0 muestral. }\par
}
{\phpg\posx850\pvpg\posy12011\absw5080\absh2645 \b \f20 \fs15 \cf0 \b \f20 \fs15
\cf0 254. INCIDENCIA Y CARACTER�STICAS DE PRESENTACI�N DE
\par}{\phpg\posx850\pvpg\posy12011\absw5080\absh2645 \sl-200 \b \f20 \fs15 \cf0
REACCIONES ADVERSAS A F�RMACOS ANTITUBERCULOSOS
\par}{\phpg\posx850\pvpg\posy12011\absw5080\absh2645 \sl-200 \b \f20 \fs15 \cf0 CON
ESQUEMA I EN EL INSTITUTO NACIONAL DE T�RAX DE MAYO
\par}{\phpg\posx850\pvpg\posy12011\absw5080\absh2645 \sl-200 \b \f20 \fs15 \cf0 A
DICIEMBRE DE 2017
\par}{\phpg\posx850\pvpg\posy12011\absw5080\absh2645 \sl-170 \par\b \f20 \fs15 \cf0
{\b0 A.}{\b0 Zelaya}{\b0 Ter�n}{\b0 y}{\b0 C.}{\b0 Vercosa}{\b0 Velasquez }
\par}{\phpg\posx850\pvpg\posy12011\absw5080\absh2645 \sl-156 \par\b \f20 \fs15 \cf0
{\b0\i Instituto}{\b0\i Nacional}{\b0\i de}{\b0\i T�rax. }
\par}{\phpg\posx850\pvpg\posy12011\absw5080\absh2645 \sl-144 \par\par\b \f20
\fs15 \cf0 Introducci�n:{\b0 Se}{\b0 realiza}{\b0 el}{\b0 trabajo}{\b0 de}{\b0
investigaci�n}{\b0 en}{\b0 el}{\b0 Instituto }
\par}{\phpg\posx850\pvpg\posy12011\absw5080\absh2645 \sl-210 \b \f20 \fs15 \cf0
{\b0 Nacional}{\b0 de}{\b0 T�rax}{\b0 por}{\b0 ser}{\b0 centro}{\b0 de}{\b0
referencia}{\b0 nacional}{\b0 con}{\b0 alta}{\b0 inci- }
\par}{\phpg\posx850\pvpg\posy12011\absw5080\absh2645 \sl-210 \b \f20 \fs15 \cf0
{\b0 dencia}{\b0 de}{\b0 rafa.}{\b0 Objetivo}{\b0 general:}{\b0 determinar}
{\b0 la}{\b0 incidencia}{\b0 y}{\b0 caracte- }
\par}{\phpg\posx850\pvpg\posy12011\absw5080\absh2645 \sl-210 \b \f20 \fs15 \cf0
{\b0 r�sticas}{\b0 de}{\b0 presentaci�n}{\b0 de}{\b0 reacciones}{\b0 adversas}
{\b0 a}{\b0 f�rmacos}{\b0 antituber- }
\par}{\phpg\posx850\pvpg\posy12011\absw5080\absh2645 \sl-210 \b \f20 \fs15 \cf0
{\b0 culosos}{\b0 en}{\b0 pacientes}{\b0 tratados}{\b0 con}{\b0 esquema}
{\b0 I}{\b0 internados}{\b0 en}{\b0 el }
\par}{\phpg\posx850\pvpg\posy12011\absw5080\absh2645 \sl-210 \b \f20 \fs15 \cf0
{\b0 Instituto}{\b0 Nacional}{\b0 de}{\b0 T�rax}{\b0 de}{\b0 mayo}{\b0 a}{\b0
diciembre}{\b0 de}{\b0 la}{\b0 gesti�n}{\b0 2017. }\par
}
{\phpg\posx6207\pvpg\posy8651\absw5020\absh5669 \b \f20 \fs15 \cf0 \b \f20 \fs15
\cf0 255. UTILIDAD DEL XPERT MTB/RIF EN EL DIAGN�STICO
\par}{\phpg\posx6207\pvpg\posy8651\absw5020\absh5669 \sl-200 \b \f20 \fs15 \cf0
TEMPRANO DE LA MENINGITIS TUBERCULOSA CON
\par}{\phpg\posx6207\pvpg\posy8651\absw5020\absh5669 \sl-200 \b \f20 \fs15 \cf0
COMPLICACIONES FATALES
\par}{\phpg\posx6207\pvpg\posy8651\absw5020\absh5669 \sl-170 \par\b \f20 \fs15 \cf0
{\b0 F.}{\b0 C�rdenas,}{\b0 A.}{\b0 Ramos,}{\b0 J.}{\b0 de}{\b0 los}{\b0
R�os}{\b0 y}{\b0 M.}{\b0 Paredes }
\par}{\phpg\posx6207\pvpg\posy8651\absw5020\absh5669 \sl-156 \par\b \f20 \fs15 \cf0
{\b0\i Hospital}{\b0\i Mar�a}{\b0\i Auxiliadora. }
\par}{\phpg\posx6207\pvpg\posy8651\absw5020\absh5669 \sl-141 \par\par\b \f20
\fs15 \cf0 Introducci�n:{\b0 Se}{\b0 presenta}{\b0 el}{\b0 caso}{\b0 de}{\b0
una}{\b0 paciente}{\b0 con}{\b0 meningitis }
\par}{\phpg\posx6207\pvpg\posy8651\absw5020\absh5669 \sl-210 \b \f20 \fs15 \cf0
{\b0 tuberculosa}{\b0 (MEC}{\b0 TB)}{\b0 de}{\b0 diagn�stico}{\b0 tard�o}{\b0
y}{\b0 complicaciones}{\b0 fatales. }
\par}{\phpg\posx6207\pvpg\posy8651\absw5020\absh5669 \sl-210 \b \f20 \fs15 \cf0
Material y m�todos:{\b0 Revisi�n}{\b0 de}{\b0 historia}{\b0 cl�nica}{\b0 y}
{\b0 bibliograf�a. }
\par}{\phpg\posx6207\pvpg\posy8651\absw5020\absh5669 \sl-210 \b \f20 \fs15 \cf0
Resultados:{\b0 Mujer}{\b0 de}{\b0 23}{\b0 a�os,}{\b0 con}{\b0 3}{\b0 meses}
{\b0 de}{\b0 enfermedad,}{\b0 caracte- }
\par}{\phpg\posx6207\pvpg\posy8651\absw5020\absh5669 \sl-210 \b \f20 \fs15 \cf0
{\b0 rizado}{\b0 por}{\b0 alucinaciones}{\b0 visuales}{\b0 y}{\b0 auditivas}
{\b0 eventuales.}{\b0 Acude}{\b0 a }
\par}{\phpg\posx6207\pvpg\posy8651\absw5020\absh5669 \sl-210 \b \f20 \fs15 \cf0
{\b0 emergencia,}{\b0 por}{\b0 fiebre,}{\b0 diplop�a}{\b0 espor�dica,}{\b0
v�mitos,}{\b0 cefalea,}{\b0 astenia, }
\par}{\phpg\posx6207\pvpg\posy8651\absw5020\absh5669 \sl-210 \b \f20 \fs15 \cf0
{\b0 con}{\b0 escala}{\b0 de}{\b0 coma}{\b0 de}{\b0 Glasgow}{\b0 de}{\b0
15/15,}{\b0 tomograf�a}{\b0 cerebral,}{\b0 sin}{\b0 al- }
\par}{\phpg\posx6207\pvpg\posy8651\absw5020\absh5669 \sl-210 \b \f20 \fs15 \cf0
{\b0 teraciones,}{\b0 liquido}{\b0 c�falo}{\b0 raqu�deo}{\b0 (LCR):}{\b0 TEST}
{\b0 ADA:}{\b0 4,5,}{\b0 BK}{\b0 directo }
\par}{\phpg\posx6207\pvpg\posy8651\absw5020\absh5669 \sl-210 \b \f20 \fs15 \cf0
{\b0 (-),}{\b0 celularidad}{\b0 escasa,}{\b0 hipoglucorraquia,}{\b0
hiperproteinorraquia,}{\b0 culti- }
\par}{\phpg\posx6207\pvpg\posy8651\absw5020\absh5669 \sl-210 \b \f20 \fs15 \cf0
{\b0 vo}{\b0 Gram}{\b0 (-),}{\b0 ex�menes}{\b0 serol�gicos}{\b0 con}{\b0
valores}{\b0 normales.}{\b0 Inicia}{\b0 trata- }
\par}{\phpg\posx6207\pvpg\posy8651\absw5020\absh5669 \sl-210 \b \f20 \fs15 \cf0
{\b0 miento}{\b0 para}{\b0 meningitis}{\b0 bacteriana,}{\b0 pero}{\b0
s�ntomas}{\b0 se}{\b0 intensifican.}{\b0 En }
\par}{\phpg\posx6207\pvpg\posy8651\absw5020\absh5669 \sl-210 \b \f20 \fs15 \cf0
{\b0 el}{\b0 d�a}{\b0 7}{\b0 se}{\b0 inicia}{\b0 cobertura}{\b0 antiviral}
{\b0 emp�rica}{\b0 con}{\b0 aciclovir,}{\b0 por}{\b0 aso- }
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\par}{\phpg\posx6207\pvpg\posy8651\absw5020\absh5669 \sl-210 \b \f20 \fs15 \cf0
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\par}{\phpg\posx6207\pvpg\posy8651\absw5020\absh5669 \sl-210 \b \f20 \fs15 \cf0
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\par}{\phpg\posx6207\pvpg\posy8651\absw5020\absh5669 \sl-210 \b \f20 \fs15 \cf0
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\par}{\phpg\posx6207\pvpg\posy8651\absw5020\absh5669 \sl-210 \b \f20 \fs15 \cf0
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\par}{\phpg\posx6207\pvpg\posy8651\absw5020\absh5669 \sl-210 \b \f20 \fs15 \cf0
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\par}{\phpg\posx6207\pvpg\posy8651\absw5020\absh5669 \sl-210 \b \f20 \fs15 \cf0
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\par}{\phpg\posx6207\pvpg\posy8651\absw5020\absh5669 \sl-210 \b \f20 \fs15 \cf0
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\par}{\phpg\posx6207\pvpg\posy8651\absw5020\absh5669 \sl-210 \b \f20 \fs15 \cf0
{\b0 terapia}{\b0 a}{\b0 dosis}{\b0 alta.}{\b0 Presenta}{\b0 signos}{\b0 de}
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}
\sect\sectd\pard\plain
\pgwsxn11905\pghsxn15874
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}}\par}{\phpg\posx680\pvpg\posy711\absw205\absh142 \f20 \fs12 \cf0 \f20 \fs12 \cf0
110 \par
}
{\phpg\posx5258\pvpg\posy713\absw1048\absh138 \i \f20 \fs12 \cf0 \i \f20 \fs12 \cf0
11.� Congreso ALAT \par
}
{\phpg\posx680\pvpg\posy1103\absw5017\absh2824 \f20 \fs15 \cf0 \f20 \fs15 \cf0 en
nueva tomograf�a cerebral se evidencia hidrocefalia, coloc�ndose
\par}{\phpg\posx680\pvpg\posy1103\absw5017\absh2824 \sl-210 \f20 \fs15 \cf0 sistema
de derivaci�n ventricular externo (SDVE) y terapia osm�tica.
\par}{\phpg\posx680\pvpg\posy1103\absw5017\absh2824 \sl-210 \f20 \fs15 \cf0
Tomograf�a cerebral de control muestra �reas isqu�micas en n�cleos
\par}{\phpg\posx680\pvpg\posy1103\absw5017\absh2824 \sl-210 \f20 \fs15 \cf0
basales, asociado a convulsiones. Presenta BK (+), en secreci�n tra-
\par}{\phpg\posx680\pvpg\posy1103\absw5017\absh2824 \sl-210 \f20 \fs15 \cf0 queal y
signos de descerebraci�n con nuevo cultivo de LCR, tomado
\par}{\phpg\posx680\pvpg\posy1103\absw5017\absh2824 \sl-210 \f20 \fs15 \cf0 de
SDVE, Klebsiella pneumoniae (+). Fallece tras 39 d�as, por compli-
\par}{\phpg\posx680\pvpg\posy1103\absw5017\absh2824 \sl-210 \f20 \fs15 \cf0
caciones s�pticas de infecci�n de SDVE.
\par}{\phpg\posx680\pvpg\posy1103\absw5017\absh2824 \sl-210 \f20 \fs15 \cf0 {\b
Conclusiones:} El diagn�stico tard�o de MEC TB, est� asociado a secue-
\par}{\phpg\posx680\pvpg\posy1103\absw5017\absh2824 \sl-210 \f20 \fs15 \cf0 las
neurol�gicas graves y muerte. En pa�ses no desarrollados los diag-
\par}{\phpg\posx680\pvpg\posy1103\absw5017\absh2824 \sl-210 \f20 \fs15 \cf0
n�sticos se basan en la cl�nica y estudio de LCR con BK, citoqu�mico y
\par}{\phpg\posx680\pvpg\posy1103\absw5017\absh2824 \sl-210 \f20 \fs15 \cf0 ADA. La
prueba de m�s alta sensibilidad y especificidad es el Xpert
\par}{\phpg\posx680\pvpg\posy1103\absw5017\absh2824 \sl-210 \f20 \fs15 \cf0
MTB/RIF, a la cual hay poco acceso por costos. Se recomienda imple-
\par}{\phpg\posx680\pvpg\posy1103\absw5017\absh2824 \sl-210 \f20 \fs15 \cf0 mentar
el Xpert MTB/RIF como medida inicial en sospecha de menin-
\par}{\phpg\posx680\pvpg\posy1103\absw5017\absh2824 \sl-210 \f20 \fs15 \cf0 gitis
tuberculosa, para evitar las complicaciones del diagn�stico tar-
\par}{\phpg\posx680\pvpg\posy1103\absw5017\absh2824 \sl-210 \f20 \fs15 \cf0 d�o.
\par
}
{\phpg\posx680\pvpg\posy4661\absw5020\absh9260 \b \f20 \fs15 \cf0 \b \f20 \fs15
\cf0 256. TUBERCULOSIS PERIC�RDICA
\par}{\phpg\posx680\pvpg\posy4661\absw5020\absh9260 \sl-170 \par\b \f20 \fs15 \cf0
{\b0 C.}{\b0 Canche }
\par}{\phpg\posx680\pvpg\posy4661\absw5020\absh9260 \sl-156 \par\b \f20 \fs15 \cf0
{\b0\i Hospital}{\b0\i General}{\b0\i Agust�n}{\b0\i O'Hor�n. }
\par}{\phpg\posx680\pvpg\posy4661\absw5020\absh9260 \sl-202 \par\b \f20 \fs15 \cf0
Introducci�n:{\b0 La}{\b0 Tuberculosis}{\b0 (TB)}{\b0 es}{\b0 una}{\b0
enfermedad}{\b0 que}{\b0 ha}{\b0 existi- }
\par}{\phpg\posx680\pvpg\posy4661\absw5020\absh9260 \sl-210 \b \f20 \fs15 \cf0 {\b0
do}{\b0 durante}{\b0 miles}{\b0 de}{\b0 a�os}{\b0 y}{\b0 contin�a}{\b0
siendo}{\b0 un}{\b0 problema}{\b0 de}{\b0 salud }
\par}{\phpg\posx680\pvpg\posy4661\absw5020\absh9260 \sl-210 \b \f20 \fs15 \cf0 {\b0
global.}{\b0 Aunque}{\b0 el}{\b0 pat�geno}{\b0 es}{\b0 principalmente}{\b0
pulmonar,}{\b0 puede}{\b0 afec- }
\par}{\phpg\posx680\pvpg\posy4661\absw5020\absh9260 \sl-210 \b \f20 \fs15 \cf0 {\b0
tar}{\b0 cualquier}{\b0 otro}{\b0 �rgano.}{\b0 Entre}{\b0 las}{\b0 formas}
{\b0 m�s}{\b0 comunes}{\b0 de}{\b0 TB}{\b0 extra- }
\par}{\phpg\posx680\pvpg\posy4661\absw5020\absh9260 \sl-210 \b \f20 \fs15 \cf0 {\b0
pulmonar}{\b0 se}{\b0 encuentran}{\b0 la}{\b0 TB}{\b0 ganglionar,}{\b0 la}
{\b0 TB}{\b0 pleural}{\b0 y}{\b0 la}{\b0 TB}{\b0 �sea. }
\par}{\phpg\posx680\pvpg\posy4661\absw5020\absh9260 \sl-210 \b \f20 \fs15 \cf0 {\b0
Sin}{\b0 embargo,}{\b0 existen}{\b0 algunas}{\b0 formas}{\b0 como}{\b0 la}
{\b0 TB}{\b0 peric�rdica}{\b0 y}{\b0 la}{\b0 TB }
\par}{\phpg\posx680\pvpg\posy4661\absw5020\absh9260 \sl-210 \b \f20 \fs15 \cf0 {\b0
men�ngea}{\b0 que}{\b0 tienen}{\b0 una}{\b0 mortalidad}{\b0 a�n}{\b0 mayor.}
{\b0 La}{\b0 forma}{\b0 peric�rdi- }
\par}{\phpg\posx680\pvpg\posy4661\absw5020\absh9260 \sl-210 \b \f20 \fs15 \cf0 {\b0
ca}{\b0 aunque}{\b0 no}{\b0 tan}{\b0 com�n,}{\b0 puede}{\b0 presentarse}{\b0
en}{\b0 forma}{\b0 de}{\b0 derrame }
\par}{\phpg\posx680\pvpg\posy4661\absw5020\absh9260 \sl-210 \b \f20 \fs15 \cf0 {\b0
peric�rdico}{\b0 y}{\b0 evolucionar}{\b0 hacia}{\b0 un}{\b0 tamponade}{\b0
cardiaco}{\b0 sino}{\b0 se}{\b0 diag- }
\par}{\phpg\posx680\pvpg\posy4661\absw5020\absh9260 \sl-210 \b \f20 \fs15 \cf0 {\b0
nostica}{\b0 y}{\b0 se}{\b0 trata}{\b0 oportunamente. }
\par}{\phpg\posx680\pvpg\posy4661\absw5020\absh9260 \sl-210 \b \f20 \fs15 \cf0
Material y m�todos:{\b0 Masculino}{\b0 de}{\b0 46}{\b0 a�os}{\b0 de}{\b0
edad.}{\b0 Antecedentes }
\par}{\phpg\posx680\pvpg\posy4661\absw5020\absh9260 \sl-210 \b \f20 \fs15 \cf0 {\b0
personales:}{\b0 estilista,}{\b0 inmunizaciones}{\b0 completas,}{\b0 Combe}{\b0
negativo, }
\par}{\phpg\posx680\pvpg\posy4661\absw5020\absh9260 \sl-210 \b \f20 \fs15 \cf0 {\b0
pr�cticas}{\b0 sexuales}{\b0 de}{\b0 riesgo.}{\b0 Consumo}{\b0 de}{\b0
alcohol,}{\b0 drogas}{\b0 y}{\b0 tabaquis- }
\par}{\phpg\posx680\pvpg\posy4661\absw5020\absh9260 \sl-210 \b \f20 \fs15 \cf0 {\b0
mo}{\b0 negados.}{\b0 Inicia}{\b0 padecimiento}{\b0 una}{\b0 semana}{\b0
previa}{\b0 al}{\b0 ingreso}{\b0 con }
\par}{\phpg\posx680\pvpg\posy4661\absw5020\absh9260 \sl-210 \b \f20 \fs15 \cf0 {\b0
tos}{\b0 no}{\b0 productiva}{\b0 y}{\b0 disnea}{\b0 de}{\b0 medianos}{\b0
esfuerzos.}{\b0 Acude}{\b0 al}{\b0 Hospital }
\par}{\phpg\posx680\pvpg\posy4661\absw5020\absh9260 \sl-210 \b \f20 \fs15 \cf0 {\b0
por}{\b0 exacerbaci�n}{\b0 de}{\b0 disnea}{\b0 y}{\b0 por}{\b0 presentar}{\b0
palpitaciones.}{\b0 A}{\b0 su}{\b0 llega- }
\par}{\phpg\posx680\pvpg\posy4661\absw5020\absh9260 \sl-210 \b \f20 \fs15 \cf0 {\b0
da}{\b0 urgencias}{\b0 signos}{\b0 vitales:}{\b0 FC}{\b0 120,}{\b0 FR}{\b0
22,}{\b0 TA}{\b0 120/80,}{\b0 T}{\b0 37,2}{\b0\up006 \fs8 o}{\b0 C,}{\b0
S0}{\b0 99%, }
\par}{\phpg\posx680\pvpg\posy4661\absw5020\absh9260 \sl-210 \b \f20 \fs15 \cf0 {\b0
peso}{\b0 62}{\b0 kg}{\b0 y}{\b0 talla}{\b0 de}{\b0 1,60}{\b0 cm.}{\b0 A}
{\b0 la}{\b0 exploraci�n}{\b0 f�sica:}{\b0 ingurgitaci�n }
\par}{\phpg\posx680\pvpg\posy4661\absw5020\absh9260 \sl-210 \b \f20 \fs15 \cf0 {\b0
yugular}{\b0 II/III}{\b0 soplos,}{\b0 uso}{\b0 de}{\b0 la}{\b0 musculatura}
{\b0 accesoria}{\b0 para}{\b0 la}{\b0 respira- }
\par}{\phpg\posx680\pvpg\posy4661\absw5020\absh9260 \sl-210 \b \f20 \fs15 \cf0 {\b0
ci�n,}{\b0 disminuci�n}{\b0 en}{\b0 la}{\b0 amplexi�n}{\b0 y}{\b0
amplexaci�n}{\b0 bilateral,}{\b0 matidez}{\b0 a }
\par}{\phpg\posx680\pvpg\posy4661\absw5020\absh9260 \sl-210 \b \f20 \fs15 \cf0 {\b0
la}{\b0 percusi�n}{\b0 en}{\b0 regi�n}{\b0 basal}{\b0 del}{\b0 hemit�rax}{\b0
izquierdo}{\b0 y}{\b0 disminuci�n }
\par}{\phpg\posx680\pvpg\posy4661\absw5020\absh9260 \sl-210 \b \f20 \fs15 \cf0 {\b0
del}{\b0 murmullo}{\b0 vesicular}{\b0 en}{\b0 ambas}{\b0 bases}{\b0
pulmonares.}{\b0 Ruidos}{\b0 card�acos }
\par}{\phpg\posx680\pvpg\posy4661\absw5020\absh9260 \sl-210 \b \f20 \fs15 \cf0 {\b0
disminuidos}{\b0 en}{\b0 intensidad}{\b0 y}{\b0 con}{\b0 ritmo}{\b0 de}{\b0
galope.}{\b0 Resto}{\b0 de}{\b0 la}{\b0 explo- }
\par}{\phpg\posx680\pvpg\posy4661\absw5020\absh9260 \sl-210 \b \f20 \fs15 \cf0 {\b0
raci�n}{\b0 f�sica}{\b0 normal.}{\b0 Bioqu�micos:}{\b0 leucocitos}{\b0 6,8/mm}
{\b0\up006 \fs8 3}{\b0 ,}{\b0 hb}{\b0 11}{\b0 g/dl, }
\par}{\phpg\posx680\pvpg\posy4661\absw5020\absh9260 \sl-210 \b \f20 \fs15 \cf0 {\b0
plaquetas}{\b0 375.000/mm}{\b0\up006 \fs8 3}{\b0 ,}{\b0 PCR}{\b0 16,2}{\b0
mg/dl,}{\b0 funci�n}{\b0 renal}{\b0 y}{\b0 hep�tica }
\par}{\phpg\posx680\pvpg\posy4661\absw5020\absh9260 \sl-210 \b \f20 \fs15 \cf0 {\b0
normal.}{\b0 EKG}{\b0 con}{\b0 disminuci�n}{\b0 de}{\b0 la}{\b0 amplitud}{\b0
del}{\b0 voltaje}{\b0 en}{\b0 todas}{\b0 las }
\par}{\phpg\posx680\pvpg\posy4661\absw5020\absh9260 \sl-210 \b \f20 \fs15 \cf0 {\b0
derivaciones.}{\b0 Rx}{\b0 posteroanterior}{\b0 de}{\b0 t�rax}{\b0 muestra}
{\b0 derrame}{\b0 pleural }
\par}{\phpg\posx680\pvpg\posy4661\absw5020\absh9260 \sl-210 \b \f20 \fs15 \cf0 {\b0
bilateral}{\b0 y}{\b0 cardiomegalia.}{\b0 TAC}{\b0 de}{\b0 t�rax}{\b0 con}
{\b0 derrame}{\b0 pleural}{\b0 bilateral, }
\par}{\phpg\posx680\pvpg\posy4661\absw5020\absh9260 \sl-210 \b \f20 \fs15 \cf0 {\b0
derrame}{\b0 peric�rdico}{\b0 cuantificado}{\b0 en}{\b0 800}{\b0 cc,}{\b0
atelectasia}{\b0 derecha.}{\b0 Se }
\par}{\phpg\posx680\pvpg\posy4661\absw5020\absh9260 \sl-210 \b \f20 \fs15 \cf0 {\b0
informa}{\b0 al}{\b0 paciente}{\b0 la}{\b0 necesidad}{\b0 de}{\b0 realizarse}
{\b0 pericardiocentesis}{\b0 para }
\par}{\phpg\posx680\pvpg\posy4661\absw5020\absh9260 \sl-210 \b \f20 \fs15 \cf0 {\b0
toma}{\b0 de}{\b0 muestras}{\b0 y}{\b0 drenaje,}{\b0 sin}{\b0 embargo}{\b0
no}{\b0 acepta.}{\b0 Se}{\b0 realiza}{\b0 tora- }
\par}{\phpg\posx680\pvpg\posy4661\absw5020\absh9260 \sl-210 \b \f20 \fs15 \cf0 {\b0
cocentesis}{\b0 obteni�ndose}{\b0 l�quido}{\b0 pleural}{\b0 amarillo-turbio.}
{\b0 Citoqu�mico }
\par}{\phpg\posx680\pvpg\posy4661\absw5020\absh9260 \sl-210 \b \f20 \fs15 \cf0 {\b0
de}{\b0 l�quido}{\b0 con}{\b0 caracter�sticas}{\b0 de}{\b0 exudado,}{\b0
acelular}{\b0 y}{\b0 pH}{\b0 7,41.}{\b0 El}{\b0 culti- }
\par}{\phpg\posx680\pvpg\posy4661\absw5020\absh9260 \sl-210 \b \f20 \fs15 \cf0 {\b0
vo}{\b0 se}{\b0 report�}{\b0 sin}{\b0 desarrollo.}{\b0 Se}{\b0 inici�}{\b0
antibioticoterapia}{\b0 emp�rica.}{\b0 48 }
\par}{\phpg\posx680\pvpg\posy4661\absw5020\absh9260 \sl-210 \b \f20 \fs15 \cf0 {\b0
horas}{\b0 posteriores}{\b0 se}{\b0 obtuvo}{\b0 PCR}{\b0 para}{\b0
Mycobacterium}{\b0 tuberculosis }
\par}{\phpg\posx680\pvpg\posy4661\absw5020\absh9260 \sl-210 \b \f20 \fs15 \cf0 {\b0
report�ndose}{\b0 positivo.}{\b0 Se}{\b0 inicia}{\b0 tratamiento}{\b0 con}{\b0
DOTBAL}{\b0 y}{\b0 predniso- }
\par}{\phpg\posx680\pvpg\posy4661\absw5020\absh9260 \sl-210 \b \f20 \fs15 \cf0 {\b0
na.}{\b0 Seguimiento}{\b0 a}{\b0 los}{\b0 dos}{\b0 meses}{\b0 con}{\b0
remisi�n}{\b0 de}{\b0 la}{\b0 sintomatolog�a}{\b0 y }
\par}{\phpg\posx680\pvpg\posy4661\absw5020\absh9260 \sl-210 \b \f20 \fs15 \cf0 {\b0
mejor�a}{\b0 radiogr�fica. }
\par}{\phpg\posx680\pvpg\posy4661\absw5020\absh9260 \sl-210 \b \f20 \fs15 \cf0
Conclusiones:{\b0 La}{\b0 pericarditis}{\b0 tuberculosa}{\b0 es}{\b0 una}{\b0
forma}{\b0 rara}{\b0 de}{\b0 infec- }
\par}{\phpg\posx680\pvpg\posy4661\absw5020\absh9260 \sl-210 \b \f20 \fs15 \cf0 {\b0
ci�n}{\b0 por}{\b0 Mycobacterium}{\b0 tuberculosis.}{\b0 Presentamos}{\b0 el}
{\b0 caso}{\b0 de}{\b0 un}{\b0 pa- }
\par}{\phpg\posx680\pvpg\posy4661\absw5020\absh9260 \sl-210 \b \f20 \fs15 \cf0 {\b0
ciente}{\b0 masculino}{\b0 sin}{\b0 antecedentes}{\b0 de}{\b0
inmunocompromiso}{\b0 presentan- }
\par}{\phpg\posx680\pvpg\posy4661\absw5020\absh9260 \sl-210 \b \f20 \fs15 \cf0 {\b0
do}{\b0 durante}{\b0 su}{\b0 evoluci�n}{\b0 limitaciones}{\b0 para}{\b0
obtener}{\b0 un}{\b0 diagn�stico}{\b0 y }
\par}{\phpg\posx680\pvpg\posy4661\absw5020\absh9260 \sl-210 \b \f20 \fs15 \cf0 {\b0
tratamiento}{\b0 �ptimo,}{\b0 pudiendo}{\b0 haber}{\b0 repercutido}{\b0 en}
{\b0 la}{\b0 evoluci�n}{\b0 y}{\b0 el }
\par}{\phpg\posx680\pvpg\posy4661\absw5020\absh9260 \sl-210 \b \f20 \fs15 \cf0 {\b0
desenlace. }\par
}
{\phpg\posx6037\pvpg\posy1100\absw5075\absh5473 \b \f20 \fs15 \cf0 \b \f20 \fs15
\cf0 257. PERICARDITIS CONSTRICTIVA SECUNDARIA A TUBERCULOSIS:
\par}{\phpg\posx6037\pvpg\posy1100\absw5075\absh5473 \sl-200 \b \f20 \fs15 \cf0
REPORTE DE CASO
\par}{\phpg\posx6037\pvpg\posy1100\absw5075\absh5473 \sl-170 \par\b \f20 \fs15 \cf0
{\b0 G.}{\b0 Zurita,}{\b0 N.}{\b0 Naveda,}{\b0 B.}{\b0 Carrasco,}{\b0 E.}{\b0
Moya}{\b0 y}{\b0 S.}{\b0 Poveda }
\par}{\phpg\posx6037\pvpg\posy1100\absw5075\absh5473 \sl-156 \par\b \f20 \fs15 \cf0
{\b0\i Hospital}{\b0\i de}{\b0\i Especialidades}{\b0\i Carlos}{\b0\i Andrade}
{\b0\i Mar�n. }
\par}{\phpg\posx6037\pvpg\posy1100\absw5075\absh5473 \sl-203 \par\b \f20 \fs15 \cf0
Introducci�n:{\b0 La}{\b0 pericarditis}{\b0 tuberculosa,}{\b0 es}{\b0 una}{\b0
rara}{\b0 manifestaci�n }
\par}{\phpg\posx6037\pvpg\posy1100\absw5075\absh5473 \sl-210 \b \f20 \fs15 \cf0
{\b0 extra-pulmonar}{\b0 de}{\b0 tuberculosis}{\b0 (TBC),}{\b0 que}{\b0 se}
{\b0 encuentra}{\b0 en}{\b0 aproxima- }
\par}{\phpg\posx6037\pvpg\posy1100\absw5075\absh5473 \sl-210 \b \f20 \fs15 \cf0
{\b0 damente}{\b0 el}{\b0 1-2%}{\b0 de}{\b0 casos}{\b0 de}{\b0 TBC}{\b0
pulmonar. }
\par}{\phpg\posx6037\pvpg\posy1100\absw5075\absh5473 \sl-210 \b \f20 \fs15 \cf0
Material y m�todos:{\b0 Caso}{\b0 cl�nico:}{\b0 mujer}{\b0 de}{\b0 17}{\b0
a�os,}{\b0 sin}{\b0 antecedentes }
\par}{\phpg\posx6037\pvpg\posy1100\absw5075\absh5473 \sl-210 \b \f20 \fs15 \cf0
{\b0 patol�gicos,}{\b0 que}{\b0 presenta}{\b0 hace}{\b0 7}{\b0 d�as}{\b0
alza}{\b0 t�rmica,}{\b0 p�rdida}{\b0 de}{\b0 peso, }
\par}{\phpg\posx6037\pvpg\posy1100\absw5075\absh5473 \sl-210 \b \f20 \fs15 \cf0
{\b0 diaforesis}{\b0 nocturna,}{\b0 tratada}{\b0 como}{\b0 faringo-
amigdalitis,}{\b0 persiste}{\b0 siendo }
\par}{\phpg\posx6037\pvpg\posy1100\absw5075\absh5473 \sl-210 \b \f20 \fs15 \cf0
{\b0 catalogado}{\b0 como}{\b0 fiebre}{\b0 tifoidea,}{\b0 posteriormente}{\b0
presenta}{\b0 hiporexia, }
\par}{\phpg\posx6037\pvpg\posy1100\absw5075\absh5473 \sl-210 \b \f20 \fs15 \cf0
{\b0 taquicardia,}{\b0 murmullo}{\b0 vesicular}{\b0 disminuido}{\b0 en}{\b0
bases,}{\b0 frote}{\b0 peric�rdi- }
\par}{\phpg\posx6037\pvpg\posy1100\absw5075\absh5473 \sl-210 \b \f20 \fs15 \cf0
{\b0 co,}{\b0 edema}{\b0 en}{\b0 miembros}{\b0 inferiores}{\b0 ++/++++,}{\b0
recibe}{\b0 tratamiento}{\b0 para }
\par}{\phpg\posx6037\pvpg\posy1100\absw5075\absh5473 \sl-210 \b \f20 \fs15 \cf0
{\b0 tuberculosis,}{\b0 con}{\b0 antif�micos}{\b0 de}{\b0 primera}{\b0 l�nea,}
{\b0 ecocardiograma}{\b0 repor- }
\par}{\phpg\posx6037\pvpg\posy1100\absw5075\absh5473 \sl-210 \b \f20 \fs15 \cf0
{\b0 ta}{\b0 derrame}{\b0 peric�rdico,}{\b0 catalog�ndose}{\b0 como}{\b0
pericarditis}{\b0 constrictiva, }
\par}{\phpg\posx6037\pvpg\posy1100\absw5075\absh5473 \sl-210 \b \f20 \fs15 \cf0
{\b0 tac}{\b0 de}{\b0 t�rax}{\b0 derrame}{\b0 pleural}{\b0 bilateral,}{\b0
adenopat�as}{\b0 mediast�nica,}{\b0 to- }
\par}{\phpg\posx6037\pvpg\posy1100\absw5075\absh5473 \sl-210 \b \f20 \fs15 \cf0
{\b0 racentesis}{\b0 izquierda}{\b0 compatible}{\b0 con}{\b0 quilot�rax}{\b0
colocan}{\b0 tubo}{\b0 tor�cico }
\par}{\phpg\posx6037\pvpg\posy1100\absw5075\absh5473 \sl-210 \b \f20 \fs15 \cf0
{\b0 e}{\b0 inician}{\b0 NPT,}{\b0 biopsia}{\b0 pleural}{\b0 derecha}{\b0
inflamaci�n}{\b0 cr�nica,}{\b0 nuevo}{\b0 eco- }
\par}{\phpg\posx6037\pvpg\posy1100\absw5075\absh5473 \sl-210 \b \f20 \fs15 \cf0
{\b0 cardiograma}{\b0 hipertensi�n}{\b0 sist�lica}{\b0 pulmonar}{\b0 leve}{\b0
a}{\b0 moderada,}{\b0 peri- }
\par}{\phpg\posx6037\pvpg\posy1100\absw5075\absh5473 \sl-210 \b \f20 \fs15 \cf0
{\b0 c�rdico}{\b0 parietal}{\b0 y}{\b0 visceral}{\b0 ligeramente}{\b0
engrosado,}{\b0 anticuerpos}{\b0 anti- }
\par}{\phpg\posx6037\pvpg\posy1100\absw5075\absh5473 \sl-210 \b \f20 \fs15 \cf0
{\b0 nucleares}{\b0 positivo,}{\b0 Ca-125}{\b0 255,}{\b0 IL-6}{\b0 15,60,}{\b0
PCR}{\b0 1,10,}{\b0 citomegalovirus }
\par}{\phpg\posx6037\pvpg\posy1100\absw5075\absh5473 \sl-210 \b \f20 \fs15 \cf0
{\b0 Igg}{\b0 >}{\b0 250.000,}{\b0 cardiolipina}{\b0 IgM}{\b0 9,10,}{\b0 TSH}
{\b0 5,3,}{\b0 ferritina}{\b0 12,40,}{\b0 se}{\b0 reali- }
\par}{\phpg\posx6037\pvpg\posy1100\absw5075\absh5473 \sl-210 \b \f20 \fs15 \cf0
{\b0 za}{\b0 biopsia}{\b0 de}{\b0 cadena}{\b0 mediastinal}{\b0 4R,}{\b0
pericardio}{\b0 y}{\b0 pulm�n}{\b0 segmento }
\par}{\phpg\posx6037\pvpg\posy1100\absw5075\absh5473 \sl-210 \b \f20 \fs15 \cf0
{\b0 1}{\b0 y}{\b0 3}{\b0 derecho,}{\b0 paciente}{\b0 en}{\b0 el}{\b0
postquir�rgico}{\b0 requiere}{\b0 ventilaci�n}{\b0 me- }
\par}{\phpg\posx6037\pvpg\posy1100\absw5075\absh5473 \sl-210 \b \f20 \fs15 \cf0
{\b0 c�nica}{\b0 y}{\b0 apoyo}{\b0 de}{\b0 vasoactivos,}{\b0 a}{\b0 dosis}
{\b0 elevadas,}{\b0 con}{\b0 shock}{\b0 refractario }
\par}{\phpg\posx6037\pvpg\posy1100\absw5075\absh5473 \sl-210 \b \f20 \fs15 \cf0
{\b0 se}{\b0 inicia}{\b0 infusi�n}{\b0 de}{\b0 bicarbonato. }
\par}{\phpg\posx6037\pvpg\posy1100\absw5075\absh5473 \sl-210 \b \f20 \fs15 \cf0
Resultados:{\b0 Fallece}{\b0 a}{\b0 las}{\b0 12}{\b0 horas}{\b0 de}{\b0 su}
{\b0 ingreso}{\b0 a}{\b0 terapia}{\b0 intensiva. }\par
}
{\phpg\posx6037\pvpg\posy13797\absw5020\absh1038 \b\i \f20 \fs15 \cf0 \b\i \f20
\fs15 \cf0 Figura.{\b0 TAC}{\b0 de}{\b0 t�rax:}{\b0 diseminc�n}{\b0
broncog�tica,}{\b0 patr�n}{\b0 micronodular}{\b0 e }
\par}{\phpg\posx6037\pvpg\posy13797\absw5020\absh1038 \sl-210 \b\i \f20 \fs15 \cf0
{\b0 intersticial,}{\b0 varios}{\b0 n�dulos,}{\b0 peric�rdico}{\b0 moderado }
\par}{\phpg\posx6037\pvpg\posy13797\absw5020\absh1038 \sl-161 \par\b\i \f20
\fs15 \cf0 {\i0 Conclusiones:}{\b0\i0 La}{\b0\i0 tuberculosis}{\b0\i0
peric�rdica}{\b0\i0 representa}{\b0\i0 el}{\b0\i0 6%}{\b0\i0 de}{\b0\i0
pericar- }
\par}{\phpg\posx6037\pvpg\posy13797\absw5020\absh1038 \sl-210 \b\i \f20 \fs15 \cf0
{\b0\i0 ditis}{\b0\i0 constrictiva}{\b0\i0 y}{\b0\i0 7%}{\b0\i0 de}{\b0\i0
taponamiento}{\b0\i0 cardiaco,}{\b0\i0 el}{\b0\i0 compromiso}{\b0\i0 peri- }
\par}{\phpg\posx6037\pvpg\posy13797\absw5020\absh1038 \sl-210 \b\i \f20 \fs15 \cf0
{\b0\i0 c�rdico}{\b0\i0 ocurre}{\b0\i0 por}{\b0\i0 diseminaci�n}{\b0\i0
linf�tica}{\b0\i0 retr�grada}{\b0\i0 o}{\b0\i0 hemat�gena }\par
}
\sect\sectd\pard\plain
\pgwsxn11905\pghsxn15874
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salud}{\b0 del}{\b0 Hospital}{\b0 Mar�a }
\par}{\phpg\posx842\pvpg\posy1931\absw5042\absh6363 \sl-210 \b \f20 \fs14 \cf0 {\b0
Auxiliadora.}{\b0 Objetivos}{\b0 secundarios:}{\b0 determinar}{\b0 las}{\b0
comorbilidades }
\par}{\phpg\posx842\pvpg\posy1931\absw5042\absh6363 \sl-210 \b \f20 \fs14 \cf0 {\b0
m�s}{\b0 frecuentes}{\b0 en}{\b0 los}{\b0 casos}{\b0 de}{\b0 tuberculosis}
{\b0 latente}{\b0 que}{\b0 motivaron}{\b0 el }
\par}{\phpg\posx842\pvpg\posy1931\absw5042\absh6363 \sl-210 \b \f20 \fs14 \cf0 {\b0
inicio}{\b0 de}{\b0 la}{\b0 quimioprofilaxis.}{\b0 Determinar}{\b0 casos}{\b0
tempranamente}{\b0 de }
\par}{\phpg\posx842\pvpg\posy1931\absw5042\absh6363 \sl-210 \b \f20 \fs14 \cf0 {\b0
tuberculosis}{\b0 activa}{\b0 y}{\b0 casos}{\b0 de}{\b0 tuberculosis}{\b0
previa. }
\par}{\phpg\posx842\pvpg\posy1931\absw5042\absh6363 \sl-210 \b \f20 \fs14 \cf0
Material y m�todos:{\b0 Estudio}{\b0 descriptivo}{\b0 transversal.}{\b0 Se}{\b0
realiz�}{\b0 la}{\b0 eva- }
\par}{\phpg\posx842\pvpg\posy1931\absw5042\absh6363 \sl-210 \b \f20 \fs14 \cf0 {\b0
luaci�n}{\b0 cl�nica,}{\b0 inmunol�gica}{\b0 y}{\b0 radiol�gica}{\b0 en}{\b0
una}{\b0 muestra}{\b0 de}{\b0 904 }
\par}{\phpg\posx842\pvpg\posy1931\absw5042\absh6363 \sl-210 \b \f20 \fs14 \cf0 {\b0
personal}{\b0 de}{\b0 salud}{\b0 de}{\b0 servicios}{\b0 administrativos}{\b0
y}{\b0 asistenciales}{\b0 del}{\b0 Hos- }
\par}{\phpg\posx842\pvpg\posy1931\absw5042\absh6363 \sl-210 \b \f20 \fs14 \cf0 {\b0
pital}{\b0 Mar�a}{\b0 Auxiliadora.}{\b0 Se}{\b0 indic�}{\b0 terapia}{\b0
preventiva}{\b0 en}{\b0 casos}{\b0 de}{\b0 tu- }
\par}{\phpg\posx842\pvpg\posy1931\absw5042\absh6363 \sl-210 \b \f20 \fs14 \cf0 {\b0
berculosis}{\b0 latente}{\b0 con}{\b0 comorbilidades}{\b0 que}{\b0
incrementan}{\b0 el}{\b0 riesgo}{\b0 a }
\par}{\phpg\posx842\pvpg\posy1931\absw5042\absh6363 \sl-210 \b \f20 \fs14 \cf0 {\b0
desarrollar}{\b0 tuberculosis}{\b0 activa. }
\par}{\phpg\posx842\pvpg\posy1931\absw5042\absh6363 \sl-210 \b \f20 \fs14 \cf0
Resultados:{\b0 De}{\b0 los}{\b0 904}{\b0 casos,}{\b0 se}{\b0 detectaron}{\b0
50%}{\b0 de}{\b0 tuberculosis}{\b0 la- }
\par}{\phpg\posx842\pvpg\posy1931\absw5042\absh6363 \sl-210 \b \f20 \fs14 \cf0 {\b0
tente,}{\b0 42%}{\b0 de}{\b0 no}{\b0 tuberculosis}{\b0 activa}{\b0 ni}{\b0
latente,}{\b0 7%}{\b0 de}{\b0 tuberculosis }
\par}{\phpg\posx842\pvpg\posy1931\absw5042\absh6363 \sl-210 \b \f20 \fs14 \cf0 {\b0
previa,}{\b0 0,9%}{\b0 de}{\b0 no}{\b0 tuberculosis}{\b0 activa}{\b0 y}{\b0
1}{\b0 caso}{\b0 de}{\b0 tuberculosis}{\b0 activa. }
\par}{\phpg\posx842\pvpg\posy1931\absw5042\absh6363 \sl-210 \b \f20 \fs14 \cf0 {\b0
De}{\b0 los}{\b0 casos}{\b0 de}{\b0 tuberculosis}{\b0 latente,}{\b0 la}{\b0
edad}{\b0 promedio}{\b0 fue}{\b0 de}{\b0 49}{\b0 a�os, }
\par}{\phpg\posx842\pvpg\posy1931\absw5042\absh6363 \sl-210 \b \f20 \fs14 \cf0 {\b0
79%}{\b0 fueron}{\b0 mujeres,}{\b0 57%}{\b0 nacieron}{\b0 en}{\b0 Lima,}{\b0
97%}{\b0 fueron}{\b0 vacunados}{\b0 con }
\par}{\phpg\posx842\pvpg\posy1931\absw5042\absh6363 \sl-210 \b \f20 \fs14 \cf0 {\b0
BCG,}{\b0 60%}{\b0 no}{\b0 refer�an}{\b0 prueba}{\b0 de}{\b0 tuberculina}{\b0
previa}{\b0 y}{\b0 el}{\b0 85%}{\b0 era}{\b0 perso- }
\par}{\phpg\posx842\pvpg\posy1931\absw5042\absh6363 \sl-210 \b \f20 \fs14 \cf0 {\b0
nal}{\b0 asistencial.}{\b0 Al}{\b0 24%}{\b0 de}{\b0 los}{\b0 casos}{\b0 de}
{\b0 tuberculosis}{\b0 latente}{\b0 se}{\b0 le}{\b0 indic� }
\par}{\phpg\posx842\pvpg\posy1931\absw5042\absh6363 \sl-210 \b \f20 \fs14 \cf0 {\b0
terapia}{\b0 preventiva.}{\b0 Las}{\b0 comorbilidades}{\b0 m�s}{\b0
frecuentes}{\b0 que}{\b0 motivaron }
\par}{\phpg\posx842\pvpg\posy1931\absw5042\absh6363 \sl-210 \b \f20 \fs14 \cf0 {\b0
la}{\b0 indicaci�n}{\b0 de}{\b0 terapia}{\b0 preventiva}{\b0 fueron:}{\b0
contacto}{\b0 reciente,}{\b0 diabetes }
\par}{\phpg\posx842\pvpg\posy1931\absw5042\absh6363 \sl-210 \b \f20 \fs14 \cf0 {\b0
mellitus,}{\b0 conversi�n}{\b0 reciente}{\b0 y}{\b0 lesi�n}{\b0 secuelar}{\b0
radiogr�fica}{\b0 sin}{\b0 tu- }
\par}{\phpg\posx842\pvpg\posy1931\absw5042\absh6363 \sl-210 \b \f20 \fs14 \cf0 {\b0
berculosis}{\b0 previa. }
\par}{\phpg\posx842\pvpg\posy1931\absw5042\absh6363 \sl-148 \par\b \f20 \fs14 \cf0
{\b0 \fs11 Tabla}{\b0 \fs11 1.}{\b0 \fs11 Diagn�stico}{\b0 \fs11 detectados}{\b0
\fs11 durante}{\b0 \fs11 el}{\b0 \fs11 estudio }
\par}{\phpg\posx842\pvpg\posy1931\absw5042\absh6363 \sl-136 \b \f20 \fs14 \cf0
\fi579 {\f10 \fs13 \cf101 d#.>##{\f63 \u1005\'3f}{\f63
\u855\'3f}#5/#'EM^d//K^#59d9/d#5K^#5hZ#Ed9#9>#9^dh5/K## }\par
}
{\phpg\posx905\pvpg\posy8999\absw3090\absh1320 \b \f10 \fs13 \cf0 \b \f10 \fs13
\cf0 5/#'EK^d//K#
\par}{\phpg\posx905\pvpg\posy8999\absw3090\absh1320 \sl-215 \b \f10 \fs13 \cf0 {\b0
EK#d./##/d/s## }
\par}{\phpg\posx905\pvpg\posy8999\absw3090\absh1320 \sl-207 \b \f10 \fs13 \cf0 {\b0
EK#d./##/d/s##EK#d./#>#d9Ed9# }
\par}{\phpg\posx905\pvpg\posy8999\absw3090\absh1320 \sl-207 \b \f10 \fs13 \cf0 {\b0
d./##/d/s## }
\par}{\phpg\posx905\pvpg\posy8999\absw3090\absh1320 \sl-206 \b \f10 \fs13 \cf0 {\b0
d./#>#d9Ed9## }
\par}{\phpg\posx905\pvpg\posy8999\absw3090\absh1320 \sl-207 \b \f10 \fs13 \cf0 {\b0
d./#WZ9s/## }
\par}{\phpg\posx905\pvpg\posy8999\absw3090\absh1320 \sl-212 \b \f10 \fs13 \cf0
d{\f63 \u381\'3f}{\f63 \u410\'3f}{\f63 \u258\'3f}{\f63 \u367\'3f}{\f63
\u853\'3f}#{\f63 \u336\'3f}{\f63 \u286\'3f}{\f63 \u374\'3f}{\f63 \u286\'3f}{\f63
\u396\'3f}{\f63 \u258\'3f}{\f63 \u367\'3f}# \par
}
{\phpg\posx3939\pvpg\posy8999\absw2370\absh1320 \b \f10 \fs13 \cf0 {\f0\fs17
\bullet }\b \f10 \fs13 \cf0 #######E{\f63 \u465\'3f}#/#^K^############{\f63
\u1081\'3f}#
\par}{\phpg\posx3939\pvpg\posy8999\absw2370\absh1320 \sl-215 \b \f10 \fs13 \cf0
{\f0\fs17 \bullet }{\b0 ###############{\f63 \u1005\'3f}{\f63
\u1004\'3f}####################{\f63 \u1004\'3f}{\f63 \u853\'3f}{\f63 \u1013\'3f}
{\f63 \u1081\'3f}# }
\par}{\phpg\posx3939\pvpg\posy8999\absw2370\absh1320 \sl-207 \b \f10 \fs13 \cf0
{\f0\fs17 \bullet }{\b0 #############{\f63 \u1007\'3f}{\f63 \u1011\'3f}{\f63
\u1013\'3f}##################{\f63 \u1008\'3f}{\f63 \u1006\'3f}{\f63 \u1081\'3f}# }
\par}{\phpg\posx3939\pvpg\posy8999\absw2370\absh1320 \sl-207 \b \f10 \fs13 \cf0
{\f0\fs17 \bullet }{\b0 ##################{\f63 \u1005\'3f}###################{\f63
\u1004\'3f}{\f63 \u853\'3f}{\f63 \u1005\'3f}{\f63 \u1081\'3f}# }
\par}{\phpg\posx3939\pvpg\posy8999\absw2370\absh1320 \sl-206 \b \f10 \fs13 \cf0
{\f0\fs17 \bullet }{\b0 ##############{\f63 \u1008\'3f}{\f63 \u1009\'3f}{\f63
\u1008\'3f}#################{\f63 \u1009\'3f}{\f63 \u1004\'3f}{\f63 \u1081\'3f}# }
\par}{\phpg\posx3939\pvpg\posy8999\absw2370\absh1320 \sl-207 \b \f10 \fs13 \cf0
{\f0\fs17 \bullet }{\b0 ###############{\f63 \u1010\'3f}{\f63
\u1004\'3f}####################{\f63 \u1011\'3f}{\f63 \u1081\'3f}# }
\par}{\phpg\posx3939\pvpg\posy8999\absw2370\absh1320 \sl-212 \b \f10 \fs13 \cf0
{\f0\fs17 \bullet }#############{\f63 \u1013\'3f}{\f63 \u1004\'3f}{\f63
\u1008\'3f}#################{\f63 \u1005\'3f}{\f63 \u1004\'3f}{\f63 \u1004\'3f}
{\f63 \u1081\'3f}# \par
}
{\phpg\posx855\pvpg\posy10440\absw5896\absh365 \b \f10 \fs13 \cf0 \b \f10 \fs13
\cf0 d#.>##{\f63 \u1005\'3f}{\f63 \u855\'3f}{\b0 #5{\f63 \u349\'3f}{\f63 \u258\'3f}
{\f63 \u336\'3f}{\f63 \u374\'3f}{\f63 \u383\'3f}{\f63 \u400\'3f}{\f63 \u410\'3f}
{\f63 \u349\'3f}{\f63 \u272\'3f}{\f63 \u381\'3f}{\f63 \u400\'3f}#{\f63 \u282\'3f}
{\f63 \u286\'3f}{\f63 \u410\'3f}{\f63 \u286\'3f}{\f63 \u272\'3f}{\f63 \u410\'3f}
{\f63 \u258\'3f}{\f63 \u282\'3f}{\f63 \u381\'3f}{\f63 \u400\'3f}#{\f63 \u282\'3f}
{\f63 \u437\'3f}{\f63 \u396\'3f}{\f63 \u258\'3f}{\f63 \u374\'3f}{\f63 \u410\'3f}
{\f63 \u286\'3f}#{\f63 \u286\'3f}{\f63 \u367\'3f}#{\f63 \u282\'3f}{\f63 \u286\'3f}
{\f63 \u400\'3f}{\f63 \u393\'3f}{\f63 \u349\'3f}{\f63 \u400\'3f}{\f63 \u410\'3f}
{\f63 \u258\'3f}{\f63 \u361\'3f}{\f63 \u286\'3f}#{\f63 \u282\'3f}{\f63
\u286\'3f}#d{\f63 \u437\'3f}{\f63 \u271\'3f}{\f63 \u286\'3f}{\f63 \u396\'3f}
{\f63 \u272\'3f}{\f63 \u437\'3f}{\f63 \u367\'3f}{\f63 \u381\'3f}{\f63 \u400\'3f}
{\f63 \u349\'3f}{\f63 \u400\'3f}##{\f63 \u272\'3f}{\f63 \u410\'3f}{\f63 \u349\'3f}
{\f63 \u448\'3f}{\f63 \u258\'3f}#{\f63 \u455\'3f}#>{\f63 \u258\'3f}{\f63 \u410\'3f}
{\f63 \u286\'3f}{\f63 \u374\'3f}{\f63 \u410\'3f}{\f63 \u286\'3f}#{\f63 \u400\'3f}
{\f63 \u286\'3f}{\f63 \u336\'3f}{\f63 \u439\'3f}{\f63 \u374\'3f}# }
\par}{\phpg\posx855\pvpg\posy10440\absw5896\absh365 \sl-201 \b \f10 \fs13 \cf0 {\b0
{\f63 \u367\'3f}{\f63 \u258\'3f}#{\f63 \u286\'3f}{\f63 \u448\'3f}{\f63 \u258\'3f}
{\f63 \u367\'3f}{\f63 \u437\'3f}{\f63 \u258\'3f}{\f63 \u272\'3f}{\f63 \u349\'3f}
{\f63 \u383\'3f}{\f63 \u374\'3f}#{\f63 \u272\'3f}{\f63 \u367\'3f}{\f63 \u351\'3f}
{\f63 \u374\'3f}{\f63 \u349\'3f}{\f63 \u272\'3f}{\f63 \u258\'3f}{\f63
\u853\'3f}#{\f63 \u349\'3f}{\f63 \u374\'3f}{\f63 \u373\'3f}{\f63 \u437\'3f}{\f63
\u374\'3f}{\f63 \u381\'3f}{\f63 \u367\'3f}{\f63 \u383\'3f}{\f63 \u336\'3f}{\f63
\u349\'3f}{\f63 \u272\'3f}{\f63 \u258\'3f}#{\f63 \u455\'3f}#{\f63 \u396\'3f}
{\f63 \u258\'3f}{\f63 \u282\'3f}{\f63 \u349\'3f}{\f63 \u381\'3f}{\f63 \u367\'3f}
{\f63 \u383\'3f}{\f63 \u336\'3f}{\f63 \u349\'3f}{\f63 \u272\'3f}{\f63
\u258\'3f}#{\f63 \u286\'3f}{\f63 \u374\'3f}#{\f63 \u286\'3f}{\f63
\u367\'3f}#{\f63 \u393\'3f}{\f63 \u286\'3f}{\f63 \u396\'3f}{\f63 \u400\'3f}{\f63
\u381\'3f}{\f63 \u374\'3f}{\f63 \u258\'3f}{\f63 \u367\'3f}#{\f63 \u282\'3f}{\f63
\u286\'3f}#{\f63 \u400\'3f}{\f63 \u258\'3f}{\f63 \u367\'3f}{\f63 \u437\'3f}{\f63
\u282\'3f}{\f63 \u856\'3f}#d./{\f63 \u855\'3f}#d{\f63 \u437\'3f}{\f63 \u271\'3f}
{\f63 \u286\'3f}{\f63 \u396\'3f}{\f63 \u272\'3f}{\f63 \u437\'3f}{\f63 \u367\'3f}
{\f63 \u381\'3f}{\f63 \u400\'3f}{\f63 \u349\'3f}{\f63 \u400\'3f}{\f63
\u856\'3f}# }\par
}
{\phpg\posx850\pvpg\posy10709\absw4903\absh470 \f20 \fs11 \cf0 \f20 \fs11 \cf0
Tabla 2. Indicaci�n de terapia preventiva en Tuberculosis latente de acuerdo a la
\par}{\phpg\posx850\pvpg\posy10709\absw4903\absh470 \sl-172 \f20 \fs11 \cf0
comorbilidad
\par}{\phpg\posx850\pvpg\posy10709\absw4903\absh470 \sl-99 \f20 \fs11 \cf0 \fi73
{\b \f10 \fs9 \cf101 d#.>##{\f63 \u1006\'3f}{\f63 \u855\'3f}#/{\f63 \u374\'3f}{\f63
\u282\'3f}{\f63 \u349\'3f}{\f63 \u272\'3f}{\f63 \u258\'3f}{\f63 \u272\'3f}{\f63
\u349\'3f}{\f63 \u383\'3f}{\f63 \u374\'3f}#{\f63 \u282\'3f}{\f63
\u286\'3f}#{\f63 \u410\'3f}{\f63 \u286\'3f}{\f63 \u396\'3f}{\f63 \u258\'3f}{\f63
\u393\'3f}{\f63 \u349\'3f}{\f63 \u258\'3f}#{\f63 \u393\'3f}{\f63 \u396\'3f}{\f63
\u286\'3f}{\f63 \u448\'3f}{\f63 \u286\'3f}{\f63 \u374\'3f}{\f63 \u410\'3f}{\f63
\u349\'3f}{\f63 \u448\'3f}{\f63 \u258\'3f}#{\f63 \u286\'3f}{\f63
\u374\'3f}#d{\f63 \u437\'3f}{\f63 \u271\'3f}{\f63 \u286\'3f}{\f63 \u396\'3f}
{\f63 \u272\'3f}{\f63 \u437\'3f}{\f63 \u367\'3f}{\f63 \u381\'3f}{\f63 \u400\'3f}
{\f63 \u349\'3f}{\f63 \u400\'3f}#{\f63 \u367\'3f}{\f63 \u258\'3f}{\f63 \u410\'3f}
{\f63 \u286\'3f}{\f63 \u374\'3f}{\f63 \u410\'3f}{\f63 \u286\'3f}#{\f63 \u282\'3f}
{\f63 \u286\'3f}#{\f63 \u258\'3f}{\f63 \u272\'3f}{\f63 \u437\'3f}{\f63 \u286\'3f}
{\f63 \u396\'3f}{\f63 \u282\'3f}{\f63 \u381\'3f}#{\f63 \u258\'3f}#{\f63 \u367\'3f}
{\f63 \u258\'3f}#{\f63 \u272\'3f}{\f63 \u381\'3f}{\f63 \u373\'3f}{\f63 \u381\'3f}
{\f63 \u396\'3f}{\f63 \u271\'3f}{\f63 \u349\'3f}{\f63 \u367\'3f}{\f63 \u349\'3f}
{\f63 \u282\'3f}{\f63 \u258\'3f}{\f63 \u282\'3f}## }
\par}{\phpg\posx850\pvpg\posy10709\absw4903\absh470 \sl-114 \par\f20 \fs11 \cf0
\fi2039 {\b \f10 \fs9 \cf101 d9Z#W/## }\par
}
{\phpg\posx895\pvpg\posy11244\absw2520\absh2155 \b \f10 \fs9 \cf0 {\f0\fs12 \bullet
}\b \f10 \fs9 \cf0
\par}{\phpg\posx895\pvpg\posy11244\absw2520\absh2155 \sl-120 \par\b \f10 \fs9 \cf0
{\cf101 d{\f63 \u437\'3f}{\f63 \u271\'3f}{\f63 \u286\'3f}{\f63 \u396\'3f}{\f63
\u272\'3f}{\f63 \u437\'3f}{\f63 \u367\'3f}{\f63 \u381\'3f}{\f63 \u400\'3f}{\f63
\u349\'3f}{\f63 \u400\'3f}#>{\f63 \u258\'3f}{\f63 \u410\'3f}{\f63 \u286\'3f}
{\f63 \u374\'3f}{\f63 \u410\'3f}{\f63 \u286\'3f}#{\f63 \u455\'3f}#/{\f63 \u381\'3f}
{\f63 \u373\'3f}{\f63 \u381\'3f}{\f63 \u396\'3f}{\f63 \u271\'3f}{\f63 \u349\'3f}
{\f63 \u367\'3f}{\f63 \u349\'3f}{\f63 \u282\'3f}{\f63 \u258\'3f}{\f63 \u282\'3f}
{\f63 \u286\'3f}{\f63 \u400\'3f}# }
\par}{\phpg\posx895\pvpg\posy11244\absw2520\absh2155 \sl-157 \b \f10 \fs9 \cf0 {\b0
d./#>#d9Ed9#{\f63 \u1085\'3f}#/KE9/d/sKW#d1## }
\par}{\phpg\posx895\pvpg\posy11244\absw2520\absh2155 \sl-153 \b \f10 \fs9 \cf0 {\b0
d./#>#d9Ed9#{\f63 \u1085\'3f}#/#E/9Z#59#D#D## }
\par}{\phpg\posx895\pvpg\posy11244\absw2520\absh2155 \sl-153 \b \f10 \fs9 \cf0 {\b0
d./#>#d9Ed9#{\f63 \u1085\'3f}#/KEd#/dK#Z9//9Ed9# }
\par}{\phpg\posx895\pvpg\posy11244\absw2520\absh2155 \sl-153 \b \f10 \fs9 \cf0 {\b0
d./#>#d9Ed9#{\f63 \u1085\'3f}#/KEs9Z^/KE#Z9//9Ed9# }
\par}{\phpg\posx895\pvpg\posy11244\absw2520\absh2155 \sl-151 \b \f10 \fs9 \cf0 {\b0
d./#>#d9Ed9#{\f63 \u1085\'3f}#/KZd//Kd9Z#W/## }
\par}{\phpg\posx895\pvpg\posy11244\absw2520\absh2155 \sl-153 \b \f10 \fs9 \cf0 {\b0
d./#>#d9Ed9#{\f63 \u1085\'3f}#5D# }
\par}{\phpg\posx895\pvpg\posy11244\absw2520\absh2155 \sl-153 \b \f10 \fs9 \cf0 {\b0
d./#>#d9Ed9#{\f63 \u1085\'3f}#5D#{\f63 \u1085\'3f}#>9^/KE#^9/h9>#Z# }
\par}{\phpg\posx895\pvpg\posy11244\absw2520\absh2155 \sl-153 \b \f10 \fs9 \cf0 {\b0
d./#>#d9Ed9#{\f63 \u1085\'3f}#>9^/KE#^9/h9>#Z# }
\par}{\phpg\posx895\pvpg\posy11244\absw2520\absh2155 \sl-151 \b \f10 \fs9 \cf0 {\b0
d./#>#d9Ed9#^/E#/D.# }
\par}{\phpg\posx895\pvpg\posy11244\absw2520\absh2155 \sl-153 \b \f10 \fs9 \cf0 {\b0
d./#>#d9Ed9#^/E#/D.#{\f63 \u1085\'3f}#/KEd#/dK#D5Z# }
\par}{\phpg\posx895\pvpg\posy11244\absw2520\absh2155 \sl-153 \b \f10 \fs9 \cf0 {\b0
d./#>#d9Ed9#{\f63 \u1085\'3f}#/KEd#/dK#Z9//9Ed9#Z{\f63 \u894\'3f},{\f63 \u895\'3f}#
}
\par}{\phpg\posx895\pvpg\posy11244\absw2520\absh2155 \sl-153 \b \f10 \fs9 \cf0 {\b0
d./#>#d9Ed9#{\f63 \u1085\'3f}#s/,## }
\par}{\phpg\posx895\pvpg\posy11244\absw2520\absh2155 \sl-157 \b \f10 \fs9 \cf0
d{\f63 \u381\'3f}{\f63 \u410\'3f}{\f63 \u258\'3f}{\f63 \u367\'3f}#{\f63 \u336\'3f}
{\f63 \u286\'3f}{\f63 \u374\'3f}{\f63 \u286\'3f}{\f63 \u396\'3f}{\f63 \u258\'3f}
{\f63 \u367\'3f}# \par
}
{\phpg\posx2889\pvpg\posy11213\absw750\absh549 \b \f10 \fs9 \cf101 \b \f10 \fs9
\cf101 WZ9s9Ed/s##
\par}{\phpg\posx2889\pvpg\posy11213\absw750\absh549 \sl-135 \par\b \f10 \fs9 \cf101
\fi293 {\cf0 EK# }
\par}{\phpg\posx2889\pvpg\posy11213\absw750\absh549 \sl-189 \b \f10 \fs9 \cf101
{\f0\fs12 \bullet }{\b0 \cf0 }\par
}
{\phpg\posx2889\pvpg\posy11827\absw91\absh960 \f10 \fs9 \cf0 {\f0\fs12
\bullet }\f10 \fs9 \cf0
\par}{\phpg\posx2889\pvpg\posy11827\absw91\absh960 \sl-153 \par\f10 \fs9 \cf0
{\f0\fs12 \bullet }
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\bullet }
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{\f63 \u1005\'3f}#
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{\f63 \u1007\'3f}{\f63 \u1011\'3f}#
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{\f63 \u1006\'3f}#
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{\f63 \u1006\'3f}#
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{\f63 \u1005\'3f}{\f63 \u1007\'3f}#
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{\f0\fs12 \bullet }
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{\f0\fs12 \bullet }
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{\f0\fs12 \bullet }
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{\f0\fs12 \bullet }
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{\f0\fs12 \bullet }
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{\f0\fs12 \bullet }
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{\f0\fs12 \bullet } \par
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{\phpg\posx4701\pvpg\posy11643\absw81\absh133 \f10 \fs9 \cf0 \f10 \fs9 \cf0
{\f63 \u1005\'3f}# \par
}
{\phpg\posx6207\pvpg\posy10553\absw5017\absh745 \f20 \fs14 \cf0 \f20 \fs14 \cf0 por
el antecedente de vacunaci�n BCG. Este estudio proporciona in-
\par}{\phpg\posx6207\pvpg\posy10553\absw5017\absh745 \sl-210 \f20 \fs14 \cf0
formaci�n v�lida y �til en nuestra poblaci�n, para un grupo de riesgo
\par}{\phpg\posx6207\pvpg\posy10553\absw5017\absh745 \sl-210 \f20 \fs14 \cf0
elevado para desarrollar enfermedad por tuberculosis, como lo son
\par}{\phpg\posx6207\pvpg\posy10553\absw5017\absh745 \sl-210 \f20 \fs14 \cf0 los
contactos intradomiciliarios de pacientes con tuberculosis activa. \par
}
{\phpg\posx6207\pvpg\posy1100\absw5021\absh8497 \b \f20 \fs14 \cf0 \b \f20 \fs14
\cf0 259. DESEMPE�O DE LA PRUEBA CUT�NEA TUBERCUL�NICA
\par}{\phpg\posx6207\pvpg\posy1100\absw5021\absh8497 \sl-200 \b \f20 \fs14 \cf0
PPD-S PARA EL DIAGN�STICO DE TUBERCULOSIS LATENTE EN
\par}{\phpg\posx6207\pvpg\posy1100\absw5021\absh8497 \sl-200 \b \f20 \fs14 \cf0
POBLACI�N CON COBERTURA ELEVADA DE VACUNACI�N BCG
\par}{\phpg\posx6207\pvpg\posy1100\absw5021\absh8497 \sl-170 \par\b \f20 \fs14 \cf0
{\b0 R.}{\b0 B�ez,}{\b0 L.}{\b0 Garc�a,}{\b0 P.}{\b0 Cruz,}{\b0 L.}{\b0
Ferreyra,}{\b0 G.}{\b0 Delgado,}{\b0 E.}{\b0 Ferreira }
\par}{\phpg\posx6207\pvpg\posy1100\absw5021\absh8497 \sl-200 \b \f20 \fs14 \cf0
{\b0 y}{\b0 A.}{\b0 Rend�n }
\par}{\phpg\posx6207\pvpg\posy1100\absw5021\absh8497 \sl-156 \par\b \f20 \fs14 \cf0
{\b0\i Instituto}{\b0\i Nacional}{\b0\i de}{\b0\i Enfermedades}{\b0\i
Respiratorias. }
\par}{\phpg\posx6207\pvpg\posy1100\absw5021\absh8497 \sl-142 \par\par\b \f20
\fs14 \cf0 Introducci�n:{\b0 La}{\b0 prueba}{\b0 cut�nea}{\b0 tubercul�nica}
{\b0 (PCT)}{\b0 para}{\b0 el}{\b0 diagn�s- }
\par}{\phpg\posx6207\pvpg\posy1100\absw5021\absh8497 \sl-210 \b \f20 \fs14 \cf0
{\b0 tico}{\b0 de}{\b0 tuberculosis}{\b0 latente}{\b0 tiene}{\b0 desempe�o}
{\b0 variable}{\b0 y,}{\b0 hay}{\b0 evidencia }
\par}{\phpg\posx6207\pvpg\posy1100\absw5021\absh8497 \sl-210 \b \f20 \fs14 \cf0
{\b0 de}{\b0 su}{\b0 utilidad}{\b0 limitada}{\b0 en}{\b0 poblaciones}{\b0
con}{\b0 vacunaci�n}{\b0 BCG}{\b0 por}{\b0 ello, }
\par}{\phpg\posx6207\pvpg\posy1100\absw5021\absh8497 \sl-210 \b \f20 \fs14 \cf0
{\b0 se}{\b0 recomienda}{\b0 evaluarla}{\b0 en}{\b0 cada}{\b0 regi�n.}{\b0
Objetivo:}{\b0 evaluar}{\b0 el}{\b0 desem- }
\par}{\phpg\posx6207\pvpg\posy1100\absw5021\absh8497 \sl-210 \b \f20 \fs14 \cf0
{\b0 pe�o}{\b0 de}{\b0 la}{\b0 PCT}{\b0 para}{\b0 el}{\b0 diagn�stico}{\b0
de}{\b0 infecci�n}{\b0 tuberculosa}{\b0 latente }
\par}{\phpg\posx6207\pvpg\posy1100\absw5021\absh8497 \sl-210 \b \f20 \fs14 \cf0
{\b0 (ITL),}{\b0 en}{\b0 contactos}{\b0 de}{\b0 pacientes}{\b0 con}{\b0
tuberculosis}{\b0 pulmonar}{\b0 activa }
\par}{\phpg\posx6207\pvpg\posy1100\absw5021\absh8497 \sl-210 \b \f20 \fs14 \cf0
{\b0 (TBP). }
\par}{\phpg\posx6207\pvpg\posy1100\absw5021\absh8497 \sl-210 \b \f20 \fs14 \cf0
Material y m�todos:{\b0 Con}{\b0 la}{\b0 t�cnica}{\b0 de}{\b0 Mantoux}{\b0
se}{\b0 aplic�}{\b0 PPD-S}{\b0 a}{\b0 113 }
\par}{\phpg\posx6207\pvpg\posy1100\absw5021\absh8497 \sl-210 \b \f20 \fs14 \cf0
{\b0 casos}{\b0 de}{\b0 TBP}{\b0 y}{\b0 194}{\b0 contactos}{\b0
intradomiciliarios.}{\b0 La}{\b0 lectura}{\b0 se}{\b0 realiz� }
\par}{\phpg\posx6207\pvpg\posy1100\absw5021\absh8497 \sl-210 \b \f20 \fs14 \cf0
{\b0 a}{\b0 las}{\b0 72}{\b0 horas}{\b0 despu�s}{\b0 de}{\b0 la}{\b0
aplicaci�n.}{\b0 Con}{\b0 una}{\b0 regla}{\b0 se}{\b0 midi�}{\b0 el }
\par}{\phpg\posx6207\pvpg\posy1100\absw5021\absh8497 \sl-210 \b \f20 \fs14 \cf0
{\b0 di�metro}{\b0 de}{\b0 la}{\b0 induraci�n}{\b0 en}{\b0 mil�metros.}{\b0
El}{\b0 est�ndar}{\b0 de}{\b0 oro}{\b0 fue}{\b0 la }
\par}{\phpg\posx6207\pvpg\posy1100\absw5021\absh8497 \sl-210 \b \f20 \fs14 \cf0
{\b0 comprobaci�n}{\b0 bacteriol�gica}{\b0 en}{\b0 los}{\b0 pacientes.}{\b0
Los}{\b0 contactos}{\b0 se}{\b0 clasi- }
\par}{\phpg\posx6207\pvpg\posy1100\absw5021\absh8497 \sl-210 \b \f20 \fs14 \cf0
{\b0 ficaron}{\b0 como}{\b0 verdaderos}{\b0 positivos}{\b0 a}{\b0 partir}{\b0
del}{\b0 punto}{\b0 de}{\b0 corte}{\b0 selec- }
\par}{\phpg\posx6207\pvpg\posy1100\absw5021\absh8497 \sl-210 \b \f20 \fs14 \cf0
{\b0 cionado}{\b0 y,}{\b0 como}{\b0 falsos}{\b0 positivos}{\b0 aquellos}{\b0
con}{\b0 reactividad}{\b0 al}{\b0 PPD-S }
\par}{\phpg\posx6207\pvpg\posy1100\absw5021\absh8497 \sl-210 \b \f20 \fs14 \cf0
{\b0 menor}{\b0 al}{\b0 punto}{\b0 de}{\b0 corte}{\b0 pero}{\b0 diferente}
{\b0 de}{\b0 0.}{\b0 La}{\b0 respuesta}{\b0 de}{\b0 la}{\b0 PCT}{\b0 se }
\par}{\phpg\posx6207\pvpg\posy1100\absw5021\absh8497 \sl-210 \b \f20 \fs14 \cf0
{\b0 grafic�}{\b0 de}{\b0 acuerdo}{\b0 a}{\b0 la}{\b0 variaci�n}{\b0 del}{\b0
nivel}{\b0 de}{\b0 su}{\b0 positividad}{\b0 mediante }
\par}{\phpg\posx6207\pvpg\posy1100\absw5021\absh8497 \sl-210 \b \f20 \fs14 \cf0
{\b0 la}{\b0 curva}{\b0 de}{\b0 caracter�sticas}{\b0 operativas}{\b0 del}{\b0
receptor}{\b0 (ROC)}{\b0 con}{\b0 ello}{\b0 se }
\par}{\phpg\posx6207\pvpg\posy1100\absw5021\absh8497 \sl-210 \b \f20 \fs14 \cf0
{\b0 midi�}{\b0 el}{\b0 �rea}{\b0 bajo}{\b0 la}{\b0 curva}{\b0 y}{\b0 se}
{\b0 identific�}{\b0 el}{\b0 mejor}{\b0 punto}{\b0 de}{\b0 corte.}{\b0
Para }
\par}{\phpg\posx6207\pvpg\posy1100\absw5021\absh8497 \sl-210 \b \f20 \fs14 \cf0
{\b0 medir}{\b0 el}{\b0 desempe�o}{\b0 de}{\b0 la}{\b0 prueba}{\b0 se}{\b0
construy�}{\b0 un}{\b0 cuadro}{\b0 de}{\b0 contin- }
\par}{\phpg\posx6207\pvpg\posy1100\absw5021\absh8497 \sl-210 \b \f20 \fs14 \cf0
{\b0 gencia}{\b0 2}{\b0 �}{\b0 2}{\b0 y}{\b0 se}{\b0 midieron}{\b0 la}{\b0
sensibilidad,}{\b0 especificidad,}{\b0 valor}{\b0 predic- }
\par}{\phpg\posx6207\pvpg\posy1100\absw5021\absh8497 \sl-210 \b \f20 \fs14 \cf0
{\b0 tivo}{\b0 (VP)}{\b0 positivo}{\b0 y}{\b0 negativo,}{\b0 as�}{\b0 como}
{\b0 el}{\b0 �ndice}{\b0 de}{\b0 probabilidad}{\b0 (IP) }
\par}{\phpg\posx6207\pvpg\posy1100\absw5021\absh8497 \sl-210 \b \f20 \fs14 \cf0
{\b0 positivo}{\b0 y}{\b0 negativo.}{\b0 Mediante}{\b0 an�lisis}{\b0 de}{\b0
regresi�n}{\b0 log�stica}{\b0 bivariada }
\par}{\phpg\posx6207\pvpg\posy1100\absw5021\absh8497 \sl-210 \b \f20 \fs14 \cf0
{\b0 se}{\b0 evalu�}{\b0 la}{\b0 asociaci�n}{\b0 entre}{\b0 la}{\b0
reactividad}{\b0 a}{\b0 la}{\b0 PCT}{\b0 como}{\b0 variable }
\par}{\phpg\posx6207\pvpg\posy1100\absw5021\absh8497 \sl-210 \b \f20 \fs14 \cf0
{\b0 dicot�mica}{\b0 (de}{\b0 acuerdo}{\b0 al}{\b0 punto}{\b0 de}{\b0 corte}
{\b0 seleccionado)}{\b0 y}{\b0 el}{\b0 antece- }
\par}{\phpg\posx6207\pvpg\posy1100\absw5021\absh8497 \sl-210 \b \f20 \fs14 \cf0
{\b0 dente}{\b0 de}{\b0 vacunaci�n}{\b0 BCG. }
\par}{\phpg\posx6207\pvpg\posy1100\absw5021\absh8497 \sl-210 \b \f20 \fs14 \cf0
Resultados:{\b0 La}{\b0 mediana}{\b0 de}{\b0 la}{\b0 edad}{\b0 en}{\b0
pacientes}{\b0 fue}{\b0 de}{\b0 39}{\b0 a�os}{\b0 y}{\b0 en }
\par}{\phpg\posx6207\pvpg\posy1100\absw5021\absh8497 \sl-210 \b \f20 \fs14 \cf0
{\b0 contactos}{\b0 21}{\b0 a�os.}{\b0 La}{\b0 mediana}{\b0 y}{\b0 la}{\b0
moda}{\b0 de}{\b0 la}{\b0 reactividad}{\b0 en}{\b0 pacien- }
\par}{\phpg\posx6207\pvpg\posy1100\absw5021\absh8497 \sl-210 \b \f20 \fs14 \cf0
{\b0 tes}{\b0 fue}{\b0 de}{\b0 14}{\b0 mm}{\b0 y}{\b0 10}{\b0 mm;}{\b0 en}
{\b0 los}{\b0 contactos}{\b0 de}{\b0 10}{\b0 mm}{\b0 y}{\b0 20}{\b0 mm.}
{\b0 El }
\par}{\phpg\posx6207\pvpg\posy1100\absw5021\absh8497 \sl-210 \b \f20 \fs14 \cf0
{\b0 mejor}{\b0 punto}{\b0 de}{\b0 corte}{\b0 fue}{\b0 entre}{\b0 10}{\b0 y}
{\b0 11}{\b0 mm}{\b0 de}{\b0 induraci�n.}{\b0 Los}{\b0 c�lculos }
\par}{\phpg\posx6207\pvpg\posy1100\absw5021\absh8497 \sl-210 \b \f20 \fs14 \cf0
{\b0 de}{\b0 la}{\b0 exactitud}{\b0 de}{\b0 la}{\b0 prueba}{\b0 se}{\b0
realizaron}{\b0 a}{\b0 un}{\b0 punto}{\b0 de}{\b0 corte}{\b0 de}{\b0 10 }
\par}{\phpg\posx6207\pvpg\posy1100\absw5021\absh8497 \sl-210 \b \f20 \fs14 \cf0
{\b0 mm,}{\b0 para}{\b0 el}{\b0 cual}{\b0 el}{\b0 �rea}{\b0 bajo}{\b0 la}
{\b0 curva}{\b0 fue}{\b0 de}{\b0 0,93.}{\b0 La}{\b0 sensibilidad}{\b0 fue }
\par}{\phpg\posx6207\pvpg\posy1100\absw5021\absh8497 \sl-210 \b \f20 \fs14 \cf0
{\b0 de}{\b0 85%,}{\b0 especificidad}{\b0 88%,}{\b0 VP}{\b0 positivo}{\b0
94%,}{\b0 VP}{\b0 negativo}{\b0 71%,}{\b0 IP}{\b0 posi- }
\par}{\phpg\posx6207\pvpg\posy1100\absw5021\absh8497 \sl-210 \b \f20 \fs14 \cf0
{\b0 tivo}{\b0 6,9}{\b0 e}{\b0 IP}{\b0 negativo}{\b0 0,17.}{\b0 La}{\b0
asociaci�n}{\b0 entre}{\b0 la}{\b0 reactividad}{\b0 a}{\b0 la}{\b0 PCT}{\b0
y }
\par}{\phpg\posx6207\pvpg\posy1100\absw5021\absh8497 \sl-210 \b \f20 \fs14 \cf0
{\b0 la}{\b0 vacunaci�n}{\b0 BCG}{\b0 demostr�}{\b0 un}{\b0 OR}{\b0 (IC95%)}
{\b0 1,14}{\b0 (0,65-2,10)}{\b0 p}{\b0 =}{\b0 0,644. }
\par}{\phpg\posx6207\pvpg\posy1100\absw5021\absh8497 \sl-210 \b \f20 \fs14 \cf0
Conclusiones:{\b0 La}{\b0 PCT}{\b0 demostr�}{\b0 un}{\b0 muy}{\b0 buen}{\b0
desempe�o}{\b0 ya}{\b0 que}{\b0 pro- }
\par}{\phpg\posx6207\pvpg\posy1100\absw5021\absh8497 \sl-210 \b \f20 \fs14 \cf0
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\par}{\phpg\posx6207\pvpg\posy1100\absw5021\absh8497 \sl-210 \b \f20 \fs14 \cf0
{\b0 probabilidad}{\b0 despu�s}{\b0 de}{\b0 la}{\b0 prueba.}{\b0 Su}{\b0
reactividad}{\b0 no}{\b0 se}{\b0 vio}{\b0 influida }\par
}
{\phpg\posx3172\pvpg\posy12867\absw194\absh272 \f10 \fs9 \cf0 \f10 \fs9 \cf0
{\f63 \u1007\'3f}{\f63 \u1007\'3f}{\f63 \u1013\'3f}#
\par}{\phpg\posx3172\pvpg\posy12867\absw194\absh272 \sl-153 \f10 \fs9 \cf0 \fi56
{\f63 \u1005\'3f}# \par
}
{\phpg\posx2889\pvpg\posy13205\absw91\absh272 \f10 \fs9 \cf0 {\f0\fs12
\bullet }\f10 \fs9 \cf0
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\bullet } \par
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{\phpg\posx3172\pvpg\posy13484\absw194\absh138 \b \f10 \fs9 \cf0 \b \f10 \fs9 \cf0
{\f63 \u1007\'3f}{\f63 \u1008\'3f}{\f63 \u1005\'3f}# \par
}
{\phpg\posx3705\pvpg\posy13484\absw194\absh138 \b \f10 \fs9 \cf0 \b \f10 \fs9 \cf0
{\f63 \u1005\'3f}{\f63 \u1004\'3f}{\f63 \u1009\'3f}# \par
}
{\phpg\posx4073\pvpg\posy13175\absw122\absh417 \f10 \fs9 \cf0 \f10 \fs9 \cf0
{\f63 \u1008\'3f}#
\par}{\phpg\posx4073\pvpg\posy13175\absw122\absh417 \sl-155 \par\f10 \fs9 \cf0 {\b
{\f63 \u1008\'3f}# }\par
}
{\phpg\posx4701\pvpg\posy13205\absw122\absh390 \f10 \fs9 \cf0 \fi28 {\f0\fs12
\bullet }\f10 \fs9 \cf0
\par}{\phpg\posx4701\pvpg\posy13205\absw122\absh390 \sl-123 \f10 \fs9 \cf0 {\f63
\u1007\'3f}#
\par}{\phpg\posx4701\pvpg\posy13205\absw122\absh390 \sl-157 \f10 \fs9 \cf0 {\b
{\f63 \u1008\'3f}# }\par
}
{\phpg\posx5463\pvpg\posy11349\absw519\absh2060 \b \f10 \fs9 \cf0 \fi80 \b \f10
\fs9 \cf0 d{\f63 \u381\'3f}{\f63 \u410\'3f}{\f63 \u258\'3f}{\f63 \u367\'3f}{\f63
\u853\'3f}#
\par}{\phpg\posx5463\pvpg\posy11349\absw519\absh2060 \sl-135 \b \f10 \fs9 \cf0
{\f63 \u336\'3f}{\f63 \u286\'3f}{\f63 \u374\'3f}{\f63 \u286\'3f}{\f63 \u396\'3f}
{\f63 \u258\'3f}{\f63 \u367\'3f}#
\par}{\phpg\posx5463\pvpg\posy11349\absw519\absh2060 \sl-157 \b \f10 \fs9 \cf0
\fi289 {\b0 {\f63 \u1011\'3f}# }
\par}{\phpg\posx5463\pvpg\posy11349\absw519\absh2060 \sl-153 \b \f10 \fs9 \cf0
\fi289 {\b0 {\f63 \u1005\'3f}# }
\par}{\phpg\posx5463\pvpg\posy11349\absw519\absh2060 \sl-153 \b \f10 \fs9 \cf0
\fi232 {\b0 {\f63 \u1007\'3f}{\f63 \u1012\'3f}# }
\par}{\phpg\posx5463\pvpg\posy11349\absw519\absh2060 \sl-153 \b \f10 \fs9 \cf0
\fi232 {\b0 {\f63 \u1005\'3f}{\f63 \u1011\'3f}# }
\par}{\phpg\posx5463\pvpg\posy11349\absw519\absh2060 \sl-151 \b \f10 \fs9 \cf0
\fi289 {\b0 {\f63 \u1006\'3f}# }
\par}{\phpg\posx5463\pvpg\posy11349\absw519\absh2060 \sl-153 \b \f10 \fs9 \cf0
\fi232 {\b0 {\f63 \u1006\'3f}{\f63 \u1011\'3f}# }
\par}{\phpg\posx5463\pvpg\posy11349\absw519\absh2060 \sl-153 \b \f10 \fs9 \cf0
\fi289 {\b0 {\f63 \u1006\'3f}# }
\par}{\phpg\posx5463\pvpg\posy11349\absw519\absh2060 \sl-153 \b \f10 \fs9 \cf0
\fi232 {\b0 {\f63 \u1005\'3f}{\f63 \u1007\'3f}# }
\par}{\phpg\posx5463\pvpg\posy11349\absw519\absh2060 \sl-151 \b \f10 \fs9 \cf0
\fi176 {\b0 {\f63 \u1007\'3f}{\f63 \u1007\'3f}{\f63 \u1013\'3f}# }
\par}{\phpg\posx5463\pvpg\posy11349\absw519\absh2060 \sl-153 \b \f10 \fs9 \cf0
\fi289 {\b0 {\f63 \u1005\'3f}# }
\par}{\phpg\posx5463\pvpg\posy11349\absw519\absh2060 \sl-153 \b \f10 \fs9 \cf0
\fi289 {\b0 {\f63 \u1008\'3f}# }
\par}{\phpg\posx5463\pvpg\posy11349\absw519\absh2060 \sl-153 \b \f10 \fs9 \cf0
\fi289 {\b0 {\f63 \u1007\'3f}# }
\par}{\phpg\posx5463\pvpg\posy11349\absw519\absh2060 \sl-157 \b \f10 \fs9 \cf0
\fi176 {\f63 \u1008\'3f}{\f63 \u1009\'3f}{\f63 \u1008\'3f}# \par
}
{\phpg\posx850\pvpg\posy13620\absw5507\absh1962 \b \f10 \fs9 \cf0 \fi73 \b \f10
\fs9 \cf0 d{\f63 \u258\'3f}{\f63 \u271\'3f}{\f63 \u367\'3f}{\f63
\u258\'3f}#{\f63 \u1006\'3f}{\f63 \u855\'3f}{\b0 #/{\f63 \u437\'3f}{\f63 \u258\'3f}
{\f63 \u282\'3f}{\f63 \u396\'3f}{\f63 \u381\'3f}#{\f63 \u282\'3f}{\f63
\u286\'3f}#{\f63 \u349\'3f}{\f63 \u374\'3f}{\f63 \u282\'3f}{\f63 \u349\'3f}{\f63
\u272\'3f}{\f63 \u258\'3f}{\f63 \u272\'3f}{\f63 \u349\'3f}{\f63 \u383\'3f}{\f63
\u374\'3f}#{\f63 \u282\'3f}{\f63 \u286\'3f}#{\f63 \u410\'3f}{\f63 \u286\'3f}
{\f63 \u396\'3f}{\f63 \u258\'3f}{\f63 \u393\'3f}{\f63 \u349\'3f}{\f63
\u258\'3f}#{\f63 \u393\'3f}{\f63 \u396\'3f}{\f63 \u286\'3f}{\f63 \u448\'3f}{\f63
\u286\'3f}{\f63 \u374\'3f}{\f63 \u410\'3f}{\f63 \u349\'3f}{\f63 \u448\'3f}{\f63
\u258\'3f}#{\f63 \u282\'3f}{\f63 \u286\'3f}#{\f63 \u258\'3f}{\f63 \u272\'3f}
{\f63 \u437\'3f}{\f63 \u286\'3f}{\f63 \u396\'3f}{\f63 \u282\'3f}{\f63
\u381\'3f}#{\f63 \u258\'3f}#{\f63 \u367\'3f}{\f63 \u258\'3f}#{\f63 \u272\'3f}
{\f63 \u381\'3f}{\f63 \u373\'3f}{\f63 \u381\'3f}{\f63 \u396\'3f}{\f63 \u271\'3f}
{\f63 \u349\'3f}{\f63 \u367\'3f}{\f63 \u349\'3f}{\f63 \u282\'3f}{\f63 \u258\'3f}
{\f63 \u282\'3f}#{\f63 \u286\'3f}{\f63 \u374\'3f}#{\f63 \u367\'3f}{\f63 \u381\'3f}
{\f63 \u400\'3f}#{\f63 \u272\'3f}{\f63 \u258\'3f}{\f63 \u400\'3f}{\f63 \u381\'3f}
{\f63 \u400\'3f}#{\f63 \u282\'3f}{\f63 \u286\'3f}#d{\f63 \u437\'3f}{\f63 \u271\'3f}
{\f63 \u286\'3f}{\f63 \u396\'3f}{\f63 \u272\'3f}{\f63 \u437\'3f}{\f63 \u367\'3f}
{\f63 \u381\'3f}{\f63 \u400\'3f}{\f63 \u349\'3f}{\f63 \u400\'3f}# }
\par}{\phpg\posx850\pvpg\posy13620\absw5507\absh1962 \sl-145 \b \f10 \fs9 \cf0
\fi73 {\b0 >{\f63 \u258\'3f}{\f63 \u410\'3f}{\f63 \u286\'3f}{\f63 \u374\'3f}
{\f63 \u410\'3f}{\f63 \u286\'3f}#}{\b0 {\f63 \u286\'3f}{\f63 \u374\'3f}#}{\b0
{\f63 \u286\'3f}{\f63 \u367\'3f}#}{\b0 {\f63 \u393\'3f}{\f63 \u286\'3f}{\f63
\u396\'3f}{\f63 \u400\'3f}{\f63 \u381\'3f}{\f63 \u374\'3f}{\f63 \u258\'3f}{\f63
\u367\'3f}#}{\b0 {\f63 \u282\'3f}{\f63 \u286\'3f}#}{\b0 {\f63 \u400\'3f}{\f63
\u258\'3f}{\f63 \u367\'3f}{\f63 \u437\'3f}{\f63 \u282\'3f}{\f63 \u856\'3f}#}{\b0
d./{\f63 \u855\'3f}#}{\b0 d{\f63 \u437\'3f}{\f63 \u271\'3f}{\f63 \u286\'3f}
{\f63 \u396\'3f}{\f63 \u272\'3f}{\f63 \u437\'3f}{\f63 \u367\'3f}{\f63 \u381\'3f}
{\f63 \u400\'3f}{\f63 \u349\'3f}{\f63 \u400\'3f}{\f63 \u854\'3f}#}{\b0 5D{\f63
\u855\'3f}#}{\b0 5{\f63 \u349\'3f}{\f63 \u258\'3f}{\f63 \u271\'3f}{\f63 \u286\'3f}
{\f63 \u410\'3f}{\f63 \u286\'3f}{\f63 \u400\'3f}#}{\b0 D{\f63 \u286\'3f}{\f63
\u367\'3f}{\f63 \u367\'3f}{\f63 \u349\'3f}{\f63 \u410\'3f}{\f63 \u437\'3f}{\f63
\u400\'3f}{\f63 \u854\'3f}#}{\b0 /D.{\f63 \u855\'3f}#}{\b0 /{\f63 \u381\'3f}{\f63
\u373\'3f}{\f63 \u381\'3f}{\f63 \u396\'3f}{\f63 \u271\'3f}{\f63 \u349\'3f}{\f63
\u367\'3f}{\f63 \u349\'3f}{\f63 \u282\'3f}{\f63 \u258\'3f}{\f63 \u282\'3f}{\f63
\u854\'3f}#}{\b0 D5Z{\f63 \u855\'3f}# }
\par}{\phpg\posx850\pvpg\posy13620\absw5507\absh1962 \sl-147 \b \f10 \fs9 \cf0
\fi73 {\b0 D{\f63 \u437\'3f}{\f63 \u367\'3f}{\f63 \u410\'3f}{\f63 \u349\'3f}
{\f63 \u282\'3f}{\f63 \u396\'3f}{\f63 \u381\'3f}{\f63 \u336\'3f}{\f63 \u381\'3f}
{\f63 \u396\'3f}{\f63 \u286\'3f}{\f63 \u400\'3f}{\f63 \u349\'3f}{\f63 \u400\'3f}
{\f63 \u410\'3f}{\f63 \u286\'3f}{\f63 \u374\'3f}{\f63 \u410\'3f}{\f63 \u286\'3f}
{\f63 \u854\'3f}#Z{\f63 \u894\'3f},{\f63 \u895\'3f}{\f63 \u855\'3f}#Z{\f63
\u286\'3f}{\f63 \u400\'3f}{\f63 \u349\'3f}{\f63 \u400\'3f}{\f63 \u410\'3f}{\f63
\u286\'3f}{\f63 \u374\'3f}{\f63 \u410\'3f}{\f63 \u286\'3f}#{\f63
\u258\'3f}#/{\f63 \u400\'3f}{\f63 \u381\'3f}{\f63 \u374\'3f}{\f63 \u349\'3f}
{\f63 \u258\'3f}{\f63 \u272\'3f}{\f63 \u349\'3f}{\f63 \u282\'3f}{\f63 \u258\'3f}
{\f63 \u854\'3f}#s/,{\f63 \u855\'3f}#/{\f63 \u374\'3f}{\f63 \u296\'3f}{\f63
\u286\'3f}{\f63 \u272\'3f}{\f63 \u272\'3f}{\f63 \u349\'3f}{\f63 \u383\'3f}{\f63
\u374\'3f}#{\f63 \u393\'3f}{\f63 \u381\'3f}{\f63 \u396\'3f}#{\f63 \u448\'3f}
{\f63 \u349\'3f}{\f63 \u396\'3f}{\f63 \u437\'3f}{\f63 \u400\'3f}#{\f63 \u282\'3f}
{\f63 \u286\'3f}#{\f63 \u349\'3f}{\f63 \u374\'3f}{\f63 \u373\'3f}{\f63 \u437\'3f}
{\f63 \u374\'3f}{\f63 \u381\'3f}{\f63 \u282\'3f}{\f63 \u286\'3f}{\f63 \u296\'3f}
{\f63 \u349\'3f}{\f63 \u272\'3f}{\f63 \u349\'3f}{\f63 \u286\'3f}{\f63 \u374\'3f}
{\f63 \u272\'3f}{\f63 \u349\'3f}{\f63 \u258\'3f}#{\f63 \u346\'3f}{\f63 \u437\'3f}
{\f63 \u373\'3f}{\f63 \u258\'3f}{\f63 \u374\'3f}{\f63 \u258\'3f}{\f63 \u854\'3f}# }
\par}{\phpg\posx850\pvpg\posy13620\absw5507\absh1962 \sl-145 \b \f10 \fs9 \cf0
\fi73 {\b0 dW/{\f63 \u855\'3f}#d{\f63 \u286\'3f}{\f63 \u396\'3f}{\f63 \u258\'3f}
{\f63 \u393\'3f}{\f63 \u349\'3f}{\f63 \u258\'3f}#W{\f63 \u396\'3f}{\f63 \u286\'3f}
{\f63 \u448\'3f}{\f63 \u286\'3f}{\f63 \u374\'3f}{\f63 \u410\'3f}{\f63 \u349\'3f}
{\f63 \u448\'3f}{\f63 \u258\'3f}#{\f63 \u272\'3f}{\f63 \u381\'3f}{\f63 \u374\'3f}#/
{\f63 \u400\'3f}{\f63 \u381\'3f}{\f63 \u374\'3f}{\f63 \u349\'3f}{\f63 \u258\'3f}
{\f63 \u272\'3f}{\f63 \u349\'3f}{\f63 \u282\'3f}{\f63 \u258\'3f}{\f63
\u854\'3f}#dWZ{\f63 \u855\'3f}#d{\f63 \u286\'3f}{\f63 \u396\'3f}{\f63 \u258\'3f}
{\f63 \u393\'3f}{\f63 \u349\'3f}{\f63 \u258\'3f}#W{\f63 \u396\'3f}{\f63 \u286\'3f}
{\f63 \u448\'3f}{\f63 \u286\'3f}{\f63 \u374\'3f}{\f63 \u410\'3f}{\f63 \u349\'3f}
{\f63 \u448\'3f}{\f63 \u258\'3f}#{\f63 \u272\'3f}{\f63 \u381\'3f}{\f63
\u374\'3f}#Z{\f63 \u349\'3f}{\f63 \u296\'3f}{\f63 \u258\'3f}{\f63 \u373\'3f}
{\f63 \u393\'3f}{\f63 \u349\'3f}{\f63 \u272\'3f}{\f63 \u349\'3f}{\f63 \u374\'3f}
{\f63 \u258\'3f}{\f63 \u856\'3f}# }
\par}{\phpg\posx850\pvpg\posy13620\absw5507\absh1962 \sl-114 \par\b \f10 \fs9
\cf0 \fi574 {\f0\fs12 \bullet }{\b0 }
\par}{\phpg\posx850\pvpg\posy13620\absw5507\absh1962 \sl-143 \b \f10 \fs9 \cf0
{\f20 \fs14 Conclusiones:}{\b0 \f20 \fs14 La}{\b0 \f20 \fs14 tuberculosis}{\b0
\f20 \fs14 latente}{\b0 \f20 \fs14 es}{\b0 \f20 \fs14 una}{\b0 \f20 \fs14
entidad}{\b0 \f20 \fs14 frecuente}{\b0 \f20 \fs14 entre }
\par}{\phpg\posx850\pvpg\posy13620\absw5507\absh1962 \sl-137 \b \f10 \fs9 \cf0
\fi73 {\f0\fs12 \bullet }{\b0\up006 }
\par}{\phpg\posx850\pvpg\posy13620\absw5507\absh1962 \sl-143 \b \f10 \fs9 \cf0 {\b0
\f20 \fs14 los}{\b0 \f20 \fs14 trabajadores}{\b0 \f20 \fs14 de}{\b0 \f20 \fs14
salud,}{\b0 \f20 \fs14 sin}{\b0 \f20 \fs14 embargo,}{\b0 \f20 \fs14 la}{\b0 \f20
\fs14 mayor�a}{\b0 \f20 \fs14 de}{\b0 \f20 \fs14 casos}{\b0 \f20 \fs14 no}
{\b0 \f20 \fs14 ameri- }
\par}{\phpg\posx850\pvpg\posy13620\absw5507\absh1962 \sl-210 \b \f10 \fs9 \cf0 {\b0
\f20 \fs14 t� #}{\b0\up006 i}{\b0 \f20 \fs14 ndicar}{\b0 \f20 \fs14 terapia}
{\b0 \f20 \fs14 preventiva. }
\par}{\phpg\posx850\pvpg\posy13620\absw5507\absh1962 \sl-171 \b \f10 \fs9 \cf0
\fi73 {\f0\fs12 \bullet }{\b0 }
\par}{\phpg\posx850\pvpg\posy13620\absw5507\absh1962 \sl-114 \par\b \f10 \fs9
\cf0 \fi73 {\f0\fs12 \bullet }{\b0 }
\par}{\phpg\posx850\pvpg\posy13620\absw5507\absh1962 \sl-113 \par\b \f10 \fs9
\cf0 \fi73 {\f0\fs12 \bullet }{\b0 }
\par}{\phpg\posx850\pvpg\posy13620\absw5507\absh1962 \sl-114 \par\b \f10 \fs9
\cf0 \fi73 {\f0\fs12 \bullet }{\b0 }\par
}
{\phpg\posx6207\pvpg\posy11801\absw5020\absh2834 \b \f20 \fs14 \cf0 \b \f20
\fs14 \cf0 260. PERFIL EPIDEMIOL�GICO MODIFICADO Y CARACTERIZACI�N
\par}{\phpg\posx6207\pvpg\posy11801\absw5020\absh2834 \sl-200 \b \f20 \fs14 \cf0 DE
LOS CASOS DE TUBERCULOSIS ATENDIDOS EN EL HOSPITAL
\par}{\phpg\posx6207\pvpg\posy11801\absw5020\absh2834 \sl-200 \b \f20 \fs14 \cf0
CAJA PETROLERA, LA PAZ, BOLIVIA (2014-2017)
\par}{\phpg\posx6207\pvpg\posy11801\absw5020\absh2834 \sl-170 \par\b \f20 \fs14
\cf0 {\b0 O.}{\b0 Hidalgo,}{\b0 J.}{\b0 Zambrana,}{\b0 Y.}{\b0 Velasquez,}{\b0
A.}{\b0 Condo}{\b0 y}{\b0 R.}{\b0 Pacheco }
\par}{\phpg\posx6207\pvpg\posy11801\absw5020\absh2834 \sl-156 \par\b \f20 \fs14
\cf0 {\b0\i Hospital}{\b0\i Caja}{\b0\i Petrolera. }
\par}{\phpg\posx6207\pvpg\posy11801\absw5020\absh2834 \sl-141 \par\par\b \f20 \fs14
\cf0 Introducci�n:{\b0 Pese}{\b0 a}{\b0 la}{\b0 monitorizaci�n}{\b0 continua}
{\b0 de}{\b0 la}{\b0 tuberculosis}{\b0 so- }
\par}{\phpg\posx6207\pvpg\posy11801\absw5020\absh2834 \sl-210 \b \f20 \fs14 \cf0
{\b0 bretodo}{\b0 del}{\b0 sistema}{\b0 p�blico}{\b0 a�n}{\b0 se}{\b0
desconoce}{\b0 las}{\b0 ocurrencias}{\b0 en}{\b0 los}{\b0 sub }
\par}{\phpg\posx6207\pvpg\posy11801\absw5020\absh2834 \sl-210 \b \f20 \fs14 \cf0
{\b0 sistemas}{\b0 privados}{\b0 y}{\b0 seguros}{\b0 a}{\b0 corto}{\b0
plazo,}{\b0 este}{\b0 trabajo}{\b0 considera}{\b0 rele- }
\par}{\phpg\posx6207\pvpg\posy11801\absw5020\absh2834 \sl-210 \b \f20 \fs14 \cf0
{\b0 vante}{\b0 la}{\b0 informaci�n}{\b0 generada}{\b0 en}{\b0 un}{\b0
tetraenio.}{\b0 Objetivo}{\b0 general:}{\b0 deter- }
\par}{\phpg\posx6207\pvpg\posy11801\absw5020\absh2834 \sl-210 \b \f20 \fs14 \cf0
{\b0 minar}{\b0 el}{\b0 perfil}{\b0 epidemiol�gico}{\b0 modificado}{\b0 y}{\b0
caracterizaci�n}{\b0 de}{\b0 los}{\b0 casos }
\par}{\phpg\posx6207\pvpg\posy11801\absw5020\absh2834 \sl-210 \b \f20 \fs14 \cf0
{\b0 de}{\b0 tuberculosis}{\b0 atendidos}{\b0 en}{\b0 el}{\b0 Hospital}{\b0
Caja}{\b0 Petrolera.}{\b0 La}{\b0 Paz}{\b0 Bolivia, }
\par}{\phpg\posx6207\pvpg\posy11801\absw5020\absh2834 \sl-210 \b \f20 \fs14 \cf0
{\b0 2014-2017.}{\b0 Objetivos}{\b0 espec�ficos:}{\b0 1.}{\b0 Determinaci�n}
{\b0 de}{\b0 la}{\b0 edad}{\b0 y}{\b0 sexo.}{\b0 2. }
\par}{\phpg\posx6207\pvpg\posy11801\absw5020\absh2834 \sl-210 \b \f20 \fs14 \cf0
{\b0 Determinaci�n}{\b0 de}{\b0 las}{\b0 caracter�sticas}{\b0 socio}{\b0
demogr�ficas.}{\b0 3.}{\b0 Determina- }\par
}
\sect\sectd\pard\plain
\pgwsxn11905\pghsxn15874
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28a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a
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0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a002
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028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028
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28a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a
28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a
0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a002
8a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a2
8a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0
028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028
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0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a002
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028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028
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0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a002
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028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028
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28a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a
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0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a002
8a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a2
8a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0
028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028
a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28
a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a00
28a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a
28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a
0028a28a0028a28a0028a28a0028a28a00ffd9
}}\par}{\phpg\posx680\pvpg\posy711\absw205\absh142 \f20 \fs11 \cf0 \f20 \fs11 \cf0
112 \par
}
{\phpg\posx5258\pvpg\posy713\absw1048\absh138 \i \f20 \fs11 \cf0 \i \f20 \fs11 \cf0
11.� Congreso ALAT \par
}
{\phpg\posx680\pvpg\posy1103\absw5019\absh6037 \f20 \fs14 \cf0 \f20 \fs14 \cf0 ci�n
de la frecuencia de tuberculosis por empresas aseguradas. 4. Deter-
\par}{\phpg\posx680\pvpg\posy1103\absw5019\absh6037 \sl-210 \f20 \fs14 \cf0
minaci�n de casos de tuberculosis detectados con baciloscopia por em-
\par}{\phpg\posx680\pvpg\posy1103\absw5019\absh6037 \sl-210 \f20 \fs14 \cf0 presas.
5. Determinaci�n de casos de tuberculosis por sus m�todos
\par}{\phpg\posx680\pvpg\posy1103\absw5019\absh6037 \sl-210 \f20 \fs14 \cf0
diagn�sticos tradicionales. 6. Determinaci�n de complicaciones.
\par}{\phpg\posx680\pvpg\posy1103\absw5019\absh6037 \sl-210 \f20 \fs14 \cf0 {\b
Material}{\b y}{\b m�todos:} Tipo de estudio, descriptivo, retrospectivo de
\par}{\phpg\posx680\pvpg\posy1103\absw5019\absh6037 \sl-210 \f20 \fs14 \cf0 corte
transversal, lugar Hospital Caja Petrolera (HCP) en 2014-2017.
\par}{\phpg\posx680\pvpg\posy1103\absw5019\absh6037 \sl-210 \f20 \fs14 \cf0
Metodolog�a: se realiz� muestra censal (78 pacientes), muestreo por
\par}{\phpg\posx680\pvpg\posy1103\absw5019\absh6037 \sl-210 \f20 \fs14 \cf0
sucesi�n aleatorizada de pacientes (SAP), con diagn�stico bacteriol�-
\par}{\phpg\posx680\pvpg\posy1103\absw5019\absh6037 \sl-210 \f20 \fs14 \cf0 gico de
tuberculosis pulmonar. Se revisaron historias cl�nicas, fichas
\par}{\phpg\posx680\pvpg\posy1103\absw5019\absh6037 \sl-210 \f20 \fs14 \cf0
epidemiol�gicas (fuente secundaria). An�lisis estad�stico: procesados
\par}{\phpg\posx680\pvpg\posy1103\absw5019\absh6037 \sl-210 \f20 \fs14 \cf0 con
SPSS 22. Estudio presentado y aprobado al comit� de �tica de
\par}{\phpg\posx680\pvpg\posy1103\absw5019\absh6037 \sl-210 \f20 \fs14 \cf0
investigaci�n conjunto interhospitalario.
\par}{\phpg\posx680\pvpg\posy1103\absw5019\absh6037 \sl-210 \f20 \fs14 \cf0 {\b
Resultados:} 1. La frecuencia del sexo masculino 62% (52) con una re-
\par}{\phpg\posx680\pvpg\posy1103\absw5019\absh6037 \sl-210 \f20 \fs14 \cf0 laci�n
de 2 a 1 respecto al sexo femenino 38% (48). 2. El promedio de
\par}{\phpg\posx680\pvpg\posy1103\absw5019\absh6037 \sl-210 \f20 \fs14 \cf0 edades
fue de 45 a�os. 3. El predominio de fuente laboral es de traba-
\par}{\phpg\posx680\pvpg\posy1103\absw5019\absh6037 \sl-210 \f20 \fs14 \cf0 jadores
activos 59% (46), rentistas y jubilados 40% (31), no asegurados
\par}{\phpg\posx680\pvpg\posy1103\absw5019\absh6037 \sl-210 \f20 \fs14 \cf0 2% (1).
4. Frecuencia de pacientes con tuberculosis por empresas ase-
\par}{\phpg\posx680\pvpg\posy1103\absw5019\absh6037 \sl-210 \f20 \fs14 \cf0 guradas
a predominio de empresas municipales de limpieza 78% (59)
\par}{\phpg\posx680\pvpg\posy1103\absw5019\absh6037 \sl-210 \f20 \fs14 \cf0 el
resto rentistas o empresas privadas 22% (19). 5. Las caracter�sticas
\par}{\phpg\posx680\pvpg\posy1103\absw5019\absh6037 \sl-210 \f20 \fs14 \cf0
sociodemogr�ficas a predominio de pacientes de la ciudad de La Paz
\par}{\phpg\posx680\pvpg\posy1103\absw5019\absh6037 \sl-210 \f20 \fs14 \cf0 61%
(47), El Alto 23% (18), y otras regiones fuera de La Paz-Bolivia. 16%
\par}{\phpg\posx680\pvpg\posy1103\absw5019\absh6037 \sl-210 \f20 \fs14 \cf0 (11).
6. Seg�n el tipo de tuberculosis, la Tb. pleural con 16% (12), tu-
\par}{\phpg\posx680\pvpg\posy1103\absw5019\absh6037 \sl-210 \f20 \fs14 \cf0
berculosis pulmonar BAAR ++ 14% (11), tb. miliar y peritoneal es de 9%
\par}{\phpg\posx680\pvpg\posy1103\absw5019\absh6037 \sl-210 \f20 \fs14 \cf0 (7). 7.
M�todos diagn�sticos est�n estudios anatomopatol�gicos 40%
\par}{\phpg\posx680\pvpg\posy1103\absw5019\absh6037 \sl-210 \f20 \fs14 \cf0 (31),
baciloscopia 16% (12), cultivo 11% (8) e imagenolog�a 9,7% (10,2).
\par}{\phpg\posx680\pvpg\posy1103\absw5019\absh6037 \sl-210 \f20 \fs14 \cf0 {\b
Conclusiones:} 1. Sexo masculino 62% (52). 2. El promedio de edades
\par}{\phpg\posx680\pvpg\posy1103\absw5019\absh6037 \sl-210 \f20 \fs14 \cf0 fue 45
a�os. 3. Fuente laboral, trabajadores activos con 59% (46). 4.
\par}{\phpg\posx680\pvpg\posy1103\absw5019\absh6037 \sl-210 \f20 \fs14 \cf0
Empresas aseguradas de �ndole municipales (limpieza municipal ur-
\par}{\phpg\posx680\pvpg\posy1103\absw5019\absh6037 \sl-210 \f20 \fs14 \cf0 bana)
78% (59). 5. Provienen de La Paz 61% (47). 6. A predominio de
\par}{\phpg\posx680\pvpg\posy1103\absw5019\absh6037 \sl-210 \f20 \fs14 \cf0
tuberculosis pleural con 16% (12). 7. Los m�todos diagn�sticos de con-
\par}{\phpg\posx680\pvpg\posy1103\absw5019\absh6037 \sl-210 \f20 \fs14 \cf0
firmaci�n fueron estudios anatomopatol�gicos 40% (31). 8. Pacientes
\par}{\phpg\posx680\pvpg\posy1103\absw5019\absh6037 \sl-210 \f20 \fs14 \cf0 con VIH
(+) 10% (4). \par
}
{\phpg\posx6037\pvpg\posy6351\absw5017\absh746 \b \f20 \fs14 \cf0 \b \f20 \fs14
\cf0 Conclusiones:{\b0 La}{\b0 cobertura}{\b0 de}{\b0 PS}{\b0 del}{\b0 PCT}
{\b0 supera}{\b0 al}{\b0 promedio}{\b0 nacio- }
\par}{\phpg\posx6037\pvpg\posy6351\absw5017\absh746 \sl-210 \b \f20 \fs14 \cf0 {\b0
nal.}{\b0 Los}{\b0 casos}{\b0 de}{\b0 XDR}{\b0 son}{\b0 en}{\b0 su}{\b0
mayor�a}{\b0 en}{\b0 pacientes}{\b0 nunca}{\b0 tratados. }
\par}{\phpg\posx6037\pvpg\posy6351\absw5017\absh746 \sl-210 \b \f20 \fs14 \cf0 {\b0
La}{\b0 mutaci�n}{\b0 KatG}{\b0 es}{\b0 la}{\b0 m�s}{\b0 frecuente}{\b0 en}
{\b0 los}{\b0 casos}{\b0 MDR}{\b0 y}{\b0 se}{\b0 asocia}{\b0 a }
\par}{\phpg\posx6037\pvpg\posy6351\absw5017\absh746 \sl-210 \b \f20 \fs14 \cf0 {\b0
una}{\b0 sensibilidad}{\b0 fenot�pica}{\b0 a}{\b0 Eto. }\par
}
{\phpg\posx680\pvpg\posy8231\absw5020\absh6047 \b \f20 \fs14 \cf0 \b \f20 \fs14
\cf0 261. EPIDEMIOLOG�A MOLECULAR Y FENOT�PICA DEL
\par}{\phpg\posx680\pvpg\posy8231\absw5020\absh6047 \sl-200 \b \f20 \fs14 \cf0 {\i
MYCOBACTERIUM}{\i TUBERCULOSIS} EN EL PCT DEL HNERM DE
\par}{\phpg\posx680\pvpg\posy8231\absw5020\absh6047 \sl-200 \b \f20 \fs14 \cf0
ESSALUD
\par}{\phpg\posx680\pvpg\posy8231\absw5020\absh6047 \sl-170 \par\b \f20 \fs14 \cf0
{\b0 S.}{\b0 Pecho }
\par}{\phpg\posx680\pvpg\posy8231\absw5020\absh6047 \sl-156 \par\b \f20 \fs14 \cf0
{\b0\i Programa}{\b0\i del}{\b0\i Control}{\b0\i de}{\b0\i la}{\b0\i
Tuberculosis}{\b0\i (PCT).}{\b0\i Hospital}{\b0\i Nacional }
\par}{\phpg\posx680\pvpg\posy8231\absw5020\absh6047 \sl-200 \b \f20 \fs14 \cf0
{\b0\i Edgardo}{\b0\i Rebagliati}{\b0\i Martins}{\b0\i (HNERM).}{\b0\i Red}
{\b0\i Asistencial}{\b0\i Rebagliati}{\b0\i (RAR). }
\par}{\phpg\posx680\pvpg\posy8231\absw5020\absh6047 \sl-200 \b \f20 \fs14 \cf0
{\b0\i Seguro}{\b0\i Social}{\b0\i del}{\b0\i Per�}{\b0\i (EsSalud). }
\par}{\phpg\posx680\pvpg\posy8231\absw5020\absh6047 \sl-222 \par\b \f20 \fs14 \cf0
Introducci�n:{\b0 EsSalud}{\b0 atiende}{\b0 el}{\b0 19%}{\b0 de}{\b0 todos}
{\b0 los}{\b0 casos}{\b0 de}{\b0 TB}{\b0 nacio- }
\par}{\phpg\posx680\pvpg\posy8231\absw5020\absh6047 \sl-210 \b \f20 \fs14 \cf0 {\b0
nales.}{\b0 Durante}{\b0 el}{\b0 2016}{\b0 se}{\b0 realizaron}{\b0 13.698}
{\b0 pruebas}{\b0 gen�ticas}{\b0 Geno- }
\par}{\phpg\posx680\pvpg\posy8231\absw5020\absh6047 \sl-210 \b \f20 \fs14 \cf0 {\b0
type}{\b0 MTBDR}{\b0 Plus}{\b0 y}{\b0 7.011}{\b0 pruebas}{\b0 MODS}{\b0 a}
{\b0 nivel}{\b0 nacional.}{\b0 Los}{\b0 pacien- }
\par}{\phpg\posx680\pvpg\posy8231\absw5020\absh6047 \sl-210 \b \f20 \fs14 \cf0 {\b0
tes}{\b0 atendidos}{\b0 en}{\b0 el}{\b0 PCT}{\b0 del}{\b0 HNERM}{\b0
corresponden}{\b0 a}{\b0 todos}{\b0 los}{\b0 casos}{\b0 de }
\par}{\phpg\posx680\pvpg\posy8231\absw5020\absh6047 \sl-210 \b \f20 \fs14 \cf0 {\b0
TB}{\b0 resistente}{\b0 en}{\b0 cualquiera}{\b0 de}{\b0 sus}{\b0 formas}{\b0
y}{\b0 reacciones}{\b0 adversas}{\b0 de}{\b0 la }
\par}{\phpg\posx680\pvpg\posy8231\absw5020\absh6047 \sl-210 \b \f20 \fs14 \cf0 {\b0
RAR.}{\b0 El}{\b0 objetivo}{\b0 es}{\b0 conocer}{\b0 el}{\b0 perfil}{\b0 de}
{\b0 resistencia}{\b0 molecular}{\b0 y}{\b0 fenot�- }
\par}{\phpg\posx680\pvpg\posy8231\absw5020\absh6047 \sl-210 \b \f20 \fs14 \cf0 {\b0
pica}{\b0 evaluando}{\b0 sus}{\b0 pruebas}{\b0 de}{\b0 sensibilidad}{\b0
(PS). }
\par}{\phpg\posx680\pvpg\posy8231\absw5020\absh6047 \sl-210 \b \f20 \fs14 \cf0
Material y m�todos:{\b0 Estudio}{\b0 retrospectivo}{\b0 y}{\b0 descriptivo}{\b0
mediante }
\par}{\phpg\posx680\pvpg\posy8231\absw5020\absh6047 \sl-210 \b \f20 \fs14 \cf0 {\b0
revisi�n}{\b0 de}{\b0 la}{\b0 PS}{\b0 en}{\b0 la}{\b0 base}{\b0 de}{\b0
datos}{\b0 www.netlab.ins.gob.pe}{\b0 de}{\b0 pacien- }
\par}{\phpg\posx680\pvpg\posy8231\absw5020\absh6047 \sl-210 \b \f20 \fs14 \cf0 {\b0
tes}{\b0 atendidos}{\b0 en}{\b0 el}{\b0 PCT}{\b0 del}{\b0 HNERM}{\b0 entre}
{\b0 setiembre}{\b0 2017}{\b0 y}{\b0 marzo }
\par}{\phpg\posx680\pvpg\posy8231\absw5020\absh6047 \sl-210 \b \f20 \fs14 \cf0 {\b0
2018}{\b0 usando}{\b0 Excel}{\b0 2017. }
\par}{\phpg\posx680\pvpg\posy8231\absw5020\absh6047 \sl-210 \b \f20 \fs14 \cf0
Resultados:{\b0 1.480}{\b0 atenciones}{\b0 para}{\b0 331}{\b0 pacientes.}{\b0
Edad}{\b0 45,5}{\b0 a�os}{\b0 � }
\par}{\phpg\posx680\pvpg\posy8231\absw5020\absh6047 \sl-210 \b \f20 \fs14 \cf0 {\b0
18,6,}{\b0 Varones}{\b0 61%.}{\b0 El}{\b0 78,54%}{\b0 (n}{\b0 =}{\b0 260)}
{\b0 cuentan}{\b0 al}{\b0 menos}{\b0 1}{\b0 PS.}{\b0 Se}{\b0 iden- }
\par}{\phpg\posx680\pvpg\posy8231\absw5020\absh6047 \sl-210 \b \f20 \fs14 \cf0 {\b0
tificaron}{\b0 24}{\b0 pruebas}{\b0 MODS,}{\b0 226}{\b0 pruebas}{\b0
Genotype}{\b0 y}{\b0 173}{\b0 pruebas }
\par}{\phpg\posx680\pvpg\posy8231\absw5020\absh6047 \sl-210 \b \f20 \fs14 \cf0 {\b0
convencionales}{\b0 de}{\b0 muestras}{\b0 de}{\b0 esputo}{\b0 entre}{\b0 el}
{\b0 2009-2018.}{\b0 9}{\b0 PS }
\par}{\phpg\posx680\pvpg\posy8231\absw5020\absh6047 \sl-210 \b \f20 \fs14 \cf0 {\b0
MODS,}{\b0 117}{\b0 Genotype}{\b0 y}{\b0 117}{\b0 convencionales}{\b0
expresan}{\b0 MDR.}{\b0 12}{\b0 expre- }
\par}{\phpg\posx680\pvpg\posy8231\absw5020\absh6047 \sl-210 \b \f20 \fs14 \cf0 {\b0
san}{\b0 XDR}{\b0 y}{\b0 36}{\b0 expresan}{\b0 Pre-XDR}{\b0 (21}{\b0 por}
{\b0 resistencia}{\b0 a}{\b0 Km,}{\b0 5}{\b0 a}{\b0 Lfx}{\b0 y}{\b0 10 }
\par}{\phpg\posx680\pvpg\posy8231\absw5020\absh6047 \sl-210 \b \f20 \fs14 \cf0 {\b0
a}{\b0 Cm);}{\b0 se}{\b0 reportan}{\b0 12}{\b0 casos}{\b0 de}{\b0 XDR}{\b0
todos}{\b0 en}{\b0 vih-seronegativos,}{\b0 9}{\b0 de }
\par}{\phpg\posx680\pvpg\posy8231\absw5020\absh6047 \sl-210 \b \f20 \fs14 \cf0 {\b0
estos}{\b0 en}{\b0 NT.}{\b0 De}{\b0 las}{\b0 226}{\b0 PS}{\b0 Genotype,}{\b0
180}{\b0 son}{\b0 resistentes}{\b0 a}{\b0 H,}{\b0 el}{\b0 64,4% }
\par}{\phpg\posx680\pvpg\posy8231\absw5020\absh6047 \sl-210 \b \f20 \fs14 \cf0 {\b0
por}{\b0 mutaci�n}{\b0 del}{\b0 Gen}{\b0 KatG}{\b0 y}{\b0 las}{\b0
restantes}{\b0 por}{\b0 InhA.}{\b0 En}{\b0 el}{\b0 caso}{\b0 de }
\par}{\phpg\posx680\pvpg\posy8231\absw5020\absh6047 \sl-210 \b \f20 \fs14 \cf0 {\b0
MDR}{\b0 el}{\b0 70,9%}{\b0 es}{\b0 por}{\b0 mutaci�n}{\b0 del}{\b0 KatG}
{\b0 y}{\b0 de}{\b0 estos}{\b0 el}{\b0 80,72%}{\b0 es}{\b0 sensi- }
\par}{\phpg\posx680\pvpg\posy8231\absw5020\absh6047 \sl-210 \b \f20 \fs14 \cf0 {\b0
ble}{\b0 a}{\b0 Eto.}{\b0 En}{\b0 los}{\b0 MDR}{\b0 por}{\b0 mutaci�n}{\b0
InhA,}{\b0 el}{\b0 59,9%}{\b0 fue}{\b0 sensible}{\b0 a}{\b0 H}{\b0 a }
\par}{\phpg\posx680\pvpg\posy8231\absw5020\absh6047 \sl-210 \b \f20 \fs14 \cf0 {\b0
altas}{\b0 concentraciones}{\b0 y}{\b0 el}{\b0 61,53%}{\b0 resistente}{\b0 a}
{\b0 Eto. }\par
}
{\phpg\posx6037\pvpg\posy8021\absw5020\absh6236 \b \f20 \fs14 \cf0 \b \f20 \fs14
\cf0 262. INFECCIONES AGREGADAS EN LA COINFECCI�N DE
\par}{\phpg\posx6037\pvpg\posy8021\absw5020\absh6236 \sl-200 \b \f20 \fs14 \cf0
TUBERCULOSIS Y VIH. CORRELACI�N ANATOMOPATOL�GICA
\par}{\phpg\posx6037\pvpg\posy8021\absw5020\absh6236 \sl-170 \par\b \f20 \fs14 \cf0
{\b0 M.}{\b0 Pacheco}{\b0 y}{\b0 P.}{\b0 Ojeda }
\par}{\phpg\posx6037\pvpg\posy8021\absw5020\absh6236 \sl-156 \par\b \f20 \fs14 \cf0
{\b0\i Hospital}{\b0\i Santa}{\b0\i Clara.}{\b0\i Bogot�. }
\par}{\phpg\posx6037\pvpg\posy8021\absw5020\absh6236 \sl-138 \par\par\b \f20
\fs14 \cf0 Introducci�n:{\b0 La}{\b0 presencia}{\b0 de}{\b0 tuberculosis}{\b0
(TB)}{\b0 se}{\b0 asocia}{\b0 a}{\b0 un}{\b0 incre- }
\par}{\phpg\posx6037\pvpg\posy8021\absw5020\absh6236 \sl-210 \b \f20 \fs14 \cf0
{\b0 mento}{\b0 de}{\b0 4}{\b0 veces}{\b0 la}{\b0 mortalidad}{\b0
relacionada}{\b0 con}{\b0 VIH}{\b0 y}{\b0 as�}{\b0 mismo}{\b0 el }
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}}\par}{\phpg\posx5428\pvpg\posy713\absw1048\absh138 \i \f20 \fs12 \cf0 \i \f20
\fs12 \cf0 11.� Congreso ALAT \par
}
{\phpg\posx11025\pvpg\posy711\absw205\absh142 \f20 \fs12 \cf0 \f20 \fs12 \cf0
113 \par
}
{\phpg\posx2752\pvpg\posy5223\absw1212\absh142 \f20 \fs12 \cf0 \f20 \fs12 \cf0
Granuloma no t�pico \par
}
{\phpg\posx6207\pvpg\posy1103\absw5020\absh6793 \f20 \fs15 \cf0 \f20 \fs15 \cf0
sonal de salud. Es importante que los programas nacionales de salud
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh6793 \sl-210 \f20 \fs15 \cf0
identifique estos factores ya que el retraso en el diagnostico de la
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh6793 \sl-210 \f20 \fs15 \cf0 TBC no
solo propicia el contagio en el �mbito domestico y laboral,
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh6793 \sl-210 \f20 \fs15 \cf0
tambi�n incrementa la morbimortalidad de los pacientes infectados
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh6793 \sl-210 \f20 \fs15 \cf0 al no
recibir tratamiento oportuno. En este estudio se plantea com-
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh6793 \sl-210 \f20 \fs15 \cf0 parar
el tiempo de demora del diagn�stico desde el primer d�a que
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh6793 \sl-210 \f20 \fs15 \cf0 inicia
la sintomatolog�a y el tiempo de demora del sistema de salud,
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh6793 \sl-210 \f20 \fs15 \cf0 a
partir de all� desglosar los diversos factores por parte del paciente
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh6793 \sl-210 \f20 \fs15 \cf0 o del
sistema de salud que produjeron el retraso en la poblaci�n
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh6793 \sl-210 \f20 \fs15 \cf0
policial del Per�.
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh6793 \sl-210 \f20 \fs15 \cf0 {\b
Material}{\b y}{\b m�todos:} Este estudio fue una investigaci�n retrospectiva,
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh6793 \sl-210 \f20 \fs15 \cf0 que se
realizo con todos los polic�as diagnosticados desde enero del
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh6793 \sl-210 \f20 \fs15 \cf0 2016
hasta diciembre del 2017. Para fines de este estudio, se dividi�
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh6793 \sl-210 \f20 \fs15 \cf0 en dos
grupos, aquellos con diagn�stico corto y diagnostico prolonga-
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh6793 \sl-210 \f20 \fs15 \cf0 do de
acuerdo al tiempo de demora.
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh6793 \sl-210 \f20 \fs15 \cf0 {\b
Resultados:} Se detectaron 192 polic�as durante el periodo menciona-
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh6793 \sl-210 \f20 \fs15 \cf0 do,
las medias obtenidas fueron; demora total del diagn�stico fue de
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh6793 \sl-210 \f20 \fs15 \cf0 45
d�as, demora del paciente 29 d�as, demora del m�dico 7 d�as, de-
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh6793 \sl-210 \f20 \fs15 \cf0 mora
en confirmar el diagn�stico. Se encontr� un como factor de ries-
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh6793 \sl-210 \f20 \fs15 \cf0 go
para demora total la automedicaci�n OR: 3,04 (IC:1,1-8,2) y factor
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh6793 \sl-210 \f20 \fs15 \cf0
protector no tener alguna comorbilidad OR: 0,48 (IC: 0,25-0,92), como
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh6793 \sl-210 \f20 \fs15 \cf0 factor
de riesgo para demora del paciente ser efectivo policial OR: 3,14
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh6793 \sl-210 \f20 \fs15 \cf0 (1,15-
8,57) y factor protector ser sintom�tico OR: 0,61 (IC:0,61-0,75)
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh6793 \sl-210 \f20 \fs15 \cf0 y como
factor protector protector de la demora para definir el diag-
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh6793 \sl-210 \f20 \fs15 \cf0
n�stico ser sintom�tico OR: 0,12 (IC: 0,02-0,647), en el resto de varia-
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh6793 \sl-210 \f20 \fs15 \cf0 bles
no se encontr� diferencias estad�sticamente significativas.
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh6793 \sl-210 \f20 \fs15 \cf0 {\b
Conclusiones:} Este estudio sirve como base para conocer la situaci�n
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh6793 \sl-210 \f20 \fs15 \cf0 actual
de la Tuberculosis en una poblaci�n cautiva como es la polic�a,
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh6793 \sl-210 \f20 \fs15 \cf0
incentivando a seguir con labores preventivo promocionales, sobre
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh6793 \sl-210 \f20 \fs15 \cf0 todo
en el �mbito de educaci�n a la poblaci�n. En este estudio se de-
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh6793 \sl-210 \f20 \fs15 \cf0 tect�
como factores de riesgo la automedicaci�n y el ser efectivo po-
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh6793 \sl-210 \f20 \fs15 \cf0
licial, este �ltimo en comparaci�n a los alumnos policiales est�n en
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh6793 \sl-210 \f20 \fs15 \cf0
constante evaluaci�n de su estado de salud. Por otro lado, a partir es
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh6793 \sl-210 \f20 \fs15 \cf0
importante que se hagan chequeos como m�nimo una vez al a�o,
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh6793 \sl-210 \f20 \fs15 \cf0 como
es en esta poblaci�n, en este estudio se tiene una media de
\par}{\phpg\posx6207\pvpg\posy1103\absw5020\absh6793 \sl-210 \f20 \fs15 \cf0 demora
m�s corta que en estudios similares. \par
}
{\phpg\posx850\pvpg\posy9555\absw5019\absh1832 \f20 \fs12 \cf0 \fi1835 \f20
\fs12 \cf0 ZN positivo en pulm�n
\par}{\phpg\posx850\pvpg\posy9555\absw5019\absh1832 \sl-199 \par\f20 \fs12 \cf0 {\b
\fs15 Conclusiones:}{\fs15 La}{\fs15 presencia}{\fs15 de}{\fs15 VIH}{\fs15 y}
{\fs15 TB}{\fs15 se}{\fs15 acompa�a}{\fs15 de}{\fs15 mayores }
\par}{\phpg\posx850\pvpg\posy9555\absw5019\absh1832 \sl-210 \f20 \fs12 \cf0 {\fs15
tasas}{\fs15 de}{\fs15 mortalidad,}{\fs15 es}{\fs15 fundamental}{\fs15 para}
{\fs15 el}{\fs15 cl�nico}{\fs15 identificar}{\fs15 las}{\fs15 di- }
\par}{\phpg\posx850\pvpg\posy9555\absw5019\absh1832 \sl-210 \f20 \fs12 \cf0 {\fs15
ferentes}{\fs15 formas}{\fs15 de}{\fs15 presentaci�n}{\fs15 de}{\fs15 esta}
{\fs15 asociaci�n}{\fs15 y}{\fs15 reconocer}{\fs15 que }
\par}{\phpg\posx850\pvpg\posy9555\absw5019\absh1832 \sl-210 \f20 \fs12 \cf0 {\fs15
en}{\fs15 un}{\fs15 45%}{\fs15 de}{\fs15 los}{\fs15 casos}{\fs15 se}{\fs15
encuentra}{\fs15 compromiso}{\fs15 bacteriano}{\fs15 agregado, }
\par}{\phpg\posx850\pvpg\posy9555\absw5019\absh1832 \sl-210 \f20 \fs12 \cf0 {\fs15
as�}{\fs15 mismo}{\fs15 un}{\fs15 10%}{\fs15 de}{\fs15 Pneumocystis}{\fs15
jirovecii}{\fs15 y}{\fs15 un}{\fs15 3%}{\fs15 de}{\fs15 Paracoccidio- }
\par}{\phpg\posx850\pvpg\posy9555\absw5019\absh1832 \sl-210 \f20 \fs12 \cf0 {\fs15
domicosis.}{\fs15 Puede}{\fs15 ser}{\fs15 importante}{\fs15 para}{\fs15 el}
{\fs15 cl�nico}{\fs15 en}{\fs15 casos}{\fs15 de}{\fs15 mala}{\fs15 res- }
\par}{\phpg\posx850\pvpg\posy9555\absw5019\absh1832 \sl-210 \f20 \fs12 \cf0 {\fs15
puesta}{\fs15 a}{\fs15 tratamientos}{\fs15 iniciales}{\fs15 tener}{\fs15 en}
{\fs15 cuenta}{\fs15 la}{\fs15 posibilidad}{\fs15 de}{\fs15 otras }
\par}{\phpg\posx850\pvpg\posy9555\absw5019\absh1832 \sl-210 \f20 \fs12 \cf0 {\fs15
infecciones}{\fs15 adicionales}{\fs15 agregadas. }\par
}
{\phpg\posx850\pvpg\posy12011\absw5018\absh2645 \b \f20 \fs15 \cf0 \b \f20 \fs15
\cf0 263. DEMORA EN EL DIAGN�STICO DE TUBERCULOSIS
\par}{\phpg\posx850\pvpg\posy12011\absw5018\absh2645 \sl-200 \b \f20 \fs15 \cf0 EN
POLIC�AS PERUANOS
\par}{\phpg\posx850\pvpg\posy12011\absw5018\absh2645 \sl-170 \par\b \f20 \fs15 \cf0
{\b0 J.}{\b0 Laca}{\b0 y}{\b0 A.}{\b0 Coz }
\par}{\phpg\posx850\pvpg\posy12011\absw5018\absh2645 \sl-156 \par\b \f20 \fs15 \cf0
{\b0\i HNPNP}{\b0\i Luis}{\b0\i N.}{\b0\i S�enz. }
\par}{\phpg\posx850\pvpg\posy12011\absw5018\absh2645 \sl-138 \par\par\b \f20
\fs15 \cf0 Introducci�n:{\b0 La}{\b0 tuberculosis}{\b0 (TBC)}{\b0 es}{\b0 una}
{\b0 enfermedad}{\b0 curable}{\b0 que }
\par}{\phpg\posx850\pvpg\posy12011\absw5018\absh2645 \sl-210 \b \f20 \fs15 \cf0
{\b0 contin�a}{\b0 siendo}{\b0 un}{\b0 gran}{\b0 problema}{\b0 de}{\b0 salud}
{\b0 p�blica.}{\b0 Afectando}{\b0 sin }
\par}{\phpg\posx850\pvpg\posy12011\absw5018\absh2645 \sl-210 \b \f20 \fs15 \cf0
{\b0 discriminar}{\b0 las}{\b0 distintas}{\b0 sociedades.}{\b0 Per�}{\b0
ocupa}{\b0 un}{\b0 lugar}{\b0 en}{\b0 el}{\b0 lista- }
\par}{\phpg\posx850\pvpg\posy12011\absw5018\absh2645 \sl-210 \b \f20 \fs15 \cf0
{\b0 do}{\b0 de}{\b0 pa�ses}{\b0 end�micos}{\b0 para}{\b0 TBC}{\b0 y}{\b0
pa�ses}{\b0 con}{\b0 alta}{\b0 carga}{\b0 de}{\b0 tubercu- }
\par}{\phpg\posx850\pvpg\posy12011\absw5018\absh2645 \sl-210 \b \f20 \fs15 \cf0
{\b0 losis}{\b0 multidrogo}{\b0 resistente}{\b0 (TBC-MDR).}{\b0 Factores}{\b0
asociados}{\b0 a}{\b0 un}{\b0 diag- }
\par}{\phpg\posx850\pvpg\posy12011\absw5018\absh2645 \sl-210 \b \f20 \fs15 \cf0
{\b0 nostico}{\b0 tard�o}{\b0 son;}{\b0 presentaci�n}{\b0 diversa}{\b0
de}{\b0 sintomatolog�a,}{\b0 la }
\par}{\phpg\posx850\pvpg\posy12011\absw5018\absh2645 \sl-210 \b \f20 \fs15 \cf0
{\b0 demora}{\b0 del}{\b0 paciente}{\b0 en}{\b0 acudir}{\b0 a}{\b0 un}{\b0
centro}{\b0 de}{\b0 salud,}{\b0 automedicaci�n, }
\par}{\phpg\posx850\pvpg\posy12011\absw5018\absh2645 \sl-210 \b \f20 \fs15 \cf0
{\b0 demora}{\b0 en}{\b0 el}{\b0 diagnostico}{\b0 e}{\b0 inicio}{\b0 de}{\b0
tratamiento}{\b0 por}{\b0 parte}{\b0 del}{\b0 per- }\par
}
{\phpg\posx6207\pvpg\posy9071\absw5020\absh5291 \b \f20 \fs15 \cf0 \b \f20 \fs15
\cf0 264. IDENTIFICACI�N DE FACTORES DE RIESGO EN PACIENTES
\par}{\phpg\posx6207\pvpg\posy9071\absw5020\absh5291 \sl-200 \b \f20 \fs15 \cf0 CON
DIAGN�STICO DE TUBERCULOSIS MILIAR EN UN HOSPITAL
\par}{\phpg\posx6207\pvpg\posy9071\absw5020\absh5291 \sl-200 \b \f20 \fs15 \cf0 DE
CONCENTRACI�N DE LA CIUDAD DE M�XICO
\par}{\phpg\posx6207\pvpg\posy9071\absw5020\absh5291 \sl-170 \par\b \f20 \fs15 \cf0
{\b0 M.}{\b0 Cruz,}{\b0 M.}{\b0 Ram�rez,}{\b0 E.}{\b0 Ram�rez,}{\b0 A.}{\b0
Hern�ndez}{\b0 y}{\b0 R.}{\b0 Cisero }
\par}{\phpg\posx6207\pvpg\posy9071\absw5020\absh5291 \sl-156 \par\b \f20 \fs15 \cf0
{\b0\i Neumolog�a.}{\b0\i Hospital}{\b0\i General}{\b0\i de}{\b0\i M�xico.}
{\b0\i Cl�nica}{\b0\i de}{\b0\i Tuberculosis. }
\par}{\phpg\posx6207\pvpg\posy9071\absw5020\absh5291 \sl-200 \b \f20 \fs15 \cf0
{\b0\i Hospital}{\b0\i General}{\b0\i de}{\b0\i M�xico. }
\par}{\phpg\posx6207\pvpg\posy9071\absw5020\absh5291 \sl-217 \par\b \f20 \fs15 \cf0
Introducci�n:{\b0 La}{\b0 tuberculosis}{\b0 extrapulmonar}{\b0 es}{\b0 un}{\b0
problema}{\b0 de}{\b0 sa- }
\par}{\phpg\posx6207\pvpg\posy9071\absw5020\absh5291 \sl-210 \b \f20 \fs15 \cf0
{\b0 lud}{\b0 p�blica}{\b0 y}{\b0 se}{\b0 define}{\b0 como}{\b0 aquella}{\b0
infecci�n}{\b0 producida}{\b0 por}{\b0 Myco- }
\par}{\phpg\posx6207\pvpg\posy9071\absw5020\absh5291 \sl-210 \b \f20 \fs15 \cf0
{\b0 bacterium}{\b0 tuberculosis}{\b0 que}{\b0 afecta}{\b0 a}{\b0 tejidos}{\b0
y}{\b0 �rganos}{\b0 fuera}{\b0 del}{\b0 par�n- }
\par}{\phpg\posx6207\pvpg\posy9071\absw5020\absh5291 \sl-210 \b \f20 \fs15 \cf0
{\b0 quima}{\b0 pulmonar,}{\b0 representa}{\b0 del}{\b0 20}{\b0 al}{\b0
25%}{\b0 de}{\b0 los}{\b0 casos}{\b0 con }
\par}{\phpg\posx6207\pvpg\posy9071\absw5020\absh5291 \sl-210 \b \f20 \fs15 \cf0
{\b0 diagnostico}{\b0 de}{\b0 tuberculosis.}{\b0 La}{\b0 tuberculosis}{\b0
miliar}{\b0 se}{\b0 produce}{\b0 por}{\b0 una }
\par}{\phpg\posx6207\pvpg\posy9071\absw5020\absh5291 \sl-210 \b \f20 \fs15 \cf0
{\b0 diseminaci�n}{\b0 hemat�gena}{\b0 a}{\b0 m�ltiples}{\b0 �rganos}{\b0 y}
{\b0 puede}{\b0 ser}{\b0 el}{\b0 resul- }
\par}{\phpg\posx6207\pvpg\posy9071\absw5020\absh5291 \sl-210 \b \f20 \fs15 \cf0
{\b0 tado}{\b0 de}{\b0 una}{\b0 primoinfecci�n}{\b0 o}{\b0 bien}{\b0
reactivaci�n}{\b0 de}{\b0 alg�n}{\b0 foco}{\b0 latente. }
\par}{\phpg\posx6207\pvpg\posy9071\absw5020\absh5291 \sl-210 \b \f20 \fs15 \cf0
{\b0 Afecta}{\b0 fundamentalmente}{\b0 a}{\b0 personas}{\b0 con}{\b0 alguna}
{\b0 clase}{\b0 de}{\b0 inmunode- }
\par}{\phpg\posx6207\pvpg\posy9071\absw5020\absh5291 \sl-210 \b \f20 \fs15 \cf0
{\b0 ficiencias}{\b0 tales}{\b0 como}{\b0 ser}{\b0 de}{\b0 la}{\b0 tercera}
{\b0 edad,}{\b0 diabetes}{\b0 mellitus,}{\b0 desnu- }
\par}{\phpg\posx6207\pvpg\posy9071\absw5020\absh5291 \sl-210 \b \f20 \fs15 \cf0
{\b0 trici�n,}{\b0 SIDA,}{\b0 etc. }
\par}{\phpg\posx6207\pvpg\posy9071\absw5020\absh5291 \sl-210 \b \f20 \fs15 \cf0
Material y m�todos:{\b0 Se}{\b0 realiz�}{\b0 un}{\b0 estudio}{\b0
prospectivo,}{\b0 transversal}{\b0 de }
\par}{\phpg\posx6207\pvpg\posy9071\absw5020\absh5291 \sl-210 \b \f20 \fs15 \cf0
{\b0 casos}{\b0 y}{\b0 controles}{\b0 de}{\b0 enero}{\b0 del}{\b0 a�o}{\b0
2015}{\b0 a}{\b0 marzo}{\b0 del}{\b0 2018}{\b0 de}{\b0 pacientes }
\par}{\phpg\posx6207\pvpg\posy9071\absw5020\absh5291 \sl-210 \b \f20 \fs15 \cf0
{\b0 ingresados}{\b0 en}{\b0 el}{\b0 servicio}{\b0 de}{\b0 Neumolog�a}{\b0
con}{\b0 sospecha}{\b0 diagn�stica}{\b0 de }
\par}{\phpg\posx6207\pvpg\posy9071\absw5020\absh5291 \sl-210 \b \f20 \fs15 \cf0
{\b0 tuberculosis}{\b0 miliar.}{\b0 Se}{\b0 emple�}{\b0 un}{\b0 modelo}{\b0
de}{\b0 regresi�n}{\b0 log�stica}{\b0 con- }
\par}{\phpg\posx6207\pvpg\posy9071\absw5020\absh5291 \sl-210 \b \f20 \fs15 \cf0
{\b0 dicional}{\b0 m�ltiple}{\b0 para}{\b0 identificar}{\b0 factores}{\b0 de}
{\b0 riesgo.}{\b0 A}{\b0 todos}{\b0 los}{\b0 pa- }
\par}{\phpg\posx6207\pvpg\posy9071\absw5020\absh5291 \sl-210 \b \f20 \fs15 \cf0
{\b0 cientes}{\b0 se}{\b0 les}{\b0 realiz�}{\b0 evaluaci�n}{\b0 cl�nica}{\b0
completa}{\b0 y}{\b0 estudios}{\b0 de}{\b0 labo- }
\par}{\phpg\posx6207\pvpg\posy9071\absw5020\absh5291 \sl-210 \b \f20 \fs15 \cf0
{\b0 ratorios}{\b0 iniciales,}{\b0 se}{\b0 realizaron}{\b0 estudios}{\b0
bacteriol�gicos}{\b0 para}{\b0 realizar }
\par}{\phpg\posx6207\pvpg\posy9071\absw5020\absh5291 \sl-210 \b \f20 \fs15 \cf0
{\b0 el}{\b0 diagn�stico}{\b0 de}{\b0 tuberculosis}{\b0 tales}{\b0 como,}{\b0
cultivo}{\b0 de}{\b0 Lowestein-Jen- }
\par}{\phpg\posx6207\pvpg\posy9071\absw5020\absh5291 \sl-210 \b \f20 \fs15 \cf0
{\b0 sen,}{\b0 MGITI960,}{\b0 tinci�n}{\b0 de}{\b0 Ziehl-Neelsen}{\b0 y}{\b0
PCR}{\b0 en}{\b0 punto}{\b0 final}{\b0 dirigida }
\par}{\phpg\posx6207\pvpg\posy9071\absw5020\absh5291 \sl-210 \b \f20 \fs15 \cf0
{\b0 a}{\b0 la}{\b0 secuencia}{\b0 de}{\b0 inserci�n}{\b0 1S6110}{\b0 para}
{\b0 M.}{\b0 tuberculosis}{\b0 de}{\b0 diversos }\par
}
\sect\sectd\pard\plain
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}}\par}{\phpg\posx680\pvpg\posy711\absw205\absh142 \f20 \fs11 \cf0 \f20 \fs11 \cf0
114 \par
}
{\phpg\posx5258\pvpg\posy713\absw1048\absh138 \i \f20 \fs11 \cf0 \i \f20 \fs11 \cf0
11.� Congreso ALAT \par
}
{\phpg\posx680\pvpg\posy1103\absw5020\absh4147 \f20 \fs14 \cf0 \f20 \fs14 \cf0
tejidos, se complement� protocolo con la realizaci�n de tomograf�a
\par}{\phpg\posx680\pvpg\posy1103\absw5020\absh4147 \sl-210 \f20 \fs14 \cf0 de alta
resoluci�n.
\par}{\phpg\posx680\pvpg\posy1103\absw5020\absh4147 \sl-210 \f20 \fs14 \cf0 {\b
Resultados:} 32 pacientes fueron identificados con diagn�stico de tu-
\par}{\phpg\posx680\pvpg\posy1103\absw5020\absh4147 \sl-210 \f20 \fs14 \cf0
berculosis miliar, 13 mujeres y 19 hombres y 64 controles con diag-
\par}{\phpg\posx680\pvpg\posy1103\absw5020\absh4147 \sl-210 \f20 \fs14 \cf0 nostico
de patolog�a pulmonar no tuberculosa. 18 pacientes se encon-
\par}{\phpg\posx680\pvpg\posy1103\absw5020\absh4147 \sl-210 \f20 \fs14 \cf0 traron
con IMC < 20, de los cuales 10 fueron con peso suficiente, 5 con
\par}{\phpg\posx680\pvpg\posy1103\absw5020\absh4147 \sl-210 \f20 \fs14 \cf0
desnutrici�n grado 2 y 3 con desnutrici�n grado 3. La media de edad
\par}{\phpg\posx680\pvpg\posy1103\absw5020\absh4147 \sl-210 \f20 \fs14 \cf0 fue de
40 a�os, la principal comorbilidad fue tabaquismo y alcoholis-
\par}{\phpg\posx680\pvpg\posy1103\absw5020\absh4147 \sl-210 \f20 \fs14 \cf0 mo. El
motivo de ingreso fue la dificultad respiratoria. La disnea (68%
\par}{\phpg\posx680\pvpg\posy1103\absw5020\absh4147 \sl-210 \f20 \fs14 \cf0 y tos
(71,8%) fueron los s�ntomas principales. El 56% presento hipoal-
\par}{\phpg\posx680\pvpg\posy1103\absw5020\absh4147 \sl-210 \f20 \fs14 \cf0
buminemia al ingreso, se evidencio elevaci�n de fosfatasa alcalina en
\par}{\phpg\posx680\pvpg\posy1103\absw5020\absh4147 \sl-210 \f20 \fs14 \cf0 el 53%
hasta valores de 2 a 3 veces por arriba del valor normal, la DHL
\par}{\phpg\posx680\pvpg\posy1103\absw5020\absh4147 \sl-210 \f20 \fs14 \cf0 se
mostro elevada en el 37,5%, hiponatremia e hipocalcemia fueron los
\par}{\phpg\posx680\pvpg\posy1103\absw5020\absh4147 \sl-210 \f20 \fs14 \cf0
trastornos hidroelectrol�ticos principales. 56% mostraron datos de fi-
\par}{\phpg\posx680\pvpg\posy1103\absw5020\absh4147 \sl-210 \f20 \fs14 \cf0
brot�rax en su radiograf�a de ingreso.
\par}{\phpg\posx680\pvpg\posy1103\absw5020\absh4147 \sl-210 \f20 \fs14 \cf0 {\b
Conclusiones:} La tuberculosis miliar es una de las formas extrapul-
\par}{\phpg\posx680\pvpg\posy1103\absw5020\absh4147 \sl-210 \f20 \fs14 \cf0 monares
de la tuberculosis y la epidemiolog�a actual asocia estas for-
\par}{\phpg\posx680\pvpg\posy1103\absw5020\absh4147 \sl-210 \f20 \fs14 \cf0 mas de
presentaci�n a factores como enfermedades cr�nico degene-
\par}{\phpg\posx680\pvpg\posy1103\absw5020\absh4147 \sl-210 \f20 \fs14 \cf0
rativas, infecci�n por HIV y estados de inmunosupresi�n. Nuestra
\par}{\phpg\posx680\pvpg\posy1103\absw5020\absh4147 \sl-210 \f20 \fs14 \cf0 serie
demuestra una contrariedad en estos datos y muestra factores
\par}{\phpg\posx680\pvpg\posy1103\absw5020\absh4147 \sl-210 \f20 \fs14 \cf0 como la
presencia de cavernas, etilismo cr�nico y tabaquismo como
\par}{\phpg\posx680\pvpg\posy1103\absw5020\absh4147 \sl-210 \f20 \fs14 \cf0
factores de riesgo con mayor importancia para ingreso hospitalario. \par
}
{\phpg\posx6037\pvpg\posy1101\absw5017\absh935 \b \f20 \fs14 \cf0 \b \f20 \fs14
\cf0 Conclusiones:{\b0 La}{\b0 tuberculosis}{\b0 miliar}{\b0 es}{\b0 una}{\b0
de}{\b0 las}{\b0 formas}{\b0 m�s}{\b0 letales }
\par}{\phpg\posx6037\pvpg\posy1101\absw5017\absh935 \sl-210 \b \f20 \fs14 \cf0 {\b0
de}{\b0 la}{\b0 tuberculosis}{\b0 con}{\b0 esta}{\b0 revisi�n}{\b0
observamos}{\b0 que}{\b0 las}{\b0 im�genes}{\b0 ra- }
\par}{\phpg\posx6037\pvpg\posy1101\absw5017\absh935 \sl-210 \b \f20 \fs14 \cf0 {\b0
diol�gicas}{\b0 son}{\b0 m�ltiples}{\b0 y}{\b0 sobre}{\b0 todo}{\b0 que}{\b0
las}{\b0 secuelas}{\b0 de}{\b0 tuberculosis }
\par}{\phpg\posx6037\pvpg\posy1101\absw5017\absh935 \sl-210 \b \f20 \fs14 \cf0 {\b0
pulmonar}{\b0 son}{\b0 un}{\b0 grupo}{\b0 de}{\b0 riesgo}{\b0 para}{\b0 el}
{\b0 desarrollo}{\b0 de}{\b0 la}{\b0 forma}{\b0 dise- }
\par}{\phpg\posx6037\pvpg\posy1101\absw5017\absh935 \sl-210 \b \f20 \fs14 \cf0 {\b0
minada}{\b0 de}{\b0 la}{\b0 enfermedad. }\par
}
{\phpg\posx680\pvpg\posy6131\absw5020\absh7937 \b \f20 \fs14 \cf0 \b \f20 \fs14
\cf0 265. HALLAZGOS RADIOGR�FICOS EN PACIENTES CON
\par}{\phpg\posx680\pvpg\posy6131\absw5020\absh7937 \sl-200 \b \f20 \fs14 \cf0
TUBERCULOSIS MILIAR EN LA UNIDAD DE NEUMOLOG�A
\par}{\phpg\posx680\pvpg\posy6131\absw5020\absh7937 \sl-200 \b \f20 \fs14 \cf0 DEL
HOSPITAL GENERAL DE M�XICO
\par}{\phpg\posx680\pvpg\posy6131\absw5020\absh7937 \sl-170 \par\b \f20 \fs14 \cf0
{\b0 M.}{\b0 Cruz,}{\b0 M.}{\b0 Ram�rez,}{\b0 E.}{\b0 Ram�rez,}{\b0 A.}{\b0
Hern�ndez}{\b0 y}{\b0 R.}{\b0 Cisero }
\par}{\phpg\posx680\pvpg\posy6131\absw5020\absh7937 \sl-156 \par\b \f20 \fs14 \cf0
{\b0\i Neumolog�a.}{\b0\i Hospital}{\b0\i General}{\b0\i de}{\b0\i M�xico.}
{\b0\i Cl�nica}{\b0\i de}{\b0\i Tuberculosis. }
\par}{\phpg\posx680\pvpg\posy6131\absw5020\absh7937 \sl-200 \b \f20 \fs14 \cf0
{\b0\i Hospital}{\b0\i General}{\b0\i de}{\b0\i M�xico. }
\par}{\phpg\posx680\pvpg\posy6131\absw5020\absh7937 \sl-217 \par\b \f20 \fs14 \cf0
Introducci�n:{\b0 La}{\b0 tuberculosis}{\b0 miliar}{\b0 se}{\b0 produce}{\b0
por}{\b0 una}{\b0 disemina- }
\par}{\phpg\posx680\pvpg\posy6131\absw5020\absh7937 \sl-210 \b \f20 \fs14 \cf0 {\b0
ci�n}{\b0 hemat�gena}{\b0 a}{\b0 m�ltiples}{\b0 �rganos}{\b0 y}{\b0 puede}
{\b0 ser}{\b0 el}{\b0 resultado}{\b0 de}{\b0 una }
\par}{\phpg\posx680\pvpg\posy6131\absw5020\absh7937 \sl-210 \b \f20 \fs14 \cf0 {\b0
primoinfecci�n}{\b0 o}{\b0 bien}{\b0 reactivaci�n}{\b0 de}{\b0 alg�n}{\b0
foco}{\b0 latente.}{\b0 Es}{\b0 una}{\b0 de}{\b0 las }
\par}{\phpg\posx680\pvpg\posy6131\absw5020\absh7937 \sl-210 \b \f20 \fs14 \cf0 {\b0
tres}{\b0 principales}{\b0 formas}{\b0 de}{\b0 presentaci�n}{\b0
extrapulmonar}{\b0 en}{\b0 nuestro }
\par}{\phpg\posx680\pvpg\posy6131\absw5020\absh7937 \sl-210 \b \f20 \fs14 \cf0 {\b0
medio.}{\b0 El}{\b0 t�rmino}{\b0 de}{\b0 miliar}{\b0 hace}{\b0 referencia}
{\b0 a}{\b0 la}{\b0 observaci�n}{\b0 en}{\b0 la }
\par}{\phpg\posx680\pvpg\posy6131\absw5020\absh7937 \sl-210 \b \f20 \fs14 \cf0 {\b0
anatom�a}{\b0 patol�gica}{\b0 de}{\b0 la}{\b0 superficie}{\b0 del}{\b0
pulm�n}{\b0 de}{\b0 peque�os}{\b0 n�dulos }
\par}{\phpg\posx680\pvpg\posy6131\absw5020\absh7937 \sl-210 \b \f20 \fs14 \cf0 {\b0
blanquecinos}{\b0 similares}{\b0 a}{\b0 semillas}{\b0 de}{\b0 mijo.}{\b0
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8a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0
028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028
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0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a002
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0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a002
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028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028
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28a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a
28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a
0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a002
8a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a2
8a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0
028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028
a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28
a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a00
28a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a
28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a
0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a002
8a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a2
8a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a00ffd9
}}\par}{\phpg\posx5428\pvpg\posy713\absw1048\absh138 \i \f20 \fs12 \cf0 \i \f20
\fs12 \cf0 11.� Congreso ALAT \par
}
{\phpg\posx850\pvpg\posy1103\absw5020\absh3767 \f20 \fs15 \cf0 \f20 \fs15 \cf0 les
de Antioquia, se decide implementar esquema de rescate con in-
\par}{\phpg\posx850\pvpg\posy1103\absw5020\absh3767 \sl-209 \f20 \fs15 \cf0 clusi�n
de meropenem, amx/clv, capreomicina, PAS, pirazinamida, I,
\par}{\phpg\posx850\pvpg\posy1103\absw5020\absh3767 \sl-209 \f20 \fs15 \cf0 Mfx,
linezolid a altas dosis, logrando conversi�n microbiol�gica al
\par}{\phpg\posx850\pvpg\posy1103\absw5020\absh3767 \sl-209 \f20 \fs15 \cf0 quinto
mes de tratamiento y cambios significativos en el par�nquima
\par}{\phpg\posx850\pvpg\posy1103\absw5020\absh3767 \sl-209 \f20 \fs15 \cf0
pulmonar (fig.).
\par}{\phpg\posx850\pvpg\posy1103\absw5020\absh3767 \sl-209 \f20 \fs15 \cf0 {\b
Conclusiones:} La tuberculosis pulmonar es una patolog�a con alta mor-
\par}{\phpg\posx850\pvpg\posy1103\absw5020\absh3767 \sl-209 \f20 \fs15 \cf0
bilidad, siendo la farmacoresistencia un par�metro de pron�stico desfa-
\par}{\phpg\posx850\pvpg\posy1103\absw5020\absh3767 \sl-209 \f20 \fs15 \cf0
vorable. El bacilo tuberculoso presenta una betalactamasa tipo A. Estu-
\par}{\phpg\posx850\pvpg\posy1103\absw5020\absh3767 \sl-209 \f20 \fs15 \cf0 dios in
vitro evidencian que el meropenem asociado al clavulanato
\par}{\phpg\posx850\pvpg\posy1103\absw5020\absh3767 \sl-209 \f20 \fs15 \cf0
disminuye el crecimiento bacteriano. In vivo los desenlaces son contro-
\par}{\phpg\posx850\pvpg\posy1103\absw5020\absh3767 \sl-209 \f20 \fs15 \cf0
versiales. Una serie de casos evidenci� la conversi�n microbiol�gica en 4
\par}{\phpg\posx850\pvpg\posy1103\absw5020\absh3767 \sl-209 \f20 \fs15 \cf0 de 5
pacientes con diagn�stico de TB-XDR. No obstante hay otros repor-
\par}{\phpg\posx850\pvpg\posy1103\absw5020\absh3767 \sl-209 \f20 \fs15 \cf0 tes
donde s�lo 2 de 3 individuos con este diagn�stico lograron dicha
\par}{\phpg\posx850\pvpg\posy1103\absw5020\absh3767 \sl-209 \f20 \fs15 \cf0
conversi�n, el tercer paciente present� una desenlace fatal. En el presen-
\par}{\phpg\posx850\pvpg\posy1103\absw5020\absh3767 \sl-209 \f20 \fs15 \cf0 te caso
se logr� la conversi�n bacteriol�gica en el 5� mes de tratamiento
\par}{\phpg\posx850\pvpg\posy1103\absw5020\absh3767 \sl-209 \f20 \fs15 \cf0
incluyendo al carbapen�mico, lo cual se correlaciona con la literatura
\par}{\phpg\posx850\pvpg\posy1103\absw5020\absh3767 \sl-209 \f20 \fs15 \cf0
mundial. En nuestro medio aun no se cuentan con reportes de curaci�n
\par}{\phpg\posx850\pvpg\posy1103\absw5020\absh3767 \sl-209 \f20 \fs15 \cf0 con
dicho esquema, por lo cual toma relevancia el presente reporte,
\par}{\phpg\posx850\pvpg\posy1103\absw5020\absh3767 \sl-209 \f20 \fs15 \cf0 como
base para el dise�o de futuros estudios que permitan reducir la
\par}{\phpg\posx850\pvpg\posy1103\absw5020\absh3767 \sl-209 \f20 \fs15 \cf0
mortalidad y morbilidad de �sta patolog�a en nuestra poblaci�n. \par
}
{\phpg\posx11025\pvpg\posy711\absw205\absh142 \f20 \fs12 \cf0 \f20 \fs12 \cf0
115 \par
}
{\phpg\posx6207\pvpg\posy1099\absw5019\absh367 \f20 \fs15 \cf0 \f20 \fs15 \cf0
cohol y drogas, recomendamos incluir apoyo sicosocial vinculado a
\par}{\phpg\posx6207\pvpg\posy1099\absw5019\absh367 \sl-209 \f20 \fs15 \cf0
adherencia al tratamiento en intervenciones en la prisi�n. \par
}
{\phpg\posx850\pvpg\posy5710\absw5020\absh8313 \b \f20 \fs15 \cf0 \b \f20 \fs15
\cf0 267. FACTORES PREDICTORES DE FRACASO AL TRATAMIENTO EN
\par}{\phpg\posx850\pvpg\posy5710\absw5020\absh8313 \sl-200 \b \f20 \fs15 \cf0 LA
TUBERCULOSIS MULTIRRESISTENTE EN PERSONAS PRIVADAS
\par}{\phpg\posx850\pvpg\posy5710\absw5020\absh8313 \sl-200 \b \f20 \fs15 \cf0 DE
SU LIBERTAD
\par}{\phpg\posx850\pvpg\posy5710\absw5020\absh8313 \sl-170 \par\b \f20 \fs15 \cf0
{\b0 S.}{\b0 Manga,}{\b0 O.}{\b0 Jave}{\b0 y}{\b0 J.}{\b0 Best }
\par}{\phpg\posx850\pvpg\posy5710\absw5020\absh8313 \sl-156 \par\b \f20 \fs15 \cf0
{\b0\i Universidad}{\b0\i Nacional}{\b0\i Mayor}{\b0\i de}{\b0\i San}{\b0\i
Marcos.}{\b0\i Instituto}{\b0\i Nacional }
\par}{\phpg\posx850\pvpg\posy5710\absw5020\absh8313 \sl-200 \b \f20 \fs15 \cf0
{\b0\i Penitenciario}{\b0\i de}{\b0\i Per�. }
\par}{\phpg\posx850\pvpg\posy5710\absw5020\absh8313 \sl-217 \par\b \f20 \fs15 \cf0
Introducci�n:{\b0 La}{\b0 actual}{\b0 epidemia}{\b0 de}{\b0 TBC}{\b0 en}{\b0
la}{\b0 regi�n}{\b0 de}{\b0 las}{\b0 Am�ricas }
\par}{\phpg\posx850\pvpg\posy5710\absw5020\absh8313 \sl-209 \b \f20 \fs15 \cf0 {\b0
se}{\b0 caracteriza}{\b0 por}{\b0 un}{\b0 contexto}{\b0 epidemiol�gico}{\b0
de}{\b0 resistencia}{\b0 a}{\b0 m�lti- }
\par}{\phpg\posx850\pvpg\posy5710\absw5020\absh8313 \sl-209 \b \f20 \fs15 \cf0 {\b0
ples}{\b0 drogas}{\b0 (MDR)}{\b0 y}{\b0 alta}{\b0 mortalidad}{\b0 en}{\b0
poblaciones}{\b0 especialmente }
\par}{\phpg\posx850\pvpg\posy5710\absw5020\absh8313 \sl-209 \b \f20 \fs15 \cf0 {\b0
vulnerables}{\b0 como}{\b0 personas}{\b0 privadas}{\b0 de}{\b0 libertad,}{\b0
en}{\b0 este}{\b0 grupo}{\b0 se}{\b0 con- }
\par}{\phpg\posx850\pvpg\posy5710\absw5020\absh8313 \sl-209 \b \f20 \fs15 \cf0 {\b0
centra}{\b0 una}{\b0 din�mica}{\b0 epidemiol�gica}{\b0 de}{\b0 mayor}{\b0
proporci�n}{\b0 de}{\b0 XDR}{\b0 TB }
\par}{\phpg\posx850\pvpg\posy5710\absw5020\absh8313 \sl-209 \b \f20 \fs15 \cf0 {\b0
que}{\b0 la}{\b0 que}{\b0 se}{\b0 da}{\b0 en}{\b0 la}{\b0 poblaci�n}{\b0
de}{\b0 referencia}{\b0 y}{\b0 las}{\b0 tasas}{\b0 de}{\b0 fracaso}{\b0 al }
\par}{\phpg\posx850\pvpg\posy5710\absw5020\absh8313 \sl-209 \b \f20 \fs15 \cf0 {\b0
tratamiento}{\b0 son}{\b0 mayores}{\b0 debido}{\b0 a}{\b0 las}{\b0
restricciones}{\b0 y}{\b0 limitaciones}{\b0 de }
\par}{\phpg\posx850\pvpg\posy5710\absw5020\absh8313 \sl-209 \b \f20 \fs15 \cf0 {\b0
la}{\b0 vida}{\b0 en}{\b0 las}{\b0 c�rceles. }
\par}{\phpg\posx850\pvpg\posy5710\absw5020\absh8313 \sl-209 \b \f20 \fs15 \cf0
Material y m�todos:{\b0 Se}{\b0 trata}{\b0 de}{\b0 un}{\b0 estudio}{\b0 de}
{\b0 cohortes}{\b0 retrospectivo }
\par}{\phpg\posx850\pvpg\posy5710\absw5020\absh8313 \sl-209 \b \f20 \fs15 \cf0 {\b0
en}{\b0 el}{\b0 que}{\b0 hemos}{\b0 estudiado}{\b0 la}{\b0 asociaci�n}{\b0
m�ltiple}{\b0 entre}{\b0 factores}{\b0 pre- }
\par}{\phpg\posx850\pvpg\posy5710\absw5020\absh8313 \sl-209 \b \f20 \fs15 \cf0 {\b0
dictores}{\b0 de}{\b0 fracaso}{\b0 al}{\b0 tratamiento}{\b0 como}{\b0 son:}
{\b0 patr�n}{\b0 de}{\b0 resistencia}{\b0 de }
\par}{\phpg\posx850\pvpg\posy5710\absw5020\absh8313 \sl-209 \b \f20 \fs15 \cf0 {\b0
tuberculosis}{\b0 (MDR}{\b0 o}{\b0 XDR),}{\b0 edad,}{\b0 uso}{\b0 de}{\b0
drogas}{\b0 y}{\b0 alcohol}{\b0 y}{\b0 co}{\b0 infec- }
\par}{\phpg\posx850\pvpg\posy5710\absw5020\absh8313 \sl-209 \b \f20 \fs15 \cf0 {\b0
ci�n}{\b0 VIH}{\b0 mediante}{\b0 an�lisis}{\b0 univariado}{\b0 y}{\b0
multivariado. }
\par}{\phpg\posx850\pvpg\posy5710\absw5020\absh8313 \sl-209 \b \f20 \fs15 \cf0
Resultados:{\b0 Se}{\b0 obtuvieron}{\b0 las}{\b0 bases}{\b0 de}{\b0 datos}
{\b0 de}{\b0 1660}{\b0 personas}{\b0 priva- }
\par}{\phpg\posx850\pvpg\posy5710\absw5020\absh8313 \sl-209 \b \f20 \fs15 \cf0 {\b0
das}{\b0 de}{\b0 libertas}{\b0 viviendo}{\b0 con}{\b0 TB}{\b0 MDR,}{\b0 764}
{\b0 (46,13%%)}{\b0 fueron}{\b0 pre}{\b0 -}{\b0 XDR }
\par}{\phpg\posx850\pvpg\posy5710\absw5020\absh8313 \sl-209 \b \f20 \fs15 \cf0 {\b0
+}{\b0 XDR}{\b0 TB}{\b0 y}{\b0 896}{\b0 poliresistente}{\b0 o}{\b0
multidrogo}{\b0 resistente,}{\b0 480}{\b0 (28,91%) }
\par}{\phpg\posx850\pvpg\posy5710\absw5020\absh8313 \sl-209 \b \f20 \fs15 \cf0 {\b0
de}{\b0 ellos}{\b0 estaban}{\b0 co-infectados}{\b0 con}{\b0 VIH,}{\b0 312}
{\b0 (65%)}{\b0 de}{\b0 ellos}{\b0 estaban }
\par}{\phpg\posx850\pvpg\posy5710\absw5020\absh8313 \sl-209 \b \f20 \fs15 \cf0 {\b0
recibiendo}{\b0 terapia}{\b0 retroviral.}{\b0 El}{\b0 �xito}{\b0 global}{\b0
del}{\b0 tratamiento}{\b0 fue}{\b0 de }
\par}{\phpg\posx850\pvpg\posy5710\absw5020\absh8313 \sl-209 \b \f20 \fs15 \cf0 {\b0
21%.}{\b0 464}{\b0 pacientes}{\b0 interrumpieron}{\b0 el}{\b0 tratamiento}{\b0
(28%).}{\b0 En}{\b0 general}{\b0 la }
\par}{\phpg\posx850\pvpg\posy5710\absw5020\absh8313 \sl-209 \b \f20 \fs15 \cf0 {\b0
adherencia}{\b0 fue}{\b0 46,4%}{\b0 entre}{\b0 aquellos}{\b0 que}{\b0
completaron}{\b0 el}{\b0 tratamiento }
\par}{\phpg\posx850\pvpg\posy5710\absw5020\absh8313 \sl-209 \b \f20 \fs15 \cf0 {\b0
en}{\b0 prisi�n}{\b0 y}{\b0 un}{\b0 19%}{\b0 entre}{\b0 quienes}{\b0
completaron}{\b0 tratamiento}{\b0 fuera}{\b0 de }
\par}{\phpg\posx850\pvpg\posy5710\absw5020\absh8313 \sl-209 \b \f20 \fs15 \cf0 {\b0
prisi�n}{\b0 (p}{\b0 =}{\b0 0,05).}{\b0 39%}{\b0 (n}{\b0 =}{\b0 647)}{\b0
declararon}{\b0 uso}{\b0 de}{\b0 alcohol}{\b0 y}{\b0 drogas, }
\par}{\phpg\posx850\pvpg\posy5710\absw5020\absh8313 \sl-209 \b \f20 \fs15 \cf0 {\b0
de}{\b0 ellos}{\b0 25%}{\b0 (n}{\b0 =}{\b0 161)}{\b0 declararon}{\b0 uso}
{\b0 excesivo}{\b0 de}{\b0 alcohol}{\b0 y}{\b0 drogas. }
\par}{\phpg\posx850\pvpg\posy5710\absw5020\absh8313 \sl-209 \b \f20 \fs15 \cf0 {\b0
An�lisis}{\b0 univariado}{\b0 indica}{\b0 que}{\b0 abandono}{\b0 del}{\b0
tratamiento,}{\b0 se}{\b0 asocia }
\par}{\phpg\posx850\pvpg\posy5710\absw5020\absh8313 \sl-209 \b \f20 \fs15 \cf0 {\b0
significativamente}{\b0 con}{\b0 uso}{\b0 de}{\b0 alcohol}{\b0 y}{\b0 drogas}
{\b0 (OR}{\b0 3,30}{\b0 o,}{\b0 IC95%}{\b0 1,53- }
\par}{\phpg\posx850\pvpg\posy5710\absw5020\absh8313 \sl-209 \b \f20 \fs15 \cf0 {\b0
7,31;}{\b0 p}{\b0 =}{\b0 0,035),}{\b0 presencia}{\b0 de}{\b0 diagn�stico}{\b0
de}{\b0 MDR}{\b0 (OR}{\b0 1,69,}{\b0 IC95% }
\par}{\phpg\posx850\pvpg\posy5710\absw5020\absh8313 \sl-209 \b \f20 \fs15 \cf0 {\b0
1,13-2,82;}{\b0 p}{\b0 =}{\b0 0,014).}{\b0 El}{\b0 modelo}{\b0 de}{\b0
regresi�n}{\b0 log�stica}{\b0 m�ltiple}{\b0 inclu- }
\par}{\phpg\posx850\pvpg\posy5710\absw5020\absh8313 \sl-209 \b \f20 \fs15 \cf0 {\b0
yo}{\b0 coinfecci�n}{\b0 VIH,}{\b0 patr�n}{\b0 de}{\b0 resistencia}{\b0 de}
{\b0 TB}{\b0 y}{\b0 uso}{\b0 de}{\b0 alcohol}{\b0 como }
\par}{\phpg\posx850\pvpg\posy5710\absw5020\absh8313 \sl-209 \b \f20 \fs15 \cf0 {\b0
variables}{\b0 independientes. }
\par}{\phpg\posx850\pvpg\posy5710\absw5020\absh8313 \sl-209 \b \f20 \fs15 \cf0
Conclusiones:{\b0 El}{\b0 fracaso}{\b0 al}{\b0 tratamiento}{\b0 se}{\b0
relacion�}{\b0 con}{\b0 alta}{\b0 tasa}{\b0 de }
\par}{\phpg\posx850\pvpg\posy5710\absw5020\absh8313 \sl-209 \b \f20 \fs15 \cf0 {\b0
uso}{\b0 de}{\b0 alcohol}{\b0 y}{\b0 drogas}{\b0 y}{\b0 alta}{\b0
proporci�n}{\b0 de}{\b0 pacientes}{\b0 coinfectados }
\par}{\phpg\posx850\pvpg\posy5710\absw5020\absh8313 \sl-209 \b \f20 \fs15 \cf0 {\b0
sin}{\b0 accesos}{\b0 apropiados}{\b0 a}{\b0 terapia}{\b0 retroviral.}{\b0
Terapia}{\b0 siqui�trica}{\b0 y}{\b0 de }
\par}{\phpg\posx850\pvpg\posy5710\absw5020\absh8313 \sl-209 \b \f20 \fs15 \cf0 {\b0
reemplazo}{\b0 farmacol�gico}{\b0 debe}{\b0 introducirse}{\b0 para}{\b0
solucionar}{\b0 las}{\b0 causas }
\par}{\phpg\posx850\pvpg\posy5710\absw5020\absh8313 \sl-209 \b \f20 \fs15 \cf0 {\b0
de}{\b0 la}{\b0 adicci�n.}{\b0 La}{\b0 rehabilitaci�n}{\b0 sicol�gica}{\b0 y}
{\b0 social}{\b0 de}{\b0 los}{\b0 convictos}{\b0 es }
\par}{\phpg\posx850\pvpg\posy5710\absw5020\absh8313 \sl-209 \b \f20 \fs15 \cf0 {\b0
una}{\b0 soluci�n}{\b0 realista}{\b0 frente}{\b0 a}{\b0 un}{\b0 problema}{\b0
importante}{\b0 que}{\b0 se}{\b0 supone }
\par}{\phpg\posx850\pvpg\posy5710\absw5020\absh8313 \sl-209 \b \f20 \fs15 \cf0 {\b0
no}{\b0 existe}{\b0 en}{\b0 las}{\b0 c�rceles}{\b0 de}{\b0 Per�}{\b0 que}
{\b0 es}{\b0 el}{\b0 consumo}{\b0 patol�gico}{\b0 de}{\b0 al- }\par
}
\sect\sectd\pard\plain
}