Treatment outcome of smear positive pulmonary tuberculosis patients

The prime goals of tuberculosis treatment are to cure diseased individuals and minimizing transmissibility of Mycobacterium tuberculosis within the community. Tuberculosis treatment imposing many challenges for patients, health care providers and control program and non adherence to this regimen increases the risk of treatment failure, relapse, emergence of drug resistance and prolonged infectivity. Directly observed treatment short course [DOTS] had been evolved as the standard care to improve treatment compliance. Despite the free availability of these medications, many patients are not successfully treated. To evaluate the treatment outcome among patients with smear positive pulmonary Tuberculosis. To identify factors that may be associated with non-successful treatment. A multi stage sample consisted of about 849 smear positive TB patients new and previously treated pulmonary cases selected from 14 Governorates. They were submitted to sputum culture and sensitivity to determine the pattern of resistance to the first line anti TB drugs. All the included subjects were followed using a special data collection form to determine the treatment outcome among them. Treatment outcome was reported in 776 patients, successful treatment occurred in about 87% among new patients vs. 47% in the previously treated group, non-successful treatment in the form of failure [11%], default [3.6%], transferred out [4.7%], and death in [3.4%]. Treatment outcome was favorable among females compared to male patients [83.3% vs. 75.5%]. Drug resistance was significantly higher among previously treated males. Successful treatment outcome was dependent on the gender, type of the patients, and the presence of multi-drug resistance using the logistic regression model. Treatment outcome is highly dependent on the pattern of drug resistance, type of the patient, and the gender

Triplet chemotherapeutic regimen in advanced or metastatic non-small cell lung cancer

Non-small-cell lung cancer [NSCLC] is the leading cause of cancer-related death. Chemotherapy is a reasonable standard treatment for well-selected patients with advanced, inoperable, or metastatic NSCLC. In a significant proportion of patients systemic treatment results in symptom control, maintenance of quality of life and some prolongation of survival when compared with best supportive care alone. The combination of Vinca alkaloid and cisplatin represents a standard option for the initial therapy of patients with advanced NSCLC. A number of new anticancer agents have also been tested and approved for the treatment of advanced NSCLC. More recently, triplet agent chemotherapy has entered clinical practice in treatment of advanced cases of NSCLC

Patients and Methods: 28 evaluable patients of NSCLC with stage III-B or IV were enrolled in this phase III comparative randomized study. One group [A] received [cisplatin 120 mg/m[2] D1, 22] and [etoposide 120 mg/m[2] D1-3 and recycle every 21 days]. The second group [B] received [gemcitabine 800 mg/m[2] D1, 8] then [oxaliplatin 80 mg/m[2] D1] and [VP16 120 mg/m[2] D1-3] and recycle every 21 days. Evaluation of response, toxicity and survival was performed

Results: Age ranged from [36-75] years with a median age of 61 years. The main side effects were nephrotoxicity, neurotoxicity and gastrointestinal tract toxicity in group [A], while hematological toxicity, orthostatic hypotension and neurotoxicity in group [B]. Febrile neutropenia occurred in 37.5% in arm [B] compared to 8.3% in arm [A]. Partial response was higher in triplet agent chemotherapy group. It occurred in 25% and 50% of cases < 60 years in group A and B, while disease progression occurred in [25%] and [18.8%] in group A and B respectively. Partial response occurred in 25% and 43.8% of cases of ECOG [0-1] in group A and B, compared to 8.3% and 12.5% of cases of ECOG -2 in both groups respectively. Improvement of dyspnea, hemoptysis, metastatic bony pains and quality of life was higher in group [B] than group [A]. Median time to disease progression was 5.3 and 7.3 months in group A and B, one-year survival was 33.3% and 56.3% in group A and B respectively

Conclusions: Even though hematological, neurotoxicities and orthostatic hypotension were higher in triplet drug regimen [gemcitabine, oxaliplatin, etoposide], but criteria of subjective improvement and objective response rate were in favor of triplet agent chemotherapy. In our study, replacing cisplatin by oxaliplatin with addition of gemcitabine and etposide increases the efficacy and response in advanced and metastatic NSCLC cases. But it does not seem to have statistically significant effect on survival; so selection of cases that may benefit from the triplet drug regimen is an important issue, especially because it is expensive and toxic regimen. It is better to be given to metastatic or advanced cases with age

Gastroesophageal reflux disease in patients with extraesophageal symptoms referred from otolaryngeal and pulmonary practices and the effect of acid supperssion therapy

To investigate the prevalence of gastroesophageal reflux disease [GERD] and the effect of acid suppression therapy among patients referred from otolaryngeal and pulmonary clinics. Fifty-nine patients who were suspected to have GERD were divided into two groups. Patients of group I were subjected to history and clinical examination, nasal endoscopy, nasal smear, laryngeal examination by direct and indirect laryngoscope. Patients of group II were subjected to history as well as clinical and radiological examination, flow- volume spirometry, morning PEF value by flowmeter, exclusion of allergen-specific IgE in serum and follow up by the subjective asthma follow up variables. Both groups had upper endoscopy, 24-hour ambulatory esophageal pH monitoring and esophageal manometry. The prevalence of GERD was determined. Patients with GERD were further randomized into two subgroups. The patients were prospectively studied after three months to evaluate the effect of acid suppression therapy. The prevalence of GERD was 76.2%. Acid suppression therapy showed a marked improvement in the ear, nose and throat symptoms [ENT] patients with GERD, a significant improvement in asthma symptoms, a decrease of nocturnal attacks, an inhaled beta-agonist use and an improvement in pulmonary function test, PEF in non atopic asthmatic patients with GERD. Omeprazole 20 mg BID for three months was superior to ranitidine as an acid suppressive therapy for the treatment of ENT and asthmatic patients with GERD

Increased levels of exhaled cardon monoxide in asthmatic patients as a marker of oxidative stress and the effects of anti-inflammatory asthma therapy

Analysis of breath constituents is of great interest as it is a non-invasive way of monitoring inflammation and oxidative stress in the lung which may help in the diagnosis and monitoring of respiratory diseases. To study the level of CO in the exhaled air of asthmatic patients as a marker of oxidative stress and airway inflammation, and to determine he effects of the anti-inflammatory asthma therapy on its level. 58 subjects were included in the study. 30 non-smoking asthmatic patients were compared to 18 healthy non-smoking subjects [control] and 10 healthy smokers. The asthmatics were subdivided into groups: GR I [17 patients] received inhaled corticosteroid and GR II [13 patients] received oral montelukast, in addition to inhaled rescue b-agonist for both group. All persons were subjected to: history, clinical and radiological examination, pulmonary function tests by flow-volume pyrometer and arterial blood gases, detection of co in exhaled air by micro co meter before and after therapy [4 weeks]. There was a high statistically significant increase in co mean value in the asthmatic patients when compared to the control group [5.7 +/- 0.4 ppm] vs [1.8 +/- 0.4 ppm] respectively, [p< 0.01]. Also, a highly significant increase in co in exhaled air of smokers [32.4 +/- 6.2 ppm] when compared to both asthmatic and control groups. The exhaled CO is significantly decreased in the asthmatic patients after receiving anti-inflammatory therapy, with better lower values after inhaled corticosteroid [GR 1] than oral montelukast [GR II], [2.4 +/- 0.6 ppm] vs [4.1 +/- 0.7 ppm] respectively [p< 0.01]. The study showed elevation of CO in exhaled air of asthmatic patients that significantly decrease with anti-inflammatory therapy with improvement in lung function. Inhaled corticosteroid has a greater effect than oral montelukast therapy on the exhaled CO, which can be used as a marker of oxidative stress and can reflect inflammation of the asthmatic airways