ABSTRACT
The Asian venous thromboembolism (VTE) prophylaxis guidelines were first published in 2012. Since its first edition, the Asian Venous Thrombosis Forum (AVTF) working group have updated the Asian VTE epidemiology and reviewed issues that were not addressed in the previous guidelines. The authors noted that the rising incidence of VTE across Asia may be attributable to aging population, dietary changes, and increasing incidence of obesity and diabetes. The new additions in the guideline include role of thrombophilia in VTE, bleeding risk in Asians, individual risk assessment, updates in the prevention of VTE in medically ill, bariatric surgery, cancer, orthopedic and trauma patients. The influence of primary thrombophilia in perioperative VTE is still unclear. The secondary risk factors, however, are similar between Asians and Caucasians. The group found no evidence of increased risk of bleeding while using pharmacological agents, including the use of novel anti-coagulants. At present, Caprini risk assessment model is widely used for individual risk assessment. Further validation of this model is needed in Asia. In medically ill patients, pharmacological agents are preferred if there is no bleeding risk. Intermittent pneumatic compression device (IPC) is recommended in patients with bleeding risk but we do not recommend using graduated compressive stockings. In bariatric patients, data on VTE is lacking in Asia. We recommend following current international guidelines. A high index of suspicion should be maintained during postbariatric surgery to detect and promptly treat portomesenteric venous thrombosis. Different cancer types have different thrombotic risks and the types of surgery influence to a large extent the overall VTE risk. Cancer patients should receive further risk assessment. In patients with higher thrombotic risk, either due to predisposing risk or concomitant surgery, low molecular weight heparin is indicated. Different countries appear to have different incidence of VTE following trauma and major orthopedic surgery. We recommend mechanical prophylaxis using IPC as the main method and additional pharmacological prophylaxis if the thrombotic risk is high. As for obstetric practice, we propose adherence to the UK Greentop guideline that is widely accepted and utilized across Asia. To improve VTE thromboprophylaxis implementation in the region, we propose that there should be better health education, establishment of hospital-based guidelines and multidisciplinary collaboration.
Subject(s)
Venous Thromboembolism/prevention & control , Venous Thromboembolism/therapy , Anticoagulants/therapeutic use , Asia/epidemiology , Female , Fibrinolytic Agents/therapeutic use , Hemorrhage/prevention & control , Humans , Incidence , Intermittent Pneumatic Compression Devices , Male , Postoperative Complications/prevention & control , Pregnancy , Risk Assessment , Risk Factors , Societies, Medical , Stockings, CompressionABSTRACT
INTRODUCTION: In the Philippines, a diagnosis of pulmonary tuberculosis is very common especially in the presence of sputum findings positive for Acid Fast Bacilli (AFB). But it should be kept in mind that not all Mycobacterium are tuberculosis(TB).A previous study done at the University of Santo Tomas (UST) Hospital from 2003 to 2009 showed a 2.17% incidence of Mycobacterium other than tuberculosis (MOTT). However, due to its growing correlation with the Human Immunedeficiency Virus (HIV), updated incidence rates are warranted.Likewise,the importance of culture in the right diagnosis of diseases should always be emphasized.OBJECTIVES: The study aimed to determine the incidence of MOTT in a tertiary hospital in Manila among patients suspected of having TB. MATERIALS AND METHODS: This is a retrospective study done at the UST Hospital, a quality-assured referral center for TB in Manila, with a TB Directly Observed Short Course (TB-DOTS) Clinic. Laboratory records of specimens submitted for culture and sensitivity studies for Mycobacterium tuberculosis (MTB) for which isolates of MOTT grew, using BACTECTM(Becton-Dickinson) method and Mycobacteria Growth Indicator Tube (MGITTM), from January 2003 to December 2014, were reviewed. RESULTS: A total of 6,886 specimens were submitted for MTB culture and sensitivity studies. Results showed 157 cases of MOTT with an incidence of 2.28%. Majority of the specimens with MOTT were from pulmonary sources (85%), most common of which was from sputum. Non pulmonary sources (15%) were mostly from urine, cerebro-spinal, and gastrointestinal tract. were isolated for MOTT. These find-ings are consistent with the previous local available data. Correct identification of this organism influence eventual decisions for treatment.CONCLUSION: The incidence of positive culture for MOTT in our institution remains to be low. However, there is an increasing trend in the number of specimens which are turning out to be positive for MOTT. A future study on the correlation with the patients' clinical profile is recommended.
Subject(s)
Humans , Mycobacterium tuberculosis , Sputum , Tertiary Care Centers , Philippines , Tuberculosis, Pulmonary , Tuberculosis , HIV Infections , Gastrointestinal TractABSTRACT
INTRODUCTION: Development of drug resistance is one of the most important barriers in achieving global control of tuberculosis (TB). Continuous surveillance, such as observation of susceptibility and resistance patterns to anti-TB drugs, together with nationwide programs aimed at TB case identification, treatment and control, physician and patient education, is a valuable tool in the goal towards reducing TB prevalence and mortality.OBJECTIVE: It is the aim of this study to determine the prevalence rate and resistance pattern of first line anti-tuberculosis drugs in a tertiary hospital in Manila, PhilippinesMATERIALS AND METHODS: Records of specimens submitted for Mycobacterium tuberculosis (MTB) culture and sensitivity, using BACTEC TM MGIT TM 960 SIRE Kit and PZA Kit, at the Section of Clinical Pathology, University of Santo Tomas Hospital, were reviewed. Isolates cultured for MTB were subjected to sensitivity studies to rifampicin (R),isoniazid (H), ethambutol (E), pyrazinamide (Z) and streptomycin (S).RESULTS: A total of 546 specimens were cultured for MTB and sent for sensitivity studies. Majority of the specimens were from pulmonary sources (77%). Overall resistance rate was 52.38% (n=286). One-drug resistance was 23.26% (n= 127; highest with R followed by H); two-drug resistance was 15.38% (n=84; highest with H-R); three-drug resistance was 8.61% (n=47; highest with H-R-E and H-R-S); four-drug resistance was 4.58% (n=25; highest with H-R-E-S) and five-drug resistance (H-R-E-S-Z) rate was 0.55% (n=3). CONCLUSION: The University of Santo Tomas Hospital, as a referral facility, is encountering an increasing number of drug-resistant tuberculosis from 2003 to 2013.