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1.
Southeast Asian J Trop Med Public Health ; 2006 Mar; 37(2): 345-50
Article Dans Anglais | IMSEAR | ID: sea-32294

Résumé

We investigated the charts of 381 new smear-positive tuberculosis patients at Khon Kaen Medical School during 1997-2001 using World Health Organization definitions to evaluate associations among treatment success or failure (defaulted, failed, died, or not evaluated) and tuberculosis clinic contact, demographics and clinical characteristics of the patients. Multinomial logistic regression was used for three-category outcome analysis: treatment success, transferred-out and clinical treatment failure. The treatment success and clinical treatment failure rates were 34.1% and 34.4%, respectively. About 46.5% and 85.8% of patients missed appointments at the tuberculosis clinic in the treatment success and treatment failure groups, respectively. The results show that patients who were absent from the tuberculosis clinic were 5.95 times more likely to have clinical treatment failure than treatment success, having adjusted for the effect of transfering-out and the effect of the treatment regimen and the sputum conversion status (adjusted odds ratio = 5.95; 95% CI: 2.99 to 11.84). The review showed that absence from the tuberculosis clinic was an independent risk factor for clinical treatment failure. We recommended that all new smear-positive tuberculosis patients should be followed closely at a tuberculosis clinic.


Sujets)
Adulte , Antituberculeux/administration et posologie , Intervalles de confiance , Femelle , Humains , Fonctions de vraisemblance , Modèles logistiques , Mâle , Adulte d'âge moyen , Odds ratio , Observance par le patient , Études rétrospectives , Facteurs de risque , Échec thérapeutique , Résultat thérapeutique , Tuberculose/traitement médicamenteux
2.
Southeast Asian J Trop Med Public Health ; 2004 Sep; 35(3): 730-4
Article Dans Anglais | IMSEAR | ID: sea-31068

Résumé

Adenosine deaminase (ADA) activity rises in various body fluids in patients with tuberculosis. A prospective study was conducted to determine the diagnostic value of ADA activity in bronchoalveolar lavage. Between March 2001 and February 2003, 148 patients were enrolled in our study, mean age 55.6 years (SD 14.6), and a male to female ratio of 2.4:1. The mean duration of symptoms was 66.2 days. All patients were either sputum-smear negative for AFB or failed to produce sputum. The final diagnosis resulted in three patient groups: 43 with pulmonary tuberculosis, 70 malignancy, and 35 miscellaneous causes. The mean ADA activity in the bronchoalveolar lavage for the pulmonary tuberculosis, malignancy, and miscellaneous causes groups was 8.98 (95% CI, 3.79-14.17), 7.63 (95% CI, 4.12-11.14), and 11.61 U/l (95% CI, 3.59-19.62), respectively. No difference was detected in the ADA level in the pulmonary tuberculosis vs other groups (p=0.56, one-way ANOVA). A high level of ADA activity was found in non-tuberculous conditions such as bronchogenic carcinoma, pulmonary hemosiderosis, chronic pneumonia with empyema thoracis and chronic myeloid leukemia. We concluded that ADA activity in the bronchoalveolar lavage was not clearly diagnostic of smear-negative pulmonary tuberculosis. Early diagnosis required histopathology of biopsied transbronchial specimens obtained by fiberoptic bronchoscopy.


Sujets)
Adenosine deaminase/métabolisme , Adolescent , Adulte , Sujet âgé , Analyse de variance , Lavage bronchoalvéolaire/méthodes , Liquide de lavage bronchoalvéolaire/composition chimique , Carcinome bronchogénique/diagnostic , Tests enzymatiques en clinique , Diagnostic différentiel , Femelle , Humains , Mâle , Adulte d'âge moyen , Études prospectives , Thaïlande , Tuberculose pulmonaire/diagnostic
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