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@#Abstract: Objective To investigate the nutritional status of patients with pulmonary tuberculosis and its effects on conventional anti-tuberculosis treatment, so as to provide a basis for improving the efficacy of conventional treatment of pulmonary tuberculosis. Methods The relevant data of 168 patients with pulmonary tuberculosis admitted to Suining Central Hospital from April 2020 to April 2022 were retrospectively analyzed. Nutritional status of the patients before treatment was investigated using the Mini Nutritional Assessment (MNA) score, and the influencing factors of nutritional status before treatment were analyzed. Therapeutic effects of anti-tuberculosis drugs in the non-nutritional risk group and the nutritional risk group were comparatively analyzed. Results Among the 168 patients, 64 were assessed as having good nutritional status before treatment, 59 had the risk of malnutrition and 45 were malnourished according to the MNA score. Univariate analysis and linear regression analysis showed that age, underlying diseases, and clinical symptoms were factors affecting the MNA score before treatment (t=3.173, 3.718, 2.018, P all<0.05); whereas gender and education level were not factors affecting MNA score before treatment (t=0.065, 0.059, P all>0.05). According to the MNA score before treatment, the patients were dividedinto a non-nutritional risk group (MNA score > 23.5) and a nutritional risk group (MNA score ≤23.5). The negative conversion rate of sputum bacteria, effective rate of focal absorption in the non-nutritional risk group were 92.19% (59/64)and90.63% (58/64) , respectively, which were significantly higher than corresponding 79.85% (82/104)and76.92% (80/104) in the nutritional risk group. The drug resistance rate, adverse reaction rate, and average treatment cost of the no nutritional risk group and nutritional risk group were 7.81% (5/64) and 21.15% (12/104), 15.63% (10/64) and 31.73% (33/104), (0.62±0.13) million yuan and (0.89±0.26) million yuan, respectively, with significant differences (χ2=5.228, 5.071, 7.685, 5.396, 7.728, P all<0.05). Conclusions Patients with pulmonary tuberculosis exhibit poor nutritional status before treatment. The patients’nutritional status is easily affected by age, underlying diseases, and clinical symptoms, thereby affecting the effect of anti-tuberculosis treatment. Therefore, early nutritional intervention for tuberculosis patients should be recommended in order to prevent malnutrition and enhance the effectiveness of anti-tuberculosis treatment.
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La tuberculose est une des maladies infectieuses les plus répandues dans le monde .Elle représente un problème de santé publique majeur dans les pays en voie de développe ment, y compris l'Algérie . À l'échelle mondiale et parmi tous les cas de tuberculose, l'OMS rapporte 14 % de tuberculose extra-pulmonaire (TEP) sans atteinte pulmonaire concomitante. Dans notre pays et durant ces dernières années, une recrudescence de la tuberculose extrapulmonaire a été observée. L'objectif de cet article était de présenter un cas atypique de tuberculose cérébrale dont le diagnostic a été tardif, posé par l'examen anatomopathologique avec une revue de la littérature. C'est le cas d'une jeune patiente hospitalisée dans le cadre de l'urgence pour un syn drome d'hypertension intracrânienne avec troubles neurologiques. La tomodensitomé trie cérébrale a objectivé de multiples localisations cérébrales avec une hydrocéphalie active. Le bilan d'extension était sans anomalie. La patiente avait bénéficié d'une inter vention chirurgicale, les suites opératoires ont été favorables. L'examen anatomo-pa thologique était en faveur d'une lésion inflammatoire spécifique granulomateuse faite de larges plages de nécrose caséeuse. La patiente a répondu au traitement antituber culeux. Le problème diagnosticque et les résultats seront discutés avec une revue de la littéra ture. La tuberculose cérébrale est une forme rare de la tuberculose extra-pulmonaire. Le tableau clinique ainsi que la neuro-imagerie (TDM, IRM) sont atypiques. Le diagnostic était postopératoire, reposant sur l'examen anatomopathologique. Le pronostic dépend de la précocité du diagnostic, du siège de la lésion et de la réponse au traitement antituberculeux.
Tuberculosis is one of the most widespread infectious diseases in the world. It constitutes a major public health problem, especially in developing countries, including Algeria. Globally and among all tuberculosis cases, WHO reports 14% extra-pulmonary tuberculosis (EPT) without concomitant pulmonary involvement. In our country and in recent years, an upsurge in extrapulmonary tuberculosis has been observed. The objective of this article was to present an atypical case of cerebral tuberculosis whose diagnosis was late, made by anatomopathological examination with a review of the literature. We report the case of a young patient hospitalized in emergency for an intracranial hypertension syndrome with neurological disorders. Cerebral computed tomography revealed multiple brain locations with active hydrocephalus. The extension assessment was without anomaly. The patient underwent a surgical intervention, the operative consequences were favorable. The pathological examination was in favor of a specific inflammatory granulomatous lesion made up of large areas of caseous necrosis. The patient was cured under anti-tuberculosis treatment. The diagnostic problem and the results will be discussed with a review of the literature. Cerebral tuberculosis is a rare form of extrapulmonary tuberculosis. The clinic as well as the neuroimaging (CT, MRI) are atypical. The diagnosis is postoperative, based on the pathological examination. The prognosis depends on the early diagnosis, the site of the lesion and the response to anti-tuberculosis treatment.
Subject(s)
Surgical Procedures, Operative , Tuberculosis , Tomography , Intracranial Hypertension , Tuberculosis, Central Nervous System , Neurologic Manifestations , Therapeutics , DiagnosisABSTRACT
Background: Tuberculosis (TB) remains a major public health concern despite being a curable and preventable disease. The treatment of TB using a cocktail of drugs over a period of six months under the directly observed treatment short-course strategy has led to a reduction in cases but is plagued by some challenges that leads to unsuccessful or poor outcomes, which can ultimately result in spread of infections, development of drug resistance and increase in morbidity and mortality. The objectives of this study are to determine outcomes of TB treatment in Dalhatu Araf Specialist Hospital, Lafia, Nasarawa State, Nigeria and the factors that may be associated with the outcomes. Methodology: This was a retrospective study using the medical records of patients who were registered for TB treatment over a five-year period between 2016 to 2020. Data from TB registers including demographic and relevant clinical information, and treatment outcomes, were extracted into a structured data extraction format, and analysed with SPSS version 21.0 software package. Univariate and bivariate analyses were conducted, and Chi square test was used to determine association between TB outcomes and independent variables at 95% confidence interval and p<0.05 was considered as the significant value. Results: Records of 1,313 patients were studied, 744 (56.7%) were males while 569 (43.3%) were females. The age range of the patients was ≤ 1 year - 96 years, with a mean age of 30±16.7 years. Most were pulmonary TB cases (88.8%, n=1,166), newly diagnosed (95.5%, n=1254), and human immunodeficiency virus (HIV) negative at the time of TB diagnosis (63.7%, n=837). Eight hundred and seven (61.5%) patients had successful treatment, and 34% (n=446) had unsuccessful outcomes made of 'loss to follow-up' 25.8% (n=339), deaths 7.8% (n=102) and treatment failure 0.4% (n=5), while 2.3% (n=30) were transferred out and 2.3% (n=30) removed from TB register. Treatment success rate was significantly higher in patients with pulmonary TB (p=0.0024), residents in Lafia LGA (p=0.0005), those treated in 2016 (p=0.0006) and bacteriologically confirmed cases (p<0.0001), while death rate was significantly lower among patients who were HIV-negative at the time of TB diagnosis (p<0.0001). Conclusion: TB treatment success rate in this study fell short of the WHO average rate. High rates of 'loss to followup' and deaths in this study is a wake-up call to all stakeholders in the facility and the State to put in place measures to reduce poor outcomes of TB treatment.
Subject(s)
Tuberculosis , Patient Compliance , Treatment Outcome , Medication Adherence , Health FacilitiesABSTRACT
Objeetive@#To understand the recurrence of tuberculosis patients in Yunnan Province and its influencing factors,so as to provide scientific basis for the prevention and control of tuberculosis.@*Methods@#Through the tuberculosis management information system, the data of successful treatment of tuberculosis cases in Yunnan Province in 2013 and the data of recurrent tuberculosis cases in Yunnan Province in 2014-2018 were collected. The recurrence rate,recurrence proportion and recurrence time of tuberculosis were analyzed, and the influencing factors of tuberculosis recurrence were analyzed by Cox multi factor proportional risk model. @*Results @#A total of 9787 cases of tuberculosis were investigated. 385 cases recurred in 5 years, accounting for 3.94%. The recurrence rate was 0.73/100 person years. The recurrence interval [M （QR）] was 35.12 （28.57） months. The following are the risk factors for pulmonary tuberculosis recurrence：male（HR=1.297,95%CI：1.031~1.631）,secondary tuberculosis(HR=2.000,95%CI：1.088~3.676) in the 40-59 age group（HR=1.618,95%CI：1.036-2.528）, the retreatment（HR=1.566,95%CI：1.040-2.356）,positive of sputum culture（HR=4.048,95%CI：1.795-9.129）and sputum?smear positive（HR=1.569,95%CI：1.266-1.945）, cavitary pulmonary tuberculosis（ HR=1.382,95%CI：1.112-1.716）.@*Conclusion@#The recurrence rate of tuberculosis is low in Yunnnan province, and the risk of pulmonary tuberculosis recurrence is high in male, in the 40-59 age group,retreatment,positive of sputum culture only and sputum smear positive,patients with cavitary tuberculosis.
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Objetivou-se identificar fatores relacionados, classificar a tendência temporal e identificar áreas com associação espacial do abandono de tratamento para tuberculose em Ribeirão Preto, São Paulo. Estudo ecológico; população composta pelos casos notificados entre 2006 a 2017. Realizou-se o teste qui-quadrado para identificar fatores relacionados. Para a tendência temporal, utilizou-se o método de Prais-Winsten para classificar a tendência temporal do evento e calculada sua porcentagem de variação anual. Para verificar associação espacial, utilizaram-se as técnicas G e Gi*. Foram notificados 146 casos de abandono do tratamento da doença no período; como fatores de risco foi identificado pessoas sem escolaridade, retratamentos pós-abandono e falência prévia; como proteção casos novos identificados pela busca ativa, não ter coinfecção Tuberculose-HIV e não fazer uso de álcool ou drogas. A taxa de abandono apresenta tendência crescente (APC=1,6%; IC95% 0.023.48). O estudo evidencia o aumento do abandono de tratamento, contrariando as políticas direcionadas pelo End TB Strategy.
The objective was to identify related factors, classify the time trend and identify areas with spatial association of abandonment of treatment for tuberculosis in Ribeirão Preto, São Paulo. Ecological study; population composed of the cases notified between 2006 and 2017. The chi-square test was performed to identify related factors. For the time trend, the Prais-Winsten method was used to classify the time trend of the event and calculate its percentage of annual variation. To verify spatial association the G and Gi* techniques were used. In the period, 146 cases of abandonment of the disease treatment were notified; as risk factors, people without education, retreatment after abandonment, and previous failure were identified; as protection, new cases were identified by active search, no Tuberculosis-HIV co-infection, and no alcohol or drug use. The abandonment rate shows an increasing trend (APC=1.6%; 95%CI 0.023.48). The study evidences the increase of abandonment of treatment, contradicting the policies directed by the End TB Strategy.
Subject(s)
Humans , Patient Dropouts , Tuberculosis , Patient Dropouts/statistics & numerical data , Public Health , Treatment Adherence and ComplianceABSTRACT
Background: This study assessed level of non-adherence to anti tuberculosis (TB) therapy among pulmonary TB patients, compares various factors among adherent and non-adherent TB patients, stressing on reasons for non-adherence at a tertiary care hospital.Methods: This institution based observational and cross-sectional study was conducted interviewing patients with pulmonary TB and assessed using Moriskys medication adherence scale-8 (MMAS-8), a pre- tested structured questionnaire based scoring system of patients treated for pulmonary TB at district TB centre SIMS, Shimoga. Descriptive statistics were employed.Results: Among 70 cases analysed, 57 were males and 13 females, with mean age group of 41.32�63 and mean MMAS score of 2.23�87. 53.33% patients were on continuous phase of treatment. The level of non-adherence were as follows, high= 18%, medium= 38% and low= 44%. The common cause for non-adherence was forgetfulness (66%) reasons being: betterment of symptoms (54%), sickness after taking medication (31%), distance of travel: far (15%). Many were labourers (62%), with low literacy rate, also chronic alcoholics (72%) and smokers (73%). Female with moderate literacy and not addicted to alcohol/smoking showed high adherence compared to males (p<0.05%).Conclusions: As prevalence of non-adherence is high, especially Patients on continuous phase of TB treatment, there arises immense need for continuous and effective health education to patients� and their family regarding the adverse effects and the need for high level of adherence to treatment for the complete cure of disease. Patients who are addicted to alcohol/smoking should be targeted with interventions to quit the same, provide free transport facility to RNTCP centres and prompt treatment of ADR, will improve adherence to medication.
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Background: India is the highest TB burden country in the world and Tuberculosis being a systemic disease, it has capacity forwide spread dissemination. Some studies done in the past provided variable evidences suggesting Thyroid dysfunction can occurfollowing antitubercular therapy, hence we have taken up this study. Methods: 50 freshly detected pulmonary and extrapulmonary tuberculosis cases were included in this study. Plasma levels of T3, T4 and TSH was measured before initiating Antituberculosis treatment (ATT) and repeated at the end of 6 months. Results: Post treatment 2(4%) subjects had change in T3 levelabove the normal reference range, no changes observed in T4 levels after the treatment. Post treatment 1(2%) subject had TSH of<0.3 Μiu/ml indicating transition in to the hyperthyroid range, majority i.e. 32(64%) subjects had TSH level within normalreference range, whereas 17(34%) subjects had TSH level above the normal reference range falling into Subclinical Hypothyroidrange. Conclusion: The common Thyroid Dysfunction seen during the study period was Hypothyroidism. Anti-tubercularmedication preferably Rifampicin probably would explain the cause for these thyroid dysfunctions noticed during the study time.
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Background: Despite effective diagnosis and free treatment, prevalence of TB is still growing. DOTS was introduced by WHO in 1997, which is more than two decades ago. It’s a known fact in TB that adherence is less due to long duration of treatment and stigma associated with it. This study was conducted with the objective of estimating and the reasons for the non- adherence to anti tuberculosis treatment in urban field practice area of SSIMS & RC, Davangere.Methods: A qualitative method of study design was used. 20 TB patients who are on anti-tuberculosis treatment were interviewed with a structured questionnaire for adherence to treatment. Among them patients who were non adherent were further interviewed in depth to know the reasons for non-adherence.Results: Data analysis resulted in extraction of five themes, which were side effects, financial burden and social support, duration of treatment, food insecurity, unawareness of consequences of non-adherence to treatment.Conclusions: Patient adherence to treatment is multi-factorial and involves individual patient factors, provider factors, and community factors. Addressing issue of non-adherence to treatment requires enhanced efforts towards resolving medical problems like adverse drug effects, developing short duration treatment regimens, motivational counselling, social, family support for patients and improving awareness about disease
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Background: Tuberculosis being a systemic disease and has a capacity for wide spread dissemination. Present study aims to identify the effects of antituberculous treatment on thyroid profile in new smear positive pulmonary tuberculosis cases.Methods: This study was conducted among 60 new smear positive pulmonary tuberculosis cases attending pulmonary medicine OPD from May 2015 to April 2017. Thyroid function test in the form of free T3, free T4 and TSH was measured before initiating Anti tuberculosis treatment (ATT), at 3 months and at the end of 6 months.Results: Out of 60 patients enrolled in present study, majority were males. Diabetes mellitus was the major co morbidity. Sick euthyroid was found to have decreasing trend during the course of treatment, and hypothyroidism was found to be increasing trend end of 6 months.Conclusions: The common Thyroid Dysfunction seen during the study period was Hypothyroidism and Sick euthyroid. Anti-tuberculous medication preferably Rifampicin probably would explain the cause for these thyroid dysfunctions noticed during the study time. And those patients with significant hypothyroid need to started on thyroid supplements. Among the drugs used for treatment, rifampicin was probably the cause for thyroid dysfunction noticed during the course of treatment. Hence, authors recommend that these patients should be started on thyroid supplements after the diagnosis of significant hypothyroidism.
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Objective To understand the clinical features of splenic tuberculosis. Methods The clinical manifestations, laboratory tests, treatment outcomes of a case of splenic tuberculosis caused by hematogenous pulmonary tuberculosis were analyzed. Related literatures about splenic tuberculosis were also reviewed. Results The patient was a 19-year-old male. Cough, fever, night sweats, and weight loss were the main manifestations. Thoracoscopy revealed tuberculosis and imaging suggested splenic tuberculosis and tuberculosis in multiple body sites. Anti-tuberculosis treatment was effective in improving patient conditions. According to literature review, there are two types of splenic tuberculosis: primary splenic tuberculosis or as part of hematogenous pulmonary tuberculosis.The clinical manifestations of primary splenic tuberculosis are usually atypical. Immune deficiency is a significant risk factor of splenic tuberculosis. The main clinical manifestations of splenic tuberculosis are splenomegaly, fever, digestive system symptoms, and occasionally spontaneous splenic rupture (3/32). Most of the patients with splenic tuberculosis (28/32) were cured or improved by anti-tuberculosis treatment and/or splenectomy. Conclusions The onset of splenic tuberculosis is mostly insidious and clinical symptoms usually atypical. The diagnosis relies on radiographic findings, biopsy and pathological examination. Anti-tuberculosis and selective splenectomy are the effective treatment. The outcome of splenic tuberculosis is good in most patients.
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A vitamina D é um hormônio essencial para o organismo, podendo ser obtida da dieta ou, principalmente, gerada pela pele após exposição à luz solar ultravioleta B. Na sua forma ativa (1,25(oH)2D) ela controla a absorção de cálcio e fósforo do intestino para a corrente sanguínea e participa de diversos processos celulares e fisiológicos. A ligação da 1,25(oH)2D ao receptor da vitamina D (VDr) presente em diversas células, como as células do sistema imunológico, induz a transcrição de genes que podem, por exemplo, modular a resposta imune inata e adquirida. A deficiência de vitamina D ou do VDR é associada a problemas de saúde como desordens esqueléticas, hipertensão, doenças cardiovasculares, diabetes mellitus, dislipidemias, doenças autoimunes e doenças infecciosas. Neste sentido, a suplementação com vitamina D tem sido proposta como uma possível medida preventiva, podendo ser aplicada em muitas patologias, em especial na tuberculose. Principal causa de morte por um único agente infeccioso, a tuberculose é responsável por cerca de 1,3 milhões de óbitos por ano no mundo. Publicações recentes apontam efeitos diversos da vitamina D na resposta imune inata e adquirida. A 1,25(oH)2D3 na presença do interferon (IFN)-γ é capaz de aumentar a atividade bactericida do macrófago contra o M. tuberculosis, aumentando a produção de peptídios antimicrobianos e estimulando a autofagia, favorecendo assim a lise de bacilos localizados em fagossomos. Por outro lado, a vitamina D em linfócitos T mostra efeito tolerogênico que favorece o controle de respostas inflamatórias excessivas. Neste trabalho de revisão são apresentados estudos recentes envolvendo efeitos da vitamina D na resposta imune inata e adquirida. Além disso, considerações sobre deficiência de vitamina D e maior risco de contrair tuberculose, e efeitos contrastantes da suplementação com vitamina D na prevenção e tratamento da TB, são discutidos.
Vitamin D is an essential hormone for the body, and can be obtained from diet or, mainly, generated by the skin after exposure to ultraviolet B sunlight. In its active form (1.25(oH)2D) it controls the absorption of calcium and phosphorus from the intestine into the bloodstream and participates in several cellular and physiological processes. Binding of 1,25(oH)2D to the Vitamin D receptor (VDr) present in several cells, such as cells of the immune system, induces transcription of genes that can, for example, modulate the innate and adaptive immune response. Deficiency of Vitamin D or VDr is associated with health problems such as skeletal disorders, hypertension, cardiovascular disease, diabetes mellitus, dyslipidemias, autoimmune diseases and infectious diseases. In this sense, Vitamin D supplementation has been proposed as a possible preventive measure and can be applied in several pathologies, especially in tuberculosis. main cause of death by a single infectious agent, tuberculosis accounts for about 1.3 million deaths per year worldwide. recent publications point to contrasting functions of Vitamin D in the innate and acquired immune response. 1.25(oH)2D3 in the presence of interferon (IFN)-γ is capable of increasing the bactericidal activity of the macrophage against M. tuberculosis, increasing the production of antimicrobial peptides and stimulating autophagy, thus favoring the lysis of bacilli located in phagosomes. on the other hand, Vitamin D in T lymphocytes shows a tolerogenic effect that favors the control of excessive inflammatory responses. In this review, recent studies involving Vitamin D effects on the innate and acquired immune responses are presented. In addition, considerations about Vitamin D deficiency and increased risk of contracting tuberculosis, and contrasting effects of Vitamin D supplementation on the prevention and treatment of TB, are discussed.
Subject(s)
Vitamin D , Immune System , Autoimmune Diseases , Sunlight , Tuberculosis , Tuberculosis/drug therapy , Vitamin D Deficiency , Calcium , Receptors, CalcitriolABSTRACT
During 2016, American Thoracic Society: ATS, Centers for Disease Control and Prevention: CDC and Infectious Disease Society of America: IDSA jointly sponsored the development of Guidelines for the treatment of drug-susceptible tuberculosis using the P-I-C-O (Patient-Intervention-Comparison-Outcome) system to answer nine questions. The preferred regimen for treating adults with drug-susceptible tuberculosis, consider a 2 month intensive phase with isoniazid (INH), rifampin (RIF), pyrazinamide (PZA), and ethambutol (EMB) followed by a continuation phase of 4 months of INH and RIF For patients who have cavitation on the initial chest radiograph and have positive cultures at completion of 2 months therapy, it is recommended to extend the continuation phase to prevent relapse. EMB can be discontinued as soon as susceptibility to INH and RIF is demonstrated. The guidelines also makes recommendations for the management in different clinical situations as in patients co-infected with HIV and in extrapulmonary tuberculosis. In tuberculous pericarditis no longer is recommended the routinely use of corticosteroids together with the anti TB treatment. In the case of tuberculous meningitis it is recommended the addition of corticosteroids and to extend the continuation phase to 9-12 months.
Durante el año 2016, la American Thoracic Society: ATS, Centers for Disease Control and Prevention: CDC y la Infectious Disease Society of America: IDSA desarrollaron en conjunto una guía de recomendaciones para el tratamiento de la tuberculosis (TBC) sensible, empleando el sistema P-I-C-O (Patient-Intervention-Comparison-Outcome) para contestar 9 preguntas. El régimen de terapia farmacológica óptima para el paciente con TBC sensible considera una fase intensiva de 2 meses de duración con isoniacida (H), rifampicina (R), pirazinamida (Z) y etambutol (E) seguida de una fase de continuación por 4 meses de H y R. En los casos con cavitación en la radiografía de tórax inicial y en pacientes con cultivo de esputo positivo al segundo mes de tratamiento, se propone prolongar la fase de continuación con el propósito de reducir el riesgo de recaída. La guía también recomienda retirar el etambutol una vez que se haya demostrado la sensibilidad a H y R. Se hacen además recomendaciones de manejo en distintas situaciones clínicas como en pacientes co-infectados con VIH y en las TBC extrapulmonares. En la pericarditis TBC se sugiere no utilizar de forma rutinaria la terapia corticoesteroidal coadyuvante al tratamiento anti TBC. En el caso de la TBC meníngea se recomienda usar corticoesteroides y prolongar la quimioterapia durante la fase de continuación a 9 -12 meses.
Subject(s)
Humans , Antitubercular Agents/administration & dosage , Surveys and Questionnaires , Tuberculosis/drug therapy , Treatment OutcomeABSTRACT
PURPOSE: Tuberculosis (TB) remains a problem in the community. TB patients usually experience malnutrition, which is characterized by both decreased body weight (BW) and body fat percentage (BFP). Leptin, an important regulator of BW, also plays an important role in cellular immunity, which is integral to defense against Mycobacterium tuberculosis infection. We analyzed the effect of an anti-TB treatment regimen on the leptin level, BW, and BFP of children with TB. METHODS: The design of this study was a group interrupted time series. The subjects were children with probable TB according to clinical criteria based on an Indonesian scoring system adopted from the Consensus of Expert Panel. BW; BFP; energy intake; fat and protein intake; and leptin levels before, 2 months after (intensive phase), and 6 months after (continuation phase) anti-TB treatment, were measured. About 40 children, aged 5–14 years, participated in this study. RESULTS: The BW, BFP and leptin level increased from before treatment to after completion of the intensive phase and still showed an increased during the continuation phase: BW 18.65 kg, 19.75 kg, and 20.85 kg; BFP 18.3%, 19.5%, and 20.2%; and leptin level 1.9 mg/dL, 3.07 mg/dL, and 3.4 mg/dL, respectively (P<0.01). CONCLUSION: Leptin level, BW, and BFP increased throughout the course of anti-TB treatment, compared with pretreatment values. Further research is needed to compare the results with data for healthy children.
Subject(s)
Child , Humans , Adipose Tissue , Body Weight , Consensus , Energy Intake , Immunity, Cellular , Interrupted Time Series Analysis , Leptin , Malnutrition , Mycobacterium tuberculosis , Tuberculosis , Weight GainABSTRACT
We assessed the incidence of adverse drug reactions (ADRs) with anti-TB medications and evaluated the risk factors for developing ADRs in previously treated tuberculosis patients in China. All patients received the first-line anti-TB regimen (2HREZS/6HRE) as recommended by the national guidelines. Clinical and laboratory evaluations were performed once a month. Out of the 354 participants, 262 (74.0%) experienced ADRs such as hyperuricemia (65.0%, 230/354), hepatotoxicity (6.2%, 22/354) and hearing disturbances (4.8%, 17/354). ADRs were significantly associated with diabetes mellitus [OR (95% CI): 15.5 (2.07-115.87)]; however, weight more than 50 kg [OR (95% CI): 0.41 (0.22-0.85)] was a protective factor for occurrence of ADRs. Hyperuricemia is the most common adverse event but, most patients with hyperuricemia showed increased tolerance for high uric acid levels. Low body weight and diabetes mellitus increased the risk of the occurrence of ADRs during anti-TB treatment.
Subject(s)
Adolescent , Adult , Female , Humans , Male , Middle Aged , Young Adult , Antitubercular Agents , Therapeutic Uses , Diabetes Mellitus , Prevalence , Retrospective Studies , Risk Factors , Tuberculosis, Pulmonary , Drug Therapy , EpidemiologyABSTRACT
ABSTRACT The use of drugs in fixed-dose combination (FDC) is now recommended by the World Health Organization (WHO) due to the emergence of multidrug-resistant strains of Mycobacterium tuberculosis. FDC uses different drugs against tuberculosis (TB) in a single tablet for phase-intensive therapeutic intervention. This therapy aims to optimize treatment, to prevent inappropriate use of drugs, and to prevent the emergence of new resistant strains. This study aims to evaluate the susceptibility of clinical isolates of M. tuberculosis against rifampicin, isoniazid, ethambutol, and pyrazinamide. The antimicrobials were tested separately and in associations according to FDC. This was used for broth microdilution method, which was compared to the proportions method previously considered as the gold standard. In antimicrobials testing alone, several strains were resistant to one, two, or three drugs. However, when applied to association of drugs in FDC, there was no antimicrobial resistance. The results strengthen the FDC's concept, which aims to unite the four anti-TB drugs to combat bacterial resistance.
Subject(s)
Pyrazinamide/administration & dosage , Rifampin/administration & dosage , Ethambutol/administration & dosage , Isoniazid/administration & dosage , Anti-Infective Agents/analysis , Mycobacterium tuberculosis , Mycobacterium tuberculosis/classification , Pharmaceutical Preparations , Disk Diffusion Antimicrobial TestsABSTRACT
To advance in the control and elimination of tuberculosis (TB) we must achieve a high level of effectiveness in the prevention of TB in populations infected by Mycobacterium tuberculosis. Latent TB prevention success with current therapies (single isoniazid or in combination with rifampicin) is close to 60%. We also must offer a high level of treatment success in first-line drugs sensitive TB patients. With currently available drugs (isoniazid, rifampicin, ethambutol and pyrazinamide) treatment success should reach at least 95%. Drug side reactions together with the lengthen treatment of infection and disease (6 months) decrease the compliance to these therapies. In Multi-Drug-Resistant TB (MDR-TB), therapies are even longer (20 months according to WHO's recommendation) and much less tolerated, with rates of success under 50%. New trials for latent TB using rifapentin and isoniacid; combined fixed-dose offirst-line drugs in sensible TB, and the addition of new drugs (fluorquinolones, bedaquiline, delamanid and linezolid) in multi-drug resistant TB, together with shorter regimens of 12 months duration which include Clofazimine (experience in Cameroon with modification of a 9 months trial previously used in Bangladesh showing 89% cure) are discussed in this article.
Para el control y eliminación de la tuberculosis se debe lograr un alto grado de eficacia en la prevención del desarrollo de tuberculosis en la población infectada por Mycobacterium tuberculosis. Esta prevención, con las terapias actuales de la tuberculosis latente (isoniazida sola o combinada con rifampicina), es cercana al 60%. También debemos alcanzar una alta tasa de curación para los enfermos con tuberculosis sensible a los fármacos de primera línea (vírgenes a tratamiento). Con los fármacos actualmente disponibles (isoniazida, rifampicina, etambutol y pirazinamida) esta curación debería alcanzar a no menos del 95%. La regular tolerancia y reacciones colaterales de los fármacos y el largo tiempo que demandan las terapias de la infección y de la enfermedad (6 meses) atenta contra su adherencia. En el caso de la Tuberculosis Multi-Drogo-Resistente (TB-MDR), los tratamientos son aún más prolongados (20 meses según recomienda la OMS actualmente) y menos tolerados, siendo sus tasas de curación inferiores a 50%. Se analizan nuevos esquemas para el tratamiento de la tuberculosis latente usando rifapentina asociada a isoniacida; dosis fijas combinadas de fármacos de primera línea para tuberculosis sensibles, y asociación de fármacos antiguos y nuevos (fluoroquinolonas, bedaquilina, delamanid y linezolid) para el tratamiento de las tuberculosis multirresistentes. También se presentan nuevos esquemas acortados, de 12 meses de duración, que incluyen clofazimina (experiencia en Camerún con modificación del esquema de 9 meses usado previamente en Bangladesh, con tasas de curación de 89%).
Subject(s)
Humans , Tuberculosis/prevention & control , Tuberculosis/drug therapy , Tuberculosis/epidemiology , Chile/epidemiology , Tuberculosis, Multidrug-Resistant , Latent TuberculosisABSTRACT
Objective To understand the potential risk factors influencing the effect of standard anti-tuberculosis (TB) treatment for TB patients co-infected with human immunodeficiency virus (HIV) and provide evidence for the improvement of anti TB therapy.Methods A retrospective study was conducted among 445 TB/HIV patients diagnosed and registered in 7 counties in Yunnan province from January 2010 to June 2012.A structured questionnaire was used to collect the patients' demographic characteristics,diagnosis and treatment information after informed consent.Chi-square test was conducted to compare successful rate of anti TB treatment among the patients with different demographic characteristics.Multivariate logistic regression analysis was conducted to identify risk factors influencing the effect of anti TB treatment.Adjusted OR＞1 means the risk factor of treatment failure.P value less than 0.05 was set as significant level.Results After standard anti TB treatment,397 patients were cured.The five risk factors influencing treatment effect were the existing of 4 suspected TB symptoms when seeking medical care for the first time(adjusted OR=2.208),TB/HIV patients detected in HIV/AIDS screening (adjusted OR=5.856),severe case (adjusted OR=4.607),non-full-course supervision during treatment (in intensive phase adjusted OR=4.129,full-course management adjusted OR=8.090) and interruption of therapy (adjusted OR=21.517).Conclusion Early detection of TB/HIV patients and conducting full course supervision during treatment can improve the effect of anti TB treatment.It is necessary to strengthen the early detection of TB/HIV patients and standarded treatment in Yunnan province.
ABSTRACT
Pulmonary tuberculosis (PT) Tuberculosis (TB) is one of the most important communicable diseases in the world. India is the highest PT TB burden country accounting for one-fifth (21%) of the global incidence (9.4 million cases). This problem is further magnified by the after-effects of the disease—post-tubercular bronchiectasis (PTBX). As a result, the sufferers run from pillar to post with sinister symptomatology. Some of them are retreated with antituberculous treatment, although there is no definite indication. Katuri Medical College is situated in the rural Guntur surrounded by number of dusty industries like granite, quarrying, cotton crop and mills, tobacco, capsicum crop, spices besides being an agricultural area on the brink of mighty Krishna River flowing at a length of more than 700 km through three states of Karnataka, Maharashtra and Andhra Pradesh. As a result the flora and fauna is complex. Workers in this area report with variegated granulomatous lung diseases to the faculty of Pulmonology. Over and above the incidence of smoking in both sexes is rampant. The final outcome in all these morbidities is bronchiectasis. Quite a few of them have had treatment for pulmonary TB in the past. With this background the present study was undertaken to find out the vagary of post-tubercular bronchiectasis ruling out the extrinsic atmospheric factors.
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INTRODUÇÃO: A tuberculose merece especial atenção dos profissionais de saúde e da sociedade. Entretanto, os serviços de saúde não estão organizados para atender esses pacientes, e a prevalência da doença permanece alta no país. O objetivo deste estudo é demonstrar o papel da Atenção Primária na melhora dos indicadores da Tuberculose a partir de ações programáticas estruturadas. MÉTODOS: Dados de pacientes com diagnóstico de TB vinculados à Unidade Básica de Saúde do Hospital de Clínicas de Porto Alegre, atendidos nos serviços de saúde do município, foram analisados e comparados antes (2002 a 2008) e depois (2009 a 2012) da implantação de um Programa de Controle de Tuberculose. Os indicadores analisados têm base nas metas estabelecidas pela Organização Mundial da Saúde. RESULTADOS: Cento e quarenta pacientes tiveram Tuberculose entre 2002 e 2012: 94 no período pré-implantação do Programa e 46 após. Com o Programa, o número anual de sintomáticos respiratórios rastreados e de pacientes diagnosticados com Tuberculose cresceu. Aumentou o diagnóstico de Tuberculose nos serviços de atenção primária de 4,3% (n = 4) para 39,1% (n = 18), (p < 0,001); e houve melhora das taxas de cura (de 78,2% para 85,7%) e abandono (de 9,3% para 9,1%). CONCLUSÃO: Nosso estudo demonstrou que após a implantação do Programa de Controle de TB no Serviço de APS do HCPA houve melhora nos índices de diagnóstico da doença, nas taxas de cura e abandono, tendo sido atingida a meta de cura preconizada pelo Ministério da Saúde
INTRODUCTION: Tuberculosis deserves special attention from health professionals and society. However, health services are not organized to attend these patients, and the prevalence of the disease remains high in the country. The objective of this paper is to demonstrate the role of primary care in improving tuberculosis indicators with structured programmatic actions METHODS: Data from patients diagnosed with tuberculosis linked to the Primary Health Care Service of the Hospital de Clínicas de Porto Alegre, attended in the health care services of the city, were analyzed and compared before (2002-2008) and after (2009-2012) the implementation of a Tuberculosis Control Program. The indicators were analyzed based on the goals established by WHO. RESULTS: One hundred and forty patients had tuberculosis between 2002 and 2012, 94 before the implementation of the Program and 46 after. With the Program, the annual number of tracked respiratory symptomatic patients and patients diagnosed with tuberculosis increased. Also, the diagnosis of tuberculosis in primary care services increased from 4.3% (n = 4) to 39.1% (n = 18) (p < 0.001); and there was an improvement in cure (78.2% to 85.7%) and therapy dropout (9.3% to 9.1%) rates. CONCLUSION: Our study showed that, after implementation of the Tuberculosis Control Program in the Primary Health Care Service of the Hospital de Clínicas de Porto Alegre, there was improvement in diagnosis of the disease, cure and treatment dropout rates, which have reached the cure rate goal established by the Ministry of Health