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1.
Rev. argent. salud publica ; 121 de Julio 2020.
Article in Spanish | LILACS (Americas), BINACIS, ARGMSAL | ID: biblio-1102341

ABSTRACT

La búsqueda activa de casos de tuberculosis (TB) puede resultar costo-efectiva debido a los potenciales beneficios a largo plazo de prevenir nuevos casos, acortar la duración de la morbilidad y minimizar el riesgo de muerte. El objetivo de este estudio fue evaluar la relación costo-efectividad de tres estrategias de detección de casos de TB pulmonar (TBp) en residentes ≥15 años de la ciudad de Santa Fe durante el período de un año. MÉTODOS: A partir de datos primarios, secundarios y del diseño y aplicación de un modelo analítico de decisión estática para evaluar costo-efectividad incremental (CEI), se comparó la búsqueda activa de casos (BAC) en la comunidad y la investigación de contactos en el hogar (ICH) con la búsqueda pasiva de casos (BPC) utilizada como práctica habitual en el contexto de los programas de control de la TB en el país. RESULTADOS: El número de casos verdaderos de TBp captados por BPC en un año fue de 55 para el total de habitantes de la ciudad (17 por 100 000), a un costo medio de USD 2625,62 por caso. El beneficio adicional de sumar la ICH a la BPC fue de 4 casos, a un costo de USD 9518,62 por caso adicional detectado. La suma de la BAC a la estrategia BPC+ICH no produjo beneficio adicional en términos de casos, si bien tuvo un costo adicional de USD 139,26. DISCUSIÓN: Según el umbral de decisión adoptado, la estrategia BPC+ICH calificó como muy costo-efectiva, además de ser más costo-efectiva que la BPC+ICH+BAC.


Subject(s)
Tuberculosis , Cost Efficiency Analysis
2.
Enferm. foco (Brasília) ; 11(1): 136-141, jun. 2020.
Article in Portuguese | LILACS (Americas), BDENF | ID: biblio-1102886

ABSTRACT

Objetivo: realizar um diagnóstico da realidade situacional relativo ao acompanhamento de usuários com tuberculose e desenvolver oficinas educativas com foco nas vulnerabilidades detectadas no processo do cuidado. Metodologia: Pesquisa/intervenção realizada junto a onze enfermeiros do município de Ibiapina-Ceará. O grupo focal foi à técnica utilizada para coleta das informações, estas foram organizadas e sintetizadas com suporte da análise temática. Resultados: Os profissionais apresentam dificuldades no desenvolvimento de estratégias preconizadas para o controle e combate da tuberculose. Surgiram ainda questões relacionadas a problemas estruturais e logísticos como limitação de locais para a realização dos exames, falta de materiais ou equipamentos, inexistência de uma conexão entre os serviços envolvidos, assim como o medo do contágio da doença. Conclusão: O estudo permitiu a identificação das dificuldades e vulnerabilidades, subsidiando a tomada de decisão e a definição de estratégias de intervenção, auxiliando na superação das fragilidades dos serviços de saúde. (AU)


Objective: to carry out a diagnosis of the situational reality related to the monitoring of users with tuberculosis and to develop educational workshops focusing on the vulnerabilities detected in the care process. Method: Research / intervention conducted with eleven nurses from the municipality of Ibiapina-Ceará. The focus group was the technique used to collect information, which was organized and synthesized with the support of thematic analysis. Results: Professionals have difficulties in developing recommended strategies for tuberculosis combat and control. There were also questions related to structural and logistical problems, such as limitation of places for the exams, lack of materials or equipment, lack of a connection between the services involved, as well as the fear of contagion of the disease. Conclusion: The study supporting the decision making and the definition of intervention strategies, helping to overcome the weaknesses of health services. (AU)


Objetivo: Realizar un diagnóstico de la realidad situacional relacionada con el monitoreo de usuarios con tuberculosis y desarrollar talleres educativos enfocados en las vulnerabilidades detectadas en el proceso asistencial. Metodo: Investigación / intervención realizada con once enfermeros del municipio de Ibiapina-Ceará. El grupo focal fue la técnica utilizada para recolectar informaciones, que se organizó y sintetizó con el apoyo del análisis temático. Resultados: Los profesionales tienen dificultades para desarrollar estrategias recomendadas para el combate y control de la tuberculosis. También surgieron preguntas relacionadas con problemas estructurales y logísticos, como la limitación de plazas para los exámenes, falta de materiales o equipos, falta de conexión entre los servicios involucrados, así como el miedo al contagio de la enfermedad. Conclusión: permitió subvencionar la toma de decisiones y la definición de estrategias de intervención, ayudando a superar las debilidades de los servicios de salud. (AU)


Subject(s)
Nursing Care , Primary Health Care , Tuberculosis , Nursing
4.
Washington; Organización Panamericana de la Salud; abr. 13, 2020.
Non-conventional in Spanish | LILACS (Americas) | ID: biblio-1096694

ABSTRACT

Ante la situación actual de la pandemia del COVID-19 se aconseja a los países que continúen con la adopción de los algoritmos de diagnóstico de TB recomendados por OPS/OMS. A pesar de las diferencias en los modos de transmisión de TB y COVID-19, ciertas medidas de protección personal son relevantes para ambas enfermedades. Las medidas habituales para protegerse de la TB deben continuar junto con las precauciones adicionales para proteger a los trabajadores de COVID-19.


Subject(s)
Pneumonia, Viral/prevention & control , Tuberculosis/diagnosis , Tuberculosis/prevention & control , DNA, Viral/analysis , Coronavirus Infections/prevention & control , Pandemics/prevention & control , Betacoronavirus
5.
Washington; Organización Panamericana de la Salud; mar. 19 2020. 5 p.
Non-conventional in Spanish | LILACS (Americas) | ID: biblio-1096599

ABSTRACT

A medida que el mundo se une para hacer frente a la pandemia del COVID-19, es importante garantizar que los servicios y operaciones esenciales para hacer frente a los problemas de salud prevalentes, continúen protegiendo la vida de las personas con TB y otras enfermedades o condiciones de salud. Los servicios de salud, incluidos los programas nacionales para combatir la TB, deben involucrarse activamente para garantizar una respuesta efectiva y rápida al COVID-19.


Subject(s)
Humans , Pneumonia, Viral/prevention & control , Tuberculosis/complications , Tuberculosis/prevention & control , Coronavirus Infections/prevention & control , Pandemics/prevention & control , Betacoronavirus
6.
Arch. argent. pediatr ; 118(1): e39-e42, 2020-02-00. ilus, tab
Article in Spanish | LILACS (Americas), BINACIS | ID: biblio-1095862

ABSTRACT

La tuberculosis es una enfermedad muy frecuente en nuestro medio. A pesar de que la detección precoz y el tratamiento adecuado logran la curación en la mayoría de los pacientes, la dificultad en el diagnóstico, el abandono del tratamiento y la aparición de resistencia a los fármacos tradicionales generan que, en la actualidad, continúe siendo un importante problema de salud pública. En la Argentina, la tasa de morbilidad es de 25/100 000 habitantes, con un leve aumento en la mortalidad.Se presenta el caso de una paciente pediátrica con tuberculosis, que tuvo múltiples complicaciones asociadas a la enfermedad y a su tratamiento, entre las cuales se incluye el síndrome in-flamatorio de reconstitución inmunológica, también conocido como reacción paradojal al tratamiento antituberculoso. Este representa una consecuencia clínica adversa al restablecimien-to de la inmunidad en el paciente que padece una infección sistémica grave, como la tuberculosis miliar.


Tuberculosis is a very frequent disease in our environment. Although early detection and adequate treatment achieve cure in most patients, the difficulty in diagnosis, the abandonment of treatment and the appearance of resistance to traditional drugs generate that at present it continues to represent an im-portant public health problem. In Argentina, the morbidity rate is 25/100,000 inhabitants, with a slight increase in mortality.We present the case of a pediatric patient with tuberculosis and multiple complications associated with the disease and its treatment. One of these complications was the immune re-constitution inflammatory syndrome or paradoxical reaction to antituberculosis treatment. It represents an adverse clinical con-sequence of the restoration of immunity in the patient suffering from a serious systemic infection such as miliary tuberculosis.


Subject(s)
Humans , Female , Child , Tuberculosis/complications , Tuberculosis, Miliary/diagnosis , Immune Reconstitution Inflammatory Syndrome , Tuberculosis, Meningeal , Tuberculosis, Miliary/drug therapy
7.
REME rev. min. enferm ; 24: e-1296, fev.2020.
Article in Portuguese | LILACS (Americas), BDENF | ID: biblio-1096478

ABSTRACT

Objetivo: avaliar o controle da tuberculose em 44 municípios paulistas segundo aspectos do contexto externo, político-organizacional e técnicooperacional dos sistemas locais de saúde. Método: estudo operacional de análise de agrupamento utilizando indicadores operacionais e de desfecho de casos novos de tuberculose para os anos de 2014 e 2015; e teste de hipótese para proporção para identificação de associação dos grupos com porte populacional, índice de Gini, cobertura de Programa de Agentes Comunitários de Saúde e Estratégia Saúde da Família e despesas per capita em atenção básica e vigilância epidemiológica. Resultados: o primeiro grupo formado (n=19) apresentou resultados satisfatórios dos indicadores operacionais e desfecho; o segundo (n=5) teve desempenho regular (resultado satisfatório de desfecho e insatisfatório para o tratamento diretamente observado) e esteve associado ao índice de Gini baixo e menor proporção de PACS; o terceiro (n=20) grupo, de desempenho insatisfatório, esteve associado a índice de Gini mais alto e porte populacional pequeno. Conclusão: os achados destacaram a relação entre aspectos socioeconômicos e o desempenho das ações de controle da tuberculose.(AU)


Objective: to evaluate tuberculosis control in 44 municipalities in São Paulo according to aspects of the external, political-organizational and technicaloperational context of local health systems. Method: operational study of cluster analysis using operational and outcome indicators of new cases of tuberculosis for the years 2014 and 2015; and hypothesis test for proportion to identify association of groups with population size, Gini index, coverage of Community Health Agents Program and Family Health Strategy and per capita expenditure in primary care and epidemiological surveillance. Results: the first group (n=19) presented satisfactory results of operational indicators and outcome; the second (n=5) had regular performance (satisfactory outcome and unsatisfactory for directly observed treatment) and was associated with low Gini index and lower proportion of PACS; the third (n=20) group, with poor performance, was associated with a higher Gini index and small population size. Conclusion: the findings highlighted the relationship between socioeconomic aspects and the performance of tuberculosis control actions.(AU)


Objetivo: evaluar el control de la tuberculosis en 44 municipios de São Paulo de acuerdo con los aspectos del contexto externo, políticoorganizativo y técnico-operativo de los sistemas locales de salud. Método: estudio operativo de análisis de conglomerados utilizando indicadores operativos y de desenlace de nuevos casos de tuberculosis para los años 2014 y 2015; y prueba de hipótesis para proporciones para identificar la asociación de grupos con el tamaño de la población, el índice de Gini, el alcance del Programa de Agentes Comunitarios de Salud (PACS) y la Estrategia de Salud Familiar y los gastos per cápita en atención primaria y vigilancia epidemiológica. Resultados: el primer grupo formado (n = 19) presentó resultados satisfactorios para indicadores operativos y desenlace; el segundo (n = 5) presentó rendimiento regular (resultado satisfactorio de desenlace e insatisfactorio para el tratamiento observado directamente) y se asoció con un índice de Gini bajo y una menor proporción de PACS; el tercer grupo (n = 20), de rendimiento insatisfactorio, se asoció con un índice de Gini más alto y poblaciones de menor tamaño. Conclusión: los hallazgos realzaron la relación entre los aspectos socioeconómicos y el desempeño de las acciones de control de la tuberculosis.(AU)


Subject(s)
Humans , Outcome and Process Assessment, Health Care , Tuberculosis , Health Evaluation , Infection Control , Quality Indicators, Health Care , Epidemiological Monitoring
8.
San Salvador; Ministerio de salud; Primera; 27/01/2020. 14 p.
Non-conventional in Spanish | LILACS (Americas), BISSAL | ID: biblio-1087889

ABSTRACT

En El Salvador, la tuberculosis (TB) continúa siendo un problema de salud pública, cada año son diagnosticados entre 3,000 a 3,500 personas de las cuales, mas del 40% están al interior del sistema penitenciario y el 16% (500 casos) en el Instituto Salvadoreño del Seguro Social y el 39% en la red de establecimientos del MINSAL. Del total de los casos del 2020 el 56% se diagnosticó a través de pruebas moleculares (gene Xpert), el 46% con baciloscopias y menos del 2% por cultivo. A través de la red de laboratorio a nivel nacional, existen 215 laboratorios que realizan baciloscopías, 24 que realizan cultivo BAAR y 11 que realizan pruebas moleculares. Desde el año 1997 El Salvador implementó la estrategia de Tratamiento Acortado Estrictamente Supervisado (TAES), la cual es aplicada en toda la red de los servicios de salud: Seguridad Social, Centros Penales, Bienestar Magisterial, Hospitales Privados; ser costo efectivo puesto que evita la hospitalización, llegando a alcanzar tasas de éxito en el tratamiento arriba de 93%, superando la meta mundial del 90% recomendada por la OMS. A partir del 12 de marzo del 2020, El Salvador declaró emergencia nacional para hacerle frente a la pandemia del COVID-19, siendo una enfermedad respiratoria al igual que la tuberculosis, las intervenciones realizadas en el control de infecciones y medidas de aislamiento contribuyen al control de ambas enfermedades. El Programa Nacional de Tuberculosis (PNTYER) ha realizado durante el mes de marzo 2,876 pruebas a través del método del Gene Xpert MTB/Rif para detectar M. tuberculosis, de las cuales han resultado 151 personas positivas a la enfermedad, de las cuales 89 (59%) corresponde a personas privadas de libertad. De las 151 personas detectadas con tuberculosis, 96 corresponden al periodo del 12 al 31 de marzo, durante el periodo de cuarentena actual. Hasta el momento no hay evidencia referente a la coexistencia del binomio TB y COVID-19. Debido a la expansión del COVID-19 en la Región, El Salvador implementó los centros de contención de personas con sospecha de COVID 19, para evitar su propagación. Durante este período de emergencia se debe garantizar el acceso a una atención integral centrada en el paciente con signos y síntomas respiratorios, sin olvidar una de las principales actividades del Programa, la detección precoz y tratamiento oportuno de la TB, con medidas y enfoque pluripatológico (un Sintomático Respiratorio podría tener TB, COVID-19, otra coinfección u otra comorbilidad) para lo cual los servicios de salud deben dar respuesta inmediata tanto con el abordaje diagnostico (con realización de baciloscopias, cultivos, Gene Xpert) como el control de infecciones, manejo y referencia del paciente, haciendo hincapié en la bioseguridad del personal en la toma, manejo y envío de muestras.


Subject(s)
Humans , Tuberculosis , Animal Proteins, Dietary , Coronavirus , Health Surveillance of Health Services
9.
Article in English | WPRIM (Western Pacific) | ID: wprim-762473

ABSTRACT

BACKGROUND: Although the incidence of tuberculosis (TB) is decreasing, cases of multidrug-resistant (MDR) TB and extensively drug-resistant (XDR) TB continue to increase. As conventional phenotype drug susceptibility testing (pDST) takes six to eight weeks, molecular assays are widely used to determine drug resistance. we developed QuantaMatrix Multiplexed Assay Platform (QMAP) MDR/XDR assay (QuantaMatrix Inc., Seoul, Korea) that can simultaneously detect mutations related to both first- and second-line drug resistance (rifampin, isoniazid, ethambutol, fluoroquinolones, second-line injectable drugs, and streptomycin). METHODS: We used 190 clinical Mycobacterium tuberculosis (MTB) strains isolated from Myanmar, compared QMAP and pDST results, and determined concordance rates. Additionally, we performed sequence analyses for discordant results. RESULTS: QMAP results were 87.9% (167/190) concordant with pDST results. In the 23 isolates with discordant results, the QMAP and DNA sequencing results completely matched. CONCLUSIONS: The QMAP MDR/XDR assay can detect all known DNA mutations associated with drug resistance for both MDR- and XDR-MTB strains. It can be used for molecular diagnosis of MDR- and XDR-TB to rapidly initiate appropriate anti-TB drug therapy.


Subject(s)
Diagnosis , DNA , Drug Resistance , Drug Therapy , Ethambutol , Extensively Drug-Resistant Tuberculosis , Fluoroquinolones , Incidence , Isoniazid , Myanmar , Mycobacterium tuberculosis , Phenotype , Seoul , Sequence Analysis , Sequence Analysis, DNA , Tuberculosis , Tuberculosis, Multidrug-Resistant
10.
Article in Korean | WPRIM (Western Pacific) | ID: wprim-785349

ABSTRACT

Pulmonary paragonimiasis and tuberculosis are endemic in Asia, South America, and Africa. However, differential diagnosis among the diseases is difficult because they present with similar clinical symptoms and diagnostic features. Here, we report a case of pulmonary paragonimiasis that was identified using Ziehl-Neelsen stain after initially being assessed for pulmonary tuberculosis. Following anti-Paragonimus chemotherapy, the patient's symptoms, laboratory test results, and lung lesions improved. Thus, the identification of Paragonimus westermani using Ziehl-Neelsen stain can be considered in the diagnosis.


Subject(s)
Africa , Asia , Diagnosis , Diagnosis, Differential , Drug Therapy , Lung , Paragonimiasis , Paragonimus westermani , South America , Tuberculosis , Tuberculosis, Pulmonary
12.
Article in English | WPRIM (Western Pacific) | ID: wprim-787236

ABSTRACT

BACKGROUND/AIMS: Anti-tumor necrosis factor (TNF) therapy is used widely for the treatment of inflammatory bowel disease (IBD). In the present study, the characteristics and outcomes of tuberculosis (TB) in IBD patients treated with anti-TNF therapy were compared with those of non-IBD TB patients.METHODS: Twenty-five IBD patients who initially developed TB during anti-TNF therapy were enrolled in this study. Seventy-five age- and gender-matched non-IBD TB patients were selected as controls in a 1:3 ratio.RESULTS: The proportion of non-respiratory symptoms was higher in the IBD patients than in the non-IBD patients (12 [48.0%] in the IBD patients vs. 15 [20.0%] in the non-IBD patients; p=0.009). Eight (32.0%) IBD patients and 19 (25.3%) non-IBD patients had extra-pulmonary lesions (p=0.516). The frequency of positive smear results for acid-fast bacilli (AFB) was significantly higher in the non-IBD patients than in the IBD patients (three [12.0%] IBD patients vs. 27 [36.0%] non-IBD patients; p=0.023). Active TB was cured in 24 (96.0%) patients in the IBD group and in 70 (93.3%) patients in the non-IBD group (p=0.409). The TB-related mortality rates were 4.0% and 1.3% in the IBD patients and non-IBD patients, respectively (p=0.439).CONCLUSIONS: The rate of extrapulmonary involvement, side effects of anti-TB medications, and clinical outcomes did not differ between the IBD patients who initially developed TB during anti-TNF therapy and non-IBD patients with TB. On the other hand, the IBD patients had a lower rate of AFB smear positivity and a higher proportion of non-respiratory symptoms.


Subject(s)
Hand , Humans , Inflammatory Bowel Diseases , Mortality , Necrosis , Tuberculosis
13.
Article in Korean | WPRIM (Western Pacific) | ID: wprim-816605

ABSTRACT

BACKGROUND: Rapid and accurate detection of Mycobacterium tuberculosis (MTB) is of primary importance for infection control and selection of anti-tuberculosis drugs. However, most clinical laboratories report MTB complex (MTC) without reporting MTB because MTC comprising MTB, Mycobacterium bovis, Mycobacterium africanum, Mycobacterium microti, Mycobacterium caprae and Mycobacterium pinnipedii have 99.9% similarity at the nucleotide level and identical 16S rRNA sequences. This study was conducted to analyze the species frequency of MTC isolates obtained from clinical specimen.METHODS: Of 310 MTC isolates obtained from clinical samples in a tertiary care hospital from February 2017 to August 2018, MolecuTech Real TB-Taq (YD Diagnostics, Korea) real-time PCR was performed, specifically to detect MTB. For DNA showing MTB negative results by MTB-specific real-time PCR or pyrazinamide-resistant strains, PCR-based MTC typing, spoligotyping, and exact tandem repeat D gene sequencing were performed.RESULTS: All the 310 MTC isolates were identified to be MTB. Two MTB strains of East-African-Indian 4-Vietnam genotype, which have not been reported in Korea, were also found.CONCLUSION: There was no zoonotic tuberculosis in this study. Since we investigated only 310 MTC isolates detected in only one medical institution, multi-center study is needed to accurately know the prevalence of zoonotic tuberculosis in Korea.


Subject(s)
DNA , Genotype , Goats , Infection Control , Korea , Mycobacterium bovis , Mycobacterium tuberculosis , Mycobacterium , Prevalence , Real-Time Polymerase Chain Reaction , Sequence Analysis , Tandem Repeat Sequences , Tertiary Healthcare , Tuberculosis
14.
Article in English | WPRIM (Western Pacific) | ID: wprim-782246

ABSTRACT

BACKGROUND: The quantitative interferon (IFN)-γ response in the IFN-γ release assay (IGRA) has been investigated to predict progression from Mycobacterium tuberculosis infection to active tuberculosis (TB). However, the significance of the quantitative IFN-γ response in active TB is rarely known. We assessed the association between IFN-γ response to nil, mitogen, and TB mycobacterial antigens, and the variations from serial IGRA testing in active TB of various primary infection sites.METHODS: In total, 102 active TB patients with serial QuantiFERON-TB Gold In-Tube (QFT-GIT) (Qiagen, Germany) were enrolled. The medical records of patients were reviewed for demographic information, infection sites, tuberculosis treatment, and the quantitative IFN-γ response to nil, mitogen, and TB antigen.RESULTS: Patients included 20, 68, and 14 cases of pulmonary TB, extrapulmonary TB, and multiple TB infection, respectively. The quantitative IFN-γ responses to TB antigens differed significantly according to the infection sites (P=0.0001). The median IFN-γ response was the highest in lymph node infection (10.0 IU/mL) and the lowest in central nervous system (CNS) infection (0.02 IU/mL). Of the total, 86.3% showed concordant results in serial testing. Both 50% of the patients with persistent negative results and 62.5% of patients with CNS TB had an insufficient IFN-γ response to mitogen.CONCLUSIONS: Different IFN-γ responses to TB antigens may indicate variable host immune responses among infection sites in active TB disease. Because a few active TB patients fail to produce an adequate IFN-γ response, a study of cellular mechanisms is needed in such unresponsive patients.


Subject(s)
Central Nervous System , Humans , Interferons , Lymph Nodes , Medical Records , Mycobacterium tuberculosis , Tuberculosis
15.
Article in English | WPRIM (Western Pacific) | ID: wprim-782225

ABSTRACT

Tuberculosis (TB) remains a threat to public health and is the leading cause of death globally. Isoniazid (INH) is an important first-line agent for the treatment of TB considering its early bactericidal activity. Resistance to INH is now the most common type of resistance. Resistance to INH reduces the probability of treatment success and increases the risk of acquiring resistance to other first-line drugs such as rifampicin (RIF), thereby increasing the risk of multidrug-resistant-TB. Studies in the 1970s and 1980s showed high success rates for INH-resistant TB cases receiving regimens comprised of first-line drugs. However, recent data have indicated that INH-resistant TB patients treated with only first-line drugs have poor outcomes. Fortunately, based on recent systematic meta-analyses, the World Health Organization published consolidated guidelines on drug-resistant TB in 2019. Their key recommendations are treatment with RIF-ethambutol (EMB)-pyrazinamide (PZA)-levofloxacin (LFX) for 6 months and no addition of injectable agents to the treatment regimen. The guidelines also emphasize the importance of excluding resistance to RIF before starting RIF-EMB-PZA-LFX regimen. Additionally, when the diagnosis of INH-resistant TB is confirmed long after starting the first-line TB treatment, the clinician must decide whether to start a 6-month course of RIF-EMB-PZA-LFX based on the patient's condition. However, these recommendations are based on observational studies, not randomized controlled trials, and are thus conditional and based on low certainty of the effect estimates. Therefore, further work is needed to optimize the treatment of INH-resistant TB.


Subject(s)
Cause of Death , Diagnosis , Humans , Isoniazid , Public Health , Rifampin , Tuberculosis , Tuberculosis, Pulmonary , World Health Organization
16.
Article in English | WPRIM (Western Pacific) | ID: wprim-782224

ABSTRACT

BACKGROUND: Chronic cough is defined as a cough lasting more than 8 weeks and socio-economic burden of chronic cough is enormous. The characteristics of chronic cough in Korea are not well understood. The Korean Academy of Tuberculosis and Respiratory Diseases (KATRD) published guidelines on cough management in 2014. The current study evaluated the clinical characteristics of chronic cough in Korea and the efficacy of the KATRD guidelines.METHODS: This was a multi-center, retrospective observational study conducted in Korea. The participants were over 18 years of age. They had coughs lasting more than 8 weeks. Subjects with current pulmonary diseases, smokers, ex-smokers with more than 10 pack-years or who quit within the past 1 year, pregnant women, and users of cough-inducing medications were excluded. Evaluation and management of cough followed the KATRD cough-management guidelines.RESULTS: Participants with chronic cough in Korea showed age in the late forties and cough duration of more than 1 year. Upper airway cough syndrome was the most common cause of cough, followed by cough-variant asthma (CVA). Gastro-esophageal reflux diseases and eosinophilic bronchitis were less frequently observed. Following the KATRD cough-management guidelines, 91.2% of the subjects improved after 4 weeks of treatment. Responders were younger, had a longer duration of cough, and an initial impression of CVA. In univariate and multivariate analyses, an initial impression of CVA was the only factor related to better treatment response.CONCLUSION: The causes of chronic cough in Korea differed from those reported in other countries. The current Korean guidelines proved efficient for treating Korean patients with chronic cough.


Subject(s)
Asthma , Bronchitis , Cohort Studies , Cough , Diagnosis , Disease Management , Eosinophils , Epidemiology , Female , Gastroesophageal Reflux , Humans , Korea , Lung Diseases , Multivariate Analysis , Observational Study , Pregnant Women , Retrospective Studies , Tuberculosis
17.
Article in English | WPRIM (Western Pacific) | ID: wprim-782218

ABSTRACT

BACKGROUND: Same-day sputum microcopy is recommended in areas where sputum smear microscopy external quality assessment (EQA) is effectively implemented and sturdy. In Addis Ababa, the status of EQA and drop-out of same-day sputum smear microcopy has not yet been assessed. The objective of this study was to assess the quality of same-day sputum smear microscopy and diagnostic drop-out of presumptive tuberculosis (TB) patients in health facilities (HFs) across Addis Ababa, Ethiopia.METHODS: Amulti-analysis was conducted from September 2016 to July 2017 to determine the status of external quality assessment and diagnostic drop-out of presumptive TB patients registered for same-day sputum smear microscopy. Data was coded and entered in Microsoft Excel, and subsequently transferred and analyzed using SPSS version 20.0.RESULTS: The drop-out of same-day sputum smear microscopy was 209 (6.2%). More than 33% of the specimens collected for purposes of same-day sputum smears were of poor quality. Among the selected HFs for the study: 13 (46.4%) used filter reagents prior to sputum smear staining while 75% of the selected HFs for the study used smear microscopy services interruption in a year. The sensitivity and specificity of the HFs participating in regional quality assessment scheme for the diagnosis of TB was 97.4% and 99.6%, respectively.CONCLUSION: The diagnostic drop-out of same-day sputum smear microscopy was high in Addis Ababa. Strengthening EQA, competency-based laboratory professionals training on sputum smear microscopy might reduce the reading errors in sputum smear. Awareness creation of the community on the benefits gained from completion of specimen provision for the same-day approach decreases diagnostic drop-out and enhances TB control program.


Subject(s)
Diagnosis , Ethiopia , Health Facilities , Humans , Indicators and Reagents , Microscopy , Sensitivity and Specificity , Sputum , Tuberculosis
18.
Article in English | WPRIM (Western Pacific) | ID: wprim-782217

ABSTRACT

BACKGROUND: The aim of this study was to investigate the effectiveness of intravenous isoniazid (H) and ethambutol (E) administered in patients with new sputum positive drug-susceptible pulmonary tuberculosis (TB) with tuberculous meningoencephalitis (TM) and human immunodeficiency virus (HIV) co-infection in the intensive phase of treatment.METHODS: Fifty-four patients with TB/TM and HIV co-infection were enrolled for this study. Group 1 comprised of 23 patients treated with E and H intravenously, while rifampicin and pyrazinamide were prescribed orally. Group 2 consisted of 31 patients treated with the first-line anti-TB drugs orally. The concentrations of H and E in blood serum were detected using a chromatographic method.RESULTS: A significant improvement in the clinical symptoms and X-ray signs in patients treated intravenously with H and E was observed and compared to group 2. The sputum Mycobacterium tuberculosis positivity was observed during the second month of the treatment in 25.0% of patients from group 1 and 76.1% of the patients from the control group (p=0.003). In addition, nine patients (39.1%) died up to 6 months when H and E were prescribed intravenously compared with 22 (70.9%) in group 2 (p=0.023).CONCLUSION: In TB/TM with HIV, the intravenous H and E treatment was more effective than oral H and E treatment at 2 months of intensive treatment in sputum conversion as well as in clinical improvement, accompanied by significantly higher mean serum concentrations. In addition, the mortality rate was lower in intravenous H and E treatment compared to oral treatment.


Subject(s)
Coinfection , Ethambutol , HIV Infections , HIV , Humans , Isoniazid , Meningoencephalitis , Methods , Mortality , Mycobacterium tuberculosis , Pyrazinamide , Rifampin , Serum , Sputum , Tuberculosis , Tuberculosis, Meningeal , Tuberculosis, Pulmonary
20.
Article in English | WPRIM (Western Pacific) | ID: wprim-782046

ABSTRACT

BACKGROUND: Evaluation of mortality and prevalence trends is important for health planning and priority decision-making in health policy. This study was performed to examine disease-specific mortality and prevalence trends for diseases in Korea from 2002 to 2015.METHODS: In this study, 206 mutually exclusive diseases and injuries were classified into 21 cause clusters, which were divided into three cause groups: 1) communicable, maternal, neonatal, and nutritional conditions; 2) non-communicable diseases (NCDs); and 3) injuries. Cause specific trends for age-standardized mortality and prevalence rates were analyzed by the joinpoint regression method.RESULTS: Between 2002 and 2015, the age-standardized mortality declined to about 177 per 100,000 population, while the age-standardized prevalence rate increased to approximately 68,065 per 100,000 population. Among the 21 cause clusters, most of the disease mortality rates showed decreasing trends. However, neurological disorders, self-harm, and interpersonal violence included periods during which the mortality rates increased in 2002–2015. In addition, the trends for prevalence rates of human immunodeficiency virus infection and acquired immune deficiency syndrome, tuberculosis, transport injuries, and self-harm, and interpersonal violence differed from the overall prevalence rates. The annual percent change in prevalence rates for transport injuries increased during 2004–2007, and then decreased. The self-harm and interpersonal violence prevalence rates decreased from 2004 to 2014.CONCLUSION: Between 2002 and 2015, overall decreasing trends in the mortality rate and increasing trends in the prevalence rate were observed for all causes in Korea. Especially, NCDs represented an important part of the increasing trends in Korea. For clusters of diseases with unusual trends, proper management must be considered.


Subject(s)
Acquired Immunodeficiency Syndrome , Health Planning , Health Policy , HIV , Korea , Methods , Mortality , Nervous System Diseases , Prevalence , Republic of Korea , Tuberculosis , Violence
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