Drug-resistant TB prevalence study in 5 health institutions in Haiti

Objectives Tuberculosis (TB) is the leading infectious cause of death in the world. Multi-drug resistant TB (MDR-TB) is a major public health problem as treatment is long, costly, and associated to poor outcomes. Here, we report epidemiological data on the prevalence of drug-resistant TB in Haiti. Methods This cross-sectional prevalence study was conducted in five health centers across Haiti. Adult, microbiologically confirmed pulmonary TB patients were included. Molecular genotyping (rpoB gene sequencing and spoligotyping) and phenotypic drug susceptibility testing were used to characterize rifampin-resistant MTB isolates detected by Xpert MTB/RIF. Results Between April 2016 and February 2018, 2,777 patients were diagnosed with pulmonary TB by Xpert MTB/RIF screening and positive MTB cultures. A total of 74 (2.7%) patients were infected by a drug-resistant (DR-TB) M. tuberculosis strain. Overall HIV prevalence was 14.1%. Patients with HIV infection were at a significantly higher risk for infection with DR-TB strains compared to pan-susceptible strains (28.4% vs. 13.7%, adjusted odds ratio 2.6, 95% confidence interval 1.5–4.4, P = 0.001). Among the detected DR-TB strains, T1 (29.3%), LAM9 (13.3%), and H3 (10.7%) were the most frequent clades. In comparison with previous spoligotypes studies with data collected in 2000–2002 and in 2008–2009 on both sensitive and resistant strains of TB in Haiti, we observed a significant increase in the prevalence of the drug-resistant MTB Spoligo-International-Types (SIT) 137 (X2 clade: 8.1% vs. 0.3% in 2000–02 and 0.9% in 2008–09, p<0.001), 5 (T1 clade: 6.8% vs 1.9 in 2000–02 and 1.7% in 2008–09, P = 0.034) and 455 (T1 clade: 5.4% vs 1.6% and 1.1%, P = 0.029). Newly detected spoligotypes (SIT 6, 7, 373, 909 and 1624) were also recorded. Conclusion This study describes the genotypic and phenotypic characteristics of DR-TB strains circulating in Haiti from April 2016 to February 2018. Newly detected MTB clades harboring multi-drug resistance patterns among the Haitian population as well as the higher risk of MDR-TB infection in HIV-positive people highlights the epidemiological relevance of these surveillance data. The importance of detecting RIF-resistant patients, as proxy for MDR-TB in peripheral sites via molecular techniques, is particularly important to provide adequate patient case management, prevent the transmission of resistant strains in the community and to contribute to the surveillance of resistant strains.

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Insights into transmission dynamics of Mycobacterium tuberculosis complex in Nepal

Tropical Medicine and Health ◽

10.1186/s41182-022-00400-z ◽

2022 ◽

Vol 50 (1) ◽

Author(s):

Yogendra Shah ◽

Sarad Paudel ◽

Kishor Pandey ◽

Govind Prasad Gupta ◽

Eddie Samuneti Solo ◽

...

Keyword(s):

Mycobacterium Tuberculosis ◽

One Health ◽

Animal Species ◽

Mycobacterium Tuberculosis Complex ◽

Public Health Problem ◽

Multi Drug Resistance ◽

Major Public Health Problem ◽

Tuberculosis Complex ◽

Mdr Tb ◽

The Government

AbstractTuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis complex (MTBC) in humans and animals. Numbers of multi drug resistance TB (MDR-TB), extrapulmonary TB (EPTB) and zoonotic TB cases are increasingly being reported every year in Nepal posing a major public health problem. Therefore, the Government of Nepal should act immediately to strengthen the screening facilities across the country to be able to identify and treat the TB infected patients as well as detect zoonotic TB in animal species. Endorsement of One Health Act by the Government of Nepal is an opportunity to initiate the joint programs for TB surveillance among human and animal species using one health approach to reduce the TB burden in Nepal.

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Identification of rpoB, gyrA and embB Gene Mutations in Mycobacterium Tuberculosis Isolates from Retreatment Tuberculosis Patients in Nepal

SAARC Journal of Tuberculosis Lung Diseases and HIV/AIDS ◽

10.3126/saarctb.v14i2.19336 ◽

2018 ◽

Vol 14 (2) ◽

pp. 39-50

Author(s):

Dhruba Kumar Khadka ◽

Rajendra Prasad Pant ◽

Bikash Lamichhane ◽

Sharat Chandra Verma ◽

R. P. Bichha ◽

...

Keyword(s):

Gene Mutations ◽

Rpob Gene ◽

Drug Susceptibility ◽

Cross Sectional Study ◽

Molecular Techniques ◽

Reference Laboratory ◽

Drug Resistant ◽

Cross Sectional ◽

Mdr Tb ◽

Embb Gene

Introduction: Tuberculosis remains one of the major public health problems in Nepal and increasing trend of multi drug resistant and extensively drug resistant tuberculosis (MDR /XDR TB) is a big challenge. Rapid diagnosis and appropriate treatment of MDR/XDR TB is crucial. Identification and comparison of MDR TB using rapid molecular techniques (for rpob, gyrA, rrs and embB gene mutations) with reference to drug susceptibility test (DST) were the main objectives of this study.Methodology: A cross sectional study was carried out in National TB Centre (NTC). Gene Xpert, proportion method and Line Probe Assay (LPA) were used for first and second line drugs susceptibility testing (FLD-DST and SLD-DST). A total of 29 mucopurulent sputum samples were freshly collected from retreatment TB patients (Female 41.4%, Male 58.6%) with median age of 40 years attending to the four MDR TB treatment centres of eastern and central Nepal (via private courier and directly to National TB Reference Laboratory (NRL) at NTC from April 2013 to October 2017.Results: Among 29 sputum samples (Female 41.4%; all smear+ve, Male 58.6%; 16 smear+ve and 1 smear-ve), Gene Xpert MTB/RIF assay detected 100% M. tuberculosis and rifampicin resistance (rpoB gene resistant) of which, 100% were culture positive by conventional Lowenstein–Jensen (LJ) method. FLDDST was performed on all culture positives of which, 96.6% showed MDR TB and 3.4% showed mono resistance to isonizid only. SLD-DST on 29 MDRTB strains by LPA showed 100%, 58.6%, 44.8% wild type for rrs, gyrA and emb B genes respectively. Mutation for gyrA and emb B genes was 41.4% and 51.2% respectively, rrs genes none. Twelve (Female 6, Male 6) MDR TB strains were identified as pre-XDR-TB. Chi square (χ2) for trend was used to analyze Gene Xpert, smear, FLD-DST and LPA results.Conclusion: From this study, 29(100%) MDRTB were detected from retreatment TB cases by Gene Xpert and FLDDST. Almost 41.4% MDR TB strains were detected as pre-XDR TB by LPA, which were found to be higher in 15-60 years group of females and males. Samples from retreatment TB patients need to be tested by rapid molecular techniques with reference to culture and DST.SAARC Journal of Tuberculosis, Lung Diseases and HIV/AIDS, Vol. 14, No. 2, 2017, Page: 39-50

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Rifampicin resistant tuberculosis in presumptive pulmonary tuberculosis cases in Dubti Hospital, Afar, Ethiopia

The Journal of Infection in Developing Countries ◽

10.3855/jidc.10462 ◽

2019 ◽

Vol 13 (01) ◽

pp. 21-27 ◽

Cited By ~ 3

Author(s):

Gebremedhin Bizayene Gebrehiwet ◽

Atsebeha Gebrekidan Kahsay ◽

Letmichael Negash Welekidan ◽

Amlsha Kahsay Hagos ◽

Getahun Kahsay Abay ◽

...

Keyword(s):

Cross Sectional Study ◽

Drug Resistant ◽

Cross Sectional ◽

Tb Treatment ◽

Resistant Tuberculosis ◽

Mdr Tb ◽

History Of ◽

Resistant Strains ◽

Logistic Regressions ◽

Structured Questionnaire

Introduction: Ethiopia stood third in drug-resistant tuberculosis (TB) in Africa, and more than 5,000 MDR-TB patients are reported each year. Greater than 90% of rifampicin (RIF) resistant strains are resistant to isoniazid (INH) and hence the objective of this study was to determine the prevalence and risk factors of RIF resistant MTB among presumptive TB cases at Dubti General Hospital, Afar, Ethiopia. Methodology: In this cross-sectional study, 384 presumptive TB cases were recruited and a structured questionnaire was used to collect socio-demographic and clinical data. Sputum samples were collected and examined using X-pertMTB/RIF assay. Bivariate, multivariate logistic regressions, and fishers' exact analysis were done to assess the associations between the prevalence of TB and MDR-TB with different socio-demographic and clinical variables. Results: In the present study, the overall prevalence of pulmonary TB was 24.5% (94/384), of this 4 (4.3%) isolates were resistant to RIF. History of anti-TB treatment (AOR = 2.4, 95% CI: 1.3-4.4 and TB contact (AOR = 3.6, 95% CI: 2.1-6.2 were significantly associated with gene X-pert MTB/RIF positive TB. Moreover, resistance to rifampicin was statistically associated with the history of TB contact with multi-drug resistant TB (P = 0.027) and khat chewer cases (P = 0.04). Conclusions: The overall prevalence of TB and its drug-resistant were relatively higher than that of in the general population in Ethiopia. History of anti-TB treatment and TB contact were significantly associated with X-pert MTB/RIF positive MDR-TB.

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Profile of tuberculosis cases attending a directly observed treatment short-course centre in North Kerala

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20195474 ◽

2019 ◽

Vol 6 (12) ◽

pp. 5219

Author(s):

Manju Thandayan Lakshmanan ◽

Jayasree Anandabhavan Kumaran ◽

Varsha S. Kumar ◽

Shwetha Suresh

Keyword(s):

Public Health Problem ◽

Common Type ◽

Multi Drug Resistance ◽

Age Group ◽

Microsoft Excel ◽

Pulmonary Tb ◽

Medical College ◽

Short Course ◽

Mdr Tb ◽

Directly Observed Treatment

Background: Tuberculosis (TB) is a worldwide public health problem. India has the highest TB burden in the world. India accounted for a quarter of global incident TB cases, 24% of multi drug resistance (MDR) TB cases and highest TB mortality rate in 2017. Thus it is important to understand the profile of TB patients. The objective of the study was to assess the profile of TB cases attending a directly observed treatment short-course (DOTS) center in North Kerala.Methods: A retrospective record based, descriptive study was done in the DOTS center of Government Medical College Kannur, in North Kerala, to assess the profile of TB patients who attended the centre from January 2015 to July 2018. Details of 548 patients were collected from the record maintained at DOTS center. Data was entered in Microsoft Excel and analysed using Epi info7 software.Results: The age group of 21-60 years was most affected. 68.53% of the patients were males. 45.62% of patients had extra-pulmonary TB (EPTB). Among the pulmonary TB patients, 74.27% tested positive for acid fast bacilli. Among cases of EPTB, most common type was TB lymphadenitis (40.8%) followed by tuberculous pleural effusion (22.4%). 87.59% of TB patients were started on category I treatment under DOTS.Conclusions: In our study, affected population was mostly males and those in productive age group. This is the group that has maximum chances of exposure to TB patients. 45.62% patients had EPTB. Total number of cases is on the rise each year, with maximum cases in 2018.

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Prevalence and Distribution of Non – Tuberculous Mycobacteria (NTM) Among MDR-TB Suspected Patients in Northern Malawi

10.21203/rs.3.rs-78155/v1 ◽

2020 ◽

Author(s):

Grace Chirwa Mabaso ◽

Maono Ngwira ◽

Pocha Samuel Kamudumuli ◽

Thomas Mughogho ◽

Michael Mzirekelenge Nkosi ◽

...

Keyword(s):

Health Workers ◽

Clinical Symptoms ◽

Public Health Problem ◽

Northern Region ◽

Confirmatory Test ◽

Multi Drug Resistance ◽

Human Pathogens ◽

Cross Sectional ◽

Mdr Tb ◽

Culture Positive

Abstract BackgroundNon-tuberculosis Mycobacteria (NTM) are increasingly being recognized as human pathogens, causing substantial morbidity and mortality in progressive lung disease, immunosuppressed, the elderly and the youth. Similarity of clinical symptoms with MTB, coupled with limited diagnostic capacities in tuberculosis (TB) endemic developing countries has led to misdiagnosis of NTM pulmonary disease. The study aimed at establishing the prevalence and distribution of NTM among Multi-Drug Resistance Tuberculosis (MDR-TB) suspected patients in Northern Region of Malawi based on laboratory culture records from 2015 to 2018 conducted at Mzuzu Central Hospital.MethodsThe study used a retrospective cross-sectional design. All culture positive underwent MTB confirmatory test using the SD-Bio line TB Ag MPT64 Kit to confirm MTB or to suspect for NTM. Data was analysed for descriptive statistics in SPSS version 20 and presented using frequency tables, charts and graphs.Results Out of 170 culture positive reports reviewed, 30 (18%) were NTM. Much as there were generally more males (69.4%) who were MDR-TB suspected patients, the proportion of NTM patients was female predominant 13/52 (25%) as compared to 17/118 (14%) for males while the age range of 30-49 was the most (22%) affected. Twenty-nine (97%) of the NTM cases were previously treated for MTB.ConclusionsThe high prevalence of NTM among MDR-TB suspected patients shows that the disease is a serious public health problem. This therefore calls for urgent attention from Ministry of Health and partners, health workers and all stakeholders involved in policy making so that NTM diagnosis should have a clear algorithm to avoid wastage a of resources as well as for good patient care.

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Early detection of Pre-XDR TB with line probe assay in a high TB burden country

African Health Sciences ◽

10.4314/ahs.v21i3.2 ◽

2021 ◽

Vol 21 (3) ◽

pp. 968-974

Author(s):

Laura Madukaji ◽

Isaac Okohu ◽

Saheed Usman ◽

Uche Oyedum ◽

Abdullah Enagi ◽

...

Keyword(s):

Public Health Problem ◽

Multidrug Resistant ◽

Major Public Health Problem ◽

Drug Resistant ◽

Line Probe Assay ◽

North Central ◽

Resistant Tuberculosis ◽

Mdr Tb ◽

Probe Assay ◽

And Control

Background: Worldwide, tuberculosis (TB) is one of the top 10 causes of death. Drug resistant tuberculosis has lately become a major public health problem that threatens progress made in Tuberculosis (TB) care and control worldwide. The aim of this study was to determine the prevalence of Pre-extensive drug resistant TB among MDR TB in North Central of Nigeria. Methods: This study was conducted from October, 2018 to August, 2019 with 150 samples. In Nigeria, guidelines for DR-TB as recommended by WHO is followed. All the samples from the patients who gave their consent were transported to a zonal reference TB laboratory (ZRL). Results: Mean age was 38.6 ± 13.4 years with peak age at 35-44. Out of these 103 samples processed with LPA, 101(98%) were rifampicin resistant and 2 were rifampicin sensitive, 99(96%) were INH resistant and 4 (4%) were INH sensitive, 5(5%) were fluoroquinolone resistant, 98(95%) were fluoroquinolone sensitive, 12 (12%) were Aminoglycoside + Capreomycin resistant, 91(83%) were Aminoglycoside + Capreomycin sensitive. Conclusion: Multidrug resistant TB and its severe forms (Pre-extensive & extensively drug resistant TB) can be detected early with rapid tool- Line Probe Assay rapid and prevented timely by early initiation on treatment. Keywords: Pre-XDR TB; line probe assay in a high TB burden country.

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Socio-demographic determinants of treatment outcome in multidrug resistant tuberculosis cases registered under Programmatic management of drug resistant tuberculosis services in Amritsar, Punjab

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20192345 ◽

2019 ◽

Vol 6 (6) ◽

pp. 2688

Author(s):

Manisha Nagpal ◽

Sarthak Chawla ◽

Priyanka Devgun ◽

Naresh Chawla

Keyword(s):

Treatment Outcome ◽

Treatment Success ◽

Public Health Problem ◽

Educational Status ◽

Multidrug Resistant ◽

Major Public Health Problem ◽

Cross Sectional ◽

Resistant Tuberculosis ◽

Multidrug Resistant Tuberculosis ◽

Mdr Tb

Background: Multidrug resistant tuberculosis (MDR-TB) has become a major public health problem. It is associated with significant morbidity and mortality. The treatment success rate worldwide is around 50%.Methods: This cross-sectional study was conducted on all MDR-TB patients who were registered and being treated under PMDT services in Amritsar district from 1st April 2014 to 31st March 2015. The treatment outcome with their socio-demographic determinants was ascertained. Data management and analysis was done by using Microsoft excel and SPSS.Results: Out of 87 MDR-TB patients, 57 (65.5%) were males and 30 (34.4%) were females. The various treatment outcomes observed were- 30 (34.5%) cured, 19 (21.8%) treatment completed, 18 (20.7%) died, 13 (14.9%) defaulted, 4 (4.6%) shifted to XDR TB regime and 3 (3.4%) failure.Conclusions: On statistical analysis, it was observed that age (p=0.000), marital status (p=0.024), educational status (p=0.011) and occupation (p=0.002) were significantly associated with the treatment outcome. Other factors like sex, type of family and socio-economic status did not affect the treatment outcome.

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Spectrum and Correlation of Clinical, Radiological and Biochemical Parameters in Tuberculosis in a Hospital in South India

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2021/80 ◽

2021 ◽

Vol 8 (8) ◽

pp. 410-414

Author(s):

Anirudha Sharma ◽

Swati Vijapurkar ◽

Siddharth Gosavi ◽

Samarth Samgamesh ◽

Aishwarya E ◽

...

Keyword(s):

Diabetes Mellitus ◽

Glycaemic Control ◽

Public Health Problem ◽

Good Control ◽

Major Public Health Problem ◽

X Rays ◽

Cross Sectional ◽

X Ray ◽

Mdr Tb ◽

Chest X Ray

BACKGROUND Tuberculosis (TB) remains a major public health problem in India. TB worsens glycaemic control in patients with diabetes mellitus (DM), complicating the treatment for each condition leading to poor treatment outcomes and increase in morbidity / mortality. Human immunodeficiency virus - tuberculosis (HIV-TB) coinfections are on the rise. The objectives of the study were to describe various comorbidities in patients with tuberculosis, determine expected radiological presentations in these patients and to determine prognosis altering metabolic indicators in patients with TB. METHODS A prospective cross-sectional study using data of 40 microbiologically diagnosed TB patients admitted in wards of C.G. Hospital, JJM Medical College, Davangere, from January to March 2020 was done. Chest x-rays, clinical and haematological tests were analysed. RESULTS TB patients with DM, kidney disease, HIV presented with higher count of fibrosis, cavities and infiltrates on chest radiographs, and was worse with renal function. Hospitalisation was prolonged in patients with anaemia, multidrug-resistance tuberculosis (MDR-TB), urosepsis, and HIV as compared to patients with no comorbidities. MDR-TB showed more fibrosis. Patients with urosepsis had higher incidence of multiple lesions and effusion by 4 times. CONCLUSIONS Increased HbA1c and sugar levels lead to increase in lesions on chest x-ray in tuberculosis. Good glycaemic control in TB is a must to achieve good control of DM and reduce hospitalisation. KEYWORDS Tuberculosis, Diabetes Mellitus, HbA1c, Chest X-Ray

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PEMANFAATAN TES CEPAT MOLEKULER (TCM) GENEXPERT SEBAGAI ALAT DIAGNOSTIK TB PARU DI RSUD WANGAYA KOTA DENPASAR

Jurnal Ekologi Kesehatan ◽

10.22435/jek.v3i18.2399 ◽

2020 ◽

Vol 18 (3) ◽

pp. 135-148

Author(s):

Novianti Novianti ◽

Oster Suriani Simarmata ◽

Dina Bisara Lolong

Keyword(s):

Public Health Problem ◽

Multidrug Resistant ◽

Rapid Diagnosis ◽

Case Finding ◽

Major Public Health Problem ◽

Drug Resistant ◽

Pulmonary Tb ◽

Negative Results ◽

The City ◽

Positive Results

ABSTRACT Tuberculosis remains a major public health problem, with an estimated 9 million TB incidence cases, 300,000 of which are drug resistant TB cases and resulted in 1.5 million deaths worldwide in 2013. However, only 58% of new cases, TB cases were confirmed bacteriologically using WHO recommended test including the Xpert® MTB/RIF Rapid Diagnosis. The use of GeneXpert in Indonesia has existed since 2014 and has never been evaluated in its utilization, including in the city of Denpasar, namely in Wangaya Hospital as one of the recipients of the GeneXpert pulmonary TB diagnostic aid. The results of this study showed that the results of GeneXpert examination were much higher in the percentage of Positive TB Case Findings compared to microscopic examination so that there is an increase in the number of positive TB cases by 14.3%. The GeneXpert examination succeeded in giving positive results compared to the microscopic results showing negative results, which were sensitive Rifampicin (14.6%) and resistant Rifampicin (2.4%). However, the utilization of TB suspect examination with GeneXpert has not been maximized in increasing the number of TB patients suspected of having TB, in fact, the percentage of positive TB case finding compared to TB suspicion is increasing. Keywords:GeneXpert, rapid diagnosis of tuberculosis, pulmonary tuberculosis ABSTRAK Tuberkulosis (TB) tetap menjadi masalah kesehatan masyarakat yang utama, diperkirakan telah terjadi 9 juta kasus insiden TB, 300.000 di antaranya adalah kasus TB multidrug resistant (TB MDR) dan mengakibatkan 1,5 juta kematian di seluruh dunia pada tahun 2013. Namun, baru 58% dari kasus baru, kasus TB dikonfirmasi secara bakteriologis menggunakan tes yang direkomendasikan oleh WHO termasuk Tes Cepat Molekuler (TCM) GeneXpert® MTB/RIF (Xpert). Pemanfaatan TCM GeneXpert di Indonesia ada sejak 2014 dan belum pernah dilakukan evaluasi dalam pemanfaatannya termasuk di Kota Denpasar yaitu di RSUD Wangaya sebagai salah satu penerima bantuan alat diagnostik TB Paru TCM GeneXpert. Hasil studi menunjukkan bahwa hasil pemeriksaan dengan TCM GeneXpert jauh lebih tinggi persentase penemuan kasus positif TBC dibanding dengan pemeriksaan mikroskopis sehingga terdapat peningkatan jumlah kasus positif TBC sebesar 14,3% di RSUD Wangaya pada tahun 2018. Pemeriksaan TCM GeneXpert berhasil memberikan hasil yang positif di saat hasil pemeriksaan mikroskopis menunjukkan hasil negatif yaitu Rifampisin sensitif (14,6%) dan Rifampisin resisten (2,4%). Pemanfaatan pemeriksaan terduga TB dengan TCM GeneXpert belum maksimal dalam meningkatkan jumlah pemeriksaan pasien terduga TB Paru, walaupun persentase penemuan kasus positif TB dibanding terduga TB meningkat. Kata kunci: Tes cepat molekuler, geneXpert, tuberkulosis paru

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Validation and Psychometric Properties of the Spanish Version of the Hopkins Symptom Checklist-25 Scale for Depression Detection in Primary Care

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18157843 ◽

2021 ◽

Vol 18 (15) ◽

pp. 7843

Author(s):

María Rodríguez-Barragán ◽

María Isabel Fernández-San-Martín ◽

Ana Clavería-Fontán ◽

Susana Aldecoa-Landesa ◽

Marc Casajuana-Closas ◽

...

Keyword(s):

Primary Care ◽

Psychometric Properties ◽

Public Health Problem ◽

Composite International Diagnostic Interview ◽

Spanish Version ◽

Major Public Health Problem ◽

Symptom Checklist ◽

Validity And Reliability ◽

Cross Sectional ◽

Hopkins Symptom Checklist

Depression constitutes a major public health problem due to its high prevalence and difficulty in diagnosis. The Hopkins Symptom Checklist-25 (HSCL-25) scale has been identified as valid, reproducible, effective, and easy to use in primary care (PC). The purpose of the study was to assess the psychometric properties of the HSCL-25 and validate its Spanish version. A multicenter cross-sectional study was carried out at six PC centers in Spain. Validity and reliability were assessed against the structured Composite International Diagnostic Interview (CIDI). Out of the 790 patients, 769 completed the HSCL-25; 738 answered all the items. Global Cronbach’s alpha was 0.92 (0.88 as calculated for the depression dimension and 0.83 for the anxiety one). Confirmatory factor analysis (CFA) showed one global factor and two correlated factors with a correlation of 0.84. Area under the curve (AUC) was 0.89 (CI 95%, 0.86–0.93%). For a 1.75 cutoff point, sensibility was 88.1% (CI 95%, 77.1–95.1%) and specificity was 76.7% (CI 95%, 73.3–79.8%). The Spanish version of the HSCL-25 has a high response percentage, validity, and reliability and is well-accepted by PC patients.

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