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y&#44; desde su regreso a Portugal hasta el diagn&#243;stico&#44; de 14&#44;0 d&#237;as &#40;10&#44;0-37&#44;0&#41;&#46; Seis pacientes &#40;35&#44;3&#37;&#41; solicitaron atenci&#243;n m&#233;dica en el pa&#237;s de inmigraci&#243;n debido a la sintomatolog&#237;a que presentaban&#44; pero en ning&#250;n caso se sospech&#243; ni se intent&#243; descartar el diagn&#243;stico de TB&#46; Entre los que no solicitaron atenci&#243;n m&#233;dica en el pa&#237;s de inmigraci&#243;n &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>11&#59; 64&#44;7&#37;&#41;&#44; un 72&#44;7&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>8&#41; trabajaba en la industria de la construcci&#243;n&#44; y estos pacientes relataron que sus empleadores les hab&#237;an aconsejado que regresaran a Portugal para obtener ayuda m&#233;dica&#46; No fue posible saber si eran trabajadores en situaci&#243;n ilegal o si hab&#237;an encontrado alguna otra barrera para acceder a la atenci&#243;n sanitaria&#46; El frotis de esputo fue positivo en los 16 pacientes con TB pulmonar en la fecha del diagn&#243;stico&#46; La mayor&#237;a de ellos refer&#237;an numerosos s&#237;ntomas de tuberculosis&#44; siendo la tos el s&#237;ntoma notificado con mayor frecuencia &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>14&#59; 82&#44;4&#37;&#41;&#44; seguido por sudoraci&#243;n nocturna &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>9&#59; 52&#44;9&#37;&#41; y p&#233;rdida de peso &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>9&#59; 52&#44;9&#37;&#41;&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Este estudio caracteriza a los emigrantes portugueses a los que se diagnostica TB al regresar a su pa&#237;s&#46; A pesar del escaso n&#250;mero de pacientes&#44; supone un esfuerzo para comprender mejor los problemas que plantea el manejo efectivo de la TB en personas migrantes&#46; La mediana de tiempo de residencia en el pa&#237;s de destino era superior a 2 a&#241;os&#44; lo que sugiere que la exposici&#243;n a la TB podr&#237;a haber ocurrido en el pa&#237;s de residencia&#46; Tres pacientes refirieron exposici&#243;n reciente a TB pulmonar&#44; 2 de ellos en el pa&#237;s de residencia y uno en Portugal&#44; y ninguno hab&#237;a sido sometido a un estudio adecuado&#46; Esta situaci&#243;n plantea algunas preguntas sobre las dificultades que puede suponer la investigaci&#243;n de los contactos de las personas con TB en el extranjero&#44; y apunta a la necesidad de reforzar los procedimientos de comunicaci&#243;n entre pa&#237;ses&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">En el presente estudio&#44; la mediana de tiempo entre la aparici&#243;n de los s&#237;ntomas y el diagn&#243;stico fue de 85&#44;5 d&#237;as&#44; similar a la comunicada en otras publicaciones&#46; En un estudio efectuado en un centro ambulatorio de TB del norte de Portugal&#44; en 2014&#44; la mediana de tiempo entre la aparici&#243;n de los s&#237;ntomas y el diagn&#243;stico fue de 36 d&#237;as<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">4</span></a>&#44; aunque la mediana fue de 104 d&#237;as en los datos nacionales del mismo a&#241;o<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">5</span></a>&#46; En 2014&#44; en la zona norte de Portugal se inform&#243; de un total de 817 casos de TB al sistema nacional de vigilancia de la TB&#44; con una mediana de 96 d&#237;as entre la aparici&#243;n de los s&#237;ntomas y el diagn&#243;stico&#46; La mediana del retraso en el diagn&#243;stico fue de 97 d&#237;as en Francia<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">6</span></a> y&#44; en una revisi&#243;n sistem&#225;tica&#44; el retraso medio en el diagn&#243;stico de TB&#44; de 61 y de 68 d&#237;as en pa&#237;ses con rentas altas y bajas-medias&#44; respectivamente<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">7</span></a>&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Otro hallazgo interesante de este trabajo es el escaso tiempo transcurrido &#40;14 d&#237;as&#41; entre el regreso a Portugal y el diagn&#243;stico de TB&#46; Esto indica que&#44; una vez en Portugal&#44; un n&#250;mero importante de pacientes solicitan atenci&#243;n m&#233;dica lo antes posible&#44; y son diagnosticados en breve tiempo&#46; De hecho&#44; un 64&#44;7&#37; de los pacientes no solicitaron atenci&#243;n m&#233;dica en el pa&#237;s de destino&#44; a pesar de presentar s&#237;ntomas&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Los esfuerzos para intentar conocer mejor las barreras a las que se enfrentan los migrantes en el diagn&#243;stico de la TB son importantes desde la perspectiva del control mundial de la enfermedad&#46; Asimismo&#44; puede contribuir a mejorar los mecanismos existentes en los diferentes pa&#237;ses para optimizar el diagn&#243;stico de TB en la poblaci&#243;n migrante&#44; y desarrollar procedimientos m&#225;s s&#243;lidos de comunicaci&#243;n entre pa&#237;ses&#46;</p></span>"
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          "leyenda" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">EPOC&#58; enfermedad pulmonar obstructiva cr&#243;nica&#59; H&#58; isoniazida&#59; R&#58; rifampicina&#59; TB&#58; tuberculosis&#59; TBMR&#58; tuberculosis multirresistente&#59; VIH&#58; virus de la inmunodeficiencia humana&#59; Z&#58; pirazinamida&#46;</p>"
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15 &#40;88&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Edad</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Conjunto de la muestra&#44; mediana &#40;25-75&#176;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">43&#44;0 &#40;34&#44;0-47&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Pa&#237;s de inmigraci&#243;n</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Francia&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Angola&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Suiza&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Espa&#241;a&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Reino Unido&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Alemania&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;47&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Estudios secundarios&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Estudios superiores&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Ocupaci&#243;n</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Profesionales&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>T&#233;cnicos y profesionales de grado medio&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Trabajadores de servicios y vendedores de comercios y mercados&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Artesanos y trabajadores de otros oficios&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Operarios de instalaciones y m&#225;quinas&#44; y montadores&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Ocupaciones b&#225;sicas&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;23&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">H&#225;bitos</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Tabaquismo&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Consumo excesivo de alcohol&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;23&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Consumo de drogas&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;17&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Comorbilidades</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>VIH&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;5&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>EPOC&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;5&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Solicit&#243; atenci&#243;n m&#233;dica en el pa&#237;s de inmigraci&#243;n</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11 &#40;64&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>S&#237;&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;35&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Lugar de diagn&#243;stico</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Centros de TB locales&#47;consultorio ambulatorio&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10 &#40;58&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Servicio de urgencias&#47;hospital&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;41&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Localizaci&#243;n de la enfermedad</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Pulmonar&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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Carta científica
Tuberculosis en los portugueses residentes en el extranjero
Tuberculosis Among Portuguese Living Abroad
Margarida Torres Redondoa,
Corresponding author
margarida.tredondo@gmail.com

Autor para correspondencia.
, Carlos Carvalhob,c, Ana Maria Correiab, Raquel Duarted,e,f
a Pulmonology Department, Centro Hospitalar de São João EPE, Oporto, Portugal
b Public Health Department, Northern Region Health Administration, Oporto, Portugal
c Institute of Biomedical Sciences Abel Salazar, University of Porto, Oporto, Portugal
d Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Oporto, Portugal
e Institute of Public Health, University of Porto Medical School, Oporto, Portugal
f Pulmonology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho EPE, Vila Nova de Gaia, Portugal
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">La tuberculosis &#40;TB&#41; contin&#250;a siendo un grave problema sanitario en todo el mundo&#44; y su control efectivo todav&#237;a plantea retos&#46; El riesgo es especialmente alto entre los migrantes&#44; que en el pa&#237;s de destino pueden tener que afrontar dificultades tales como cambios en sus redes sociales&#44; exclusi&#243;n social&#44; dificultades para acceder a la atenci&#243;n sanitaria&#44; participaci&#243;n no igualitaria en la sociedad y falta de confianza&#44; y comprensi&#243;n o respeto del sistema<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a>&#46; Portugal es el pa&#237;s de la Uni&#243;n Europea con mayor n&#250;mero de emigrantes per c&#225;pita&#44; y m&#225;s de 2 millones de ciudadanos portugueses residen en otros pa&#237;ses<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">2</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Para caracterizar a los emigrantes portugueses a los que se diagnostica TB cuando regresan a su pa&#237;s&#44; los autores efectuaron un an&#225;lisis retrospectivo de todos los emigrantes portugueses a los que se diagnostic&#243; TB en el norte del pa&#237;s en 2014&#46; Se evaluaron datos cl&#237;nicos y sociodemogr&#225;ficos&#46; Los casos nuevos de TB se identificaron a trav&#233;s del sistema nacional de vigilancia de la TB y&#44; para obtener informaci&#243;n m&#225;s detallada&#44; se contact&#243; con centros de atenci&#243;n a la TB locales&#46; Las variables continuas se describieron con la mediana y el rango intercuart&#237;lico &#40;percentiles 25-75&#176;&#41;&#44; y las categ&#243;ricas mediante frecuencias relativas &#40;en porcentaje&#41;&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Durante el periodo analizado&#44; en el norte de Portugal se diagnosticaron 17 casos de TB a ciudadanos portugueses emigrantes&#46; En la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a> se presentan las caracter&#237;sticas sociodemogr&#225;ficas&#44; de estilo de vida y cl&#237;nicas&#46; La mediana de edad en el momento del diagn&#243;stico era de 43&#44;0 a&#241;os y un 88&#44;2&#37; de los pacientes eran varones&#46; La mayor&#237;a eran inmigrantes en pa&#237;ses en los que la carga de TB es baja &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>13&#59; 76&#44;5&#37;&#41;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">3</span></a>&#46; La mediana de tiempo de residencia en el pa&#237;s de destino era de 42&#44;0 meses &#40;4&#44;3-138&#44;0&#41;&#46; Respecto a la ocupaci&#243;n&#44; la mayor parte de ellos trabajaban en la industria de la construcci&#243;n &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>9&#59; 52&#44;9&#37;&#41;&#44; y uno era un trabajador sanitario&#46; Un 53&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>9&#41; compart&#237;a vivienda con personas no familiares&#44; y la mayor&#237;a compart&#237;a habitaci&#243;n con un compa&#241;ero de trabajo &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>6&#59; 66&#44;7&#37;&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Tres pacientes &#40;17&#44;6&#37;&#41; informaron haber estado expuestos recientemente a infecci&#243;n tuberculosa pulmonar &#40;en los 2 a&#241;os anteriores&#41;&#44; uno de ellos a un familiar cercano en Portugal y los otros 2 a personas con las que compart&#237;an vivienda en Angola y Francia&#44; respectivamente&#46; Los 3 pacientes afirmaron que no se hab&#237;an sometido a rastreo de los contactos y cribado de TB&#46; Uno de ellos refiri&#243; antecedentes personales de TB pulmonar&#46; Ninguno tomaba f&#225;rmacos inmunosupresores&#46; La mediana de tiempo desde la aparici&#243;n de los s&#237;ntomas hasta el diagn&#243;stico fue de 85&#44;5 d&#237;as &#40;59&#44;5-147&#44;0&#41; y&#44; desde su regreso a Portugal hasta el diagn&#243;stico&#44; de 14&#44;0 d&#237;as &#40;10&#44;0-37&#44;0&#41;&#46; Seis pacientes &#40;35&#44;3&#37;&#41; solicitaron atenci&#243;n m&#233;dica en el pa&#237;s de inmigraci&#243;n debido a la sintomatolog&#237;a que presentaban&#44; pero en ning&#250;n caso se sospech&#243; ni se intent&#243; descartar el diagn&#243;stico de TB&#46; Entre los que no solicitaron atenci&#243;n m&#233;dica en el pa&#237;s de inmigraci&#243;n &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>11&#59; 64&#44;7&#37;&#41;&#44; un 72&#44;7&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>8&#41; trabajaba en la industria de la construcci&#243;n&#44; y estos pacientes relataron que sus empleadores les hab&#237;an aconsejado que regresaran a Portugal para obtener ayuda m&#233;dica&#46; No fue posible saber si eran trabajadores en situaci&#243;n ilegal o si hab&#237;an encontrado alguna otra barrera para acceder a la atenci&#243;n sanitaria&#46; El frotis de esputo fue positivo en los 16 pacientes con TB pulmonar en la fecha del diagn&#243;stico&#46; La mayor&#237;a de ellos refer&#237;an numerosos s&#237;ntomas de tuberculosis&#44; siendo la tos el s&#237;ntoma notificado con mayor frecuencia &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>14&#59; 82&#44;4&#37;&#41;&#44; seguido por sudoraci&#243;n nocturna &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>9&#59; 52&#44;9&#37;&#41; y p&#233;rdida de peso &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>9&#59; 52&#44;9&#37;&#41;&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Este estudio caracteriza a los emigrantes portugueses a los que se diagnostica TB al regresar a su pa&#237;s&#46; A pesar del escaso n&#250;mero de pacientes&#44; supone un esfuerzo para comprender mejor los problemas que plantea el manejo efectivo de la TB en personas migrantes&#46; La mediana de tiempo de residencia en el pa&#237;s de destino era superior a 2 a&#241;os&#44; lo que sugiere que la exposici&#243;n a la TB podr&#237;a haber ocurrido en el pa&#237;s de residencia&#46; Tres pacientes refirieron exposici&#243;n reciente a TB pulmonar&#44; 2 de ellos en el pa&#237;s de residencia y uno en Portugal&#44; y ninguno hab&#237;a sido sometido a un estudio adecuado&#46; Esta situaci&#243;n plantea algunas preguntas sobre las dificultades que puede suponer la investigaci&#243;n de los contactos de las personas con TB en el extranjero&#44; y apunta a la necesidad de reforzar los procedimientos de comunicaci&#243;n entre pa&#237;ses&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">En el presente estudio&#44; la mediana de tiempo entre la aparici&#243;n de los s&#237;ntomas y el diagn&#243;stico fue de 85&#44;5 d&#237;as&#44; similar a la comunicada en otras publicaciones&#46; En un estudio efectuado en un centro ambulatorio de TB del norte de Portugal&#44; en 2014&#44; la mediana de tiempo entre la aparici&#243;n de los s&#237;ntomas y el diagn&#243;stico fue de 36 d&#237;as<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">4</span></a>&#44; aunque la mediana fue de 104 d&#237;as en los datos nacionales del mismo a&#241;o<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">5</span></a>&#46; En 2014&#44; en la zona norte de Portugal se inform&#243; de un total de 817 casos de TB al sistema nacional de vigilancia de la TB&#44; con una mediana de 96 d&#237;as entre la aparici&#243;n de los s&#237;ntomas y el diagn&#243;stico&#46; La mediana del retraso en el diagn&#243;stico fue de 97 d&#237;as en Francia<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">6</span></a> y&#44; en una revisi&#243;n sistem&#225;tica&#44; el retraso medio en el diagn&#243;stico de TB&#44; de 61 y de 68 d&#237;as en pa&#237;ses con rentas altas y bajas-medias&#44; respectivamente<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">7</span></a>&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Otro hallazgo interesante de este trabajo es el escaso tiempo transcurrido &#40;14 d&#237;as&#41; entre el regreso a Portugal y el diagn&#243;stico de TB&#46; Esto indica que&#44; una vez en Portugal&#44; un n&#250;mero importante de pacientes solicitan atenci&#243;n m&#233;dica lo antes posible&#44; y son diagnosticados en breve tiempo&#46; De hecho&#44; un 64&#44;7&#37; de los pacientes no solicitaron atenci&#243;n m&#233;dica en el pa&#237;s de destino&#44; a pesar de presentar s&#237;ntomas&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Los esfuerzos para intentar conocer mejor las barreras a las que se enfrentan los migrantes en el diagn&#243;stico de la TB son importantes desde la perspectiva del control mundial de la enfermedad&#46; Asimismo&#44; puede contribuir a mejorar los mecanismos existentes en los diferentes pa&#237;ses para optimizar el diagn&#243;stico de TB en la poblaci&#243;n migrante&#44; y desarrollar procedimientos m&#225;s s&#243;lidos de comunicaci&#243;n entre pa&#237;ses&#46;</p></span>"
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Nivel acad&#233;mico</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Estudios primarios no finalizados&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Estudios primarios&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Estudios secundarios&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Estudios superiores&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Ocupaci&#243;n</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Profesionales&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>T&#233;cnicos y profesionales de grado medio&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Trabajadores de servicios y vendedores de comercios y mercados&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Artesanos y trabajadores de otros oficios&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Ocupaciones b&#225;sicas&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">H&#225;bitos</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Tabaquismo&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>EPOC&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Solicit&#243; atenci&#243;n m&#233;dica en el pa&#237;s de inmigraci&#243;n</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                      "titulo" => "Tuberculosis control in vulnerable groups"
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                          "autores" => array:2 [
                            0 => "J&#46;I&#46; Figueroa-Munoz"
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                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Bull World Health Organ"
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                        "paginaFinal" => "735"
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18797650"
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                  "referenciaCompleta" => "Observat&#243;rio da Emigra&#231;&#227;o&#46; Emigra&#231;&#227;o Portuguesa-Relat&#243;rio Estat&#237;stico 2014&#46; Observat&#243;rio da Emigra&#231;&#227;o e Rede Migra&#44; Lisboa&#44; Julho de 2014&#46;"
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                      "titulo" => "Global tuberculosis report 2015"
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              "identificador" => "bib0060"
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                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Delay in the diagnosis of tuberculosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "M&#46; Guimar&#227;es"
                            1 => "O&#46; Oliveira"
                            2 => "C&#46; Teixeira"
                            3 => "A&#46;R&#46; Gaio"
                            4 => "R&#46; Duarte"
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
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                0 => array:1 [
                  "referenciaCompleta" => "Dire&#231;&#227;o Geral da Sa&#250;de&#46; Portugal-Infe&#231;&#227;o por VIH&#44; SIDA e Tuberculose em n&#250;meros 2015&#46; Dire&#231;&#227;o Geral da Sa&#250;de&#44; Lisboa&#44; Novembro de 2015&#46;"
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                    0 => array:2 [
                      "titulo" => "Factors associated with patient and health care system delay in the diagnosis of tuberculosis in France"
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Article information
ISSN: 03002896
Original language: Spanish
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