Changes of cytokine levels before and after anti-tuberculosis treatment / 中国热带医学

@#Abstract： Objective　To analyze the changes of cytokine levels in patients with sensitive pulmonary tuberculosis and drug-resistant pulmonary tuberculosis before and after anti-tuberculosis treatment. Methods　The clinical data of 213 pulmonary tuberculosis patients admitted to the Eighth Affiliated Hospital of Xinjiang Medical University from August 2019 to October 2020 were collected, and divided into a sensitive pulmonary tuberculosis group and a drug-resistant pulmonary tuberculosis group, of which 141 were in the sensitive group and 72 in the drug-resistant group , and the pro-inflammatory factors tumor necrosis factor-α (TNF-α), IL-6, IL-17, interferon-γ (IFN-γ) and anti-inflammatory factors IL-10 and IL-4 in plasma before treatment, 3 months and 6 months after treatment were compared. Results　Compared with the healthy group, the levels of plasma IL-6 in the sensitive group and the resistant group were significantly increased, difference was statistically significant (P<0.01). The plasma levels of IFN-γ and IL-17 in the sensitive group were increased, and the difference was statistically significant (P<0.05). Compared with before treatment, the levels of IL-6 and IL-4 in the plasma of the sensitive group after 6 months of treatment were lower than those after 3 months of treatment, and the difference was statistically significant (P<0.05), and IFN-γ was significantly decreased (P<0.001). After 6 months of treatment, the IL-10 content was lower than that before treatment, and the difference was statistically significant (P<0.05), and the IFN-γ decreased significantly (P<0.000 1). The levels of IFN-γ at 3 months were higher than those in the resistant group, and the difference was statistically significant (P<0.01). After 6 months of treatment, there was no significant difference in the content of IFN-γ between the sensitive group and the resistant group. The effective rate of CT absorption was 70% in the sensitive group and only 43.33% in the resistant group at 3 months of treatment, and there was no significant difference in the effective rate between the two groups after 6 months of treatment. Conclusions　Detection of pro-inflammatory cytokines and anti-inflammatory cytokines in plasma can provide reference for host-directed therapy of pulmonary tuberculosis. Understanding this important feature of cytokines on pathogen-host interactions can provide new insights into the study of virulence mechanisms and may provide new approaches for immune intervention in pulmonary tuberculosis.

Caracterización de la tuberculosis sensible en el Ecuador: una visión epidemiológica a un antiguo y latente problema de salud / Characterization of sensitive tuberculosis in Ecuador: an epidemiological view of an ancient and latent health problem

Contexto: se calcula que en el año 2013, nueve millones de sujetos contrajeron tuberculosis y 1,5 millones fallecieron, de éstos, 360.000 sujetos fueron VIH positivos. Material y métodos: se realizó un estudio descriptivo transversal, en pacientes con diagnóstico de tuberculosis sensible en el Ecuador durante el período enero 2009 a diciembre 2013. El universo comprende el 100% de la población afectada por tuberculosis sensible. Resultados: predomina el sexo masculino, con una razón media de 1,8 hombres por mujer, con un intervalo de 15-54 años, la provincia de Guayas concentra un poco más del 50% de los casos de Tb; el 75% de casos se concentró en 5 provincias que son Guayas, Los Ríos, Pichincha, El Oro y Manabí. Los fracasos terapéuticos, en el 2011 en Ecuador alcanza una media 6,6%, el abandono terapéutico fue de 9,9% con un paulatino descenso, la tasa de mortalidad muestra una reducción superior al 50%. Conclusión: los resultados reflejan la necesidad de definir una estrategia para de incrementar el porcentaje de identificación de sintomáticos respiratorios, lo que aumentará el número de casos diagnosticados para aproximarse como país a la estimaciones de la OMS. Adicionalmente deberá fortalecerse la estrategia DOT con el fin de mejorar el éxito terapéutico y recudir los fracasos y abandonos. (AU)

Context: It is estimated that in 2013, nine million subjects contracted tuberculosis and 1.5 mil-lion died, of which 360,000 subjects were HIV positive. Material and methods: A cross-sectional descriptive study was performed in patients diagnosed with tuberculosis in Ecuador during the period January 2009 to December 2013. The universe comprises 100% of the population affected by sensitive tuberculosis. Results: men predominate, with an average ratio of 1.8 men per woman, with an interval of 15-54 years, the province of Guayas concentrates a little more than 50% of the cases of Tb; 75% of cases were concentrated in 5 provinces that are Guayas, Los Ríos, Pichincha, El Oro and Manabí. The therapeutic failures, in 2011 in Ecuador reaches a mean of 6.6%, the thera-peutic abandonment was 9.9% with a gradual decrease, the mortality rate shows a reduction of more than 50%. Conclusion: the results reflect the need to define a strategy to increase the per-centage of symptomatic respiratory identification, which will increase the number of cases diag-nosed to approximate the WHO country estimates. In addition, the DOT strategy should be strengthened in order to improve therapeutic success and recuse failures and dropouts. (AU)

Efectividad de la consejer¡a en enfermería en la adherencia al tratamiento farmacológico en pacientes con tuberculosis de la microred de salud Jaime Zubieta Calderón en San Juan de Lurigancho, Lima, Perú / Effectiveness of the counseling in nursing adherence to drug treatment in patients with tuberculosis of the micro red de salud Jaime Zubieta Calderón in San Juan de Lurigancho, Lima, Perú

Objetivos: determinar la efectividad de la consejería en enfermería en la adherencia al tratamiento farmacológico en pacientes nuevos con tuberculosis sensible al tratamiento, en la Micro red de salud Jaime Zubieta Calderón perteneciente a la DISA IV de Lima Este en San Juan de Lurigancho durante los meses de octubre 2013 hasta agosto 2014. Material y Métodos: estudio cuasi experimental con grupo control histórico. La muestra estuvo conformada por 30 pacientes nuevos con diagnóstico tuberculosis sensible, los controles se tomaron teniendo los mismos criterios de inclusión y el periodo de tiempo durante los meses de octubre 2012-setiembre 2013 obteniendo 72 controles. La recolección de datos se realizó a través de la tarjeta de control de asistencia y administración de medicamentos de cada uno. Los resultados se tabularon en el programa Excel 2010, posteriormente analizados en el programa SPSS versión 22. Resultados: se realizó un cuadro de homogeneidad donde se evidenció un nivel de significancia estadística 4.62, siendo el valor de p=0.032. El grupo intervenido obtuvo 100% de adherencia; a diferencia del grupo control histórico que tuvo una adherencia 86 %, se evidenció un incremento del 14% a lo esperado. Conclusiones: la consejería de enfermería es efectiva en la mejora de la adherencia al tratamiento antituberculoso en pacientes con TB sensible. Además, favorece a la asistencia diaria a la toma del tratamiento, citas médicas, nutrición y enfermería.

Objectives: to determine the effectiveness of counseling in nursing adherence to drug treatment in new patients with tuberculosis in “Micro red de salud Jaime Zubieta Calderon” belongs to the DISA IV Lima Este in San Juan de Lurigancho district during the months of October 2013 to August 2014. Material and Methods: a quasi-experimental research design with historical control. The sample was conducted with 30 patients new sensitive diagnosed with tuberculosis, where evaluated over a period of two months-a period greater risk to non-adherence- issues about the disease, treatment is addressed, and the particular needs of each user is identified. Controls were taken to have the same inclusion criteria and the period during the months of October 2012 to September 2013 obtaining 72 controls. The results are tabulated in the Excel 2010 program subsequently analyzed in SPSS version 22. Results: Homogeneity box where a level of statistical significance was performed evidenced 4.62, the value of p = 0.032. The interview group the percentage of adherence was 100%; than the history control group had a 86 % adherence is achieved a 14% increased the percentage expected. Conclusions: Nursing counseling is effective in improving adherence to tuberculosis treatment in patients with sensitive TB. Furthermore, fauvors the daily attendance taking treatment, medical appointments, nutrition and nursing.

Polymorphisms of HLA-DRB1 and -DQB1 Genes in Korean Patients with Pulmonary Tuberculosis / 결핵

BACKGROUND: It is well known that only 10% of those infected with Mycobacterium tuberculosis actually develop clinical disease, indicating the existence of host genetic factors regulating disease expression. In this study, we investigated HLA-DRB1 and -DQB1 gene polymorphisms in Korean patients with pulmonary tuberculosis (PTB). METHODS: HLA-DRB1 and -DQB1 gene polymorphisms were investigated in 67 PTB patients without previous treatment history, 38 drug-sensitive (DS) and 29 multidrug-resistant (MDR) cases, and 200 healthy controls. HLA-DRB1 typing was done using reverse SSO (sequence specific oligonucleotide) and PCR-SSCP (single strand conformational polymorphism) methods and DQB1 typing was done using PCR-RFLP (restriction fragment length polymorphism), PCR-SSCP and PCR-SSP (sequence specific primer) methods. RESULTS: Among the PTB patients, MDR-TB cases showed frequencies of DRB1*0701 and *08032 increased by about two-fold compared to those of normal controls, and likewise for their associated DQB1 alleles, DQB1*0202 and *0601 (15.5% vs. 34.5%, p=0.01). The frequency of HLA-DQB1*0609 was significantly increased in PTB patients (4.0% vs. 14.9%, p=0.004), showing similar increases in both DS and MDR cases. There was also an association of HLA alleles with the clinical severity of the disease according to the extent of lung lesion. Significantly increased frequencies of DRB1*08032 (4.2% vs. 32.6%, p=0.007) and DQB1*0601 (12.5% vs. 34.9%, p=0.047) were observed in more advanced (moderately & far advanced/DS and far advanced/MDR), compared with less advanced (minimal/DS and moderately advanced/MDR) lung lesions. Although DRB1*0701, DQB1*0202 and DQB1*0609 showed significant increases in different subsets of the disease, these HLA alleles did not show consistent association with disease severity. CONCLUSION: HLA-DRB1*08032 and DQB1*0601 alleles were associated with genetic susceptibility to MDR-TB in Korean patients, and also with disease severity and progression of PTB.