Comparative yield of different active TB case finding interventions in a large urban TB project in central Uganda: a descriptive study

Introduction: Systematic screening for TB among patients presenting to care and among high risk populations is recom- mended to improve TB case finding. We aimed to describe the comparative yield of three TB screening approaches imple- mented by a large urban TB project in central Uganda. Methods: We abstracted data on the screening cascade from 65 health facilities and their surrounding communities (num- bers screened, with presumptive TB, receiving a diagnostic test and diagnosed with TB) from the different clinic and com- munity TB registers. Results: From January 2018 to December 2019, 93,378 (24%) of all patients screened at health facilities had presumptive TB; 77,381 (82.9%) received a diagnostic test and 14,305 (18.5%) were diagnosed with TB. The screening yield (the number of patients diagnosed with TB out of all patients screened) was 0.3% and was three times higher among men than women (0.6% vs 0.2% p<0.01). During targeted community screening interventions, 9874 (21.1%) of all patients screened had presumptive TB; 7034 (71.2%) of these received a diagnostic test and 1699 (24.2%) were diagnosed with TB. The screening yield was higher among men, (3.7% vs 3.3% p<0.01) and highest among children 0-14 (4.8% vs 3.2% p<0.01). Conclusion: Targeted community TB screening interventions improve access to TB diagnosis for men and children 0-14 years

Cross-sectional study of Sociodemographic Factors Affecting Persistent Sputum Positivity among Adult Pulmonary Tuberculosis Patients under Treatment in a Tuberculosis Unit, Bagalkot, Karnataka

Tuberculosis (TB) treatment not only cures the patient but also helps in prevention, as it stops transmission of infection by rendering the patient’s sputum non-infectious. Sputum conversion is an important milestone during treatment and is to be achieved as soon as possible. When there is non-conversion, patient sputum persists to be positive for tubercle bacilli and patient continues to be infective. There are multiple factors responsible for this persistence of sputum positivity which have explored by various studies. There are variations in the association of these predisposing factors with persistent sputum positivity. Objectives: The current study was conducted to know the prevalence and the sociodemographic factors responsible for persistent sputum positivity in Bagalkot Taluk TB unit. Materials and Methods: A total of 170 adult pulmonary TB (Category – I) patients of Bagalkot Taluk TB Unit were selected. A community-based survey with the pre-tested questionnaire was administered to collect relevant sociodemographic data regarding factors that influence persistent sputum positivity. Laboratory data were collected through concerned health facilities. Data were tabulated in MS-EXCEL 2013 and analyzed in Openepi version 3.01 and SPSS version 20. Results: Among 170 patients, pulmonary TB was seen more frequently among males (63.5%), middle-aged (31.7%), urban residents (55.3%), lower socioeconomic status (95.4%), and illiterates (28.8%). Prevalence of persistent sputum positivity was 10.59%. Among the persistent sputum positive patients, a higher prevalence was seen in males (66.67%) and lower socioeconomic class (88.33%). Age, literacy, and occupation were associated, whereas gender, place of residence, type of family, smoking, and alcoholism were not associated with persistent sputum positivity.

Nuevos desafíos en tuberculosis / New challenges in tuberculosis

Tuberculosis (TB) is a main cause of disease and death in many countries of the world. The efforts to control this scourge have not been very successful. Even in Chile where we are near to reach the advanced stage of elimination of TB as a public health problem, five persons each week die of this disease. The main challenges for the control of TB and the most recent advances to counteract them are reviewed. A series of modern methods of diagnosis based on the techniques of molecular biology are reviewed. There is a need to develop procedures that can be applied in the so called "point of diagnosis", like the Xpert MTB/RIF test. There are new techniques for the diagnosis of latent TB infection (IGRA's), in order to identify infected subjects of high risk to develop disease to subject them to chemo-profilaxis. We need to develop shorter treatments for new cases and better drugs for multi-resistant patients. Ten new drugs have progressed into the clinical development pipeline for TB. New vaccines against tuberculosis are being investigated. Some of them are already being tried in the field. In the last years two new challenges have appeared: the association TB-AIDS, and the new epidemics of Multi Drug Resistant Tuberculosis (TB MDR and TB XDR). New techniques of diagnosis are described. Our main challenge is to make all this advances available for everybody. In Chile only the private sector has some of these techniques.

La tuberculosis (TBC) sigue siendo una de las principales causas de morbi-mortalidad en el mundo y los esfuerzos para controlarla han demostrado ser insuficientes. Aun en Chile, donde estamos cerca de alcanzar la etapa avanzada de su eliminación como problema de salud pública, fallecen 5 personas por semana de TBC. Este artículo presenta los principales desafíos de los Programas de Control de la TBC y los avances más recientes para enfrentarlos. Se analiza una serie de métodos de diagnóstico basados en técnicas de biología molecular. Se necesitan técnicas más sensibles que la baciloscopia que puedan ser empleadas en la periferia, en el llamado "punto del diagnóstico", como el test Xpert MTB/RIF. Están en estudio nuevos métodos de diagnóstico de la infección tuberculosa latente -los IGRA's - para identificar con mayor especificidad que con el PPD, a los infectados con alto riesgo de progresar a TBC para someterlos a quimioprofilaxis. Necesitamos tratamientos más breves para los casos nuevos, y drogas más eficaces para los enfermos de TBC multi-resistentes. Está en desarrollo la introducción de 10 nuevos medicamentos anti-TBC. Se necesitan vacunas más eficaces que la BCG, capaces no sólo de prevenir la infección, sino también de reforzar la inmunidad de los infectados y aún de los enfermos. Varias de estas vacunas se están ensayando en África. En los últimos decenios han aparecido dos nuevos desafíos: la asociación TBC-SIDA y las epidemias de TBC multi-resistentes (TB MDR y XDR). Se han desarrollado técnicas para identificar polimorfismos del gen rpo B, principal causa de resistencia a la rifampicina, considerada marcador de TB MDR. El principal desafío actual es poner todos estos avances al alcance de los que más los necesitan. En Chile sólo disponemos de algunas de estas nuevas técnicas, en su mayoría en clínicas privadas.

Primary Tuberculous Abscess of Vastus Lateralis Muscle.

Skeletal muscle tuberculosis without underlying osseous or extra osseous involvement is an extremely rare presentation of tuberculosis. We present a case of isolated tubercular abscess of the vastus lateralis muscle without an evident primary focus in a 52 year old immunocompetent male. The diagnosis was confirmed by histological examination. The patient showed marked improvement with a standard fourdrug regimen.

Controversia sobre la efectividad del tratamiento supervisado en tuberculosis / Controversy about the effectiveness of directly observed therapy for tuberculosis

En el contexto de los objetivos establecidos por la Organización Mundial de la salud (OMS) para el control de la tuberculosis -detección del 70% de los casos bacilíferos positivos y cura del 85% de los detectados- y de los componentes de la estrategia de tratamiento directamente supervisado -compromiso político con financiamiento sostenido, detección de los casos a través del uso de bacteriología de alta calidad, tratamiento supervisado abreviado, provisión y administración de las drogas, monitoreo continuo y evaluación del impacto del tratamiento- se describen los resultados de la revisión sistemática de la Colaboración Cochrane que pone en duda la efectividad y la pertinencia de recomendar la supervisión directa, especialmente en países pobres.

n the context of the objectives stated by the World Health Organization (WHO) for tuberculosis control (detection of 70% ofpatients with a positive sputum and cure of 85% of the detected cases) and the components of the directly observed therapystrategy (political commitment with sustained funding, detection of cases using high quality bacteriology laboratories, brief super-vised treatment, drug provision and administration, continuous monitoring and evaluation of treatment impact) the authordescribes the results of the systematic revision of the Cochrane Collaboration that questions the effectiveness and rationality ofdirect supervision strategy, especially in poor countries

Observations on the Grouping Pattern of Scalp Hairs and Compound Hair in a Normal healthy Population / 대한피부과학회지

BACKGROUND: Although one hair usually arises from a single follicular opening in normal healthy subjects, we can see two or more hairs emerging from the single opening through close inspection. The latter is called "compound hair", described by Lowenthal in 1946, however, few reports on this have been made since. Histopatholoigcally two or more hairs which have an independant external root sheath arise from one follicular opening like its clinical appearance. We examined the distribution and density of compound hair in order to define its difference according to anatomical sites and aging process. OBJECTIVE AND METHOD: We counted the number of hairs in the circle(2 cm in diameter) at te frontal, temporal and occipital scalp of 24 old young men(22.5+/-2.0 years old) and 24 old men(64.4+/-12.9 years old), respectively. RESULTS: The summated number of grouped hair, which was mostly regarded at compound hair, was greater in the young group than in old group in the frontal area, but was smaller in young group than in old group in from the temporal and occipital areas. The proportion of grouped hair to total hair in the older group was lower in the frontal area, but higher in the temporal and occipital areas(p<0.05, p<0.01) according to aging process, however, no significant change was seen between the frontal area and the sum of single hair to compound hair was significantly decreased in the temporal and occipital areas(p<0.05, p<0.01) according to aging process, however, no significant change was seen between the frontal area and the sum of the three tested areas. CONCLUSION: Compound hairs are observed frequently on the scalp of normal healthy subjects and are most frequently seen on the occipital scalp in both of the young and old.