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Sample records for discriminating tb patients

  1. A multiplexed and miniaturized serological tuberculosis assay identifies antigens that discriminate maximally between TB and non-TB sera

    NARCIS (Netherlands)

    Tong, Miao; Jacobi, Catharina E.; van de Rijke, Frans M.; Kuijper, Sjoukje; van de Werken, Sjaak; Lowary, Todd L.; Hokke, Cornelis H.; Appelmelk, Ben J.; Nagelkerke, Nico J. D.; Tanke, Hans J.; van Gijlswijk, Rob P. M.; Veuskens, Jacques; Kolk, Arend H. J.; Raap, Anton K.

    2005-01-01

    We have developed a multiplexed and miniaturized TB serological assay with the aim of identifying (combinations of) antigens that maximally discriminate between TB and non-TB patients. It features a microarray accommodating 54 TB antigens, less than 1 microl serum consumption and an indirect

  2. Screening contacts of patients with extrapulmonary TB for latent TB infection.

    Science.gov (United States)

    Humphreys, Anna; Abbara, Aula; Williams, Sion; John, Laurence; Corrah, Tumena; McGregor, Alastair; Davidson, Robert N

    2018-03-01

    2016 TB National Institute for Health and Care Excellence (NICE) guidelines imply that contacts of extrapulmonary TB do not require screening for latent TB infection. At our high TB prevalence site, we identified 189 active cases of TB for whom there were 698 close contacts. 29.1% of the contacts of pulmonary TB and 10.7% of the contacts of extrapulmonary TB had active or latent TB infection. This supports screening contacts of extrapulmonary TB at our site and presents a way to access high-risk individuals. We propose to continue to screen the contacts of our patients with extrapulmonary TB and recommend other TB units audit their local results. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  3. Antiretroviral treatment uptake in patients with HIV associated TB ...

    African Journals Online (AJOL)

    Background. Delivery of integrated care for patients with HIV-associated TB is challenging. We assessed the uptake and timing of antiretroviral treatment (ART) among eligible patients attending a primary care service with co-located ART and TB clinics. Methods. In a retrospective cohort study, all HIV-associated TB patients ...

  4. Antiretroviral treatment uptake in patients with HIV- associated TB ...

    African Journals Online (AJOL)

    ART results in a 64 - 95% reduction in mortality risk 5 and is an essential component of care. How soon to start. ART after TB treatment initiation has become clearer from randomised controlled trials. These show that integration of ART and TB treatment in all HIV-associated TB patients regardless of CD4 count significantly.

  5. Patients direct costs to undergo TB diagnosis.

    Science.gov (United States)

    de Cuevas, Rachel M Anderson; Lawson, Lovett; Al-Sonboli, Najla; Al-Aghbari, Nasher; Arbide, Isabel; Sherchand, Jeevan B; Nnamdi, Emenyonu E; Aseffa, Abraham; Yassin, Mohammed A; Abdurrahman, Saddiq T; Obasanya, Joshua; Olanrewaju, Oladimeji; Datiko, Daniel; Theobald, Sally J; Ramsay, Andrew; Squire, S Bertel; Cuevas, Luis E

    2016-03-24

    A major impediment to the treatment of TB is a diagnostic process that requires multiple visits. Descriptions of patient costs associated with diagnosis use different protocols and are not comparable. We aimed to describe the direct costs incurred by adults attending TB diagnostic centres in four countries and factors associated with expenditure for diagnosis. Surveys of 2225 adults attending smear-microscopy centres in Nigeria, Nepal, Ethiopia and Yemen. Adults >18 years with cough >2 weeks were enrolled prospectively. Direct costs were quantified using structured questionnaires. Patients with costs >75(th) quartile were considered to have high expenditure (cases) and compared with patients with costs <75(th) quartile to identify factors associated with high expenditure. The most significant expenses were due to clinic fees and transport. Most participants attended the centres with companions. High expenditure was associated with attending with company, residing in rural areas/other towns and illiteracy. The costs incurred by patients are substantial and share common patterns across countries. Removing user fees, transparent charging policies and reimbursing clinic expenses would reduce the poverty-inducing effects of direct diagnostic costs. In locations with limited resources, support could be prioritised for those most at risk of high expenditure; those who are illiterate, attend the service with company and rural residents.

  6. Rehabilitation of treated TB patients: Social, psychological and economic aspects.

    Science.gov (United States)

    Kumar, Blessina Amulya

    2016-12-01

    To highlight the need for post-treatment rehabilitation of TB patient; including social psychological and economic aspects. Patient interaction, informal interviews, field observations and secondary research. The minimum duration of treatment (for drug-susceptible TB) is 6months. Treatment for drug-resistant TB can be from anywhere between 18 and 24months. In some cases treatment can last for more than 5years. Despite this, little attention is given to the social, psychological and economic impact extended treatment can have on the lives of individuals. Due, to a large extent, to the high levels of stigma that continue to exist in many high-burden countries, people affected must face obstacles even before diagnosis. These challenges persist at every stage of the treatment process (diagnosis, accessing appropriate care, treatment and post-treatment), but impact the individual's lives in various ways. Research has shown that despite diagnosis and treatment being provided for free, most individuals have to face high out-of-pocket expenditure (on transport, additional medication, nutritional supplementation etc.). In many countries, these expenses often have a significant negative impact on family finances. In most national programs, pre-treatment counselling is not included. This means that those affected are not prepared for the implications (in terms of time, money and physiological effects) that their treatment can have. The side effects of TB medication (especially DR-TB) are sometimes extreme, and require extensive therapy and/or rehabilitation. Some side effects such as hearing-loss are often permanent. Nutritional support is another key factor that receives little attention in national programs. Adding to all these physiological challenges is the constant stigma and discrimination that individuals face from friends, family and even healthcare workers. Returning to jobs or to their education is a challenge as many workplaces and educational institutions do not

  7. HIV screening among TB patients and level of antiretroviral therapy ...

    African Journals Online (AJOL)

    The aim of this study was to assess the prevalence of HIV among TB patients and initiation of ART and provision of CPT for TB/HIV co-infected patients in Hawassa university referral hospital. Methods: A five year document ... Data analysis was done by using SPSS version 20 software. Bivariate and multivariate logistic ...

  8. Outcomes of TB treatment in HIV co-infected TB patients in Ethiopia: a cross-sectional analytic study

    Directory of Open Access Journals (Sweden)

    Solomon Ahmed Ali

    2016-11-01

    Full Text Available Abstract Background TB and HIV are the most prevalent communicable diseases of major public health importance in the populations of sub-Saharan African countries, and an estimated 30 % of HIV infected persons have dual infection with TB. TB is the leading cause of death in HIV infected individuals, and HIV co-infected TB patients have multiple individual, disease specific and treatment related factors that can adversely affect their treatment outcomes. There is lack of evidence on the individual patient outcomes of HIV co-infected TB patients who receive anti-TB treatment. It is relevant to understand the differential patient outcomes of HIV co-infected TB patients and identify the factors that are associated with these outcomes. Methods A comparative analysis was done on the data from a random sample of 575 TB patients who were enrolled for TB treatment from January 2013 to December 2013 at eight health facilities in Ethiopia. A descriptive analysis was done on the data, and chi-square test and logistic regression analysis was conducted to compare TB treatment outcomes based on HIV status and to identify factors associated with these outcomes. Results Out of a total of 575 TB patients enrolled into the study, 360 (62.6 % were non-HIV infected, 169 (29.4 % were HIV co-infected, and 46 (8 % had no documented HIV status. The overall treatment success rate was 91.5 % for all the study participants. HIV co-infected TB patients have a treatment success rate of 88.2 % compared with 93.6 % for non-HIV infected study participants (P = 0.03. HIV co-infected TB patients had a significantly higher rate (11.8 % versus 6.4 %, P = 0.03 of unfavourable outcomes. The cure rate was significantly lower (10.1 % versus 24.2 %, P = 0.001 and the death rate higher in HIV co-infected TB patients (8.3 % versus 2.5 %, P = 0.014. Age and TB classification were significantly associated with treatment outcome. No association was found with starting ART

  9. Incidence of TB and HIV in Prospectively Followed Household Contacts of TB Index Patients in South Africa

    OpenAIRE

    van Schalkwyk, Cari; Variava, Ebrahim; Shapiro, Adrienne E.; Rakgokong, Modiehi; Masonoke, Katlego; Lebina, Limakatso; Welte, Alex; Martinson, Neil

    2014-01-01

    OBJECTIVE: To report the incidence rates of TB and HIV in household contacts of index patients diagnosed with TB. DESIGN: A prospective cohort study in the Matlosana sub-district of North West Province, South Africa. METHODS: Contacts of index TB patients received TB and HIV testing after counseling at their first household visit and were then followed up a year later, in 2010. TB or HIV diagnoses that occurred during the period were determined. RESULTS: For 2,377 household contacts, the over...

  10. Is Knowledge Regarding Tuberculosis Associated with Stigmatising and Discriminating Attitudes of General Population towards Tuberculosis Patients? Findings from a Community Based Survey in 30 Districts of India.

    Science.gov (United States)

    Sagili, Karuna D; Satyanarayana, Srinath; Chadha, Sarabjit S

    2016-01-01

    Stigmatising and discriminating attitudes may discourage tuberculosis (TB) patients from actively seeking medical care, hide their disease status, and discontinue treatment. It is expected that appropriate knowledge regarding TB should remove stigmatising and discriminating attitudes. In this study we assessed the prevalence of stigmatising and discriminating attitudes towards TB patients among general population and their association with knowledge regarding TB. A cross-sectional knowledge, attitude and practice survey was conducted in 30 districts of India in January-March 2011. A total of 4562 respondents from general population were interviewed using semi-structured questionnaires which contained items to measure stigma, discrimination and knowledge on TB. Of the 4562 interviewed, 3823 were eligible for the current analysis. Of these, 73% (95% CI 71.4-74.2) had stigmatising and 98% (95% CI 97.4-98.3) had discriminating attitude towards TB patients. Only 17% (95% CI 15.6-18.0) of the respondents had appropriate knowledge regarding TB with even lower levels observed amongst females, rural areas and respondents from low income groups. Surprisingly stigmatising (adjusted OR 1.31 (0.78-2.18) and discriminating (adjusted OR 0.79 (0.43-1.44) attitudes were independent of knowledge regarding TB. Stigmatising and discriminating attitudes towards TB patients remain high among the general population in India. Since these attitudes were independent of the knowledge regarding TB, it is possible that the current disseminated knowledge regarding TB which is mainly from a medical perspective may not be adequately addressing the factors that lead to stigma and discrimination towards TB patients. Therefore, there is an urgent need to review the messages and strategies currently used for disseminating knowledge regarding TB among general population and revise them appropriately. The disseminated knowledge should include medical, psycho-social and economic aspects of TB that not

  11. Molecular detection of multi drug resistant tuberculosis (mdr-tb) in mdr-tb patients' attendant in north western pakistan

    International Nuclear Information System (INIS)

    Shah, T.; Hayat, A.; Shah, Z.; Hayat, A.; Khan, S.B.

    2017-01-01

    Objective: To determine the drugs susceptibility pattern of mycobacterium tuberculosis (M.TB) in multi-drug resistant tuberculosis (MDR-TB) patients' attendants in North Western, Pakistan. Study Design: Cross sectional study. Place and Duration of Study: This study was conducted at Peshawar Tuberculosis Research Laboratory (PTRL), Provincial TB Control Program Hayatabad Medical Complex Peshawar, (KP) from August 2013 to March 2014. Material and Methods: A cross sectional study in which four hundred and eighty sputum samples from MDR-TB patients' attendants were processed for the detection of M.TB through Ziehl-Neelsen staining, Lowenstein-Jensen, BACTEC MGIT-960 culture and line probe assay. Results: Out of 480 samples, 06 (2.1%) were found positive for M.TB through Ziehl-Neelsen staining while 10 (2.8%) were positive through LJ and BACTEC MGIT-960 culture. The 10 positive samples were further subjected to drugs susceptibility testing and line probes assay test to find out rifampicin, isoniazid, streptomycin and ethambutol resistant and it was found that 6 M.TB isolates were resistant while 4 were sensitive to rifampicin and isoniazid. Among the 6 resistant M.TB strains, 4 showed mutation in rpoB gene at 531, 516 and 526 codons. Conclusion: Majority of MDR-TB patients' attendants had drug-resistant tuberculosis and the rate of drug susceptible TB was low. (author)

  12. Characteristics and programme-defined treatment outcomes among childhood tuberculosis (TB patients under the national TB programme in Delhi.

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    Srinath Satyanarayana

    Full Text Available BACKGROUND: Childhood tuberculosis (TB patients under India's Revised National TB Control Programme (RNTCP are managed using diagnostic algorithms and directly observed treatment with intermittent thrice-weekly short-course treatment regimens for 6-8 months. The assignment into pre-treatment weight bands leads to drug doses (milligram per kilogram that are lower than current World Health Organization (WHO guidelines for some patients. OBJECTIVES: The main aim of our study was to describe the baseline characteristics and treatment outcomes reported under RNTCP for registered childhood (age <15 years TB patients in Delhi. Additionally, we compared the reported programmatic treatment completion rates between children treated as per WHO recommended anti-TB drug doses with those children treated with anti-TB drug doses below that recommended in WHO guidelines. METHODS: For this cross-sectional retrospective study, we reviewed programme records of all 1089 TB patients aged <15 years registered for TB treatment from January to June, 2008 in 6 randomly selected districts of Delhi. WHO disease classification and treatment outcome definitions are used by RNTCP, and these were extracted as reported in programme records. RESULTS AND CONCLUSIONS: Among 1074 patients with records available, 651 (61% were females, 122 (11% were <5 years of age, 1000 (93% were new cases, and 680 (63% had extra-pulmonary TB (EP-TB--most commonly peripheral lymph node disease [310 (46%]. Among 394 pulmonary TB (PTB cases, 165 (42% were sputum smear-positive. The overall reported treatment completion rate was 95%. Similar reported treatment completion rates were found in all subgroups assessed, including those patients whose drug dosages were lower than that currently recommended by WHO. Further studies are needed to assess the reasons for the low proportion of under-5 years of age TB case notifications, address challenges in reaching all childhood TB patients by RNTCP, the

  13. TB diagnostic process management of patients in a referral hospital in Mozambique in comparison with the 2007 WHO recommendations for the diagnosis of smear-negative pulmonary TB and extrapulmonary TB

    NARCIS (Netherlands)

    Bos, Jeannet C.; Smalbraak, Lisette; Macome, Augusto C.; Gomes, Ermelinda; van Leth, Frank; Prins, Jan M.

    2013-01-01

    In sub-Saharan African countries, the high proportion of smear-negative pulmonary TB (SNTB) and extrapulmonary TB (EPTB) contributes to a delay in TB diagnosis and treatment. We evaluated the TB diagnostic process of adult patients with presumptive TB in a referral hospital in Mozambique according

  14. Treatment Outcomes of Patients with Multidrug-Resistant Tuberculosis (MDR- TB) Compared with Non-MDR-TB Infections in Peninsular Malaysia.

    Science.gov (United States)

    Elmi, Omar Salad; Hasan, Habsah; Abdullah, Sarimah; Mat Jeab, Mat Zuki; Ba, Zilfalil; Naing, Nyi Nyi

    2016-07-01

    Treating patients with multidrug-resistant tuberculosis (MDR-TB) strains is more complicated, complex, toxic, expensive, than treating patients with susceptible TB strains. This study aims to compare the treatment outcomes and potential factors associated between patients with MDR-TB and non MDR TB infections in peninsular Malaysia. This study was a retrospective cohort study. Data were collected from the medical records of all registered MDR-TB patients and Non-MDR-TB patients at five TB hospitals in peninsular Malaysia from January 2010 to January 2014. A total of 314 subjects were studied, including 105 MDR-TB cases and 209 non-MDR-TB. After TB treatment, 24.8% of the MDR-TB patients and 17.7% of non MDR TB relapsed; 17.1% of the MDR-TB patients and 16.3% of non MDR TB defaulted from TB treatment. A significant difference seen in treatment success rate 17.1% for MDR-TB; 63.1% for non MDR TB (P history of TB treatment, and presence of HIV infection.

  15. Management of MDR-TB in HIV co-infected patients in Eastern Europe

    DEFF Research Database (Denmark)

    Efsen, A M W; Schultze, A; Miller, R F

    2018-01-01

    OBJECTIVES: Mortality among HIV patients with tuberculosis (TB) remains high in Eastern Europe (EE), but details of TB and HIV management remain scarce. METHODS: In this prospective study, we describe the TB treatment regimens of patients with multi-drug resistant (MDR) TB and use of antiretroviral...... therapy (ART). RESULTS: A total of 105 HIV-positive patients had MDR-TB (including 33 with extensive drug resistance) and 130 pan-susceptible TB. Adequate initial TB treatment was provided for 8% of patients with MDR-TB compared with 80% of those with pan-susceptible TB. By twelve months, an estimated 57.......3% (95%CI 41.5-74.1) of MDR-TB patients had started adequate treatment. While 67% received ART, HIV-RNA suppression was demonstrated in only 23%. CONCLUSIONS: Our results show that internationally recommended MDR-TB treatment regimens were infrequently used and that ART use and viral suppression was well...

  16. Multiplex analysis of plasma cytokines/chemokines showing different immune responses in active TB patients, latent TB infection and healthy participants.

    Science.gov (United States)

    Yao, Xiangyang; Liu, Yongliang; Liu, Yang; Liu, Wei; Ye, Zhizhong; Zheng, Chao; Ge, Shengxiang

    2017-12-01

    Interferon gamma release assays (IGRAs) have been widely used to diagnose Mycobacterium tuberculosis (MTB) infection. However, IGRAs cannot discriminate between active TB patients and latent TB infection (LTBI), and the sensitivity of IGRAs for MTB infection is suboptimal. Here, we analyzed cytokines/chemokines in MTB antigen-stimulated and -unstimulated plasma samples to identify host biomarkers that are associated with active TB and MTB infection. Active TB patients, subjects with LTBI and healthy participants were recruited. Seventy-one soluble cytokines and chemokines were tested using Luminex liquid array-based multiplexed immunoassays. For the 71 examined factors, our results indicated that the unstimulated levels of IL-8 Nil , IP-10 Nil , MIP-1a Nil , and sIL-2Ra Nil and the antigen stimulated levels of IL-8 (Ag-Nil) , VEGF (Ag-Nil) , and MCP-3 (Ag-Nil) were potential biomarkers for differentiating between active TB and LTBI, with AUCs of 0.8, 0.86, 0.755, 0.845, 0.825, 0.812 and 0.75, respectively. The G-CSF (Ag-Nil) , GM-CSF (Ag-Nil) , IL-1a (Ag-Nil) , IL-2 (Ag-Nil) , IP-10 (Ag-Nil) , BCA-1 (Ag-Nil) and Eotaxin-1 (Ag-Nil) responses were significantly higher in patients with active TB and LTBI compared with healthy participants (p TB as well as additional biomarkers, except IFN-γ, for MTB infection. Copyright © 2017 Elsevier Ltd. All rights reserved.

  17. Incidence of TB and HIV in prospectively followed household contacts of TB index patients in South Africa.

    Directory of Open Access Journals (Sweden)

    Cari van Schalkwyk

    Full Text Available OBJECTIVE: To report the incidence rates of TB and HIV in household contacts of index patients diagnosed with TB. DESIGN: A prospective cohort study in the Matlosana sub-district of North West Province, South Africa. METHODS: Contacts of index TB patients received TB and HIV testing after counseling at their first household visit and were then followed up a year later, in 2010. TB or HIV diagnoses that occurred during the period were determined. RESULTS: For 2,377 household contacts, the overall observed TB incidence rate was 1.3 per 100 person years (95% CI 0.9-1.9/100py and TB incidence for individuals who were HIV-infected and HIV seronegative at baseline was 5.4/100py (95% CI 2.9-9.0/100py and 0.7/100py (95% CI 0.3-1.4/100py, respectively. The overall HIV incidence rate was 2.2/100py (95% CI 1.3-8.4/100py. CONCLUSIONS: In the year following a household case finding visit when household contacts were tested for TB and HIV, the incidence rate of both active TB and HIV infection was found to be extremely high. Clearly, implementing proven strategies to prevent HIV acquisition and preventing TB transmission and progression to disease remains a priority in settings such as South Africa.

  18. Quality of life of pulmonary TB patients after intensive phase treatmentin the health centers of Medan city, Indonesia

    Science.gov (United States)

    Wahyuni, A. S.; Soeroso, N.; Harahap, J.; Amelia, R.; Alona, I.

    2018-03-01

    Tuberculosis (TB) is one of the chronic diseases that has become a long major health problem in the world, as well as in Indonesia. TB treatment takes a long time (6-9 months) to cover both intensive and advanced phases. TB patients experience significant disruptions in their social life, exposed to stigma and discrimination. The purpose of this study was to determine the quality of life of TB patients after two months of TB intensive treatment phase. We conducted a quantitative study through cross-sectional design. This research recruited 100 TB patients aged > 18 years old and Category I with AFB(+) result. We involved patients from 7 Health Centers in Medan City. We utilised SF 36 instrument to assess the patients quality of lifein the interview. To analyse the collected data, we performed Independent t-analysis. The result of this study was that the quality of life of TB patients who had undergone initial treatment phase wasina low category with a score of 63.9. The two best-measured aspects of quality of life among the eight dimensions assessed in the instrument were pain and physical function.

  19. CD4 cell count recovery in HIV/TB co-infected patients versus TB uninfected HIV patients

    Directory of Open Access Journals (Sweden)

    Wanchu A

    2010-10-01

    Full Text Available Background: There is lack of data comparing the improvement in CD4 count following antitubercular (ATT and antiretroviral therapy (ART in patients presenting with Human Immunodeficiency Virus/Tuberculosis (HIV/TB dual infection compared with CD4 matched cohort of TB uninfected HIV patients initiated on ART. We sought to test the hypothesis; TB additionally contributes to reduction in CD4 count in HIV/TB co-infected patients and this would result in greater improvement in count following treatment compared with CD4 matched TB uninfected individuals. Materials and Methods: In a retrospective cohort study design we studied the change in CD4 cell counts in two groups of patients - those with CD4 cell count >100 cells / mm 3 (Group 1 and <100/mm 3 (Group 2 at presentation. In each group the change in CD4 cell count in dually infected patients following six-month ATT and ART was compared to cohorts of CD4 matched TB uninfected patients initiated on ART. Results: In Group 1 (52 patients dually infected subjects′ CD4 count improved from 150 cells/ mm 3 to 345 cells/mm 3 (P=0.001. In the control TB uninfected patients, the change was from 159 cells/mm 3 to 317 cells/mm 3 (P=0.001. Additional improvement in dually infected patients compared to the control group was not statistically significant (P=0.24. In Group 2 (65 patients dually infected subjects count improved from 49 cells/mm3 to 249 cells/mm 3 (P=0.001 where as in control TB uninfected patients improvement was from 50 cells/ mm 3 to 205 cells/mm 3 (P=0.001, there being statistically significant additional improvement in dually infected subjects (P=0.01. Conclusion: Greater increment in CD4 counts with ATT and ART in dually infected patients suggests that TB additionally influences the reduction of CD4 counts in HIV patients.

  20. Management of MDR-TB in HIV co-infected patients in Eastern Europe: Results from the TB:HIV study.

    Science.gov (United States)

    Efsen, A M W; Schultze, A; Miller, R F; Panteleev, A; Skrahin, A; Podlekareva, D N; Miro, J M; Girardi, E; Furrer, H; Losso, M H; Toibaro, J; Caylà, J A; Mocroft, A; Lundgren, J D; Post, F A; Kirk, O

    2018-01-01

    Mortality among HIV patients with tuberculosis (TB) remains high in Eastern Europe (EE), but details of TB and HIV management remain scarce. In this prospective study, we describe the TB treatment regimens of patients with multi-drug resistant (MDR) TB and use of antiretroviral therapy (ART). A total of 105 HIV-positive patients had MDR-TB (including 33 with extensive drug resistance) and 130 pan-susceptible TB. Adequate initial TB treatment was provided for 8% of patients with MDR-TB compared with 80% of those with pan-susceptible TB. By twelve months, an estimated 57.3% (95%CI 41.5-74.1) of MDR-TB patients had started adequate treatment. While 67% received ART, HIV-RNA suppression was demonstrated in only 23%. Our results show that internationally recommended MDR-TB treatment regimens were infrequently used and that ART use and viral suppression was well below the target of 90%, reflecting the challenging patient population and the environment in which health care is provided. Urgent improvement of management of patients with TB/HIV in EE, in particular for those with MDR-TB, is needed and includes widespread access to rapid TB diagnostics, better access to and use of second-line TB drugs, timely ART initiation with viral load monitoring, and integration of TB/HIV care. Copyright © 2017 The British Infection Association. Published by Elsevier Ltd. All rights reserved.

  1. TB in HIV Patients: Strengthening Control Measures | Saleh ...

    African Journals Online (AJOL)

    Although most of those immune-competent individuals exposed to the TB pathogen (M. Tuberculosis) do not become infected, the disease seen in HIV immune-compromised patients occurs either as a new infection, re-infection or reactivation as a result of poor cellular immunity. Several studies have shown that despite ...

  2. When students become patients: TB disease among medical ...

    African Journals Online (AJOL)

    patient, I just wanted to leave.' (P10). Participants made several recommendations to improve diagnosis, treatment and psychosocial support for students diagnosed with TB. (Table 2). Discussion. This study highlights the vulnerability of medical students at two of the eight SA medical schools, documenting substantial TB ...

  3. TB tracer teams in South Africa: knowledge, practices and challenges of tracing TB patients to improve adherence.

    Science.gov (United States)

    Bristow, Claire C; Podewils, Laura Jean; Bronner, Liza Ellen; Bantubani, Nonkqubela; Walt, Martie van der; Peters, Annatjie; Mametja, David

    2013-09-04

    In 2008-2009 the South African National Tuberculosis (TB) Program (NTP) implemented a national pilot project, the TB Tracer Project, aiming to decrease default rates and improve patient outcomes. The current study aimed to inform the NTP by describing the knowledge, attitudes, and practices of TB program personnel involved with tracing activities. A self-administered written questionnaire was sent to TB staff, managers and tracer team leaders to assess basic TB knowledge, attitudes and practices. Descriptive statistics were used to summarize results and the chi-squared statistic was used to compare responses of staff at facilities that participated in the TB Tracer Project (tracer) and those that followed standard NTP care (non-tracer). Of 560 total questionnaires distributed, 270 were completed and returned (response rate 48%). Total TB knowledge ranged from 70.8-86.3% correct across all response groups. However, just over half (range 50-59.3%) of each respondent group was able to correctly identify the four components of a DOT encounter. A patient no longer feeling sick was cited by 72.1% of respondents as the reason patients fail to adhere to treatment. Tracer teams were viewed as an effective means to get patients to return to treatment by 96.3% of health facility level respondents. Tracer team leaders reported concerns including lack of logistical support (41.7%), insufficient physical safety precautions (41.7%), and inadequate protection from contracting TB (39.1%). Upon patients returning to treatment at the clinic, facilities included in the TB Tracer Project were significantly more likely to discuss alternate DOTS arrangements than non-tracer facilities (79.2 vs. 66.4%, p = 0.03). This study identified key components of knowledge, attitudes, and practices regarding TB patient tracing activities in South Africa. Educating patients on the essential need to complete treatment irrespective of clinical symptoms may help improve treatment adherence. Future

  4. Oxidative stress and TB outcomes in patients with diabetes mellitus?

    Science.gov (United States)

    Yew, Wing Wai; Leung, Chi Chiu; Zhang, Ying

    2017-06-01

    In patients with diabetes mellitus, TB treatment outcomes are poorer. Most parameters, when measured, reflect the slower bacteriological conversion from positivity to negativity and higher risks of disease relapse and mortality, as well as a greater propensity to develop drug-resistant TB. Aside from the well-known immunological dysfunction inherent to patients with diabetes mellitus, oxidative stress is likely a major underlying mechanism adversely impacting their TB treatment outcomes. Mycobacterium tuberculosis persisters, formed as a result of the core dormancy response to stress, possibly play a central role in this hypothesis. This hypothetical model also underscores the paramount importance of programmatic management of TB and diabetes mellitus, in collaboration, to improve the outcomes of patients with both diseases. The validity of these ideas could be further ascertained by laboratory and clinical research. © The Author 2017. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  5. Risk factors for poor treatment outcomes in patients with MDR-TB and XDR-TB in China: retrospective multi-center investigation.

    Science.gov (United States)

    Tang, Shenjie; Tan, Shouyong; Yao, Lan; Li, Fujian; Li, Li; Guo, Xinzhi; Liu, Yidian; Hao, Xiaohui; Li, Yanqiong; Ding, Xiuxiu; Zhang, Zhanjun; Tong, Li; Huang, Jianan

    2013-01-01

    The treatment of patients with MDR- and XDR-TB is usually more complex, toxic and costly and less effective than treatment of other forms of TB. However, there is little information available on risk factors for poor outcomes in patients with MDR- and XDR-TB in China. We retrospectively analyzed the clinical records of HIV-negative TB Patients with culture-proven MDR- or XDR-TB who were registered from July 2006 to June 2011 at five large-scale Tuberculosis Specialized Hospitals in China. Among 1662 HIV-seronegative TB cases which were culture-positive for M. tuberculosis complex and had positive sputum-smear microscopy results, 965 cases (58.1%) were DR-TB, and 586 cases (35.3%) were classified as having MDR-TB, accounting for 60.7% of DR-TB. 169 cases (10.2%) were XDR-TB, accounting for 17.5% of DR-TB, 28.8% of MDR-TB. The MDR-TB patients were divided into XDR-TB group (n=169) and other MDR-TB group (non-XDR MDR-TB) (n=417). In total, 240 patients (40.95%) had treatment success, and 346 (59.05%) had poor treatment outcomes. The treatment success rate in other MDR-TB group was 52.2%, significantly higher than that in the XDR-TB group (13%, PChina.The presence of extensive drug resistance, low BMI, hypoalbuminemia, comorbidity, cavitary disease and previous anti-TB treatment are independent prognostic factors for poor outcome in patients with MDR-TB.

  6. Prevalence of diabetes mellitus (DM) in tuberculosis (TB) patients: clinical and radiologic features in the TB-DM association based on a five-year hospital study.

    Science.gov (United States)

    Pavlović, Jovana M; Pavlovic, Aleksandar D; Bulajić, Milica V; Pešut, Dragica P

    2018-03-01

    A previously known association of tuberculosis (TB), now a global emergency, with diabetes mellitus (DM), a chronic disease of increasing prevalence worldwide, has resurfaced. DM is a recognised TB risk factor and M. tuberculosis infection usually disturbs glycoregulation. We aimed to estimate DM prevalence among TB patients and to analyse clinical and radiologic manifestations of TB in this group. The cross-sectional study included 1017 patients discharged with a TB diagnosis from a tertiary level facility in a five-year period. After exclusion of 128 patients with TB sequelae, we selected 889 patients with confirmed active TB, and the final selection led to 88 subjects with both active TB and DM. DM was found in 9.89% of active TB patients. Testing hypotheses for single-sample proportions showed that the prevalence was significantly higher than the prevalence in the general population (pTB in 96.3% of the 88 subjects, and extrapulmonary in 3.4%, the latter more frequently in women (p=0.08). Cavities were more frequently found in tobacco smokers compared to non-smokers (p=0.002) and in patients living in rural settings (p=0.002); haemoptysis was detected more frequently in men compared to women (p=0.044). Half of the patients had no fever at all, and only 14.8% had tachycardia. Auscultatory findings were positive in 57 (64.8%) patients. Radiographic changes were atypical in 17/88 (19.3%) patients and included pulmonary bases in seven patients, upper lobe anterior segment, and disseminated miliary pattern in two patients. DM prevalence is significantly higher among TB patients compared to the general population. The mean age of TB patients with DM is significantly higher than expected in TB patients alone. Knowledge of TB clinical and radiologic variations in this group of patients may reduce the delay in TB diagnosis with its clinical and epidemiologic consequences.

  7. Interleukin-1 receptor antagonist, a biomarker of response to anti-TB treatment in HIV/TB co-infected patients.

    Science.gov (United States)

    Nouhin, Janin; Pean, Polidy; Madec, Yoann; Chevalier, Mathieu F; Didier, Celine; Borand, Laurence; Blanc, François-Xavier; Scott-Algara, Daniel; Laureillard, Didier; Weiss, Laurence

    2017-05-01

    Despite the high frequency of tuberculosis-associated immune reconstitution inflammatory syndrome (TB-IRIS) in human immunodeficiency virus (HIV)/TB co-infected patients, no diagnostic test is available. Here, we investigated whether monocyte/macrophage activation markers can predict TB-IRIS occurrence and if they are modulated by anti-TB treatment. Frozen plasma was obtained from 127 HIV/TB co-infected adults naïve for antiretroviral therapy, enrolled in the CAMELIA trial, 36 of whom developed TB-IRIS. Concentrations of IL-1Ra, sCD14, and sCD163 were measured at anti-TB treatment onset (baseline), after 8 weeks of anti-TB treatment and at TB-IRIS time. At baseline, IL-1Ra and sCD14 concentrations were similar in TB-IRIS and non-IRIS patients. sCD163 concentrations, although significantly higher in TB-IRIS patients, did not remain associated with TB-IRIS occurrence in multivariate analysis. At the time of TB-IRIS, patients displayed higher concentrations of IL-1Ra (p = 0.002) and sCD14 (p TB treatment (median reduction: -63% (p TB-IRIS occurrence. However, repeated measurement of IL-1Ra could help for the diagnosis of TB-IRIS. The substantial reduction of IL-1Ra under treatment suggests that IL-1Ra could be a surrogate biomarker of anti-TB treatment response in HIV-infected patients. Copyright © 2017 The British Infection Association. Published by Elsevier Ltd. All rights reserved.

  8. Factors associated with mortality of TB/HIV co-infected patients in ...

    African Journals Online (AJOL)

    Background: Despite the large number of TB patients on ART in Ethiopia, their mortality remains high. This study reports the effect of TB on HIV related mortality and determinants of TB/HIV co-infection related mortality. Methods: A longitudinal study design was employed as part of the Advanced Clinical Monitoring of ART ...

  9. Regulatory T Cells Subvert Mycobacterial Containment in Patients Failing Extensively Drug-resistant TB Treatment.

    Science.gov (United States)

    Davids, Malika; Pooran, Anil S; Pietersen, Elize; Wainwright, Helen C; Binder, Anke; Warren, Robin; Dheda, Keertan

    2018-02-09

    The advent of extensively (XDR-TB) and totally drug-resistant TB, with limited or no treatment options, has facilitated renewed interest in host directed immunotherapy, particularly for therapeutically destitute patients. However, the selection and utility of such approaches depend upon understanding the host immune response in XDR-TB, which hitherto remains unexplored. To determine the host immunological profile in patients with XDR-TB, compared to drug-sensitive TB, using peripheral blood and explanted lung tissue. Blood and explanted lung tissue were obtained from patients with XDR-TB (n=31), drug-sensitive TB (DS-TB, n=20) and presumed latent-TB infection (LTBI, n=20). T-cell phenotype (Th1/Th2/Th17/Tregs) was evaluated in all patient groups, and Treg function assessed in XDR-TB non-responders by co-culturing PPD pre-primed effector T-cells with H37Rv-infected monocyte-derived macrophages, with or without autologous Tregs. Mycobacterial containment was evaluated by counting colony-forming units. Patients failing XDR-TB treatment had an altered immuno-phenotype characterized by a substantial increase in the frequency (median; IQR) of CD4+CD25+FoxP3+ regulatory T-cells (11.5; 5.9-15.2) compared to DS-TB (3.4 %; 1.6-5.73; p TB patients suppressed T-cell proliferation (up to 90%) and subverted containment of H37Rv-infected monocyte-derived macrophages (by 30%; p= 0.03) by impairing effector T-cell function through a mechanism independent of direct cell-to-cell contact, IL-10, TGF-beta and CTLA-4. Collectively, these data suggest that Tregs may be contributing to immune dysfunction, and bacterial persistence, in patients with XDR-TB. The relevant cellular pathways may serve as potential targets for immunotherapeutic intervention.

  10. Community-based MDR-TB care project improves treatment initiation in patients diagnosed with MDR-TB in Myanmar.

    Science.gov (United States)

    Wai, Pyae Phyo; Shewade, Hemant Deepak; Kyaw, Nang Thu Thu; Thein, Saw; Si Thu, Aung; Kyaw, Khine Wut Yee; Aye, Nyein Nyein; Phyo, Aye Mon; Maung, Htet Myet Win; Soe, Kyaw Thu; Aung, Si Thu

    2018-01-01

    The Union in collaboration with national TB programme (NTP) started the community-based MDR-TB care (CBMDR-TBC) project in 33 townships of upper Myanmar to improve treatment initiation and treatment adherence. Patients with MDR-TB diagnosed/registered under NTP received support through the project staff, in addition to the routine domiciliary care provided by NTP staff. Each township had a project nurse exclusively for MDR-TB and 30 USD per month (max. for 4 months) were provided to the patient as a pre-treatment support. To assess whether CBMDR-TBC project's support improved treatment initiation. In this cohort study (involving record review) of all diagnosed MDR-TB between January 2015 and June 2016 in project townships, CBMDR-TBC status was categorized as "receiving support" if date of project initiation in patient's township was before the date of diagnosis and "not receiving support", if otherwise. Cox proportional hazards regression (censored on 31 Dec 2016) was done to identify predictors of treatment initiation. Of 456 patients, 57% initiated treatment: 64% and 56% among patients "receiving support (n = 208)" and "not receiving support (n = 228)" respectively (CBMDR-TBC status was not known in 20 (4%) patients due to missing diagnosis dates). Among those initiated on treatment (n = 261), median (IQR) time to initiate treatment was 38 (20, 76) days: 31 (18, 50) among patients "receiving support" and 50 (26,101) among patients "not receiving support". After adjusting other potential confounders (age, sex, region, HIV, past history of TB treatment), patients "receiving support" had 80% higher chance of initiating treatment [aHR (0.95 CI): 1.8 (1.3, 2.3)] when compared to patients "not receiving support". In addition, age 15-54 years, previous history of TB and being HIV negative were independent predictors of treatment initiation. Receiving support under CBMDR-TBC project improved treatment initiation: it not only improved the proportion initiated but also

  11. Access to and affordability of healthcare for TB patients in China: issues and challenges.

    Science.gov (United States)

    Tang, Shenglan; Wang, Lixia; Wang, Hong; Chin, Daniel P

    2016-01-29

    This paper introduces the background, aim and objectives of the project entitled "China-the Gates Foundation Collaboration on TB Control in China" that has been underway for many years. It also summarizes the key findings of the nine papers included in this special issue, which used data from the baseline survey of Phase II of the project. Data were collected from the survey of TB and MDR-TB patients, from designated hospitals, health insurance agencies and the routine health information systems, as well as key informant interviews and focus group discussions with relevant key stakeholders. Key issues discussed in this series of papers include the uses of TB services and anti-TB medicines and their determining factors related to socio-economic and health systems development; expenditures on TB care and the financial burden incurred on TB patients; and the impact of health insurance schemes implemented in China on financial protection.

  12. vBarriers and facilitators of adherence to TB treatment in patients on concomitant TB and HIV treatment: a qualitative study

    Directory of Open Access Journals (Sweden)

    Frich Jan C

    2010-10-01

    Full Text Available Abstract Background Tuberculosis is a major public health problem in Ethiopia, and a high number of TB patients are co-infected with HIV. There is a need for more knowledge about factors influencing treatment adherence in co-infected patients on concomitant treatment. The aim of the present study is to explore patients' and health care professionals' views about barriers and facilitators to TB treatment adherence in TB/HIV co-infected patients on concomitant treatment for TB and HIV. Methods Qualitative study using in-depth interviews with 15 TB/HIV co-infected patients and 9 health professionals and focus group discussions with 14 co-infected patients. Results We found that interplay of factors is involved in the decision making about medication intake. Factors that influenced adherence to TB treatment positively were beliefs in the curability of TB, beliefs in the severity of TB in the presence of HIV infection and support from families and health professionals. Barriers to treatment adherence were experiencing side effects, pill burden, economic constraints, lack of food, stigma with lack of disclosure, and lack of adequate communication with health professionals. Conclusion Health professionals and policy makers should be aware of factors influencing TB treatment in TB/HIV co-infected patients on concomitant treatment for TB and HIV. Our results suggest that provision of food and minimal financial support might facilitate adherence. Counseling might also facilitate adherence, in particular for those who start ART in the early phases of TB treatment, and beliefs related to side-effects and pill burden should be addressed. Information to the public may reduce TB and HIV related stigma.

  13. Non-adherence to anti-TB drugs among TB/HIV co-infected patients ...

    African Journals Online (AJOL)

    Background: Non-adherence to treatment remains a major obstacle to efficient tuberculosis control in developing countries. The dual infection of Tuberculosis and HIV presents further adherence problems because of high pill burden and adverse effects. This poses a risk of increased multi-drug resistant TB. However, the ...

  14. Measuring Quality Gaps in TB Screening in South Africa Using Standardised Patient Analysis.

    Science.gov (United States)

    Christian, Carmen S; Gerdtham, Ulf-G; Hompashe, Dumisani; Smith, Anja; Burger, Ronelle

    2018-04-12

    This is the first multi-district Standardised Patient (SP) study in South Africa. It measures the quality of TB screening at primary healthcare (PHC) facilities. We hypothesise that TB screening protocols and best practices are poorly adhered to at the PHC level. The SP method allows researchers to observe how healthcare providers identify, test and advise presumptive TB patients, and whether this aligns with clinical protocols and best practice. The study was conducted at PHC facilities in two provinces and 143 interactions at 39 facilities were analysed. Only 43% of interactions resulted in SPs receiving a TB sputum test and being offered an HIV test. TB sputum tests were conducted routinely (84%) while HIV tests were offered less frequently (47%). Nurses frequently neglected to ask SPs whether their household contacts had confirmed TB (54%). Antibiotics were prescribed without taking temperatures in 8% of cases. The importance of returning to the facility to receive TB test results was only explained in 28%. The SP method has highlighted gaps in clinical practice, signalling missed opportunities. Early detection of sub-optimal TB care is instrumental in decreasing TB-related morbidity and mortality. The findings provide the rationale for further quality improvement work in TB management.

  15. Comparison of bacteriological conversion and treatment outcomes among MDR-TB patients with and without diabetes in Mexico: Preliminary data

    OpenAIRE

    Muñoz-Torrico, M.; Caminero Luna, J.; Migliori, G.B.; D’Ambrosio, L.; Carrillo-Alduenda, J.L.; Villareal-Velarde, H.; Torres-Cruz, A.; Flores-Ergara, H.; Martínez-Mendoza, D.; García-Sancho, C.; Centis, R.; Salazar-Lezama, M.Á.; Pérez-Padilla, R.

    2017-01-01

    Diabetes mellitus (DM) is a well-known risk factor for tuberculosis (TB). However, it is not known to what extent DM affects the outcome in patients with multidrug-resistant (MDR-TB) and extensively drug-resistant TB (XDR-TB) treated with second-line anti-TB drugs.The objective of this study was to compare the microbiological evolution (sputum smear and culture conversion) and final outcomes of MDR/XDR-TB patients with and without DM, managed at the national TB reference centre in Mexico City...

  16. Ocular disease in patients with TB and HIV presenting with fever in ...

    African Journals Online (AJOL)

    Among the patients with AIDS, 32 (17%) had retinal microangiopathy manifest by cotton wool spots; one (0.5%) had signs of active cytomegalovirus (CMV) retinitis. The presence of microangiopathy was not related to TB. Conclusions. In Malawian patients with TB presenting acutely with fever, choroidal granulomas were ...

  17. When students become patients: TB disease among medical ...

    African Journals Online (AJOL)

    Background. Medical students acquire latent tuberculosis (TB) infection at a rate of 23 cases/100 person-years. The frequency and impact of occupational TB disease in this population are unknown. Methods. A self-administered questionnaire was distributed via email and social media to current medical students and ...

  18. When students become patients: TB disease among medical ...

    African Journals Online (AJOL)

    access article is distributed under. Creative Commons licence CC-BY-NC 4.0. Background. Medical students acquire latent tuberculosis (TB) infection at a rate of 23 cases/100 person-years. The frequency and impact of occupational TB disease ...

  19. The relationship between perceived discrimination and psychological distress among Chinese pulmonary tuberculosis patients: the moderating role of self-esteem.

    Science.gov (United States)

    Feng, Danjun; Xu, Lingzhong

    2015-01-01

    This study described the prevalence of psychological distress and examined the moderating effect of self-esteem in the relationship between perceived discrimination and psychological distress among Chinese pulmonary tuberculosis (TB) patients. Seven hundred and twenty patients with TB from three cities of Shandong Province in eastern China participated in a cross-sectional survey. Patients were measured with the Kessler 10 (K10), the Rosenberg self-esteem scale, and a self-developed perceived discrimination questionnaire. A total of 58.6% of patients with TB scored above 16 on the K10, indicating moderate and serious psychological distress. Chi-square test revealed that female patients reported higher psychological distress than male patients. The structural equation modeling (SEM) analysis among the whole sample indicated that perceived discrimination was significantly related with psychological distress (β = .28, p ≤ .01). The multiple group analysis of SEM showed that perceived discrimination had a significantly substantial (β = .50, p ≤ .001), significantly moderate (β = .15, p ≤ .01), and insignificant effect (β = .05, p ≥ .05) on psychological distress among low self-esteem, moderate self-esteem, and high self-esteem patients with TB, respectively, which verified the moderating effect of self-esteem in the relationship between perceived discrimination and psychological distress.

  20. Tuberculosis-specific CD8 cells in HLA A*02-positive TB- and LTBI patients

    DEFF Research Database (Denmark)

    Fløe, Andreas; Brix, Liselotte; Wejse, Christian

    Background: Understanding the CD8+ response against Mycobacterium tuberculosis (MTB) may be a key to improved TB diagnostics and vaccine development. Aims and Objectives: To detect a CD8+ T-cell response against Mycobacterium tuberculosis (MTB) in active tuberculosis (TB) and latent TB (LTBI...... candidates, from which we constructed MHC multimers (Dextramers). Peripheral blood mononuclear cells (PBMC) from 7 TB-patients, 16 LTBI patients and 8 MTB-exposed, IGRA-negative, healthy subjects (HE), all HLA A*02 positive, were stained with the Dextramers and with anti-CD8 and anti-CD3, and analyzed...... on a flow cytometer. The MTB epitopes were analyzed in 5 pools (3-7 epitopes each). Positive responses included >0.001 % of CD8+, CD3+ cells, supported by inspection of flow cytometry plots. Results: MTB-specific CD8+ T-cells were detected more often in TB patients (57%) than in LTBI patients (41...

  1. EFFICIENCY OF INPATIENT TREATMENT OF TUBERCULOSIS PATIENTS WITH DRUG-RESISTANT TB

    Directory of Open Access Journals (Sweden)

    I. F. Kopylova

    2013-01-01

    Full Text Available The composition and effectiveness of the treatment of patients 159 drug-resistant TB of Mycobacterium tuberculosis. Dominated by common processes (87%, massive bacterioexcretion (74.2% and multidrug-resistant TB. Full clinical effect achieved in 54.8% (n = 68, including 28.8% (37 by surgical methods. 

  2. Is Chemoprophylaxis for Child Contacts of Drug-Resistant TB Patients Beneficial? A Systematic Review

    Directory of Open Access Journals (Sweden)

    C. Padmapriyadarsini

    2018-01-01

    Full Text Available Background. Preventive therapy for child contacts of multidrug-resistant tuberculosis (MDR-TB patients is poorly studied, and no consensus about the role and the rationale of chemoprophylaxis has been reached. Objective. To conduct systematic review with an aim to determine the effectiveness of TB preventive therapy in reducing the incidence of TB disease in pediatric contacts of MDR-TB patients. Methods. We conducted a literature search for randomized control trials, cohort studies, and case reports of chemoprophylaxis for pediatric contacts of MDR-TB patients in PubMed, EMBASE, Cochrane Databases of Systematic Reviews, metaRegister of Controlled Trials, and other clinical registries through March 2017, using appropriate search strategy. In addition we searched abstracts from international conferences and references of published articles and reviews. Results. Of the 153 references assessed from various databases, seven studies were identified as relevant after adaption of eligibility criteria and assessed for systematic review. Of these, only two studies contributed data for the pooled meta-analysis. Conclusions. Though the available evidences suggest that the chemoprophylaxis for child contacts of MDR-TB patients is beneficial, data to support or reject preventive therapy is very limited. Further clinical research, in Tb endemic settings like India, needs to be performed to prove the beneficial effect of chemoprophylaxis for pediatric contacts of MDR-TB.

  3. Risk factors for inadequate TB case finding in Rural Western Kenya: a comparison of actively and passively identified TB patients.

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    Anna H Van't Hoog

    Full Text Available The findings of a prevalence survey conducted in western Kenya, in a population with 14.9% HIV prevalence suggested inadequate case finding. We found a high burden of infectious and largely undiagnosed pulmonary tuberculosis (PTB, that a quarter of the prevalent cases had not yet sought care, and a low case detection rate.We aimed to identify factors associated with inadequate case finding among adults with PTB in this population by comparing characteristics of 194 PTB patients diagnosed in a health facility after self-report, i.e., through passive case detection, with 88 patients identified through active case detection during the prevalence survey. We examined associations between method of case detection and patient characteristics, including HIV-status, socio-demographic variables and disease severity in univariable and multivariable logistic regression analyses.HIV-infection was associated with faster passive case detection in univariable analysis (crude OR 3.5, 95% confidence interval (CI 2.0-5.9, but in multivariable logistic regression this was largely explained by the presence of cough, illness and clinically diagnosed smear-negative TB (adjusted OR (aOR HIV 1.8, 95% CI 0.85-3.7. Among the HIV-uninfected passive case detection was less successful in older patients aOR 0.76, 95%CI 0.60-0.97 per 10 years increase, and women (aOR 0.27, 95%CI 0.10-0.73. Reported current or past alcohol use reduced passive case detection in both groups (0.42, 95% CI 0.23-0.79. Among smear-positive patients median durations of cough were 4.0 and 6.9 months in HIV-infected and uninfected patients, respectively.HIV-uninfected patients with infectious TB who were older, female, relatively less ill, or had a cough of a shorter duration were less likely found through passive case detection. In addition to intensified case finding in HIV-infected persons, increasing the suspicion of TB among HIV-uninfected women and the elderly are needed to improve TB case

  4. Pharmacokinetics of Isoniazid, Pyrazinamide, and Ethambutol in newly diagnosed pulmonary TB patients in Tanzania

    DEFF Research Database (Denmark)

    Denti, Paolo; Jeremiah, Kidola; Chigutsa, Emmanuel

    2015-01-01

    Exposure to lower-than-therapeutic levels of anti-tuberculosis drugs is likely to cause selection of resistant strains of Mycobacterium tuberculosis and treatment failure. The first-line anti-tuberculosis (TB) regimen consists of rifampicin, isoniazid, pyrazinamide, and ethambutol, and correct...... management reduces risk of TB relapse and development of drug resistance. In this study we aimed to investigate the effect of standard of care plus nutritional supplementation versus standard care on the pharmacokinetics of isoniazid, pyrazinamide and ethambutol among sputum smear positive TB patients...... with and without HIV. In a clinical trial in 100 Tanzanian TB patients, with or without HIV infection, drug concentrations were determined at 1 week and 2 months post initiation of anti-TB medication. Data was analysed using population pharmacokinetic modelling. The effect of body size was described using...

  5. Estimating the effect of lay knowledge and prior contact with pulmonary TB patients, on health-belief model in a high-risk pulmonary TB transmission population.

    Science.gov (United States)

    Zein, Rizqy Amelia; Suhariadi, Fendy; Hendriani, Wiwin

    2017-01-01

    The research aimed to investigate the effect of lay knowledge of pulmonary tuberculosis (TB) and prior contact with pulmonary TB patients on a health-belief model (HBM) as well as to identify the social determinants that affect lay knowledge. Survey research design was conducted, where participants were required to fill in a questionnaire, which measured HBM and lay knowledge of pulmonary TB. Research participants were 500 residents of Semampir, Asemrowo, Bubutan, Pabean Cantian, and Simokerto districts, where the risk of pulmonary TB transmission is higher than other districts in Surabaya. Being a female, older in age, and having prior contact with pulmonary TB patients significantly increase the likelihood of having a higher level of lay knowledge. Lay knowledge is a substantial determinant to estimate belief in the effectiveness of health behavior and personal health threat. Prior contact with pulmonary TB patients is able to explain the belief in the effectiveness of a health behavior, yet fails to estimate participants' belief in the personal health threat. Health authorities should prioritize males and young people as their main target groups in a pulmonary TB awareness campaign. The campaign should be able to reconstruct people's misconception about pulmonary TB, thereby bringing around the health-risk perception so that it is not solely focused on improving lay knowledge.

  6. Clinical and laboratory profile of patients with TB/HIV coinfection: A case series of 50 patients

    Directory of Open Access Journals (Sweden)

    Anand K Patel

    2011-01-01

    Full Text Available Background: Tuberculosis (TB is said to be one of the commonest opportunistic infection in patients with HIV/AIDS. Objective: To study the clinical and laboratory profile of patients with HIV/TB coinfection. Materials and Methods: Fifty adult TB patients having confirmed HIV seropositivity were included in randomized manner. A detailed history and thorough physical examination was done. Laboratory and radiological investigations were carried out as appropriately warranted. Results: Most of the patients were farm workers (30% followed by manual laborers (22% and transport drivers (16%. Heterosexual route was found in 86% of patients. Cough was present in 94% while fever and weight loss in 86% and 78% of patients, respectively. Out of 50 patients, 40% had only pulmonary TB (PTB, 46% had pulmonary and extra-pulmonary TB (EPTB, 10% had only EPTB and 4% had multisystemic EPTB. Mediastinal lymphadenopathy was present in 34% while pleural effusion and extra-thoracic lymph nodes was present in 20% and 18% of patients, respectively. Positive smear for acid-fast bacilli (AFB was found in 25.58% while positive Mantoux test was found in 32.14% of patients. Conclusion: HIV/TB coinfection is more common in sexually active age group and commonest mode of HIV infection is heterosexual transfer. Sputum smear AFB and Mantoux test positivity is low in TB patients having HIV. Disseminated TB is common in HIV. Mediastinal lymphadenopathy is common site among extra-pulmonary tuberculosis.

  7. Age-specific mortality among TB patients in Denmark 1998-2010

    DEFF Research Database (Denmark)

    Fløe, Andreas; Løkke, Anders; Ibsen, Rikke

    Objective: To evaluate the age-specific mortality in a national TB cohort, and to estimate relative age-specific mortality compared with matched controls, in a retrospective case-control study. Methods: Using Danish National Patient Registry, we retrospectively identified TB-patients between 1998...... followed for max. 12 (span: 0-12) years. Mortality was higher for cases than controls in all age groups, and significantly so for age groups above 20 years, peaking at a Hazard Ratio of 8.7 (95% CI: 5.53;16.69) in the 30-39 years age Conclusion: Cumulative mortality of TB-patients is significantly inferior...... to matched controls. While the difference in survival is substantial among elderly patients, a high relative risk of dying is particularly of concern among young and middle-aged adult TB patients....

  8. Should sputum-negative presumptive TB patients be actively followed to identify missing cases in India?

    Science.gov (United States)

    Waikar, S; Pathak, A; Ghule, V; Kapoor, A; Sagili, K; Babu, E R; Chadha, S

    2017-12-21

    Setting: Sputum smear microscopy, the primary diagnostic tool used for diagnosis of tuberculosis (TB) in India's Revised National TB Control Programme (RNTCP), has low sensitivity, resulting in a significant number of TB cases reported as sputum-negative. As the revised guidelines pose challenges in implementation, sputum-negative presumptive TB (SNPT) patients are subjected to 2 weeks of antibiotics, followed by chest X-ray (CXR), resulting in significant loss to care among these cases. Objective: To determine whether reducing delays in CXR would yield additional TB cases and reduce initial loss to follow-up for diagnosis among SNPT cases. Methods: In an ongoing intervention in five districts of Maharashtra, SNPT patients were offered upfront CXR. Results: Of 119 male and 116 female SNPT patients with a mean age of 45 years who were tested by CXR, 32 (14%) were reported with CXR suggestive of TB. Administering upfront CXR in SNPT patients yielded twice as many additional cases, doubling the proportion of cases detected among all those tested as against administering CXR 2 weeks after smear examination. Conclusion: Our interventional study showed that the yield of TB cases was significantly greater when upfront CXR examination was undertaken without waiting for a 2-week antibiotic trial.

  9. How did the TB patients reach DOTS services in Delhi? A study of patient treatment seeking behavior.

    Directory of Open Access Journals (Sweden)

    Sunil K Kapoor

    Full Text Available SETTING: Revised National Tuberculosis Control Programme (RNTCP, Delhi, India. OBJECTIVE: To ascertain the number and sequence of providers visited by TB patients before availing treatment services from DOTS; to describe the duration between onset of symptoms to treatment. STUDY DESIGN: A cross sectional, qualitative study. Information was gathered through in-depth interviews of TB patients registered during the month of Oct, 2012 for availing TB treatment under the Revised National TB Control Programme from four tuberculosis diagnosis and treatment centers in Delhi. RESULTS: Out of the 114 patients who registered, 108 participated in the study. The study showed that informal providers and retail chemists were the first point of contact and source of clinical advice for two-third of the patients, while the rest sought medical care from qualified providers directly. Most patients sought medical care from more than two providers, before being diagnosed as TB. Female TB patients and patients with extra-pulmonary TB had long mean duration between onset of symptoms to initiation of treatment (6.3 months and 8.4 months respectively. CONCLUSION: The pathways followed by TB patients, illustrated in this study, provide valuable lessons on the importance of different types of providers (both formal and informal in the health system in a society like India and the delays in the diagnosis and treatment of tuberculosis.

  10. Cellular immune response in MDR-TB patients to different protein expression of MDR and susceptible Mycobacterium tuberculosis: Rv0147, a novel MDR-TB biomarker.

    Science.gov (United States)

    Hadizadeh Tasbiti, Alireza; Yari, Shamsi; Siadat, Seyed Davar; Tabarsi, Payam; Saeedfar, Kayvan; Yari, Fatemeh

    2018-02-01

    Tuberculosis (TB) is a crucial public health problem with prevalence of multidrug resistant (MDR) rising. An accurate TB biomarker is urgently needed to monitor the response to treatment in patients with MDR tuberculosis. To analyze interaction between selected MDR-TB purified protein and immune cells, dendritic cells from MDR-TB patients and healthy subjects were stimulated by 55KDa protein fractions (Rv0147). The purified proteins identified by proteomic techniques (two-dimensional gel electrophoresis, mass spectrometry) and peptide sequences are known to bind a MHC class I alleles which are extracted from the Immune Epitope Database and Analysis Resource database ( www.iedb.org ). T cells were isolated from PBMC by negative selection and cells were cultured in RPMI-1640 at 37 °C and 5% CO 2 . Cell culture was assayed for cytokine IL-10 and INF-γ by ELISA. We found that INF-γ production was significantly (335 ± 35.5 pg/ml, P ˂ 0.05) upregulated after protein candidate (Rv0147) stimulation by dendritic cells from MDR-TB patients, whereas IL-10 production was greatly reduced compared with production in healthy subjects (212 ± 9.94 pg/ml, P ˂ 0.05). In fact, the purified protein, Rv0147, stimulated dendritic cells from MDR-TB patients, failed to produce IL-10 and directly stimulates INF-γ production by T cells. These results suggest that the purified protein, Rv0147, may stimulate Th1 type protective cytokine response in MDR-TB patients but not in normal subjects. The production of INF-γ but not IL-10 in the presence of purified protein, Rv0147, may be shifted to Th1 responses in MDR-TB patients and supports its potential as protein vaccine candidates against TB.

  11. Mind the gap! Risk factors for poor continuity of care of TB patients discharged from a hospital in the Western Cape, South Africa.

    Science.gov (United States)

    Dudley, Lilian; Mukinda, Fidele; Dyers, Robin; Marais, Frederick; Sissolak, Dagmar

    2018-01-01

    TB patients discharged from hospitals in South Africa experience poor continuity of care, failing to continue TB treatment at other levels of care. Factors contributing to poor continuity of TB care are insufficiently described to inform interventions. To describe continuity of care and risk factors in TB patients discharged from a referral hospital in the Western Cape, South Africa. This retrospective observational study used routine information to describe continuity of care and risk factors in TB patients discharged from hospital. 788 hospitalized TB patients were identified in 6 months. Their median age was 32 years, 400 (51%) were male, and 653 (83%) were urban. A bacteriological TB test was performed for 74%, 25% were tested for HIV in hospital, and 32% of all TB patients had documented evidence of HIV co-infection. Few (13%) were notified for TB; 375 (48%) received TB medication; 284 (36%) continued TB treatment after discharge; 91 (24%) had a successful TB treatment outcome, and 166 (21%) died. Better continuity of care was associated with adults, urban residence, bacteriological TB tests in hospital and TB medication on discharge. Fragmented hospital TB data systems did not provide continuity with primary health care information systems. Discharged TB patients experienced poor continuity of care, with children, rural patients, those not tested for TB in hospital or discharged without TB medication at greatest risk. Suboptimal quality of hospital TB care and a fragmented hospital information system without linkages to other levels underpinned poor continuity of care.

  12. Mind the gap! Risk factors for poor continuity of care of TB patients discharged from a hospital in the Western Cape, South Africa

    Science.gov (United States)

    Mukinda, Fidele; Dyers, Robin; Marais, Frederick; Sissolak, Dagmar

    2018-01-01

    Background TB patients discharged from hospitals in South Africa experience poor continuity of care, failing to continue TB treatment at other levels of care. Factors contributing to poor continuity of TB care are insufficiently described to inform interventions. Objective To describe continuity of care and risk factors in TB patients discharged from a referral hospital in the Western Cape, South Africa. Design This retrospective observational study used routine information to describe continuity of care and risk factors in TB patients discharged from hospital. Results 788 hospitalized TB patients were identified in 6 months. Their median age was 32 years, 400 (51%) were male, and 653 (83%) were urban. A bacteriological TB test was performed for 74%, 25% were tested for HIV in hospital, and 32% of all TB patients had documented evidence of HIV co-infection. Few (13%) were notified for TB; 375 (48%) received TB medication; 284 (36%) continued TB treatment after discharge; 91 (24%) had a successful TB treatment outcome, and 166 (21%) died. Better continuity of care was associated with adults, urban residence, bacteriological TB tests in hospital and TB medication on discharge. Fragmented hospital TB data systems did not provide continuity with primary health care information systems. Conclusions Discharged TB patients experienced poor continuity of care, with children, rural patients, those not tested for TB in hospital or discharged without TB medication at greatest risk. Suboptimal quality of hospital TB care and a fragmented hospital information system without linkages to other levels underpinned poor continuity of care. PMID:29370162

  13. HIV screening among newly diagnosed TB patients: a cross sectional study in Lima, Peru.

    Science.gov (United States)

    Ramírez, Suzanne; Mejía, Fernando; Rojas, Marlene; Seas, Carlos; Van der Stuyft, Patrick; Gotuzzo, Eduardo; Otero, Larissa

    2018-03-20

    Since 2006, the Peruvian National TB program (NTP) recommends voluntary counseling and testing (VCT) for all tuberculosis (TB) patients. Responding to the differential burden of both diseases in Peru, TB is managed in peripheral health facilities while HIV is managed in referral centers. This study aims to determine the coverage of HIV screening among TB patients and the characteristics of persons not screened. From March 2010 to December 2011 we enrolled new smear-positive pulmonary TB adults in 34 health facilities in a district in Lima. NTP staff offered VCT to all TB patients. Patients with an HIV positive result were referred for confirmation tests and management. We interviewed patients to collect their demographic and clinical characteristics and registered if patients opted in or out of the screening. Of the 1295 enrolled TB patients, nine had a known HIV diagnosis. Of the remaining, 76.1% (979) were screened for HIV. Among the 23.9% (307) not screened, 38.4% (118) opted out of the screening. TB patients at one of the health care facilities of the higher areas of the district (OR = 3.38, CI 95% 2.17-5.28 for the highest area and OR = 2.82, CI 95% 1.78-4.49 for the high area) as well as those reporting illegal drug consumption (OR = 1.65, CI 95% 1.15-2.37) were more likely not to be screened. Twenty-four were HIV positive (1.9% of all patients 1295, or 2.4% of those screened). Of 15 patients diagnosed with HIV during the TB episode, ten were enrolled in an HIV program. The median time between the result of the HIV screening and the first consultation at the HIV program was 82 days (IQR, 32-414). The median time between the result of the HIV screening and antiretroviral initiation was 148.5 days (IQR 32-500). An acceptable proportion of TB patients were screened for HIV in Lima. Referral systems of HIV positive patients should be strengthened for timely ART initiation.

  14. Prevalence of post-traumatic stress symptoms and associated factors in tuberculosis (TB), TB retreatment and/or TB-HIV co-infected primary public health-care patients in three districts in South Africa.

    Science.gov (United States)

    Peltzer, Karl; Naidoo, Pamela; Matseke, Gladys; Louw, Julia; McHunu, Gugu; Tutshana, Bomkazi

    2013-01-01

    High rates of tuberculosis (TB) and TB/HIV co-infection is often linked with mental health issues such as post-traumatic stress disorder (PTSD) symptoms, which is further associated with poor health outcomes. In a country such as South Africa where rates of these infectious diseases are high, it is concerning that there is limited/no data on prevalence rates of mental disorders such as PTSD and its associated factors. Therefore, the aim of this study was to establish the prevalence of PTSD symptoms and associated factors in TB, TB retreatment and/or TB-HIV co-infected primary public health-care patients in three districts in South Africa. Brief screening self-report tools were used to measure: PTSD symptoms, psychological distress (anxiety and depression) and alcohol misuse. Other relevant measures, such as adherence to medication, stressful life events and sexual risk-taking behaviours, were obtained through structured questions. A total of 4900 public primary care adult patients from clinics in high TB burden districts from three provinces in South Africa participated. All the patients screened positive for TB (either new or retreatment cases). The prevalence of PTSD symptoms was 29.6%. Patients who screened positive for PTSD symptoms and psychological distress were more likely to be on antidepressant medication. Factors that predicted PTSD symptoms were poverty, residing in an urban area, psychological distress, suicide attempt, alcohol and/or drug use before sex, unprotected sex, TB-HIV co-infected and the number of other chronic conditions. Health-care systems should be strengthened to improve delivery of mental health care, by focusing on existing programmes and activities, such as those which address the prevention and treatment of TB and HIV.

  15. Adverse Events among HIV/MDR-TB Co-Infected Patients Receiving Antiretroviral and Second Line Anti-TB Treatment in Mumbai, India

    Science.gov (United States)

    Isaakidis, Petros; Varghese, Bhanumati; Mansoor, Homa; Cox, Helen S.; Ladomirska, Joanna; Saranchuk, Peter; Da Silva, Esdras; Khan, Samsuddin; Paryani, Roma; Udwadia, Zarir; Migliori, Giovanni Battista; Sotgiu, Giovanni; Reid, Tony

    2012-01-01

    Background Significant adverse events (AE) have been reported in patients receiving medications for multidrug- and extensively-drug-resistant tuberculosis (MDR-TB & XDR-TB). However, there is little prospective data on AE in MDR- or XDR-TB/HIV co-infected patients on antituberculosis and antiretroviral therapy (ART) in programmatic settings. Methods Médecins Sans Frontières (MSF) is supporting a community-based treatment program for drug-resistant tuberculosis in HIV-infected patients in a slum setting in Mumbai, India since 2007. Patients are being treated for both diseases and the management of AE is done on an outpatient basis whenever possible. Prospective data were analysed to determine the occurrence and nature of AE. Results Between May 2007 and September 2011, 67 HIV/MDR-TB co-infected patients were being treated with anti-TB treatment and ART; 43.3% were female, median age was 35.5 years (Interquartile Range: 30.5–42) and the median duration of anti-TB treatment was 10 months (range 0.5–30). Overall, AE were common in this cohort: 71%, 63% and 40% of patients experienced one or more mild, moderate or severe AE, respectively. However, they were rarely life-threatening or debilitating. AE occurring most frequently included gastrointestinal symptoms (45% of patients), peripheral neuropathy (38%), hypothyroidism (32%), psychiatric symptoms (29%) and hypokalaemia (23%). Eleven patients were hospitalized for AE and one or more suspect drugs had to be permanently discontinued in 27 (40%). No AE led to indefinite suspension of an entire MDR-TB or ART regimen. Conclusions AE occurred frequently in this Mumbai HIV/MDR-TB cohort but not more frequently than in non-HIV patients on similar anti-TB treatment. Most AE can be successfully managed on an outpatient basis through a community-based treatment program, even in a resource-limited setting. Concerns about severe AE in the management of co-infected patients are justified, however, they should not cause delays

  16. Physician-initiated courtesy MODS testing for TB and MDR-TB diagnosis and patient management.

    Science.gov (United States)

    Nic Fhogartaigh, C J; Vargas-Prada, S; Huancaré, V; Lopez, S; Rodríguez, J; Moore, D A J

    2008-05-01

    Laboratorio de Investigación de Enfermedades Infecciosas, Universidad Peruana Cayetano Heredia (UPCH) and government health centres, Lima, Peru. To evaluate the contribution of unselected (courtesy) microscopic observation drug susceptibility (MODS) testing to the diagnosis and/or drug susceptibility testing (DST) of tuberculosis and their subsequent impact upon patient management. Retrospective database analysis and case note review of MODS culture-positive cases. Mycobacterium tuberculosis was isolated in 28.9% of 225 samples (209 patients); 22.2% of 63 positive cases were multidrug-resistant. In 58 MODS culture-positive cases with follow-up data available, MODS provided culture confirmation of diagnosis, DST or both in 82.8%, before any standard method. In 41.4%, this result should have prompted a modification in patient management. Delays between laboratory result and initiation or change of treatment, where applicable, took on average 42 and 64 days, respectively, of which a delay of respectively 17 and 48 days occurred after the receipt of results by the health facility. MODS provides important data for clinical management within a meaningful timeframe and should contribute positively to patient outcomes due to earlier initiation of appropriate therapy. Although clinicians may successfully select patients likely to benefit from MODS, ongoing work is required to identify optimal implementation of the assay and to reduce logistical and health system derived delays.

  17. Differential cellular recognition pattern to M. tuberculosis targets defined by IFN-γ and IL-17 production in blood from TB + patients from Honduras as compared to health care workers: TB and immune responses in patients from Honduras.

    Science.gov (United States)

    Alvarez-Corrales, Nancy; Ahmed, Raija K; Rodriguez, Carol A; Balaji, Kithiganahalli N; Rivera, Rebeca; Sompallae, Ramakrishna; Vudattu, Nalini K; Hoffner, Sven E; Zumla, Alimuddin; Pineda-Garcia, Lelany; Maeurer, Markus

    2013-03-06

    A better understanding of the quality of cellular immune responses directed against molecularly defined targets will guide the development of TB diagnostics and identification of molecularly defined, clinically relevant M.tb vaccine candidates. Recombinant proteins (n = 8) and peptide pools (n = 14) from M. tuberculosis (M.tb) targets were used to compare cellular immune responses defined by IFN-γ and IL-17 production using a Whole Blood Assay (WBA) in a cohort of 148 individuals, i.e. patients with TB + (n = 38), TB- individuals with other pulmonary diseases (n = 81) and individuals exposed to TB without evidence of clinical TB (health care workers, n = 29). M.tb antigens Rv2958c (glycosyltransferase), Rv2962c (mycolyltransferase), Rv1886c (Ag85B), Rv3804c (Ag85A), and the PPE family member Rv3347c were frequently recognized, defined by IFN-γ production, in blood from healthy individuals exposed to M.tb (health care workers). A different recognition pattern was found for IL-17 production in blood from M.tb exposed individuals responding to TB10.4 (Rv0288), Ag85B (Rv1886c) and the PPE family members Rv0978c and Rv1917c. The pattern of immune target recognition is different in regard to IFN-γ and IL-17 production to defined molecular M.tb targets in PBMCs from individuals frequently exposed to M.tb. The data represent the first mapping of cellular immune responses against M.tb targets in TB patients from Honduras.

  18. Molecular detection of rifampin and isoniazid resistance to guide chronic TB patient management in Burkina Faso

    Directory of Open Access Journals (Sweden)

    Pinsi Gabriele

    2009-08-01

    Full Text Available Abstract Background Drug-resistant tuberculosis (DR-TB is considered a real threat to the achievement of TB control. Testing of mycobacterial culture and testing of drug susceptibility (DST capacity are limited in resource-poor countries, therefore inadequate treatment may occur, favouring resistance development. We evaluated the molecular assay GenoType® MTBDRplus (Hain Lifescience, Germany in order to detect DR-TB directly in clinical specimens as a means of providing a more accurate management of chronic TB patients in Burkina Faso, a country with a high TB-HIV co-infection prevalence. Methods Samples were collected in Burkina Faso where culture and DST are not currently available, and where chronic cases are therefore classified and treated based on clinical evaluation and sputum-smear microscopy results. One hundred and eight chronic TB patients (sputum smear-positive, after completing a re-treatment regimen for pulmonary TB under directly observed therapy were enrolled in the study from December 2006 to October 2008. Two early morning sputum samples were collected from each patient, immediately frozen, and shipped to Italy in dry ice. Samples were decontaminated, processed for smear microscopy and DNA extraction. Culture was attempted on MGIT960 (Becton Dickinson, Cockeysville, USA and decontaminated specimens were analyzed for the presence of mutations conferring resistance to rifampin and isoniazid by the molecular assay GenoType® MTBDRplus. Results We obtained a valid molecular test result in 60/61 smear-positive and 47/47 smear-negative patients. Among 108 chronic TB cases we identified patients who (i harboured rifampin- and isoniazid-susceptible strains (n 24, (ii were negative for MTB complex DNA (n 24, and (iii had non-tuberculous mycobacteria infections (n 13. The most represented mutation conferring rifampin-resistance was the D516V substitution in the hotspot region of the rpoB gene (43.8% of cases. Other mutations recognized

  19. What are the reasons for patients not adhering to their anti-TB ...

    African Journals Online (AJOL)

    Conclusions: The most important recommendation is to improve the relationship between patients and TB nurses through training in communication skills. A more holistic assessment of patients would help identify issues such as depression, and a more patient-centred approach would help to understand and address ...

  20. Initial default among sputum-positive pulmonary TB patients at a referral hospital in Uttarakhand, India.

    Science.gov (United States)

    Mehra, Darshan; Kaushik, Rajeev M; Kaushik, Reshma; Rawat, Jagdish; Kakkar, Rajesh

    2013-09-01

    Initial default is a serious issue which can enhance the transmission of TB. We determined the magnitude of and the causative factors for initial default among sputum-positive pulmonary TB (PTB) patients. In this prospective study, 2310 patients attending a referral hospital in Uttarakhand state, north India, with presumptive TB were investigated and 555 patients with sputum-positive PTB were followed-up for initiation of anti-TB treatment (ATT) during 2010-2012. The patients not confirmed as having started ATT were considered initial defaulters. Initial default was seen in 120 (21.6%) patients comprising 22 (18.3%) defaulters during diagnosis and 98 (81.6%) defaulters after referral for directly observed treatment, short-course (DOTS). The initial default rate was significantly higher among patients from rural areas than urban areas, illiterate patients than literate patients and smokeless tobacco-users than non-users (pdefault among patients referred for DOTS were limited trust in DOTS (n = 44, 44.8%), adverse effects of previous ATT (n = 41, 41.8%), dissatisfaction with health services (n = 38, 38.7%), local deaths while taking DOTS (n = 28, 28.5%), advice by others against DOTS (n = 25, 25.5%), disbelief in the diagnosis (n = 18, 18.3%) and patient death before starting treatment (n = 4, 4.0%). A high initial default rate was seen among patients with PTB. There is an urgent need to promote public awareness to lower the initial default rate.

  1. AWARENESS OF LYME BORRELIOSIS OF THE PATIENTS OF TERNOPIL REGIONAL TB DISPENSARY

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    L. P. Melnyk

    2017-07-01

    Full Text Available Background. Lyme disease has many clinical features similar tothose in sarcoidosis and tuberculosis. Epidemiological data in the world, in particular in Ukraine, proves the increase in Lyme borreliosis incidence. Ternopil region is endemic with Lyme borreliosis. Objective. The research was aimed to investigate the prevalence of infection with Borrelia burgdorferi and epidemiology features of borreliosis among the patients of Ternopil Regional TB Dispensary. Methods. In total, 29 patients were admitted to Departments of Differential Diagnostic, TB Therapy and TB Surgery of Ternopil Regional TB Dispensary in October 2016-January 2017. All the surveyed answered the questions of an integrated international questionnaire, where they noted the area and a number of tick bites, described the removal method, noted the survey for borreliosis pathogen and complaints after tick bites. Results. It was established that 5 respondents had a history of tick bites episodes, but only in one case the patient was examined of borreliosis. Tick bites were noticed in 3 patients with sarcoidosis and 1 with tuberculosis (TB and exudative pleurisy, respectively. Conclusions. The absence of appeals for medical care, lack of sufficient information on Lyme borreliosis and disuse of preventive measures for tick bites by the interviewed patients of Ternopil regional TB dispensary departments proves the need of improvement of health education on Lyme borreliosis (LB among this category of population. 24 (82.7% of 29 respondents did not remember the tick bite. The symptoms of (LB are similar to those in sarcoidosis and tuberculosis (pleural lesions, heart, joints, nervous system, skin, and the presence of tick bites gives the reasons to examine these patients of Borrelia burgdorferi senso lato.

  2. Trèlat's beads as oral manifestations in patients with HIV/TB

    Directory of Open Access Journals (Sweden)

    Elcio Magdalena Giovani

    2016-07-01

    Full Text Available Tuberculosis (TB is a contagious infectious disease caused by Mycobacterium tuberculosis (Koch's bacillus. Co-infection with human immunodeficiency virus (HIV and TB has reached a significant importance as a public health problem and this association has been recognized as the most significant event that changed “the balance between man and Koch's bacillus” in the last century, and has a large contribution to the risk for disease spreading. Tuberculosis has two main standard categories of clinical manifestations: primary and secondary. Primary TB is responsible for the initial infection with lungs being the involved organ. Oral lesions are observed as a secondary TB clinical manifestation with most frequent sites being hard and soft palate, tongue, lips, gums, tonsils, and salivary glands. A case of classical TB lesions in the oral cavity is reported, and the importance of a correct diagnosis through careful history taking is emphasized. Treatment selection needs to be done assertively, with great determination and building a link between patient and treatment protocol, in order to promote patient's adherence.

  3. Comparison of bacteriological conversion and treatment outcomes among MDR-TB patients with and without diabetes in Mexico: Preliminary data

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    M. Muñoz-Torrico

    2017-01-01

    Full Text Available Diabetes mellitus (DM is a well-known risk factor for tuberculosis (TB. However, it is not known to what extent DM affects the outcome in patients with multidrug-resistant (MDR-TB and extensively drug-resistant TB (XDR-TB treated with second-line anti-TB drugs.The objective of this study was to compare the microbiological evolution (sputum smear and culture conversion and final outcomes of MDR/XDR-TB patients with and without DM, managed at the national TB reference centre in Mexico City. Results: Ninety patients were enrolled between 2010 and 2015: 73 with MDR-TB (81.1%, 11 with pre-XDR-TB (e.g. MDR-TB with additional resistance to one injectable drug or a fluoroquinolone, 12.2% and 6 (6.7% with XDR-TB. Out of these, 49 (54.4% had DM and 42 (86% were undergoing insulin treatment.No statistically significant differences were found in treatment outcomes comparing DM vs. non-DM MDR-TB cases: 18/32 (56.3% of DM cases and 19/24 (79.2% non DM patients achieved treatment success (p = 0.07. The time to sputum smear and culture conversion was longer (although not statistically in patients without DM, as follows: the mean (±SD time to sputum smear conversion was 53.9 (±31.4 days in DM patients and 65.2 (±34.8 days in non-DM ones (p = 0.15, while the time to culture conversion was 66.2 (±27.6 days for DM and 81.4 (±37.7 days for non-DM MDR-TB cases (p = 0.06. Conclusions: The study results support the Mexican National TB programme to strengthen its collaboration with the DM programme, as an entry point for TB (and latent TB infection screening and management. Keywords: Diabetes mellitus, Delay, Sputum and culture conversion, MDR-TB, High treatment adherence

  4. Household HIV Testing Uptake among Contacts of TB Patients in South Africa.

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    Kavindhran Velen

    Full Text Available In high HIV prevalence settings, offering HIV testing may be a reasonable part of contact tracing of index tuberculosis (TB patients. We evaluated the uptake of HIV counselling and testing (HCT among household contacts of index TB patients and the proportion of newly diagnosed HIV-infected persons linked into care as part of a household TB contact tracing study.We recruited index TB patients at public health clinics in two South African provinces to obtain consent for household contact tracing. During scheduled household visits we offered TB symptom screening to all household members and HCT to individuals ≥14years of age. Factors associated with HCT uptake were investigated using a random effects logistic regression model.Out of 1,887 listed household members ≥14 years old, 984 (52% were available during a household visit and offered HCT of which 108 (11% self-reported being HIV infected and did not undergo HCT. Of the remaining 876, a total of 304 agreed to HCT (35%; 26 (8.6% were newly diagnosed as HIV positive. In multivariable analysis, factors associated with uptake of HCT were prior testing (odds ratio 1.6; 95% confidence interval [CI]: 1.1-2.3 and another member in the household testing (odds ratio 2.4; 95% CI: 1.7-3.4. Within 3 months of testing HIV-positive, 35% reported initiating HIV care.HCT as a component of household TB contact tracing reached individuals without prior HIV testing, however uptake of HIV testing was poor. Strategies to improve HIV testing in household contacts should be evaluated.

  5. Barriers to completing TB diagnosis in Yemen: services should respond to patients' needs.

    Science.gov (United States)

    Anderson de Cuevas, Rachel M; Al-Sonboli, Najla; Al-Aghbari, Nasher; Yassin, Mohammed A; Cuevas, Luis E; Theobald, Sally J

    2014-01-01

    Obtaining a diagnosis of tuberculosis (TB) is a prerequisite for accessing specific treatment, yet one third of estimated new cases are missed worldwide by National Programmes. This study investigated economic, geographical, socio-cultural and health system factors hindering adults' attendance and completion of the TB diagnostic process in Yemen, to inform interventions designed to improve patient access to services. The study employed a mixed methods design comprising a cross-sectional survey and In-Depth-Interviews (IDIs) and Focus Group Discussions (FGDs) among patients abandoning the diagnosis or registering for treatment. Adults with cough of ≥ 2 weeks attending a large governmental referral centre in Sana'a, Yemen, between 2009 and 2010, were eligible to participate. 497 and 446 (89.7%) participants were surveyed the first and second day of attending the services and 48 IDIs and 12 FGDs were also conducted. The majority of patients were disadvantaged and had poor literacy (61% illiterate), had travelled from rural areas (47%) and attended with companions (84%). Key barriers for attendance identified were clinic and transport costs (augmented by companions), distance from home, a preference for private services, strong social stigma and a lack of understanding of the diagnostic process. There were discrepancies between patient- and doctor-reported diagnosis and 46% of patients were unaware that TB treatment is free. Females faced more difficulties to attend than men. The laboratory practice of providing first-day negative smear results and making referrals to the private sector also discouraged patients from returning. Strategies to bring TB diagnostic services closer to communities and address the multiple barriers patients face to attend, will be important to increase access to TB diagnosis and care.

  6. Barriers to completing TB diagnosis in Yemen: services should respond to patients' needs.

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    Rachel M Anderson de Cuevas

    Full Text Available OBJECTIVES AND BACKGROUND: Obtaining a diagnosis of tuberculosis (TB is a prerequisite for accessing specific treatment, yet one third of estimated new cases are missed worldwide by National Programmes. This study investigated economic, geographical, socio-cultural and health system factors hindering adults' attendance and completion of the TB diagnostic process in Yemen, to inform interventions designed to improve patient access to services. METHODOLOGY: The study employed a mixed methods design comprising a cross-sectional survey and In-Depth-Interviews (IDIs and Focus Group Discussions (FGDs among patients abandoning the diagnosis or registering for treatment. Adults with cough of ≥ 2 weeks attending a large governmental referral centre in Sana'a, Yemen, between 2009 and 2010, were eligible to participate. RESULTS: 497 and 446 (89.7% participants were surveyed the first and second day of attending the services and 48 IDIs and 12 FGDs were also conducted. The majority of patients were disadvantaged and had poor literacy (61% illiterate, had travelled from rural areas (47% and attended with companions (84%. Key barriers for attendance identified were clinic and transport costs (augmented by companions, distance from home, a preference for private services, strong social stigma and a lack of understanding of the diagnostic process. There were discrepancies between patient- and doctor-reported diagnosis and 46% of patients were unaware that TB treatment is free. Females faced more difficulties to attend than men. The laboratory practice of providing first-day negative smear results and making referrals to the private sector also discouraged patients from returning. Strategies to bring TB diagnostic services closer to communities and address the multiple barriers patients face to attend, will be important to increase access to TB diagnosis and care.

  7. The prevalence of human immunodeficiency virus infection among TB patients in Port Harcourt Nigeria

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    O Erhabor

    2010-01-01

    Full Text Available O Erhabor1, Z A Jeremiah2, T C Adias1, Okere CE21Department of Medical Laboratory Sciences, College of Health Sciences, Niger Delta University, Wilbeforce Island, Bayelsa State, Nigeria; 2Department of Medical Laboratory Sciences, Rivers State University of Science and Technology, Port Harcourt, NigeriaAbstract: The joint statement by the American Thoracic Society, Centers for Disease Control and Prevention, and Infectious Diseases Society of America recommends that all patients with tuberculosis (TB undergo testing for human immunodeficiency virus (HIV infection after counseling. In this study, we investigated the prevalence of HIV infection among 120 patients diagnosed with microbiologically proven TB aged 18 to 54 years with a mean age of 39.5 years (standard deviation 6.75. The subjects studied were 36 male (30% and 84 females (70%. Enzyme-linked immunosorbent assay methods were used to screen for HIV infection among the subjects. Of the 120 TB patients tested 30 (25% were positive for HIV infection. The prevalence of HIV was higher in females 24 (80% compared to males 6 (20% and among singles (66.7% compared to married subjects (33.3% (χ2 = 83.5 and χ2 = 126.2, respectively P = 0.001. HIV-1 was the predominant viral subtype. HIV prevalence was significantly higher in subjects in the 38–47 year and 28–37 year age groups (both 40% followed by the 18–28 year age group (20% (χ2 = 42.6, P = 0.05. The mean CD4 lymphocyte count of the HIV-infected TB subjects was significantly lower (195 ± 40.5 cells/μL compared to the non-HIV infected (288 ± 35.25 cells/μL P = 0.01. This study has shown a high prevalence of HIV among TB patients. Reactivation of TB among people living with HIV can be reduced by TB preventive therapy and by universal access to antiretroviral therapy.Keywords: human immunodeficiency virus, HIV, acquired immunodeficiency syndrome AIDS, tuberculosis, TB, Port Harcourt, Nigeria

  8. Predicting treatment failure, death and drug resistance using a computed risk score among newly diagnosed TB patients in Tamaulipas, Mexico.

    Science.gov (United States)

    Abdelbary, B E; Garcia-Viveros, M; Ramirez-Oropesa, H; Rahbar, M H; Restrepo, B I

    2017-10-01

    The purpose of this study was to develop a method for identifying newly diagnosed tuberculosis (TB) patients at risk for TB adverse events in Tamaulipas, Mexico. Surveillance data between 2006 and 2013 (8431 subjects) was used to develop risk scores based on predictive modelling. The final models revealed that TB patients failing their treatment regimen were more likely to have at most a primary school education, multi-drug resistance (MDR)-TB, and few to moderate bacilli on acid-fast bacilli smear. TB patients who died were more likely to be older males with MDR-TB, HIV, malnutrition, and reporting excessive alcohol use. Modified risk scores were developed with strong predictability for treatment failure and death (c-statistic 0·65 and 0·70, respectively), and moderate predictability for drug resistance (c-statistic 0·57). Among TB patients with diabetes, risk scores showed moderate predictability for death (c-statistic 0·68). Our findings suggest that in the clinical setting, the use of our risk scores for TB treatment failure or death will help identify these individuals for tailored management to prevent these adverse events. In contrast, the available variables in the TB surveillance dataset are not robust predictors of drug resistance, indicating the need for prompt testing at time of diagnosis.

  9. Patients' perception of the seriousness of TB scourge in Enugu state ...

    African Journals Online (AJOL)

    Objetive: To understand Patients' perception of the seriousness of TB and who may be at risk of contracting the disease in Enugu metropolis, Nigeria. Materials and Methods: This is a cross-sectional study and involved the use of the questionnaire in information collection from the respondents on their perception of the ...

  10. Infrequent detection of Pneumocystis jirovecii by PCR in oral wash specimens from TB patients with or without HIV and healthy contacts in Tanzania

    DEFF Research Database (Denmark)

    Jensen, Lotte; Jensen, Andreas V.; Praygod, George

    2010-01-01

    In tuberculosis (TB) endemic parts of the world, patients with pulmonary symptoms are managed as "smear-negative TB patients" if they do not improve on a two-week presumptive, broad-spectrum course of antibiotic treatment even if they are TB microscopy smear negative. These patients are frequently...... HIV positive and have a higher mortality than smear-positive TB patients. Lack of access to diagnose Pneumocystis jirovecii pneumonia might be a contributing reason. We therefore assessed the prevalence of P. jirovecii by PCR in oral wash specimens among TB patients and healthy individuals in an HIV......- and TB-endemic area of sub-Saharan Africa....

  11. Common mental disorders in TB/HIV co-infected patients in Ethiopia

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    Abebe Gemeda

    2010-07-01

    Full Text Available Abstract Background- The relationship between TB/HIV co-infection and common mental disorders (CMD has been scarcely investigated. In this study, we compared the occurrence of CMD in TB/HIV co-infected and non-co-infected HIV patients in Ethiopia. Methods- We conducted a cross sectional study in three hospitals in Ethiopia from February to April, 2009. The study population consisted of 155 TB/HIV co-infected and 465 non-co-infected HIV patients. CMD was assessed through face to face interviews by trained clinical nurses using the Kessler 10 scale. Several risk factors for CMD were assessed using a structured questionnaire. Results- TB/HIV co-infected patients had significantly (p = 0.001 greater risk of CMD (63.7% than the non-co-infected patients (46.7%. When adjusted for the effect of potential confounding variables, the odds of having CMD for TB/HIV co-infected individuals was 1.7 times the odds for non-co-infected patients [OR = 1.7, (95%CI: 1.0, 2.9]. Individuals who had no source of income [OR = 1.7, (95%CI: 1.1, 2.8], and day labourers [OR = 2.4, 95%CI: 1.2, 5.1] were more likely to have CMD as compared to individuals who had a source of income and government employees respectively. Patients who perceived stigma [OR = 2.2, 95%CI: 1.5, 3.2] and who rate their general health as "poor" [OR = 10.0, 95%CI: 2.8, 35.1] had significantly greater risk of CMD than individual who did not perceive stigma or who perceived their general health to be "good". Conclusion- TB/HIV control programs should develop guidelines to screen and treat CMD among TB/HIV co-infected patients. Screening programs should focus on individuals with no source of income, jobless people and day labourers.

  12. Equity and the Sun Quality Health Private Provider Social Franchise: comparative analysis of patient survey data and a nationally representative TB prevalence survey

    Science.gov (United States)

    2013-01-01

    Introduction Since 2004, the Sun Quality Health (SQH) franchise network has provided TB care in Myanmar through a network of established private medical clinics. This study compares the wealth distribution of the TB patients to non-TB patients to determine if TB is most common among the poor, and compares the wealth of all TB patients to SQH TB patients to assess whether the franchise achieves its goal of serving the poor. Methods The study uses data from two sources: 1) Myanmar’s first nationally representative TB prevalence study conducted in 2009, and 2) client exit interviews from TB patients from SQH clinics. In total, 1,114 TB-positive individuals were included in the study, including 739 from the national sample and 375 from the SQH sample. Results TB patients at SQH clinics were poorer than TB-positive individuals in the overall population, though not at a statistically significant level (p > 0.05). After stratification we found that in urban areas, TB patients at SQH clinics were more likely to be in the poorest quartile compared to general TB positive population (16.8% vs. 8.6%, respectively; p  0.05). Conclusion Franchised clinics in Myanmar are reaching poor populations of TB patients in urban areas; more efforts are needed in order to reach the most vulnerable in rural areas. PMID:23305063

  13. Equity and the Sun Quality Health Private Provider Social Franchise: comparative analysis of patient survey data and a nationally representative TB prevalence survey

    Directory of Open Access Journals (Sweden)

    Montagu Dominic

    2013-01-01

    Full Text Available Abstract Introduction Since 2004, the Sun Quality Health (SQH franchise network has provided TB care in Myanmar through a network of established private medical clinics. This study compares the wealth distribution of the TB patients to non-TB patients to determine if TB is most common among the poor, and compares the wealth of all TB patients to SQH TB patients to assess whether the franchise achieves its goal of serving the poor. Methods The study uses data from two sources: 1 Myanmar’s first nationally representative TB prevalence study conducted in 2009, and 2 client exit interviews from TB patients from SQH clinics. In total, 1,114 TB-positive individuals were included in the study, including 739 from the national sample and 375 from the SQH sample. Results TB patients at SQH clinics were poorer than TB-positive individuals in the overall population, though not at a statistically significant level (p > 0.05. After stratification we found that in urban areas, TB patients at SQH clinics were more likely to be in the poorest quartile compared to general TB positive population (16.8% vs. 8.6%, respectively; p  0.05. Conclusion Franchised clinics in Myanmar are reaching poor populations of TB patients in urban areas; more efforts are needed in order to reach the most vulnerable in rural areas.

  14. Equity and the Sun Quality Health Private Provider Social Franchise: comparative analysis of patient survey data and a nationally representative TB prevalence survey.

    Science.gov (United States)

    Montagu, Dominic; Sudhinaraset, May; Lwin, Thandar; Onozaki, Ikushi; Win, Zaw; Aung, Tin

    2013-01-10

    Since 2004, the Sun Quality Health (SQH) franchise network has provided TB care in Myanmar through a network of established private medical clinics. This study compares the wealth distribution of the TB patients to non-TB patients to determine if TB is most common among the poor, and compares the wealth of all TB patients to SQH TB patients to assess whether the franchise achieves its goal of serving the poor. The study uses data from two sources: 1) Myanmar's first nationally representative TB prevalence study conducted in 2009, and 2) client exit interviews from TB patients from SQH clinics. In total, 1,114 TB-positive individuals were included in the study, including 739 from the national sample and 375 from the SQH sample. TB patients at SQH clinics were poorer than TB-positive individuals in the overall population, though not at a statistically significant level (p > 0.05). After stratification we found that in urban areas, TB patients at SQH clinics were more likely to be in the poorest quartile compared to general TB positive population (16.8% vs. 8.6%, respectively; p  0.05). Franchised clinics in Myanmar are reaching poor populations of TB patients in urban areas; more efforts are needed in order to reach the most vulnerable in rural areas.

  15. Mycobacteria and TB

    National Research Council Canada - National Science Library

    Kaufmann, S. H. E. (Stephan H. E.); Hahn, Helmut

    2003-01-01

    .... Scientists investigating the epidemiology, immunology and molecular biology of TB or engaged in vaccine and drug development as well as physicians and social workers treating TB patients will benefit...

  16. Delayed Sputum Conversion in TB-HIV Co-Infected Patients with Low Isoniazid and Rifampicin Concentrations.

    Science.gov (United States)

    Sekaggya-Wiltshire, Christine; von Braun, Amrei; Lamorde, Mohammed; Ledergerber, Bruno; Buzibye, Allan; Henning, Lars; Musaazi, Joseph; Gutteck, Ursula; Denti, Paolo; de Kock, Miné; Jetter, Alexander; Byakika-Kibwika, Pauline; Eberhard, Nadia; Matovu, Joshua; Joloba, Moses; Muller, Daniel; Manabe, Yukari C; Kamya, Moses R; Corti, Natascia; Kambugu, Andrew; Castelnuovo, Barbara; Fehr, Jan S

    2018-03-03

    The relationship between concentrations of anti-tuberculosis (TB) drugs, sputum conversion and treatment outcome remains unclear. We sought to determine the association between anti-TB drug concentrations and sputum conversion among TB-HIV co-infected patients on first-line anti-TB drugs. We enrolled HIV-infected Ugandans with pulmonary TB. Estimation of first-line anti-TB drug concentrations was performed 1, 2, and 4 hours after drug intake at 2, 8, and 24 weeks of TB treatment. Serial sputum cultures were performed at each visit. Time-to-event analysis was used to determine factors associated with sputum culture conversion. We enrolled 268 HIV-infected patients. Patients with low isoniazid and rifampicin concentrations were less likely to have sputum culture conversion before the end of TB treatment or by the end of follow-up; Hazard ratio (HR) 0.54: 95% confidence interval (CI): 0.37-0.77, P=0.001 and HR: 0.61, 95% CI: 0.44-0.85, P=0.003, respectively. Patients in the highest AUC quartile for rifampicin and isoniazid were approximately two times more likely to experience sputum conversion. Rifampicin and isoniazid concentrations below the thresholds and being in a weight band TB treatment outcomes. Only 4.4% of the participants had treatment failure. Although low anti-TB drug concentrations did not translate to a high proportion of patients with treatment failure, the association between low concentrations of rifampicin and isoniazid and delayed culture conversion may have implications on TB transmission.

  17. Optimization of TB/HIV co-treatment in Ethiopian patients

    OpenAIRE

    Degu, Wondwossen Amogne

    2015-01-01

    Tuberculosis (TB) and HIV infection act with deadly synergy. HIV is the most important risk factor for latent TB reactivation and active TB progression following exposure or reinfection while TB accelerates HIV progression. TB is the most frequent cause of morbidity and mortality in HIV infection. Anti-TB therapy (ATT) must precede initiation of combination Antiretroviral Therapy (cART), TB being the most immediate threat. Undoubtedly cART benefits; however, important clinical ...

  18. Limitations of the QuantiFERON-TB Gold test in detecting Mycobacterium tuberculosis infection in immunocompromised patients

    DEFF Research Database (Denmark)

    Hornum, Mads; Mortensen, Klaus Leth; Kamper, Anne-Lise

    2008-01-01

    Four cases are presented, immunosuppressed by at least three different mechanisms: one HIV-positive patient with a CD4 count of 0.29 x 10(6)/ml, one malnourished patient, and two kidney-transplanted patients. All patients had a negative interferon (IFN)-gamma test for suspected tuberculosis (TB......), but a positive culture. We conclude that a negative IFN-gamma test does not exclude TB disease in immunosuppressed patients....

  19. resistant TB

    African Journals Online (AJOL)

    2014-01-24

    Jan 24, 2014 ... Background. Symptomatic symmetrical peripheral neuropathy (SSPN) is common in patients with HIV infection. It is also a common adverse event associated with both tuberculosis (TB) treatment and antiretroviral therapy (ART), particularly stavudine. While tenofovir is the one of recommended first-line ...

  20. Host markers in Quantiferon supernatants differentiate active TB from latent TB infection: preliminary report

    Directory of Open Access Journals (Sweden)

    Walzl Gerhard

    2009-05-01

    Full Text Available Abstract Background Interferon gamma release assays, including the QuantiFERON® TB Gold In Tube (QFT have been shown to be accurate in diagnosing Mycobacterium tuberculosis infection. These assays however, do not discriminate between latent TB infection (LTBI and active TB disease. Methods We recruited twenty-three pulmonary TB patients and 34 household contacts from Cape Town, South Africa and performed the QFT test. To investigate the ability of new host markers to differentiate between LTBI and active TB, levels of 29 biomarkers in QFT supernatants were evaluated using a Luminex multiplex cytokine assay. Results Eight out of 29 biomarkers distinguished active TB from LTBI in a pilot study. Baseline levels of epidermal growth factor (EGF soluble CD40 ligand (sCD40L, antigen stimulated levels of EGF, and the background corrected antigen stimulated levels of EGF and macrophage inflammatory protein (MIP-1β were the most informative single markers for differentiation between TB disease and LTBI, with AUCs of 0.88, 0.84, 0.87, 0.90 and 0.79 respectively. The combination of EGF and MIP-1β predicted 96% of active TB cases and 92% of LTBIs. Combinations between EGF, sCD40L, VEGF, TGF-α and IL-1α also showed potential to differentiate between TB infection states. EGF, VEGF, TGF-α and sCD40L levels were higher in TB patients. Conclusion These preliminary data suggest that active TB may be accurately differentiated from LTBI utilizing adaptations of the commercial QFT test that includes measurement of EGF, sCD40L, MIP-1β, VEGF, TGF-α or IL-1α in supernatants from QFT assays. This approach holds promise for development as a rapid diagnostic test for active TB.

  1. Factors associated with negative T-SPOT.TB results among smear-negative tuberculosis patients in China.

    Science.gov (United States)

    Kang, Wanli; Wu, Meiying; Yang, Kunyun; Ertai, A; Wu, Shucai; Geng, Shujun; Li, Zhihui; Li, Mingwu; Pang, Yu; Tang, Shenjie

    2018-03-09

    We compared the positive rates of T-SPOT.TB and bacterial culture in the smear-negative PTB, and analyzed the factors affecting the results of negative T-SPOT.TB and bacterial culture. Retrospective evaluation of data from smear-negative PTB patients who underwent T-SPOT.TB and bacterial culture were done. The agreement and concordance were analyzed between T-SPOT.TB and bacterial culture. Multivariable logistic regression analysis was used to explore the factors associated with positive results of T-SPOT.TB and bacterial culture in smear-negative PTB. 858 eligible smear-negative PTB patients were included in the study. The agreement rate was 25.6% (22.7~28.5%) between T-SPOT.TB and bacterial culture in smear- negative PTB patients. The positive rate of T-SPOT.TB was higher than that of bacterial culture in smear-negative PTB patients (p TB and bacterial culture (p > 0.05). Using multivariable logistic regression analysis we found that older age ≥ 60 years (OR = 0.469, 95% CI: 0.287-0.768) and decreased albumin (OR = 0.614, 95% CI: 0.380-0.992) were associated with negative diagnostic results of T-SPOT.TB in smear-negative PTB patients. Female (OR = 0.654, 95% CI: 0.431-0.992) were associated with negative diagnostic results of bacteria culture in smear-negative PTB patients. Our results indicated that the older age and decreased albumin were independently associated with negative T-SPOT.TB responses.

  2. Patient satisfaction with TB care clinical consultations in Kampala: a ...

    African Journals Online (AJOL)

    the personal manner (courtesy, respect, sensitivity, friend- liness) of the person he/she saw and the overall satisfac- tion with the consultation visit. Patients were told to rate each variable as good, fair, or poor. Data analysis: Raw data was reviewed by the quality as- surance officer of the study and all inconsistencies were.

  3. Analysis of Serum Metabolic Profile by Ultra-performance Liquid Chromatography-mass Spectrometry for Biomarkers Discovery: Application in a Pilot Study to Discriminate Patients with Tuberculosis

    Directory of Open Access Journals (Sweden)

    Shuang Feng

    2015-01-01

    Full Text Available Background: Tuberculosis (TB is a chronic wasting inflammatory disease characterized by multisystem involvement, which can cause metabolic derangements in afflicted patients. Metabolic signatures have been exploited in the study of several diseases. However, the serum that is successfully used in TB diagnosis on the basis of metabolic profiling is not by much. Methods: Orthogonal partial least-squares discriminant analysis was capable of distinguishing TB patients from both healthy subjects and patients with conditions other than TB. Therefore, TB-specific metabolic profiling was established. Clusters of potential biomarkers for differentiating TB active from non-TB diseases were identified using Mann-Whitney U-test. Multiple logistic regression analysis of metabolites was calculated to determine the suitable biomarker group that allows the efficient differentiation of patients with TB active from the control subjects. Results: From among 271 participants, 12 metabolites were found to contribute to the distinction between the TB active group and the control groups. These metabolites were mainly involved in the metabolic pathways of the following three biomolecules: Fatty acids, amino acids, and lipids. The receiver operating characteristic curves of 3D, 7D, and 11D-phytanic acid, behenic acid, and threoninyl-γ-glutamate exhibited excellent efficiency with area under the curve (AUC values of 0.904 (95% confidence interval [CI]: 0863-0.944, 0.93 (95% CI: 0.893-0.966, and 0.964 (95% CI: 00.941-0.988, respectively. The largest and smallest resulting AUCs were 0.964 and 0.720, indicating that these biomarkers may be involved in the disease mechanisms. The combination of lysophosphatidylcholine (18:0, behenic acid, threoninyl-γ-glutamate, and presqualene diphosphate was used to represent the most suitable biomarker group for the differentiation of patients with TB active from the control subjects, with an AUC value of 0.991. Conclusion: The

  4. Major challenges in clinical management of TB/HIV co-infected patients in Eastern Europe compared with Western Europe and Latin America

    DEFF Research Database (Denmark)

    Efsen, Anne Marie; Schultze, Anna; Post, Frank

    2014-01-01

    INTRODUCTION: Rates of both TB/HIV co-infection and multi-drug-resistant (MDR) TB are increasing in Eastern Europe (EE). Data on the clinical management of TB/HIV co-infected patients are scarce. Our aim was to study the clinical characteristics of TB/HIV patients in Europe and Latin America (LA......) and LA from January 2011 to December 2013. Among patients who completed DST within the first month of TB therapy, we linked initial TB treatment regimens to the DST results and calculated the distribution of patients receiving 0, 1, 2, 3 and ≥4 active drugs in each region. Risk factors for MDR-TB were...... identified in logistic regression models. RESULTS: Significant differences were observed between EE (n=844), WE (n=152), SE (n=164) and LA (n=253) for use of combination antiretroviral therapy (cART) at TB diagnosis (17%, 40%, 44% and 35%, p

  5. Profile and response to anti-tuberculosis treatment among elderly tuberculosis patients treated under the TB Control programme in South India.

    Science.gov (United States)

    Velayutham, Banu Rekha Vaithilingam; Nair, Dina; Chandrasekaran, Vedachalam; Raman, Balambal; Sekar, Gomathy; Watson, Basilea; Charles, Niruparani; Malaisamy, Muniyandi; Thomas, Aleyamma; Swaminathan, Soumya

    2014-01-01

    The demographic transition in India has resulted in an increase in the elderly population. There is limited data on the profile of elderly tuberculosis (TB) patients and their treatment outcomes in India. To compare the clinical profile, presentation and response to anti-TB treatment among elderly (≥ 60 yrs) and younger (15-59 yrs) TB patients treated under the Revised National TB Control programme. Retrospective cohort analysis of TB patients treated from May 1999 to December 2004 in one Tuberculosis Unit of Tiruvallur district, South India. Records of 865 elderly and 4343 younger TB patients were examined: elderly were more likely to be male (84% vs. 71%), smokers (46% vs.37%), illiterate (63% vs. 45%), identified by active case finding through survey (19% vs. 11%), have pulmonary TB (96% vs. 91%) and initial smear negative disease (46% vs. 36%) compared to younger (for all ptuberculosis susceptibility to first line anti-TB drugs did not differ (elderly 87% vs. younger 84%) (p = 0.20). Side effects related to anti-TB drugs were reported by a higher proportion of elderly patients (63% vs. 54%) (p = 0.005). Previously treated patients had similar treatment outcomes in both the groups. Elderly TB patients are less likely to have smear positive disease. Newly diagnosed elderly TB patients are more likely to be lost to follow-up or die and report drug side effects. Suitable interventions need to be developed for effective management and better treatment outcomes of TB in the elderly.

  6. Major Challenges in Clinical Management of TB/HIV Coinfected Patients in Eastern Europe Compared with Western Europe and Latin America

    DEFF Research Database (Denmark)

    Efsen, Anne Marie W; Schultze, Anna; Post, Frank A

    2015-01-01

    OBJECTIVES: Rates of TB/HIV coinfection and multi-drug resistant (MDR)-TB are increasing in Eastern Europe (EE). We aimed to study clinical characteristics, factors associated with MDR-TB and predicted activity of empiric anti-TB treatment at time of TB diagnosis among TB/HIV coinfected patients...... in EE, Western Europe (WE) and Latin America (LA). DESIGN AND METHODS: Between January 1, 2011, and December 31, 2013, 1413 TB/HIV patients (62 clinics in 19 countries in EE, WE, Southern Europe (SE), and LA) were enrolled. RESULTS: Significant differences were observed between EE (N = 844), WE (N = 152......% of participants in EE compared with 90-96% in other regions (pmanagement of TB/HIV patients in EE requires...

  7. TB Terms

    Science.gov (United States)

    ... Studies Consortium Research Projects Publications TB Trials Consortium Study Descriptions Background Behavioral & Social Science Research Infection Control TB in Specific Populations African-American Community Stop TB in the African-American ...

  8. Use of anti-retroviral therapy in tuberculosis patients on second-line anti-TB regimens: a systematic review.

    Directory of Open Access Journals (Sweden)

    Matthew Arentz

    Full Text Available Use of antiretroviral therapy (ART during treatment of drug susceptible tuberculosis (TB improves survival. However, data from HIV infected individuals with drug resistant TB are lacking. Second line TB drugs when combined with ART may increase drug interactions and lead to higher rates of toxicity and greater noncompliance. This systematic review sought to determine the benefit of ART in the setting of second line drug therapy for drug resistant TB.We included individual patient data from studies that evaluated treatment of drug-resistant tuberculosis in HIV-1 infected individuals published between January 1980 and December of 2009. We evaluated the effect of ART on treatment outcomes, time to smear and culture conversion, and adverse events.Ten observational studies, including data from 217 subjects, were analyzed. Patients using ART during TB treatment had increased likelihood of cure (hazard ratio (HR 3.4, 95% CI 1.6-7.4 and decreased likelihood of death (HR 0.4, 95% CI 0.3-0.6 during treatment for drug resistant TB. These associations remained significant in patients with a CD4 less than 200 cells/mm(3 and less than 50 cells/mm(3, and when correcting for drug resistance pattern.We identified only observational studies from which individual patient data could be drawn. Limitations in study design, and heterogeneity in a number of the outcomes of interest had the potential to introduce bias.While there are insufficient data to determine if ART use increases adverse drug interactions when used with second line TB drugs, ART use during treatment of drug resistant TB appears to improve cure rates and decrease risk of death. All individuals with HIV appear to benefit from ART use during treatment for TB.

  9. Outcomes of TB/HIV co-infected patients presenting with ...

    African Journals Online (AJOL)

    induced liver injury. ... South Africa has a significant burden of tuberculosis (TB). Anti-TB drug-induced liver injury (TB DILI) is one of the ... The rate of death/loss to follow-up was higher in the ART/TB DILI group (18.9% v. 14.5%). Conclusion.

  10. Vitamin D deficiency in medical patients at a central hospital in Malawi: a comparison with TB patients from a previous study.

    Directory of Open Access Journals (Sweden)

    Yamikani Mastala

    Full Text Available OBJECTIVES: To determine the prevalence of vitamin D deficiency (VDD in adult medical, non-tuberculous (non-TB patients. To investigate associations with VDD. To compare the results with a similar study in TB patients at the same hospital. DESIGN: Cross-sectional sample. SETTING: Central hospital in Malawi. PARTICIPANTS: Adult non-TB patients (n = 157, inpatients and outpatients. OUTCOME MEASURES: The primary outcome was the prevalence of VDD. Potentially causal associations sought included nutritional status, in/outpatient status, HIV status, anti-retroviral therapy (ART and, by comparison with a previous study, a diagnosis of tuberculosis (TB. RESULTS: Hypovitaminosis D (≤75 nmol/L occurred in 47.8% (75/157 of patients, 16.6% (26/157 of whom had VDD (≤50 nmol/L. None had severe VDD (≤25 nmol/L. VDD was found in 22.8% (23/101 of in-patients and 5.4% (3/56 of out-patients. In univariable analysis in-patient status, ART use and low dietary vitamin D were significant predictors of VDD. VDD was less prevalent than in previously studied TB patients in the same hospital (68/161 = 42%. In multivariate analysis of the combined data set from both studies, having TB (OR 3.61, 95%CI 2.02-6.43 and being an in-patient (OR 2.70, 95%CI 1.46-5.01 were significant independent predictors of VDD. CONCLUSIONS: About half of adult medical patients without TB have suboptimal vitamin D status, which is more common in in-patients. VDD is much more common in TB patients than non-TB patients, even when other variables are controlled for, suggesting that vitamin D deficiency is associated with TB.

  11. Training social workers to enhance patient-centered care for drug-resistant TB-HIV in South Africa.

    Science.gov (United States)

    Zelnick, J R; Seepamore, B; Daftary, A; Amico, K R; Bhengu, X; Friedland, G; Padayatchi, N; Naidoo, K; O'Donnell, M R

    2018-03-21

    KwaZulu-Natal, South Africa, is the epicenter of an epidemic of drug-resistant tuberculosis (DR-TB) and human immunodeficiency virus (HIV) co-infection, characterized by low rates of medication adherence and retention in care. Social workers may have a unique role to play in improving DR-TB-HIV outcomes. We designed, implemented and evaluated a model-based pilot training course on patient-centered care, treatment literacy in DR-TB and HIV coinfection, patient support group facilitation, and self-care. Ten social workers participated in a 1-day training course. Post-training questionnaire scores showed significant overall gains ( P = 0.003). A brief training intervention may be a useful and feasible way to engage social workers in patient-centered care for DR-TB and HIV coinfection.

  12. MDR-TB Outbreak among HIV-Negative Tunisian Patients followed during 11 Years.

    Directory of Open Access Journals (Sweden)

    Naira Dekhil

    Full Text Available Multidrug-resistant tuberculosis (MDR-TB outbreaks that evolve, from the outset, in a context strictly negative for HIV infection deserve special consideration since they reflect the true intrinsic epidemic potential of the causative strain. To our knowledge, the long-term evolution of such exceptional outbreaks and the treatment outcomes for the involved patients has never been reported hitherto. Here we provide a thorough description, over an 11-year period, of an MDR-TB outbreak that emerged and expanded in an HIV-negative context, Northern Tunisia.From October 2001 to June 2011, the MDR-TB outbreak involved 48 HIV-negative individuals that are mainly young (mean age 31.09 yrs; 89.6% male and noninstitutionalized. Drug susceptibility testing coupled to mutational analysis revealed that initial transmission involved an isolate that was simultaneously resistant to isoniazid, rifampicin, ethambutol, and streptomycin. The causative Haarlem3-ST50 outbreak strain expanded mainly as an 11-banded IS6110 RFLP profile (77.1%, from which a 12-banded subclone evolved. After undergoing a 2-year treatment with second-line drugs, 22 (45.8% patients were cured and 3 (6.2% completed treatment, thus yielding an overall treatment success rate of 52.1%. Among the patients that experienced unfavorable treatment outcomes, 10 (20.8% failed treatment, 3 (6.2% were lost to follow-up, 5 (10.4% died, and 5 (10.4% could not be evaluated. Poor adherence to treatment was found to be the main independent predictor of unfavorable outcomes (HR: 9.15; 95% CI 1.72-48.73; P = 0.014. Intriguingly, the evolved 12-banded subclone proved significantly associated with unfavorable outcomes (HR: 4.90; 95% CI 1.04-23.04, P = 0.044. High rate of fatality and relapse was further demonstrated at the long-term, since 70% of those whose treatment failed have died, and 24% among those deemed successfully treated have relapsed.Taken together, the data obtained in this study indicate that MDR-TB

  13. Profile of tuberculosis and its response to anti-TB drugs among tuberculosis patients treated under the TB control programme at Felege-Hiwot Referral Hospital, Ethiopia

    Directory of Open Access Journals (Sweden)

    Yohannes Zenebe

    2016-08-01

    Full Text Available Abstract Background Tuberculosis (TB is a global concern for both developing and developed countries. Currently it becomes more complex due to increasing levels of drug resistance and HIV co-infection. Delayed diagnosis and high case load are major factors contributing to continued transmission and failure to the treatment outcome. The study was conducted to determine the profile and treatment outcomes of TB patients at Felege-Hiwot Referral Hospital. Methods We analyzed the records of 1761 TB patients registered for treatment in Felege Hiwot Referral Hospital from July 2010 to June 2015. Data on patients’ socio-demographic characteristics, type of TB, HIV status and treatment outcome were analysed. Descriptive statistics and binary logistic regression models were used to present data. The odds ratio and the 95 % confidence intervals were calculated. A p-value of < 0.05 was considered statistical significant. Results The proportion of smear positive, smear-negative and extra-pulmonary TB were 205 (11.6 %, 548 (31.1 % and 1008 (57.2 %, respectively. The overall treatment success rate accounts 542(80.8 % with unsuccessful treatment of 129(19.2 %. The treatment outcome varied by the years from 68.9 to 97.4 %. Among tuberculosis patients, 459(26.1 % of them were HIV positive. Being HIV positive (AOR = 4.29, 95 % CI, 2.20–8.37 P = 0.001, retreatment (AOR = 5.32, 95 % CI, 1.92–14.3, P = 0.001, rural residency (AOR = 18.0, 95 % CI, 9.06–37.82, P = 0.001 and the age group of 15–24 years (AOR = 2.91, 95%CI, 1.00–8.45, P = 0.04 showed statistical significant association for poor treatment outcome. Conclusions In the studied region, the overall treatment success rate was still below the WHO target of success rate, 85 %. However, the trend of treatment success rate showed a promising increment. Patients at high risk of unsuccessful treatment outcome should be identified early and given additional

  14. Discriminating active from latent tuberculosis in patients presenting to community clinics.

    Directory of Open Access Journals (Sweden)

    Gurjinder Sandhu

    Full Text Available Because of the high global prevalence of latent TB infection (LTBI, a key challenge in endemic settings is distinguishing patients with active TB from patients with overlapping clinical symptoms without active TB but with co-existing LTBI. Current methods are insufficiently accurate. Plasma proteomic fingerprinting can resolve this difficulty by providing a molecular snapshot defining disease state that can be used to develop point-of-care diagnostics.Plasma and clinical data were obtained prospectively from patients attending community TB clinics in Peru and from household contacts. Plasma was subjected to high-throughput proteomic profiling by mass spectrometry. Statistical pattern recognition methods were used to define mass spectral patterns that distinguished patients with active TB from symptomatic controls with or without LTBI.156 patients with active TB and 110 symptomatic controls (patients with respiratory symptoms without active TB were investigated. Active TB patients were distinguishable from undifferentiated symptomatic controls with accuracy of 87% (sensitivity 84%, specificity 90%, from symptomatic controls with LTBI (accuracy of 87%, sensitivity 89%, specificity 82% and from symptomatic controls without LTBI (accuracy 90%, sensitivity 90%, specificity 92%.We show that active TB can be distinguished accurately from LTBI in symptomatic clinic attenders using a plasma proteomic fingerprint. Translation of biomarkers derived from this study into a robust and affordable point-of-care format will have significant implications for recognition and control of active TB in high prevalence settings.

  15. Predictors and Timing of ATT Initiation among HIV-TB Patients at ART Centers of Karnataka, India: Two Year Follow-Up.

    Directory of Open Access Journals (Sweden)

    Suresh Shastri

    Full Text Available In India, TB and HIV co-infection remains as a serious public health problem. From 2006 onwards, the intensified TB-HIV collaborative activities are being jointly implemented by National AIDS Control Programme (NACP and Revised National TB Control programme (RNTCP at high HIV burden states.To determine (a the predictors of outcome among a cohort of HIV-TB co-infected patients after two years after initiation of ART treatment. (b prognostic significance of time difference between the initiation of ATT and ART in HIV-TB co-infected patients.Patients registered at sixteen ART centres in Karnataka, from October through December 2009 formed the study cohort and were followed till December 2011.A total of 604 HIV-TB patients were registered. Follow-up (a at the end of one year had shown 63.6% (377patients with unfavorable TB treatment outcomes (b at the end of second year, 55.6% (336patients were alive on ART treatment. The variables male, smear negative TB, CD4 count less than 50cells per cumm and unfavorable TB outcome were significantly associated with unfavorable ART treatment outcome.The programmes need to review the existing strategies and strengthen HIV-TB collaborative activities for timely treatment initiation with intensive monitoring of HIV-TB patients on treatment.

  16. Consensus statement: Management of drug-induced liver injury in HIV-positive patients treated for TB

    Directory of Open Access Journals (Sweden)

    E Jong

    2013-09-01

    Full Text Available Drug-induced liver injury (DILI in HIV/tuberculosis (TB co-infected patients is a common problem in the South African setting, and re-introduction of anti-TB drugs can be challenging for the healthcare worker. Although international guidelines on the re-introduction of TB treatment are available, the definition of DILI is not uniform, management of antiretroviral therapy (ART in HIV co-infection is not mentioned, and the guidance on management is not uniform and lacks a practical approach. In this consensus statement, we summarise important aspects of DILI and provide practical guidance for healthcare workers for different patient groups and healthcare settings on the re-introduction of anti-TB drugs and ART in HIV/TB co-infected individuals presenting with DILI.

  17. Impact of socio-psychological factors on treatment adherence of TB patients in Russia.

    Science.gov (United States)

    Jakubowiak, W M; Bogorodskaya, E M; Borisov, S E; Danilova, I D; Lomakina, O B; Kourbatova, E V

    2008-09-01

    The aim of this study was to assess the impact of social and psychological factors on treatment adherence of patients with tuberculosis (TB). To this end a cross-sectional questionnaire-based study was conducted among TB patients in four Russian regions (Orel, Vladimir, Belgorod oblasts, and Republic of Mari-El) from 01/04/2004 to 31/03/2005. A total of 87 non-adherent and 1302 adherent patients were interviewed. Compared to adherents, non-adherents were significantly more likely to be male, unemployed, have a technical college education, have a history of imprisonment, have a negative emotional status, consider themselves "not sick", not know the treatment period, have negative feelings and distrust for medical staff, not believe they will fully recover, and not want to continue treatment. Patients at highest risk for non-adherence should be identified at the start of treatment, and offered the services of a psychologist. A case management and patient-centered approach should be applied.

  18. Patient satisfaction with TB care clinical consultations in Kampala: a cross sectional study.

    Science.gov (United States)

    Ssengooba, Willy; Kirenga, Bruce; Muwonge, Catherine; Kyaligonza, Steven; Kasozi, Samuel; Mugabe, Frank; Boeree, Martin; Joloba, Moses; Okwera, Alphonse

    2016-12-01

    Patient satisfaction towards care during encounter with clinicians is key for better treatment outcomes. We assessed patient satisfaction with TB clinical care consultations in Kampala, Uganda. This was a facility-based cross sectional study done between September 2012 and February 2013 using qualitative method of data collection. Participants consecutively completed a pre-tested structured satisfaction questionnaire. A criteria of the rating as good; >75% was considered acceptable, (50-75%) as more effort is needed and patient satisfaction, were: time spent with clinician (85.4%), explanation of what was done (87.6%), technical skills (91.6%), personal manner of the clinician seen (91.6%). Factors for low satisfaction were; waiting time before getting an appointment (61.8%), convenience of location of consultation office (53.4%), getting through to the office by phone (21.3%) and length of time waiting at the office (61.2%). Tuberculosis patients in Kampala are satisfied with TB clinical care consultations. Addressing factors with low patient satisfaction may significantly impact on treatment outcome.

  19. Combination of Cytokine Responses Indicative of Latent TB and Active TB in Malawian Adults

    Science.gov (United States)

    Hur, Yun-Gyoung; Gorak-Stolinska, Patricia; Ben-Smith, Anne; Lalor, Maeve K.; Chaguluka, Steven; Dacombe, Russell; Doherty, T. Mark; Ottenhoff, Tom H.; Dockrell, Hazel M.; Crampin, Amelia C.

    2013-01-01

    Background An IFN-γ response to M. tuberculosis-specific antigens is an effective biomarker for M. tuberculosis infection but it cannot discriminate between latent TB infection and active TB disease. Combining a number of cytokine/chemokine responses to M. tuberculosis antigens may enable differentiation of latent TB from active disease. Methods Asymptomatic recently-exposed individuals (spouses of TB patients) were recruited and tuberculin skin tested, bled and followed-up for two years. Culture supernatants, from a six-day culture of diluted whole blood samples stimulated with M. tuberculosis-derived PPD or ESAT-6, were measured for IFN-γ, IL-10, IL-13, IL-17, TNF-α and CXCL10 using cytokine ELISAs. In addition, 15 patients with sputum smear-positive pulmonary TB were recruited and tested. Results Spouses with positive IFN-γ responses to M. tuberculosis ESAT-6 (>62.5 pg/mL) and TB patients showed high production of IL-17, CXCL10 and TNF-α. Higher production of IL-10 and IL-17 in response to ESAT-6 was observed in the spouses compared with TB patients while the ratios of IFN-γ/IL-10 and IFN-γ/IL-17 in response to M. tuberculosis-derived PPD were significantly higher in TB patients compared with the spouses. Tuberculin skin test results did not correlate with cytokine responses. Conclusions CXCL10 and TNF-α may be used as adjunct markers alongside an IFN-γ release assay to diagnose M. tuberculosis infection, and IL-17 and IL-10 production may differentiate individuals with LTBI from active TB. PMID:24260295

  20. Combination of cytokine responses indicative of latent TB and active TB in Malawian adults.

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    Yun-Gyoung Hur

    Full Text Available An IFN-γ response to M. tuberculosis-specific antigens is an effective biomarker for M. tuberculosis infection but it cannot discriminate between latent TB infection and active TB disease. Combining a number of cytokine/chemokine responses to M. tuberculosis antigens may enable differentiation of latent TB from active disease.Asymptomatic recently-exposed individuals (spouses of TB patients were recruited and tuberculin skin tested, bled and followed-up for two years. Culture supernatants, from a six-day culture of diluted whole blood samples stimulated with M. tuberculosis-derived PPD or ESAT-6, were measured for IFN-γ, IL-10, IL-13, IL-17, TNF-α and CXCL10 using cytokine ELISAs. In addition, 15 patients with sputum smear-positive pulmonary TB were recruited and tested.Spouses with positive IFN-γ responses to M. tuberculosis ESAT-6 (>62.5 pg/mL and TB patients showed high production of IL-17, CXCL10 and TNF-α. Higher production of IL-10 and IL-17 in response to ESAT-6 was observed in the spouses compared with TB patients while the ratios of IFN-γ/IL-10 and IFN-γ/IL-17 in response to M. tuberculosis-derived PPD were significantly higher in TB patients compared with the spouses. Tuberculin skin test results did not correlate with cytokine responses.CXCL10 and TNF-α may be used as adjunct markers alongside an IFN-γ release assay to diagnose M. tuberculosis infection, and IL-17 and IL-10 production may differentiate individuals with LTBI from active TB.

  1. Limitations of the QuantiFERON-TB Gold test in detecting Mycobacterium tuberculosis infection in immunocompromised patients

    DEFF Research Database (Denmark)

    Hornum, M.; Mortensen, K.L.; Kamper, Anne-Lise

    2008-01-01

    Four cases are presented, immunosuppressed by at least three different mechanisms: one HIV-positive patient with a CD4 count of 0.29 x 10(6)/ml, one malnourished patient, and two kidney-transplanted patients. All patients had a negative interferon (IFN)-gamma test for suspected tuberculosis (TB),...

  2. TB Meningitis in HIV-Positive Patients in Europe and Argentina: Clinical Outcome and Factors Associated with Mortality

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    Anne Marie W. Efsen

    2013-01-01

    Full Text Available Objectives. The study aimed at describing characteristics and outcome of tuberculous meningitis (TBM in HIV-positive patients and comparing these parameters with those of extrapulmonary TB (TBEP and pulmonary TB (TBP. Methods. Kaplan-Meier estimation and Poisson regression models were used to assess the mortality following TB diagnosis and to evaluate potential prognostic factors for the 3 groups of TB patients separately. Results. A total of 100 patients with TBM, 601 with TBEP, and 371 TBP were included. Patients with TBM had lower CD4 cell counts and only 17.0% received antiretroviral therapy (ART at TB diagnosis. The cumulative probability of death at 12 months following TB was 51.2% for TBM (95% CI 41.4–61.6%, 12.3% for TBP (8.9–15.7%, and 19.4% for TBEP (16.1–22.6 (P<0.0001; log-rank test. For TBM, factors associated with a poorer prognosis were not being on ART (adjusted incidence rate ratio (aIRR 4.00 (1.72–9.09, a prior AIDS diagnosis (aIRR=4.82 (2.61–8.92, and receiving care in Eastern Europe (aIRR=5.41 (2.58–11.34. Conclusions. TBM among HIV-positive patients was associated with a high mortality rate, especially for patients from Eastern Europe and patients with advanced HIV-infection, which urgently calls for public health interventions to improve both TB and HIV aspects of patient management.

  3. Pharmacogenetic & pharmacokinetic biomarker for efavirenz based ARV and rifampicin based anti-TB drug induced liver injury in TB-HIV infected patients.

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    Getnet Yimer

    Full Text Available BACKGROUND: Implication of pharmacogenetic variations and efavirenz pharmacokinetics in concomitant efavirenz based antiviral therapy and anti-tubercular drug induced liver injury (DILI has not been yet studied. We performed a prospective case-control association study to identify the incidence, pharmacogenetic, pharmacokinetic and biochemical predictors for anti-tubercular and antiretroviral drugs induced liver injury (DILI in HIV and tuberculosis (TB co-infected patients. METHODS AND FINDINGS: Newly diagnosed treatment naïve TB-HIV co-infected patients (n = 353 were enrolled to receive efavirenz based ART and rifampicin based anti-TB therapy, and assessed clinically and biochemically for DILI up to 56 weeks. Quantification of plasma efavirenz and 8-hydroxyefaviernz levels and genotyping for NAT2, CYP2B6, CYP3A5, ABCB1, UGT2B7 and SLCO1B1 genes were done. The incidence of DILI and identification of predictors was evaluated using survival analysis and the Cox Proportional Hazards Model. The incidence of DILI was 30.0%, or 14.5 per 1000 person-week, and that of severe was 18.4%, or 7.49 per 1000 person-week. A statistically significant association of DILI with being of the female sex (p = 0.001, higher plasma efavirenz level (p = 0.009, efavirenz/8-hydroxyefavirenz ratio (p = 0.036, baseline AST (p = 0.022, ALT (p = 0.014, lower hemoglobin (p = 0.008, and serum albumin (p = 0.007, NAT2 slow-acetylator genotype (p = 0.039 and ABCB1 3435TT genotype (p = 0.001. CONCLUSION: We report high incidence of anti-tubercular and antiretroviral DILI in Ethiopian patients. Between patient variability in systemic efavirenz exposure and pharmacogenetic variations in NAT2, CYP2B6 and ABCB1 genes determines susceptibility to DILI in TB-HIV co-infected patients. Close monitoring of plasma efavirenz level and liver enzymes during early therapy and/or genotyping practice in HIV clinics is recommended for early identification

  4. High pre-diagnosis attrition among patients with presumptive MDR-TB: an operational research from Bhopal district, India.

    Science.gov (United States)

    Shewade, Hemant Deepak; Kokane, Arun M; Singh, Akash Ranjan; Verma, Manoj; Parmar, Malik; Chauhan, Ashish; Chahar, Sanjay Singh; Tiwari, Manoj; Khan, Sheeba Naz; Gupta, Vivek; Tripathy, Jaya Prasad; Nagar, Mukesh; Singh, Sanjai Kumar; Mehra, Pradeep Kumar; Kumar, Ajay Mv

    2017-04-04

    Pre-diagnosis attrition needs to be addressed urgently if we are to make progress in improving MDR-TB case detection and achieve universal access to MDR-TB care. We report the pre-diagnosis attrition, along with factors associated, and turnaround times related to the diagnostic pathway among patient with presumptive MDR-TB in Bhopal district, central India (2014). Study was conducted under the Revised National Tuberculosis Control Programme setting. It was a retrospective cohort study involving record review of all registered TB cases in Bhopal district that met the presumptive MDR-TB criteria (eligible for DST) in 2014. In quarter 1, Line Probe Assay (LPA) was used if sample was smear/culture positive. Quarter 2 onwards, LPA and Cartridge-based Nucleic Acid Amplification Test (CbNAAT) was used for smear positive and smear negative samples respectively. Pre-diagnosis attrition was defined as failure to undergo DST among patients with presumptive MDR-TB (as defined by the programme). Of 770 patients eligible for DST, 311 underwent DST and 20 patients were diagnosed as having MDR-TB. Pre-diagnosis attrition was 60% (459/770). Among those with pre-diagnosis attrition, 91% (417/459) were not identified as 'presumptive MDR-TB' by the programme. TAT [median (IQR)] to undergo DST after eligibility was 4 (0, 10) days. Attrition was more than 40% across all subgroups. Age more than 64 years; those from a medical college; those eligible in quarter 1; patients with presumptive criteria 'previously treated - recurrent TB', 'treatment after loss-to-follow-up' and 'previously treated-others'; and patients with extra-pulmonary TB were independent risk factors for not undergoing DST. High pre-diagnosis attrition was contributed by failure to identify and refer patients. Attrition reduced modestly with time and one factor that might have contributed to this was introduction of CbNAAT in quarter 2 of 2014. General health system strengthening which includes improvement in

  5. Hypovitaminosis D increases TB co-infection risk on HIV patients

    Science.gov (United States)

    Gayatri, Y. A. A. A.; Sukmawati, D. D.; Utama, S. M.; Somia, I. K. A.; Merati, T. P.

    2018-03-01

    Tuberculosis is causes of mortality and morbidity in patients with HIV. Hypovitaminosis D, a defective cell-mediated immune response to Mycobacterium tuberculosis infection has been extensively described in HIV patients, but studies assessing the role of vitamin D in TB-HIV co-infection are lacking. We, therefore, conducted a 1:1 pair- matched case-control study to verify hypovitaminosis D possible risk factor of TB- HIV co- infection. Consecutive HIV patients starting ARV and sex, age and CD4 cell count matched were by recruiting. Tuberculosis has confirmed by thepresence of acid-fast bacilli in sputum or mycobacterium detected in specimens culture/Gene Xpert/PCR. Vitamin D levels were by measuring direct chemiluminescent immunoassay on a LIAISON®25OH analyzer. The study comprised 25 cases and 25 controls, median (interquartile range) 25(OH)D3 serum concentration were 19.80 (12.15-27.45) ng/mL in cases and 33.30 (27.2-39.4) ng/mL in controls (PHIV patients.(OR 26.154 (90% CI: 4.371-156.541); p HIV co-infection.

  6. Risk factors associated with default among new smear positive TB patients treated under DOTS in India.

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    Sophia Vijay

    2010-04-01

    Full Text Available Poor treatment adherence leading to risk of drug resistance, treatment failure, relapse, death and persistent infectiousness remains an impediment to the tuberculosis control programmes. The objective of the study was to identify predictors of default among new smear positive TB patients registered for treatment to suggest possible interventions to set right the problems to sustain and enhance the programme performance.Twenty districts selected from six states were assigned to six strata formed, considering the geographic, socio-cultural and demographic setup of the area. New smear positive patients registered for treatment in two consecutive quarters during III quarter 2004 to III quarter 2005 formed the retrospective study cohort. Case control analysis was done including defaulted patients as "cases" and equal number of age and sex matched patients completing treatment as "controls". The presence and degree of association between default and determinant factors was computed through univariate and multivariate logistic regression analysis. Data collection was through patient interviews using pre-tested semi structured questionnaire and review of treatment related records. Information on a wide range of socio demographic and patient related factors was obtained. Among the 687 defaulted and equal numbers of patients in completed group, 389 and 540 patients respectively were satisfactorily interviewed. In the logistic regression analysis, factors independently associated with default were alcoholism [AOR-1.72 (1.23-2.44], illiteracy [AOR-1.40 (1.03-1.92], having other commitments during treatment [AOR-3.22 (1.1-9.09], inadequate knowledge of TB [AOR-1.88(1.35-2.63], poor patient provider interaction [AOR-1.72(1.23-2.44], lack of support from health staff [AOR-1.93(1.41-2.64], having instances of missed doses [AOR-2.56(1.82-3.57], side effects to anti TB drugs [AOR-2.55 (1.87-3.47] and dissatisfaction with services provided [AOR-1.73 (1

  7. Patient satisfaction with HIV and TB treatment in a public programme in rural KwaZulu-Natal: evidence from patient-exit interviews

    Science.gov (United States)

    2014-01-01

    Background Patient satisfaction is a determinant of treatment uptake, adherence and retention, and an important health systems outcome. Queues, health worker-patient contact time, staff attitudes, and facility cleanliness may affect patient satisfaction. We quantified dimensions of patient satisfaction among HIV and TB patients in a rural sub-district of KwaZulu-Natal, South Africa, and identified underlying satisfaction factors that explained the data. Methods We conducted patient-exit interviews with 300 HIV and 300 TB patients who were randomly selected using a two-stage cluster random sampling approach with primary sampling units (primary healthcare clinics) selected with probability-proportional-to-size sampling. We performed factor analysis to investigate underlying patient satisfaction factors. We compared the satisfaction with HIV and TB services and examined the relationships between patient satisfaction and patients’ socio-demographic characteristics in multivariable regression. Results Almost all patients (95% HIV, 97% TB) reported to be globally satisfied with the healthcare services received on the day of the interview. However, patient satisfaction with specific concrete aspects of the health services was substantially lower: 52% of HIV and 40% of TB patients agreed that some staff did not treat patients with sufficient respect (p = 0.02 for difference between the two patient groups); 65% of HIV and 40% of TB patients agreed that health worker queues were too long (p patient satisfaction variables could be reduced to a few underlying factors that align broadly with concepts previously identified in the literature as affecting access to healthcare. Increases in health systems resources for HIV and TB, but also improvements in facility maintenance, staff attitudes and communication, are likely to substantially improve HIV and TB patients’ satisfaction with the care they receive in public-sector treatment programmes in rural communities in South

  8. Profile of HIV-1 RNA viral load among HIV-TB co-infected patients in ...

    African Journals Online (AJOL)

    The overlapping epidemiology of human immunodeficiency virus (HIV) infection and tuberculosis (TB) is expected in Nigeria that is ranked 10th amongst the 22 countries that bears the burden of TB worldwide. This study aims to estimate the HIV-1 RNA viral load and impact of anti TB therapy (ATT) in a CD4 cell count ...

  9. The time delay of patients presenting with symptoms of TB at TC ...

    African Journals Online (AJOL)

    Tuberculosis (TB) is a major health problem in South Africa. The early detection and treatment of TB cases are essential. The impression of senior staff working at the TC Newman Community Health Centre (TCN), Paarl was that there often is an unnecessary time delay between the presentation of TB symptoms and the ...

  10. Profile and response to anti-tuberculosis treatment among elderly tuberculosis patients treated under the TB Control programme in South India.

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    Banu Rekha Vaithilingam Velayutham

    Full Text Available INTRODUCTION: The demographic transition in India has resulted in an increase in the elderly population. There is limited data on the profile of elderly tuberculosis (TB patients and their treatment outcomes in India. OBJECTIVE: To compare the clinical profile, presentation and response to anti-TB treatment among elderly (≥ 60 yrs and younger (15-59 yrs TB patients treated under the Revised National TB Control programme. METHODOLOGY: Retrospective cohort analysis of TB patients treated from May 1999 to December 2004 in one Tuberculosis Unit of Tiruvallur district, South India. RESULTS: Records of 865 elderly and 4343 younger TB patients were examined: elderly were more likely to be male (84% vs. 71%, smokers (46% vs.37%, illiterate (63% vs. 45%, identified by active case finding through survey (19% vs. 11%, have pulmonary TB (96% vs. 91% and initial smear negative disease (46% vs. 36% compared to younger (for all p<0.001. Among a total of 352 elderly and 1933 younger new smear positive pulmonary TB, the elderly had higher loss to follow-up (15% vs. 11%; p = 0.03 and death rates (9% vs. 4%; p<0.001. Mycobacterium tuberculosis susceptibility to first line anti-TB drugs did not differ (elderly 87% vs. younger 84% (p = 0.20. Side effects related to anti-TB drugs were reported by a higher proportion of elderly patients (63% vs. 54% (p = 0.005. Previously treated patients had similar treatment outcomes in both the groups. CONCLUSION: Elderly TB patients are less likely to have smear positive disease. Newly diagnosed elderly TB patients are more likely to be lost to follow-up or die and report drug side effects. Suitable interventions need to be developed for effective management and better treatment outcomes of TB in the elderly.

  11. When students become patients: TB disease among medical undergraduates in Cape Town, South Africa.

    Science.gov (United States)

    Van der Westhuizen, Helene-Mari; Dramowski, Angela

    2017-05-24

    Medical students acquire latent tuberculosis (TB) infection at a rate of 23 cases/100 person-years. The frequency and impact of occupational TB disease in this population are unknown. A self-administered questionnaire was distributed via email and social media to current medical students and recently graduated doctors (2010 - 2015) at two medical schools in Cape Town. Individuals who had developed TB disease as undergraduate students were eligible to participate. Quantitative and qualitative data collected from the questionnaire and semi-structured interviews were analysed with descriptive statistics and a framework approach to identify emerging themes. Twelve individuals (10 female) reported a diagnosis of TB: pulmonary TB (n=6), pleural TB (n=3), TB lymphadenitis (n=2) and TB spine (n=1); 2/12 (17%) had drug-resistant disease (DR-TB). Mean diagnostic delay post consultation was 8.1 weeks, with only 42% of initial diagnoses being correct. Most consulted private healthcare providers (general practitioners (n=7); pulmonologists (n=4)), and nine underwent invasive procedures (bronchoscopy, pleural fluid aspiration and tissue biopsy). Substantial healthcare costs were incurred (mean ZAR25 000 for drug-sensitive TB, up to  ZAR104 000 for DR-TB). Students struggled to obtain treatment, incurred high transport costs and missed academic time. Students with DR-TB interrupted their studies and experienced severe side-effects (hepatotoxicity, depression and permanent ototoxicity). Most participants cited poor TB infection-control practices at their training hospitals as a major risk factor for occupational TB. Undergraduate medical students in Cape Town are at high risk of occupationally acquired TB, with an unmet need for comprehensive occupational health services and support.

  12. When students become patients: TB disease among medical undergraduates in Cape Town, South Africa

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    Helene-Mari van der Westhuizen

    2017-06-01

    Full Text Available Background. Medical students acquire latent tuberculosis (TB infection at a rate of 23 cases/100 person-years. The frequency and impact of occupational TB disease in this population are unknown. Methods. A self-administered questionnaire was distributed via email and social media to current medical students and recently graduated doctors (2010 - 2015 at two medical schools in Cape Town. Individuals who had developed TB disease as undergraduate students were eligible to participate. Quantitative and qualitative data collected from the questionnaire and semi-structured interviews were analysed with descriptive statistics and a framework approach to identify emerging themes. Results. Twelve individuals (10 female reported a diagnosis of TB: pulmonary TB (n=6, pleural TB (n=3, TB lymphadenitis (n=2 and TB spine (n=1; 2/12 (17% had drug-resistant disease (DR-TB. Mean diagnostic delay post consultation was 8.1 weeks, with only 42% of initial diagnoses being correct. Most consulted private healthcare providers (general practitioners (n=7; pulmonologists (n=4, and nine underwent invasive procedures (bronchoscopy, pleural fluid aspiration and tissue biopsy. Substantial healthcare costs were incurred (mean ZAR25 000 for drug-sensitive TB, up to ZAR104 000 for DR-TB. Students struggled to obtain treatment, incurred high transport costs and missed academic time. Students with DR-TB interrupted their studies and experienced severe side-effects (hepatotoxicity, depression and permanent ototoxicity. Most participants cited poor TB infection-control practices at their training hospitals as a major risk factor for occupational TB. Conclusions. Undergraduate medical students in Cape Town are at high risk of occupationally acquired TB, with an unmet need for comprehensive occupational health services and support.

  13. Characteristics and treatment outcomes of patients with MDR and XDR tuberculosis in a TB referral hospital in Beijing: a 13-year experience.

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    Cui Hua Liu

    Full Text Available BACKGROUND: Information on treatment outcomes among hospitalized patients with multidrug-resistant tuberculosis (MDR-TB and extensively drug-resistant tuberculosis (XDR-TB are scarce in China. METHODOLOGY/PRINCIPAL FINDINGS: We conducted this retrospective study to analyze the characteristics and treatment outcomes in MDR- and XDR-TB patients in the 309 Hospital in Beijing, China during 1996-2009. Socio-demographic and clinical data were retrieved from medical records and analyzed. Logistic regression analysis was performed to identify risk factors associated with poor treatment outcomes and Cox proportional hazards regression model was further used to determine risk factors associated with death in TB patients. Among the 3,551 non-repetitive hospitalized TB patients who had drug susceptibility testing (DST results, 716 (20.2% had MDR-TB and 51 (1.4% had XDR-TB. A total of 3,270 patients who had medical records available were used for further analyses. Treatment success rates (cured and treatment completed were 90.9%, 53.4% and 29.2% for patients with non-MDR-TB, patients with MDR-TB excluding XDR-TB and patients with XDR-TB, respectively. Independent risk factors associated with poor treatment outcomes in MDR-TB patients included being a migrant (adjusted OR = 1.77, smear-positivity at treatment onset (adjusted OR = 1.94 and not receiving 3 or more potentially effective drugs (adjusted OR = 3.87. Independent risk factors associated with poor treatment outcomes in XDR-TB patients were smear-positivity at treatment onset (adjusted OR = 10.42 and not receiving 3 or more potentially effective drugs (adjusted OR = 14.90. The independent risk factors associated with death in TB patients were having chronic obstructive pulmonary disease (adjusted HR = 5.25 and having hypertension (adjusted HR = 4.31. CONCLUSIONS/SIGNIFICANCE: While overall satisfactory treatment success for non-MDR-TB patients was achieved, more intensive

  14. Socioeconomic impact of TB on patients registered within RNTCP and their families in the year 2007 in Chennai, India

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    Ramya Ananthakrishnan

    2012-01-01

    Full Text Available Background: Tuberculosis patients are registered in government clinics under Directly Observed Treatment Short-course (DOTS program in Chennai city catering to 4.34 million population. With the entire country geographically covered under the DOTS program, research into socioeconomic impact of TB on patients and their households is crucial for providing comprehensive patient-friendly TB services and to document the benefits of DOTS. Objective: To assess the social and economic impact of TB on patients registered under DOTS program and their families. Materials and Methods: A cross-sectional study of 300 TB patients was done using a pre-coded semi-quantitative questionnaire between March and June 2007 in all the Tuberculosis Units (TUs of Chennai city. Results: Social and economic impact was perceived by 69.0% and 30.3% patients, respectively. About 24.3% suffered from both social and economic impact, while 75% patients suffered from any one form of impact. Social impact was perceived by more female patients as compared to males (80.7% vs. 62%; P < 0.001. More patients with extra-pulmonary disease (44.4% and patients belonging to joint families (40.7% perceived economic impact (P < 0.05. Conclusion: After 8 years of DOTS implementation, the present study has shown that with the availability of DOTS, percentage of patients who mortgaged assets or took loans has reduced. Social impact of TB is still perceived by two-thirds of the patients (69%. Elimination or reduction of social stressors with specific, focused, and intense social support services, awareness generation, and counseling to patients and families need to be built into the program.

  15. Prevalence, patterns, and correlates of HIV disclosure among TB-HIV patients initiating antiretroviral therapy in Lesotho.

    Science.gov (United States)

    Hayes-Larson, Eleanor; Hirsch-Moverman, Yael; Saito, Suzue; Frederix, Koen; Pitt, Blanche; Maama, Bridget Llang; Howard, Andrea A

    2017-08-01

    Disclosure of HIV-positive status has important implications for patient outcomes and preventing HIV transmission, but has been understudied in TB-HIV patients. We assessed disclosure patterns and correlates of non-disclosure among adult TB-HIV patients initiating ART enrolled in the START Study, a mixed-methods cluster-randomized trial conducted in Lesotho, which evaluated a combination intervention package (CIP) versus standard of care. Interviewer-administered questionnaire data were analyzed to describe patterns of disclosure. Patient-related factors were assessed for association with non-disclosure to anyone other than a health-care provider and primary partners using generalized linear mixed models. Among 371 participants, 95% had disclosed their HIV diagnosis to someone other than a health-care provider, most commonly a spouse/primary partner (76%). Age, TB knowledge, not planning to disclose TB status, greater perceived TB stigma, and CIP were associated with non-disclosure in unadjusted models (p TB knowledge (adjusted odds ratio [aOR] 0.59, 95% confidence interval [CI] 0.39-0.90) and CIP (aOR 0.20, 95% CI 0.05-0.79) remained statistically significant. Among 220 participants with a primary partner, 76% had disclosed to that partner. Significant correlates of partner non-disclosure (p TB knowledge. Adjusted point estimates were largely similar, and being married/cohabitating (aOR 0.03, 95% CI 0.01-0.12), having electricity at home (aOR 0.38, 95% CI 0.17-0.85) and greater TB knowledge (aOR 0.76, 95% CI 0.59-0.98) remained significant. In conclusion, although nearly all participants reported disclosing their HIV status to someone other than a health-care provider at ART initiation, nearly a quarter of participants with a primary partner had not disclosed to their partner. Additional efforts to support HIV disclosure (e.g., counseling) may be needed for TB-HIV patients, particularly for women and those unaware of their partners' status.

  16. Spatial distribution of extensively drug-resistant tuberculosis (XDR TB patients in KwaZulu-Natal, South Africa.

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    Thandi Kapwata

    Full Text Available KwaZulu-Natal province, South Africa, has among the highest burden of XDR TB worldwide with the majority of cases occurring due to transmission. Poor access to health facilities can be a barrier to timely diagnosis and treatment of TB, which can contribute to ongoing transmission. We sought to determine the geographic distribution of XDR TB patients and proximity to health facilities in KwaZulu-Natal.We recruited adults and children with XDR TB diagnosed in KwaZulu-Natal. We calculated distance and time from participants' home to the closest hospital or clinic, as well as to the actual facility that diagnosed XDR TB, using tools within ArcGIS Network analyst. Speed of travel was assigned to road classes based on Department of Transport regulations. Results were compared to guidelines for the provision of social facilities in South Africa: 5km to a clinic and 30km to a hospital.During 2011-2014, 1027 new XDR TB cases were diagnosed throughout all 11 districts of KwaZulu-Natal, of whom 404 (39% were enrolled and had geospatial data collected. Participants would have had to travel a mean distance of 2.9 km (CI 95%: 1.8-4.1 to the nearest clinic and 17.6 km (CI 95%: 11.4-23.8 to the nearest hospital. Actual distances that participants travelled to the health facility that diagnosed XDR TB ranged from 50 km (n = 109, 27%, with a mean of 69 km. The majority (77% of participants travelled farther than the recommended distance to a clinic (5 km and 39% travelled farther than the recommended distance to a hospital (30 km. Nearly half (46% of participants were diagnosed at a health facility in eThekwini district, of whom, 36% resided outside the Durban metropolitan area.XDR TB cases are widely distributed throughout KwaZulu-Natal province with a denser focus in eThekwini district. Patients travelled long distances to the health facility where they were diagnosed with XDR TB, suggesting a potential role for migration or transportation in the XDR TB

  17. The Risk of TB in Patients With Type 2 Diabetes Initiating Metformin vs Sulfonylurea Treatment.

    Science.gov (United States)

    Pan, Sheng-Wei; Yen, Yung-Feng; Kou, Yu Ru; Chuang, Pei-Hung; Su, Vincent Yi-Fong; Feng, Jia-Yih; Chan, Yu-Jiun; Su, Wei-Juin

    2017-12-16

    Metformin and the sulfonylureas are common initial antidiabetic agents; the former has demonstrated anti-TB action in in vitro and animal studies. The comparative effect of metformin vs the sulfonylureas on TB risk in patients with type 2 diabetes mellitus (T2DM) remains unclear. In this retrospective cohort study, patients without chronic kidney disease who received a T2DM diagnosis during 2003 to 2013 were identified from the Taiwan National Health Insurance Research Database. Participants with ≥ 2 years of follow-up were reviewed and observed for TB until December 2013. Patients receiving metformin ≥ 60 cumulative defined daily dose (cDDD) and sulfonylureas TB risk by multivariate Cox regression analysis. Among 40,179 patients with T2DM, 263 acquired TB (0.65%) over a mean follow-up of 6.1 years. In multivariate analysis, the initial 2-year dosage of metformin, but not that of the sulfonylureas, was an independent predictor of TB (60-cDDD increase (adjusted hazard ratio [HR], 0.931; 95% CI, 0.877-0.990) after adjustment by cofactors, including adapted diabetes complication severity index. Metformin majors had a significantly lower TB risk than that of sulfonylurea majors before and after matching (HR, 0.477; 95% CI, 0.268-0.850 and HR, 0.337; 95% CI, 0.169-0.673; matched pairs, n = 3,161). Compared with the reference group (initial 2-year metformin TB risk (60-219 cDDD; HR, 0.860; 95% CI, 0.637-1.161; 220-479 cDDD, HR, 0.706; 95% CI, 0.485-1.028; ≥ 480 cDDD, HR, 0.319; 95% CI, 0.118-0.863). Metformin use in the initial 2 years was associated with a decreased risk of TB, and metformin users had a reduced risk compared with their sulfonylurea comparators. Copyright © 2017 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

  18. CT findings of TB in diabetic and non-diabetic patients: A comparison before and after anti-tuberculous therapy

    Directory of Open Access Journals (Sweden)

    Hao Wu

    2016-03-01

    Conclusion: CT findings of tuberculosis in diabetic patients are different from those in non-diabetic patients, with a higher occurrence of non-segmental distribution and multiple cavities within a tuberculous lesion. By follow-up re-examination, diabetic patients show a slower and unobvious therapeutic response on CT scans compared to non-diabetic patients. CT can provide important information for the diagnosis and management of TB in diabetic and non-diabetic patients.

  19. Quantifying the need for enhanced case management for TB patients as part of TB cohort audit in the North West of England: a descriptive study.

    Science.gov (United States)

    Tucker, Angela; Mithoo, Jeniffer; Cleary, Paul; Woodhead, Mark; MacPherson, Peter; Wingfield, Tom; Davies, Stefanie; Wake, Carolyn; McMaster, Paddy; Bertel Squire, S

    2017-11-15

    Patients with TB have diverse and often challenging clinical and social needs that may hamper successful treatment outcomes. Understanding the need for additional support during treatment (enhanced case management, or ECM) is important for workforce capacity planning. North West England TB Cohort Audit (TBCA) has introduced a 4-level ECM classification system (ECM 0-3) to quantify the need for ECM in the region. This study describes the data from the first 2 years of ECM classification. Data collected between April 2013 and July 2015 were used to analyse the proportions of patients allocated to each ECM level and the prevalence of social and clinical factors indicating need for ECM. Single variable and multivariable logistic regression models were constructed to examine the association between ECM level and treatment outcome. Of 1714 notified cases 99.8% were assigned an ECM level: 31% ECM1, 19% ECM2 and 14% ECM3. The most common factors indicating need for ECM were language barriers (20.3%) and clinical complexity (16.9%). 1342/1493 (89.9%) of drug-sensitive, non-CNS cases completed treatment within 12 months. Patients in ECM2 and 3 were less likely to complete treatment at 12 months than patients in ECM0 (adjusted OR 0.47 [95% CI 0.27-0.84] and 0.23 [0.13-0.41] respectively). Use of TBCA to quantify different levels of need for ECM is feasible and has demonstrated that social and clinical complexity is common in the region. Results will inform regional workforce planning and assist development of innovative methods to improve treatment outcomes in these vulnerable groups.

  20. Epidemiological Characteristics and Clinical Outcome of HIV-Related Tuberculosis in a Population of TB Patients in South-western Nigeria.

    Science.gov (United States)

    Olowe, Olugbenga A; Makanjuola, Olufunmilola B; Adekanmi, Adeniyi S; Adefioye, Olusola J; Olowe, Rita A

    2017-06-01

    Tuberculosis (TB) is the second leading cause of death from infectious disease globally with its impact more dramatic in resource limited settings. Individuals with human immunodeficiency virus (HIV) infection who also develop tuberculosis represent a significant challenge to TB control. This study was carried out to determine the prevalence of TB-HIV coinfection and pattern of infection among TB patients. We also compared treatment outcome among coinfected patients with those not coinfected. A six-year retrospective review of records of patients managed at the Tuberculosis Treatment Center of the LAUTECH Teaching Hospital, South-Western Nigeria from January 2009 to December 2014 was carried out. One hundred and five (26.3%) of the 399 TB patients seen in the study period were coinfected with HIV. About 10% of the subjects had extrapulmonary tuberculosis. Treatment failure was significantly worse among patients who had both HIV and TB compared with those who had TB only (49.5% vs. 32%, p = 0.001). Death rate was also higher in the coinfected individuals implying a poorer clinical outcome. High prevalence of TB-HIV coinfection and poor treatment outcome in this group of individuals, though predictable, calls for a more concerted effort in the management of TB-HIV coinfection.

  1. Discrimination against gay, lesbian and bisexual family physicians by patients

    Science.gov (United States)

    Druzin, P; Shrier, I; Yacowar, M; Rossignol, M

    1998-01-01

    BACKGROUND: Discrimination against gay, lesbian and bisexual (GLB) patients by physicians is well known. Discrimination against GLB physicians by their colleagues and superiors is also well known and includes harassment, denial of positions and refusal to refer patients to them. The purpose of this study was to identify and quantify the attitudes of patients toward GLB physicians. METHODS: Telephone interviews were conducted with 500 randomly selected people living in a large urban Canadian city. Subjects were asked if they would refuse to see a GLB family physician and, if so, to describe the reason why. They were then given a choice of 6 reasons obtained from consultation with 10 GLB people and 10 heterosexual people. RESULTS: Of the 500 subjects 346 (69.2%) were reached and agreed to participate. Of the 346 respondents 41 (11.8%) stated that they would refuse to see a GLB family physician. The 2 most common reasons for the discrimination (prevalence rate more than 50%) were that GLB physicians would be incompetent and the respondent would feel "uncomfortable" having a GLB physician. Although more male than female respondents discriminated against GLB physicians, the difference was not statistically significant. The proportion of male and female respondents who discriminated increased with age (p discrimination against GLB family physicians is significant. The results suggest that the discrimination is based on emotional reasons and is not related to such factors as misinformation about STDs and fear of being thought of sexually. Therefore, educational efforts should be directed against general perceptions of homosexuality rather than targeting specific medical concerns. PMID:9526472

  2. History Taking in TB Patients at Likuni Mission Hospital In Malawi

    African Journals Online (AJOL)

    this process. There is no substitute to a systematic history taking. We reviewed case files at Likuni Mission Hospital to determine whether a proper history had been obtained in pulmonary TB sus- pects who were later diagnossed as having the disease. Method. As part of the on-going Lilongwe decentralisation TB project we.

  3. Vitamin D enhances IL-1β secretion and restricts growth of Mycobacterium tuberculosis in macrophages from TB patients

    Directory of Open Access Journals (Sweden)

    Daniel Eklund

    2013-01-01

    Full Text Available The emergence of multidrug-resistant strains of Mycobacterium tuberculosis (MTB, the bacterium responsible for tuberculosis (TB, has rekindled the interest in the role of nutritional supplementation of micronutrients, such as vitamin D, as adjuvant treatment. Here, the growth of virulent MTB in macrophages obtained from the peripheral blood of patients with and without TB was studied. The H37Rv strain genetically modified to express Vibrio harveyi luciferase was used to determine the growth of MTB by luminometry in the human monocyte-derived macrophages (hMDMs from study subjects. Determination of cytokine levels in culture supernatants was performed using a flow cytometry-based bead array technique. No differences in intracellular growth of MTB were observed between the different study groups. However, stimulation with 100nM 1,25-dihydroxyvitamin D significantly enhanced the capacity of hMDMs isolated from TB patients to control the infection. This effect was not observed in hMDMs from the other groups. The interleukin (IL-1β and IL-10 release by hMDMs was clearly increased upon stimulation with 1,25-dihydroxyvitamin D. Furthermore, the 1,25-dihydroxyvitamin D stimulation also led to elevated levels of TNF-α (tumor necrosis factor-alpha and IL-12p40. It was concluded that vitamin D triggers an inflammatory response in human macrophages with enhanced secretion of cytokines, as well as enhancing the capacity of hMDMs from patients with active TB to restrict mycobacterial growth.

  4. Adverse events in the treatment of MDR-TB patients within and outside the NTP in Pham Ngoc Thach hospital, Ho Chi Minh City, Vietnam.

    Science.gov (United States)

    Hoa, Nguyen Binh; Nhung, Nguyen Viet; Khanh, Pham Huyen; Hai, Nguyen Viet; Quyen, Bui Thi Tu

    2015-12-22

    Treatment outcomes of a high proportion of inpatients with multi-drug resistant tuberculosis (MDR-TB) were not reported to the Vietnamese National Tuberculosis Program because they received treatment outside of the green light committee (GLC) program. The study aimed (1) to describe the strengths and weaknesses of treatment of GLC and non-GLC MDR-TB patients as well as the factors influencing treatment completion and (2) to determine the incidence of adverse drug reactions. This cross-sectional study comprised two elements: (1) in-depth interviews with clinical doctors, hospital pharmacists; and focus group discussions with MDR-TB patients; and (2) a review of the charts of all GLC and non-GLC MDR-TB patients in 2010. A total of 282 MDR-TB patients were recruited, including 79(28%) MDR-TB patients treated through the GLC program and 203(72%) MDR-TB patients treated outside of the GLC program. The main strengths of GLC treatment were the supply of quality assured second line TB drugs, routine monitoring and clinical evaluation, free diagnostic tests and close clinical monitoring. The greatest barriers to patients treated outside of the GLC program was difficulty paying for second line TB drugs and other treatment costs. There was no significant difference between the incidence of adverse events among GLC (46.8%) and non-GLC treated patients (52.2%; p = 0.417). Among 143 patients who reported 226 adverse reaction events, arthralgia/joint pain (35.8%), gastrointestinal (14.2%), ototoxicity (8.4%), cutaneous (6.6%), and giddiness (5.8%) were the most common. The non-GLC MDR-TB patients face substantial barriers to treatment, and require greater support if they are to complete treatment and improve disease outcomes. Staff training about the management of adverse drug reactions is needed.

  5. Classification of Bladder Cancer Patients via Penalized Linear Discriminant Analysis

    Science.gov (United States)

    Raeisi Shahraki, Hadi; Bemani, Peyman; Jalali, Maryam

    2017-05-01

    Objectives: In order to identify genes with the greatest contribution to bladder cancer, we proposed a sparse model making the best discrimination from other patients. Methods: In a cross-sectional study, 22 genes with a key role in most cancers were considered in 21 bladder cancer patients and 14 participants of the same age (± 3 years) without bladder cancer in Shiraz city, Southern Iran. Real time-PCR was carried out using SYBR Green and for each of the 22 target genes 2-Δct as a quantitative index of gene expression was reported. We determined the most affective genes for the discriminant vector by applying penalized linear discriminant analysis using LASSO penalties. All the analyses were performed using SPSS version 18 and the penalized LDA package in R.3.1.3 software. Results: Using penalized linear discriminant analysis led to elimination of 13 less important genes. Considering the simultaneous effects of 22 genes with important influence on many cancers, it was found that TGFβ, IL12A, Her2, MDM2, CTLA-4 and IL-23 genes had the greatest contribution in classifying bladder cancer patients with the penalized linear discriminant vector. The receiver operating characteristic (ROC) curve revealed that the proposed vector had good performance with minimal (only 3) mis- classification. The area under the curve (AUC) of our proposed test was 96% (95% CI: 83%- 100%) and sensitivity, specificity, positive and negative predictive values were 90.5%, 85.7%, 90.5% and 85.7%, respectively. Conclusions: The penalized discriminant method can be considered as appropriate for classifying bladder cancer cases and searching for important biomarkers. Creative Commons Attribution License

  6. TB or not TB?: a case of isolated testicular TB with scrotal involvement.

    LENUS (Irish Health Repository)

    Bhargava, A

    2009-06-01

    Despite the genitourinary tract being the most common site affected by extrapulmonary TB, isolated testicular TB remains a rare clinical entity. In patients with co-morbidities such as hepatic impairment, treatment proves a challenge, as first-line hepatotoxic pharmaceuticals are contraindicated. Here, we report a case of isolated testicular TB with scrotal involvement, on a background of hepatic dysfunction.

  7. Clinical presentation of T.b. rhodesiense sleeping sickness in second stage patients from Tanzania and Uganda.

    Directory of Open Access Journals (Sweden)

    Irene Kuepfer

    Full Text Available BACKGROUND: A wide spectrum of disease severity has been described for Human African Trypanosomiasis (HAT due to Trypanosoma brucei rhodesiense (T.b. rhodesiense, ranging from chronic disease patterns in southern countries of East Africa to an increase in virulence towards the north. However, only limited data on the clinical presentation of T.b. rhodesiense HAT is available. From 2006-2009 we conducted the first clinical trial program (Impamel III in T.b. rhodesiense endemic areas of Tanzania and Uganda in accordance with international standards (ICH-GCP. The primary and secondary outcome measures were safety and efficacy of an abridged melarsoprol schedule for treatment of second stage disease. Based on diagnostic findings and clinical examinations at baseline we describe the clinical presentation of T.b. rhodesiense HAT in second stage patients from two distinct geographical settings in East Africa. METHODOLOGY/PRINCIPAL FINDINGS: 138 second stage patients from Tanzania and Uganda were enrolled. Blood samples were collected for diagnosis and molecular identification of the infective trypanosomes, and T.b. rhodesiense infection was confirmed in all trial subjects. Significant differences in diagnostic parameters and clinical signs and symptoms were observed: the median white blood cell (WBC count in the cerebrospinal fluid (CSF was significantly higher in Tanzania (134 cells/mm(3 than in Uganda (20 cells/mm(3; p<0.0001. Unspecific signs of infection were more commonly seen in Uganda, whereas neurological signs and symptoms specific for HAT dominated the clinical presentation of the disease in Tanzania. Co-infections with malaria and HIV did not influence the clinical presentation nor treatment outcomes in the Tanzanian study population. CONCLUSIONS/SIGNIFICANCE: We describe a different clinical presentation of second stage T.b. rhodesiense HAT in two distinct geographical settings in East Africa. In the ongoing absence of sensitive diagnostic

  8. Randomized controlled study of the effectiveness of annual and 6-monthly screening with mass miniature radiography (MMR) for the active case-finding of cardiopulmonary TB patients

    CSIR Research Space (South Africa)

    Churchyard, JG

    2003-05-01

    Full Text Available Committee Project Summary : Gen 524 Project Title: A Randomized Controlled study of the effectiveness of annual and 6-monthly screening with mass miniature radiography (MMR) for the active case-finding of cardiopulmonary TB patients Author(s... tuberculosis (TB) control programme, TB case rates in the gold mining industry have risen progressively during the 1990s to levels of over 3,000 per 100,000 men per year. Deaths while on TB treatment now account for twice as many deaths among gold miners...

  9. Early morning urine collection to improve urinary lateral flow LAM assay sensitivity in hospitalised patients with HIV-TB co-infection.

    Science.gov (United States)

    Gina, Phindile; Randall, Philippa J; Muchinga, Tapuwa E; Pooran, Anil; Meldau, Richard; Peter, Jonny G; Dheda, Keertan

    2017-05-12

    Urine LAM testing has been approved by the WHO for use in hospitalised patients with advanced immunosuppression. However, sensitivity remains suboptimal. We therefore examined the incremental diagnostic sensitivity of early morning urine (EMU) versus random urine sampling using the Determine® lateral flow lipoarabinomannan assay (LF-LAM) in HIV-TB co-infected patients. Consenting HIV-infected inpatients, screened as part of a larger prospective randomized controlled trial, that were treated for TB, and could donate matched random and EMU samples were included. Thus paired sample were collected from the same patient, LF-LAM was graded using the pre-January 2014, with grade 1 and 2 manufacturer-designated cut-points (the latter designated grade 1 after January 2014). Single sputum Xpert-MTB/RIF and/or TB culture positivity served as the reference standard (definite TB). Those treated for TB but not meeting this standard were designated probable TB. 123 HIV-infected patients commenced anti-TB treatment and provided matched random and EMU samples. 33% (41/123) and 67% (82/123) had definite and probable TB, respectively. Amongst those with definite TB LF-LAM sensitivity (95%CI), using the grade 2 cut-point, increased from 12% (5-24; 5/43) to 39% (26-54; 16/41) with random versus EMU, respectively (p = 0.005). Similarly, amongst probable TB, LF-LAM sensitivity increased from 10% (5-17; 8/83) to 24% (16-34; 20/82) (p = 0.001). LF-LAM specificity was not determined. This proof of concept study indicates that EMU could improve the sensitivity of LF-LAM in hospitalised TB-HIV co-infected patients. These data have implications for clinical practice.

  10. Prescription patterns and treatment outcomes of MDR-TB patients treated within and outside the National Tuberculosis Programme in Pham Ngoc Thach hospital, Viet Nam.

    Science.gov (United States)

    Hoa, Nguyen B; Khanh, Pham H; Chinh, Nguyen V; Hennig, Cornelia M

    2014-09-01

    To describe and analyse the prescription patterns and treatment outcomes of MDR-TB patients managed within Green Light Committee (GLC) and outside (non-GLC) the National TB programme in Viet Nam. Retrospective cohort study with two elements: (i) in-depth interviews and focus group discussions with clinical doctors, hospital pharmacists, and the non-GLC patients with MDR-TB; (ii) review of treatment cards and patients' charts of all GLC and non-GLC patients with MDR-TB put on treatment during 2010. Of 282 patients with MDR-TB, comprising 79 (28%) GLC patients MDR-TB and 203 (72%) non-GLC patients with MDR-TB, were enrolled in the study. Treatment delay was significantly higher in the GLC group (12.8 days) than the non-GLC group (2.3 days), (P = 0.004). The success rate was significantly better in GLC patients (84.8%) than in non-GLC patients (53.7%) (P < 0.001). The default rate was significantly higher in non-GLC patients than in GLC patients (25.6% vs. 6.3%), (P < 0.001). The risk of unsuccessful outcome was higher in non-GLC patients (Hazard ratio = 4.6, 95% CI: 1.8-11.8). The treatment outcomes of patients with MDR-TB in the GLC group were significantly better than in the non-GLC group. Reasons for the high default rate in non-GLC patients with MDR-TB must be further investigated. © 2014 John Wiley & Sons Ltd.

  11. Tuberculosis (TB): Treatment

    Science.gov (United States)

    ... Education & Training Home Conditions Tuberculosis (TB) Tuberculosis: Treatment Tuberculosis: Treatment Make an Appointment Refer a Patient Ask ... or bones is treated longer. NEXT: Preventive Treatment Tuberculosis: Diagnosis Tuberculosis: History Clinical Trials For more than ...

  12. A phase I, dose-escalation study of TB-403, a monoclonal antibody directed against PlGF, in patients with advanced solid tumours

    DEFF Research Database (Denmark)

    Lassen, U; Nielsen, D L; Sørensen, M

    2012-01-01

    BACKGROUND: TB-403 (RO 5323441), a humanised monoclonal antibody, is a novel antiangiogenesis agent directed against placental growth factor. The safety, pharmacokinetics (PK), and antitumour activity of TB-403 were assessed in a phase I, dose-escalation study in patients with advanced solid tumo...

  13. Clinical and epidemiological characteristics associated with unfavorable tuberculosis treatment outcomes in TB-HIV co-infected patients in Brazil: a hierarchical polytomous analysis

    Directory of Open Access Journals (Sweden)

    Thiago Nascimento do Prado

    2017-03-01

    Conclusions: Socio-economic vulnerability has a significant effect on treatment outcomes among TB-HIV co-infected patients in Brazil. Enhancing social support, incorporation of alcohol abuse screening and counseling into current TB surveillance programs and targeting interventions to specific age groups are interventions that could improve treatment outcomes.

  14. Serious treatment related adverse drug reactions amongst anti-retroviral naïve MDR-TB patients.

    Directory of Open Access Journals (Sweden)

    Martha Van der Walt

    Full Text Available BACKGROUND: Globally treatment outcomes for multidrug-resistant Mycobacterium tuberculosis (MDR-TB remain poor and this is compounded by high drug toxicity. Little is known about the influence of adverse drug reactions (ADRs on treatment outcomes in South Africa. METHODS: We evaluated the impact of severe ADRs among a prospective cohort of MDR-TB patients in South Africa (2000-2004. The HIV-infected study participants were anti-retroviral naïve. RESULTS: Of 2,079 patients enrolled, 1,390 (66.8% were included in this analysis based on known HIV test results (39.1% HIV-infected. At least one severe ADR was reported in 83 (6.9% patients with ototoxicity being the most frequent ADR experienced (38.9%. CONCLUSIONS: We found that being HIV-infected but antiretroviral naïve did not increase occurrence of SADRs in patients on second-line anti-tuberculosis drugs. Early screening and proactive management of ADRs in this patient population is essential, especially given the rollout of decentralized care and the potential for overlapping toxicity of concomitant MDR-TB and HIV treatment.

  15. Low pre-diagnosis attrition but high pre-treatment attrition among patients with MDR-TB: An operational research from Chennai, India.

    Science.gov (United States)

    Shewade, Hemant Deepak; Nair, Dina; Klinton, Joel S; Parmar, Malik; Lavanya, J; Murali, Lakshmi; Gupta, Vivek; Tripathy, Jaya Prasad; Swaminathan, Soumya; Kumar, Ajay M V

    2017-12-01

    Worldwide, there's concern over high pre-diagnosis and pre-treatment attritions or delays in Multidrug resistant tuberculosis (MDR-TB) diagnosis and treatment pathway (DTP). We conducted this operational research among patients with presumptive MDR-TB in north and central Chennai, India to determine attrition and turnaround times (TAT) at various steps of DTP and factors associated with attrition. Study was conducted in Revised National Tuberculosis Control Programme setting. It was a retrospective cohort study involving record review of all patients with presumptive MDR-TB (eligible for DST) in 2014. Of 628 eligible for DST, 557 (88%) underwent DST and 74 (13%) patients were diagnosed as having MDR-TB. Pre-diagnosis and pre-treatment attrition was 11% (71/628) and 38% (28/74) respectively. TAT [median (IQR)] to test from eligibility for DST and initiate DR-TB treatment from diagnosis were 14 (9,27) and 18 (13,36) days respectively. Patients with smear negative TB and detected in first quarter of 2014 were less likely to undergo DST. Patients in first quarter of 2014 had significantly lower risk of pre-treatment attrition. There was high uptake of DST. However, urgent attention is required to reduce pre-treatment attrition, improve TAT to test from eligibility for DST and improve DST among patients with smear-negative TB. Copyright © 2017 Ministry of Health, Saudi Arabia. Published by Elsevier Ltd. All rights reserved.

  16. Scaling up of HIV-TB collaborative activities: Achievements and challenges in India.

    Science.gov (United States)

    Deshmukh, Rajesh; Shah, Amar; Sachdeva, K S; Sreenivas, A N; Gupta, R S; Khaparde, S D

    2016-01-01

    India has been implementing HIV/TB collaborative activities since 2001 with rapid scale-up of infrastructure across the country during past decade in National AIDS Control Programme and Revised National TB Control Programme. India has shown over 50% reduction in new infections and around 35% reduction in AIDS-related deaths, thereby being one of the success stories globally. Substantial progress in the implementation of collaborative TB/HIV activities has occurred in India and it is marching towards target set out in the Global Plan to Stop TB and endorsed by the UN General Assembly to halve HIV associated TB deaths by 2015. While the successful approaches have led to impressive gains in HIV/TB control in India, there are emerging challenges including newer pockets with rising HIV trends in North India, increasing drug resistance, high mortality among co-infected patients, low HIV testing rates among TB patients in northern and eastern states in India, treatment delays and drop-outs, stigma and discrimination, etc. In spite of these difficulties, established HIV/TB coordination mechanisms at different levels, rapid scale-up of facilities with decentralisation of treatment services, regular joint supervision and monitoring, newer initiatives like use of rapid diagnostics for early diagnosis of TB among people living with HIV, TB notification, etc. have led to success in combating the threat of HIV/TB in India. This article highlights the steps taken by India, one of the largest HIV/TB programmes in world, in scaling up of the joint HIV-TB collaborative activities, the achievements so far and discusses the emerging challenges which could provide important lessons for other countries in scaling up their programmes. Copyright © 2016 Tuberculosis Association of India. Published by Elsevier B.V. All rights reserved.

  17. Tuberculosis (TB)

    Science.gov (United States)

    ... with facebook share with twitter share with linkedin Tuberculosis Go to Information for Researchers ► Tuberculosis (TB) is ... are drug resistant. Why Is the Study of Tuberculosis a Priority for NIAID? Tuberculosis is one of ...

  18. Alcohol and drug use disorders, HIV status and drug resistance in a sample of Russian TB patients

    Science.gov (United States)

    Fleming, M. F.; Krupitsky, E.; Tsoy, M.; Zvartau, E.; Brazhenko, N.; Jakubowiak, W.; E. McCaul, M.

    2006-01-01

    SUMMARY SETTING: Alcohol use, tuberculosis (TB) drug resistance and human immunodeficiency virus (HIV) risk behavior are of increasing concern in Russian TB patients. DESIGN: A prevalence study of alcohol use and HIV risk behavior was conducted in a sample of 200 adult men and women admitted to TB hospitals in St Petersburg and Ivanovo, Russia. RESULTS: Of the subjects, 72% were men. The mean age was 41. Active TB was diagnosed using a combination of chest X-ray, sputum smears and sputum cultures. Sixty-two per cent met DSM-IV criteria for current alcohol abuse or dependence. Drug use was uncommon, with only two patients reporting recent intravenous heroin use. There was one case of HIV infection. The mean total risk assessment battery score was 3.4. Depression was present in 60% of the sample, with 17% severely depressed. Alcohol abuse/dependence was associated with an eight-fold increase in drug resistance (OR 8.58; 95% CI 2.09-35.32). Patients with relapsing or chronic TB were more likely to meet the criteria for alcohol abuse/dependence (OR 2.56; 95% CI 1.0-6.54). CONCLUSION: Alcohol use disorders are common in patients being treated for active TB, and are associated with significant morbidity. Additional surveys are needed to examine the relationship between alcohol use disorders and anti-tuberculosis drug resistance. CONTEXTE: Chezles patients tuberculeux russes, l’utilisation d’alcool, la résistance aux médicaments antituberculeux et un comportement à risque pour le virus de l’immunodéficience humaine (VIH) sont des sujets croissants d’inquiétude. SCHÉMA: Une étude: de prévalence de l’utilisation d’alcool et du comportement à risque pour le VIH a été menée sur un échantillon de 200 hommes et femmes adultes, admis dans des hôpitaux pour la tuberculose (TB) de Saint-Pétersbourg et d’Ivanovo en Russie. RÉSULTATS: Il y avait 72% d’hommes dans l’échantillon. L’âge moyen est de 41 ans. On a diagnostiqué la TB active par l

  19. Development of a Patient-Centred, Psychosocial Support Intervention for Multi-Drug-Resistant Tuberculosis (MDR-TB Care in Nepal.

    Directory of Open Access Journals (Sweden)

    Sudeepa Khanal

    Full Text Available Multi-drug-resistant tuberculosis (MDR-TB poses a major threat to public health worldwide, particularly in low-income countries. The current long (20 month and arduous treatment regime uses powerful drugs with side-effects that include mental ill-health. It has a high loss-to-follow-up (25% and higher case fatality and lower cure-rates than those with drug sensitive tuberculosis (TB. While some national TB programmes provide small financial allowances to patients, other aspects of psychosocial ill-health, including iatrogenic ones, are not routinely assessed or addressed. We aimed to develop an intervention to improve psycho-social well-being for MDR-TB patients in Nepal. To do this we conducted qualitative work with MDR-TB patients, health professionals and the National TB programme (NTP in Nepal. We conducted semi-structured interviews (SSIs with 15 patients (10 men and 5 women, aged 21 to 68, four family members and three frontline health workers. In addition, three focus groups were held with MDR-TB patients and three with their family members. We conducted a series of meetings and workshops with key stakeholders to design the intervention, working closely with the NTP to enable government ownership. Our findings highlight the negative impacts of MDR-TB treatment on mental health, with greater impacts felt among those with limited social and financial support, predominantly married women. Michie et al's (2011 framework for behaviour change proved helpful in identifying corresponding practice- and policy-level changes. The findings from this study emphasise the need for tailored psycho-social support. Recent work on simple psychological support packages for the general population can usefully be adapted for use with people with MDR-TB.

  20. Differential cellular recognition pattern to M. tuberculosis targets defined by IFN-γ and IL-17 production in blood from TB + patients from Honduras as compared to health care workers: TB and immune responses in patients from Honduras

    Science.gov (United States)

    2013-01-01

    Background A better understanding of the quality of cellular immune responses directed against molecularly defined targets will guide the development of TB diagnostics and identification of molecularly defined, clinically relevant M.tb vaccine candidates. Methods Recombinant proteins (n = 8) and peptide pools (n = 14) from M. tuberculosis (M.tb) targets were used to compare cellular immune responses defined by IFN-γ and IL-17 production using a Whole Blood Assay (WBA) in a cohort of 148 individuals, i.e. patients with TB + (n = 38), TB- individuals with other pulmonary diseases (n = 81) and individuals exposed to TB without evidence of clinical TB (health care workers, n = 29). Results M.tb antigens Rv2958c (glycosyltransferase), Rv2962c (mycolyltransferase), Rv1886c (Ag85B), Rv3804c (Ag85A), and the PPE family member Rv3347c were frequently recognized, defined by IFN-γ production, in blood from healthy individuals exposed to M.tb (health care workers). A different recognition pattern was found for IL-17 production in blood from M.tb exposed individuals responding to TB10.4 (Rv0288), Ag85B (Rv1886c) and the PPE family members Rv0978c and Rv1917c. Conclusions The pattern of immune target recognition is different in regard to IFN-γ and IL-17 production to defined molecular M.tb targets in PBMCs from individuals frequently exposed to M.tb. The data represent the first mapping of cellular immune responses against M.tb targets in TB patients from Honduras. PMID:23497342

  1. Sub therapeutic drug levels among HIV/TB co-infected patients ...

    African Journals Online (AJOL)

    Daniel W. Gunda

    2016-11-01

    Nov 1, 2016 ... of HIV/TB co-infection,8 with a rapid scaling up of Antiretro- viral therapy programs especially in resource restricted coun- tries, where tuberculosis is for the .... parametric continuous data were summarized as median with interquartile range and the difference in medians within the categories of ARV plasma ...

  2. Manifestations of Tuberculosis in TB-HIV co-infected patients: A ...

    African Journals Online (AJOL)

    Of all the symptoms recorded, cough was the commonest symptom 320 (94.4%), recorded followed by weight loss 235(69.3%), fever 233(68.7%), night sweats 122(36%), anorexia 78(23%) and chest pain 27(8%) respectively. Radiological findings showed that pulmonary TB (PTB) was present in 310(91.4%) and extra ...

  3. Assessing care for patients with TB/HIV/STI infections in a rural ...

    African Journals Online (AJOL)

    Setting. Despite the prioritisation of TB, HIV and STI programmes in South Africa, service targets are not achieved, have had little effect, and the magnitude of the epidemics continues to escalate. Objective. To report on a participatory quality improvement intervention designed to evaluate these priority programmes in ...

  4. Finding patients eligible for antiretroviral therapy using TB services as entry point for HIV treatment

    NARCIS (Netherlands)

    Bwire, Robert; Nagelkerke, Nico J. D.; Borgdorff, Martien W.

    2006-01-01

    OBJECTIVE: To estimate the proportion of antiretroviral therapy (ART) eligible adults (15-49 years) with tuberculosis potentially identifiable through tuberculosis services using a CD4 count below 350 cells/mm3 as cut-off value for ART initiation. METHODS: Using TB notification rate data, HIV

  5. Socio-demographic and AIDS-related factors associated with tuberculosis stigma in southern Thailand: a quantitative, cross-sectional study of stigma among patients with TB and healthy community members.

    Science.gov (United States)

    Kipp, Aaron M; Pungrassami, Petchawan; Nilmanat, Kittikorn; Sengupta, Sohini; Poole, Charles; Strauss, Ronald P; Chongsuvivatwong, Virasakdi; Van Rie, Annelies

    2011-08-30

    Tuberculosis (TB) remains one of the most important infectious diseases worldwide. A comprehensive approach towards disease control that addresses social factors including stigma is now advocated. Patients with TB report fears of isolation and rejection that may lead to delays in seeking care and could affect treatment adherence. Qualitative studies have identified socio-demographic, TB knowledge, and clinical determinants of TB stigma, but only one prior study has quantified these associations using formally developed and validated stigma scales. The purpose of this study was to measure TB stigma and identify factors associated with TB stigma among patients and healthy community members. A cross-sectional study was performed in southern Thailand among two different groups of participants: 480 patients with TB and 300 healthy community members. Data were collected on socio-demographic characteristics, TB knowledge, and clinical factors. Scales measuring perceived TB stigma, experienced/felt TB stigma, and perceived AIDS stigma were administered to patients with TB. Community members responded to a community TB stigma and community AIDS stigma scale, which contained the same items as the perceived stigma scales given to patients. Stigma scores could range from zero to 30, 33, or 36 depending on the scale. Three separate multivariable linear regressions were performed among patients with TB (perceived and experience/felt stigma) and community members (community stigma) to determine which factors were associated with higher mean TB stigma scores. Only low level of education, belief that TB increases the chance of getting AIDS, and AIDS stigma were associated with higher TB stigma scores in all three analyses. Co-infection with HIV was associated with higher TB stigma among patients. All differences in mean stigma scores between index and referent levels of each factor were less than two points, except for incorrectly believing that TB increases the chance of getting

  6. Socio-demographic and AIDS-related factors associated with tuberculosis stigma in southern Thailand: a quantitative, cross-sectional study of stigma among patients with TB and healthy community members

    Directory of Open Access Journals (Sweden)

    Strauss Ronald P

    2011-08-01

    Full Text Available Abstract Background Tuberculosis (TB remains one of the most important infectious diseases worldwide. A comprehensive approach towards disease control that addresses social factors including stigma is now advocated. Patients with TB report fears of isolation and rejection that may lead to delays in seeking care and could affect treatment adherence. Qualitative studies have identified socio-demographic, TB knowledge, and clinical determinants of TB stigma, but only one prior study has quantified these associations using formally developed and validated stigma scales. The purpose of this study was to measure TB stigma and identify factors associated with TB stigma among patients and healthy community members. Methods A cross-sectional study was performed in southern Thailand among two different groups of participants: 480 patients with TB and 300 healthy community members. Data were collected on socio-demographic characteristics, TB knowledge, and clinical factors. Scales measuring perceived TB stigma, experienced/felt TB stigma, and perceived AIDS stigma were administered to patients with TB. Community members responded to a community TB stigma and community AIDS stigma scale, which contained the same items as the perceived stigma scales given to patients. Stigma scores could range from zero to 30, 33, or 36 depending on the scale. Three separate multivariable linear regressions were performed among patients with TB (perceived and experience/felt stigma and community members (community stigma to determine which factors were associated with higher mean TB stigma scores. Results Only low level of education, belief that TB increases the chance of getting AIDS, and AIDS stigma were associated with higher TB stigma scores in all three analyses. Co-infection with HIV was associated with higher TB stigma among patients. All differences in mean stigma scores between index and referent levels of each factor were less than two points, except for

  7. Comparison of PPD test in household contacts of smear-positive and -negative tuberculosis (TB

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    Zohreh Azarkar

    2015-01-01

    Conclusions: The most important way to prevent TB is omission of the disease transmission sources (TB patients by anti-TB treatment. Extensive studies are needed to ensure that contacts of patients with pulmonary TB are identified and appropriately screened.

  8. TB deaths reach historic levels. International (global).

    Science.gov (United States)

    More tuberculosis (TB)-related deaths occurred in 1995 than in any other year in history (almost 3 million, vs. 2.1 million for the TB epidemic around 1990). In the next 50 years, as many as 500 million people may develop TB if current rates continue. More and more of these people will develop multidrug resistant TB. TB affects all social groups. It is the leading fatal infection in youth and adults. HIV positive people are more likely to die from TB than any other condition. More women die from TB than all causes of maternal mortality combined. Almost 50% of the world's refugees may have TB. All people are at risk of TB since TB bacteria, which enter the air via coughing or sneezing, can be suspended in the air for hours. Increased air travel and migration have brought TB back to industrialized countries. Multi-drug resistant TB has emerged in New York City, London, Milan, Paris, Atlanta, Chicago, and cities in developing countries. Governments of industrialized and developing countries have been slow to understand the effects of multi-drug resistant TB for public health. During the 1970s and 1980s, TB was greatly neglected resulting in the current multi-drug resistant TB epidemic. Policy makers have not applied the tools discovered by scientists to help eliminate TB. The World Health Organization recommends directly observed treatment, short-course (DOTS) to fight TB. DOTS can increase the number of cured TB patients two-fold. It can cure almost 95% of TB patients with medicines costing less than $11 in some areas of the world. Yet DOTS is being used to cure only 10% of all TB patients in the world. If it were used in Bangladesh, Brazil, China, Ethiopia, India, Indonesia, Mexico, Nigeria, Pakistan, Russian Federation, South Africa, and Zaire, about 75% of all TB cases would be cured. In DOTS, health workers, not the TB patient, are responsible for curing the TB patient. Poor patient compliance is responsible for the current TB epidemic because TB patients remain

  9. Unacceptable treatment outcomes and associated factors among India's initial cohorts of multidrug-resistant tuberculosis (MDR-TB) patients under the revised national TB control programme (2007-2011): Evidence leading to policy enhancement.

    Science.gov (United States)

    Parmar, Malik M; Sachdeva, Kuldeep Singh; Dewan, Puneet K; Rade, Kiran; Nair, Sreenivas A; Pant, Rashmi; Khaparde, Sunil D

    2018-01-01

    Globally, India has the world's highest burden of multidrug-resistant tuberculosis (MDR-TB). Programmatic Management of Drug Resistant TB (PMDT) in India began in 2007 and nationwide coverage was achieved in early 2013. Poor initial microbiological outcomes under the Revised National Tuberculosis Control Programme (RNTCP) prompted detailed analysis. This is the first study on factors significantly associated with poor outcomes in MDR-TB patients treated under the RNTCP. To evaluate initial sputum culture conversion, culture reversion and final treatment outcomes among MDR-TB patients registered in India from 2007 to early 2011 who were treated with a standard 24-month regimen under daily-observed treatment. This is a retrospective cohort study. Clinical and microbiological data were abstracted from PMDT records. Initial sputum culture conversion, culture reversion and treatment outcomes were defined by country adaptation of the standard WHO definitions (2008). Cox proportional hazards modeling with logistic regression, multinomial logistic regression and adjusted odds ratio was used to evaluate factors associated with interim and final outcomes respectively, controlling for demographic and clinical characteristics. In the cohort of 3712 MDR-TB patients, 2735 (73.6%) had initial sputum culture conversion at 100 median days (IQR 92-125), of which 506 (18.5%) had culture reversion at 279 median days (IQR 202-381). Treatment outcomes were available for 2264 (60.9%) patients while 1448 (39.0%) patients were still on treatment or yet to have a definite outcome at the time of analysis. Of 2264 patients, 781 (34.5%) had treatment success, 644 (28.4%) died, 670 (29.6%) were lost to follow up, 169 (7.5%) experienced treatment failure or were changed to XDR-TB treatment. Factors significantly associated with either culture non-conversion, culture reversion and/or unfavorable treatment outcomes were baseline BMI TB patients, 62 (59.6%) had Ofloxacin resistance among whom only

  10. Definition of drug resistance of Mycobacterium tuberculosis to antituberculosis drugs in patients with multidrugresistant tuberculosis and TB with extremely drug resistant depending on the case of the disease

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    Kryzhanovsky D.G.

    2014-11-01

    Full Text Available There was studied the profile of drug resistance to the main (I line and reserve (II line antituberculosis drugs in patients with MDR and XDR tuberculosis, depending of the case of the disease. According to the randomized retrospective research 200 patients with MDR and XDR tuberculosis, who received treatment in the clinic of hospital Municipal institution «Dnipropetrovsk rigional clinical association «Phthisiology» Dnipropetrovsk regional Council» during the period 2010 – 2012 were involved. Data about patients contained the data on a case of the disease and the results of the test of drug sensitivity to MBT. XDR – TB was revealed in 7.5% of patients with MDR tuberculosis. In patients with MDR tuberculosis as compared with patients with XDR tuberculosis «new cases» were diagnosed in 19.5% against 18.5% (p <0.05. In patients with MDR tuberculosis and with XDR tuberculosis resistance to the antituberculosis drug more commonly developed to S - 88.5%, E - 55% and Z - 24%. The presence of MDR-TB and XDR-TB prevails in patients, who underwent previous courses of treatment with anti-TB drugs in case history as compared with patients with «new cases» of treatment. The development of resistance to anti-TB drugs depends on the availability of these drugs in the previous treatment regimens.

  11. CHARACTERISTICS OF TUBERCULOSIS (TB IN GERIATRIC PATIENTS - INITIAL TREATMENT AND OUTCOME

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    Zoran P. Stamenković

    2003-07-01

    Full Text Available 1090 TB pts were diagnosed and treated during the l992 - 2001. year (y. 227(20,8% pts were older then 65. y, mean age of 73,5 - 1,5 y, with male / female ratio of 57,3% / 42,7%. Most of them were farmers (44,9% and retired (37,4%. Most dominant symptoms were chronic cough (90, 3%, weight loss (83, 2%. 44,5% had positive tuberculin test. 87,7% were new cases, 11,8% defaulters and 0,5% chronic cases (WHO criteria. Most concomitant diseases were diabetes mellitus (19,8%, cardiac diseases (15,9%, while 3,5% had active malignancy. Chest X-ray shown cavities in 41,4% pts, infiltrations in 29,9% and milliary lesions in 3,9%. 30,4% lesions were atypical, while 60,8% pts had bilateral fibrosis lesions. Extra pulmonary TB were in 9,7% pts, mostly on pleura (59,1%, and kidney (13,6%. 41,4% treated with H, R, Z, S / E, 46,3% H, R, Z / E and 12,4% H, R, Z, S, E. 10,6% pts had liver function disturbances, 7,9% had allergy on Z and 4,4% pts died. Conversion rate in only the culture positive pts were faster and shown significance (p<0,05.TB in the elderly has extended / latent clinical picture, atypical radio graphic localization, high frequency of concomitant diseases, demanding longer hospital treatment. Fibrotic pulmonary lesions, atypical pulmonary infiltrations and presence of concomitant diseases in elderly, must be alarm in future TB screening.

  12. THE EFFECT OF DIFFERENT TB DRUGS AND ANTIMICROBIAL AGENTS ON THE EFFICIENCY OF TREATMENT OF TUBERCULOSIS PATIENTS WITH MULTIPLE DRUG RESISTANCE

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    I. A. Vasilyeva

    2017-01-01

    Full Text Available Objective of the study: to study the effect of specific TB drugs and antimicrobial agents constituting chemotherapy regimens on the efficiency of treatment of tuberculosis patients with various patterns of multiple drug resistance.Subjects and Methods. 412 pulmonary tuberculosis patients with bacillary excretion and various patterns of multiple drug resistance were enrolled into the study (117 patients with MDR TB (non pre-XDR and non-XDR; 120 patients with pre-XDR TB and 175 with XDR TB. Patients in the subgroups were compatible regarding sex and age. The patients were prescribed regimens including 5-6 drugs in accordance with their drug resistance pattern. The time of sputum conversion (by culture versus the year of treatment was selected as a surrogate endpoint. The effect of specific TB drugs and antimicrobial agents on treatment efficiency was assessed through calculation of odds ratio (OR of achieving a surrogate endpoint in the patients receiving and not receiving a certain drug.Results. In the subgroup of pre-XDR TB, the following drugs demonstrated the valid increase of odds of sputum conversion: ethambutol (OR 11.8, pyrazinamide (OR 10.2, moxifloxacin (OR 7.8, capreomicin (OR 4.41. Sputum conversion was achieved in all 11 patients treated with bedaquiline.In the subgroup of XDR TB, the following drugs provided a positive effect on the achievement of sputum conversion: bedaquiline (OR 9.62, linezolid (OR 8.15, cycloserine (OR 7.88, pyrazinamide (OR 7.29, moxifloxacin (OR 7.08, and ethambutol (OR 6.69. Ofloxacin demonstrated a confident negative effect on achieving sputum conversion (95% CI 0.06-0.32. 

  13. Association between health systems performance and treatment outcomes in patients co-infected with MDR-TB and HIV in KwaZulu-Natal, South Africa: implications for TB programmes.

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    Marian Loveday

    Full Text Available To improve the treatment of MDR-TB and HIV co-infected patients, we investigated the relationship between health system performance and patient treatment outcomes at 4 decentralised MDR-TB sites.In this mixed methods case study which included prospective comparative data, we measured health system performance using a framework of domains comprising key health service components. Using Pearson Product Moment Correlation coefficients we quantified the direction and magnitude of the association between health system performance and MDR-TB treatment outcomes. Qualitative data from participant observation and interviews analysed using systematic text condensation (STC complemented our quantitative findings.We found significant differences in treatment outcomes across the sites with successful outcomes varying from 72% at Site 1 to 52% at Site 4 (p<0.01. Health systems performance scores also varied considerably across the sites. Our findings suggest there is a correlation between treatment outcomes and overall health system performance which is significant (r = 0.99, p<0.01, with Site 1 having the highest number of successful treatment outcomes and the highest health system performance. Although the 'integration' domain, which measured integration of MDR-TB services into existing services appeared to have the strongest association with successful treatment outcomes (r = 0.99, p<0.01, qualitative data indicated that the 'context' domain influenced the other domains.We suggest that there is an association between treatment outcomes and health system performance. The chance of treatment success is greater if decentralised MDR-TB services are integrated into existing services. To optimise successful treatment outcomes, regular monitoring and support are needed at a district, facility and individual level to ensure the local context is supportive of new programmes and implementation is according to guidelines.

  14. Patient and Provider Reported Reasons for Lost to Follow Up in MDRTB Treatment: A Qualitative Study from a Drug Resistant TB Centre in India.

    Science.gov (United States)

    Deshmukh, Rajesh D; Dhande, D J; Sachdeva, Kuldeep Singh; Sreenivas, Achuthan; Kumar, A M V; Satyanarayana, Srinath; Parmar, Malik; Moonan, Patrick K; Lo, Terrence Q

    2015-01-01

    Multidrug-resistant Tuberculosis (MDR TB) is emerging public health concern globally. Lost to follow-up (LTFU) is one of the key challenge in MDRTB treatment. In 2013, 18% of MDR TB patients were reported LTFU in India. A qualitative study was conducted to obtain better understanding of both patient and provider related factors for LTFU among MDR TB treatment. Qualitative semi-structured personal interviews were conducted with 20 MDRTB patients reported as LTFU and 10 treatment providers in seven districts linked to Nagpur Drug resistant TB Centre (DRTBC) during August 2012-February 2013. Interviews were transcribed and inductive content analysis was performed to derive emergent themes. We found multiple factors influencing MDR TB treatment adherence. Barriers to treatment adherence included drug side effects, a perceived lack of provider support, patient financial constraints, conflicts with the timing of treatment services, alcoholism and social stigma. Patient adherence to treatment is multi-factorial and involves individual patient factors, provider factors, and community factors. Addressing issue of LTFU during MDRTB treatment requires enhanced efforts towards resolving medical problems like adverse drug effects, developing short duration treatment regimens, reducing pill burden, motivational counselling, flexible timings for DOT services, social, family support for patients & improving awareness about disease.

  15. A strong TB programme embedded in a developing primary healthcare system is a lose-lose situation: insights from patient and community perspectives in Cambodia.

    Science.gov (United States)

    Sundaram, Neisha; James, Richard; Sreynimol, Um; Linda, Pen; Yoong, Joanne; Saly, Saint; Koeut, Pichenda; Eang, Mao Tan; Coker, Richard; Khan, Mishal S

    2017-10-01

    As exemplified by the situation in Cambodia, disease specific (vertical) health programmes are often favoured when the health system is fragile. The potential of such an approach to impede strengthening of primary healthcare services has been studied from a health systems perspective in terms of access and quality of care. In this bottom-up, qualitative study we investigate patient and community member experiences of health services when a strong tuberculosis (TB) programme is embedded into a relatively underutilized primary healthcare system. We conducted six gender-stratified community focus group discussions (n = 49) and seven mixed-gender focus group discussions with TB patients (n = 45) in three provinces located in urban, peri-urban and rural areas of Cambodia. Our analysis of health-seeking behaviour and experiences for TB and TB-like illness indicates that building a strong vertical TB control programme has had numerous benefits, including awareness of typical symptoms and need to seek care early; confidence in free TB services at public facilities; and willingness to complete treatment. However, there was a clear dichotomy in experiences and behaviour with respect to care-seeking for less severe illness at primary health services, which were generally avoided owing to access barriers and perceived poor quality. The tendency to delay seeking health care until the development of severe symptoms clearly indicative of TB is a major barrier to early diagnosis and treatment of TB. Our study indicates that an imbalance in the strength of vertical and primary health services could be a lose-lose situation as this impedes improvements in health system functioning and constrains progress of vertical disease control programmes. © The Author 2017. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  16. Number of patients needed to discriminate between subgroups in patient reported outcome measures

    DEFF Research Database (Denmark)

    Paulsen, Aksel

    2011-01-01

    Background: Patient reported outcome-measures (PROs) are increasingly used in orthopedics. Information on number of patients needed in different settings is warranted. Aim: To assess the number of patients needed for different PROs to discriminate between subgroups of age, gender, and diagnosis...... with sample size calculations or by power calculations and simulated ANOVA F tests, depending on the number of groups. Results: To discriminate between gender, the least number needed to find a statistically significant difference in mean sum score in each group was 298 (OHS) while HOOS QoL required the most....... Methods: 5777 primary THA patients, operated 1‐2, 5‐6, and 10‐11 years ago. SF‐12 Health Survey (SF-12), EQ-5D, Oxford 12‐item Hip Score (OHS), and Hip dysfunction and Osteoarthritis Outcome Score (HOOS) were included. The different PRO subscales abilities to discriminate between groups were studied using...

  17. Community-based directly observed treatment for TB patients to improve HIV services: a cross-sectional study in a South African province.

    Science.gov (United States)

    Howell, Embry M; Kigozi, N Gladys; Heunis, J Christo

    2018-04-07

    There is uncertainty about how directly observed treatment (DOT) support for tuberculosis (TB) can be delivered most effectively and how DOT support can simultaneously be used to strengthen human immunodeficiency virus (HIV) prevention and control among TB patients. This study describes how DOT support by community health workers (CHWs) was used in four municipalities in the Free State province - a high TB/HIV burden, poorly-resourced setting - to provide HIV outreach, referrals, and health education for TB patients. The study was part of a larger cross-sectional study of HIV counselling and testing (HCT) among 1101 randomly-selected TB patients registered at 40 primary health care (PHC) facilities (clinics and community health centres) across small town/rural and large town/urban settings. Univariate analysis of percentages, chi-square tests and t-tests for difference in means were used to describe differences between the types of TB treatment support and patient characteristics, as well as the types of - and patient satisfaction with - HIV information and referrals received from various types of treatment supporters including home-based DOT supporters, clinic-based DOT supporters or support from family/friends/employers. Multivariate logistic regression was used to predict the likelihood of not having receiving home-based DOT and of never having received HIV counselling. The independent variables include poverty-related health and socio-economic risk factors for poor outcomes. Statistical significance is shown using a 95% confidence interval and a 0.05 p-value. Despite the fact that DOT support for all TB patients was the goal of South African health policy at the time (2012), most TB patients were not receiving formal DOT support. Only 155 (14.1%) were receiving home-based DOT, while 114 (10.4%) received clinic-based DOT. TB patients receiving home-based DOT reported higher rates of HIV counselling than other patients. Public health providers should train DOT

  18. Listening to Those at the Frontline: Patient and Healthcare Personnel Perspectives on Tuberculosis Treatment Barriers and Facilitators in High TB Burden Regions of Argentina

    Directory of Open Access Journals (Sweden)

    Sarah J. Iribarren

    2014-01-01

    Full Text Available Purpose. In Argentina, tuberculosis (TB control measures have not achieved key treatment targets. The purpose of this study was to identify modes of treatment delivery and explore patient and healthcare personnel perceptions of barriers and facilitators to treatment success. Methods. We used semistructured group and individual interviews for this descriptive qualitative study. Eight high burden municipalities were purposively selected. Patients in treatment for active TB (n=16, multidisciplinary TB team members (n=26, and TB program directors (n=12 at local, municipal, regional, and national levels were interviewed. Interviews were recorded, transcribed verbatim, and analyzed using thematic analysis. Results. Modes of treatment delivery varied across municipalities and types of healthcare facility and were highly negotiated with patients. Self-administration of treatment was common in hospital-based and some community clinics. Barriers to TB treatment success were concentrated at the system level. This level relied heavily on individual personal commitment, and many system facilitators were operating in isolation or in limited settings. Conclusions. We outline experiences and perspectives of the facilitating and challenging factors at the individual, structural, social, and organizational levels. Establishing strong patient-healthcare personnel relationships, responding to patient needs, capitalizing on community resources, and maximizing established decentralized system could mitigate some of the barriers.

  19. Kinetics of the QuantiFERON-TB Gold In-Tube test during treatment of patients with sputum smear-positive tuberculosis in relation to initial TST result and severity of disease

    DEFF Research Database (Denmark)

    Idh, Jonna; Abate, Ebba; Westman, Anna

    2010-01-01

    The QuantiFERON-TB Gold In-Tube test (QFN) measures interferon-gamma production in response to Mycobacterium tuberculosis antigens. Our aim was to assess the kinetics of the QFN and initial tuberculin skin test (TST) result in relation to severity of disease in a tuberculosis (TB) endemic area.......8% to 62.5% in HIV-negative/TB; 70.3% to 33.3% in HIV-positive/TB patients) down to a level comparable to a control group of blood donors (51.2%). The agreement between TST and QFN was poor in TB patients compared to healthy controls. A negative TST correlated to more advanced TB in contrast to a negative...... QFN test. We conclude that the QFN reactivity is significantly reduced at the end of treatment against active TB to the background level of healthy blood donors, and that the agreement between TST and QFN is poor including correlation to the severity of disease....

  20. Perception of Patients With HIV/AIDS From Stigma and Discrimination

    Science.gov (United States)

    Saki, Mandana; Mohammad Khan Kermanshahi, Sima; Mohammadi, Eesa; Mohraz, Minoo

    2015-01-01

    Background: Stigma and discrimination among patients with HIV/AIDS cause various problems for the patients and their health systems. Objectives: The purpose of this study was to explain the perceived experiences of the patients from stigma and discrimination and their roles on health-seeking services among patients. Patients and Methods: This was a qualitative research using content analysis approach and semi-structured interviews, conducted on patients living with HIV/ADS, during 2013 - 2014 in Iran. Sampling started purposefully and continued in a snowball. Results: The experiences of patients with HIV/AIDS from stigma and discrimination led to exploring three main themes and nine subthemes. The main themes were multidimensional stigma, rejection, and insult and discrimination in receiving health services. Conclusions: Stigma and discrimination play an important role in patients' lives and hinder them from accessing the treatment. The patients' responses to this event by secrecy strategy can be an important factor in the disease prevalence. PMID:26290751

  1. [Speech discrimination through telephone in patients implanted with a Combi 40+].

    Science.gov (United States)

    Castro, A; Lassaletta, L; Bastarrica, M; Prim, M P; de Sarriá, M J; Gavilán, J

    2005-01-01

    To assess speech discrimination through line and mobile telephone in cochlear implanted patients. Eighteen patients implanted with a Combi 40+ went through different speech discrimination tests with a line telephone and three mobile telephones, in quiet and noisy environment. Mean scores for telephonic speech discrimination were 84-92% using CID sentences, 27-58% using bisyllabic words in quiet environment and 15-41% using bisyllabic words in noisy environment. Among the mobile telephones tested, the Siemens M55 reached the best scores. Telephonic speech discrimination is achieved by a significant number of cochlear implanted patients. Certain mobile telephone models appear to be more advisable for these patients.

  2. Health care discrimination, processes of care, and diabetes patients' health status.

    Science.gov (United States)

    Piette, John D; Bibbins-Domingo, Kirsten; Schillinger, Dean

    2006-01-01

    We examined whether diabetes patients report discrimination when seeking health care, whether problems with interpersonal processes of care (IPC) were associated with discrimination reports, and the linkage between discrimination and patients' health. 810 diabetes patients were surveyed. Surveys were linked to hemoglobin A1c (A1C) and total cholesterol test results. 14% of participants reported experiencing discrimination in health care during the prior year, including discrimination due to their race (8%), education or income (9%), age (7%), and gender (10% of women). Patients with poorer than average ratings of their IPC had 2-8 times greater risk of reporting health care discrimination. Patients reporting health care discrimination had A1C levels that were higher than other patients (P = 0.002), more symptoms (P discrimination are strongly linked to the quality of their interactions with providers as well as multiple health outcomes. Physicians exert control over the clinical encounter and should endeavor to reduce patients' perceptions of discrimination during outpatient visits. Such efforts may result in more satisfied patients as well as improved health outcomes.

  3. TB control: challenges and opportunities for India.

    Science.gov (United States)

    Pai, Madhukar; Daftary, Amrita; Satyanarayana, Srinath

    2016-03-01

    India's TB control programme has treated over 19 million patients, but the incidence of TB continues to be high. TB is a major killer and drug-resistant TB is a growing threat. There are several likely reasons, including social conditions and co-morbidities that fuel the TB epidemic: under-investment by the government, weak programme implementation and management, suboptimal quality of care in the private sector, and insufficient advocacy around TB. Fortunately, India possesses the technical know-how, competence and resources to address these challenges. The End TB Strategy by WHO offers India an excellent blueprint to advance the agenda of TB control. © The Author 2016. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  4. Time and money: the true costs of health care utilization for patients receiving ‘free’ HIV/TB care and treatment in rural KwaZulu-Natal

    Science.gov (United States)

    Chimbindi, Natsayi; Bor, Jacob; Newell, Marie-Louise; Tanser, Frank; Baltusen, Rob; Hontelez, Jan; de Vlas, Sake; Lurie, Mark; Pillay, Deenan; Bärnighausen, Till

    2015-01-01

    Background HIV and TB services are provided free-of-charge in many sub-Saharan African countries, but patients still incur costs. Methods Patient-exit interviews were conducted with a representative sample of 200 HIV-infected patients not yet on ART (pre-ART), 300 ART patients, and 300 TB patients receiving public sector care in rural South Africa. For each group, we calculated health expenditures across different spending categories, time spent traveling to and utilizing services, and how patients financed their spending. Associations between patient group and costs were assessed in multivariate regression models. Results Total monthly health expenditures (1 USD = 7.3 South African Rand, ZAR) were: ZAR 171 (95% CI 134, 207) for pre-ART, ZAR 164 (95% CI 141, 187) for ART, and ZAR 122 (95% CI 105, 140) for TB patients (p=0.01). Total monthly time costs (in hours) were: 3.4 (95% CI 3.3, 3.5) for pre-ART, 5.0 (95% CI 4.7, 5.3) for ART and 3.2 (95% CI 2.9, 3.4) for TB patients (pART patients spent on average ZAR 29.2 more on traditional healers and ZAR 25.9 more on chemists and private doctors than ART patients, while ART patients spent ZAR 34.0 more than pre-ART patients on transport to clinics (pART, 39% of ART and 41% of TB patients borrowed money or sold assets to finance health costs. Conclusions Patients receiving nominally free care for HIV/TB face large private costs, commonly leading to financial distress. Subsidized transport, fewer clinic visits, and drug pickup points closer to home could reduce costs for ART patients, potentially improving retention and adherence. Large expenditure on alternative care among pre-ART patients suggests that transitioning patients to ART earlier, as under HIV treatment-as-prevention policies, may not substantially increase patients’ financial burden. PMID:26371611

  5. Whole genome sequencing reveals mycobacterial microevolution among concurrent isolates from sputum and blood in HIV infected TB patients.

    Science.gov (United States)

    Ssengooba, Willy; de Jong, Bouke C; Joloba, Moses L; Cobelens, Frank G; Meehan, Conor J

    2016-08-05

    In the context of advanced immunosuppression, M. tuberculosis is known to cause detectable mycobacteremia. However, little is known about the intra-patient mycobacterial microevolution and the direction of seeding between the sputum and blood compartments. From a diagnostic study of HIV-infected TB patients, 51 pairs of concurrent blood and sputum M. tuberculosis isolates from the same patient were available. In a previous analysis, we identified a subset with genotypic concordance, based on spoligotyping and 24 locus MIRU-VNTR. These paired isolates with identical genotypes were analyzed by whole genome sequencing and phylogenetic analysis. Of the 25 concordant pairs (49 % of the 51 paired isolates), 15 (60 %) remained viable for extraction of high quality DNA for whole genome sequencing. Two patient pairs were excluded due to poor quality sequence reads. The median CD4 cell count was 32 (IQR; 16-101)/mm(3) and ten (77 %) patients were on ART. No drug resistance mutations were identified in any of the sequences analyzed. Three (23.1 %) of 13 patients had SNPs separating paired isolates from blood and sputum compartments, indicating evidence of microevolution. Using a phylogenetic approach to identify the ancestral compartment, in two (15 %) patients the blood isolate was ancestral to the sputum isolate, in one (8 %) it was the opposite, and ten (77 %) of the pairs were identical. Among HIV-infected patients with poor cellular immunity, infection with multiple strains of M. tuberculosis was found in half of the patients. In those patients with identical strains, whole genome sequencing indicated that M. tuberculosis intra-patient microevolution does occur in a few patients, yet did not reveal a consistent direction of spread between sputum and blood. This suggests that these compartments are highly connected and potentially seed each other repeatedly.

  6. Clinical and programmatic considerations in the treatment of MDR-TB in children: a series of 16 patients from Lima, Peru.

    Science.gov (United States)

    Mukherjee, J S; Joseph, J K; Rich, M L; Shin, S S; Furin, J J; Seung, K J; Sloutsky, A; Socci, A R; Vanderwarker, C; Vasquez, L; Palacios, E; Guerra, D; Viru, F A; Farmer, P; Del Castillo, H E

    2003-07-01

    Since 2000, the directly observed treatment, short-course (DOTS) strategy has been expanded in several countries to include treatment of multidrug-resistant tuberculosis (MDR-TB). This strategy is known as DOTS-Plus. Tuberculosis is a common cause of morbidity and mortality for children throughout the developing world. Children may also be infected with MDR-TB, yet most developing countries do not specifically address pediatric MDR-TB. To present the intermediate outcomes of the first 16 children enrolled in the Peruvian DOTS-Plus program and to demonstrate the tolerability of second-line anti-tuberculosis drugs. Three children completed therapy and are cured, one child had bacteriologic and clinical failure after 12 months of therapy and died of respiratory insufficiency, and 12 have intermediate outcomes demonstrating favorable clinical, bacteriologic, and radiographic evidence of improvement after 9-19 months of therapy. Of the 16 pediatric DOTS-Plus patients, 15 have tolerated therapy well and have had favorable clinical evolution. However, the diagnosis of pediatric MDR-TB is often extremely delayed due to reliance on the adult case definition and should be changed to prevent progressive, chronic illness in such children. Programmatic changes could facilitate earlier diagnosis and treatment of pediatric MDR-TB in Peru and in other DOTS-Plus programs.

  7. Testing for TB Infection

    Science.gov (United States)

    ... Studies Consortium Research Projects Publications TB Trials Consortium Study Descriptions Background Behavioral & Social Science Research Infection Control TB in Specific Populations African-American Community Stop TB in the African-American ...

  8. Employment discrimination against obese women in obesity clinic's patients perspective.

    Science.gov (United States)

    Obara-Gołębiowska, Małgorzata

    2016-01-01

    The workplace is one of many areas of life where obese people are unfairly treated. According to the literature obese women are particularly susceptible to discrimination in employment. There is a lack of polish researches of this subject. The main objective of this study was to analyze personal, subjective experiences related to weight bias and discrimination against obese people in the workplace of obese Polish women. The study was carried out in a hospital clinic for obesity management. A total of 420 women with BMI>30, aged 21 to 72, participated in group interviews focused on the weight bias and discrimination against obese people in the workplace. In the group of clinically obese women, 5.3% of subjects had experienced employment discrimination and 10.5% had been victims of verbal and social abuse in the workplace. The most common psycho-physical consequences of the weight stigma were emotional problems, lack of motivation and overeating in response to stress. Weight-based discrimination in the workplace poses a problem in Poland. The weight stigma and occupational discrimination lead to psycho-physical discomfort which exacerbates overeating and obesity.

  9. A DNA-PKcs mutation in a radiosensitive T-B- SCID patient inhibits Artemis activation and nonhomologous end-joining

    NARCIS (Netherlands)

    M. van der Burg (Mirjam); H. IJspeert (Hanna); N.S. Verkaik (Nicole); T. Turul (Tuba); W.W. Wiegant (Wouter); K. Morotomi-Yano (Keiko); P.O. Mari (Pierre-Olivier); I. Tezcan (Ilhan); D.J. Chen (David); M.Z. Zdzienicka (Malgorzata); J.J.M. van Dongen (Jacques); D.C. van Gent (Dik)

    2009-01-01

    textabstractRadiosensitive T-B- severe combined immunodeficiency (RS-SCID) is caused by defects in the nonhomologous end-joining (NHEJ) DNA repair pathway, which results in failure of functional V(D)J recombination. Here we have identified the first human RS-SCID patient to our knowledge with a

  10. The relationship between perceived discrimination and patient experiences with health care.

    Science.gov (United States)

    Weech-Maldonado, Robert; Hall, Allyson; Bryant, Thomas; Jenkins, Kevin A; Elliott, Marc N

    2012-09-01

    Prior studies have shown that racial/ethnic minorities have lower Consumer Assessments of Healthcare Providers and Systems (CAHPS) scores. Perceived discrimination may mediate the relationship between race/ethnicity and patient experiences with care. To examine the relationship between perceived discrimination based on race/ethnicity and Medicaid insurance and CAHPS reports and ratings of care. The study analyzed 2007 survey data from 1509 Florida Medicaid beneficiaries. CAHPS reports (getting needed care, timeliness of care, communication with doctor, and health plan customer service) and ratings (personal doctor, specialist care, overall health care, and health plan) of care were the primary outcome variables. Patient perceptions of discrimination based on their race/ethnicity and having Medicaid insurance were the primary independent variables. Regression analysis modeled the effect of perceptions of discrimination on CAHPS reports and ratings controlling for age, sex, education, self-rated health status, race/ethnicity, survey language, and fee-for-service enrollment. SEs were corrected for correlation within plans. Medicaid beneficiaries reporting discrimination based on race/ethnicity had lower CAHPS scores, ranging from 15 points lower (on a 0-100 scale) for getting needed care to 6 points lower for specialist rating, compared with those who never experienced discrimination. Similar results were obtained for perceived discrimination based on Medicaid insurance. Perceptions of discrimination based on race/ethnicity and Medicaid insurance are prevalent and are associated with substantially lower CAHPS reports and ratings of care. Practices must develop and implement strategies to reduce perceived discrimination among patients.

  11. Factors Associated with Treatment Failure among Smear Positive TB Patients in Khorasan-e-Razavi and Sistan-Baluchistan Provinces, Iran

    Directory of Open Access Journals (Sweden)

    Hekmatollah Khoubfekr, Narges Khanjani, Yunes Jahani, Mahmoud Moosazadeh

    2016-12-01

    Full Text Available Introduction: Tuberculosis (TB treatment failure is one of the major problems of the health sector in developing countries. Poor treatment of patients leads to drug resistance, relapse, death, and ultimately prevents TB control programs. This study was conducted to determine the factors affecting tuberculosis treatment failure in Khorasan and Sistan- Balochistan regions which have a high prevalence of TB. Methods: In this case - control study 270 patients with tuberculosis (90 cases, 180 controls were analyzed. New TB patients registered with failure to treatment according to the national protocol between March 2008 - March 2012 were chosen as cases and new TB patients with negative sputum smear in the same time frame were enrolled as control group. Demographic data and clinical treatment outcomes were collected through interviews and file records. Multivariate logistic regression analysis was used to determine the predictors of treatment failure in SPSS 19. Results: Independent factors and predictors of failure treatment included illiteracy, a three plus positive sputum smear, positive sputum smear at end of the second month, non-implementation of the Directly Observed Treatment Short strategy by healthcare staff, history of addiction and history of diabetes. Conclusion: Intervention programs for early detection and control of diabetes, drug control programs, giving priority to providing DOTS by health care workers, more individual care and attention to patients with initial smear p + 3 or those that remain sputum positive at the end of the second month or those who are less educated is necessary. J Microbiol Infect Dis 2016;6(4: 172-178

  12. Why healthcare workers are sick of TB

    Directory of Open Access Journals (Sweden)

    Arne von Delft

    2015-03-01

    Full Text Available Dr Thato Mosidi never expected to be diagnosed with tuberculosis (TB, despite widely prevalent exposure and very limited infection control measures. The life-threatening diagnosis of primary extensively drug-resistant TB (XDR-TB came as an even greater shock. The inconvenient truth is that, rather than being protected, Dr Mosidi and thousands of her healthcare colleagues are at an increased risk of TB and especially drug-resistant TB. In this viewpoint paper we debunk the widely held false belief that healthcare workers are somehow immune to TB disease (TB-proof and explore some of the key factors contributing to the pervasive stigmatization and subsequent non-disclosure of occupational TB. Our front-line workers are some of the first to suffer the consequences of a progressively more resistant and fatal TB epidemic, and urgent interventions are needed to ensure the safety and continued availability of these precious healthcare resources. These include the rapid development and scale-up of improved diagnostic and treatment options, strengthened infection control measures, and focused interventions to tackle stigma and discrimination in all its forms. We call our colleagues to action to protect themselves and those they care for.

  13. Outcomes of multi-drug resistant tuberculosis (MDR-TB among a cohort of South African patients with high HIV prevalence.

    Directory of Open Access Journals (Sweden)

    Jason E Farley

    Full Text Available Multidrug-resistant tuberculosis (MDR-TB is a major clinical challenge, particularly in patients with human immunodeficiency virus (HIV co-infection. MDR-TB treatment is increasingly available, but outcomes have not been well characterized. South Africa has provided MDR-TB treatment for a decade, and we evaluated outcomes by HIV status for patients enrolled between 2000 and 2004 prior to anti-retroviral access.We assessed treatment outcomes in a prospective cohort of patients with MDR-TB from eight provincial programs providing second line drugs. World Health Organization definitions were used. Results were stratified by HIV status.Seven hundred fifty seven patients with known HIV status were included in the final analysis, and HIV infection was documented in 287 (38%. Overall, 348 patients (46.0% were successfully treated, 74 (9.8% failed therapy, 177 (23.4% died and 158 (20.9% defaulted. Patients with HIV were slightly younger and less likely to be male compared to HIV negative patients. Patients with HIV were less likely to have a successful treatment outcome (40.0 vs. 49.6; P<0.05 and more likely to die (35.2 vs. 16.2; P<0.0001. In a competing risk survival analysis, patients with HIV had a higher hazard of death (HR: 2.33, P<0.0001. Low baseline weight (less than 45 kg and less than 60 kg was also associated with a higher hazard of death (HR: 2.52, P<0.0001; and HR: 1.50, P<0.0001, respectively, compared to weight greater than 60 kg. Weight less than 45 kg had higher risk of failure (HR: 3.58, P<0.01. Any change in treatment regimen was associated with a higher hazard of default (HR: 2.86; 95% CI 1.55-5.29, P<0.001 and a lower hazard of death (HR: 0.63, P<0.05.In this MDR-TB treatment program patients with HIV infection and low weight had higher hazards of death. Overall treatment outcomes were poor. Efforts to improve treatment for MDR-TB are urgently needed.

  14. History taking in TB patients at Likuni mission hospital in Malawi ...

    African Journals Online (AJOL)

    In the file audit for patients diagnosed and treated at Likuni Mission Hospital from January to July 1997 the results show unsystematic recording of patient history. Out of 88 case notes reviewed none contained patients' events before diagnosis was made. 34% had no duration of symptoms recorded and 19% had no ...

  15. Tuberculosis Facts - Exposure to TB

    Science.gov (United States)

    Tuberculosis (TB) Facts Exposure to TB What is TB? “TB” is short for a disease called tuberculosis. TB is spread through the air from one ... Viral Hepatitis, STD, and TB Prevention Division of Tuberculosis Elimination

  16. Tuberculosis Facts - Testing for TB

    Science.gov (United States)

    Tuberculosis (TB) Facts Testing for TB What is TB? “TB” is short for a disease called tuberculosis. TB is spread through the air from one ... Viral Hepatitis, STD, and TB Prevention Division of Tuberculosis Elimination

  17. Pathways Between Discrimination and Quality of Life in Patients with Type 2 Diabetes.

    Science.gov (United States)

    Achuko, Obinna; Walker, Rebekah J; Campbell, Jennifer A; Dawson, Aprill Z; Egede, Leonard E

    2016-03-01

    Discrimination is a social determinant that has been linked to poor physical and mental health outcomes. This study aimed to examine the pathway whereby discrimination influences quality of life in patients with type 2 diabetes. Six hundred fifteen patients were recruited from two adult primary care clinics in the southeastern United States. Measures included perceived discrimination, perceived stress, social support, and social cohesion and were based on a theoretical model for the pathways by which perceived discrimination influences mental and physical health. Quality of life was measured using the SF-12 questionnaire. The final model [χ(2)(106) = 157.35, P = 0.009, R(2) = 0.99, root mean square error of approximation = 0.03, comparative fit index = 0.99] indicates direct effects of higher perceived stress (r = -1.02, P Discrimination and social cohesion were not significantly directly related to MCS. However, higher discrimination (r = 0.47, P discrimination was significantly associated with stress and served as a pathway to influence the mental health component of quality of life (MCS). Social support had a direct and an indirect effect on MCS through a negative association with stress. These results suggest that future interventions should be developed to decrease stress and increase social support surrounding discrimination to improve the MCS of quality of life in patients with diabetes.

  18. [Healthcare mistreatment attributed to discrimination among mapuche patients and discontinuation of diabetes care].

    Science.gov (United States)

    Ortiz, Manuel S; Baeza-Rivera, María José; Salinas-Oñate, Natalia; Flynn, Patricia; Betancourt, Héctor

    2016-10-01

    The negative impact of perceived discrimination on health outcomes is well established. However, less attention has been directed towards understanding the effect of perceived discrimination on health behaviors relevant for the treatment of diabetes in ethnic minorities. To examine the effects of healthcare mistreatment attributed to discrimination on the continuity of Type 2 Diabetes (DM2) care among mapuche patients in a southern region of Chile. A non-probabilistic sample of 85 mapuche DM2 patients were recruited from public and private health systems. Eligibility criteria included having experienced at least one incident of interpersonal healthcare mistreatment. All participants answered an instrument designed to measure healthcare mistreatment and continuity of diabetes care. Healthcare mistreatment attributed to ethnic discrimination was associated with the discontinuation of diabetes care. Healthcare mistreatment attributed to discrimination negatively impacted the continuity of diabetes care, a fact which may provide a better understanding of health disparities in ethnic minorities.

  19. Determination of circulating Mycobacterium tuberculosis strains and transmission patterns among TB patients in Iran, using 15 loci MIRU-VNTR

    Directory of Open Access Journals (Sweden)

    S Zamani

    2015-01-01

    Conclusions: MIRU-VNTR typing showed a high genetic diversity and suggests the possibility of transmission from Sistan–Baluchestan to other provinces of Iran. This method could be considered a suitable tool for studying the transmission routes of TB and leading to more appropriate measures for TB control. MIRU-VNTR typing leads to a much better understanding of the bacterial population structure and phylogenetic relationships between strains of MTB in different regions of Iran.

  20. Find TB. Treat TB. Working together to eliminate TB.

    Centers for Disease Control (CDC) Podcasts

    2014-02-26

    In this podcast, Dr. Sundari Mase, Medical Team Lead in the Field Services and Evaluation Branch in the Division of Tuberculosis Elimination, discusses World TB Day and the 2014 theme.  Created: 2/26/2014 by National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP).   Date Released: 2/26/2014.

  1. Survival of HIV-TB co-infected adult patients under ART in Ambo ...

    African Journals Online (AJOL)

    admin

    Objectives: To estimate the survival of HIV/AIDS co-infected patients and to identify predictors of survival based on data obtained from Ambo referral hospital, .... done using SPSS, SAS, and STATA software. The response/outcome variable of this ..... Control Program Manual, Fourth Edition. Addis. Ababa; Ethiopia, 2008. 7.

  2. What are the reasons for patients not adhering to their anti-TB ...

    African Journals Online (AJOL)

    2008-11-13

    Nov 13, 2008 ... needs to be done in terms of helping patients to access facilities through transport, or in making services more available at the community level through DOTS (Directly .... Data were collated in Excel and analysed by a consultant statistician, using Statistica 8 at the ..... Cochrane Database [ 2001 4]. 9. WHO.

  3. Patient-reported Communication Quality and Perceived Discrimination in Maternity Care.

    Science.gov (United States)

    Attanasio, Laura; Kozhimannil, Katy B

    2015-10-01

    High-quality communication and a positive patient-provider relationship are aspects of patient-centered care, a crucial component of quality. We assessed racial/ethnic disparities in patient-reported communication problems and perceived discrimination in maternity care among women nationally and measured racial/ethnic variation in the correlates of these outcomes. Data for this analysis came from the Listening to Mothers III survey, a national sample of women who gave birth to a singleton baby in a US hospital in 2011-2012. Outcomes were reluctance to ask questions and barriers to open discussion in prenatal care, and perceived discrimination during the birth hospitalization, assessed using multinomial and logistic regression. We also estimated models stratified by race/ethnicity. Over 40% of women reported communication problems in prenatal care, and 24% perceived discrimination during their hospitalization for birth. Having hypertension or diabetes was associated with higher levels of reluctance to ask questions and higher odds of reporting each type of perceived discrimination. Black and Hispanic (vs. white) women had higher odds of perceived discrimination due to race/ethnicity. Higher education was associated with more reported communication problems among black women only. Although having diabetes was associated with perceptions of discrimination among all women, associations were stronger for black women. Race/ethnicity was associated with perceived racial discrimination, but diabetes and hypertension were consistent predictors of communication problems and perceptions of discrimination. Efforts to improve communication and reduce perceived discrimination are an important area of focus for improving patient-centered care in maternity services.

  4. Hospital design to accommodate multi- and extensively drug-resistant TB patients

    CSIR Research Space (South Africa)

    Parsons, SA

    2008-10-01

    Full Text Available facilities or the refurbishing of existing structures. Moreover, the need to improve the quality and functionality of health facilities through better design and operational management is a priority if infection control risk management processes... ventilation rates to minimise risk. Whilst the disadvantages of reliance on natural ventilation for infection control may include climate dependence and impact on patient comfort, the low cost of installation, operation and maintenance should...

  5. Factors Associated with Medical Doctors' Intentions to Discriminate Against Transgender Patients in Kuala Lumpur, Malaysia

    Science.gov (United States)

    Vijay, Aishwarya; Earnshaw, Valerie A.; Tee, Ying Chew; Pillai, Veena; White Hughto, Jaclyn M.; Clark, Kirsty; Kamarulzaman, Adeeba; Altice, Frederick L.

    2018-01-01

    Abstract Purpose: Transgender people are frequent targets of discrimination. Discrimination against transgender people in the context of healthcare can lead to poor health outcomes and facilitate the growth of health disparities. This study explores factors associated with medical doctors' intentions to discriminate against transgender people in Malaysia. Methods: A total of 436 physicians at two major university medical centers in Kuala Lumpur, Malaysia, completed an online survey. Sociodemographic characteristics, stigma-related constructs, and intentions to discriminate against transgender people were measured. Bivariate and multivariate linear regression were used to evaluate independent covariates of discrimination intent. Results: Medical doctors who felt more fearful of transgender people and more personal shame associated with transgender people expressed greater intention to discriminate against transgender people, whereas doctors who endorsed the belief that transgender people deserve good care reported lower discrimination intent. Stigma-related constructs accounted for 42% of the variance and 8% was accounted for by sociodemographic characteristics. Conclusions: Constructs associated with transgender stigma play an important role in medical doctors' intentions to discriminate against transgender patients. Development of interventions to improve medical doctors' knowledge about and attitudes toward transgender people are necessary to reduce discriminatory intent in healthcare settings. PMID:29227183

  6. Factors Associated with Medical Doctors' Intentions to Discriminate Against Transgender Patients in Kuala Lumpur, Malaysia.

    Science.gov (United States)

    Vijay, Aishwarya; Earnshaw, Valerie A; Tee, Ying Chew; Pillai, Veena; White Hughto, Jaclyn M; Clark, Kirsty; Kamarulzaman, Adeeba; Altice, Frederick L; Wickersham, Jeffrey A

    2018-01-01

    Transgender people are frequent targets of discrimination. Discrimination against transgender people in the context of healthcare can lead to poor health outcomes and facilitate the growth of health disparities. This study explores factors associated with medical doctors' intentions to discriminate against transgender people in Malaysia. A total of 436 physicians at two major university medical centers in Kuala Lumpur, Malaysia, completed an online survey. Sociodemographic characteristics, stigma-related constructs, and intentions to discriminate against transgender people were measured. Bivariate and multivariate linear regression were used to evaluate independent covariates of discrimination intent. Medical doctors who felt more fearful of transgender people and more personal shame associated with transgender people expressed greater intention to discriminate against transgender people, whereas doctors who endorsed the belief that transgender people deserve good care reported lower discrimination intent. Stigma-related constructs accounted for 42% of the variance and 8% was accounted for by sociodemographic characteristics. Constructs associated with transgender stigma play an important role in medical doctors' intentions to discriminate against transgender patients. Development of interventions to improve medical doctors' knowledge about and attitudes toward transgender people are necessary to reduce discriminatory intent in healthcare settings.

  7. Sputum is a surrogate for bronchoalveolar lavage for monitoring Mycobacterium tuberculosis transcriptional profiles in TB patients.

    Science.gov (United States)

    Garcia, Benjamin J; Loxton, Andre G; Dolganov, Gregory M; Van, Tran T; Davis, J Lucian; de Jong, Bouke C; Voskuil, Martin I; Leach, Sonia M; Schoolnik, Gary K; Walzl, Gerhard; Strong, Michael; Walter, Nicholas D

    2016-09-01

    Pathogen-targeted transcriptional profiling in human sputum may elucidate the physiologic state of Mycobacterium tuberculosis (M. tuberculosis) during infection and treatment. However, whether M. tuberculosis transcription in sputum recapitulates transcription in the lung is uncertain. We therefore compared M. tuberculosis transcription in human sputum and bronchoalveolar lavage (BAL) samples from 11 HIV-negative South African patients with pulmonary tuberculosis. We additionally compared these clinical samples with in vitro log phase aerobic growth and hypoxic non-replicating persistence (NRP-2). Of 2179 M. tuberculosis transcripts assayed in sputum and BAL via multiplex RT-PCR, 194 (8.9%) had a p-value <0.05, but none were significant after correction for multiple testing. Categorical enrichment analysis indicated that expression of the hypoxia-responsive DosR regulon was higher in BAL than in sputum. M. tuberculosis transcription in BAL and sputum was distinct from both aerobic growth and NRP-2, with a range of 396-1020 transcripts significantly differentially expressed after multiple testing correction. Collectively, our results indicate that M. tuberculosis transcription in sputum approximates M. tuberculosis transcription in the lung. Minor differences between M. tuberculosis transcription in BAL and sputum suggested lower oxygen concentrations or higher nitric oxide concentrations in BAL. M. tuberculosis-targeted transcriptional profiling of sputa may be a powerful tool for understanding M. tuberculosis pathogenesis and monitoring treatment responses in vivo. Published by Elsevier Ltd.

  8. Developing a point-of-care electronic medical record system for TB/HIV co-infected patients: experiences from Lighthouse Trust, Lilongwe, Malawi.

    Science.gov (United States)

    Tweya, Hannock; Feldacker, Caryl; Gadabu, Oliver Jintha; Ng'ambi, Wingston; Mumba, Soyapi L; Phiri, Dave; Kamvazina, Luke; Mwakilama, Shawo; Kanyerere, Henry; Keiser, Olivia; Mwafilaso, Johnbosco; Kamba, Chancy; Egger, Matthias; Jahn, Andreas; Simwaka, Bertha; Phiri, Sam

    2016-03-05

    Implementation of user-friendly, real-time, electronic medical records for patient management may lead to improved adherence to clinical guidelines and improved quality of patient care. We detail the systematic, iterative process that implementation partners, Lighthouse clinic and Baobab Health Trust, employed to develop and implement a point-of-care electronic medical records system in an integrated, public clinic in Malawi that serves HIV-infected and tuberculosis (TB) patients. Baobab Health Trust, the system developers, conducted a series of technical and clinical meetings with Lighthouse and Ministry of Health to determine specifications. Multiple pre-testing sessions assessed patient flow, question clarity, information sequencing, and verified compliance to national guidelines. Final components of the TB/HIV electronic medical records system include: patient demographics; anthropometric measurements; laboratory samples and results; HIV testing; WHO clinical staging; TB diagnosis; family planning; clinical review; and drug dispensing. Our experience suggests that an electronic medical records system can improve patient management, enhance integration of TB/HIV services, and improve provider decision-making. However, despite sufficient funding and motivation, several challenges delayed system launch including: expansion of system components to include of HIV testing and counseling services; changes in the national antiretroviral treatment guidelines that required system revision; and low confidence to use the system among new healthcare workers. To ensure a more robust and agile system that met all stakeholder and user needs, our electronic medical records launch was delayed more than a year. Open communication with stakeholders, careful consideration of ongoing provider input, and a well-functioning, backup, paper-based TB registry helped ensure successful implementation and sustainability of the system. Additional, on-site, technical support provided

  9. Cloning and expression of pab gene of M. tuberculosis isolated from pulmonary TB patient in E.coli DH5α

    Directory of Open Access Journals (Sweden)

    Tri Y. M. Raras

    2011-11-01

    Full Text Available Background: Mycobacterium tuberculosis antigen38 is a potent serodiagnostic agent containing two M. tuberculosisspecific B-cell epitopes. The high price of imported diagnostic agents hinders realization of fast clinical TB diagnosis in developing countries. Therefore, we produced recombinant antigen38 (recAg38M from M. tuberculosis local strain, which might be used to produce economical tuberculosis serodiagnostic kit.Methods: Pab gene that was isolated from pulmonary TB patient in Malang was cloned into a plasmid vector (pGEMTeasy to construct pMB38. The E.coli DH5α clone carrying pMb38 was selected on X-gal medium. The expression of pab was mediated using pPRoExHTc under the control of Trc promoter and E.coli DH5α as host.Results: Alignment of the pab sequence from the white E.coli DH5α clones with that of M. tuberculosis H37Rv showed 98% homology. The recombinant protein in which the signal peptide has been deleted to prevent the protein being secreted into medium was found in the cytoplasm.Conclusion: pab gene of M. tuberculosis isolated from a TB patient could be expressed in heterologous system in E.coliDH5α. (Med J Indones 2011; 20:247-54Keywords: Mycobacterium tuberculosis, Pab gene expression, recombinant antigen38

  10. Mental Health-Related Stigma and Discrimination in Ghana: Experience of Patients and Their Caregivers.

    Science.gov (United States)

    Tawiah, P E; Adongo, P B; Aikins, M

    2015-03-01

    Mental health is now attracting increased public health attention from health professionals, policy makers and the general population. However, stigma and discrimination usually have enormous negative impact on the patients and their families. This study reports on stigma and discrimination faced by mental health patients and their caregivers in a suburban area of Ghana and the coping strategies used. This is a cross-sectional exploratory study which used both quantitative and qualitative approaches. Two hundred and seventy seven mental health patients were purposively interviewed. Focus group discussions were held with caregivers and in-depth interviews were held with mental health professionals. The quantitative data were analyzed using SPSS and Microsoft Excel(®) whilst the qualitative data were coded and manually analyzed thematically. Mental disorder cuts across all age, sex, education, ethnicity, employment, and marital status. More females were stigmatized than males at the work/employment and educational levels. Various forms of stigma were observed at the economic, psychological and social levels, whilst for discrimination it was only observed at the economic and social levels. Caregivers were also stigmatized and discriminated. The coping strategies adopted by the mental patients and their caregivers were also economic, psychological and social in nature. Mental health patients and their families suffer from stigma and discrimination from the individual, family, work, employment, education to the health level. Thus, community level policy on mental health care needs to be developed and implemented. Furthermore mental health education needs to be intensified at the community level.

  11. Deficits in recognition, identification, and discrimination of facial emotions in patients with bipolar disorder

    Directory of Open Access Journals (Sweden)

    Adolfo Benito

    2013-12-01

    Full Text Available Objective: To analyze the recognition, identification, and discrimination of facial emotions in a sample of outpatients with bipolar disorder (BD. Methods: Forty-four outpatients with diagnosis of BD and 48 matched control subjects were selected. Both groups were assessed with tests for recognition (Emotion Recognition-40 - ER40, identification (Facial Emotion Identification Test - FEIT, and discrimination (Facial Emotion Discrimination Test - FEDT of facial emotions, as well as a theory of mind (ToM verbal test (Hinting Task. Differences between groups were analyzed, controlling the influence of mild depressive and manic symptoms. Results: Patients with BD scored significantly lower than controls on recognition (ER40, identification (FEIT, and discrimination (FEDT of emotions. Regarding the verbal measure of ToM, a lower score was also observed in patients compared to controls. Patients with mild syndromal depressive symptoms obtained outcomes similar to patients in euthymia. A significant correlation between FEDT scores and global functioning (measured by the Functioning Assessment Short Test, FAST was found. Conclusions: These results suggest that, even in euthymia, patients with BD experience deficits in recognition, identification, and discrimination of facial emotions, with potential functional implications.

  12. The performance and limitation of T-SPOT.TB for the diagnosis of TB in a high prevalence setting.

    Science.gov (United States)

    Zhu, Changtai; Liu, Zhonghua; Li, Zhiqiang; Mei, Shencong; Hu, Zhongyi

    2014-06-01

    Tuberculosis (TB) diagnosis remains difficulty. The previous reports have shown that the T-SPOT.TB assay may be a more promising diagnostic tool for TB, however, it needs a further study to evaluate the diagnostic value of T-SPOT.TB for the specific populations in a high prevalence setting. In this present study, we conducted stratified and comparable analyses to explore the clinical value and the limitation of T-SPOT.TB assay in TB diagnosis in a high TB prevalence setting, Southern China. A total of 413 subjects including 163 pulmonary TB (PTB), 39 extrapulmonary TB (EPTB), 106 non-TB pulmonary diseases (NTBPDs), 20 medical staff and 85 healthy controls were included in the study. According to T-SPOT.TB, there had a high incidence of latent TB infection (LTBI) in general population in Southern China, especially in the NTBPDS and medical staff. The T-SPOT.TB had a high performance in the diagnosis of active TB (ATB) in a lower risk of TB infection population such as the general population, however, the T-SPOT.TB for the diagnosis of ATB in the high risk of TB infection populations involving close contacts such as the patients with pulmonary diseases (PD) or medical staff isn't reliable due to the interference by LTBI. Under this condition, the value of rule-out of the assay was seemed to be better than that of rule-in. We believed that the T-SPOT.TB is suitable for screening both the EPTB and the ATB combined with diabetes mellitus (DM). However, we found that the sensitivity of T-SPOT.TB in sputum smear-negative population wasn't as high as that in smear-positive population. The T-SPOT.TB testing results should be interpreted with caution combined with subject's characteristics in a high prevalence setting.

  13. Matrix Metalloproteinases in Tuberculosis-Immune Reconstitution Inflammatory Syndrome and Impaired Lung Function Among Advanced HIV/TB Co-infected Patients Initiating Antiretroviral Therapy

    Directory of Open Access Journals (Sweden)

    Shruthi Ravimohan

    2016-01-01

    Conclusions: ART-induced MMP increases are associated with TB-IRIS and may affect lung function post-TB cure. End-organ damage due to TB-IRIS and mechanisms whereby immune restoration impairs lung function in pTB deserve further investigation.

  14. Is the 'Trondsen Discriminant Function' useful in patients referred for endoscopic retrograde cholangiopancreatography?

    DEFF Research Database (Denmark)

    Ainsworth, A P; Pless, T; Mortensen, M B

    2003-01-01

    BACKGROUND: Ideally, patients should only be referred to endoscopic retrograde cholangiopancreatography (ERCP) if therapy is indicated. The aim of this study was to evaluate whether or not the 'Trondsen Discriminant Function' (DF) could be used for selecting patients directly for ERCP. METHODS...

  15. Analysis of gene expression using gene sets discriminates cancer patients with and without late radiation toxicity

    NARCIS (Netherlands)

    Svensson, J. Peter; Stalpers, Lukas J. A.; Esveldt-van Lange, Rebecca E. E.; Franken, Nicolaas A. P.; Haveman, Jaap; Klein, Binie; Turesson, Ingela; Vrieling, Harry; Giphart-Gassler, Micheline

    2006-01-01

    BACKGROUND: Radiation is an effective anti-cancer therapy but leads to severe late radiation toxicity in 5%-10% of patients. Assuming that genetic susceptibility impacts this risk, we hypothesized that the cellular response of normal tissue to X-rays could discriminate patients with and without late

  16. Diagnosis of active TB using aptamers

    CSIR Research Space (South Africa)

    Khati, M

    2013-08-01

    Full Text Available ) and the 6-kDa early secreted antigen target (ESAT-6), which are potent T-cell antigens that are recognised by over 70% of TB patients. We then used these aptamers to develop a TB diagnostic tool that can be used at point-of-care for early and rapid detection...

  17. Litigation as TB Rights Advocacy

    Science.gov (United States)

    2016-01-01

    Abstract One thousand people die every day in India as a result of TB, a preventable and treatable disease, even though the Constitution of India, government schemes, and international law guarantee available, accessible, acceptable, quality health care. Failure to address the spread of TB and to provide quality treatment to all affected populations constitutes a public health and human rights emergency that demands action and accountability. As part of a broader strategy, health activists in India employ Public Interest Litigation (PIL) to hold the state accountable for rights violations and to demand new legislation, standards for patient care, accountability for under-spending, improvements in services at individual facilities, and access to government entitlements in marginalized communities. Taking inspiration from right to health PIL cases (PILs), lawyers in a New Delhi-based rights organization used desk research, fact-findings, and the Right To Information Act to build a TB PIL for the Delhi High Court, Sanjai Sharma v. NCT of Delhi and Others (2015). The case argues that inadequate implementation of government TB schemes violates the Constitutional rights to life, health, food, and equality. Although PILs face substantial challenges, this paper concludes that litigation can be a crucial advocacy and accountability tool for people living with TB and their allies. PMID:27781000

  18. Clinical utility of QuantiFERON-TB GOLD In-Tube and tuberculin skin test in patients with tuberculous pleural effusions.

    Science.gov (United States)

    Chung, Jae Ho; Han, Chang Hoon; Kim, Chong Ju; Lee, Sun Min

    2011-11-01

    Interferon gamma release assays are used for diagnosing latent tuberculosis (TB); however, their role in diagnosing tuberculous pleural effusion (TPE) is not defined. The aim of this study was to evaluate the usefulness of the QuantiFERON-TB Gold In-Tube assay (QFT-IT) and compare this assay with the tuberculin skin test (TST) for diagnosing TPE in settings where tuberculosis is endemic and bacillus Calmette-Guérin vaccination is mandatory. The TST and QFT-IT test were conducted prospectively with 101 patients presenting with clinically suspected TPE. Of the 97 evaluable subjects, 54 had TPE. The sensitivity, specificity, positive predictive value, and negative predictive value were, respectively, 76.9%, 61.1%, 74.1%, and 64.7% for QFT-IT; 72.5%, 71.7%, 77.1%, and 66.7% for TST; and 83.7%, 45.7%, 68.3%, and 66.7% for QFT-IT plus TST. Thus, the QFT-IT test may be more useful than the TST for diagnosing TPE. Although the combination of QFT-IT and TST had higher sensitivity, it had poor specificity owing to the high prevalence of latent TB in our setting. Copyright © 2011 Elsevier Inc. All rights reserved.

  19. Heightened Plasma Levels of Heme Oxygenase-1 and Tissue Inhibitor of Metalloproteinase-4 as Well as Elevated Peripheral Neutrophil Counts Are Associated With TB-Diabetes Comorbidity

    Science.gov (United States)

    Pavan Kumar, Nathella; Sridhar, Rathinam; Banurekha, Vaithilingam V.; Jawahar, Mohideen S.; Nutman, Thomas B.; Sher, Alan; Babu, Subash

    2014-01-01

    Background: The increased prevalence of type 2 diabetes mellitus (T2DM) in countries endemic for TB poses a serious complication in the clinical management of this major infectious disease. Understanding the impact of T2DM on TB and the determinants of comorbidity is critical in responding to this growing public health problem with better therapeutic approaches. Here, we performed an exploratory study assessing a series of biologic parameters that could serve as markers of pathogenesis in TB with T2DM. Methods: Cross-sectional analyses of levels of heme oxygenase-1 (HO-1), acute phase proteins, tissue metalloproteinases, and tissue inhibitors of metalloproteinase (TIMPs) as well as cytokines and chemokines were performed in plasma samples from individuals with active pulmonary TB or with coincident TB and T2DM from South India. Results: Compared with patients with TB without diabetes, those with coincident T2DM exhibited increased Mycobacterium tuberculosis bacillary loads in sputum. Plasma levels of HO-1 but not of other acute phase proteins were higher in patients with TB and T2DM than in patients without diabetes, independent of bacillary sputum loads. HO-1 concentrations also positively correlated with random plasma glucose, circulating glycosylated hemoglobin, and low-density lipoprotein levels. Moreover, patients with coincident TB and T2DM exhibited increased plasma levels of TIMP-4 and elevated peripheral blood neutrophil counts, which, when considered together with HO-1, resulted in increased power to discriminate individuals with active TB with and without T2DM. Conclusions: Elevated plasma levels of HO-1 and TIMP-4 and peripheral blood neutrophil counts are potential single and combined markers of pathogenesis in TB and T2DM. PMID:24458266

  20. Extensively Drug-Resistant TB

    Centers for Disease Control (CDC) Podcasts

    2016-12-16

    Dr. Charlotte Kvasnovsky, a surgery resident and Ph.D. candidate in biostatistics, discusses various types of drug resistance in TB patients in South Africa.  Created: 12/16/2016 by National Center for Emerging and Zoonotic Infectious Diseases (NCEZID).   Date Released: 12/16/2016.

  1. Integration of TB and ART services fails to improve TB treatment ...

    African Journals Online (AJOL)

    The median CD4+ count of HIV-positive patients was 152 cells/μl (interquartile range (IQR) 71 - 277) for integrated facilities and 148 cells/μl (IQR 67 - 260) for single-service facilities. There was no statistical difference in the TB treatment outcome profile between integrated and single-service facilities for all TB patients (p=0.

  2. [Features and influencing factors of self-discrimination among HIV/AIDS patients according to sex].

    Science.gov (United States)

    Ju, L H; Lyu, P; Xu, P; Chen, W Y; He, H J; Ma, L P

    2016-10-06

    Objective: To investigate the features and influencing factors of self-discrimination among patients with HIV/AIDS according to sex. Methods: A total of 2 432 HIV/AIDS patients were recruited in Yunnan, Henan, Hubei, Jiangsu, Shanxi, Jilin, and Inner Mongolia provinces by a multistage stratified cluster sampling method, based on HIV epidemic and transmission modes, from May 2013 to October 2013. All participants were ≥18 years old, and we excluded those with mental disorders, hearing loss or other factors that prevented them from properly answering questions, and those who were unwilling to participate. A self-designed questionnaire was conducted to collect information about self-discrimination features and social behavior changes among HIV/AIDS patients. Differences in performance and self-discrimination features between participants of different sexes were compared using the chi-squared test. Factors influencing self-discrimination were analyzed by sex, using unconditional logistic regression. Results: Of the 2 432 cases, 78.9%(1 918 cases)were male and 21.1%(514 cases)female. The proportion of self-discrimination overall was 76.1%(1 850 cases); this proportion among female HIV/AIDS patients was 80.5%(414 cases), which was higher than that among men(74.9%, 1 436 cases)(χ 2 =7.17, P= 0.007). Of the 11 forms of self-discrimination performance, proportions of feeling guilt, shame, and self-abasement among participants were greater than 50%. Proportions of feeling shame, inferiority, and blaming others among females were 61.3%, 59.5%, and 45.3%, respectively, which were higher than these among males(49.8%, 50.0%, 28.4%, respectively)( Pdiscrimination among those with HIV confirmatory testing time ≥1 year was higher than those with HIV confirmatory testing time discrimination among male farm workers was higher( OR= 1.62, 95 % CI :1.03-2.54). The risks of self-discrimination in males who had been infected with HIV by transmission routes of blood transfusion or

  3. The role of antiretroviral therapy in reducing TB incidence and mortality in high HIV-TB burden countries

    Directory of Open Access Journals (Sweden)

    Anthony D Harries

    2016-03-01

    Full Text Available With the adoption of the new Sustainable Development Goals in 2016, all countries have committed to end the tuberculosis (TB epidemic by 2030, defined as dramatic reductions in TB incidence and mortality combined with zero TB-induced catastrophic costs for families. This paper explores how antiretroviral therapy (ART in high HIV-TB burden countries may help in reducing TB incidence and mortality and thus contribute to the ambitious goal of ending TB. ART in people living with HIV has a potent TB preventive effect, with this being most apparent in those with the most advanced immunodeficiency. Early ART also significantly reduces the risk of TB, and with new World Health Organization guidance released in 2015 about initiating ART in all persons living with HIV irrespective of CD4 count, there is the potential for enormous benefit at the population level. Already, several countries with high HIVTB burdens have seen dramatic declines in TB case notification rates since ART scale up started in 2004. In patients already diagnosed with HIV-associated TB, mortality can be significantly decreased by ART, especially if started within 2–8 weeks of anti-TB treatment. The benefits of ART on TB incidence and TB mortality can be further augmented respectively by the addition of isoniazid preventive therapy and cotrimoxazole preventive therapy. These interventions must be effectively implemented and scaled up in order to end the TB epidemic by 2030.

  4. Combination of TB lymphadenitis and metastatic LAP in breast cancer

    Directory of Open Access Journals (Sweden)

    Abdolhassan Talaiezadeh

    2015-06-01

    Full Text Available Tuberculosis (TB may present as pulmonary and extra-pulmonary. TB lymphadenitis is the most common presentation of extra-pulmonary TB. TB lymphadenitis should be taken into account in the differential diagnosis of different disorders such as metastatic lymphadenopathy. The reported patient was a 65-year-old lady with breast cancer and conglomerated and matted axillary lymphadenopathy who received chemotherapy. She presented with more extensive axillary LAP contrary to our expectation. Modified radical mastectomy was done and pathology analysis reported TB lymphadenitis associated with metastatic LAP. Under cover of anti-TB therapy adjuvant chemoradiation therapy was started. Accordingly, we recommend TB be ruled out in every patient who needs chemotherapy in the endemic region because chemotherapy may cause the extension of TB in the body.

  5. Comparison of discrimination and prognostic value of two US Doppler scoring systems in rheumatoid arthritis patients

    DEFF Research Database (Denmark)

    Ellegaard, Karen; Terslev, Lene; Christensen, Robin

    2014-01-01

    images. The SRM, predictive validity and discriminative ability for both systems were calculated using DAS28 as the measure of disease improvement. RESULTS: Fourty-six patients with RA (80% females) were included. The mean Doppler activity at baseline was QS:24.4% (SD=17.7%) and SQS:2.0 (SD=0...

  6. Application Values of T-SPOT.TB in Clinical Rapid Diagnosis of Tuberculosis.

    Science.gov (United States)

    Zhu, Feng; Ou, Qinfang; Zheng, Jian

    2018-01-01

    This paper aims to explore the application value of tuberculosis-specific enzyme-linked immunospot assay (T-SPOT.TB) in the diagnosis of tuberculosis. Fifty one patients with tuberculosis (TB) admitted to Wuxi No.5 People's Hospital, Wuxi, China from June 2015 to June 2017 were selected as the TB group, and 40 patients without tuberculosis admitted in the same period were randomly selected as the non-TB group. Patients in the two groups received T-SPOT.TB, TB antibody (TB-Ab) test and mycobacterium TB deoxyribonucleic acid (TB-DNA) test, and the results were compared. Comparisons of the sensitivity of the three methods showed that the sensitivity of T-SPOT.TB was the highest, followed by TB-DNA from sputum samples, and that of TB-Ab was the lowest. The specificity of TB-Ab was the highest, followed by T-SPOT.TB, and that of TB-DNA from sputum samples was the lowest. In the receiver operating characteristic (ROC) curve analysis, the area under curve (AUC) of T-SPOT.TB (0.896) was the highest, followed by TB-DNA from sputum samples (0.772), and that of sputum smears (0.698) was the lowest. T-SPOT.TB can quickly and accurately determine the presence of tuberculosis infection, and it is a non-invasive examination, which can further assist in the diagnosis and guide the treatment.

  7. Gene expression patterns in blood leukocytes discriminate patients with acute infections

    Science.gov (United States)

    Allman, Windy; Chung, Wendy; Mejias, Asuncion; Ardura, Monica; Glaser, Casey; Wittkowski, Knut M.; Piqueras, Bernard; Banchereau, Jacques; Palucka, A. Karolina; Chaussabel, Damien

    2007-01-01

    Each infectious agent represents a unique combination of pathogen-associated molecular patterns that interact with specific pattern-recognition receptors expressed on immune cells. Therefore, we surmised that the blood immune cells of individuals with different infections might bear discriminative transcriptional signatures. Gene expression profiles were obtained for 131 peripheral blood samples from pediatric patients with acute infections caused by influenza A virus, Gram-negative (Escherichia coli) or Gram-positive (Staphylococcus aureus and Streptococcus pneumoniae) bacteria. Thirty-five genes were identified that best discriminate patients with influenza A virus infection from patients with either E coli or S pneumoniae infection. These genes classified with 95% accuracy (35 of 37 samples) an independent set of patients with either influenza A, E coli, or S pneumoniae infection. A different signature discriminated patients with E coli versus S aureus infections with 85% accuracy (34 of 40). Furthermore, distinctive gene expression patterns were observed in patients presenting with respiratory infections of different etiologies. Thus, microarray analyses of patient peripheral blood leukocytes might assist in the differential diagnosis of infectious diseases. PMID:17105821

  8. Reduced autobiographical memory specificity is associated with impaired discrimination learning in anxiety disorder patients

    Science.gov (United States)

    Lenaert, Bert; Boddez, Yannick; Vervliet, Bram; Schruers, Koen; Hermans, Dirk

    2015-01-01

    Associative learning plays an important role in the development of anxiety disorders, but a thorough understanding of the variables that impact such learning is still lacking. We investigated whether individual differences in autobiographical memory specificity are related to discrimination learning and generalization. In an associative learning task, participants learned the association between two pictures of female faces and a non-aversive outcome. Subsequently, six morphed pictures functioning as generalization stimuli (GSs) were introduced. In a sample of healthy participants (Study 1), we did not find evidence for differences in discrimination learning as a function of memory specificity. In a sample of anxiety disorder patients (Study 2), individuals who were characterized by low memory specificity showed deficient discrimination learning relative to high specific individuals. In contrast to previous findings, results revealed no effect of memory specificity on generalization. These results indicate that impaired discrimination learning, previously shown in patients suffering from an anxiety disorder, may be—in part—due to limited memory specificity. Together, these studies emphasize the importance of incorporating cognitive variables in associative learning theories and their implications for the development of anxiety disorders. In addition, re-analyses of the data (Study 3) showed that patients suffering from panic disorder showed higher outcome expectancies in the presence of the stimulus that was never followed by an outcome during discrimination training, relative to patients suffering from other anxiety disorders and healthy participants. Because we used a neutral, non-aversive outcome (i.e., drawing of a lightning bolt), these data suggest that learning abnormalities in panic disorder may not be restricted to fear learning, but rather reflect a more general associative learning deficit that also manifests in fear irrelevant contexts. PMID

  9. Reduced autobiographical memory specificity is associated with impaired discrimination learning in anxiety disorder patients

    Directory of Open Access Journals (Sweden)

    Bert eLenaert

    2015-07-01

    Full Text Available Associative learning plays an important role in the development of anxiety disorders, but a thorough understanding of the variables that impact such learning is still lacking. We investigated whether individual differences in autobiographical memory specificity are related to discrimination learning and generalization. In an associative learning task, participants learned the association between two pictures of female faces and a non-aversive outcome. Subsequently, six morphed pictures functioning as generalization stimuli (GSs were introduced. In a sample of healthy participants (Study 1, we did not find evidence for differences in discrimination learning as a function of memory specificity. In a sample of anxiety disorder patients (Study 2, individuals who were characterized by low memory specificity showed deficient discrimination learning relative to high specific individuals. In contrast to previous findings, results revealed no effect of memory specificity on generalization. These results indicate that impaired discrimination learning, previously shown in patients suffering from an anxiety disorder, may be – in part – due to limited memory specificity. Together, these studies emphasize the importance of incorporating cognitive variables in associative learning theories and their implications for the development of anxiety disorders. In addition, re-analyses of the data (Study 3 showed that patients suffering from panic disorder showed higher outcome expectancies in the presence of the stimulus that was never followed by an outcome during discrimination training, relative to patients suffering from other anxiety disorders and healthy participants. Because we used a neutral, non-aversive outcome (i.e., drawing of a lightning bolt, these data suggest that learning abnormalities in panic disorder may not be restricted to fear learning, but rather reflect a more general associative learning deficit that also manifests in fear irrelevant

  10. Treatment: Latent TB Infection (LTBI) and TB Disease

    Science.gov (United States)

    ... Studies Consortium Research Projects Publications TB Trials Consortium Study Descriptions Background Behavioral & Social Science Research Infection Control TB in Specific Populations African-American Community Stop TB in the African-American ...

  11. Comparison of discrimination and prognostic value of two US Doppler scoring systems in rheumatoid arthritis patients

    DEFF Research Database (Denmark)

    Ellegaard, Karen; Terslev, Lene; Christensen, Robin

    2014-01-01

    OBJECTIVES: The aim of this paper is to investigate sensitivity to change (SRM), predictive validity and discriminative ability of a quantitative (QS) and a semi-quantitative (SQS) Doppler ultrasound scoring systems in patients with rheumatoid arthritis (RA) treated with anti-TNF-α therapy. METHODS......: RA patients with wrist joint affection treated with TNF-α inhibitor were followed for one year. The wrist was examined with Doppler before initiating therapy and after one year. DAS28 was determined at both visits. One person trained in the SQS system and one in the QS system evaluated the anonymised...... images. The SRM, predictive validity and discriminative ability for both systems were calculated using DAS28 as the measure of disease improvement. RESULTS: Fourty-six patients with RA (80% females) were included. The mean Doppler activity at baseline was QS:24.4% (SD=17.7%) and SQS:2.0 (SD=0...

  12. The antiretroviral efficacy of highly active antiretroviral therapy and plasma nevirapine concentrations in HIV-TB co-infected Indian patients receiving rifampicin based antituberculosis treatment

    Directory of Open Access Journals (Sweden)

    Sinha Sanjeev

    2011-11-01

    Full Text Available Abstract Background Rifampicin reduces the plasma concentrations of nevirapine in human immunodeficiency virus (HIV and tuberculosis (TB co-infected patients, who are administered these drugs concomitantly. We conducted a prospective interventional study to assess the efficacy of nevirapine-containing highly active antiretroviral treatment (HAART when co-administered with rifampicin-containing antituberculosis treatment (ATT and also measured plasma nevirapine concentrations in patients receiving such a nevirapine-containing HAART regimen. Methods 63 cases included antiretroviral treatment naïve HIV-TB co-infected patients with CD4 counts less than 200 cells/mm3 started on rifampicin-containing ATT followed by nevirapine-containing HAART. In control group we included 51 HIV patients without tuberculosis and on nevirapine-containing HAART. They were assessed for clinical and immunological response at the end of 24 and 48 weeks. Plasma nevirapine concentrations were measured at days 14, 28, 42 and 180 of starting HAART. Results 97 out of 114 (85.1% patients were alive at the end of 48 weeks. The CD4 cell count showed a mean increase of 108 vs.113 cells/mm3 (p=0.83 at 24 weeks of HAART in cases and controls respectively. Overall, 58.73% patients in cases had viral loads of less than 400 copies/ml at the end of 48 weeks. The mean (± SD Nevirapine concentrations of cases and control at 14, 28, 42 and 180 days were 2.19 ± 1.49 vs. 3.27 ± 4.95 (p = 0.10, 2.78 ± 1.60 vs. 3.67 ± 3.59 (p = 0.08, 3.06 ± 3.32 vs. 4.04 ± 2.55 (p = 0.10 respectively and 3.04 μg/ml (in cases. Conclusions Good immunological and clinical response can be obtained in HIV-TB co-infected patients receiving rifampicin and nevirapine concomitantly despite somewhat lower nevirapine trough concentrations. This suggests that rifampicin-containing ATT may be co administered in resource limited setting with nevirapine-containing HAART regimen without substantial reduction in

  13. Discrimination of Motor Imagery-Induced EEG Patterns in Patients with Complete Spinal Cord Injury

    Directory of Open Access Journals (Sweden)

    G. Pfurtscheller

    2009-01-01

    Full Text Available EEG-based discrimination between different motor imagery states has been subject of a number of studies in healthy subjects. We investigated the EEG of 15 patients with complete spinal cord injury during imagined right hand, left hand, and feet movements. In detail we studied pair-wise discrimination functions between the 3 types of motor imagery. The following classification accuracies (mean ± SD were obtained: left versus right hand 65.03% ± 8.52, left hand versus feet 68.19% ± 11.08, and right hand versus feet 65.05% ± 9.25. In 5 out of 8 paralegic patients, the discrimination accuracy was greater than 70% but in only 1 out of 7 tetraplagic patients. The present findings provide evidence that in the majority of paraplegic patients an EEG-based BCI could achieve satisfied results. In tetraplegic patients, however, it is expected that extensive training-sessions are necessary to achieve a good BCI performance at least in some subjects.

  14. Identification of plasma biomarkers for discrimination between tuberculosis infection/disease and pulmonary non tuberculosis disease.

    Science.gov (United States)

    La Manna, Marco Pio; Orlando, Valentina; Li Donni, Paolo; Sireci, Guido; Di Carlo, Paola; Cascio, Antonio; Dieli, Francesco; Caccamo, Nadia

    2018-01-01

    We used the Luminex Bead Array Multiplex Immunoassay to measure cytokines, chemokines and growth factors responses to the same antigens used for RD1-based Interferon γ Release Assay (IGRA) test. Seventy-nine individuals, 27 active TB, 32 latent infection subsets, 20 individuals derivative purified protein (PPD) negative (subjects that do not have any indurative cutaneous reaction after 72 hrs of intradermal injection of PPD) and with other pulmonary disease were retrospectively studied. Forty-eight analytes were evaluated by Luminex Assay in plasma obtained from whole blood stimulated cells. The diagnostic accuracies of the markers detected were evaluated by ROC curve analysis and by the combination of multiple biomarkers to improve the potential to discriminate between infection/disease and non infection. Among 48 cytokines, 13 analytes, namely IL-3, IL-12-p40, LIF, IFNα2, IL-2ra, IL-13, b-NGF, SCF, TNF-β, TRAIL, IL-2, IFN-γ, IP-10, and MIG, were significantly higher in the active TB and LTBI groups, compared to NON-TB patients, while MIF was significantly lower in active TB patients compared to NON-TB and LTBI groups. The diagnostic accuracies of the markers detected in the culture supernatants evaluated by ROC curve analysis revealed that 11 analytes (IL2, IP10, IFN-γ, IL13, MIG, SCF, b-NGF, IL12-p40, TRAIL, IL2 Ra, LIF) discriminated between NON-TB and LTBI groups, with AUC for all analytes ≥0.73, while 14 analytes (IL2, IP10, IFN-γ, MIG, SCF, b-NGF, IL12-p40, TRAIL, IL2Ra, MIF, TNF-β, IL3, IFN-α2, LIF) discriminated between NON-TB and active TB groups, with AUC ≥0.78, that is a moderate, value in terms of accuracy of a diagnostic test. Finally, the combinations of seven biomarkers resulted in the accurate prediction of 88.89% of active TB patients, 82.35% of subjects with latent infection and 90% of non-TB patients, respectively. Taken together, our data suggest that combinations of whole blood Mycobacterium tuberculosis (Mtb) antigen dependent

  15. Discrimination of elderly patients in the health care system of Lithuania

    Directory of Open Access Journals (Sweden)

    Kristina Selli

    2016-07-01

    Full Text Available Aim: This study aimed to explore and describe the barriers that elderly Lithuanians experience with respect to going to court or other institutions to defend their right not to be discriminated regarding medical care. Methods: We used a mixed methods approach due to the scarcity of information in Lithuania. First, the review of laws was done using the e-tar database and court cases were searched using the e-teismai database followed by policy analysis. Additional sources of information were identified searching Google Scholar and PubMed, as well as Google for grey literature. The keywords used were: ageism in patient care, discrimination against elderly, elderly and health (English and Lithuanian: 2000-2015. Secondly, we conducted in-depth individual interviews with 27 clients of newly-established integrated home care services: 13 elderly patients, and 14 informal caregivers. Results:  This study identified five groups of barriers explaining why Lithuanian elderly are hesitant to fight discrimination in the health system. The results of the study disclose the following barriers that the elderly in Lithuania face: i the lack of recognition of the phenomenon of discrimination against the elderly in patient care; ii the lack of information for complaining and the fear of consequences of complaining; iii the deficiencies and uncertainties of laws and regulations devoted to discrimination; iv the high level of burden of proof in court cases and lack of good practices; v the lack of a patient (human rights-based approach in all policies and in education as well as the lack of intersectoral work. Conclusions:  This study disclosed the need to: encourage training of legists and lawyers in expanding knowledge and skills in human rights in patient care;  encourage training of health care professionals – the burden of leadership for this has to be assumed by universities and public health professionals; incorporate a new article in the ‘Law on the

  16. TB in Captive Elephants

    Centers for Disease Control (CDC) Podcasts

    2017-04-27

    Dr. Barry Kreiswirth, founding director of the Public Health Research Institute, TB Center, at Rutgers University, discusses TB in three captive elephants.  Created: 4/27/2017 by National Center for Emerging and Zoonotic Infectious Diseases (NCEZID).   Date Released: 4/27/2017.

  17. Questions and Answers about TB

    Science.gov (United States)

    ... Studies Consortium Research Projects Publications TB Trials Consortium Study Descriptions Background Behavioral & Social Science Research Infection Control TB in Specific Populations African-American Community Stop TB in the African-American ...

  18. Quantitative ultrasound technique at the phalanges in discriminating between uremic and osteoporotic patients

    International Nuclear Information System (INIS)

    Guglielmi, G.; De Terlizzi, F.; Aucella, F.; Scillitani, A.

    2006-01-01

    This study was conducted to test the ability of quantitative ultrasound technique (QUS) at the phalanges to discriminate between uremic and osteoporotic patients. Three groups of subjects (38 dialytic women, 16 osteoporotic women with vertebral fractures, 19 non-dialytic and non-fractured women) were recruited at the Department of Radiology at 'Casa Sollievo della Sofferenza' Hospital, San Giovanni Rotondo, Italy. The groups were matched for age and body mass index (BMI). On all subjects the following measurements were performed: spinal BMD by QCT and by DXA, Femoral BMD by DXA, phalangeal QUS. For QUS measurements, the DBM Sonic (IGEA, Carpi, Italy) was applied to the metaphysis of the proximal phalanges of the last four fingers of the hand. Osteoporotic women with vertebral fractures showed significantly lower values of spinal BMD by QCT and DXA and Ward's Triangle BMD with respect to hemodialytic patients (p < 0.005). All QUS values, except for BTT and SoS, showed lower values in osteoporotic women with respect to hemodialytic patients (p < 0.05). Control group showed higher values of AD-SoS, BTT and SoS than hemodialytic patients (p < 0.005) while the two groups did not differ for BMD values measured with both QCT and DXA. UBPI and FWA data showed a similar behaviour to DXA and QCT results, whereas BTT and SoS showed a completely different behaviour. AD-SoS was the only parameter that could effectively discriminate among the three groups (ANOVA, p < 0.0001). We conclude that phalangeal QUS can discriminate between hemodialysed patients and controls with similar bone mineral density, and can also discriminate between hemodialysed and osteoporotic subjects with vertebral fractures. Different characteristics of ultrasound signal can be ascribed to each bone tissue condition, enabling a clear differentiation of bone tissue changes occurring in menopause, osteoporosis and renal osteodystrophy

  19. Quantitative ultrasound technique at the phalanges in discriminating between uremic and osteoporotic patients

    Energy Technology Data Exchange (ETDEWEB)

    Guglielmi, G. [Department of Radiology, Scientific Institute Hospital ' Casa Sollievo della Sofferenza' , Viale Cappuccini 1, 71013 San Giovanni Rotondo (Italy)]. E-mail: guglielmi_g@hotmail.com; De Terlizzi, F. [IGEA srl, Carpi (Italy); Aucella, F. [Division of Nephrology, Scientific Institute Hospital ' Casa Sollievo della Sofferenza' , San Giovanni Rotondo (Italy); Scillitani, A. [Division of Endocrinology, Scientific Institute Hospital ' Casa Sollievo della Sofferenza' , San Giovanni Rotondo (Italy)

    2006-10-15

    This study was conducted to test the ability of quantitative ultrasound technique (QUS) at the phalanges to discriminate between uremic and osteoporotic patients. Three groups of subjects (38 dialytic women, 16 osteoporotic women with vertebral fractures, 19 non-dialytic and non-fractured women) were recruited at the Department of Radiology at 'Casa Sollievo della Sofferenza' Hospital, San Giovanni Rotondo, Italy. The groups were matched for age and body mass index (BMI). On all subjects the following measurements were performed: spinal BMD by QCT and by DXA, Femoral BMD by DXA, phalangeal QUS. For QUS measurements, the DBM Sonic (IGEA, Carpi, Italy) was applied to the metaphysis of the proximal phalanges of the last four fingers of the hand. Osteoporotic women with vertebral fractures showed significantly lower values of spinal BMD by QCT and DXA and Ward's Triangle BMD with respect to hemodialytic patients (p < 0.005). All QUS values, except for BTT and SoS, showed lower values in osteoporotic women with respect to hemodialytic patients (p < 0.05). Control group showed higher values of AD-SoS, BTT and SoS than hemodialytic patients (p < 0.005) while the two groups did not differ for BMD values measured with both QCT and DXA. UBPI and FWA data showed a similar behaviour to DXA and QCT results, whereas BTT and SoS showed a completely different behaviour. AD-SoS was the only parameter that could effectively discriminate among the three groups (ANOVA, p < 0.0001). We conclude that phalangeal QUS can discriminate between hemodialysed patients and controls with similar bone mineral density, and can also discriminate between hemodialysed and osteoporotic subjects with vertebral fractures. Different characteristics of ultrasound signal can be ascribed to each bone tissue condition, enabling a clear differentiation of bone tissue changes occurring in menopause, osteoporosis and renal osteodystrophy.

  20. Critical appraisal of discriminant formulas for distinguishing thalassemia from iron deficiency in patients with microcytic anemia.

    Science.gov (United States)

    Urrechaga, Eloísa; Hoffmann, Johannes J M L

    2017-08-28

    Many discriminant formulas have been reported for distinguishing thalassemia trait from iron deficiency in patients with microcytic anemia. Independent verification of several discriminant formulas is deficient or even lacking. Therefore, we have retrospectively investigated discriminant formulas in a large, well-characterized patient population. The investigational population consisted of 2664 patients with microcytic anemia: 1259 had iron deficiency, 1196 'pure' thalassemia trait (877 β- and 319 α-thalassemia), 150 had thalassemia trait with concomitant iron deficiency or anemia of chronic disease, and 36 had other diseases. We investigated 25 discriminant formulas that only use hematologic parameters available on all analyzers; formulas with more advanced parameters were disregarded. The diagnostic performance was investigated using ROC analysis. The three best performing formulas were the Jayabose (RDW index), Janel (11T), and Green and King formulas. The differences between them were not statistically significant (p>0.333), but each of them had significantly higher area under the ROC curve than any other formula. The Jayabose and Green and King formulas had the highest sensitivities: 0.917 both. The highest specificity, 0.925, was found for the Janel formula, which is a composite score of 11 other formulas. All investigated formulas performed significantly better in distinguishing β- than α-thalassemia from iron deficiency. In our patient population, the Jayabose RDW index, the Green and King formula and the Janel 11T score are superior to all other formulas examined for distinguishing between thalassemia trait and iron deficiency anemia. We confirmed that all formulas perform much better in β- than in α-thalassemia carriers and also that they incorrectly classify approximately 30% of thalassemia carriers with concomitant other anemia as not having thalassemia. The diagnostic performance of even the best formulas is not high enough for making a final

  1. The patient under the influence of alcohol – Discriminated victim or aggressor?

    Directory of Open Access Journals (Sweden)

    Anna Burak

    2016-09-01

    Results: The occurrence of unequal treatment by medical staff of patients under the influence of alcohol was observed in the performed studies. There is a correlation between medical staff workplace and the prevalence of discrimination against this group of patients. It most frequently takes place in EDs. In the respondents’ opinion, care and treatment of patients under the influence of alcohol is aggravated by their vulgar behaviour. From viewpoint of the medical staff, the existence of a special care institution for intoxicated persons is justified.

  2. Perfil epidemiológico de pacientes portadores de TB internados em um hospital de referência na cidade do Rio de Janeiro Epidemiological profile of hospitalized patients with TB at a referral hospital in the city of Rio de Janeiro, Brazil

    Directory of Open Access Journals (Sweden)

    Hedi Marinho de Melo Guedes de Oliveira

    2009-08-01

    Full Text Available OBJETIVO: Analisar o perfil epidemiológico dos pacientes internados em um hospital especializado no tratamento da TB. MÉTODOS: Foi realizado estudo descritivo e retrospectivo dos prontuários dos pacientes internados com TB no Hospital Estadual Santa Maria (HESM, na cidade do Rio de Janeiro, entre janeiro de 2002 e dezembro de 2003, por meio de formulário previamente padronizado. RESULTADOS: Dos 451 pacientes incluídos, 313 (69,4% foram referenciados para o HESM por unidades de saúde, e 302 (67,0% eram do gênero masculino. A maioria dos pacientes tinha entre 30 e 59 anos, 443 (98,2% residiam na região metropolitana, e 298 (66,1% residiam no município do Rio de Janeiro. O motivo de internação mais frequente foi mau estado geral (em 237, 52,5%. A AIDS foi a comorbidade mais frequente (em 137, 30,4%. Os sinais e sintomas mais frequentes no momento da internação foram emagrecimento, febre e tosse produtiva. A baciloscopia foi positiva em 122 casos (71,0% com tosse produtiva no momento da internação. Dos 212 pacientes que estavam em retratamento, 156 (73,6% referiram abandono a tratamento anterior. Quanto ao desfecho, 297 (65,8% foram encaminhados para centros municipais de saúde, 83 (18,4% evoluíram para óbito, e 44 (9,8% curaram. As altas indesejadas ocorreram em 27 (6,0% dos casos. CONCLUSÕES: A provisão de hospitais especializados em TB é de relevância para o controle da TB, principalmente em regiões metropolitanas. Esses hospitais precisam estar adequados a medidas de biossegurança, assim como estar mais bem equipados e capacitados para prestar atendimento a pacientes com diversas comorbidades e problemas sociais associados à TB. A realização deste estudo resultou em melhorias para o HESM.OBJECTIVE: To determine the epidemiological profile of inpatients at a TB referral hospital. METHODS: This was a descriptive, retrospective study of the medical charts of patients with TB hospitalized at the Hospital Estadual Santa

  3. Health Care Neglect, Perceived Discrimination, and Dignity-Related Distress Among Chinese Patients With HIV.

    Science.gov (United States)

    Yu, Nancy Xiaonan; Zhang, Jianxin; Chan, Cecilia L W

    2016-02-01

    Dignity-related distress is overlooked in patients with HIV (PHIV). The dignity model, which elucidates the key features of dignity-related distress, has not been applied to the context of stigmatized diseases. By targeting the stigmatized disease of HIV among a Chinese sample, the present study examined the roles of health care neglect and perceived discrimination in dignity-related distress. In this cross-sectional study, 119 Chinese PHIV completed measures of dignity-related distress, psychological symptoms, physical symptoms, health care neglect, and perceived discrimination. The results showed that psychological symptoms, physical symptoms, and health care neglect not only independently predicted dignity-related distress, but also moderated with each other to show a three-way interaction. Perceived discrimination also explained the variance in dignity-related distress. Our findings contribute to the dignity model by providing evidence for factors associated with dignity-related distress, with focus on HIV. Suggestions to advocate for fair treatment for PHIV and reduce HIV-related discrimination are given.

  4. The Characteristics of TB Epidemic and TB/HIV Co-Infection Epidemic: A 2007-2013 Retrospective Study in Urumqi, Xinjiang Province, China.

    Directory of Open Access Journals (Sweden)

    Wang Wei

    Full Text Available This study was aimed to find out epidemiologic characteristic of tuberculosis (TB cases, and Human Immunodeficiency Virus (HIV positive cases among TB patients (TB/HIV co-infection through demographic, temporal, and spatial study in Urumqi.Descriptive statistics and multivariate logistic regression were applied to identify the epidemiologic characteristics and risk factors of TB epidemic and TB/HIV co-infection epidemic. All addresses of each TB case, TB/HIV co-infection case, and administrative street were transformed into geographical coordinate. Subsequently, the geocoded address for 82 streets was transformed into a dot map used as the basis of spatial datasets. In addition, the paper also used quantile map and the spatial scan statistic in order to identify the spatial distribution and spatial clusters of TB epidemic and TB/HIV co-infection epidemic.There was a declining trend of the notification rates of TB epidemic from 2007 to 2009, as well as a rising trend from 2010 to 2013. However, the notification rates of TB/HIV co-infection epidemic showed a rising trend from 2007 to 2010, and a declining trend from 2011 to 2013. Moreover, a significant share of TB epidemic and TB/HIV co-infection epidemic happened between the age of 15 to 45 years old, indicating an increase in risk of TB and TB/HIV infection. It is worth noting that the risk of HIV infection for male TB patients was 2.947 times (95% CI [2.178, 3.988] than that of female patients. Han ethnicity and Uygur ethnicity in urban region accounted for a large proportion of total TB and TB/HIV co-infection cases. Most of the TB cases of minorities in Urumqi showed a statistically significant increase in risk of HIV infection than Han ethnicity in Urumqi. In addition, the spatial distribution of TB epidemic and TB/HIV co-infection epidemic was highly skewed. Most of the local clusters were located in urban area and rural-urban continuum where showed an increase in risk of TB and TB

  5. Gait characteristics and their discriminative power in geriatric patients with and without cognitive impairment.

    Science.gov (United States)

    Kikkert, Lisette H J; Vuillerme, Nicolas; van Campen, Jos P; Appels, Bregje A; Hortobágyi, Tibor; Lamoth, Claudine J C

    2017-08-15

    A detailed gait analysis (e.g., measures related to speed, self-affinity, stability, and variability) can help to unravel the underlying causes of gait dysfunction, and identify cognitive impairment. However, because geriatric patients present with multiple conditions that also affect gait, results from healthy old adults cannot easily be extrapolated to geriatric patients. Hence, we (1) quantified gait outcomes based on dynamical systems theory, and (2) determined their discriminative power in three groups: healthy old adults, geriatric patients with- and geriatric patients without cognitive impairment. For the present cross-sectional study, 25 healthy old adults recruited from community (65 ± 5.5 years), and 70 geriatric patients with (n = 39) and without (n = 31) cognitive impairment from the geriatric dayclinic of the MC Slotervaart hospital in Amsterdam (80 ± 6.6 years) were included. Participants walked for 3 min during single- and dual-tasking at self-selected speed while 3D trunk accelerations were registered with an IPod touch G4. We quantified 23 gait outcomes that reflect multiple gait aspects. A multivariate model was built using Partial Least Square- Discriminant Analysis (PLS-DA) that best modelled participant group from gait outcomes. For single-task walking, the PLS-DA model consisted of 4 Latent Variables that explained 63 and 41% of the variance in gait outcomes and group, respectively. Outcomes related to speed, regularity, predictability, and stability of trunk accelerations revealed with the highest discriminative power (VIP > 1). A high proportion of healthy old adults (96 and 93% for single- and dual-task, respectively) was correctly classified based on the gait outcomes. The discrimination of geriatric patients with and without cognitive impairment was poor, with 57% (single-task) and 64% (dual-task) of the patients misclassified. While geriatric patients vs. healthy old adults walked slower, and less regular, predictable, and

  6. Antigen-Specific Interferon-Gamma Responses and Innate Cytokine Balance in TB-IRIS

    NARCIS (Netherlands)

    Goovaerts, Odin; Jennes, Wim; Massinga-Loembé, Marguerite; Ceulemans, Ann; Worodria, William; Mayanja-Kizza, Harriet; Colebunders, Robert; Kestens, Luc; Loembé, Marguerite Massinga; Mayanja, Harriet; Mascart, Francoise; van den Bergh, Rafael; Locht, Camille; Reiss, Peter; Cobelens, Frank; Ondoa, Pascale; Pakker, Nadine; Mugerwa, Roy

    2014-01-01

    Background: Tuberculosis-associated immune reconstitution inflammatory syndrome (TB-IRIS) remains a poorly understood complication in HIV-TB patients receiving antiretroviral therapy (ART). TB-IRIS could be associated with an exaggerated immune response to TB-antigens. We compared the recovery of

  7. Assessing the effect of TB-HIV collaborative activities on knowledge ...

    African Journals Online (AJOL)

    Abstract: Introduction: The burden of TB is so closely linked to the HIV epidemic that prevention of HIV must become a priority for TB programmes, just as TB care and prevention should be a major concern of HIV/AIDS programmes. Provider initiated HIV testing and counseling (PITC) among TB patients along with provision ...

  8. Early Parkinson's disease patients on rasagiline present with better odor discrimination.

    Science.gov (United States)

    Haehner, Antje; Habersack, Angela; Wienecke, Miriam; Storch, Alexander; Reichmann, Heinz; Hummel, Thomas

    2015-11-01

    The effects of rasagiline on olfaction in animal studies are convincing. However, apart from various anecdotal patient reports, they could not be reproduced in prospective studies in humans. Cross-sectional data of large patient groups are still missing. The aim of this study was therefore to determine the olfactory function in a broad heterogeneous Parkinson's disease (PD) population with and without rasagiline intake. In this single-center, cross-sectional study 224 PD patients with and without rasagiline (1 mg/day) participated. Seventy-four of them received rasagiline as mono, or adjunct therapy. One-hundred fifty patients were untreated or received PD medication other than rasagiline. Comprehensive olfactory testing was performed for phenyl-ethyl alcohol odor thresholds, odor discrimination, and odor identification. Olfactory function did not differ between the two treatment groups with disease duration up to 29 years. Rasagiline-treated patients with disease duration of less than 8 years, however, presented with significant better odor discrimination abilities compared to PD patients without rasagiline treatment. This effect was no longer evident in patients with longer disease duration and proofed to be independent of age, sex, and medication. Our results may suggest that rasagiline treatment has a positive effect on the processing of olfactory information in early PD.

  9. [Etiological analysis and establishment of a discriminant model for lower respiratory tract infections in hospitalized patients].

    Science.gov (United States)

    Chen, Y S; Lin, X H; Li, H R; Hua, Z D; Lin, M Q; Huang, W S; Yu, T; Lyu, H Y; Mao, W P; Liang, Y Q; Peng, X R; Chen, S J; Zheng, H; Lian, S Q; Hu, X L; Yao, X Q

    2017-12-12

    Objective: To analyze the pathogens of lower respiratory tract infection(LRTI) including bacterial, viral and mixed infection, and to establish a discriminant model based on clinical features in order to predict the pathogens. Methods: A total of 243 hospitalized patients with lower respiratory tract infections were enrolled in Fujian Provincial Hospital from April 2012 to September 2015. The clinical data and airway (sputum and/or bronchoalveolar lavage) samples were collected. Microbes were identified by traditional culture (for bacteria), loop-mediated isothermal amplification(LAMP) and gene sequencing (for bacteria and atypical pathogen), or Real-time quantitative polymerase chain reaction (Real-time PCR)for viruses. Finally, a discriminant model was established by using the discriminant analysis methods to help to predict bacterial, viral and mixed infections. Results: Pathogens were detected in 53.9% (131/243) of the 243 cases.Bacteria accounted for 23.5%(57/243, of which 17 cases with the virus, 1 case with Mycoplasma pneumoniae and virus), mainly Pseudomonas Aeruginosa and Klebsiella Pneumonia. Atypical pathogens for 4.9% (12/243, of which 3 cases with the virus, 1 case of bacteria and viruses), all were mycoplasma pneumonia. Viruses for 34.6% (84/243, of which 17 cases of bacteria, 3 cases with Mycoplasma pneumoniae, 1 case with Mycoplasma pneumoniae and bacteria) of the cases, mainly Influenza A virus and Human Cytomegalovirus, and other virus like adenovirus, human parainfluenza virus, respiratory syncytial virus, human metapneumovirus, human boca virus were also detected fewly. Seven parameters including mental status, using antibiotics prior to admission, complications, abnormal breath sounds, neutrophil alkaline phosphatase (NAP) score, pneumonia severity index (PSI) score and CRUB-65 score were enrolled after univariate analysis, and discriminant analysis was used to establish the discriminant model by applying the identified pathogens as the

  10. Tuberculosis Facts - TB and HIV/AIDS

    Science.gov (United States)

    Tuberculosis (TB) Facts TB and HIV/AIDS What is TB? “TB” is short for a disease called tuberculosis. TB is spread through the air from one ... Viral Hepatitis, STD, and TB Prevention Division of Tuberculosis Elimination

  11. HIV and Tuberculosis (TB)

    Science.gov (United States)

    ... AIDS Drugs Clinical Trials Apps skip to content HIV and Opportunistic Infections, Coinfections, and Conditions Home Understanding ... 4 p.m. ET) Send us an email HIV and Tuberculosis (TB) Last Reviewed: July 26, 2017 ...

  12. Validation of brief screening tools for depressive and alcohol use disorders among TB and HIV patients in primary care in Zambia

    Directory of Open Access Journals (Sweden)

    Patel Vikram

    2011-05-01

    Full Text Available Abstract Background This study was conducted to evaluate the diagnostic accuracy and determine the optimum cut-off scores for clinical use of the Center for Epidemiological Studies Depression scale (CES-D and Alcohol Use Disorders Identification Test (AUDIT against a reference psychiatric diagnostic interview, in TB and anti-retroviral therapy (ART patients in primary care in Zambia. Methods This was a cross-sectional study in 16 primary level care clinics. Consecutive sampling was used to select 649 participants who started TB treatment or ART in the preceding month. Participants were first interviewed using the CES-D and AUDIT, and subsequently with a psychiatric diagnostic interview for current major depressive disorder (MDD and alcohol use disorders (AUDs using the Mini-International Neuropsychiatric Interview (MINI. The diagnostic accuracy was calculated using the Area Under the Receiver Operating Characteristic curve (AUROC. The optimum cut-off scores for clinical use were calculated using sensitivity and positive predictive value (PPV. Results The CES-D and AUDIT had high internal consistency (Cronbach's alpha = 0.84; 0.98 respectively. Confirmatory factor analysis showed that the four-factor CES-D model was not a good fit for the data (Tucker-Lewis Fit Index (TLI = 0.86; standardized root-mean square residual (SRMR = 0.06 while the two-factor AUDIT model fitted the data well (TFI = 0.99; SRMR = 0.04. Both the CES-D and AUDIT demonstrated good discriminatory ability in detecting MINI-defined current MDDs and AUDs (AUROC for CES-D = 0.78; AUDIT = 0.98 for women and 0.75 for men. The optimum CES-D cut-off score in screening for current MDD was 22 (sensitivity 73%, PPV 76% while that of the AUDIT in screening for AUD was 24 for women (sensitivity 60%, PPV 60%, and 20 for men (sensitivity 55%, PPV 50%. Conclusions The CES-D and AUDIT showed high discriminatory ability in measuring MINI-defined current MDD and AUD respectively. They are

  13. Retinopathy risk factors in type II diabetic patients using factor analysis and discriminant analysis.

    Science.gov (United States)

    Tazhibi, Mahdi; Sarrafzade, Sheida; Amini, Masoud

    2014-01-01

    Diabetes is one of the most common chronic diseases in the world. Incidence and prevalence of diabetes are increasing in developing countries as well as in Iran. Retinopathy is the most common chronic disorder in diabetic patients. In this study, we used the information of diabetic patients' reports that refer to endocrine and metabolism research center of Isfahan University of Medical Sciences to determine diabetic retinopathy risk factors. We used factor analysis to extract retinopathy's factors. Factor analysis is using to analyze multivariate data, in which a large number of dependent variables summarize into the fewer independent factors. Factor analysis is applied, in both diabetic and nondiabetic patients, separately. To investigate the efficacy of factor analysis, we used discriminant analysis. We investigated 3535 diabetic patients whose prevalence of retinopathy was 53.4%. Six factors were extracted in each group (i.e. diabetic and nondiabetic groups). These six factors were explained 69.5% and 69.6% of total variance in diabetic and nondiabetic groups, respectively. Using original variables such as sex, weight, blood sugar control method, and some laboratory variables, the correct classification rate of discriminant analysis was identified as 67.4%. However, it decreased to 49.5% by using extracted factors. Retinopathy is one of the important disorders in diabetic patients that involves a large number of variables and can affect its incidence. By the method of factor analysis, we summarize diabetic retinopathy risk factors. Factor analysis is applied separately, in two diabetic and nondiabetic group. In this way, 10 variables were summarized into the six factors. Discriminant analysis was used to investigate the efficacy of factor analysis. Although factor analysis is a powerful way to reduce the number of variables, in this study did not worked very well.

  14. Treating the invisible: Gaps and opportunities for enhanced TB control along the Thailand-Myanmar border.

    Science.gov (United States)

    Tschirhart, Naomi; Thi, Sein Sein; Swe, Lei Lei; Nosten, Francois; Foster, Angel M

    2017-01-13

    In Thailand's northwestern Tak province, contextual conditions along the border with Myanmar pose difficulties for TB control among migrant populations. Incomplete surveillance data, migrant patient mobility, and loss to follow-up make it difficult to estimate the TB burden and implement effective TB control measures. This multi-methods study examined tuberculosis, tuberculosis and human immunodeficiency virus co-infection, and multidrug-resistant tuberculosis treatment accessibility for migrants and refugees in Tak province, health system response, and public health surveillance. In this study we conducted 13 interviews with key informants working in public health or TB treatment provision to elicit information on TB treatment availability and TB surveillance practices. In addition we organized 15 focus group discussions with refugee and migrant TB, TB/HIV, and MDR-TB patients and non-patients to discuss treatment access. We analyzed the data using thematic analysis and created treatment availability maps with Google maps. The study identified surveillance, treatment, and funding gaps. Migrant TB cases are underreported in the provincial statistics due to jurisdictional interpretations and resource barriers. Our results suggest that TB/HIV and MDR-TB treatment options are limited for migrants and a heavy reliance on donor funding may lead to potential funding gaps for migrant TB services. We identified several opportunities that positively contribute to TB control in Tak province: improved diagnostics, comprehensive care, and collaboration through data sharing, planning, and patient referrals. The various organizations providing TB treatment to migrant and refugee populations along the border and the Tak Provincial Public Health Office are highly collaborative which offers a strong foundation for future TB control initiatives. Our findings suggest the need to enhance the surveillance system to include all migrant TB patients who seek treatment in Tak province and

  15. Prevalence and management out comes of anti TB drugs induced ...

    African Journals Online (AJOL)

    Patients and Methods: All TB patients admitted in the Hospital during the study period are the source of population, the study groups were been selected by detecting the possible confounding factors for jaundice. Base line LFT before anti TB initiation was determined before developed jaundice. Those patients, whom the ...

  16. Isolation unit for multidrug-resistant tuberculosis patients in a low endemic country, a step towards the World Health Organization End TB Strategy.

    Science.gov (United States)

    Payen, M C; VAN Vooren, J P; Vandenberg, O; Clumeck, N; DE Wit, S

    2017-05-01

    Tuberculosis (TB) remains a threat to public health and is the second cause of death due to a single infectious agent after HIV/AIDS. The worldwide distribution of TB is heterogeneous. The incidence is decreasing in most high-income regions, but the situation remains worrying in many parts of the world. The emergence of Mycobacterium tuberculosis strains resistant to key agents used in treatment (rifampin and isoniazid) contributes to TB transmission around the world. To achieve TB elimination, both high and low endemic countries must upscale their efforts to decrease disease transmission and improve cure rates. Management of drug-resistant TB is of particular importance. In this paper, we discuss the different models of care of multidrug-resistant TB (MDR-TB), the ethical considerations and the specific constraints present in high income countries. The management model chosen by the Belgian TB specialists in accordance with public health authorities as well as building of a specific MDR/XDR-TB isolation unit are also discussed.

  17. TREATMENT COSTS EVALUATION FOR DRUG SUSCEPTIBLE AND DRUG RESISTANT TUBERCULOSIS PATIENTS IN THE UNITS OF TOMSK REGIONAL TB SERVICES

    Directory of Open Access Journals (Sweden)

    I. E. Gel'manova

    2016-01-01

    Full Text Available Basing on the data of capital expenses and current costs of Tomsk TB Service in 2011, prime costs of 1 month of treatment of a tuberculosis case in various units of TB Service were evaluated. The prime costs of treatment in the in-patient department as per the 1st, 2nd and 3rd regimens made 23,837 RUR per month and it was 89% higher than the cost of treatment in the day hospital (12,612 RUR, and by 173% higher than the treatment in the polyclinic (8,722 RUR, by 145% than treatment at home (9,717 RUR and by 91% than treatment within the Sputnik program (12,499 RUR. Treatment as per the 4th regimen turned out to be the most expensive in the in-patient hospital (29,880 RUR exceeding by 55% the treatment cost in the day center (19,336 RUR, by 112% – in the polyclinic (14,107 RUR, by 71% – treatment at home (17,512 RUR, and by 29% – Sputnik program (23,207 RUR.

  18. T-SPOT.TB in Detection of Active Tuberculosis During Pregnancy: A Retrospective Study in China.

    Science.gov (United States)

    Chen, Qiaopei; Guo, Xuxiao; Wang, Xinfeng; Wang, Maoshui

    2016-01-06

    Interferon-gamma release assays have not been validated in active TB among pregnant women. Therefore, the objective of this retrospective study was to estimate the diagnostic value of T-SPOT.TB in active TB among pregnant women. Between May 2012 and May 2015, 26 consecutive pregnant women with suspected TB were enrolled in our study. The clinicopathological characteristics and T-SPOT.TB results were reviewed and analyzed. Pregnant patients were divided into a TB group (n=21) and a Non-TB group (n=5). In the TB group, 5 patients had pulmonary TB, 5 had pulmonary TB+ extrapulmonary TB, and 11 had exclusively extrapulmonary TB. The most common site of extrapulmonary TB was pleural (n=11). Statistical analysis showed that the lymphocyte count in the TB group was lower than in the Non-TB group (Pgood performance in detection of active tuberculosis during pregnancy. Interferon gamma release assay for TB screening of pregnant women is recommended in clinical practice because it may be a more appropriate diagnostic tool than the tuberculin skin test.

  19. The discriminative value of inflammatory back pain in patients with persistent low back pain

    DEFF Research Database (Denmark)

    Arnbak, B.; Hendricks, O.; Horslev-Petersen, K.

    2016-01-01

    OBJECTIVES: To estimate the prevalence of inflammatory back pain (IBP) characteristics and analyse the discriminative value of IBP relative to axial spondyloarthritis (SpA) according to the Assessment of SpondyloArthritis international Society (ASAS) criteria. METHOD: Patients who had low back pain...... the pain characteristics included in the Calin, Berlin, and ASAS IBP definitions. RESULTS: Of the 759 included patients, 99% [95% confidence interval (CI) 98-100] had at least one IBP characteristic. The prevalence of the single IBP characteristics ranged from 10% (95% CI 7-12) for 'pain worst...... value was low, as IBP could not differentiate patients with SpA according to ASAS criteria from patients with other causes of back pain....

  20. Antiretroviral Treatment Scale-Up and Tuberculosis Mortality in High TB/HIV Burden Countries: An Econometric Analysis

    OpenAIRE

    Yan, Isabel; Bendavid, Eran; Korenromp, Eline L.

    2016-01-01

    textabstractIntroduction Antiretroviral therapy (ART) reduces mortality in patients with active tuberculosis (TB), but the population-level relationship between ART coverage and TB mortality is untested. We estimated the reduction in population-level TB mortality that can be attributed to increasing ART coverage across 41 high HIV-TB burden countries. Methods We compiled TB mortality trends between 1996 and 2011 from two sources: (1) national program-reported TB death notifications, adjusted ...

  1. Prediction of Depression in Cancer Patients With Different Classification Criteria, Linear Discriminant Analysis versus Logistic Regression.

    Science.gov (United States)

    Shayan, Zahra; Mohammad Gholi Mezerji, Naser; Shayan, Leila; Naseri, Parisa

    2015-11-03

    Logistic regression (LR) and linear discriminant analysis (LDA) are two popular statistical models for prediction of group membership. Although they are very similar, the LDA makes more assumptions about the data. When categorical and continuous variables used simultaneously, the optimal choice between the two models is questionable. In most studies, classification error (CE) is used to discriminate between subjects in several groups, but this index is not suitable to predict the accuracy of the outcome. The present study compared LR and LDA models using classification indices. This cross-sectional study selected 243 cancer patients. Sample sets of different sizes (n = 50, 100, 150, 200, 220) were randomly selected and the CE, B, and Q classification indices were calculated by the LR and LDA models. CE revealed the a lack of superiority for one model over the other, but the results showed that LR performed better than LDA for the B and Q indices in all situations. No significant effect for sample size on CE was noted for selection of an optimal model. Assessment of the accuracy of prediction of real data indicated that the B and Q indices are appropriate for selection of an optimal model. The results of this study showed that LR performs better in some cases and LDA in others when based on CE. The CE index is not appropriate for classification, although the B and Q indices performed better and offered more efficient criteria for comparison and discrimination between groups.

  2. Simplifying the human serum proteome for discriminating patients with bipolar disorder of other psychiatry conditions.

    Science.gov (United States)

    de Jesus, Jemmyson Romário; Galazzi, Rodrigo Moretto; de Lima, Tatiani Brenelli; Banzato, Cláudio Eduardo Muller; de Almeida Lima E Silva, Luiz Fernando; de Rosalmeida Dantas, Clarissa; Gozzo, Fábio Cézar; Arruda, Marco Aurélio Zezzi

    2017-12-01

    An exploratory analysis using proteomic strategies in blood serum of patients with bipolar disorder (BD), and with other psychiatric conditions such as Schizophrenia (SCZ), can provide a better understanding of this disorder, as well as their discrimination based on their proteomic profile. The proteomic profile of blood serum samples obtained from patients with BD using lithium or other drugs (N=14), healthy controls, including non-family (HCNF; N=3) and family (HCF; N=9), patients with schizophrenia (SCZ; N=23), and patients using lithium for other psychiatric conditions (OD; N=4) were compared. Four methods for simplifying the serum samples proteome were evaluated for both removing the most abundant proteins and for enriching those of lower-abundance: protein depletion with acetonitrile (ACN), dithiothreitol (DTT), sequential depletion using DTT and ACN, and protein equalization using commercial ProteoMiner® kit (PM). For proteomic evaluation, 2-D DIGE and nanoLC-MS/MS analysis were employed. PM method was the best strategy for removing proteins of high abundance. Through 2-D DIGE gel image comparison, 37 protein spots were found differentially abundant (p<0.05, Student's t-test), which exhibited ≥2.0-fold change of the average value of normalized spot intensities in the serum of SCZ, BD and OD patients compared to subject controls (HCF and HCNF). From these spots detected, 13 different proteins were identified: ApoA1, ApoE, ApoC3, ApoA4, Samp, SerpinA1, TTR, IgK, Alb, VTN, TR, C4A and C4B. Proteomic analysis allowed the discrimination of patients with BD from patients with other mental disorders, such as SCZ. The findings in this exploratory study may also contribute for better understanding the pathophysiology of these disorders and finding potential serum biomarkers for these conditions. Copyright © 2017 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.

  3. Usefulness of interferon-γ release assay for the diagnosis of sputum smear-negative pulmonary and extra-pulmonary TB in Zhejiang Province, China.

    Science.gov (United States)

    Ji, Lei; Lou, Yong-Liang; Wu, Zhong-Xiu; Jiang, Jin-Qin; Fan, Xing-Li; Wang, Li-Fang; Liu, Xiao-Xiang; Du, Peng; Yan, Jie; Sun, Ai-Hua

    2017-09-01

    Quick diagnosis of smear-negative pulmonary tuberculosis (TB) and extra-pulmonary TB are urgently needed in clinical diagnosis. Our research aims to investigate the usefulness of the interferon-γ release assay (IGRA) for the diagnosis of smear-negative pulmonary and extra-pulmonary TB. We performed TB antibody and TB-IGRA tests on 389 pulmonary TB patients (including 120 smear-positive pulmonary TB patients and 269 smear-negative pulmonary TB patients), 113 extra-pulmonary TB patients, 81 patients with other pulmonary diseases and 100 healthy controls. Blood samples for the TB-Ab test and the TB-IGRA were collected, processed, and interpreted according to the manufacturer's protocol. The detection ratio of smear-positive pulmonary TB patients and smear-negative pulmonary TB patients were 90.8% (109 of 120) and 89.6% (241 of 269), respectively. There was no statistically significant difference of its performance between these two sample sets (P > 0.05). The detection ratio of positive TB patients and extra-pulmonary TB patients were 90.0% (350 of 389) and 87.6% (99 of 113), respectively, which was not significantly different (P > 0.05). In this work, the total detection ratio using TB-IGRA was 89.4%, therefore TB-IGRA has diagnostic values in smear-negative pulmonary TB and extra-pulmonary TB diagnosis.

  4. Tuberculosis Facts - You Can Prevent TB

    Science.gov (United States)

    Tuberculosis (TB) Facts You Can Prevent TB What is TB? “TB” is short for a disease called tuberculosis. TB is spread through the air from one ... Viral Hepatitis, STD, and TB Prevention Division of Tuberculosis Elimination TB Facts: You Can Prevent TB What ...

  5. Tuberculosis Facts - TB Can Be Treated

    Science.gov (United States)

    Tuberculosis (TB) Facts TB Can Be Treated What is TB? “TB” is short for a disease called tuberculosis. TB is spread through the air from one ... Viral Hepatitis, STD, and TB Prevention Division of Tuberculosis Elimination Page 1 of 2 TB Facts: TB ...

  6. EDITORIAL South Africa and national TB control: Are we making ...

    African Journals Online (AJOL)

    The analysis of the ten leading underlying natural causes of death showed that six of the top ten ... A systematic review on TB and poverty identified the contribution of patient costs in sub-Saharan Africa. The authors reported that. TB patients in sub-Saharan Africa incur both substantial direct and indirect costs before, during ...

  7. Assessing the consequences of stigma for tuberculosis patients in urban Zambia.

    Directory of Open Access Journals (Sweden)

    Anne Lia Cremers

    Full Text Available Stigma is one of the many factors hindering tuberculosis (TB control by negatively affecting hospital delay and treatment compliance. In Zambia, the morbidity and mortality due to TB remains high, despite extended public health attempts to control the epidemic and to diminish stigma.To enhance understanding of TB-related stigmatizing perceptions and to describe TB patients' experiences of stigma in order to point out recommendations to improve TB policy.We conducted a mixed method study at Kanyama clinic and surrounding areas, in Lusaka, Zambia; structured interviews with 300 TB patients, multiple in-depth interviews with 30 TB patients and 10 biomedical health workers, 3 focus group discussions with TB patients and treatment supporters, complemented by participant observation and policy analysis of the TB control program. Predictors of stigma were identified by use of multivariate regression analyses; qualitative analysis of the in-depth interviews, focus group discussions and participant observation was used for triangulation of the study findings.We focused on the 138/300 patients that described TB-related perceptions and attitudes, of whom 113 (82% reported stigma. Stigma provoking TB conceptions were associated with human immunodeficiency virus (HIV-infection, alleged immoral behaviour, (perceived incurability, and (traditional myths about TB aetiology. Consequences of stigma prevailed both among children and adults and included low self-esteem, insults, ridicule, discrimination, social exclusion, and isolation leading to a decreased quality of life and social status, non-disclosure, and/or difficulties with treatment compliance and adherence. Women had significantly more stigma-related problems than men.The findings illustrate that many TB patients faced stigma-related issues, often hindering effective TB control and suggesting that current efforts to reduce stigma are not yet optimal. The content and implementation of sensitization

  8. Changes in employment status and experience of discrimination among cancer patients: findings from a nationwide survey in Korea.

    Science.gov (United States)

    Park, Jae-Hyun; Park, Jong-Hyock; Kim, Sung-Gyeong; Lee, Kyung-Sook; Hahm, Myung-Il

    2010-12-01

    As the number of working cancer patients increases, workplace discrimination and its relationship to changes in employment status among cancer patients is becoming an increasingly important social concern. The aim of this study is to provide a comprehensive overview of the relationship between changes in employment status and discrimination following a diagnosis of cancer. A total of 748 cancer patients, aged 18 years and older, who were employed before receiving a diagnosis of cancer, were enrolled in this study. Patients were recruited from ten cancer centers in Korea. Sociodemographic data, work-related data, and clinical information, as well as information on changes in employment status and incidences of discrimination, were collected from all patients. A change in employment status was reported by 73.4% of the sample, with unemployment being the most common change (46.4%). Forty-two (5.6%) patients reported that they had experienced discrimination in the workplace. Reports of discrimination were only weakly correlated with changes in employment status, but were significantly correlated with forced unemployment. Additional analyses revealed that being female, being from a lower socioeconomic status group and having a disability were risk-factors for unemployment, while being male, being from a higher socioeconomic status group and having a disability were risk-factors for workplace discrimination or forced unemployment. More attention should be paid to vulnerable who are diagnosed with cancer. An individualized and culture-based approach should be taken to minimize undesirable changes in employment status and to reduce discrimination among patients receiving a diagnosis of cancer. Copyright © 2010 John Wiley & Sons, Ltd.

  9. Linkage to care and treatment for TB and HIV among people newly diagnosed with TB or HIV-associated TB at a large, inner city South African hospital.

    Directory of Open Access Journals (Sweden)

    Yara Voss De Lima

    Full Text Available To assess the outcomes of linkage to TB and HIV care and identify risk factors for poor referral outcomes.Cohort study of TB patients diagnosed at an urban hospital.Linkage to care was determined by review of clinic files, national death register, and telephone contact, and classified as linked to care, delayed linkage to care (>7 days for TB treatment, >30 days for HIV care, or failed linkage to care. We performed log-binomial regression to identify patient and referral characteristics associated with poor referral outcomes.Among 593 TB patients, 23% failed linkage to TB treatment and 30.3% of the 77.0% who linked to care arrived late. Among 486 (86.9% HIV-infected TB patients, 38.3% failed linkage to HIV care, and 32% of the 61.7% who linked to care presented late. One in six HIV-infected patients failed linkage to both TB and HIV care. Only 20.2% of HIV-infected patients were referred to a single clinic for integrated care. A referral letter was present in 90.3%, but only 23.7% included HIV status and 18.8% CD4 cell count. Lack of education (RR 1.85 and low CD4 count (CD4≤50 vs. >250cells/mm(3; RR 1.66 were associated with failed linkage to TB care. Risk factors for failed linkage to HIV care were antiretroviral-naïve status (RR 1.29, and absence of referral letter with HIV or CD4 cell count (RR1.23.Linkage to TB/HIV care should be strengthened by communication of HIV and CD4 results, ART initiation during hospitalization and TB/HIV integration at primary care.

  10. Patient-reported racial/ethnic healthcare provider discrimination and medication intensification in the Diabetes Study of Northern California (DISTANCE).

    Science.gov (United States)

    Lyles, Courtney R; Karter, Andrew J; Young, Bessie A; Spigner, Clarence; Grembowski, David; Schillinger, Dean; Adler, Nancy

    2011-10-01

    Racial/ethnic minority patients are more likely to report experiences with discrimination in the healthcare setting, potentially leading to reduced access to appropriate care; however, few studies evaluate reports of discrimination with objectively measured quality of care indicators. To evaluate whether patient-reported racial/ethnic discrimination by healthcare providers was associated with evidence of poorer quality care measured by medication intensification. Baseline data from the Diabetes Study of Northern California (DISTANCE), a random, race-stratified sample from the Kaiser Permanente Diabetes Registry from 2005-2006, including both survey and medical record data. Self-reported healthcare provider discrimination (from survey data) and medication intensification (from electronic prescription records) for poorly controlled diabetes patients (A1c ≥9.0%; systolic BP ≥140 mmHg or diastolic BP ≥90 mmHg; low-density lipoprotein (LDL) ≥130 mg/dl). Of 10,409 eligible patients, 21% had hyperglycemia, 14% had hyperlipidemia, and 32% had hypertension. Of those with hyperglycemia, 59% had their medications intensified, along with 40% with hyperlipidemia, 33% with hypertension, and 47% in poor control of any risk factor. In adjusted log-binomial GEE models, discrimination was not associated with medication intensification [RR = 0.96 (95% CI: 0.74, 1.24) for hyperglycemia, RR = 1.23 (95% CI: 0.93, 1.63) for hyperlipidemia, RR = 1.06 (95% CI: 0.69, 1.61) for hypertension, and RR = 1.08 (95% CI: 0.88, 1.33) for the composite cohort]. We found no evidence that patient-reported healthcare discrimination was associated with less medication intensification. While not associated with this technical aspect of care, discrimination could still be associated with other aspects of care (e.g., patient-centeredness, communication).

  11. Perceived discrimination is a potential contributing factor to substance use and mental health problems among primary care patients in Chile.

    Science.gov (United States)

    Capezza, Nicole M; Zlotnick, Caron; Kohn, Robert; Vicente, Benjamin; Saldivia, Sandra

    2012-12-01

    Perceived discrimination is a prevalent problem that has been linked to negative health outcomes for victims. The goal of this research was to examine whether perceived discrimination within the past 6 months was related to 6-month prevalence of problem drinking, illicit drug use, major depressive disorder (MDD), and posttraumatic stress disorder (PTSD) in a sample of primary care patients in Chile. Structured diagnostic assessments were administered to assess for MDD and PTSD using the Composite International Diagnostic Interview. The Alcohol Use Disorders Identification Test assessed hazardous alcohol use. Additional measures captured illegal drug use and discrimination in the past 6 months. Measures were administered to 2839 participants between the ages of 15 to 98 in primary care centers in the Chilean cities of Concepcion and Talcahuano. Controlling for demographic variables and previous trauma victimization, patients who reported discrimination in the past 6 months were significantly more likely to engage in hazardous alcohol use, illegal drug use, be diagnosed with MDD, and PTSD within this same time period than patients not reporting discrimination. This study highlights the importance of considering discrimination as a potential contributing factor to substance use and mental health problems in a Latin American sample.

  12. Implementing the End TB Strategy in the Western Pacific Region: Translating vision into reality.

    Science.gov (United States)

    Rahevar, Kalpeshsinh; Fujiwara, Paula I; Ahmadova, Shalala; Morishita, Fukushi; Reichman, Lee B

    2018-04-12

    The End TB Strategy aims to end the global tuberculosis (TB) epidemic by 2035 in line with the sustainable development goals targets and has been implemented in the World Health Organization (WHO) Western Pacific Region since 2015. Significant progress has been made in implementing this strategy. However, several challenges still remain. In 2016, an estimated 1.8 million people developed TB in the region, and of these about 20% were missed by national TB programmes. The gap in diagnosis and enrolment as well as treatment completion is greater with drug-resistant TB. Many TB-affected families face catastrophic costs due to the disease. Sustaining financing for TB care is a long-term challenge in many countries. This article emphasizes targeted interventions in high-risk populations, including systematic screening and patient-centred TB care. Several other approaches including improving TB diagnostic tools and algorithm, and engaging all care providers are suggested to find missing TB patients. Drug-resistant TB requires additional resourcing for laboratories, enrolment and patient support. Specific measures are required at different levels to mitigate financial burden due to TB including linking TB to overall social protection schemes. The Moscow Ministerial conference in 2017 and upcoming United Nations (UN) 2018 high-level meeting provide an opportunity to raise TB higher on the global agenda, forge partnerships and move towards universal health coverage. © 2018 Asian Pacific Society of Respirology.

  13. Efficacy and Safety of Antiretroviral Therapy Initiated One Week after Tuberculosis Therapy in Patients with CD4 Counts < 200 Cells/μL: TB-HAART Study, a Randomized Clinical Trial.

    Directory of Open Access Journals (Sweden)

    Wondwossen Amogne

    Full Text Available Given the high death rate the first two months of tuberculosis (TB therapy in HIV patients, it is critical defining the optimal time to initiate combination antiretroviral therapy (cART.A randomized, open-label, clinical trial comparing efficacy and safety of efavirenz-based cART initiated one week, four weeks, and eight weeks after TB therapy in patients with baseline CD4 count < 200 cells/μL was conducted. The primary endpoint was all-cause mortality rate at 48 weeks. The secondary endpoints were hepatotoxicity-requiring interruption of TB therapy, TB-associated immune reconstitution inflammatory syndrome, new AIDS defining illnesses, CD4 counts, HIV RNA levels, and AFB smear conversion rates. All analyses were intention-to-treat.We studied 478 patients with median CD4 count of 73 cells/μL and 5.2 logs HIV RNA randomized to week one (n = 163, week four (n = 160, and week eight (n = 155. Sixty-four deaths (13.4% occurred in 339.2 person-years. All-cause mortality rates at 48 weeks were 25 per 100 person-years in week one, 18 per 100 person-years in week four and 15 per 100 person-years in week eight (P = 0.2 by the log-rank test. All-cause mortality incidence rate ratios in subgroups with CD4 count below 50 cells/μL versus above were 2.8 in week one (95% CI 1.2-6.7, 3.1 in week four (95% CI 1.2-8.6 and 5.1 in week eight (95% CI 1.8-16. Serum albumin < 3 gms/dL (adjusted HR, aHR = 2.3 and CD4 < 50 cells/μL (aHR = 2.7 were independent predictors of mortality. Compared with similar subgroups from weeks four and eight, first-line TB treatment interruption was high in week one deaths (P = 0.03 and in the CD4 subgroup <50 cells/μL (P = 0.02.Antiretroviral therapy one week after TB therapy doesn't improve overall survival. Despite increased mortality with CD4 < 50 cells/μL, we recommend cART later than the first week of TB therapy to avoid serious hepatotoxicity and treatment interruption.ClinicalTrials.gov NCT 01315301.

  14. More significance of TB-IGRA except for the diagnose of tuberculosis.

    Science.gov (United States)

    Xu, Jun-Chi; Li, Ze-Yi; Chen, Xin-Nian; Shi, Cui-Lin; Wu, Mei-Ying; Chen, Hui; Zhu, Xiao-Yan; Song, Hua-Feng; Wu, Min-Juan; Xu, Ping

    2018-01-01

    Tuberculosis (TB)-interferon gamma release assay (IGRA) test has the characteristics of short time, high specificity, and high sensitivity, but it lacks the correlation research between TB-IGRA test results and body's immune cells, disease progression and prognosis, which is explored in this study. A retrospective study was carried out on positive TB-IGRA patients who were infected with TB and diagnosed at our hospital from January 2014 to June 2015. The TB-IGRA, routine blood test, T-cell subgroup data were collected for statistical analysis. TB-IGRA results were in positive proportion to the lymphocytes, CD4 + T cells and CD4 + CD28 + T cells, whereas negative to the Treg cells. Patient with unilateral pulmonary lesion had higher TB-IGRA than those with bilateral pulmonary lesions. After the stimulation of TB-specific antigen, the proportion of CD4 + IFN-γ + and CD8 + IFN-γ + T Tcells were both increased and the CD4 + IFN-γ + T had positive correlation with the value of TB-IGRA. IFN-γ was tested with TB-IGRA in patients with TB by the specific TB T cells and correlated with the lymphocytes, while the lymphocytes also closely related to the host's anti-TB immunity and disease outcome. Hence the result of TB-IGRA could reflect the specific anti-TB immunity ability of the host, disease progression and prognosis. This study further expands the application scope of TB-IGRA technology in the diagnosis of TB and lays a foundation for clinical practice to understand the immunity state of the patients with TB and the application of auxiliary clinical immunity regulators. © 2017 Wiley Periodicals, Inc.

  15. SF-36v2 norms and its' discriminative properties among healthy households of tuberculosis patients in Malaysia.

    Science.gov (United States)

    Atif, Muhammad; Sulaiman, Syed Azhar Syed; Shafie, Asrul Akmal; Asif, Muhammad; Ahmad, Nafees

    2013-10-01

    The aim of the study was to obtain norms of the SF-36v2 health survey and the association of summary component scores with socio-demographic variables in healthy households of tuberculosis (TB) patients. All household members (18 years and above; healthy; literate) of registered tuberculosis patients who came for contact tracing during March 2010 to February 2011 at the respiratory clinic of Penang General Hospital were invited to complete the SF-36v2 health survey using the official translation of the questionnaire in Malay, Mandarin, Tamil and English. Scoring of the questionnaire was done using Quality Metric's QM Certified Scoring Software version 4. Multivariate analysis was conducted to uncover the predictors of physical and mental health. A total of 649 eligible respondents were approached, while 525 agreed to participate in the study (response rate = 80.1 %). Out of consenting respondents, 46.5 % were male and only 5.3 % were over 75 years. Internal consistencies met the minimum criteria (α > 0.7). Reliability coefficients of the scales were always less than their own reliability coefficients. Mean physical component summary scale scores were equivalent to United States general population norms. However, there was a difference of more than three norm-based scoring points for mean mental component summary scores indicating poor mental health. A notable proportion of the respondents was at the risk of depression. Respondents aged 75 years and above (p = 0.001; OR 32.847), widow (p = 0.013; OR 2.599) and postgraduates (p health while unemployment (p = 0.033; OR 1.721) was the only predictor of poor mental health. The SF-36v2 is a valid instrument to assess HRQoL among the households of TB patients. Study findings indicate the existence of poor mental health and risk of depression among family caregivers of TB patients. We therefore recommend that caregivers of TB patients to be offered intensive support and special attention to cope with these emotional

  16. 8__Aisha_Detection ofMDR-TB

    African Journals Online (AJOL)

    User

    Among the MDR-TB cases rifampicin resistance was associated with rpoB WT gene and rpoB MUT gene in 100% and 62% of the ... diagnosis of TB patients, and proper treatment and management of the infected cases to minimize the spread and ..... in an amino acid change and concluded that this is one of the reasons ...

  17. Serial QuantiFERON-TB Gold In-Tube testing for psoriatic patients receiving antitumor necrosis factor-alpha therapy

    Directory of Open Access Journals (Sweden)

    Chun-Yu Cheng

    2015-09-01

    Conclusion: This study demonstrated that 14.29% of psoriatic patients undergoing long-term TNF-α antagonist therapy had a QFT-GIT conversion. Although a decreased IFN-γ level and QFT-GIT reversion were observed in most cases following prophylactic therapy, the value of QFT-GIT for evaluating the effect of LTBI prophylaxis remains controversial.

  18. 'When I get better I will do the test': Facilitators and barriers to HIV testing in Northwest Region of Cameroon with implications for TB and HIV/AIDS control programmes.

    Science.gov (United States)

    Barnabas Njozing, Nwarbébé; Edin, Kerstin E; Hurtig, Anna-Karin

    2010-12-01

    The World Health Organization has recommended collaborative activities between TB and HIV programmes with routine counseling and testing for HIV among TB patients in order to improve the uptake of HIV services. We carried out qualitative research interviews with 21 TB patients in four selected TB and HIV/AIDS treatment centres in the Northwest Region of Cameroon to explore the facilitators and barriers to HIV testing. The desire to be healthy and live longer from knowing one's status inspired by the anticipated support from loved ones, faith in a supreme being, influence and trust in the medical authority, encouraged HIV testing. Men also demonstrated their masculinity by testing, thus portraying themselves as positive role models for other men. Meanwhile, the overwhelming burden of facing both TB and HIV simultaneously, influenced by the fear of disclosure of results, harmful gender norms and practices, fear of stigma and discrimination, and misconceptions surrounding HIV/AIDS deterred HIV testing. However, as a result of conflicting emotional experiences regarding to test or not to test, the decision-making process was not straightforward and this complex process needs to be acknowledged by health care providers when advocating for routine HIV testing among TB patients.

  19. Extensively drug-resistant tuberculosis (XDR-TB) in Morocco.

    Science.gov (United States)

    Ennassiri, Wifak; Jaouhari, Sanae; Cherki, Wafa; Charof, Reda; Filali-Maltouf, Abdelkarim; Lahlou, Ouafae

    2017-12-01

    Extensively drug-resistant tuberculosis (XDR-TB) has recently been identified as a major global health threat. The aim of this study was to evaluate the presence of XDR-TB among Mycobacterium tuberculosis isolates in Morocco and its association with demographic, clinical and epidemiological features. A total of 524 patients from the Moroccan National Tuberculosis Reference Laboratory, representative of all of the geographic regions, were subject to first-line drug susceptibility testing (DST). Subsequently, 155 isolates found to be multidrug-resistant tuberculosis (MDR-TB) underwent second-line DST. Moreover, to enhance our understanding of the genetic basis of these drug-resistant strains, drug resistance-associated mutations were investigated in isolates either identified as pre-XDR- and XDR-TB or suspected resistant using the GenoType ® MTBDRsl V1.0 assay. In this study, 4 (2.6%) XDR-TB and 18 (11.6%) pre-XDR-TB isolates were identified. Agreement between the MTBDRsl assay results and phenotypic DST was 95.2% for ofloxacin, 81.0% for kanamycin and 95.2% for amikacin. To the best of our knowledge, this is the first study to evaluate the frequency of XDR-TB in Morocco. These results highlight the need to reinforce the TB management policy in Morocco with regard to control and detection strategies in order to prevent further spread of XDR-TB isolates. Copyright © 2017. Published by Elsevier Ltd.

  20. Chest Radiographs for Pediatric TB Diagnosis: Interrater Agreement and Utility

    Directory of Open Access Journals (Sweden)

    G. Kaguthi

    2014-01-01

    Full Text Available The chest radiograph (CXR is considered a key diagnostic tool for pediatric tuberculosis (TB in clinical management and endpoint determination in TB vaccine trials. We set out to compare interrater agreement for TB diagnosis in western Kenya. A pediatric pulmonologist and radiologist (experts, a medical officer (M.O, and four clinical officers (C.Os with basic training in pediatric CXR reading blindly assessed CXRs of infants who were TB suspects in a cohort study. C.Os had access to clinical findings for patient management. Weighted kappa scores summarized interrater agreement on lymphadenopathy and abnormalities consistent with TB. Sensitivity and specificity of raters were determined using microbiologically confirmed TB as the gold standard (n=8. A total of 691 radiographs were reviewed. Agreement on abnormalities consistent with TB was poor; k=0.14 (95% CI: 0.10–0.18 and on lymphadenopathy moderate k=0.26 (95% CI: 0.18–0.36. M.O [75% (95% CI: 34.9%–96.8%] and C.Os [63% (95% CI: 24.5%–91.5%] had high sensitivity for culture confirmed TB. TB vaccine trials utilizing expert agreement on CXR as a nonmicrobiologically confirmed endpoint will have reduced specificity and will underestimate vaccine efficacy. C.Os detected many of the bacteriologically confirmed cases; however, this must be interpreted cautiously as they were unblinded to clinical features.

  1. The sensitivity and specificity of using a computer aided diagnosis program for automatically scoring chest X-rays of presumptive TB patients compared with Xpert MTB/RIF in Lusaka Zambia.

    Directory of Open Access Journals (Sweden)

    Monde Muyoyeta

    Full Text Available OBJECTIVE: To determine the sensitivity and specificity of a Computer Aided Diagnosis (CAD program for scoring chest x-rays (CXRs of presumptive tuberculosis (TB patients compared to Xpert MTB/RIF (Xpert. METHOD: Consecutive presumptive TB patients with a cough of any duration were offered digital CXR, and opt out HIV testing. CXRs were electronically scored as normal (CAD score ≤ 60 or abnormal (CAD score > 60 using a CAD program. All patients regardless of CAD score were requested to submit a spot sputum sample for testing with Xpert and a spot and morning sample for testing with LED Fluorescence Microscopy-(FM. RESULTS: Of 350 patients with evaluable data, 291 (83.1% had an abnormal CXR score by CAD. The sensitivity, specificity, positive predictive value (PPV and negative predictive value (NPV of CXR compared to Xpert were 100% (95%CI 96.2-100, 23.2% (95%CI 18.2-28.9, 33.0% (95%CI 27.6-38.7 and 100% (95% 93.9-100, respectively. The area under the receiver operator curve (AUC for CAD was 0.71 (95%CI 0.66-0.77. CXR abnormality correlated with smear grade (r = 0.30, p<0.0001 and with Xpert CT(r = 0.37, p<0.0001. CONCLUSIONS: To our knowledge this is the first time that a CAD program for TB has been successfully tested in a real world setting. The study shows that the CAD program had high sensitivity but low specificity and PPV. The use of CAD with digital CXR has the potential to increase the use and availability of chest radiography in screening for TB where trained human resources are scarce.

  2. Discriminative ability of reflex receptive fields to distinguish patients with acute and chronic low back pain.

    Science.gov (United States)

    Müller, Monika; Biurrun Manresa, José A; Treichel, Fabienne; Agten, Christoph A; Heini, Paul; Andersen, Ole K; Curatolo, Michele; Jüni, Peter

    2016-12-01

    Low back pain has a life time prevalence of 70% to 85%. Approximately 10% to 20% of all patients experience recurrent episodes or develop chronic low back pain. Sociodemographic, clinical, and psychological characteristics explain the transition from acute to chronic low back pain only to a limited extent. Altered central pain processing may be a contributing mechanism. The measurement of reflex receptive fields (RRF) is a novel method to assess altered central pain processing. The RRF area denotes the area of the foot sole from which spinal nociceptive reflexes can be elicited. It was shown to be enlarged in patients with acute and chronic low back pain compared with pain-free individuals. The aim of the study was to explore the discriminative ability of the RRF to distinguish patients with acute and chronic low back pain with the hypothesis that enlarged RRF are associated with chronic low back pain. We included 214 patients with either acute or chronic low back pain and compared RRF between groups in both univariable and multivariable analyses adjusted for different sociodemographic and clinical characteristics possibly associated with the transition to chronic pain. We found a mean difference between patients with acute and chronic low back pain of -0.01 (95% confidence interval [CI], -0.06 to 0.04) in the crude, -0.02 (95% CI, -0.08 to 0.04) in the age and sex adjusted, and -0.02 (95% CI, -0.09 to 0.05) in the fully adjusted model. Our results suggest that the enlargement of RRF area may not be associated with the transition from acute to chronic low back pain.

  3. Inaccuracy of Death Certificate Diagnosis of Tuberculosis and Potential Underdiagnosis of TB in a Region of High HIV Prevalence

    Directory of Open Access Journals (Sweden)

    Theresa T. Liu

    2012-01-01

    Full Text Available Despite the South African antiretroviral therapy rollout, which should reduce the incidence of HIV-associated tuberculosis (TB, the number of TB-attributable deaths in KwaZuluNatal (KZN remains high. TB is often diagnosed clinically, without microbiologic confirmation, leading to inaccurate estimates of TB-attributed deaths. This may contribute to avoidable deaths, and impact population-based TB mortality estimates. Objectives. (1 To measure the number of cases with microbiologically confirmed TB in a retrospective cohort of deceased inpatients with TB-attributed hospital deaths. (2 To estimate the rates of multi-drug resistant (MDR and extensively drug resistant (XDR TB in this cohort. Results. Of 2752 deaths at EDH between September 2006 and March 2007, 403 (15% were attributed to TB on the death certificate. 176 of the TB-attributed deaths (44% had a specimen sent for smear or culture; only 64 (36% had a TB diagnosis confirmed by either test. Of the 39 culture-confirmed cases, 27/39 (69% had fully susceptible TB and 27/39 (69% had smear-negative culture-positive TB (SNTB. Two patients had drug monoresistance, three patients had MDR-TB, and one had XDR-TB. Conclusions. Most TB-attributed deaths in this cohort were not microbiologically confirmed. Of confirmed cases, most were smear-negative, culture positive and were susceptible to all first line drugs.

  4. The association of cumulative discrimination on quality of care, patient-centered care, and dissatisfaction with care in adults with type 2 diabetes.

    Science.gov (United States)

    Cykert, David M; Williams, Joni S; Walker, Rebekah J; Davis, Kimberly S; Egede, Leonard E

    2017-01-01

    Discrimination is linked to negative health outcomes, but little research has investigated how the cumulative effect of discrimination impacts perceptions of care. This study investigated the influence of cumulative perceived discrimination on quality of care, patient-centeredness, and dissatisfaction with care in adults with type 2 diabetes. Six hundred two patients from two primary care clinics in Charleston, SC. Linear regression models assessed associations between perceived discrimination and quality of care, patient-centered care, and dissatisfaction with care. The models control for race, site, age, gender, marital status, duration of diabetes, education, hours worked weekly, income, and health status. The mean age was 61.5years, with 66.3% non-Hispanic blacks, and 41.9% earning less than $20,000 annually. In final adjusted analyses, lower patient-centered care was associated with a higher discrimination score (β=-0.28; p=0.006), reporting at least 1 category of discrimination (β=-1.47; p=0.002), and reporting at least 2 categories of discrimination (β=-1.34; p=0.004). Dissatisfaction with care was associated with at least 2 categories of discrimination (β=0.45; p=0.002). No significant associations were seen with quality of care indicators. Increased cumulative discrimination was associated with decreased feeling of patient-centeredness and increased dissatisfaction with care. However, these perceptions of discrimination were not significantly associated with quality indicators. Copyright © 2017 Elsevier Inc. All rights reserved.

  5. Evaluation of rapid GeneXpert MTB/RIF method using DNA tissue specimens of vertebral bones in patients with suspected spondylitis TB.

    Science.gov (United States)

    Massi, Muhammad Nasrum; Biatko, Karya Triko; Handayani, Irda; Pratama, Muhammad Yogi; Septriani, Sari; Nurdin, Gaby Maulida; Ali, Marina B

    2017-03-01

    To detect Mycobacterium tuberculosis DNA and rifampicin resistance in vertebral bone tissue specimens from spondylitis TB suspects. The rapid GeneXpert MTB/RIF and MGIT 960 liquid culture methods have been used in the specimens. Results from 70 suspects with spondylitis TB shown that 31.42% identified positive for spondylitis TB using culture method, while 88.57% shown positive results using rapid GeneXpert MTB/RIF method. The validity of GeneXpert MTB/RIF shown sensitivity value of 100%, specificity value of 16.6%, PPV of 35.48%, and NPV of 100%. GeneXpert has a high sensitivity but low specificity value in this study.

  6. HIV/TB: WHEN IS IT SAFE TO START HAART? DEBATE

    African Journals Online (AJOL)

    2008-12-17

    Dec 17, 2008 ... HIV-infected patients with TB meningitis varied between. 2 weeks and 12 months after starting TB medications.4 ... (63%), cryptococcal meningitis (13%), other acute pneumonic illnesses (10%) or multiple opportunistic ... However, it should be noted that TB cases were not included in this study population.

  7. Visual discrimination and short-term memory for random patterns in patients with a focal cortical lesion

    NARCIS (Netherlands)

    Greenlee, MW; Koessler, M; Cornelissen, FW; Mergner, T

    1997-01-01

    Visual discrimination and short-term recognition memory for computer-generated random patterns were explored in 23 patients with a postsurgical lesion in one of the cortical hemispheres. Their results are compared with those of 23 age-matched volunteers. In a same-different forced-choice

  8. Oxidative Stress Markers in Tuberculosis and HIV/TB Co-Infection.

    Science.gov (United States)

    Rajopadhye, Shreewardhan Haribhau; Mukherjee, Sandeepan R; Chowdhary, Abhay S; Dandekar, Sucheta P

    2017-08-01

    Dysfunction of redox homeostasis has been implicated in many pathological conditions. An imbalance of pro- and anti-oxidants have been observed in Tuberculosis (TB) and its co-morbidities especially HIV/AIDS. The pro inflammatory milieu in either condition aggravates the physiological balance of the redox mechanisms. The present study therefore focuses on assessing the redox status of patients suffering from TB and HIV-TB co-infection. To assess the oxidative stress markers in the HIV-TB and TB study cohort. The current prospective study was conducted in Haffkine Institute, Parel, Maharashtra, India, during January 2013 to December 2015. Blood samples from 50 patients each suffering from active TB and HIV-TB co-infection were collected from Seth G.S.Medical College and KEM Hospital Mumbai and Group of Tuberculosis Hospital, Sewree Mumbai. Samples were processed and the experiments were carried out at the Department of Biochemistry, Haffkine Institute. Samples from 50 healthy volunteers were used as controls. Serum was assessed for pro-oxidant markers such as Nitric Oxide (NO), Thiobarbituric Acid Reactive Species (TBARS), C-Reactive Protein (CRP), superoxide anion. Antioxidant markers such as catalase and Superoxide Dismutase (SOD) were assessed. Total serum protein, was also assessed. Among the pro-oxidants, serum NO levels were decreased in TB group while no change was seen in HIV-TB group. TBARS and CRP levels showed significant increase in both groups; superoxide anion increased significantly in HIV-TB group. Catalase levels showed decreased activities in TB group. SOD activity significantly increased in HIV-TB but not in TB group. The total serum proteins were significantly increased in HIV-TB and TB groups. The values of Control cohort were with the normal reference ranges. In the present study, we found the presence of oxidative stress to be profound in the TB and HIV-TB co-infection population.

  9. A pilot study assessing the impact of a fortified supplementary food on the health and well-being of crèche children and adult TB patients in South Africa.

    Directory of Open Access Journals (Sweden)

    Michael Rudolph

    Full Text Available The South African population faces many of the global concerns relating to micronutrient deficiency and the impact this has on health and well-being. Moreover, there is a high prevalence of HIV infection, compounded by a high level of co-infection with TB.This pilot study evaluates the impact of a fortified supplementary food on the health and well-being of a cohort of crèche children, aged 3 to 6, and adult TB patients drawn from the Presidential Node of Alexandra, Johannesburg, South Africa. A further aim of this study was to evaluate the sensitivity and validity of non-invasive indicators of nutritional status in a field-based population sample.The investigational product, e'Pap, is supported by extensive anecdotal evidence that whole grain cereals with food-style nutrients constitute an effective supplementary food for those suffering from the effects of food insecurity, poor health and well-being, and coping with TB and HIV infection.The results indicate a beneficial effect of e'Pap for both study populations, and particularly for adult TB patients, whose baseline data reflected severe food insecurity and malnutrition in the majority of cases. There is evidence to suggest statistically significant improvements in key micronutrient levels, well-being and energy, hand-grip strength, the Bioelectrical Impedance Analysis (BIA Illness Marker, and certain clinical indicators. Although Body Mass Index (BMI and Mid Upper Arm Circumference (MUAC are frequently used as standard measures to evaluate the efficacy of nutritional interventions, these indicators were not sufficiently sensitive in this study. Nor does weight gain necessarily indicate improved nutritional status. Hand-grip strength, lean body mass, and the BIA Illness Marker seem to be more useful indicators of change in nutritional status.

  10. “I Can Also Serve as an Inspiration”: A Qualitative Study of the TB&Me Blogging Experience and Its Role in MDR-TB Treatment

    Science.gov (United States)

    Horter, Shona; Stringer, Beverley; Venis, Sarah; du Cros, Philipp

    2014-01-01

    Background In 2011, Médecins Sans Frontières (MSF) established a blogging project, “TB&Me,” to enable patients with multidrug-resistant tuberculosis (MDR-TB) to share their experiences. By September 2012, 13 MDR-TB patients had blogged, either directly or with assistance, from the UK, Australia, Philippines, Swaziland, Central African Republic, Uganda, South Africa, India, and Armenia. Due to the lack of research on the potential for social media to support MDR-TB treatment and the innovative nature of the blog, we decided to conduct a qualitative study to examine patient and staff experiences. Our aim was to identify potential risks and benefits associated with blogging to enable us to determine whether social media had a role to play in supporting patients with MDR-TB. Methods and Findings Participants were identified and selected purposively. TB&Me bloggers, project staff, MSF headquarters staff involved with TB and WHO European Region TB policy advisors were invited to participate in a semi-structured interview. Twenty interviews were conducted (five with bloggers). Data analysis drew upon principles of grounded theory, with constant comparison of data, cases and categories, and attention to deviant cases. We found that the TB&Me blog was associated with identified health benefits, with no reported instances of harm. There were three main findings: blogging was reported as useful for adherence to DR-TB treatment and supportive of the treatment-taking process by all bloggers and project staff; blogging provided support to patients (peer support, shared experience and reduction in isolation); and the blog was perceived as giving patients strength and voice. Conclusion The TB&Me blog was seen to be associated with positive identified health and emotional benefits. Component 5 of the Stop TB Global Plan highlights the importance of empowering TB patients and communities. Blogging could be a useful tool to help achieve that ambition. PMID:25251404

  11. "I can also serve as an inspiration": a qualitative study of the TB&Me blogging experience and its role in MDR-TB treatment.

    Science.gov (United States)

    Horter, Shona; Stringer, Beverley; Venis, Sarah; du Cros, Philipp

    2014-01-01

    In 2011, Médecins Sans Frontières (MSF) established a blogging project, "TB&Me," to enable patients with multidrug-resistant tuberculosis (MDR-TB) to share their experiences. By September 2012, 13 MDR-TB patients had blogged, either directly or with assistance, from the UK, Australia, Philippines, Swaziland, Central African Republic, Uganda, South Africa, India, and Armenia. Due to the lack of research on the potential for social media to support MDR-TB treatment and the innovative nature of the blog, we decided to conduct a qualitative study to examine patient and staff experiences. Our aim was to identify potential risks and benefits associated with blogging to enable us to determine whether social media had a role to play in supporting patients with MDR-TB. Participants were identified and selected purposively. TB&Me bloggers, project staff, MSF headquarters staff involved with TB and WHO European Region TB policy advisors were invited to participate in a semi-structured interview. Twenty interviews were conducted (five with bloggers). Data analysis drew upon principles of grounded theory, with constant comparison of data, cases and categories, and attention to deviant cases. We found that the TB&Me blog was associated with identified health benefits, with no reported instances of harm. There were three main findings: blogging was reported as useful for adherence to DR-TB treatment and supportive of the treatment-taking process by all bloggers and project staff; blogging provided support to patients (peer support, shared experience and reduction in isolation); and the blog was perceived as giving patients strength and voice. The TB&Me blog was seen to be associated with positive identified health and emotional benefits. Component 5 of the Stop TB Global Plan highlights the importance of empowering TB patients and communities. Blogging could be a useful tool to help achieve that ambition.

  12. Difference Between Latent TB Infection and Active TB Disease

    Science.gov (United States)

    ... ATS) and CDC. Diagnostic standards and classification of tuberculosis in adults and children. (PDF) Am J Respir Crit Care Med 2000 ; 161. http: / / ajrccm. atsjournals. org/ cgi/ content/ full/ 161/ 4/ 1376 2. ... Tuberculosis (MDR TB) . http: / / www. cdc. gov/ tb/ publications/ ...

  13. Socio-demographic determinants of stigma among patients with ...

    African Journals Online (AJOL)

    Background: Patients living with tuberculosis (TB) experience significant disruption of their social life and are exposed to stigma and discrimination. This situation impacts on treatment adherence by individual patients and on disease control especially in developing nations. Different aetiological propositions have been ...

  14. Are we doing enough to stem the tide of acquired MDR-TB in countries with high TB burden? Results of a mixed method study in Chongqing, China.

    Directory of Open Access Journals (Sweden)

    Ying Li

    Full Text Available Multi-drug resistant tuberculosis (MDR-TB represents a threat to health and development in countries with high TB burden. China's MDR-TB prevalence rate of 6.8% is the highest in the world. Interventions to remove barriers against effective TB control, and prevention of MDR-TB are urgently needed in the country. This paper reports a cross-sectional questionnaire survey of 513 pulmonary TB (PTB patients, and qualitative interviews of 10 healthcare workers (HCWs, and 15 PTB patients. The objective was to assess barriers against effective control of PTB and prevention of MDR-TB by elucidating the perspectives of patients and healthcare providers. Results showed that more than half of the patients experienced patient delay of over 12.5 days. A similar proportion also experienced detection delay of over 30 days, and delay in initiating treatment of over 31 days. Consulting a non-TB health facility ≥3 times before seeking care at TB dispensary was a risk factor for both detection delay [AOR (95% CI: 1.89(1.07, 3.34 and delay in initiating treatment[AOR (95% CI: 1.88 (1.06, 3.36. Results revealed poor implementation of Directly Observed Therapy (DOT, whereby treatment of 34.3% patients was never monitored by HCWs. Only 31.8% patients had ever accessed TB health education before their TB diagnosis. Qualitative data consistently disclosed long patient delay, and indicated that patient's poor TB knowledge and socioeconomic barriers were primary reasons for patient delay. Seeking care and being treated at a non-TB hospital was an important reason for detection delay. Patient's long work hours and low income increased risk for treatment non-adherence. Evidence-based measures to improve TB health seeking behavior, reduce patient and detection delays, improve the quality of DOT, address financial and system barriers, and increase access to TB health promotion are urgently needed to address the burgeoning prevalence of MDR-TB in China.

  15. TB in Children in the United States

    Science.gov (United States)

    ... Studies Consortium Research Projects Publications TB Trials Consortium Study Descriptions Background Behavioral & Social Science Research Infection Control TB in Specific Populations African-American Community Stop TB in the African-American ...

  16. Extensively Drug-Resistant Tuberculosis (XDR TB)

    Science.gov (United States)

    ... Studies Consortium Research Projects Publications TB Trials Consortium Study Descriptions Background Behavioral & Social Science Research Infection Control TB in Specific Populations African-American Community Stop TB in the African-American ...

  17. Discrimination and other barriers to accessing health care: perspectives of patients with mild and moderate intellectual disability and their carers.

    Directory of Open Access Journals (Sweden)

    Afia Ali

    Full Text Available People with intellectual disability have a higher prevalence of physical health problems but often experience disparities in accessing health care. In England, a number of legislative changes, policies and recommendations have been introduced to improve health care access for this population. The aim of this qualitative study was to examine the extent to which patients with intellectual disability and their carers experience discrimination or other barriers in accessing health services, and whether health care experiences have improved over the last decade years.Twenty nine participants (14 patient and carer dyads, and one carer took part in semi-structured interviews. The interviews were audio-taped and transcribed and analysed using thematic analysis. Eight themes were identified. Half the participants thought that the patient had been treated unfairly or had been discriminated against by health services. There were accounts of negative staff attitudes and behaviour, and failure of services to make reasonable adjustments. Other barriers included problems with communication, and accessing services because of lack of knowledge of local services and service eligibility issues; lack of support and involvement of carers; and language problems in participants from minority ethnic groups. Most participants were able to report at least one example of good practice in health care provision. Suggestions for improving services are presented.Despite some improvements to services as a result of health policies and recommendations, more progress is required to ensure that health services make reasonable adjustments to reduce both direct and indirect discrimination of people with intellectual disability.

  18. Immigrants and health system challenges to TB control in Oman

    Directory of Open Access Journals (Sweden)

    Fochsen Grethe

    2010-07-01

    Full Text Available Abstract Background During the past three decades, Oman has made significant progress in controlling TB within it's borders. However, the national TB control program elimination target has yet to be reached. This study aims to explore the perceived roles played by the immigrant population and the private health sector in relation to TB control in Oman. Methods We conducted seventeen interviews with different health care providers. The verbatim transcripts were processed using content analysis. Results Three main themes emerged. Firstly the threat of repatriation faced by underprivileged expatriates, secondly the criticized and forgotten private health sector as a key player and thirdly the user and provider barriers faced by Omani patients in the Omani public health system. Conclusions The study has identified some of the challenges and barriers to TB control in Oman. These challenges are mainly related to unintended negative consequences arising from the current repatriation policy of immigrants and to and the lack of involvement of the private sector in TB control. TB control strategies designed to address these challenges are needed, for Oman to reach its TB elimination targets.

  19. Global spread of TB worrying trend for Canadian physicians.

    OpenAIRE

    Cairney, R

    1996-01-01

    Canada has one of the world's lowest rates of tuberculosis infection, but that doesn't mean the disease poses no threat here. TB represents a growing problem in prisons and among Canadians of native and Asian descent. Patients with active TB can be misdiagnosed because few physicians ever see the disease and because the bacillus can infect organs other than the lungs. Frequent screening of at-risk populations and a rigorous course of antibiotics for those who are infected are recommended.

  20. Sensitivity of cognitive tests in four cognitive domains in discriminating MDD patients from healthy controls: a meta-analysis.

    Science.gov (United States)

    Lim, JaeHyoung; Oh, In Kyung; Han, Changsu; Huh, Yu Jeong; Jung, In-Kwa; Patkar, Ashwin A; Steffens, David C; Jang, Bo-Hyoung

    2013-09-01

    We performed a meta-analysis in order to determine which neuropsychological domains and tasks would be most sensitive for discriminating between patients with major depressive disorder (MDD) and healthy controls. Relevant articles were identified through a literature search of the PubMed and Cochrane Library databases for the period between January 1997 and May 2011. A meta-analysis was conducted using the standardized means of individual cognitive tests in each domain. The heterogeneity was assessed, and subgroup analyses according to age and medication status were performed to explore the sources of heterogeneity. A total of 22 trials involving 955 MDD patients and 7,664 healthy participants were selected for our meta-analysis. MDD patients showed significantly impaired results compared with healthy participants on the Digit Span and Continuous Performance Test in the attention domain; the Trail Making Test A (TMT-A) and the Digit Symbol Test in the processing speed domain; the Stroop Test, the Wisconsin Card Sorting Test, and Verbal Fluency in the executive function domain; and immediate verbal memory in the memory domain. The Finger Tapping Task, TMT-B, delayed verbal memory, and immediate and delayed visual memory failed to separate MDD patients from healthy controls. The results of subgroup analysis showed that performance of Verbal Fluency was significantly impaired in younger depressed patients (specific cognitive domains have sensitivity to discriminate MDD patients from healthy controls.

  1. Detectemos la TB. Tratemos la TB. Trabajemos juntos para eliminar la TB. (Find TB. Treat TB. Working together to eliminate TB.)

    Centers for Disease Control (CDC) Podcasts

    2014-02-26

    Este podcast trata sobre el Día Mundial de la Tuberculosis y el tema de los CDC para el año 2014.  Created: 2/26/2014 by National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP).   Date Released: 2/26/2014.

  2. Study on the early diagnostic value of T-SPOT.TB assay detecting mononuclear cells in cerebrospinal fluid of patients with tuberculous meningitis

    Directory of Open Access Journals (Sweden)

    FAN Xue-wen

    2013-02-01

    Full Text Available Background Tuberculous meningitis (TBM is a worldwide central nervous system infectious disease and is seriously harmful to human beings. The traditional normal assay of cerebrospinal fluid (CSF and radiological examination always delay the clinical treatment because of low sensitivity and specificity. Therefore, a more sensitive method for the clinical diagnosis of TBM is badly in need. This article uses T lymphocytes enzyme-linked immunospot assay (ELISPOT to detect mononuclear cells in peripheral blood (PB and CSF of TBM patients, and compares the sensitivity and specificity in the diagnosis of TBM between the two methods, for the purpose of providing effective examination method for the early diagnosis of TBM. Methods PB and CSF samples were collected from 30 cases of TBM (case group and 30 cases of non-TBM (control group respectively, and mononuclear cells were separated and extracted through cryopreservation and rapid thawing. A spot test using T lymphocytes infected with tubercle bacillus (T-SPOT.TB was applied to check T lymphocytes secreted by interferon-γ in PB and CSF, so that the sensitivity and specificity for diagnosing TBM by this method were evaluated. Results CSF mononuclear cells ELISPOT assay showed that 28 cases in the case group were diagnosed as TBM and other 2 cases were diagnosed as non-TBM, with the positive rate being 93.33% (28/30 ; as for control group, 1 case was diagnosed as TBM, and 29 cases were diagnosed as non-TBM, with the positive rate being 3.33% (1/30. In CSF mononuclear cells ELISPOT assay, the sensitivity and specificity were 93.33% and 96.67%; false positive rate was 3.33%; false negative rate was 6.67%; positive likelihood ratio was 28.33; negative likelihood ratio was 0.07. PB mononuclear cells ELISPOT assay showed that 23 cases in the case group were diagnosed as TBM and 7 cases were diagnosed as non-TBM, with the positive rate being 76.67% (23 /30; as for control group, 4 cases were diagnosed as TBM

  3. Initiation and adherence to TB treatment in a Pakistani community influenced more by perceptions than by knowledge of tuberculosis

    Directory of Open Access Journals (Sweden)

    Mubashir Zafar

    2013-01-01

    Full Text Available Background: The tuberculosis (TB literature is written almost entirely from a biomedical perspective, while recent studies show that it is imperative to understand lay perception to determine why people seek treatment and may stop taking treatment. Aims: To investigate knowledge about TB, perceptions of (access to TB treatment, and adherence to treatment among a Pakistani population. Setting and Design: Descriptive cross-sectional study. Materials and Methods: A total of 175 participants were selected nonrandomly, 100 were TB patient and 75 were non-TB patient in proportion to the total number of participants in each ward of hospital. Statistical Analysis: Analysis of attitudes and perceptions toward TB, adherence to TB treatment, health seeking behavior, and TB treatment types done by frequency counts and percentages. Regression analysis and logistic regression analysis were performed to test whether differences in age, gender, and education level led to different knowledge scores and different attitudes and preferences toward TB, adherence to TB treatment, health seeking behavior, and TB treatment types. All statistical analyses were performed using Statistical Package for Social Sciences (SPSS 16.0. Result: TB knowledge can be considered fairly well among this community. Respondents′ perceptions suggest that stigma may influence TB patients′ decision in health seeking behavior and adherence to TB treatment. A full 95% of those interviewed believe people with TB tend to hide their TB status out of fear of what others may say. Conclusion: Most of the subjects were unaware of TB that seems to be due to their illiteracy and those who knew had got the knowledge from media, but the majority of the patients who were on directly observed treatment, short-course (DOTS were found to be satisfied.

  4. Inhibition of placenta growth factor with TB-403

    DEFF Research Database (Denmark)

    Nielsen, Dorte Lisbet; Sengeløv, Lisa

    2012-01-01

    targeting angiogenesis. AREAS COVERED: The data are obtained by searching in the PubMed database. The search terms used included antiangiogenic therapy, TB-403 (RO5323441), placenta growth factor (PlGF) and VEGFR-1 (Flt-1). We review preclinical data concerning the function and inhibition of PlGF...... and summarize data on expression of PlGF in cancer patients. Data from early-phase clinical trials of TB-403 (RO5323441), a monoclonal antibody inhibiting PlGF, are discussed. Future development strategies, therapeutic potentials and limitations of TB-403 are further evaluated. EXPERT OPINION: There are some...... conflicting data on the function of PlGF and the importance of its role in primary tumor growth. Data from some preclinical models of PlGF inhibition and early-phase clinical trials with TB-403 are, however, promising, although the true potential of the drug is yet to be determined. Further clinical...

  5. TB Risk Perceptions among Medical Residents at a Tertiary Care Center in India

    Directory of Open Access Journals (Sweden)

    Geeta S. Pardeshi

    2017-01-01

    Full Text Available Setting. Government tertiary health care center in India. Objective. To understand the perceptions of medical residents about their risk of developing TB in the workplace. Design. Cross-sectional study in which a semistructured questionnaire which included an open-ended question to assess their main concerns regarding TB in workplace was used to collect data. Results. Out of 305 resident doctors approached, 263 (94% completed a structured questionnaire and 200 of these responded to an open-ended question. Daily exposure to TB was reported by 141 (64% residents, 13 (5% reported a prior history of TB, and 175 (69% respondents were aware of TB infection control guidelines. A majority reported concerns about acquiring TB (78% and drug-resistant TB (88%. The key themes identified were concerns about developing drug-resistant TB (n=100; 50%; disease and its clinical consequences (n=39; 20%; social and professional consequences (n=37; 19%; exposure to TB patients (n=32; 16%; poor infection control measures (n=27; 14%; and high workload and its health consequences (n=16; 8%. Conclusion. Though many resident doctors were aware of TB infection control guidelines, only few expressed concern about lack of TB infection control measures. Doctors need to be convinced of the importance of these measures which should be implemented urgently.

  6. Patients infected by tuberculosis and human immunodeficiency virus facing their disease, their reactions to disease diagnosis and its implication about their families and communities, in Burkina Faso: a mixed focus group and cross sectional study.

    Science.gov (United States)

    Méda, Ziemlé Clément; Somé, Télesphore; Sombié, Issiaka; Maré, Daouda; Morisky, Donald E; Chen, Yi-Ming Arthur

    2016-07-29

    Patients facing tuberculosis (TB) and human immunodeficiency virus (HIV) infection receive particular care. Despite efforts in the care, misconceptions about TB and HIV still heavily impact patients, their families and communities. This situation severely limits achievement of TB and HIV programs goals. This study reports current situation of TB patients and patients living with HIV/AIDS (PLWHA) facing their disease and its implications, by comparing results from both qualitative and quantitative study design. Cross sectional study using mixed methods was used and excluded patients co-infected by TB and HIV. Focus group included 96 patients (6 patients per group) stratified by setting, disease profile and gender; from rural (Orodara Health District) and urban (Bobo Dioulasso) areas, all from Hauts-Bassins region in Burkina Faso. Quantitative study included 862 patients (309 TB patients and 553 PLWHA) attending TB and HIV care facilities in two main regions (Hauts-Bassins and Centre) of Burkina Faso. A content analysis of reports found TB patients and PLWHA felt discriminated and stigmatized because of misconceptions with its aftermaths (rejection, emotional and financial problems), mainly among PLWHA and women patients. PLWHA go to healers when facing limited solutions in health system. There are fewer associations for TB patients, and less education and sensitization sessions to give them opportunity for sharing disease status and learning from other TB patients. TB patients and PLWHA still need to better understand their disease and its implication. Access to care (diagnosis and treatment) remains one of the key issues in health system, especially for PLWHA. Individual counseling is centered among PLWHA but not for TB patients. With research progress and experiences sharing, TB patients and PLWHA have some hope to implement their life project, and to receive psychosocial and nutritional support. Despite international aid, TB patients and PLWHA are facing

  7. Antiretroviral treatment scale-up and tuberculosis mortality in high TB/HIV burden countries: An econometric analysis

    NARCIS (Netherlands)

    I. Yan (Isabel); A. Bendavid (Avrom); E.L. Korenromp (Eline)

    2016-01-01

    textabstractIntroduction Antiretroviral therapy (ART) reduces mortality in patients with active tuberculosis (TB), but the population-level relationship between ART coverage and TB mortality is untested. We estimated the reduction in population-level TB mortality that can be attributed to increasing

  8. Accelerating access to quality TB care for pediatric TB cases through better diagnostic strategy in four major cities of India.

    Science.gov (United States)

    Raizada, Neeraj; Khaparde, Sunil D; Salhotra, Virender Singh; Rao, Raghuram; Kalra, Aakshi; Swaminathan, Soumya; Khanna, Ashwani; Chopra, Kamal Kishore; Hanif, M; Singh, Varinder; Umadevi, K R; Nair, Sreenivas Achuthan; Huddart, Sophie; Prakash, C H Surya; Mall, Shalini; Singh, Pooja; Saha, B K; Denkinger, Claudia M; Boehme, Catharina; Sarin, Sanjay

    2018-01-01

    solution to address TB diagnosis in children. The high levels of rifampicin resistance detected in presumptive pediatric TB patients tested under the project are a major cause of concern from a public health perspective which underscores the need to further prioritize upfront Xpert access to this vulnerable population.

  9. The Use of Xpert MTB/Rif for Active Case Finding among TB Contacts in North West Province, South Africa

    OpenAIRE

    Lebina, Limakatso; Fuller, Nigel; Osoba, Tolu; Scott, Lesley; Motlhaoleng, Katlego; Rakgokong, Modiehi; Abraham, Pattamukkil; Variava, Ebrahim; Martinson, Neil Alexander

    2016-01-01

    Introduction. Tuberculosis is a major cause of morbidity and mortality especially in high HIV burden settings. Active case finding is one strategy to potentially reduce TB disease burden. Xpert MTB/Rif has recently been recommended for diagnosis of TB. Methods. Pragmatic randomized trial to compare diagnosis rate and turnaround time for laboratory testing for Xpert MTB/Rif with TB microscopy and culture in household contacts of patients recently diagnosed with TB. Results. 2464 household cont...

  10. Scale-up of collaborative TB/HIV activities in Guyana.

    Science.gov (United States)

    Baker, Brian J; Peterson, Brandy; Mohanlall, Jeetendra; Singh, Shanti; Hicks, Collene; Jacobs, Ruth; Ramos, Ruth; Allen, Barbara; Pevzner, Eric

    2017-04-20

    To assess scale-up of recommended tuberculosis (TB)/HIV activities in Guyana and to identify specific strategies for further expansion. Medical records and clinic registers were reviewed at nine TB clinics and 10 HIV clinics. At TB clinics, data were collected on HIV testing and antiretroviral therapy (ART) for patients with TB/HIV; at HIV clinics, data were collected on intensified case finding (ICF), tuberculin skin test (TST) results, and provision of isoniazid preventive therapy (IPT). At TB clinics, among 461 patients newly diagnosed with TB, 419 (90.9%) had a known HIV status and 121 (28.9%) were HIV-infected. Among the 63 patients with TB/HIV, 33 (52.4%) received ART. Among the 45 patients with TB/HIV for whom dates of HIV diagnosis were available, 38 (84.4%) individuals knew their HIV status prior to TB diagnosis. At HIV clinics, among 127 patients eligible to receive a TST, 87 (68.5%) received a TST, 66 (75.9%) had a TST result, seven (10.6%) had a newly positive result, two had a previously positive result, and six of nine patients with positive results (66.7%) received IPT. ICF could not be assessed because of incomplete or discrepant documentation. An in-depth evaluation of TB/HIV activities successfully identified areas of success and remaining challenges. At TB clinics, HIV testing rates are high; further scale-up of ART for persons with TB/HIV is needed. At HIV clinics, use of TST to focus IPT is a feasible and efficient strategy; improving rates of annual TST screening will allow for further expansion of IPT.

  11. Discrimination and Other Barriers to Accessing Health Care: Perspectives of Patients with Mild and Moderate Intellectual Disability and Their Carers

    Science.gov (United States)

    Ali, Afia; Scior, Katrina; Ratti, Victoria; Strydom, Andre; King, Michael; Hassiotis, Angela

    2013-01-01

    Background People with intellectual disability have a higher prevalence of physical health problems but often experience disparities in accessing health care. In England, a number of legislative changes, policies and recommendations have been introduced to improve health care access for this population. The aim of this qualitative study was to examine the extent to which patients with intellectual disability and their carers experience discrimination or other barriers in accessing health services, and whether health care experiences have improved over the last decade years. Method and Main Findings Twenty nine participants (14 patient and carer dyads, and one carer) took part in semi-structured interviews. The interviews were audio-taped and transcribed and analysed using thematic analysis. Eight themes were identified. Half the participants thought that the patient had been treated unfairly or had been discriminated against by health services. There were accounts of negative staff attitudes and behaviour, and failure of services to make reasonable adjustments. Other barriers included problems with communication, and accessing services because of lack of knowledge of local services and service eligibility issues; lack of support and involvement of carers; and language problems in participants from minority ethnic groups. Most participants were able to report at least one example of good practice in health care provision. Suggestions for improving services are presented. Conclusion Despite some improvements to services as a result of health policies and recommendations, more progress is required to ensure that health services make reasonable adjustments to reduce both direct and indirect discrimination of people with intellectual disability. PMID:23951026

  12. Knowledge of Tuberculosis and Self Disclosure amongst Patients ...

    African Journals Online (AJOL)

    adedamla

    person to undesirable stereotypes that result in unfair. 7 treatment and discrimination. A sense of desperation and fear of judgmental approach from health workers may ... In each health center, a nurse or community health officer is usually responsible for the TB patients care. Study population: The study population includes ...

  13. Price Discrimination

    OpenAIRE

    Armstrong, M.

    2008-01-01

    This paper surveys recent economic research on price discrimination, both in monopoly and oligopoly markets. Topics include static and dynamic forms of price discrimination, and both final and input markets are considered. Potential antitrust aspects of price discrimination are highlighted throughout the paper. The paper argues that the informational requirements to make accurate policy are very great, and with most forms of price discrimination a laissez-faire policy may be the best availabl...

  14. An Evaluation of the Responsiveness and Discriminant Validity of Shoulder Questionnaires among Patients Receiving Surgical Correction of Shoulder Instability

    Directory of Open Access Journals (Sweden)

    Kyle A. R. Kemp

    2012-01-01

    Full Text Available Health-related quality-of-life (HRQL measures must detect clinically important changes over time and between different patient subgroups. Forty-three patients (32 M, 13 F; mean age  =  26.00  ±  8.19 years undergoing arthroscopic Bankart repair completed three validated shoulder questionnaires (Western Ontario Shoulder Instability index (WOSI, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment form (ASES, Constant score preoperatively, and at 6, 12, and 24 months postoperatively. Responsiveness and discriminant validity was assessed between those with a satisfactory outcome and those with (1 a major recurrence of instability, (2 a single episode of subluxation, (3 any postoperative episode of instability. Eight (20% patients reported recurrent instability. Compared to baseline, the WOSI detected improvement at the 6- (P<0.001 and 12-month (P=0.011 evaluations. The ASES showed improvement at 6 months (P=0.003, while the Constant score did not report significant improvement until 12 months postoperatively (P=0.001. Only the WOSI detected differential shoulder function related to shoulder instability. Those experiencing even a single episode of subluxation reported a 10% drop in their WOSI score, attaining the previously established minimal clinically important difference (MCID. Those experiencing a frank dislocation or multiple episodes of subluxation reported a 20% decline. The WOSI allows better discrimination of the severity of postoperative instability symptoms following arthroscopic Bankart repair.

  15. "We'll Get to You When We Get to You": Exploring Potential Contributions of Health Care Staff Behaviors to Patient Perceptions of Discrimination and Satisfaction.

    Science.gov (United States)

    Tajeu, Gabriel S; Cherrington, Andrea L; Andreae, Lynn; Prince, Candice; Holt, Cheryl L; Halanych, Jewell H

    2015-10-01

    We qualitatively assessed patients' perceptions of discrimination and patient satisfaction in the health care setting specific to interactions with nonphysician health care staff. We conducted 12 focus-group interviews with African American and European American participants, stratified by race and gender, from June to November 2008. We used a topic guide to facilitate discussion and identify factors contributing to perceived discrimination and analyzed transcripts for relevant themes using a codebook. We enrolled 92 participants: 55 African Americans and 37 European Americans, all of whom reported perceived discrimination and lower patient satisfaction as a result of interactions with nonphysician health care staff. Perceived discrimination was associated with 2 main characteristics: insurance or socioeconomic status and race. Both verbal and nonverbal communication style on the part of nonphysician health care staff were related to individuals' perceptions of how they were treated. The behaviors of nonphysician health care staff in the clinical setting can potentially contribute to patients' perceptions of discrimination and lowered patient satisfaction. Future interventions to reduce health care discrimination should include a focus on staff cultural competence and customer service skills.

  16. Hemostasis and Lipoprotein Indices Signify Exacerbated Lung Injury in TB With Diabetes Comorbidity.

    Science.gov (United States)

    Dong, Zhengwei; Shi, Jingyun; Dorhoi, Anca; Zhang, Jie; Soodeen-Lalloo, Adiilah K; Tan, WenLing; Yin, Hongyun; Sha, Wei; Li, Weitong; Zheng, Ruijuan; Liu, Zhonghua; Yang, Hua; Qin, Lianhua; Wang, Jie; Huang, Xiaochen; Wu, Chunyan; Kaufmann, Stefan H E; Feng, Yonghong

    2017-12-07

    Exacerbated immunopathology is a frequent consequence of TB that is complicated by diabetes mellitus (DM); however, the underlying mechanisms are still poorly defined. In the two groups of age- and sex-matched patients with TB and DM (DM-TB) and with TB and without DM, we microscopically evaluated the areas of caseous necrosis and graded the extent of perinecrotic fibrosis in lung biopsies from the sputum smear-negative (SN) patients. We scored acid-fast bacilli in sputum smear-positive (SP) patients and compiled CT scan data from both the SN and SP patients. We compared inflammatory biomarkers and routine hematologic and biochemical parameters. Binary logistic regression analyses were applied to define the indices associated with the extent of lung injury. Enlarged caseous necrotic areas with exacerbated fibrotic encapsulations were found in SN patients with DM-TB, consistent with the higher ratio of thick-walled cavities and more bacilli in the sputum from SP patients with DM-TB. Larger necrotic foci were detected in men compared with women within the SN TB groups. Significantly higher fibrinogen and lower high-density lipoprotein cholesterol (HDL-C) were observed in SN patients with DM-TB. Regression analyses revealed that diabetes, activation of the coagulation pathway (shown by increased platelet distribution width, decreased mean platelet volume, and shortened prothrombin time), and dyslipidemia (shown by decreased low-density lipoprotein cholesterol, HDL-C, and apolipoprotein A) are risk factors for severe lung lesions in both SN and SP patients with TB. Hemostasis and dyslipidemia are associated with granuloma necrosis and fibroplasia leading to exacerbated lung damage in TB, especially in patients with DM-TB. Copyright © 2017 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

  17. Integration of HIV and TB Services Results in Improved TB Treatment Outcomes and Earlier Prioritized ART Initiation in a Large Urban HIV Clinic in Uganda

    NARCIS (Netherlands)

    Hermans, Sabine M.; Castelnuovo, Barbara; Katabira, Catherine; Mbidde, Peter; Lange, Joep M. A.; Hoepelman, Andy I. M.; Coutinho, Alex; Manabe, Yukari C.

    2012-01-01

    Background: The World Health Organization recommends that treatment of tuberculosis (TB) in HIV-infected patients should be integrated with HIV care. In December 2008, a separate outdoor-integrated TB/HIV clinic was instituted for attendees of a large urban HIV clinic in Uganda. We sought to

  18. Antiretroviral Treatment Scale-Up and Tuberculosis Mortality in High TB/HIV Burden Countries: An Econometric Analysis.

    Science.gov (United States)

    Yan, Isabel; Bendavid, Eran; Korenromp, Eline L

    2016-01-01

    Antiretroviral therapy (ART) reduces mortality in patients with active tuberculosis (TB), but the population-level relationship between ART coverage and TB mortality is untested. We estimated the reduction in population-level TB mortality that can be attributed to increasing ART coverage across 41 high HIV-TB burden countries. We compiled TB mortality trends between 1996 and 2011 from two sources: (1) national program-reported TB death notifications, adjusted for annual TB case detection rates, and (2) WHO TB mortality estimates. National coverage with ART, as proportion of HIV-infected people in need, was obtained from UNAIDS. We applied panel linear regressions controlling for HIV prevalence (5-year lagged), coverage of TB interventions (estimated by WHO and UNAIDS), gross domestic product per capita, health spending from domestic sources, urbanization, and country fixed effects. Models suggest that that increasing ART coverage was followed by reduced TB mortality, across multiple specifications. For death notifications at 2 to 5 years following a given ART scale-up, a 1% increase in ART coverage predicted 0.95% faster mortality rate decline (p = 0.002); resulting in 27% fewer TB deaths in 2011 alone than would have occurred without ART. Based on WHO death estimates, a 1% increase in ART predicted a 1.0% reduced TB death rate (peconometric analysis supports a substantial impact of ART on population-level TB mortality realized already within the first decade of ART scale-up, that is apparent despite variable-quality mortality data.

  19. Differential discriminator

    International Nuclear Information System (INIS)

    Dukhanov, V.I.; Mazurov, I.B.

    1981-01-01

    A principal flowsheet of a differential discriminator intended for operation in a spectrometric circuit with statistical time distribution of pulses is described. The differential discriminator includes four integrated discriminators and a channel of piled-up signal rejection. The presence of the rejection channel enables the discriminator to operate effectively at loads of 14x10 3 pulse/s. The temperature instability of the discrimination thresholds equals 250 μV/ 0 C. The discrimination level changes within 0.1-5 V, the level shift constitutes 0.5% for the filling ratio of 1:10. The rejection coefficient is not less than 90%. Alpha spectrum of the 228 Th source is presented to evaluate the discriminator operation with the rejector. The rejector provides 50 ns time resolution

  20. H+ searches in ATLAS (II): H+ to tb

    CERN Document Server

    Mir, Lluisa-Maria; The ATLAS collaboration

    2016-01-01

    A search for charged Higgs bosons heavier than the top quark and decaying via to tb is presented. The analysis uses 13.2 ifb of pp collision data at a centre-of-mass energy of sqrt(s) = 13 TeV collected with the ATLAS detector at the Large Hadron Collider. The production of a charged Higgs boson in association with a top quark and a bottom quark, pp to tbH+-, is explored in the mass range 300 to 1000 GeV using multi-jet final states with one electron or muon from the top-quark decay. Events are categorised according to the multiplicity of jets and b-tagged jets. Multivariate techniques are used to discriminate between signal and background events. No significant excess above the background-only hypothesis is observed and upper limits are set on the tbH+- production cross section times the branching fraction BR(H+- to tb), together with their interpretation in benchmark scenarios of the Minimal Supersymmetric Standard Model.

  1. Biomarkers of latent TB infection

    DEFF Research Database (Denmark)

    Ruhwald, Morten; Ravn, Pernille

    2009-01-01

    For the last 100 years, the tuberculin skin test (TST) has been the only diagnostic tool available for latent TB infection (LTBI) and no biomarker per se is available to diagnose the presence of LTBI. With the introduction of M. tuberculosis-specific IFN-gamma release assays (IGRAs), a new area...... of in vitro immunodiagnostic tests for LTBI based on biomarker readout has become a reality. In this review, we discuss existing evidence on the clinical usefulness of IGRAs and the indefinite number of potential new biomarkers that can be used to improve diagnosis of latent TB infection. We also present...... early data suggesting that the monocyte-derived chemokine inducible protein-10 may be useful as a novel biomarker for the immunodiagnosis of latent TB infection....

  2. Treating the invisible: Gaps and opportunities for enhanced TB control along the Thailand-Myanmar border

    OpenAIRE

    Tschirhart, Naomi; Thi, Sein Sein; Swe, Lei Lei; Nosten, Francois; Foster, Angel M.

    2017-01-01

    Background In Thailand’s northwestern Tak province, contextual conditions along the border with Myanmar pose difficulties for TB control among migrant populations. Incomplete surveillance data, migrant patient mobility, and loss to follow-up make it difficult to estimate the TB burden and implement effective TB control measures. This multi-methods study examined tuberculosis, tuberculosis and human immunodeficiency virus co-infection, and multidrug-resistant tuberculosis treatment accessib...

  3. Impact of introduction of Xpert MTB/RIF test on tuberculosis (TB) diagnosis in a city with high TB incidence in Brazil.

    Science.gov (United States)

    Pereira, Giovana Rodrigues; Barbosa, Márcia Silva; Dias, Natan José Dutra; Almeida, Carlos Podalirio Borges de; Silva, Denise Rossato

    2018-01-01

    Xpert MTB/RIF is increasingly used in many countries as the initial diagnostic test for tuberculosis (TB). Few studies have evaluated the effect of Xpert on TB diagnosis under programmatic conditions in Brazil. The aim of the present study was to evaluate the impact of introduction of Xpert MTB/RIF on TB diagnosis in a city with high TB incidence in Brazil. We included patients evaluated with conventional diagnostic tests during one year before Xpert introduction (pre-Xpert group) and patients evaluated using Xpert during one year after the test introduction (post-Xpert group). 620 patients met the inclusion criteria (208 in the pre-Xpert group and 412 in the post-Xpert group) and were included in the analysis. The time until TB diagnosis was shorter in post-Xpert group (0.7 day, IQR: 0.5-1.0 day) than in pre-Xpert group (2.0 days, IQR: 2.0-2.0 days) (pTB were more common in post-Xpert group than in pre-Xpert group (pTB diagnosis, especially in cases with atypical disease manifestations. These results are likely to be generalizable to settings with a similar high TB incidence.

  4. Management and control of multidrug-resistant tuberculosis (MDR-TB): Addressing policy needs for India.

    Science.gov (United States)

    Atre, Sachin R; Murray, Megan B

    2016-05-06

    Multidrug-resistant tuberculosis (MDR-TB) challenges TB control efforts because of delays in diagnosis plus its long-term treatment which has toxic effects. Of TB high-incidence countries, India carries the highest burden of MDR-TB cases. We describe policy issues in India concerning MDR-TB diagnosis and management in a careful review of the literature including a systematic review of studies on the prevalence of MDR-TB. Of 995 articles published during 2001-2016 and retrieved from the PubMed, only 20 provided data on the population prevalence of MDR-TB. We further reviewed and describe diagnostic criteria and treatment algorithms in use and endorsed by the Revised National TB Control Program of India. We discuss problems encountered in treating MDR-TB patients with standardized regimens. Finally, we provide realistic suggestions for policymakers and program planners to improve the management and control of MDR-TB in India.Journal of Public Health Policy advance online publication, 6 May 2016; doi:10.1057/jphp.2016.14.

  5. Selecting the most relevant brain regions to discriminate Alzheimer's disease patients from healthy controls using multiple kernel learning: A comparison across functional and structural imaging modalities and atlases

    Directory of Open Access Journals (Sweden)

    Jane Maryam Rondina

    2018-01-01

    Conclusion: The MKL-ROI approach highlights the high discriminative weight of a subset of brain regions of known relevance to AD, the selection of which contributes to increased classification accuracy when applied to 18F-FDG-PET data. Moreover, the MKL-ROI approach demonstrates that brain regions typically spared in mild stages of AD also contribute substantially in the individual discrimination of AD patients from controls.

  6. Five years retrospective cohort analysis of treatment outcomes of TB ...

    African Journals Online (AJOL)

    Background: Human immunodeficiency virus (HIV) associated tuberculosis (TB) remains a major global public health challenge, with an estimated 1.4 million patients worldwide. Co-infection with HIV leads to challenges in the diagnosis and treatment of patients. Objectives: The aim of this study was to assess treatment ...

  7. Five years retrospective cohort analysis of treatment outcomes of TB ...

    African Journals Online (AJOL)

    Abstract. Background: Human immunodeficiency virus (HIV) associated tuberculosis (TB) remains a major global public health chal- lenge, with an estimated 1.4 million patients worldwide. Co-infection with HIV leads to challenges in the diagnosis and treatment of patients. Objectives: The aim of this study was to assess ...

  8. Fixed Dose Combination for TB treatment

    Directory of Open Access Journals (Sweden)

    Tjandra Y. Aditama

    2003-06-01

    Full Text Available According to the World Health Organization, a third of the world’s population is infected with tuberculosis. The disease is responsible for nearly 2 million deaths each year and over 8 million were developing active diseases. Moreover, according to WHO (2000, tuberculosis deaths are estimated to increase to 35 million between 2000-2020. The majority of tuberculosis patients worldwide are still treated with single drugs, or with 2-drug fixed-dose combinations (FDCs. To improve tuberculosis treatment, 2- and 3-drug FDCs were recommended by the World Health Organization (WHO as part of the DOTS strategy. Since 1999 a 4-drug FDC was included on the WHO Model List of Essential Drugs. Today, FDCs are important tools to further improve the quality of care for people with TB, and accelerate DOTS expansion to reach the global TB control targets. Fixed dose combination TB drugs could simplifies both treatment and management of drug supply, and may prevent the emergence of drug resistance .Prevention of drug resistance is just one of the potential benefits of the use of FDCs. FDCs simplify administration of drugs by reducing the number of pills a patient takes each day and decreasing the risk of incorrect prescriptions. Most tuberculosis patients need only take 3–4 FDCs tablets per day during the intensive phase of treatment, instead of the 15–16 tablets per day that is common with single-drug formulations It is much simpler to explain to patients that they need to take four tablets of the same type and colour, rather than a mixture of tablets of different shapes, colours and sizes. Also, the chance of taking an incomplete combination of drugs is eliminated, since the four essential drugs are combined into one tablet. FDCs are also simpler for care-givers as they minimize the risk of confusion. Finally, drug procurement, in all its components (stock management, shipping, distribution, is simplified by FDCs. Adverse reactions to drugs are not more

  9. A rapid and low-cost microscopic observation drug susceptibility assay for detecting TB and MDR-TB among individuals infected by HIV in South India

    Directory of Open Access Journals (Sweden)

    S Solomon

    2013-01-01

    Full Text Available Background: The converging epidemics of HIV and tuberculosis (TB pose one of the greatest public health challenges of our time. Rapid diagnosis of TB is essential in view of its infectious nature, high burden of cases, and emergence of drug resistance. Objective: The purpose of this present study was to evaluate the feasibility of implementing the microscopic observation drug susceptibility (MODS assay, a novel assay for the diagnosis of TB and multi-drug-resistant tuberculosis (MDR-TB directly from sputum specimens, in the Indian setting. Materials and Methods: This study involved a cross-sectional, blinded assessment of the MODS assay on 1036 suspected cases of pulmonary TB in HIV-positive and HIV-negative patients against the radiometric method, BD-BACTEC TB 460 system. Results: Overall, the sensitivity, specificity, positive predictive value, and negative predictive value of the MODS assay in detecting MTB among TB suspected patients were 89.1%, 99.1%, 94.2%, 95.8%, respectively. In addition, in the diagnosis of drug-resistant TB, the MODS assay was 84.2% sensitive for those specimens reporting MDR, 87% sensitivity for those specimens reporting INH mono-resistance, and 100% sensitive for specimens reporting RIF mono-resistance. The median time to detection of TB in the MODS assay versus BACTEC was 9 versus 21 days (P < 0.001. Conclusion: Costing 5 to 10 times lesser than the automated culture methods, the MODS assay has the potential clinical utility as a simple and rapid method. It could be effectively used as an alternative method for diagnosing TB and detection of MDR-TB in a timely and affordable way in resource-limited settings.

  10. Estimation of Symptom Severity Scores for Patients with Schizophrenia Using ERP Source Activations during a Facial Affect Discrimination Task

    Directory of Open Access Journals (Sweden)

    Do-Won Kim

    2017-08-01

    Full Text Available Precise diagnosis of psychiatric diseases and a comprehensive assessment of a patient's symptom severity are important in order to establish a successful treatment strategy for each patient. Although great efforts have been devoted to searching for diagnostic biomarkers of schizophrenia over the past several decades, no study has yet investigated how accurately these biomarkers are able to estimate an individual patient's symptom severity. In this study, we applied electrophysiological biomarkers obtained from electroencephalography (EEG analyses to an estimation of symptom severity scores of patients with schizophrenia. EEG signals were recorded from 23 patients while they performed a facial affect discrimination task. Based on the source current density analysis results, we extracted voxels that showed a strong correlation between source activity and symptom scores. We then built a prediction model to estimate the symptom severity scores of each patient using the source activations of the selected voxels. The symptom scores of the Positive and Negative Syndrome Scale (PANSS were estimated using the linear prediction model. The results of leave-one-out cross validation (LOOCV showed that the mean errors of the estimated symptom scores were 3.34 ± 2.40 and 3.90 ± 3.01 for the Positive and Negative PANSS scores, respectively. The current pilot study is the first attempt to estimate symptom severity scores in schizophrenia using quantitative EEG features. It is expected that the present method can be extended to other cognitive paradigms or other psychological illnesses.

  11. Immunoendocrine Interactions during HIV-TB Coinfection: Implications for the Design of New Adjuvant Therapies

    Directory of Open Access Journals (Sweden)

    Guadalupe Veronica Suarez

    2015-01-01

    Full Text Available Worldwide, around 14 million individuals are coinfected with both tuberculosis (TB and human immunodeficiency virus (HIV. In coinfected individuals, both pathogens weaken immunological system synergistically through mechanisms that are not fully understood. During both HIV and TB infections, there is a chronic state of inflammation associated to dramatic changes in immune cytokine and endocrine hormone levels. Despite this, the relevance of immunoendocrine interaction on both the orchestration of an effective immune response against both pathogens and the control of the chronic inflammation induced during HIV, TB, or both infections is still controversial. The present study reviews immunoendocrine interactions occurring during HIV and TB infections. We also expose our own findings on immunoendocrine cross talk in HIV-TB coinfection. Finally, we evaluate the use of adrenal hormones and their derivatives in immune-therapy and discuss the use of some of these compounds like the adjuvant for the prevention and treatment of TB in HIV patients.

  12. TB in Wild Asian Elephants

    Centers for Disease Control (CDC) Podcasts

    2017-05-10

    Dr. Susan Mikota, co-founder of Elephant Care International, discusses TB in wild Asian elephants.  Created: 5/10/2017 by National Center for Emerging and Zoonotic Infectious Diseases (NCEZID).   Date Released: 5/10/2017.

  13. Community Involvement in TB Research

    NARCIS (Netherlands)

    M. van der Werf (Marloes); S.G. Heumann (Silke); E.M.H. Mitchell

    2011-01-01

    textabstractWhile communities at risk have been both drivers and partners in HIV research, their important role in TB research is yet to be fully realized. Involvement of communities in tuberculosis care and prevention is currently on the international agenda. This creates opportunities and

  14. ESR spectroscopy of blood serum in thalassemia: discrimination of iron overload severity in deferoxamine-cured patients

    International Nuclear Information System (INIS)

    Preoteasa, E.A.; Schianchi, G.; Giori, D.C.; Pedrazzi, G.

    1997-01-01

    Iron impairments in homozygous β-thalassemia include iron overload syndrome, partially prevented by deferoxamine (DF) and methemalbumin (MHA) in serum. The latter has been studied by electron spin resonance ESR before the clinical use of DF and recently in DF cured subjects. We monitored by X-band ESR at 163 K, the Fe (III) bound in MHA and transferrin (Tf) in serum from transfused, DF-cured patients. Plotting MHA/Tf versus individual DF dose divided the patients into two subgroups, A and B; A with the two variables correlated linearly and B presenting no correlation. The patients in B presented a higher incidence and severity of clinical complications and lower therapy responsiveness as compared to subjects in A. The ratio MHA/Tf evidenced a quadratic dependence on the mass of transfused erythrocytes (TE) in A, and no regularity in B. Similar patterns appeared in plots of ferritin (FT) and hemoglobin (Hb) vs. DF and TE, but all correlation become visible only after A vs. B discrimination by ESR. The results point to a heavier iron overload in B than in A patients, suggesting different Hb degradation pathways in the two subgroups with more toxic 'free' iron produced in B than in A. Therefore, ESR of serum might serve for improving the precision of diagnosis, for prognosis of dissimilar therapeutic efficiency of DF in patients and for monitoring the long-term efficiency of therapy in homozygous β-thalassemia. (authors)

  15. Diagnostic usefulness of the QuantiFERON-TB gold in-tube test (QFT-GIT) for tuberculous vertebral osteomyelitis.

    Science.gov (United States)

    Choi, Sungim; Jung, Kyung Hwa; Son, Hyo-Ju; Lee, Seung Hyun; Hong, Jung Min; Kim, Min Chul; Kim, Min Jae; Chong, Yong Pil; Sung, Heungsup; Lee, Sang-Oh; Choi, Sang-Ho; Kim, Yang Soo; Woo, Jun Hee; Kim, Sung-Han

    2018-05-01

    Interferon (IFN)-γ-releasing assay for diagnosing tuberculosis (TB) has shown promise; however, there are only a few reports on usefulness of the QuantiFERON-TB Gold In-Tube test (QFT-GIT) for diagnosing TB vertebral osteomyelitis. All patients presenting at a tertiary hospital between January 2010 and July 2016 with suspected TB vertebral osteomyelitis were retrospectively enrolled to evaluate the diagnostic performance of QFT-GIT. We used QFT-GIT to measure the IFN-γ response to ESAT-6, CFP-10 and TB7.7. A total of 141 patients were enrolled; 32 (23%) were categorized as having confirmed TB, (1%) as probable TB, 14 (10%) as possible TB and 93 (66%) as not TB. Of these, 16 patients with probable and possible TB were excluded from the final analysis. Chronic granulomas with/without necrosis, acid-fast bacilli stain, M. tuberculosis polymerase chain reaction and cultures for M. tuberculosis were positive in 14 (44%), 12 (38%), 22 (69%) and 28 (88%) patients, respectively, among the 32 patients with confirmed TB. The overall sensitivity, specificity, positive predictive value, negative predictive value, likelihood ratio for a positive result, and likelihood ratio for a negative result of the QFT-GIT for TB vertebral osteomyelitis were 91% (95% confidence interval [CI], 75-98%), 65% (95% CI, 54-75%), 50% (95% CI, 42-58%), 95% (95% CI, 86-98%), 2.59 (95% CI, 1.89-3.55) and 0.14 (95% CI, 0.05-0.43), respectively. The QFT-GIT appears to be a useful adjunct test for diagnosing TB vertebral osteomyelitis because the negative test results may be useful for excluding a diagnosis of active TB vertebral osteomyelitis.

  16. Digital health for the End TB Strategy: developing priority products and making them work.

    Science.gov (United States)

    Falzon, Dennis; Timimi, Hazim; Kurosinski, Pascal; Migliori, Giovanni Battista; Van Gemert, Wayne; Denkinger, Claudia; Isaacs, Chris; Story, Alistair; Garfein, Richard S; do Valle Bastos, Luis Gustavo; Yassin, Mohammed A; Rusovich, Valiantsin; Skrahina, Alena; Van Hoi, Le; Broger, Tobias; Abubakar, Ibrahim; Hayward, Andrew; Thomas, Bruce V; Temesgen, Zelalem; Quraishi, Subhi; von Delft, Dalene; Jaramillo, Ernesto; Weyer, Karin; Raviglione, Mario C

    2016-07-01

    In 2014, the World Health Organization (WHO) developed the End TB Strategy in response to a World Health Assembly Resolution requesting Member States to end the worldwide epidemic of tuberculosis (TB) by 2035. For the strategy's objectives to be realised, the next 20 years will need novel solutions to address the challenges posed by TB to health professionals, and to affected people and communities. Information and communication technology presents opportunities for innovative approaches to support TB efforts in patient care, surveillance, programme management and electronic learning. The effective application of digital health products at a large scale and their continued development need the engagement of TB patients and their caregivers, innovators, funders, policy-makers, advocacy groups, and affected communities.In April 2015, WHO established its Global Task Force on Digital Health for TB to advocate and support the development of digital health innovations in global efforts to improve TB care and prevention. We outline the group's approach to stewarding this process in alignment with the three pillars of the End TB Strategy. The supplementary material of this article includes target product profiles, as developed by early 2016, defining nine priority digital health concepts and products that are strategically positioned to enhance TB action at the country level. The content of this work is ©the authors or their employers. Design and branding are ©ERS 2016.

  17. HUBUNGAN ANTARA PERILAKU PENCEGAHAN DAN KEPATUHAN BEROBAT PENDERITA TB DI INDONESIA

    Directory of Open Access Journals (Sweden)

    Noor Edi Widya Sukoco

    2012-11-01

    Full Text Available Background: Indonesia constitutes the third highest of Tuberculosis (TB cases after India and China. One of the problem in TB control is still low of drug treatment compliance of TB patients. The objective of this study was to know the relationship between TB disease prevention behaviors with treatment compliance of TB patients in Indonesia. Methods: Data explored from National Basic Health Survey (Riskesdas 2010. The data is designed to represent provinces. Design of study is cross sectional. The population is all respondents of Riskesdas 2010, while samples were chosen aged > 5 years with Pulmonary TB, particularly the TB patients who was received medication and treated by health facilities. The number of samples are all 968 patients. Interviews were conducted by skilled interviewers. Data were processed by SPSS 15 version. Results: The behavior of respondents drying the wrong mattress have risk non-compliant treatment about 1. 64 compared with the behavior of respondents drying the right mattress (OR = 1. 64; P = 0.001; confidence interval (CI=1. 21-2.22. Likewise, low education has risk non-compliant treatment in the amount of 1.62 compared with highly educated respondents (OR= 1.62; P = 0.005; confidence interval (CI = 1.15-2.27. Conclusion: The updated data signify that analysis of drug adherence TB patients will show significantly in correlation between drug adherence with level of education, and behaviour of dry mattress. Key words: drug compliance, preventive behavior. tuberculosis

  18. Prevalence and Factors Associated with Tuberculosis Treatment Success among TB/HIV Co-Infection in North-East Malaysia.

    Science.gov (United States)

    Jalal, Tengku Mardhiah Tengku; Abdullah, Sarimah; Wahab, Farhanah Abd; Dir, Sharina; Naing, Nyi Nyi

    2017-12-01

    One of the six strategies developed by WHO, in order to stop Tuberculosis (TB) is addressing TB/HIV high-risk groups. This study aimed to determine the prevalence of successful TB treatment and factors associated with TB treatment success among TB/HIV co-infection patients in North-East Malaysia. A cross-sectional study was carried out in the a-year period from 2003 to 2012 by reviewing TB/HIV records in all hospitals and health clinics. The outcome of interest was treatment success as defined by Ministry of Health (MOH) when the patients was cured or completed TB treatment. Out of 1510 total TB/HIV co-infection cases, 27.9% (95% CI: 25.2, 30.6) of the patients were having treatment success. A majority of TB/HIV co-infection cases were male (91.1%). Fifty-eight percent the patients were drug addicts and 6% were having positive tuberculin tests. The multiple logistic regression revealed that male (OR: 0.39, 95% CI: 0.22, 0.71) and positive tuberculin test result (OR: 2.61, 95% CI: 1.63, 4.19) were significantly associated with the treatment success of TB/HIV co-infection patients. Other factors such as age, comorbid, sputum smear and x-ray findings were not significantly factors in this study. Female patients and those with negative tuberculin test should be emphasised for successful tuberculosis treatment.

  19. Staying on Track with TB Medicine

    Science.gov (United States)

    ... will help show if your TB medicines are working the right way and how your body is handling the medicine. If you are being treated for TB disease, you may also get additional chest x-rays. • If you have TB disease along with other ...

  20. Postoperative Perfection: Ceiling Effects and Lack of Discrimination With Both SRS-22 and -24 Outcomes Instruments in Patients With Adolescent Idiopathic Scoliosis.

    Science.gov (United States)

    Bastrom, Tracey P; Bartley, Carrie; Marks, Michelle C; Yaszay, Burt; Newton, Peter O

    2015-12-01

    Review of a prospective database registry. To compare the Scoliosis Research Society (SRS)-22 and SRS-24 outcomes instruments in terms of scores, rate of ceiling effects, and discriminant ability in patients with pre- and postoperative adolescent idiopathic scoliosis. Despite improvements noted with the SRS-22, the SRS-24 is still occasionally used prospectively and for comparisons with previous studies reporting SRS-24 scores. Previous work has demonstrated that postoperative scores from the 2 versions are not interchangeable. A multicenter prospective registry of patients who underwent surgical correction of adolescent idiopathic scoliosis was queried for preoperative and 2-year postoperative SRS-22 and SRS-24 scores. Scores were compared between versions and ceiling effects were identified. Groups of deformity severity were created to evaluate discriminant ability. 829 patients were identified. The SRS-22 scores for pain and general function were significantly greater than SRS-24 scores (P self-image (P self-image domain was able to discriminate between large (29°+) and small (≤11°) residual curves (P < 0.05). Scores obtained by the SRS-22 and the SRS-24 are not translatable despite shared domains. Whereas both versions demonstrated preoperative discriminant ability, postoperative discrimination of residual deformity is lacking in both. Patient-reported outcomes of treatment are crucial in advancing treatment, and improvement in the ability to assess subjective outcomes is essential. 3.

  1. The yield and feasibility of integrated screening for TB, diabetes and HIV in four public hospitals in Ethiopia.

    Science.gov (United States)

    Jerene, Degu; Hiruy, Nebiyu; Jemal, Ilili; Gebrekiros, Wondimu; Anteneh, Tadesse; Habte, Dereje; Melese, Muluken; Suarez, Pedro; Sangiwa, Gloria

    2017-03-01

    Our objective was to demonstrate the feasibility of integrated care for TB, HIV and diabetes mellitus (DM) in a pilot project in Ethiopia. Healthcare workers in four hospitals screened patients with TB for HIV and DM; patients with HIV for DM and TB; and patients with DM for TB. Fasting and random plasma glucose (RPG) tests were used to confirm the diagnosis of DM. We used screening checklists for TB and DM, and additional risk scoring criteria to identify patients at risk of DM. Of 3439 study participants, 888 were patients with DM, 439 patients with TB and 2112 from HIV clinics. Six of the patients with DM had TB of whom five were already on treatment; and 141 (32.4%) patients with TB had DM, of whom only five were previously diagnosed with DM. Symptomatic patients and those with a risk score of 5 or more were about three times more likely to have abnormal blood glucose level. Of 2075 HIV patients with RPG determined, only 31 (1.5%) had abnormal RPG. Tri-directional screening was feasible for detecting and managing previously undiagnosed TB and DM. More work is needed to better understand the interaction between HIV and DM. © The Author 2017. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  2. Prognostic value of reduced discrimination and oedema on cerebral computed tomography in a daily clinical cohort of out-of-hospital cardiac arrest patients

    DEFF Research Database (Denmark)

    Langkjær, Sandra; Hassager, Christian; Kjaergaard, Jesper

    2015-01-01

    bleeding' in 4(3%), 'new cerebral infarction' in 10(7%), and 'reduced discrimination between white and grey matter and/or oedema' in 45(30%) patients. 'Reduced discrimination and/or oedema' by late cCT was independently associated with higher 30-day mortality compared to patients with a normal late CT (HR......(adjusted) = 2.6 (95%CI: 1.4-4.8, p = 0.002). CONCLUSION: Our observations suggest that a cCT may be useful as part of the neurological prognostication in patients with OHCA. 'Reduced discrimination between white and grey matter and/or oedema' on cCT was independently associated with a poor prognosis....

  3. Measurement of 160Tb and 161Tb in nuclear forensics samples

    International Nuclear Information System (INIS)

    Jiang, J.; Davies, A.V.; Britton, R.E.

    2017-01-01

    160 Tb and 161 Tb are important radionuclides to measure when analysing a Nuclear Forensics sample. An analytical method for the measurement of both 160 Tb and 161 Tb was developed in this study. Terbium was separated and purified using exchange resin and TrisKem LN Resin. The purified fraction containing 160 Tb and 161 Tb was measured by gamma spectrometry and liquid scintillation counting. The counting efficiencies of 160 Tb and 161 Tb were determined using the CIEMAT/NIST efficiency tracing method. The LSC count rate ratio, R160 Tb /R161 Tb , on the reference date was determined by sequential counting and calculated using a custom script based on their half-lives. (author)

  4. Structural Discrimination

    DEFF Research Database (Denmark)

    Thorsen, Mira Skadegård

    In this article, I discuss structural discrimination, an underrepresented area of study in Danish discrimination and intercultural research. It is defined here as discursive and constitutive, and presented as a central element of my analytical approach. This notion is employed in the with which t...

  5. TB/HIV integration at primary care level: A quantitative assessment ...

    African Journals Online (AJOL)

    Background. In 2004 the World Health Organization (WHO) released the Interim Policy on Collaborative TB/HIV activities. According to the policy, for people living with HIV (PLWH), activities include intensified case finding, isoniazid preventive therapy (IPT) and infection control. For TB patients, activities included HIV ...

  6. Treatment outcome of tb/hiv positive and negative smear positive ...

    African Journals Online (AJOL)

    Background: In our previous study we found that half of the patients treated at the Nylon District Hospital tuberculosis (TB) treatment centre were seropositive. HIV does not only fuel the number of tuberculosis (TB) cases worldwide but it is also at least in part, responsible for the non-achievement of the 85% cure rate target.

  7. Relationship between National TB program and prevalence of TB drug resistance in Algeria, 1965 to 2013

    OpenAIRE

    Fadila Boulahbal

    2015-01-01

    The Algerian National TB program was first implemented in Algeria in 1965. Since 1965, the Ministry of Health has endorsed many instructions which have given important improvements in the fight against tuberculosis (TB) in the country. The government has actively participated in the fight against TB as expressed in its endorsement of many decisions to this end, such as the withdrawal of TB medications from the private pharmacies, the free-of-charge diagnostics and the treatment for TB pati...

  8. Role of routine abdominal ultrasonography in intensified tuberculosis case finding algorithms at HIV clinics in high TB burden settings.

    Science.gov (United States)

    Spalgais, Sonam; Agarwal, Upasna; Sarin, Rohit; Chauhan, Devesh; Yadav, Anita; Jaiswal, Anand

    2017-05-18

    High proportion of TB in people living with HIV (PLHIV) is undiagnosed. Due to this active TB case finding is recommended for HIV clinics in high TB burden countries. Presently sputum examination and chest radiography are frontline tests recommended for HIV infected TB presumptives. Abdominal TB which occurs frequently in PLHIV may be missed even by existing programmatic intensified case finding protocols. This study evaluated the routine use of ultrasonography (USG) for active case finding of abdominal TB in HIV clinics. Retrospective analysis of eight years' data from an HIV Clinic in a TB hospital in India. Patients underwent chest x-ray, sputum examination, USG abdomen and routine blood tests at entry to HIV care. Case forms were scrutinized for diagnosis of TB, USG findings and CD4 cell counts. Abdominal TB was classified as probable or possible TB. Probable TB was based on presence of two major USG (abdomen) findings suggestive of active TB, or one major USG finding with at least two minor USG findings or at least two symptoms, or any USG finding with microbiologically confirmed active TB at another site. Possible TB was based on the presence of one major USG finding, or the presence of two minor USG findings with at least two symptoms. Bacteriological confirmation was not obtained. Eight hundred and eighty-nine people PLHIV underwent a baseline USG abdomen. One hundred and thirteen of 340 cases already diagnosed with TB and 87 of the 91 newly diagnosed with TB at time of HIV clinic registration had abdominal TB. Non-abdominal symptoms like weight loss, fever and cough were seen in 53% and 22% cases had no symptoms at all. Enlarged abdominal lymph nodes with central caseation, ascitis, splenic microabsesses, bowel thickening and hepatosplenomegaly were the USG findings in these cases. Abdominal TB is a frequent TB site in PLHIV presenting with non-abdominal symptoms. It can be easily detected on basis of features seen on a simple abdominal ultrasound

  9. How to avoid unfair discrimination against disabled patients in healthcare resource allocation.

    Science.gov (United States)

    Sinclair, Sean

    2012-03-01

    The paper proposes a new method of researching public opinion for the purposes of valuing the outcomes of healthcare interventions. The issue I address is that, under the quality-adjusted life-year system, disabled patients face a higher cost-effectiveness hurdle than able-bodied patients. This seems inequitable. The author considers the alternative approaches to valuing healthcare interventions that have been proposed, and shows that all of them face the same problem. It is proposed that to value an outcome, instead of researching the general public, the population that is to be targeted with the intervention should be researched.

  10. Spatial discrimination and visual discrimination

    DEFF Research Database (Denmark)

    Haagensen, Annika M. J.; Grand, Nanna; Klastrup, Signe

    2013-01-01

    in a visual discrimination test. The juvenile minipigs were able to learn the spatial hole-board discrimination test and showed improved working and reference memory during the learning phase. Performance in the memory phases was affected by the retention intervals, but the minipigs were able to remember...... the concept of the test in both memory phases. Working memory and reference memory were significantly improved in the last trials of the memory phases. In the visual discrimination test, the minipigs learned to discriminate between the three figures presented to them within 9-14 sessions. For the memory test......Two methods investigating learning and memory in juvenile Gottingen minipigs were evaluated for potential use in preclinical toxicity testing. Twelve minipigs were tested using a spatial hole-board discrimination test including a learning phase and two memory phases. Five minipigs were tested...

  11. Alternative medicine: an ethnographic study of how practitioners of Indian medical systems manage TB in Mumbai.

    Science.gov (United States)

    McDowell, Andrew; Pai, Madhukar

    2016-03-01

    Mumbai is a hot spot for drug-resistant TB, and private practitioners trained in AYUSH systems (Ayurveda, yoga, Unani, Siddha and homeopathy) are major healthcare providers. It is important to understand how AYUSH practitioners manage patients with TB or presumptive TB. We conducted semi-structured interviews of 175 Mumbai slum-based practitioners holding degrees in Ayurveda, homeopathy and Unani. Most providers gave multiple interviews. We observed 10 providers in clinical interactions, documenting: clinical examinations, symptoms, history taking, prescriptions and diagnostic tests. No practitioners exclusively used his or her system of training. The practice of biomedicine is frequent, with practitioners often using biomedical disease categories and diagnostics. The use of homeopathy was rare (only 4% of consultations with homeopaths resulted in homeopathic remedies) and Ayurveda rarer (3% of consultations). For TB, all mentioned chest x-ray while 31 (17.7%) mentioned sputum smear as a TB test. One hundred and sixty-four practitioners (93.7%) reported referring TB patients to a public hospital or chest physician. Eleven practitioners (6.3%) reported treating patients with TB. Nine (5.1%) reported treating patients with drug-susceptible TB with at least one second-line drug. Important sources of health care in Mumbai's slums, AYUSH physicians frequently use biomedical therapies and most refer patients with TB to chest physicians or the public sector. They are integral to TB care and control. © The Author 2016. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  12. FEATURES OF ADOLESCENTS TUBERCULOSIS AT A REFERRAL TB'S HOSPITAL IN TEHRAN, IRAN

    Directory of Open Access Journals (Sweden)

    Ferial Lotfian

    2016-01-01

    Full Text Available Abstract OBJECTIVE: To identify the pattern of the clinical, radiological, diagnostic procedures and loss to follow -up of the diagnosed cases of active tuberculosis (TB adolescents. METHODS: This study was a retrospective analysis of the medical records of 143 adolescents aged 10 to 18 years with tuberculosis who were admitted TB wards of National Research Institute of Tuberculosis and Lung Disease (NRITLD in Tehran, Iran, between March 2006 and March2011. RESULTS: Of the 143 patients identified, 62.9% were females. Median age of the patients was 16 years. The contact source was identified in 47.5%.The most common presenting symptom was cough (86%.Isolated pulmonary TB (PTB was detected in 113 patients (79%, 21 patients (14.7% had extrapulmonary TB(EPTB, and 9 patients (6.3% had PTB and EP TB .The most common site of  EPTB was pleural (14% .The most common radiographic finding was infiltration (61%.Positive acid fast smears were seen in 67.8%.Positive cultures for Mycobacterium tuberculosis(M. TB were seen in 31.6%. Positive PCR results were seen in 60%.The adolescents aged 15 to 18 years were more likely to lose weight (p=0.001, smear positive (p=0.002and have positive PCR results (p=0.009. The type of TB (p=0.017 was a significant factor influencing loss to follow-up. CONCLUSIONS: Adolescents with the high rate of positive sputum smear results and the high treatment default rate are more likely to increase risk for TB transmission to the community. The TB control programs should pay more attention to prevention and treatment of TB in adolescents.     Key words: adolescents, tuberculosis, Lost to follow-up, prevention

  13. Family support, discrimination, and quality of life among ART-treated HIV-infected patients: a two-year study in China.

    Science.gov (United States)

    Xu, Jun-Fang; Ming, Zhong-Qiang; Zhang, Yu-Qian; Wang, Pei-Cheng; Jing, Jun; Cheng, Feng

    2017-11-21

    By September 2016, approximately 653,865 people in China were living with HIV/AIDS (PLWHA) and 492,725 people were receiving antiretroviral therapy (ART). PLWHA frequently experience discrimination in all domains of their personal and social lives. The World Health Organization includes discrimination in its list of social determinants of health factors that have been linked to poor physical and psychological health. This paper identifies the family support enjoyed and discrimination faced by people infected with HIV and examines the effect they have on patients' quality of life (QOL) as they undergo ART in China. We conducted this observational cohort study of ART-treated patients with HIV in Guangxi Province using a questionnaire survey at baseline, 6, 12, and 24 months, starting in 2010. Descriptive analysis was used to describe the demographic characteristics (e.g., age, sex, educational level, marital status, and employment status) of participants. Generalized estimating equations (GEE) were employed to examine the relationships between family support, discrimination, and QOL. In the study, 90.4% (n = 281) of patients received family support at baseline, here defined as the initiation of ART, 91.8% (n = 244) received family support 6 months into ART, 95.5% (n = 220) at 12 months, and 94.3% (n = 230) at 24 months. The proportion of patients who did not feel discriminated against by their families was 87.2% (n = 274) at baseline, 90.4% (n = 229) 6 months into ART, 90.0% (n = 210) at 12 months, and 94.5% (n = 219) at 24 months. Patients' overall QOL scores were positively associated with having received family support (OR = 2.74, P = 0.040, 95% CI: 1.68-4.47), not feeling discriminated against by their families (OR = 1.3, P = 0.041, 95% CI: 1.07-1.59) or discrimination from patients themselves, including never experiencing fear of abandonment by family (OR = 2.05, P = 0.025, 95% CI: 1.49-2.82). Family support along with no or

  14. Interferon gamma release assays for the diagnosis of latent TB infection in HIV-infected individuals in a low TB burden country.

    Directory of Open Access Journals (Sweden)

    Clíona Ní Cheallaigh

    Full Text Available Interferon gamma release assays (IGRAs are used to diagnose latent tuberculosis infection. Two IGRAs are commercially available: the Quantiferon TB Gold In Tube (QFT-IT and the T-SPOT.TB. There is debate as to which test to use in HIV+ individuals. Previous publications from high TB burden countries have raised concerns that the sensitivity of the QFT-IT assay, but not the T-SPOT.TB, may be impaired in HIV+ individuals with low CD4+ T-cell counts. We sought to compare the tests in a low TB burden setting.T-SPOT.TB, QFT-IT, and tuberculin skin tests (TST were performed in HIV infected individuals. Results were related to patient characteristics. McNemar's test, multivariate regression and correlation analysis were carried out using SPSS (SPSS Inc. 256 HIV infected patients were enrolled in the study. The median CD4+ T-cell count was 338 cells/µL (range 1-1328. 37 (14% patients had a CD4+ T-cell count of <100 cells/µL. 46/256 (18% of QFT-IT results and 28/256 (11% of T-SPOT.TB results were positive. 6 (2% of QFT-IT and 18 (7% of T-SPOT.TB results were indeterminate. An additional 9 (4% of T-SPOT.TB results were unavailable as tests were not performed due to insufficient cells or clotting of the sample. We found a statistically significant association between lower CD4+ T-cell count and negative QFT-IT results (OR 1.055, p=0.03, and indeterminate/unavailable T-SPOT.TB results (OR 1.079, p=0.02.In low TB prevalence settings, the QFT-IT yields more positive and fewer indeterminate results than T-SPOT.TB. Negative results on the QFT-IT and indeterminate/unavailable results on the T-SPOT.TB were more common in individuals with low CD4+ T-cell counts.

  15. FAKTOR DETERMINAN BUDAYA KESEHATAN DALAM PENULARAN PENYAKIT TB PARU

    Directory of Open Access Journals (Sweden)

    Niniek Lely Pratiwi

    2013-03-01

    Full Text Available ABSTRACT Background: TB DO TS Strategy policy as the government's efforts in order to decrease TB patients is facilitated through the state budget cost resources, budget, global foreign aid fund, and the WHO. This qualitative study aimed to determinan poeing on cultural efforts in the prevention of pulmonary TB disease. Method of data collection participatory observation, in-depth interviews in patients with pulmonary TB and families, health care workers in the provinces, and districts. FGD on public figures, cross-sector and NGOs. Research sites in the city of Pariaman, West Lombok district and the district Rote Ndao NTT. Results:The results showed cultural determinants of health factors on the prevalence of pulmonary TB disease is a public perception of ilness Roe Ndao district, that of pulmonary TB disease as a hereditary disease, infectious disease and "Hosse". Norma betel nut as a treat for guests, custom home Sel, Sei traditional beliefs of newborns who smoked for 40 days with ground floor houses almost 50% of the population. Norms, stigma society in urban areas Pariaman, pulmonary TB disease as a disease because Tamakan, due to use-for others who are not happy, as evidenced by the habits, behavior of people carelessly throw spit spot. In western Sumatra, the city of Pariaman norms, fear of stigma, shame as people with TB, so there are many people who call it the perception of pain as a disease of old Cough, cough 40 days, dry cough, and asthma. Confidence/belief communities in the western province of NTB Lombok district who think if drinking water used Kiai progenitor Ishmael receive healing. Supervisory personnel selection as taking medication/PMO less in accordance with existing social structures in local communities, tribes sasak NTB, Rote tribe. Recommendalion: is required from a variety of participatory other NGOs, in an integrated cross-sector to perform the preventive, promotive control TB disease of the housing ministry, social

  16. The Ontario Universal Typing of Tuberculosis (OUT-TB Surveillance Program – What It Means to You

    Directory of Open Access Journals (Sweden)

    Shelly Bolotin

    2010-01-01

    Full Text Available BACKGROUND: Tuberculosis (TB is a serious disease that is transmitted primarily by the airborne route. Effective disease control and outbreak management requires the timely diagnosis, isolation and treatment of infected individuals with active disease; contact tracing to identify secondary cases likely to benefit from treatment of latent infection; and laboratory identification or confirmation of epidemiologically linked cases. TB genotyping enables the comparison of Mycobacterium tuberculosis complex (MTBC strains and the identification of cases that may or may not be linked. The increased availability of molecular methods for genotyping has allowed for greater discrimination of MTBC strains and greatly enhanced understanding of TB transmission patterns.

  17. Genetic Discrimination

    Science.gov (United States)

    Skip to main content Genetic Discrimination Enter Search Term(s): Español Research Funding An Overview Bioinformatics Current Grants Education and Training Funding Extramural Research News Features Funding Divisions ...

  18. SEISMIC DISCRIMINATION

    Science.gov (United States)

    a potential new discriminant , and to study depth phases. Surface- and body-wave magnitude data have been obtained and used to study regionalization...and signal equalization studies initiated. Upgrading of software and hardware facilities has continued. (Author)

  19. The Short Physical Performance Battery is a discriminative tool for identifying patients with COPD at risk of disability

    Directory of Open Access Journals (Sweden)

    Bernabeu-Mora R

    2015-12-01

    Full Text Available Roberto Bernabeu-Mora,1,2 Françesc Medina-Mirapeix,2 Eduardo Llamazares-Herrán,3 Gloria García-Guillamón,2 Luz María Giménez-Giménez,2 Juan Miguel Sánchez-Nieto1,4 1Division of Pneumology, Hospital Morales Meseguer, 2Department of Physical Therapy, University of Murcia, Murcia, 3Department of Physical Therapy, Alcala University, Alcala de Henares, 4Department of Intern Medical, University of Murcia, Murcia, Spain Background: Limited mobility is a risk factor for developing chronic obstructive pulmonary disease (COPD-related disabilities. Little is known about the validity of the Short Physical Performance Battery (SPPB for identifying mobility limitations in patients with COPD. Objective: To determine the clinical validity of the SPPB summary score and its three components (standing balance, 4-meter gait speed, and five-repetition sit-to-stand for identifying mobility limitations in patients with COPD.Methods: This cross-sectional study included 137 patients with COPD, recruited from a hospital in Spain. Muscle strength tests and SPPB were measured; then, patients were surveyed for self-reported mobility limitations. The validity of SPPB scores was analyzed by developing receiver operating characteristic curves to analyze the sensitivity and specificity for identifying patients with mobility limitations; by examining group differences in SPPB scores across categories of mobility activities; and by correlating SPPB scores to strength tests.Results: Only the SPPB summary score and the five-repetition sit-to-stand components showed good discriminative capabilities; both showed areas under the receiver operating characteristic curves greater than 0.7. Patients with limitations had significantly lower SPPB scores than patients without limitations in nine different mobility activities. SPPB scores were moderately correlated with the quadriceps test (r>0.40, and less correlated with the handgrip test (r<0.30, which reinforced convergent and

  20. Viral hepatitis and HIV-associated tuberculosis: Risk factors and TB treatment outcomes in Thailand

    Directory of Open Access Journals (Sweden)

    Likanonsakul Sirirat

    2008-07-01

    Full Text Available Abstract Background The occurrence of tuberculosis (TB, human immunodeficiency virus (HIV, and viral hepatitis infections in the same patient poses unique clinical and public health challenges, because medications to treat TB and HIV are hepatotoxic. We conducted an observational study to evaluate risk factors for HBsAg and/or anti-HCV reactivity and to assess differences in adverse events and TB treatment outcomes among HIV-infected TB patients. Methods Patients were evaluated at the beginning, during, and at the end of TB treatment. Blood samples were tested for aspartate aminotransferase (AST, alanine aminotransferase (ALT, total bilirubin (BR, complete blood count, and CD4+ T lymphocyte cell count. TB treatment outcomes were assessed at the end of TB treatment according to international guidelines. Results Of 769 enrolled patients, 752 (98% had serologic testing performed for viral hepatitis: 70 (9% were reactive for HBsAg, 237 (31% for anti-HCV, and 472 (63% non-reactive for both markers. At the beginning of TB treatment, 18 (26% patients with HBsAg reactivity had elevated liver function tests compared with 69 (15% patients non-reactive to any viral marker (p = 0.02. At the end of TB treatment, 493 (64% were successfully treated. Factors independently associated with HBsAg reactivity included being a man who had sex with men (adjusted odds ratio [AOR], 2.1; 95% confidence interval [CI], 1.1–4.3 and having low TB knowledge (AOR, 1.8; CI, 1.0–3.0. Factors most strongly associated with anti-HCV reactivity were having injection drug use history (AOR, 12.8; CI, 7.0–23.2 and living in Bangkok (AOR, 15.8; CI, 9.4–26.5. The rate of clinical hepatitis and death during TB treatment was similar in patients HBsAg reactive, anti-HCV reactive, both HBsAg and anti-HCV reactive, and non-reactive to any viral marker. Conclusion Among HIV-infected TB patients living in Thailand, markers of viral hepatitis infection, particularly hepatitis C virus

  1. Current and developing therapies for the treatment of multi drug resistant tuberculosis (MDR-TB) in India.

    Science.gov (United States)

    Muniyandi, Malaisamy; Ramachandran, Rajeswari

    2017-09-01

    India accounts for 25% of the global burden of MDR-TB. In 2016, the India's Revised National TB Control Programme reported a success rate of 46% among 19,298 MDR-TB patients treated under the programme. This suboptimal treatment outcome warrants an urgent need for newer drugs and newer regimens in the treatment of MDR-TB. India requires new shorter, cheap, safe and effective anti-TB regimen to treat MDR-TB. Areas covered: We used different search strategies to obtain relevant literature from PubMed, on Indian experiences of developing therapies for the treatment of MDR-TB. Further information from the Central TB Division Government of India on programmatic management of resistant TB was collected. Expert opinion: In 2016 WHO recommended a shorter MDR-TB regimen of 9-12 months (4-6 Km-Mfx-Pto-Cfz-Z-Hhigh-dose-E /5 Mfx-Cfz-Z-E) may be used instead of longer regimens. Currently, conducting trials involving newer drugs such as bedaquiline, have been proposed. The regimen will be of a shorter duration containing isoniazid, prothionamide, bedaquiline, levofloxacin, ciprofloxacin, ethambutol and pyrazinamide (STREAM regimen). To successfully treat MDR-TB one requires new classes of antibiotic and newer diagnostic tests. This represents an enormous financial and technical challenge to the programme managers and policy makers.

  2. TB Anywhere Is TB Everywhere: The Intersection of U.S. Immigration Enforcement Policy and TB

    Science.gov (United States)

    2016-09-01

    is not the primary goal (e.g., in high turnover jails or in some homeless shelters ).316 The ACET does not define a “high turnover jail,” but the...conflicts with religious practices, a stigma associated with TB infection, lack of financial resources, poor access to healthcare, frequently changing...residences, and an inability to attend DOT sessions due to lack of transportation or work schedule.125 D. TUBERCULOSIS IN SELECTED COUNTRIES OF INTEREST

  3. TB treatment initiation and adherence in a South African community influenced more by perceptions than by knowledge of tuberculosis

    Directory of Open Access Journals (Sweden)

    Møller Valerie

    2010-02-01

    Full Text Available Abstract Background Tuberculosis (TB is a global health concern. Inadequate case finding and case holding has been cited as major barrier to the control of TB. The TB literature is written almost entirely from a biomedical perspective, while recent studies show that it is imperative to understand lay perception to determine why people seek treatment and may stop taking treatment. The Eastern Cape is known as a province with high TB incidence, prevalence and with one of the worst cure rates of South Africa. Its inhabitants can be considered lay experts when it comes to TB. Therefore, we investigated knowledge, perceptions of (access to TB treatment and adherence to treatment among an Eastern Cape population. Methods An area-stratified sampling design was applied. A total of 1020 households were selected randomly in proportion to the total number of households in each neighbourhood. Results TB knowledge can be considered fairly good among this community. Respondents' perceptions suggest that stigma may influence TB patients' decision in health seeking behavior and adherence to TB treatment. A full 95% of those interviewed believe people with TB tend to hide their TB status out of fear of what others may say. Regression analyses revealed that in this population young and old, men and women and the lower and higher educated share the same attitudes and perceptions. Our findings are therefore likely to reflect the actual situation of TB patients in this population. Conclusions The lay experts' perceptions suggests that stigma appears to effect case holding and case finding. Future interventions should be directed at improving attitudes and perceptions to potentially reduce stigma. This requires a patient-centered approach to empower TB patients and active involvement in the development and implementation of stigma reduction programs.

  4. Determination of ketones and ethyl acetate-a preliminary study for the discrimination of patients with lung cancer.

    Science.gov (United States)

    Santos, Patricia Martín; Del Nogal Sánchez, Miguel; Pozas, Ángel Pedro Crisolino; Pavón, José Luis Pérez; Cordero, Bernardo Moreno

    2017-09-01

    In this work, ten possible volatile biomarkers of lung cancer (acetone, 2-butanone, ethyl acetate, 2-pentanone, 4-methyl-2-pentanone, 2-hexanone, 3-heptanone, 2-heptanone, 3-octanone, and 2-nonanone) have been analyzed to evaluate their different concentration levels in urine samples from lung cancer patients (n = 12) and healthy controls (n = 12). The volatile compounds were generated with a headspace autosampler and analyzed with a gas chromatograph equipped with a programmed temperature vaporizer and mass spectrometry detector (HS-PTV-GC-MS). With the aim of evaluating the aforementioned differences, a Mann-Whitney U test and box-plots were obtained. Very good discrimination between cancer and control groups was achieved for three (ethyl acetate, 3-heptanone, and 3-octanone) of the ten analytes studied. With a view to assigning samples to the group of healthy or ill individuals, the Wilcoxon signed-rank test has been used. In spite of the small number of urine samples assayed, the results may suggest that the studied compounds could be considered useful tools in order to discern samples and they could be employed as a complementary test in a diagnosis. Graphical abstract Classification of samples (lung cancer patients and controls) with the Wilcoxon signed rank test.

  5. Development of a POC test for TB based on multiple immunodominant epitopes of M. tuberculosis specific cell-wall proteins.

    Directory of Open Access Journals (Sweden)

    Jesus M Gonzalez

    Full Text Available The need for an accurate, rapid, simple and affordable point-of-care (POC test for Tuberculosis (TB that can be implemented in microscopy centers and other peripheral health-care settings in the TB-endemic countries remains unmet. This manuscript describes preliminary results of a new prototype rapid lateral flow TB test based on detection of antibodies to immunodominant epitopes (peptides derived from carefully selected, highly immunogenic M. tuberculosis cell-wall proteins. Peptide selection was initially based on recognition by antibodies in sera from TB patients but not in PPD-/PPD+/BCG-vaccinated individuals from TB-endemic settings. The peptides were conjugated to BSA; the purified peptide-BSA conjugates striped onto nitrocellulose membrane and adsorbed onto colloidal gold particles to devise the prototype test, and evaluated for reactivity with sera from 3 PPD-, 29 PPD+, 15 PPD-unknown healthy subjects, 10 patients with non-TB lung disease and 124 smear-positive TB patients. The assay parameters were adjusted to determine positive/negative status within 15 minutes via visual or instrumented assessment. There was minimal or no reactivity of sera from non-TB subjects with the striped BSA-peptides demonstrating the lack of anti-peptide antibodies in subjects with latent TB and/or BCG vaccination. Sera from most TB patients demonstrated reactivity with one or more peptides. The sensitivity of antibody detection ranged from 28-85% with the 9 BSA-peptides. Three peptides were further evaluated with sera from 400 subjects, including additional PPD-/PPD+/PPD-unknown healthy contacts, close hospital contacts and household contacts of untreated TB patients, patients with non-TB lung disease, and HIV+TB- patients. Combination of the 3 peptides provided sensitivity and specificity>90%. While the final fully optimized lateral flow POC test for TB is under development, these preliminary results demonstrate that an antibody-detection based rapid POC

  6. KEMANDIRIAN MASYARAKAT DALAM PERILAKU PENCEGAHAN PENULARAN PENYAKIT TB PARU

    Directory of Open Access Journals (Sweden)

    Niniek Lely Pratiwi

    2013-03-01

    Full Text Available ABSTRACT Background: Prevention of tuberculosis, particularly pulmonary tuberculosis in lndonesia was started in 1969, but the number of pulmonary TB patients is increasing. Methods:Ethnographic qualitative study aims to assess the independence of the community effort in preventing pulmonary TB disease transmission. Methods: of data collection participatory observation, in-depth interviews with informants pulmonary TB patients and families. Research sites in the city of Pariaman, West Lombok district and the district Rote Ndao NTT. Results:The analysis of four independent indicators of the knowledge society is stilllow considering that most of the informants consider pulmonary TB disease as a hereditary disease, and infectious diseases as the people in the district Hossa Rote Ndao. Illness perceptions of people in the city of Pariaman, pulmonary TB disease as a disease because "ismeken", due to use-for others who are not happy ln the town of West Lombok fear of stigma, shame as people with TB, so there are many people who call it the perception of illness as a disease of old cough, dry cough of 40 days, and asthma. Confidence/trust society still depends on health workers, yet there are cadres who provide direct counseling on prevention of transmission. Capability community is lacking, people still believe in the health care workers to provide counseling. Selection of the PMO staff (Supervisors taking medication were not appropriate to the social structures that exist in society Lobar districts with 'sasak' social structure, then the host teacher, 'Kyai' can be as social support surrounding communities. 'Kyai' expected to affect the mindset of people, motivate people to air PHBs. Rote Ndao district as a social support from church leaders as well as the city of Pariaman, a descendant of the king, can motivate people. Participatory community by providing prevention counseling in a variety of pulmonary TB disease or group of containers carried on a

  7. Intact and cleaved forms of the urokinase receptor enhance discrimination of cancer from non-malignant conditions in patients presenting with symptoms related to colorectal cancer

    DEFF Research Database (Denmark)

    Lomholt, A F; Høyer-Hansen, G; Nielsen, H J

    2009-01-01

    plasminogen activator receptor (suPAR) was proposed as a marker in CRC patients. This study was undertaken to evaluate the individual molecular forms of suPAR as discriminators in a group of patients undergoing endoscopical examination following symptoms related to colorectal cancer. METHODS: In a case......-control study comprising 308 patients undergoing endoscopical examination following CRC-related symptoms, 77 CRC patients with adenocarcinoma were age and gender matched to: 77 patients with adenomas; 77 with other non-malignant findings, and 77 with no findings. The different uPAR forms were measured...

  8. TB

    African Journals Online (AJOL)

    Tuberculous spondylitis/spondylodiscitis is caused by the Mycobacterium tuberculosis bacillus. The features of the disease were first described by. Percival Pott. The disease has potentially serious morbidity with severe neurological impairment and disfiguring deformity. Also known as Pott's disease, spinal infection follows ...

  9. TB in healthcare workers in the UK: a cohort analysis 2009-2013.

    Science.gov (United States)

    Davidson, Jennifer A; Lalor, Maeve K; Anderson, Laura F; Tamne, Surinder; Abubakar, Ibrahim; Thomas, H Lucy

    2017-07-01

    To describe the burden of TB in healthcare workers (HCWs) in the UK and determine whether HCWs are at increased risk of TB due to occupational exposure. Retrospective cohort analysis of national UK TB surveillance and genotyping data between 2009 and 2013. The rate of TB in HCWs compared with non-HCWs to calculate incidence rate ratios stratified by country of birth. 2320 cases of TB in HCWs were notified in the study period, 85% were born abroad. The TB rate in HCWs was 23.4 (95% CI 22.5 to 24.4) per 100 000 compared with 16.2 (95% CI 16.0 to 16.3) per 100 000 in non-HCWs. After stratifying by country of birth, there was not an increased TB incidence in HCWs for the majority of countries of birth, including in the UK-born. Using combined genotyping and epidemiological data, only 10 confirmed nosocomial transmission events involving HCWs were identified between 2010 and 2012. Of these, only two involved transmission to patients. The lack of an increased risk of TB after stratifying by country of birth, and the very few transmission events involving nosocomial transmission in the UK suggests that TB in HCWs in the UK is not generally acquired through UK occupational exposure. The majority of cases in foreign-born HCWs are likely to result from reactivation of latent TB infection (LTBI) acquired abroad, and is not likely to be prevented by BCG vaccination in the UK. Testing and treatment of LTBI in HCWs with exposure to high TB burden countries should be the focus of occupational health prevention activities. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  10. [10 years comparative clinico-epidemiological analysis of smoking and alcohol consumption in TB patients (Myc. Tuberculosis) and with mycobacteriosis (Myc. Kansas].

    Science.gov (United States)

    Przybylski, Grzegorz; Nowakowska-Arendt, Agnieszka; Pilaczyńska-Cemel, Marta; Gołda, Ryszard

    2014-01-01

    Smoking and alcohol consumption are a major public health problem. More and more are mentioned, also, these two drugs, tobacco and alcohol as risk factors for tuberculosis and mycobacteriosis. Comparative analysis of epidemiological and clinical patients with tuberculosis and mycobacteriosis M.kansasii smoking cigarettes and abuse alcohol. The study included 2025 patients with tuberculosis and 140 patients with diagnosed lung mycobacteriosis hospitalized in Kuyavian-Pomeranian Center of Pulmonology in the years 2003-2013. Data were obtained from the central database of the hospital on admission to the hospital. There were 1403 smokers (69.3%) of tuberculosis patients and 79 (56.4%) with mycobacteriosis, and alcohol dependence were 534 (26.4%) and 16 (11.4%) respectively. Both of smokers and drinkers, men prevailed. Smokers who have developed tuberculosis were significantly younger than patients with mycobacteriosis, often touched their homelessness and unemployment, and often lived in rural areas. Conversely, smokers with mycobacteriosis are people often married, professionally active. In the group of abusers, patients with tuberculosis were younger, living in the country. side, often unemployed, homeless and single compared to patients with my. cobacteriosis. The clinical picture of patients with tuberculosis and mycobacteriosis did not differ significantly between the groups. A retrospective study of patients with tuberculosis and my. cobacteriosis showed significantly more use of tobacco and alcohol abuse than in the general Polish population. It should be noted that cigarette smoking and alcohol abuse are major risk and mycobacteriosis. Therefore, it is important to conduct anti-tobacco education and prevention of alcohol abuse.

  11. NEW SCREENING AND DIAGNOSTIC OPTIONS OF VARIOUS TRAITS OF TB INFECTION AMONG CHILDREN AND ADOLESCENTS IN RUSSIA

    Directory of Open Access Journals (Sweden)

    V.A. Aksenova

    2011-01-01

    Full Text Available In modern epidemiologic conditions revealing of children under the maximal risk of TB infection is the most important object of pediatric phtisiology. Study object: efficacy enhancement of early TB diagnmostics among children and adolescents in public healthcare system. Methods: a multicenter study was carried out in the city of Moscow, Samara and Ryazan regions. Children and adolescents under high risk of TB infection were included into this study. The study consisted of three phases: first — Diaskintest intracutaneous test assessment in children and adolescents within TB dispensery; second — same procedure performed among children and adolescents not registered in TB despensery but taken care of by a local pediatrician; third — among pupils of secondary complementary education institutions. Results: first phase of the study showed that every second child, registered in TB dispensery due to MTB contamination, which was revealed via traditional diagnostic procedures, receives unreasonable chemoprophylaxis. Among pediatric patients (second phase TB was diagnosed in 2.3% of total amount of children from this group and among 26.7% of Diaskintestpositive patients. Testing patients in the third phase of the study (pupils of of secondary complementary education institutions revealed TB infection in 0.6% of tested and in 21.2% among Diaskintest-positive patients. Conclusion: Diaskintest use as a screening method among children helps revealing patients under highest risk of TB infection.Key words: children, tuberculosis, diagnostics, Diaskintest, Mantoux test.(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (4: 16–22

  12. Prospective evaluation of simply modified MODS assay: an effective tool for TB diagnosis and detection of MDR-TB

    Directory of Open Access Journals (Sweden)

    Chaiyasirinroje B

    2012-05-01

    Full Text Available Boonchai Chaiyasirinroje1,*, Myo Nyein Aung2,3,*, Saiyud Moolphate1,4, Yuthichai Kasetjaroen5, Somsak Rienthong5, Dhanida Rienthong5, Oranuch Nampaisan1, Supalert Nedsuwan6, Wiravoot Sangchun6, Narin Suriyon7, Satoshi Mitarai4, Norio Yamada41TB/HIV Research Project, RIT, Chiang Rai, Thailand; 2Department of Public Health, Graduate School of Medicine, Juntendo University, Tokyo, Japan; 3Boromrajonani College of Nursing Nakhon Lampang (BCNLP, Lampang, Thailand; 4Research Institute of Tuberculosis (RIT, Tokyo, Japan; 5Bureau of Tuberculosis, Bangkok, Thailand; 6Chiang Rai Regional Hospital, Chiang Rai, Thailand; 7Chiang Rai Provincial Health Office, Chiang Rai, Thailand *These authors contributed equally to this workBackground and setting: Thailand is one of the highest tuberculosis (TB-burdened countries. Chiang Rai, the northernmost province of Thailand has high tuberculosis and human immunodeficiency virus (HIV prevalence and the laboratory workload for TB culture and drug susceptibility testing is increasing.Objectives: To evaluate the simply modified microscopic-observation drug-susceptibility assay (MODS in the setting of a developing country.Methods: In this cross-sectional diagnostic study, a total of 202 sputum samples of clinically diagnosed TB patients were used to test the performance of MODS assay in reference to gold standard BACTEC™ MGIT™ 960 liquid culture system and Ogawa solid culture. Sputum samples were collected from clinically diagnosed TB patients. Culture growth rate and time to culture positivity were compared among three methods. Performance of modified MODS assay was evaluated for detection of mycobacterium drug resistance in reference to MGIT antimicrobial susceptibility test (AST.Result: Median time to culture positivity by MODS, solid, and liquid culture were 12, 30, and 6 days respectively. Compared to the drug susceptibility test (DST result of reference liquid culture, the sensitivity and specificity of MODS for

  13. The risk factor of false-negative and false-positive for T-SPOT.TB in active tuberculosis.

    Science.gov (United States)

    Di, Li; Li, Yan

    2018-02-01

    T-SPOT.TB is a promising diagnosis tool to identify both pulmonary tuberculosis and extrapulmonary tuberculosis, as well as latent tuberculosis; however, the factors that affect the results of T-SPOT.TB remains unclear. In this study, we aim to figure out the risk factor of T-SPOT.TB for active TB. A total of 349 patients were recruited between January 1st, 2016 and January 22st, 2017 at Renmin Hospital of Wuhan University, including 98 subjects with TB and 251 subjects with non-TB disease, and received T-SPOT.TB (Oxford Immunotec Ltd). Statistics were analyzed by SPSS 19.0 using logistic regression. The overall specificity and sensitivity of the T-SPOT.TB was 92.83% (233/251; 95%CI 0.8872-0.9557) and 83.67% (82/98; 95%CI 0.7454-0.9010), respectively. Patients with tuberculous meningitis were more likely to have false-negative results (OR 17.4, 95%CI 3.068-98.671; PTB tended to induce false-positive results (OR 30.297; 95%CI 7.069-129.849; PTB (exclude tuberculous meningitis) (P>.05). Tuberculous meningitis was a risk factor of false-negative for T-SPOT.TB, while cured TB was a risk factor of false-positive. © 2017 Wiley Periodicals, Inc.

  14. Effect of glycemic control and type of diabetes treatment on unsuccessful TB treatment outcomes among people with TB-Diabetes: A systematic review.

    Directory of Open Access Journals (Sweden)

    Hemant Deepak Shewade

    unsuccessful treatment outcomes (aOR (0.95 CI: 0.72 (0.64-0.81 and 2.8 times higher odds of 'no recurrence' (aOR (0.95 CI: 2.83 (2.60-2.92 among patients with optimal glycemic control at baseline. A Peruvian study reported faster culture conversion among those with glycemic control (aHR (0.95 CI: 2.2 (1.1,4. Two poor quality studies reported the effect of insulin on TB treatment outcomes.We identified few studies that were free of the risk of bias. There were limited data and inconsistent findings among available studies. We recommend robustly designed and analyzed studies including randomized controlled trials on the effect of glucose lowering treatment options on TB treatment outcomes.

  15. Effect of glycemic control and type of diabetes treatment on unsuccessful TB treatment outcomes among people with TB-Diabetes: A systematic review.

    Science.gov (United States)

    Shewade, Hemant Deepak; Jeyashree, Kathiresan; Mahajan, Preetam; Shah, Amar N; Kirubakaran, Richard; Rao, Raghuram; Kumar, Ajay M V

    2017-01-01

    unsuccessful treatment outcomes (aOR (0.95 CI): 0.72 (0.64-0.81)) and 2.8 times higher odds of 'no recurrence' (aOR (0.95 CI): 2.83 (2.60-2.92)) among patients with optimal glycemic control at baseline. A Peruvian study reported faster culture conversion among those with glycemic control (aHR (0.95 CI): 2.2 (1.1,4)). Two poor quality studies reported the effect of insulin on TB treatment outcomes. We identified few studies that were free of the risk of bias. There were limited data and inconsistent findings among available studies. We recommend robustly designed and analyzed studies including randomized controlled trials on the effect of glucose lowering treatment options on TB treatment outcomes.

  16. Discrimination between Clinically Relevant and Nonrelevant Acanthamoeba Strains Isolated from Contact Lens- Wearing Keratitis Patients in Austria

    Science.gov (United States)

    Walochnik, J.; Haller-Schober, E.-M.; Kölli, H.; Picher, O.; Obwaller, A.; Aspöck, H.

    2000-01-01

    Eighteen cases of Acanthamoeba-associated keratitis among contact lens wearers seen at the Department of Ophthalmology, Karl-Franzens-University, Graz, Austria, between 1996 and 1999 are reviewed. The amoebae were proven to be the causative agents in three patients. The aim of our study was to discriminate between clinically relevant and nonrelevant isolates and to assess the relatedness of the isolates to published strains. Altogether, 20 strains of free-living amoebae, including 15 Acanthamoeba strains, 3 Vahlkampfia strains, and 2 Hartmannella strains, were isolated from clinical specimens. The virulent Acanthamoeba strains were identified as A. polyphaga and two strains of A. hatchetti. To our knowledge this is the first determination of keratitis-causing Acanthamoeba strains in Austria. Clinically relevant isolates differed markedly from nonrelevant isolates with respect to their physiological properties. 18S ribosomal DNA sequence types were determined for the three physiologically most-divergent strains including one of the keratitis-causing strains. This highly virulent strain exhibited sequence type T6, a sequence type not previously associated with keratitis. Sequence data indicate that Acanthamoeba strains causing keratitis as well as nonpathogenic strains of Acanthamoeba in Austria are most closely related to published strains from other parts of the world. Moreover, the results of our study support the assumption that pathogenicity in Acanthamoeba is a distinct capability of certain strains and not dependent on appropriate conditions for the establishment of an infection. PMID:11060047

  17. T Cell Reactivity against Mycolyl Transferase Antigen 85 of M. tuberculosis in HIV-TB Coinfected Subjects and in AIDS Patients Suffering from Tuberculosis and Nontuberculous Mycobacterial Infections

    Directory of Open Access Journals (Sweden)

    Pascal Launois

    2011-01-01

    Full Text Available The mycolyl transferase antigen 85 complex is a major secreted protein family from mycobacterial culture filtrate, demonstrating powerful T cell stimulatory properties in most HIV-negative, tuberculin-positive volunteers with latent M.tuberculosis infection and only weak responses in HIV-negative tuberculosis patients. Here, we have analyzed T cell reactivity against PPD and Ag85 in HIV-infected individuals, without or with clinical symptoms of tuberculosis, and in AIDS patients with disease caused by nontuberculous mycobacteria. Whereas responses to PPD were not significantly different in HIV-negative and HIV-positive tuberculin-positive volunteers, responses to Ag85 were significantly decreased in the HIV-positive (CDC-A and CDC-B group. Tuberculosis patients demonstrated low T cell reactivity against Ag85, irrespective of HIV infection, and finally AIDS patients suffering from NTM infections were completely nonreactive to Ag85. A one-year follow-up of twelve HIV-positive tuberculin-positive individuals indicated a decreased reactivity against Ag85 in patients developing clinical tuberculosis, highlighting the protective potential of this antigen.

  18. Limited discriminant value of lipoprotein AI, lipoprotein Lp(a) and other lipoprotein particles in patients with and without early onset ischaemic heart disease.

    Science.gov (United States)

    Vallance, D T; Staunton, H A; Winder, A F

    1995-01-01

    AIMS--To assess whether the ability of lipoprotein related variables to discriminate between individuals with or without premature clinical ischaemic heart disease (IHD) was improved using data on high density lipoprotein-lipoprotein AI (HDL-LpAI) fractions, alone or in combination with data on Lp(a). METHODS--Lipid and apolipoprotein concentrations were measured in 26 middle-aged men (mean age 50.3 years) with early onset IHD and coronary artery bypass grafting prior to sampling, and in 26 matched lipaemic and 26 normolipaemic asymptomatic controls. RESULTS--Triglyceride and Lp(a) concentrations were higher, while HDL cholesterol and apolipoprotein A-I (apoA-I) concentrations were lower in patients than in controls. LpAI concentrations were also lower in IHD patients and were correlated with HDL and apoA-I in both IHD and control groups. Lp(a) was not correlated with any other lipid or apolipoprotein measured in either patients or controls. Univariate discriminant function analysis showed that the proportion correctly classified as patients or controls was marginally greater using LpAI concentrations as the discriminator, which was not increased in combination with Lp(a). Serum triglycerides, HDL cholesterol, apoA-I and Lp(a) alone all had similar, but weaker, discriminant power, which increased in various combinations with LpAI. CONCLUSIONS--LpAI particle measurement may be useful in research to define mechanisms of cardiovascular protection by HDL but the discriminating power for IHD was only marginally superior to measuring total apoA-I or Lp(a) concentrations. Little further advantage arose through combining LpAI data with other variables. PMID:7706525

  19. Feasibility of shortening isolation of TB-suspects by first-sample PCR

    DEFF Research Database (Denmark)

    Fløe, Andreas; Wejse, Christian; Thomsen, Vibeke Østergaard

    Rationale: Isolation of patients suspected for tuberculosis (TB) is usually guided by serial sputum smears. Many of patients initially isolated will turn out not to have TB, or will not be regarded as contagious. Current standards imply isolation for hours or days until contagiousness has been......-positive on the sample that produced the PCR-negative result. Conclusion: Though adequate sensitivity in diagnosing TB still requires serial samples for microbiological examination, the question of isolation can be determined by first-sample PCR in the majority of cases, when the test is negative. In our study, less...

  20. Impact of tuberculosis treatment on CD4 cell count, HIV RNA, and p24 antigen in patients with HIV and tuberculosis

    DEFF Research Database (Denmark)

    Wejse, Christian; Furtado, A.; Camara, C.

    2013-01-01

    To describe HIV RNA levels during tuberculosis (TB) infection in patients co-infected with TB and HIV. Moreover, to examine the p24 antigen profile during TB treatment.......To describe HIV RNA levels during tuberculosis (TB) infection in patients co-infected with TB and HIV. Moreover, to examine the p24 antigen profile during TB treatment....

  1. Molecular epidemiology of TB – Its impact on multidrug-resistant tuberculosis control in China☆

    Directory of Open Access Journals (Sweden)

    Biao Xu

    2015-01-01

    Results: In total, 238 bacteriologic confirmed pulmonary TB patients from DQ and 393 from GY diagnosed between 2008 and 2011 were recruited in the study. Of the 631 isolates, 220 (34.9% were resistant to at least one anti-TB drug, including 95 (15.1% simultaneously resistant to isoniazid and rifampicin or MDR, albeit with the similar distribution between DQ and GY (32/238 vs. 63/393; p, 0.378. The MIRU-VNTR genotyping revealed 35 isolates from DQ and 86 from GY exhibited 15 and 32 clustering patterns with four patterns shared between two counties. Compared with GY county, DQ had a significantly lower clustering proportion in MTB isolates susceptible to first-line drugs (25/167 vs. 46/198; p, 0.047 and total drug resistant TB isolates (12/71 vs. 44/149; p, 0.044, but a similar clustering proportion in MDR-TB isolates (8/32 vs. 18/63; p, 0.712. A significant higher clustering proportion was observed in the previously treated patients in both counties, but in the sputum smear-positive patients with cavitaries only in GY. Comparing the previously treated patients between the two counties, the proportion of MDR-TB and clustering proportion exhibited a similar distribution, while the average age of previously treated patients in DQ is significantly older than that in GY. Conclusions: A lower proportion of recent transmissions was observed in the county with long-term DOTS implementation. However, DOTS itself might not have worked enough on blocking the recent transmission of MDR-TB. This observation suggests the urgent needs of implementing the Stop-TB strategies; in particular, accelerating the use of rapid molecularbasedTBdiagnosisand drug susceptibility testing, providing active case findings in a high risk population of MDR-TB and enhancing infection control in high MDR-TB burden countries.

  2. Role of Quantiferon TB gold assays in monitoring the efficacy of antituberculosis therapy

    Directory of Open Access Journals (Sweden)

    N. Helmy

    2012-10-01

    Conclusion: The analysis of QFT-G assay results showed that in the majority of our TB patients there was a correlation between clinical treatment outcome and changes of IFN-γ response to M. tuberculosis-specific antigens.

  3. Segmental neurofibromatosis type 2: discriminating two hit from four hit in a patient presenting multiple schwannomas confined to one limb.

    Science.gov (United States)

    Castellanos, Elisabeth; Bielsa, Isabel; Carrato, Cristina; Rosas, Imma; Solanes, Ares; Hostalot, Cristina; Amilibia, Emilio; Prades, José; Roca-Ribas, Francesc; Lázaro, Conxi; Blanco, Ignacio; Serra, Eduard

    2015-01-24

    A clinical overlap exists between mosaic Neurofibromatosis Type 2 and sporadic Schwannomatosis conditions. In these cases a molecular analysis of tumors is recommended for a proper genetic diagnostics. This analysis is challenged by the fact that schwannomas in both conditions bear a somatic double inactivation of the NF2 gene. However, SMARCB1-associated schwannomas follow a four-hit, three-step model, in which both alleles of SMARCB1 and NF2 genes are inactivated in the tumor, with one of the steps being always the loss of a big part of chromosome 22 involving both loci. Here we report a 36-year-old woman who only presented multiple subcutaneous schwannomas on her right leg. To help discriminate between both possible diagnoses, an exhaustive molecular genetic and genomic analysis was performed on two schwannomas of the patient, consisting in cDNA and DNA sequencing, MLPA, microsatellite multiplex PCR and SNP-array analyses. The loss of a big part of chromosome 22 (22q12.1q13.33) was identified in both tumors. However, this loss involved the NF2 but not the SMARCB1 locus. SNP-array analysis revealed the presence of the same deletion breakpoint in both schwannomas, indicating that this alteration was actually the first NF2 inactivating hit. In addition, a distinct NF2 point mutation in each tumor was identified, representing independent second hits. In accordance with these results, no deletions or point mutations in the SMARCB1 gene were identified. None of the mutations were present in the blood. Two of the patient's children inherited chromosome 22 deleted in schwannomas of the mother, but in its wild type form. These results conclusively confirm the segmental mosaic NF2 nature of the clinical phenotype presented.

  4. Relationship between National TB program and prevalence of TB drug resistance in Algeria, 1965 to 2013

    Directory of Open Access Journals (Sweden)

    Fadila Boulahbal

    2015-01-01

    The different steps will be presented of the development of the National TB program in Algeria between 1964 and 2014, and in the same way the variations of the prevalence rate of TB drug resistance to demonstrate that the drug resistance surveillance is an acceptable indicator of the performance of TB control program in the country.

  5. TB incidence in an adolescent cohort in South Africa

    NARCIS (Netherlands)

    Mahomed, Hassan; Ehrlich, Rodney; Hawkridge, Tony; Hatherill, Mark; Geiter, Lawrence; Kafaar, Fazlin; Abrahams, Deborah Ann; Mulenga, Humphrey; Tameris, Michele; Geldenhuys, Hennie; Hanekom, Willem Albert; Verver, Suzanne; Hussey, Gregory Dudley

    2013-01-01

    Tuberculosis (TB) is a major public health problem globally. Little is known about TB incidence in adolescents who are a proposed target group for new TB vaccines. We conducted a study to determine the TB incidence rates and risk factors for TB disease in a cohort of school-going adolescents in a

  6. Detection of Multidrug Resistant Tuberculosis (MDR-TB) among ...

    African Journals Online (AJOL)

    A.I. Aminu, A.D. Tukur. Abstract. The Emergence of drug-resistant Mycobacterium tuberculosis strains especially multidrug resistant-TB (MDR-TB) and indeed extensively drug resistant TB (XDR-TB) is considered a real threat to achieving TB control. Thus, the WHO identified the need for accelerated access to rapid testing ...

  7. Identifying patients at high risk of tuberculosis recurrence

    Directory of Open Access Journals (Sweden)

    Ruxana T Sadikot

    2016-01-01

    Full Text Available Several studies have been done in relation to recurrence of tuberculosis (TB following completion of treatment. However, recurrence of TB is still a major problem from a public health perspective in high-burden countries, where no special attention is being given to this issue. Disease recurrence is an important indicator of the efficacy of antituberculosis treatment. The rate of recurrence is highly variable and has been estimated to range from 4.9% to 25%. This variability is not only a reflection of regional epidemiology of recurrence but differences in the definitions used by the TB control programs. In addition to treatment failure related to medication adherence, there are several key host factors that are associated with high rates of recurrence. The widely recognized host factors independent of treatment program that predispose to TB recurrence include: malnutrition; human immunodeficiency virus; substance abuse including tobacco use; comorbidity such as diabetes, renal failure and systemic diseases, especially immunosuppressive states; and environmental exposure such as silicosis. With improved understanding of the human genome, proteome, and metabolome, additional host-specific factors that predispose to recurrence are being discovered. Information on temporal and geographical trends of TB cases as well as genotyping might provide further information to enable us to fully understand TB recurrence and discriminate between reactivation and new infection. The recently launched World Health Organization End TB Strategy emphasizes the importance of integrated, patient-centered TB care. Continued improvement in diagnosis, treatment approaches, and defining host-specific factors are needed to fully understand the clinical epidemiological and social determinants of TB recurrence.

  8. Stop TB in My Lifetime: A Call for a World Free of TB - World TB Day 2013

    Centers for Disease Control (CDC) Podcasts

    2012-03-12

    In this podcast Dr. Kenneth Castro, Director of the Division of Tuberculosis Elimination, discusses World TB Day, the 2013 slogan and theme.  Created: 3/12/2012 by National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP).   Date Released: 3/13/2012.

  9. The face and its emotion: right N170 deficits in structural processing and early emotional discrimination in schizophrenic patients and relatives.

    Science.gov (United States)

    Ibáñez, Agustín; Riveros, Rodrigo; Hurtado, Esteban; Gleichgerrcht, Ezequiel; Urquina, Hugo; Herrera, Eduar; Amoruso, Lucía; Reyes, Migdyrai Martin; Manes, Facundo

    2012-01-30

    Previous studies have reported facial emotion recognition impairments in schizophrenic patients, as well as abnormalities in the N170 component of the event-related potential. Current research on schizophrenia highlights the importance of complexly-inherited brain-based deficits. In order to examine the N170 markers of face structural and emotional processing, DSM-IV diagnosed schizophrenia probands (n=13), unaffected first-degree relatives from multiplex families (n=13), and control subjects (n=13) matched by age, gender and educational level, performed a categorization task which involved words and faces with positive and negative valence. The N170 component, while present in relatives and control subjects, was reduced in patients, not only for faces, but also for face-word differences, suggesting a deficit in structural processing of stimuli. Control subjects showed N170 modulation according to the valence of facial stimuli. However, this discrimination effect was found to be reduced both in patients and relatives. This is the first report showing N170 valence deficits in relatives. Our results suggest a generalized deficit affecting the structural encoding of faces in patients, as well as the emotion discrimination both in patients and relatives. Finally, these findings lend support to the notion that cortical markers of facial discrimination can be validly considered as vulnerability markers. © 2011 Elsevier Ireland Ltd. All rights reserved.

  10. Discriminant function analysis of the occurrence risk of abnormal electrocardiogram in thyroidectomized differentiated thyroid carcinoma patients with short-term overt hypothyroidism.

    Science.gov (United States)

    Guan, Feng; Zhao, Hongguang; Jiao, Benzheng; Liu, Shanshan; Sa, Ri; Hou, Sen; Lin, Qiuyu; Wang, Qi; Lin, Chenghe

    2016-02-01

    The common form and risk factors of electrocardiogram (ECG) abnormality in thyroidectomized differentiated thyroid carcinoma (DTC) patients with short-term overt hypothyroidism were investigated and some discriminant formulas for forecasting the occurrence of abnormal ECG in this specific population were deduced in this study. A total of 260 thyroidectomized DTC patients were retrospectively reviewed, 67 of whom had abnormal ECG and 193 normal ECG after short-term (3 weeks) levothyroxine (L-T4) withdrawal. One-way ANOVA, Spearman's rank correlation analysis and discriminant function analysis were performed using data from these DTC patients. A flat or inverted T wave in inferior myocardial and left ventricular wall leads was the most common abnormal ECG finding in short-term overt hypothyroidism. Statistical analyses showed that age, interval, TSH-end (The serum hormothyrin level at the end of L-T4 withdrawal for 3 weeks), and TSH-vel (The average ascending velocity of serum hormothyrin level during L-T4 withdrawal for 3 weeks) were statistically significant and positively correlated with the occurrence of abnormal ECG. Meanwhile, TSH-vel showed the highest correlation coefficient (r = 0.358, p = 0.000). The formulas, especially deduced from age, interval and TSH-vel, could discriminate patients with abnormal ECG or not as high as 77.6 and 70.5%, respectively (resubstitution accuracy: 72.3%). The thyroidectomized DTC patients undergoing short-term L-T4 withdrawal before their first radioiodine ablative therapy, who had one or more of the above-mentioned risk factors, are likely to show abnormal ECG findings. The formulas from discriminant function analysis may be helpful for predicting patients with abnormal ECG with short-term L-T4 withdrawal and allow appropriate medical intervention beforehand.

  11. Tuberculosis Treatment Adherence of Patients in Kosovo

    OpenAIRE

    Krasniqi, Shaip; Jakupi, Arianit; Daci, Armond; Tigani, Bahri; Jupolli-Krasniqi, Nora; Pira, Mimoza; Zhjeqi, Valbona; Neziri, Burim

    2017-01-01

    Setting. The poor patient adherence in tuberculosis (TB) treatment is considered to be one of the most serious challenges which reflect the decrease of treatment success and emerging of the Multidrug Resistance-TB (MDR-TB). To our knowledge, the data about patients’ adherence to anti-TB treatment in our country are missing. Objective. This study was aimed to investigate the anti-TB treatment adherence rate and to identify factors related to eventual nonadherence among Kosovo TB patients. Desi...

  12. Coping with the economic burden of Diabetes, TB and co-prevalence: evidence from Bishkek, Kyrgyzstan.

    Science.gov (United States)

    Arnold, Matthias; Beran, David; Haghparast-Bidgoli, Hassan; Batura, Neha; Akkazieva, Baktygul; Abdraimova, Aida; Skordis-Worrall, Jolene

    2016-04-05

    The increasing number of patients co-affected with Diabetes and TB may place individuals with low socio-economic status at particular risk of persistent poverty. Kyrgyz health sector reforms aim at reducing this burden, with the provision of essential health services free at the point of use through a State-Guaranteed Benefit Package (SGBP). However, despite a declining trend in out-of-pocket expenditure, there is still a considerable funding gap in the SGBP. Using data from Bishkek, Kyrgyzstan, this study aims to explore how households cope with the economic burden of Diabetes, TB and co-prevalence. This study uses cross-sectional data collected in 2010 from Diabetes and TB patients in Bishkek, Kyrgyzstan. Quantitative questionnaires were administered to 309 individuals capturing information on patients' socioeconomic status and a range of coping strategies. Coarsened exact matching (CEM) is used to generate socio-economically balanced patient groups. Descriptive statistics and logistic regression are used for data analysis. TB patients are much younger than Diabetes and co-affected patients. Old age affects not only the health of the patients, but also the patient's socio-economic context. TB patients are more likely to be employed and to have higher incomes while Diabetes patients are more likely to be retired. Co-affected patients, despite being in the same age group as Diabetes patients, are less likely to receive pensions but often earn income in informal arrangements. Out-of-pocket (OOP) payments are higher for Diabetes care than for TB care. Diabetes patients cope with the economic burden by using social welfare support. TB patients are most often in a position to draw on income or savings. Co-affected patients are less likely to receive social welfare support than Diabetes patients. Catastrophic health spending is more likely in Diabetes and co-affected patients than in TB patients. This study shows that while OOP are moderate for TB affected patients

  13. TB Testing for People Living with HIV

    Centers for Disease Control (CDC) Podcasts

    2012-07-23

    Dr. Kenneth Castro, Director of the Division of Tuberculosis Elimination, explains why it is important for people living with HIV to be tested for TB.  Created: 7/23/2012 by National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP).   Date Released: 7/23/2012.

  14. Luminescence of YAG:Tm, Tb

    International Nuclear Information System (INIS)

    Scholl, M.S.; Trimmier, J.R.

    1986-01-01

    Two rare earth cations, thulium (Tm) and terbium (Tb) have been incorporated into a yttrium aluminum garnet (YAG) host material to obtain a blue phosphor. Thulium concentrations of up to 5% yield a saturated dark blue phosphor which exhibits a low efficiency. The highest efficiency for YAG:Tm occurs at a Tm concentration of 2%. A 0.5% concentration of terbium yields an unsaturated blue phosphor with an efficiency of approximately a factor of 15 times greater than that of Tm. The cathodoluminescence spectrum of YAG:Tm, Tb depicts features identifiable with YAG:Tb even at low Tb concentrations (0.5%). The light emitted by a Tb, Tm coactivated phosphor exhibits a clear shift toward the green region of the spectrum. There appears to be a resonant energy transfer from the 1 D 2 Tm 3+ state to the 5 D 4 Tb 3+ state. In the case of small concentrations of Tb in YAG, thulium behaves as a sensitizer for Tb cathodoluminescence

  15. Associations between non-discrimination and training policies and physicians’ attitudes and knowledge about sexual and gender minority patients: a comparison of physicians from two hospitals

    Directory of Open Access Journals (Sweden)

    Jennifer M. Jabson

    2016-03-01

    Full Text Available Abstract Background Some physicians lack knowledge and awareness about health issues specific to sexual and gender minority (SGM individuals. To help improve this, hospitals have implemented policies that mandate non-discrimination and training to promote sexual and gender minority health. There is limited evidence about how such policies relate to physicians’ knowledge, attitudes, and gender and sexual minority affirmative practices. Method A random sample of 1000 physicians was recruited from a complete list of physicians affiliated with one of two university Hospitals located in Tennessee and 180 physicians completed the survey concerning attitudes and knowledge about SGM individuals. Physicians were affiliated with either Hospital A that had not implemented policies for non-discrimination and training, or Hospital B that did. Results Physicians held different attitudes about SGM patients than non-patients. Physicians affiliated with Hospital A held more negative attitudes about SGM individuals who were non-patients than physicians affiliated with Hospital B. There were no differences between the two hospitals in physicians’ attitudes and knowledge about SGM patients. Conclusion Policies that mandate non-discrimination and training as they currently exist may not improve physicians’ attitudes and knowledge about SGM individuals. Additional research is needed to understand how these policies and trainings relate to physicians’ SGM affirmative practices.

  16. Associations between non-discrimination and training policies and physicians' attitudes and knowledge about sexual and gender minority patients: a comparison of physicians from two hospitals.

    Science.gov (United States)

    Jabson, Jennifer M; Mitchell, Jason W; Doty, S Benjamin

    2016-03-12

    Some physicians lack knowledge and awareness about health issues specific to sexual and gender minority (SGM) individuals. To help improve this, hospitals have implemented policies that mandate non-discrimination and training to promote sexual and gender minority health. There is limited evidence about how such policies relate to physicians' knowledge, attitudes, and gender and sexual minority affirmative practices. A random sample of 1000 physicians was recruited from a complete list of physicians affiliated with one of two university Hospitals located in Tennessee and 180 physicians completed the survey concerning attitudes and knowledge about SGM individuals. Physicians were affiliated with either Hospital A that had not implemented policies for non-discrimination and training, or Hospital B that did. Physicians held different attitudes about SGM patients than non-patients. Physicians affiliated with Hospital A held more negative attitudes about SGM individuals who were non-patients than physicians affiliated with Hospital B. There were no differences between the two hospitals in physicians' attitudes and knowledge about SGM patients. Policies that mandate non-discrimination and training as they currently exist may not improve physicians' attitudes and knowledge about SGM individuals. Additional research is needed to understand how these policies and trainings relate to physicians' SGM affirmative practices.

  17. Antiretroviral Treatment Scale-Up and Tuberculosis Mortality in High TB/HIV Burden Countries: An Econometric Analysis

    Science.gov (United States)

    Yan, Isabel; Bendavid, Eran; Korenromp, Eline L.

    2016-01-01

    Introduction Antiretroviral therapy (ART) reduces mortality in patients with active tuberculosis (TB), but the population-level relationship between ART coverage and TB mortality is untested. We estimated the reduction in population-level TB mortality that can be attributed to increasing ART coverage across 41 high HIV-TB burden countries. Methods We compiled TB mortality trends between 1996 and 2011 from two sources: (1) national program-reported TB death notifications, adjusted for annual TB case detection rates, and (2) WHO TB mortality estimates. National coverage with ART, as proportion of HIV-infected people in need, was obtained from UNAIDS. We applied panel linear regressions controlling for HIV prevalence (5-year lagged), coverage of TB interventions (estimated by WHO and UNAIDS), gross domestic product per capita, health spending from domestic sources, urbanization, and country fixed effects. Results Models suggest that that increasing ART coverage was followed by reduced TB mortality, across multiple specifications. For death notifications at 2 to 5 years following a given ART scale-up, a 1% increase in ART coverage predicted 0.95% faster mortality rate decline (p = 0.002); resulting in 27% fewer TB deaths in 2011 alone than would have occurred without ART. Based on WHO death estimates, a 1% increase in ART predicted a 1.0% reduced TB death rate (peconometric analysis supports a substantial impact of ART on population-level TB mortality realized already within the first decade of ART scale-up, that is apparent despite variable-quality mortality data. PMID:27536864

  18. Stratification by interferon-γ release assay level predicts risk of incident TB.

    Science.gov (United States)

    Winje, Brita Askeland; White, Richard; Syre, Heidi; Skutlaberg, Dag Harald; Oftung, Fredrik; Mengshoel, Anne Torunn; Blix, Hege Salvesen; Brantsæter, Arne Broch; Holter, Ellen Kristine; Handal, Nina; Simonsen, Gunnar Skov; Afset, Jan Egil; Bakken Kran, Anne Marte

    2018-04-05

    Targeted testing and treatment of latent TB infection (LTBI) are priorities on the global health agenda, but LTBI management remains challenging. We aimed to evaluate the prognostic value of the QuantiFERON TB-Gold (QFT) test for incident TB, focusing on the interferon (IFN)-γ level, when applied in routine practice in a low TB incidence setting. In this large population-based prospective cohort, we linked QFT results in Norway (1 January 2009-30 June 2014) with national registry data (Norwegian Surveillance System for Infectious Diseases, Norwegian Prescription Database, Norwegian Patient Registry and Statistics Norway) to assess the prognostic value of QFT for incident TB. Participants were followed until 30 June 2016. We used restricted cubic splines to model non-linear relationships between IFN-γ levels and TB, and applied these findings to a competing risk model. The prospective analyses included 50 389 QFT results from 44 875 individuals, of whom 257 developed TB. Overall, 22% (n=9878) of QFT results were positive. TB risk increased with the IFN-γ level until a plateau level, above which further increase was not associated with additional prognostic information. The HRs for TB were 8.8 (95% CI 4.7 to 16.5), 19.2 (95% CI 11.6 to 31.6) and 31.3 (95% CI 19.8 to 49.5) times higher with IFN-γ levels of 0.35 to 4.00 IU/mL, respectively, compared with negative tests (TB with rising IFN-γ concentrations, indicating that IFN-γ levels may be used to guide targeted treatment of LTBI. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  19. Discriminating MGMT promoter methylation status in patients with glioblastoma employing amide proton transfer-weighted MRI metrics.

    Science.gov (United States)

    Jiang, Shanshan; Rui, Qihong; Wang, Yu; Heo, Hye-Young; Zou, Tianyu; Yu, Hao; Zhang, Yi; Wang, Xianlong; Du, Yongxing; Wen, Xinrui; Chen, Fangyao; Wang, Jihong; Eberhart, Charles G; Zhou, Jinyuan; Wen, Zhibo

    2017-12-12

    To explore the feasibility of using amide proton transfer-weighted (APTw) MRI metrics as surrogate biomarkers to identify the O6-methylguanine-DNA methyltransferase (MGMT) promoter methylation status in glioblastoma (GBM). Eighteen newly diagnosed GBM patients, who were previously scanned at 3T and had a confirmed MGMT methylation status, were retrospectively analysed. For each case, a histogram analysis in the tumour mass was performed to evaluate several quantitative APTw MRI metrics. The Mann-Whitney test was used to evaluate the difference in APTw parameters between MGMT methylated and unmethylated GBMs, and the receiver-operator-characteristic analysis was further used to assess diagnostic performance. Ten GBMs were found to harbour a methylated MGMT promoter, and eight GBMs were unmethylated. The mean, variance, 50th percentile, 90th percentile and Width 10-90 APTw values were significantly higher in the MGMT unmethylated GBMs than in the MGMT methylated GBMs, with areas under the receiver-operator-characteristic curves of 0.825, 0.837, 0.850, 0856 and 0.763, respectively, for the discrimination of MGMT promoter methylation status. APTw signal metrics have the potential to serve as valuable imaging biomarkers for identifying MGMT methylation status in the GBM population. • APTw-MRI is applied to predict MGMT promoter methylation status in GBMs. • GBMs with unmethylated MGMT promoter present higher APTw-MRI than methylated GBMs. • Multiple APTw histogram metrics can identify MGMT methylation status. • Mean APTw values showed the highest diagnostic accuracy (AUC = 0.825).

  20. Use of the T-spot.TB test for the diagnosis of latent tuberculosis infection

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    Andrea Amodeo

    2010-09-01

    Full Text Available Background:Tuberculosis (TB represents a major health problem both in developing and both in industrialized countries.The identification of individuals latently infected with Mycobacterium tuberculosis (Mtb play a key role for the efficacy of TB control. These individuals with a latent tuberculosis infection (LTBI, especially those with high risk of reactivation (e.g. HIV + / AIDS-infected individuals, patients undergoing immunosuppressive therapy and children younger than 5 years could benefit from a preventive treatment with isoniazid reducing the risk of progression from LTBI to active TB. Until recently, detection of LTBI has relied on the tuberculin skin test (TST, but despite the widespread use in clinical practice,TST does not reliably diagnose LTBI because several drawbacks, e.g. lacking in specificity, particularly in who were exposed to non-tuberculous mycobacteria (NTM or were vaccinated with Bacille Calmette-Guerin (BCG In addition, in young subjects,TST sensitivity is hampered by impaired T cell function leading frequently to false negative results.These several drawbacks limit the use of TST for the diagnose an LTBI in patients who may benefit from preventive chemotherapy. On the other hand, an accurate diagnosis of LTBI avoid the over-treatment of those patients with a positive TST results but not latently infected with Mtb. Recently, new tests based on the detection of interferon-gamma (IFN-γ after stimulation with Mtb-specific antigens: Early secretory Antigenic Target-6 (ESAT-6 and Culture Filtrate Protein-10 (CFP-10 have been proposed for the diagnosis of active TB and LTBI. Methods: During the period from January 2009 to June 2009, in our laboratory 70 patients were tested with T-SPOT.TB (Oxford Immunotech, Abingdon, United Kingdom.We enrolled transplant patients and subjects ongoing transplant, patients immigrants from high prevalence TB countries, patients screened for immunosuppressive treatment, HIV / AIDS – infected

  1. Tuberculosis: The Connection between TB and HIV (the AIDS Virus)

    Science.gov (United States)

    ... Studies Consortium Research Projects Publications TB Trials Consortium Study Descriptions Background Behavioral & Social Science Research Infection Control TB in Specific Populations African-American Community Stop TB in the African-American ...

  2. Sensitivity and specificity of QuantiFERON-TB Gold Plus compared with QuantiFERON-TB Gold In-Tube and T-SPOT.TB on active tuberculosis in Japan.

    Science.gov (United States)

    Takasaki, Jin; Manabe, Toshie; Morino, Eriko; Muto, Yoshikazu; Hashimoto, Masao; Iikura, Motoyasu; Izumi, Shinyu; Sugiyama, Haruhito; Kudo, Koichiro

    2018-03-01

    The QuantiFERON-TB Gold Plus (QFT-Plus) was introduced in 2015 as a new generation of interferon-gamma release assays (IGRAs) designed to detect Mycobacterium tuberculosis infection (TB). Examination of its diagnostic accuracy is crucial before it is launched in Japan. We examined 99 patients with laboratory-confirmed active TB (patients) and 117 healthy volunteers with no risk of TB infection (controls) at a medical center in Tokyo, Japan. Blood samples were collected from both the patients and controls and tested using three types of IGRAs: the QFT-Plus, the QuantiFERON-TB Gold In-Tube (QFT-GIT), and the T-SPOT.TB (T-SPOT). The sensitivity and specificity of each IGRA were examined and compared. The sensitivity of the QFT-Plus was 98.9% (95% confidence interval [CI], 0.934-0.998) and similar to that of the QFT-GIT (97.9%; 95% CI, 0.929-0.998) and T-SPOT (96.9%; 95% CI, 0.914-0.994). The specificity of the QFT-Plus was the same as that of the QFT-GIT and T-SPOT (98.1%; 95% CI, 0.934-0.998). One patient with uncontrolled diabetes mellitus showed negative results on all three IGRAs. The QFT-Plus showed a high degree of agreement with the QFT-GIT and T-SPOT, with high sensitivity and specificity. Severe diabetes mellitus may influence the results of IGRAs. Larger studies are needed to validate the accuracy of the GFT-Plus and determine whether it can contribute as adjunctive method for the early diagnosis of active TB in Japan. Copyright © 2017 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

  3. Mapping sites of high TB transmission risk: Integrating the shared air and social behaviour of TB cases and adolescents in a South African township.

    Science.gov (United States)

    Patterson, Benjamin; Morrow, Carl D; Kohls, Daniel; Deignan, Caroline; Ginsburg, Samuel; Wood, Robin

    2017-04-01

    Tuberculosis remains a major public health problem in poverty-stricken areas of the world. Communal gathering places account for the majority of TB transmission in high burden settings. To investigate the social behaviour patterns of individuals who have developed TB disease and adolescents at risk of infection. To develop a cheap and effective method to locate transmission hot spots in high burden communities. Portable, combined CO 2 /GIS monitors and location diaries were given to individuals from a South African township. The three groups: newly diagnosed TB patients, recently treated TB patients and adolescents recorded their activities over a median of two days. Rebreathed air volumes (RAVs) at all GIS locations were calculated from CO 2 levels using the Rudnick-Milton variant of the Wells-Riley TB transmission model. Hot spot analysis was performed to determine the communal buildings which correspond to spatially clustered high RAVs. Analysis of diaries found that the adolescent group spent greater time in congregate settings compared with the other two groups driven by time spent in school/work (new TB: 1%, recent TB: 8%, and adolescents: 23%). Adolescents also changed their location more frequently (9.0, 6.0, 14.3 changes per day; pbuildings associated with high RAVs were found to be a clinic, two schools and a library. Hot spot analysis revealed the most intense clustering of high RAVs at a community school. Our study demonstrates a new methodology to uncover TB transmission hot spots using a technique that avoids the need to pre-select locations. Investigation of a South African township highlighted the high risk potential of schools and high risk social behaviour of adolescents. Consequently the targeting of transmission reduction strategies to schools may prove highly efficacious in high burden settings. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

  4. Within centre evaluation of hypercalcaemia discriminant

    DEFF Research Database (Denmark)

    Nielsen, Bo Friis; Conradsen, Knut

    1996-01-01

    Diagnostic hypercalcaemia discriminant functions, discriminating between clinically significant and non-significant hypercalcaemia, were tested 5 years after their development in order to evaluate the impact of time on their diagnostic capacity. Two populations, consisting of 257 and 129 patients...

  5. Exploring intentions to discriminate against patients living with HIV/AIDS among future healthcare providers in Malaysia.

    Science.gov (United States)

    Earnshaw, Valerie A; Jin, Harry; Wickersham, Jeffrey; Kamarulzaman, Adeeba; John, Jacob; Altice, Frederick L

    2014-06-01

    Stigma towards people living with HIV/AIDS (PLWHA) is strong in Malaysia. Although stigma has been understudied, it may be a barrier to treating the approximately 81 000 Malaysian PLWHA. The current study explores correlates of intentions to discriminate against PLWHA among medical and dental students, the future healthcare providers of Malaysia. An online, cross-sectional survey of 1296 medical and dental students was conducted in 2012 at seven Malaysian universities; 1165 (89.9%) completed the survey and were analysed. Socio-demographic characteristics, stigma-related constructs and intentions to discriminate against PLWHA were measured. Linear mixed models were conducted, controlling for clustering by university. The final multivariate model demonstrated that students who intended to discriminate more against PLWHA were female, less advanced in their training, and studying dentistry. They further endorsed more negative attitudes towards PLWHA, internalised greater HIV-related shame, reported more HIV-related fear and disagreed more strongly that PLWHA deserve good care. The final model accounted for 38% of the variance in discrimination intent, with 10% accounted for by socio-demographic characteristics and 28% accounted for by stigma-related constructs. It is critical to reduce stigma among medical and dental students to eliminate intentions to discriminate and achieve equitable care for Malaysian PLWHA. Stigma-reduction interventions should be multipronged, addressing attitudes, internalised shame, fear and perceptions of deservingness of care. © 2014 John Wiley & Sons Ltd.

  6. Enhancing TB case detection: experience in offering upfront Xpert MTB/RIF testing to pediatric presumptive TB and DR TB cases for early rapid diagnosis of drug sensitive and drug resistant TB.

    Directory of Open Access Journals (Sweden)

    Neeraj Raizada

    Full Text Available Diagnosis of pulmonary tuberculosis (PTB in children is challenging due to difficulties in obtaining good quality sputum specimens as well as the paucibacillary nature of disease. Globally a large proportion of pediatric tuberculosis (TB cases are diagnosed based only on clinical findings. Xpert MTB/RIF, a highly sensitive and specific rapid tool, offers a promising solution in addressing these challenges. This study presents the results from pediatric groups taking part in a large demonstration study wherein Xpert MTB/RIF testing replaced smear microscopy for all presumptive PTB cases in public health facilities across India.The study covered a population of 8.8 million across 18 programmatic sub-district level tuberculosis units (TU, with one Xpert MTB/RIF platform established at each study TU. Pediatric presumptive PTB cases (both TB and Drug Resistant TB (DR-TB accessing any public health facilities in study area were prospectively enrolled and tested on Xpert MTB/RIF following a standardized diagnostic algorithm.4,600 pediatric presumptive pulmonary TB cases were enrolled. 590 (12.8%, CI 11.8-13.8 pediatric PTB were diagnosed. Overall 10.4% (CI 9.5-11.2 of presumptive PTB cases had positive results by Xpert MTB/RIF, compared with 4.8% (CI 4.2-5.4 who had smear-positive results. Upfront Xpert MTB/RIF testing of presumptive PTB and presumptive DR-TB cases resulted in diagnosis of 79 and 12 rifampicin resistance cases, respectively. Positive predictive value (PPV for rifampicin resistance detection was high (98%, CI 90.1-99.9, with no statistically significant variation with respect to past history of treatment.Upfront access to Xpert MTB/RIF testing in pediatric presumptive PTB cases was associated with a two-fold increase in bacteriologically-confirmed PTB, and increased detection of rifampicin-resistant TB cases under routine operational conditions across India. These results suggest that routine Xpert MTB/RIF testing is a promising

  7. Influence knowledge and behavior of TB medical personnels’ concordance principle based communications skill at primary healthcare, Medan, Indonesia

    Science.gov (United States)

    Wahyuni, A. S.; Soeroso, N. N.; Alona, I.; Yunanda, Y.; Siregar, I.

    2018-03-01

    Concordance behavior of TB management is a form of collaboration among doctors, personnel, and patients in treating TB. Approvalamong them could be achieved if credibility and policy occur. This study is aimed to analyze the influence of TB medical personnel’s concordance behaviour principle to patient obedience at primary health care in Medan.The design of this study was quasi experimental, focusing on interventional primary health care, which is those who applied concordance behaviour principle to non-interventionalprimary health care. The population is TB patients, starting from 18 years old, TB category I with positive Acid Fast Bacilli Smear Test (AFBST), and taking TB regimens at Medan. Seventy- four patients were selected to be samples. They had undergone interview based on validated concordance principle, knowledge, behavior, and treatment. Data were analyzed using chi- square. The percentage of knowledge, behavior of TB patient to the treatment is higher on interventional primary health care than noninterventional ones. Treatment awareness based on concordance principle is expected to planish DOTS-based TB programs.

  8. A deadly combination of AIDS, TB and cardiac tumour.

    Science.gov (United States)

    Sahasrabudhe, Tushar Ramesh

    2013-05-22

    Immunocompromised status in AIDS makes differential diagnosis of any symptom very difficult for a clinician. Sharp clinical judgement and plenty of investigations may be needed to reach the diagnosis, as in this case. We hereby present a case of AIDS and active tuberculosis (TB) under treatment. The patient developed acute onset multifocal neurological symptoms following an episode of fever and diarrhoea. The MRI scan revealed numerous large cerebral infarcts. On investigations to evaluate brain infarcts, we made a diagnosis of left atrial cardiac tumour. Association of cardiac tumours with AIDS has only been rarely reported. It is uncertain if these can be opportunistic tumours in AIDS. The patient successfully came out of this deadly combination of diseases, viz AIDS, TB and large brain infarcts due to atrial tumour; with almost complete recovery.

  9. TB/HIV integration at primary care level: A quantitative assessment at 3 clinics in Johannesburg, South Africa

    Directory of Open Access Journals (Sweden)

    L Page-Shipp

    2012-08-01

    Full Text Available Background. In 2004 the World Health Organization (WHO released the Interim Policy on Collaborative TB/HIV activities. According to the policy, for people living with HIV (PLWH, activities include intensified case finding, isoniazid preventive therapy (IPT and infection control. For TB patients, activities included HIV counselling and testing (HCT, prevention messages, and cotrimoxazole preventive therapy (CPT, care and support, and antiretroviral therapy (ART for those with HIV-associated TB. While important progress has been made in implementation, targets of the WHO Global Plan to Stop TB have not been reached. Objective. To quantify TB/HIV integration at 3 primary healthcare clinics in Johannesburg, South Africa. Methods. Routinely collected TB and HIV data from the HCT register, TB ‘suspect’ register, TB treatment register, clinic files and HIV electronic database, collected over a 3-month period, were reviewed. Results. Of 1 104 people receiving HCT: 306 (28% were HIV-positive; a CD4 count was documented for 57%; and few received TB screening or IPT. In clinic encounters among PLWH, 921 (15% had documented TB symptoms; only 10% were assessed by smear microscopy, and few asymptomatic PLWH were offered IPT. Infection control was poorly documented and implemented. HIV status was documented for 155 (75% of the 208 TB patients; 90% were HIV-positive and 88% had a documented CD4 count. Provision of CPT and ART was poorly documented. Conclusion. The coverage of most TB/HIV collaborative activities was below Global Plan targets. The lack of standardised recording tools and incomplete documentation impeded assessment at facility level and limited the accuracy of compiled data.

  10. TB and HIV Therapeutics: Pharmacology Research Priorities

    Directory of Open Access Journals (Sweden)

    Kelly E. Dooley

    2012-01-01

    Full Text Available An unprecedented number of investigational drugs are in the development pipeline for the treatment of tuberculosis. Among patients with tuberculosis, co-infection with HIV is common, and concurrent treatment of tuberculosis and HIV is now the standard of care. To ensure that combinations of anti-tuberculosis drugs and antiretrovirals are safe and are tested at doses most likely to be effective, selected pharmacokinetic studies based on knowledge of their metabolic pathways and their capacity to induce or inhibit metabolizing enzymes of companion drugs must be conducted. Drug interaction studies should be followed up by evaluations in larger populations to evaluate safety and pharmacodynamics more fully. Involving patients with HIV in trials of TB drugs early in development enhances the knowledge gained from the trials and will ensure that promising new tuberculosis treatments are available to patients with HIV as early as possible. In this review, we summarize current and planned pharmacokinetic and drug interaction studies involving investigational and licensed tuberculosis drugs and antiretrovirals and suggest priorities for tuberculosis-HIV pharmacokinetic, pharmacodynamic, and drug-drug interaction studies for the future. Priority studies for children and pregnant women with HIV and tuberculosis co-infection are briefly discussed.

  11. [Comparative study of concordance and costs between tuberculin skin test and QuantiFERON(®)-TB Gold In-Tube in the diagnosis of latent tuberculosis infection among contacts of patients with pulmonary tuberculosis].

    Science.gov (United States)

    Martinez Lacasa, Xavier; Canals Font, Roser; Jaen Manzanera, Angels; Cuchi Burgos, Eva; Lite Lite, Josep

    2015-11-20

    Recently diagnosis of latent tuberculosis infection (LTBI) can be made using the tuberculin skin test (TST) or by techniques known as interferon-γ release assays (IGRAS), being QuantiFERON(®)-TB Gold In-Tube (QF-G-IT) the most used. The IGRAS avoid some drawbacks of the TST, especially cross-reaction with bacillus Calmette-Guérin (BCG) vaccine, but also present some problems such as those arising from cost and the need of having an adequate infrastructure and experience. There is no clear consensus on which technique should be preferentially used for the diagnosis of LTBI. This is a comparative study between the TST and QT-G-IT in a cohort of contacts of patients with pulmonary tuberculosis during the study period. An analysis of global agreement and groups was performed according to whether the contacts were vaccinated with BCG or not. A study of costs of both techniques and diagnostic strategies based on these techniques was performed. The agreement between TST and QF-G-IT was acceptable in the whole sample yet it was very good in the unvaccinated group. Few cases of indeterminate values were recorded. The cost study showed that TST was cheaper than QF-G-IT; however when we analyzed the cost of the strategies according to each technique, the QF-G-IT showed a better cost-benefit. We suggest considering QF-G-IT as the only preferred technique for the diagnosis of LTBI in household contacts, based on good overall agreement between the 2 techniques (even if we eliminate the effect of the vaccine) and a cost analysis favorable to QF-G-IT. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

  12. Increased Diagnostic Accuracy of Digital vs. Conventional Clock Drawing Test for Discrimination of Patients in the Early Course of Alzheimer's Disease from Cognitively Healthy Individuals.

    Science.gov (United States)

    Müller, Stephan; Preische, Oliver; Heymann, Petra; Elbing, Ulrich; Laske, Christoph

    2017-01-01

    The conventional Clock Drawing Test (cCDT) is a rapid and inexpensive screening tool for detection of moderate and severe dementia. However, its usage is limited due to poor diagnostic accuracy especially in patients with mild cognitive impairment (MCI). The diagnostic value of a newly developed digital Clock Drawing Test (dCDT) was evaluated and compared with the cCDT in 20 patients with early dementia due to AD (eDAT), 30 patients with amnestic MCI (aMCI) and 20 cognitively healthy controls (HCs). Parameters assessed by dCDT were time while transitioning the stylus from one stroke to the next above the surface (i.e., time-in-air), time the stylus produced a visible stroke (i.e., time-on-surface) and total-time during clock drawing. Receiver-operating characteristic (ROC) curves were calculated and logistic regression analyses have been conducted for statistical analysis. Using dCDT, time-in-air was significantly increased in eDAT (70965.8 ms) compared to aMCI (54073.7 ms; p = 0.027) and HC (32315.6 ms; p < 0.001). In addition, time-in-air was significantly longer in patients with aMCI compared to HC ( p = 0.003), even in the aMCI group with normal cCDT score (54141.8 ms; p < 0.001). Time-in-air using dCDT allowed discrimination of patients with aMCI from HCs with a sensitivity of 81.3% and a specificity of 72.2% while cCDT scoring revealed a sensitivity of 62.5% and a specificity of 83.3%. Most interestingly, time-in-air allowed even discrimination of aMCI patients with normal cCDT scores (80% from all aMCI patients) from HCs with a clinically relevant sensitivity of 80.8% and a specificity of 77.8%. A combination of dCDT variables and cCDT scores did not improve the discrimination of patients with aMCI from HC. In conclusion, assessment of time-in-air using dCDT yielded a higher diagnostic accuracy for discrimination of aMCI patients from HCs than the use of cCDT even in those aMCI patients with normal cCDT scores. Modern digitizing devices offer the opportunity

  13. Increased Diagnostic Accuracy of Digital vs. Conventional Clock Drawing Test for Discrimination of Patients in the Early Course of Alzheimer’s Disease from Cognitively Healthy Individuals

    Science.gov (United States)

    Müller, Stephan; Preische, Oliver; Heymann, Petra; Elbing, Ulrich; Laske, Christoph

    2017-01-01

    The conventional Clock Drawing Test (cCDT) is a rapid and inexpensive screening tool for detection of moderate and severe dementia. However, its usage is limited due to poor diagnostic accuracy especially in patients with mild cognitive impairment (MCI). The diagnostic value of a newly developed digital Clock Drawing Test (dCDT) was evaluated and compared with the cCDT in 20 patients with early dementia due to AD (eDAT), 30 patients with amnestic MCI (aMCI) and 20 cognitively healthy controls (HCs). Parameters assessed by dCDT were time while transitioning the stylus from one stroke to the next above the surface (i.e., time-in-air), time the stylus produced a visible stroke (i.e., time-on-surface) and total-time during clock drawing. Receiver-operating characteristic (ROC) curves were calculated and logistic regression analyses have been conducted for statistical analysis. Using dCDT, time-in-air was significantly increased in eDAT (70965.8 ms) compared to aMCI (54073.7 ms; p = 0.027) and HC (32315.6 ms; p < 0.001). In addition, time-in-air was significantly longer in patients with aMCI compared to HC (p = 0.003), even in the aMCI group with normal cCDT score (54141.8 ms; p < 0.001). Time-in-air using dCDT allowed discrimination of patients with aMCI from HCs with a sensitivity of 81.3% and a specificity of 72.2% while cCDT scoring revealed a sensitivity of 62.5% and a specificity of 83.3%. Most interestingly, time-in-air allowed even discrimination of aMCI patients with normal cCDT scores (80% from all aMCI patients) from HCs with a clinically relevant sensitivity of 80.8% and a specificity of 77.8%. A combination of dCDT variables and cCDT scores did not improve the discrimination of patients with aMCI from HC. In conclusion, assessment of time-in-air using dCDT yielded a higher diagnostic accuracy for discrimination of aMCI patients from HCs than the use of cCDT even in those aMCI patients with normal cCDT scores. Modern digitizing devices offer the opportunity

  14. A deadly combination of AIDS, TB and cardiac tumour

    OpenAIRE

    Sahasrabudhe, Tushar Ramesh

    2013-01-01

    Immunocompromised status in AIDS makes differential diagnosis of any symptom very difficult for a clinician. Sharp clinical judgement and plenty of investigations may be needed to reach the diagnosis, as in this case. We hereby present a case of AIDS and active tuberculosis (TB) under treatment. The patient developed acute onset multifocal neurological symptoms following an episode of fever and diarrhoea. The MRI scan revealed numerous large cerebral infarcts. On investigations to evaluate br...

  15. Psycho-Socio-Economic Issues Challenging Multidrug Resistant Tuberculosis Patients: A Systematic Review.

    Directory of Open Access Journals (Sweden)

    Beena Elizabeth Thomas

    Full Text Available Limited treatment options, long duration of treatment and associated toxicity adversely impact the physical and mental well-being of multidrug-resistant tuberculosis (MDR-TB patients. Despite research advances in the microbiological and clinical aspects of MDR-TB, research on the psychosocial context of MDR-TB is limited and less understood.We searched the databases of PubMed, MEDLINE, Embase and Google Scholar to retrieve all published articles. The final manuscripts included in the review were those with a primary focus on psychosocial issues of MDR-TB patients. These were assessed and the information was thematically extracted on the study objective, methodology used, key findings, and their implications. Intervention studies were evaluated using components of the methodological and quality rating scale. Due to the limited number of studies and the multiple methodologies employed in the observational studies, we summarized these studies using a narrative approach, rather than conducting a formal meta-analysis. We used 'thematic synthesis' method for extracting qualitative evidences and systematically organised to broader descriptive themes.A total of 282 published articles were retrieved, of which 15 articles were chosen for full text review based on the inclusion criteria. Six were qualitative studies; one was a mixed methods study; and eight were quantitative studies. The included studies were divided into the following issues affecting MDR-TB patients: a psychological issues b social issues and economic issues c psychosocial interventions. It was found that all studies have documented range of psychosocial and economic challenges experienced by MDR-TB patients. Depression, stigma, discrimination, side effects of the drugs causing psychological distress, and the financial constraints due to MDR-TB were some of the common issues reported in the studies. There were few intervention studies which addressed these psychosocial issues most of

  16. Progress and challenges in TB vaccine development.

    Science.gov (United States)

    Voss, Gerald; Casimiro, Danilo; Neyrolles, Olivier; Williams, Ann; Kaufmann, Stefan H E; McShane, Helen; Hatherill, Mark; Fletcher, Helen A

    2018-01-01

    The Bacille Calmette Guerin (BCG) vaccine can provide decades of protection against tuberculosis (TB) disease, and although imperfect, BCG is proof that vaccine mediated protection against TB is a possibility. A new TB vaccine is, therefore, an inevitability; the question is how long will it take us to get there? We have made substantial progress in the development of vaccine platforms, in the identification of antigens and of immune correlates of risk of TB disease. We have also standardized animal models to enable head-to-head comparison and selection of candidate TB vaccines for further development.  To extend our understanding of the safety and immunogenicity of TB vaccines we have performed experimental medicine studies to explore route of administration and have begun to develop controlled human infection models. Driven by a desire to reduce the length and cost of human efficacy trials we have applied novel approaches to later stage clinical development, exploring alternative clinical endpoints to prevention of disease outcomes. Here, global leaders in TB vaccine development discuss the progress made and the challenges that remain. What emerges is that, despite scientific progress, few vaccine candidates have entered clinical trials in the last 5 years and few vaccines in clinical trials have progressed to efficacy trials. Crucially, we have undervalued the knowledge gained from our "failed" trials and fostered a culture of risk aversion that has limited new funding for clinical TB vaccine development. The unintended consequence of this abundance of caution is lack of diversity of new TB vaccine candidates and stagnation of the clinical pipeline. We have a variety of new vaccine platform technologies, mycobacterial antigens and animal and human models.  However, we will not encourage progression of vaccine candidates into clinical trials unless we evaluate and embrace risk in pursuit of vaccine development.

  17. The TB epidemic from 1992 to 2002.

    Science.gov (United States)

    Raviglione, Mario C

    2003-01-01

    In 1992, less than 20 countries were implementing a sound TB control strategy. At the same time, TB was being resurrected as a major public health problem world-wide after two decades of neglect. Awareness of upward trends in the industrialized countries and MDR-TB outbreaks in large cities were driving forces behind the re-emergence of TB in the international health agenda. New evidence, and consequent estimates, suggested that the situation in developing countries, especially in sub-Saharan Africa, was deteriorating rapidly. Similarly, major increases were observed in the former USSR. It was estimated that some 7-8 million new cases and 2-3 million deaths were occurring annually in the world. The global targets of reaching 85% cure rates and 70% case detection among infectious cases were established by the World Health Assembly in 1991. Both the WHO declaration of TB as a global emergency in 1993 and the launch of the five-element DOTS strategy in 1994-1995 resulted in countries adopting DOTS in encouraging numbers. In fact, in 2000, 148 countries including all 22 highest burden countries (HBC) responsible for 80% of cases world-wide, had adopted the new DOTS strategy. Nevertheless, progress in case detection remained slow due to incomplete geographical coverage or need to widen detection and notification capacity with innovative schemes. The major constraints to TB control became increasingly clear, and a global Stop TB Partnership was eventually established to address such constraints. A Global DOTS Expansion Plan revealed the needs and the gaps to achieve the global targets in 2005. Today, in 2002, the top priority remains that of expanding DOTS, as rapidly as possible, using a number of new approaches to increase case detection and notification while maintaining high cure rates. These must involve collaboration with the private sector and communities, as well as strengthening of primary care services. Similarly, crucial is the rapid identification of

  18. Double Standards in Global Health: Medicine, Human Rights Law and Multidrug-Resistant TB Treatment Policy.

    Science.gov (United States)

    Nicholson, Thomas; Admay, Catherine; Shakow, Aaron; Keshavjee, Salmaan

    2016-06-01

    The human rights arguments that underpinned the fight against HIV over the last three decades were poised, but ultimately failed, to provide a similar foundation for success against multidrug-resistant TB (MDR-TB) and other diseases of the poor. With more than 1.5 million deaths since 2000 attributed to strains of MDR-TB, and with half a million new, and mostly untreated, MDR-TB cases in the world each year, the stakes could not be higher. The World Health Organization (WHO), whose mandate is to champion the attainment by all peoples of the highest possible level of health, recommended unsound medical treatment for MDR-TB patients in resource-poor settings from 1993-2002. Citing cost considerations, WHO did not recommend the available standard of care that had been successfully used to contain and defeat MDR-TB in rich countries. By acting as a strategic gatekeeper in its technical advisory role to donor agencies and countries, it also facilitated the global implementation of a double standard for TB care in low- and middle-income countries (LMICs), upending important legal and scientific priorities. This raises serious questions about whether the organization violated international human rights standards and those established in its own constitution. While calling for additional analysis and discussion on this topic, the authors propose that policymakers should reject double standards of this kind and instead embrace the challenge of implementing the highest standard of care on a global level.

  19. World TB Day 2018: The Challenge of Drug Resistant Tuberculosis.

    Science.gov (United States)

    Gupta-Wright, Ankur; Tomlinson, Gillian S; Rangaka, Molebogeng X; Fletcher, Helen A

    2018-01-01

    On 24th March, the world commemorates the day in 1882 when Dr Robert Koch announced his discovery of Mycobacterium tuberculosis (MTB). Over 130 years later, tuberculosis (TB) continues to affect individuals, communities, and entire health systems and economies. Koch unsuccessfully tried to 'cure' TB, and despite major advances in other areas of medicine, control of TB remains elusive- in 2016 TB was the leading infectious cause of death. The STOP TB partnership and World Health Organization (WHO) have announced their theme for World TB Day 2018 "Wanted: Leaders for a TB-Free World. You can make history. End TB." This theme recognizes that TB is much larger than any one person, institute or discipline of research, and provides an opportunity for us to reflect on the major challenges and consider how we, as a scientific community, can work together and take the lead to address the global crisis of drug-resistant TB (DR-TB).

  20. Culture and Next-generation sequencing-based drug susceptibility testing unveil high levels of drug-resistant-TB in Djibouti: results from the first national survey.

    Science.gov (United States)

    Tagliani, Elisa; Hassan, Mohamed Osman; Waberi, Yacine; De Filippo, Maria Rosaria; Falzon, Dennis; Dean, Anna; Zignol, Matteo; Supply, Philip; Abdoulkader, Mohamed Ali; Hassangue, Hawa; Cirillo, Daniela Maria

    2017-12-15

    Djibouti is a small country in the Horn of Africa with a high TB incidence (378/100,000 in 2015). Multidrug-resistant TB (MDR-TB) and resistance to second-line agents have been previously identified in the country but the extent of the problem has yet to be quantified. A national survey was conducted to estimate the proportion of MDR-TB among a representative sample of TB patients. Sputum was tested using XpertMTB/RIF and samples positive for MTB and resistant to rifampicin underwent first line phenotypic susceptibility testing. The TB supranational reference laboratory in Milan, Italy, undertook external quality assurance, genotypic testing based on whole genome and targeted-deep sequencing and phylogenetic studies. 301 new and 66 previously treated TB cases were enrolled. MDR-TB was detected in 34 patients: 4.7% of new and 31% of previously treated cases. Resistance to pyrazinamide, aminoglycosides and capreomycin was detected in 68%, 18% and 29% of MDR-TB strains respectively, while resistance to fluoroquinolones was not detected. Cluster analysis identified transmission of MDR-TB as a critical factor fostering drug resistance in the country. Levels of MDR-TB in Djibouti are among the highest on the African continent. High prevalence of resistance to pyrazinamide and second-line injectable agents have important implications for treatment regimens.

  1. Mortality from HIV and TB coinfections is higher in Eastern Europe than in Western Europe and Argentina

    DEFF Research Database (Denmark)

    Podlekareva, Daria; Mocroft, Amanda; Post, Frank A

    2009-01-01

    BACKGROUND AND OBJECTIVES: Tuberculosis (TB) is a leading cause of death in HIV-infected patients worldwide. We aimed to study clinical characteristics and outcome of 1075 consecutive patients diagnosed with HIV/TB from 2004 to 2006 in Europe and Argentina. METHODS: One-year mortality was assessed...... in patients stratified according to region of residence, and factors associated with death were evaluated in multivariable Cox models. RESULTS: At TB diagnosis, patients in Eastern Europe had less advanced immunodeficiency, whereas a greater proportion had a history of intravenous drug use, coinfection...... with 7, 9 and 11% in Central/Northern Europe, Southern Europe, and Argentina, respectively (P

  2. Association of plasma cytokines with radiological recovery in pulmonary tuberculosis patients

    Directory of Open Access Journals (Sweden)

    Najeeha Talat Iqbal

    2016-01-01

    Conclusion: In-depth analysis of cytokines and its association with radiological recovery in TB patients may be useful in monitoring TB patients postchemotherapy for both clinicians and TB control program.

  3. Mortality among MDR-TB cases: comparison with drug-susceptible tuberculosis and associated factors.

    Directory of Open Access Journals (Sweden)

    Kocfa Chung-Delgado

    Full Text Available An increase in multidrug-resistant tuberculosis (MDR-TB cases is evident worldwide. Its management implies a complex treatment, high costs, more toxic anti-tuberculosis drug use, longer treatment time and increased treatment failure and mortality. The aims of this study were to compare mortality between MDR and drug-susceptible cases of tuberculosis, and to determine risk factors associated with mortality among MDR-TB cases.A retrospective cohort study was performed using data from clinical records of the National Strategy for Prevention and Control of Tuberculosis in Lima, Peru. In the first objective, MDR-TB, compared to drug-susceptible cases, was the main exposure variable and time to death, censored at 180 days, the outcome of interest. For the second objective, different variables obtained from clinical records were assessed as potential risk factors for death among MDR-TB cases. Cox regression analysis was used to determine hazard ratios (HR and 95% confidence intervals (95%CI. A total of 1,232 patients were analyzed: mean age 30.9 ±14.0 years, 60.0% were males. 61 patients (5.0% died during treatment, whereas the MDR-TB prevalence was 19.2%. MDR-TB increased the risk of death during treatment (HR = 7.5; IC95%: 4.1-13.4 when compared to presumed drug-susceptible cases after controlling for potential confounders. Education level (p = 0.01, previous TB episodes (p<0.001, diabetes history (p<0.001 and HIV infection (p = 0.04 were factors associated with mortality among MDR-TB cases.MDR-TB is associated with an increased risk of death during treatment. Lower education, greater number of previous TB episodes, diabetes history, and HIV infection were independently associated with mortality among MDR-TB cases. New strategies for appropriate MDR-TB detection and management should be implemented, including drug sensitivity tests, diabetes and HIV screening, as well as guarantee for a complete adherence to therapy.

  4. Selecting the most relevant brain regions to discriminate Alzheimer's disease patients from healthy controls using multiple kernel learning: A comparison across functional and structural imaging modalities and atlases.

    Science.gov (United States)

    Rondina, Jane Maryam; Ferreira, Luiz Kobuti; de Souza Duran, Fabio Luis; Kubo, Rodrigo; Ono, Carla Rachel; Leite, Claudia Costa; Smid, Jerusa; Nitrini, Ricardo; Buchpiguel, Carlos Alberto; Busatto, Geraldo F

    2018-01-01

    Machine learning techniques such as support vector machine (SVM) have been applied recently in order to accurately classify individuals with neuropsychiatric disorders such as Alzheimer's disease (AD) based on neuroimaging data. However, the multivariate nature of the SVM approach often precludes the identification of the brain regions that contribute most to classification accuracy. Multiple kernel learning (MKL) is a sparse machine learning method that allows the identification of the most relevant sources for the classification. By parcelating the brain into regions of interest (ROI) it is possible to use each ROI as a source to MKL (ROI-MKL). We applied MKL to multimodal neuroimaging data in order to: 1) compare the diagnostic performance of ROI-MKL and whole-brain SVM in discriminating patients with AD from demographically matched healthy controls and 2) identify the most relevant brain regions to the classification. We used two atlases (AAL and Brodmann's) to parcelate the brain into ROIs and applied ROI-MKL to structural (T1) MRI, 18 F-FDG-PET and regional cerebral blood flow SPECT (rCBF-SPECT) data acquired from the same subjects (20 patients with early AD and 18 controls). In ROI-MKL, each ROI received a weight (ROI-weight) that indicated the region's relevance to the classification. For each ROI, we also calculated whether there was a predominance of voxels indicating decreased or increased regional activity (for 18 F-FDG-PET and rCBF-SPECT) or volume (for T1-MRI) in AD patients. Compared to whole-brain SVM, the ROI-MKL approach resulted in better accuracies (with either atlas) for classification using 18 F-FDG-PET (92.5% accuracy for ROI-MKL versus 84% for whole-brain), but not when using rCBF-SPECT or T1-MRI. Although several cortical and subcortical regions contributed to discrimination, high ROI-weights and predominance of hypometabolism and atrophy were identified specially in medial parietal and temporo-limbic cortical regions. Also, the weight of

  5. Baseline prediction of combination therapy outcome in hepatitis C virus 1b infected patients by discriminant analysis using viral and host factors.

    Science.gov (United States)

    Saludes, Verónica; Bracho, Maria Alma; Valero, Oliver; Ardèvol, Mercè; Planas, Ramón; González-Candelas, Fernando; Ausina, Vicente; Martró, Elisa

    2010-11-30

    Current treatment of chronic hepatitis C virus (HCV) infection has limited efficacy -especially among genotype 1 infected patients-, is costly, and involves severe side effects. Thus, predicting non-response is of major interest for both patient wellbeing and health care expense. At present, treatment cannot be individualized on the basis of any baseline predictor of response. We aimed to identify pre-treatment clinical and virological parameters associated with treatment failure, as well as to assess whether therapy outcome could be predicted at baseline. Forty-three HCV subtype 1b (HCV-1b) chronically infected patients treated with pegylated-interferon alpha plus ribavirin were retrospectively studied (21 responders and 22 non-responders). Host (gender, age, weight, transaminase levels, fibrosis stage, and source of infection) and viral-related factors (viral load, and genetic variability in the E1-E2 and Core regions) were assessed. Logistic regression and discriminant analyses were used to develop predictive models. A "leave-one-out" cross-validation method was used to assess the reliability of the discriminant models. Lower alanine transaminase levels (ALT, p=0.009), a higher number of quasispecies variants in the E1-E2 region (number of haplotypes, nHap_E1-E2) (p=0.003), and the absence of both amino acid arginine at position 70 and leucine at position 91 in the Core region (p=0.039) were significantly associated with treatment failure. Therapy outcome was most accurately predicted by discriminant analysis (90.5% sensitivity and 95.5% specificity, 85.7% sensitivity and 81.8% specificity after cross-validation); the most significant variables included in the predictive model were the Core amino acid pattern, the nHap_E1-E2, and gamma-glutamyl transferase and ALT levels. Discriminant analysis has been shown as a useful tool to predict treatment outcome using baseline HCV genetic variability and host characteristics. The discriminant models obtained in this

  6. TB/ HIV coordination through Public Private Partnership: lessons from the field.

    Science.gov (United States)

    Dholakia, Yatin N

    2013-01-01

    Co-infection with tuberculosis adversely affects the quality of life of HIV infected individuals and additionally, HIV testing among TB patients gives an opportunity for prevention and treatment of HIV infection. TB-HIV coordination activities are therefore a good public health intervention. It was a three-year Public Private Partnership Project, implemented in four districts of Maharashtra, to improve access to public health facilities through community awareness and motivating referrals. Outreach workers were engaged to motivate patients attending Integrated Counselling and Testing Centres (ICTCs) and Designated Microscopy Centres (DMCs) for cross referrals and adherence to services. Community leaders and private health providers were sensitized to issues around TB and HIV/AIDS. 357 outreach workers referred 17,200 individuals for HIV testing and 32,549 TB suspects were referred for testing. An average of 18% TB cases (13% to 26%) and 7% (4% to 13%) HIV infected cases were identified. Involvement of PLHA and cured TB patients can better motivate symptomatics to avail of diagnostic services. Erratic funding affects smooth implementation of programmes. Public Private Partnerships improve access to care. Constant dialogue between all stake holders is essential for successful implementation of such partnerships.

  7. Nilai Diagnostik Metode “Real Time” PCR GeneXpert pada TB Paru BTA Negatif

    Directory of Open Access Journals (Sweden)

    Eka Kurniawan

    2016-09-01

    Full Text Available  AbstrakTuberkulosis (TB paru adalah penyakit menular yang disebabkan oleh kuman Mycobacterium tuberkulosis. TB masih tetap menjadi masalah kesehatan dunia karena lebih kurang 1/3 penduduk dunia terinfeksi oleh kuman ini dan sumber penularannya berasal dari Basil Tahan Asam (BTA positif maupun negatif. TB paru BTA negatif didiagnosis berdasarkan gambaran klinis dan rontgen torak yang sesuai TB serta pertimbangan dokter sehingga hal ini dapat menimbulkan under atau over diagnosis TB. GeneXpert merupakan pemeriksaan molekuler dengan metode “real time“ PCR dan merupakan penemuan terobosan untuk mendiagnosis TB secara cepat. Tujuan penelitiian ini adalah melakukan penilaian validitas GeneXpert pada TB paru BTA negatif dibandingkan dengan kultur Loweinstein Jensen. Desain penelitian uji diagnostik ini adalah cross sectional study. Penelitian dilakukan terhadap 40 orang pasien TB paru BTA negatif di Puskesmas sekitar kota Padang dan pasien yang dirawat di Bagian Penyakit Dalam RS dr. M. Djamil Padang. Dilakukan pemeriksaan sputum dengan GeneXpert dan dibandingkan dengan kultur Loweinstein Jensen. Hasil uji diagnostik dengan GeneXpert untuk mendiagnosis TB paru BTA negatif didapatkan sensitivitas 83.33%, spesifisitas 95.46%, nilai prediksi positif 93.75%, nilai prediksi negatif 87.5% dan akurasi 90% serta hasil uji kappa didapatkan 0.796. Disimpulkan GeneXpert memiliki sensitivitas, spesifisitas, nilai prediksi positif, nilai prediksi negatif dan akurasi yang tinggi pada TB paru BTA negatif.Kata kunci: nilai diagnostik, TB paru BTA negatif, GeneXpert AbstractPulmonary tuberculosis is an infectious disease caused by Mycobacterium tuberculosis. TB is still a global health problem. Approximately one third of the world population is infected by Mycobacterium tuberculosis and the source of infection came from smear positive and negative patient. Smear negative pulmonary TB can be considered based on clinical symptom and chest x-ray as well as

  8. UPGRADE OF TB SERVICES IN NEW SOCIAL AND EPIDEMIC CONDITIONS

    Directory of Open Access Journals (Sweden)

    T. G. Gireev

    2017-01-01

    Full Text Available In Dagestan as in Russia in general, tuberculosis situation has been stably improving for the last 15 years, which resulted in the reduction of efficiency and cost-effectiveness of regular screening in the adult population. Due to this it is necessary to relocate tuberculosis control resources from standard mass screening to activities targeted at risk groups. First of all, these risk groups include children and adolescents, the HIV infected, those exposed to infectious cases of tuberculosis, patients with remaining post-tuberculosis changes and diseases increasing the risk of tuberculosis - those addicted to alcohol and substances, suffering from diabetes, peptic ulcer, chronic non-specific pulmonary diseases as well as those living in poor conditions. It is reasonable to perform work aimed at the upgrade of TB services in the regions with favorable TB situation with the incidence below 40 per 100,000 population.

  9. HIV-Associated TB: Facts 2013

    Science.gov (United States)

    ... 2012 . Around 75% of these people live in sub-Saharan Africa.  TB is the leading cause of death among ... adopted by policy makers and implemented by all health facilities offering HIV care services.  The number of ...

  10. CXCL10/IP10 is a novel potential in vitro marker of TB infection

    Directory of Open Access Journals (Sweden)

    Ilaria Sauzullo

    2009-06-01

    Full Text Available Introduction IFN-γ is a pivotal cytokine in the immune response to Myc. tuberculosis, infact this is the key cytokine produced in response to antigens specific following tuberculosis exposure causing either active or latent tuberculosis (TB and this observation forms the basis of interferon gamma release assay (IGRA, but there are alternative or additional cytokines and chemokines that could be used to improve detection of Myc. tuberculosis infection.The aim of this study was to evaluate the diagnostic utility of chemokine CXCL10/IP-10 as biomarker of active TB and to compare the results with classical QuantiFERON-Gold assay . Methods CXCL10/IP-10 and IFN-γ responses to stimulation with ESAT-6 and CFP-10 were evaluated in 21 patients with active tuberculosis and in 6 healthy unexposed subjects with no history of TB or TB contact were used as controls healthy controls. QuantiFERON-TB Gold (QFT-G, Cellestis was used for the measurement of IFN-γ levels; CXCL10/IP-10 was detected by ELISA (R&D Systems . Results Of the 21 TB patients included, 11 had a QFT-G positive and 10 had negative QFT-G results.All QFT-G positive patients had increased levels of CXCL10/IP-10 (median, pg/ml in both ESAT-6 and CFP-10 stimulated samples patients compared to healthy controls (1807 and 1111 vs 251 and 188 of controls, respectively (p<0.001 for both. The patients with active TB and QFT-G negative exhibited higher concentrations of CXCL10/IP-10 following antigen stimulation (837 pg/ml for ESAT-6;1674 pg/ml for CFP-10 (p<0.001. Conclusion Our study showed that in all patients with active TB, the CXCL10/IP-10 is expressed in higher amounts than IFN-γ following Myc. tuberculosis antigen-specific stimulation, and CXCL10/IP-10 appeared to be even more sensitive than QuantiFERON TB-Gold in TB patients with negative IFN-γ response. The measurement of chemokine CXCL10/IP-10, although not specific for tuberculosis, may have potential as an alternative or additional marker

  11. Standards for TB care in India: A tool for universal access to TB care.

    Science.gov (United States)

    Nair, Sreenivas Achuthan; Sachdeva, K S; Malik, Parmar; Chandra, S; Ramachandran, R; Kulshrestha, N; Chopra, K K; Khaparde, S D

    2015-10-01

    In 2014, Government of India in collaboration with World Health Organization Country Office for India released the policy document on Standards for tuberculosis (TB) care in India after in-depth deliberation with national and international experts. The standards for TB care represent what is expected for quality TB care from the Indian healthcare system including both public and private systems. The details of each standard have been compiled in this review article. It is envisioned that the standards detailed in the manuscript are adapted by all TB care providers across the country. Copyright © 2015 Tuberculosis Association of India. Published by Elsevier B.V. All rights reserved.

  12. Evaluation of Patient Satisfaction with Tuberculosis Services in Southern Nigeria

    OpenAIRE

    Onyeonoro, Ugochukwu U; Chukwu, Joseph N; Nwafor, Charles C; Meka, Anthony O; Omotowo, Babatunde I; Madichie, Nelson O; Ogbudebe, Chidubem; Ikebudu, Joy N; Oshi, Daniel C; Ekeke, Ngozi; Paul, Nsirimobu I; Duru, Chukwuma B

    2015-01-01

    Objective Knowing tuberculosis (TB) patients’ satisfaction enables TB program managers to identify gaps in service delivery and institute measures to address them. This study is aimed at evaluating patients’ satisfaction with TB services in southern Nigeria. Materials and Methods A total of 378 patients accessing TB care were studied using a validated Patient Satisfaction (PS-38) questionnaire on various aspects of TB services. Factor analysis was used to identify eight factors related to TB ...

  13. The effects of Tb 3+ doping concentration on luminescence ...

    Indian Academy of Sciences (India)

    Engineering Research Center of Optoelectronic Functional Materials of the Ministry of Education,. Changchun University of Science and Technology, Changchun 130022, PR China .... which are dependent on the distance among Tb3+ ions. The interaction of Tb3+–Tb3+ is dependent on the dis- tance among Tb3+ ions.

  14. Migration, TB control and elimination: Whom to screen and treat.

    Science.gov (United States)

    Rendon, A; Centis, R; Zellweger, J-P; Solovic, I; Torres-Duque, C A; Robalo Cordeiro, C; de Queiroz Mello, F C; Manissero, D; Sotgiu, G

    Tuberculosis (TB) in migrants represents an important clinical and public health threat, particularly in low TB incidence countries. The current review is aimed to assess issues related to screening and treatment of migrants with latent TB infection or TB disease. Copyright © 2017 Sociedade Portuguesa de Pneumologia. Published by Elsevier España, S.L.U. All rights reserved.

  15. The effects of Tb 3 doping concentration on luminescence properties ...

    Indian Academy of Sciences (India)

    This paper is aimed at explaining the effects of Tb3+ concentration on structure and luminescence properties and clarifying the concentration quenching mechanism of Tb3+. The lattice of BaF2 decreases with the increase of Tb3+ ions concentration. The emission spectrum of BaF2:Tb3+ consists of blue emission band and ...

  16. HIV, multidrug-resistant TB and depressive symptoms: when three conditions collide

    Directory of Open Access Journals (Sweden)

    Mrinalini Das

    2014-09-01

    Full Text Available Background: Management of multidrug-resistant TB (MDR-TB patients co-infected with human immunodeficiency virus (HIV is highly challenging. Such patients are subject to long and potentially toxic treatments and may develop a number of different psychiatric illnesses such as anxiety and depressive disorders. A mental health assessment before MDR-TB treatment initiation may assist in early diagnosis and better management of psychiatric illnesses in patients already having two stigmatising and debilitating diseases. Objective: To address limited evidence on the baseline psychiatric conditions of HIV-infected MDR-TB patients, we aimed to document the levels of depressive symptoms at baseline, and any alteration following individualized clinical and psychological support during MDR-TB therapy, using the Patient Health Questionnaire-9 (PHQ-9 tool, among HIV-infected patients. Design: This was a retrospective review of the medical records of an adult (aged >15 years HIV/MDR-TB cohort registered for care during the period of August 2012 through to March 2014. Results: A total of 45 HIV/MDR-TB patients underwent baseline assessment using the PHQ-9 tool, and seven (16% were found to have depressive symptoms. Of these, four patients had moderate to severe depressive symptoms. Individualized psychological and clinical support was administered to these patients. Reassessments were carried out for all patients after 3 months of follow-up, except one, who died during the period. Among these 44 patients, three with baseline depressive symptoms still had depressive symptoms. However, improvements were observed in all but one after 3 months of follow-up. Conclusion: Psychiatric illnesses, including depressive symptoms, during MDR-TB treatment demand attention. Routine administration of baseline mental health assessments by trained staff has the potential to assist in determining appropriate measures for the management of depressive symptoms during MDR-TB

  17. Potential of DosR and Rpf antigens from Mycobacterium tuberculosis to discriminate between latent and active tuberculosis in a tuberculosis endemic population of Medellin Colombia.

    Science.gov (United States)

    Arroyo, Leonar; Marín, Diana; Franken, Kees L M C; Ottenhoff, Tom H M; Barrera, Luis F

    2018-01-08

    Tuberculosis (TB) remains one of the most deadly infectious diseases. One-third to one-fourth of the human population is estimated to be infected with Mycobacterium tuberculosis (Mtb) without showing clinical symptoms, a condition called latent TB infection (LTBI). Diagnosis of Mtb infection is based on the immune response to a mixture of mycobacterial antigens (PPD) or to Mtb specific ESAT-6/CFP10 antigens (IGRA), highly expressed during the initial phase of infection. However, the immune response to PPD and IGRA antigens has a low power to discriminate between LTBI and PTB. The T-cell response to a group of so-called latency (DosR-regulon-encoded) and Resuscitation Promoting (Rpf) antigens of Mtb has been proved to be significantly higher in LTBI compared to active TB across many populations, suggesting their potential use as biomarkers to differentiate latent from active TB. PBMCs from a group LTBI (n = 20) and pulmonary TB patients (PTB, n = 21) from an endemic community for TB of the city of Medellín, Colombia, were in vitro stimulated for 7 days with DosR- (Rv1737c, Rv2029c, and Rv2628), Rpf- (Rv0867c and Rv2389c), the recombinant fusion protein ESAT-6-CFP10 (E6-C10)-, or PPD-antigen. The induced IFNγ levels detectable in the supernatants of the antigen-stimulated cells were then used to calculate specificity and sensitivity in discriminating LTBI from PTB, using different statistical approaches. IFNγ production in response to DosR and Rpf antigens was significantly higher in LTBI compared to PTB. ROC curve analyses of IFNγ production allowed differentiation of LTBI from PTB with areas under the curve higher than 0.70. Furthermore, Multiple Correspondence Analysis (MCA) revealed that LTBI is associated with higher levels of IFNγ in response to the different antigens compared to PTB. Analysis based on decision trees showed that the IFNγ levels produced in response to Rv2029c was the leading variable that best-classified disease status. Finally

  18. Latently and uninfected healthcare workers exposed to TB make protective antibodies against Mycobacterium tuberculosis.

    Science.gov (United States)

    Li, Hao; Wang, Xing-Xing; Wang, Bin; Fu, Lei; Liu, Guan; Lu, Yu; Cao, Min; Huang, Hairong; Javid, Babak

    2017-05-09

    The role of Igs in natural protection against infection by Mycobacterium tuberculosis (Mtb), the causative agent of TB, is controversial. Although passive immunization with mAbs generated against mycobacterial antigens has shown protective efficacy in murine models of infection, studies in B cell-depleted animals only showed modest phenotypes. We do not know if humans make protective antibody responses. Here, we investigated whether healthcare workers in a Beijing TB hospital-who, although exposed to suprainfectious doses of pathogenic Mtb, remain healthy-make antibody responses that are effective in protecting against infection by Mtb. We tested antibodies isolated from 48 healthcare workers and compared these with 12 patients with active TB. We found that antibodies from 7 of 48 healthcare workers but none from active TB patients showed moderate protection against Mtb in an aerosol mouse challenge model. Intriguingly, three of seven healthcare workers who made protective antibody responses had no evidence of prior TB infection by IFN-γ release assay. There was also good correlation between protection observed in vivo and neutralization of Mtb in an in vitro human whole-blood assay. Antibodies mediating protection were directed against the surface of Mtb and depended on both immune complexes and CD4+ T cells for efficacy. Our results indicate that certain individuals make protective antibodies against Mtb and challenge paradigms about the nature of an effective immune response to TB.

  19. Investing to end epidemics: the role of the Global Fund to control TB by 2030.

    Science.gov (United States)

    Kunii, Osamu; Yassin, Mohammed A; Wandwalo, Eliud

    2016-03-01

    The Global Fund to fight AIDS, Tuberculosis and Malaria provides over three-quarters of all international financing towards TB programs with US$4.7 billion disbursed, supporting provision of treatment for 13.2 million patients with smear-positive TB and 210 000 patients with multidrug-resistant TB in over 100 countries since 2002. In 2013, the Global Fund launched a new funding model that, among others, is advancing strategic investments to maximize impact, addressing 'missing' TB cases, enhancing a synergistic response to TB/HIV dual epidemics, and building resilient and sustainable systems for health. A new Global Fund Strategy is under development through consultation with various stakeholders, with which the Global Fund will work to play a more catalytic role and foster innovations to end the TB epidemic. © The Author 2016. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  20. Discriminant validity of the Ankylosing Spondylitis Disease Activity Score (ASDAS) in patients with non-radiographic axial spondyloarthritis and ankylosing spondylitis: a cohort study.

    Science.gov (United States)

    Kilic, Erkan; Kilic, Gamze; Akgul, Ozgur; Ozgocmen, Salih

    2015-06-01

    The aim of this study was to assess discriminant validity of Ankylosing Spondylitis Disease Activity Score (ASDAS)-C-reactive protein (-CRP) and ASDAS-erythrocyte sedimentation rate (-ESR) and to compare with The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) as clinical tools for the measurement of disease activity in patients with non-radiographic axial spondyloarthritis (nr-axSpA) and ankylosing spondylitis (AS). Also, the cut-off values for ASDAS-CRP in nr-axSpA and AS is revisited. Patients with axSpA were recruited from Erciyes Spondyloarthritis Cohort (ESPAC) and were assessed for disease activity, quality of life and functional measures. The discriminatory ability of ASDAS-CRP and ASDAS-ESR was assessed using standardized mean differences and receiver operating characteristic (ROC) curves analysis. Optimal cut-off values for disease activity scores were calculated. Two hundred and eighty-seven patients with axSpA (nr-axSpA:132, AS:155) were included in this study. Two ASDAS versions and BASDAI had good correlations with patient's and physician's global assessment in both groups. Discriminatory ability of ASDAS-CRP, ASDAS-ESR and BASDAI were similar in patients with nr-axSpA and AS when the patients were assigned into low and high disease activity according to the ASAS partial remission, patient's and physician's global assessment scores (based on the comparison of ROC curves). ASDAS cut-off values are quite similar between groups indicating that ASDAS-CRP works similarly well in nr-axSpA and AS. The performance of ASDAS to discriminate low and high disease activity and cut-off values are quite similar in patients with AS and non-radiographic axial SpA.

  1. TB incidence in an adolescent cohort in South Africa.

    Directory of Open Access Journals (Sweden)

    Hassan Mahomed

    Full Text Available BACKGROUND: Tuberculosis (TB is a major public health problem globally. Little is known about TB incidence in adolescents who are a proposed target group for new TB vaccines. We conducted a study to determine the TB incidence rates and risk factors for TB disease in a cohort of school-going adolescents in a high TB burden area in South Africa. METHODS: We recruited adolescents aged 12 to 18 years from high schools in Worcester, South Africa. Demographic and clinical information was collected, a tuberculin skin test (TST performed and blood drawn for a QuantiFERON TB Gold assay at baseline. Screening for TB cases occurred at follow up visits and by surveillance of registers at public sector TB clinics over a period of up to 3.8 years after enrolment. RESULTS: A total of 6,363 adolescents were enrolled (58% of the school population targeted. During follow up, 67 cases of bacteriologically confirmed TB were detected giving an overall incidence rate of 0.45 per 100 person years (95% confidence interval 0.29-0.72. Black or mixed race, maternal education of primary school or less or unknown, a positive baseline QuantiFERON assay and a positive baseline TST were significant predictors of TB disease on adjusted analysis. CONCLUSION: The adolescent TB incidence found in a high burden setting will help TB vaccine developers plan clinical trials in this population. Latent TB infection and low socio-economic status were predictors of TB disease.

  2. Colour discrimination ellipses in choroideremia.

    Science.gov (United States)

    Seitz, Immanuel P; Jolly, Jasleen K; Dominik Fischer, M; Simunovic, Matthew P

    2018-02-05

    The purpose of this study was to characterise alterations in colour discrimination in a cohort of patients with choroideremia prior to gene therapy, using a test previously validated for use in patients with retinal dystrophies. We tested 20 eyes of 10 patients with a diagnosis of choroideremia and an age-matched cohort of 10 eyes of 10 normal controls using the "Cambridge Colour Test" (CCT), in which subjects are required to distinguish the gap in a C presented in one of 4 orientations in a Stilling-type array. Colour discrimination was probed along eight axes in the CIE L*u*v* colour space, and the resulting data were plotted in the CIE 1976 chromaticity diagram and fitted with least-squares ellipses. Subsequently, we estimated the achromatic area for each subject by calculating the area of the resultant discrimination ellipse and calculated sensitivity thresholds along relevant colour confusion axes. Colour discrimination-as quantified by log 10 of the ellipse area expressed in square 1/1000th 2 units in CIE 1976-was 2.26 (range 1.82 to 2.67) for normal subjects and 3.85 (range 2.35 to 5.41) for choroideremia patients. There was a statistically significant correlation between both achromatic area and red-green colour discrimination at the CCT and BCVA, and to a lesser degree between blue colour discrimination at the CCT and BCVA. The majority of ellipses in choroideremia were aligned close to the tritan axis, and loss of sensitivity was significantly larger in the tritan direction than in the red-green. The majority of our patients demonstrated greater loss in tritan discrimination than in red-green colour discrimination using the CCT. There was a significant correlation between achromatic area and BCVA. In keeping with our current understanding of the machinery of colour vision, there was a significant correlation between BCVA and colour discrimination thresholds, which was stronger for red-green colour discrimination, than for tritan colour discrimination. We

  3. Barriers to accessing TB diagnosis for rural-to-urban migrants with chronic cough in Chongqing, China: A mixed methods study

    Science.gov (United States)

    Long, Qian; Li, Ying; Wang, Yang; Yue, Yong; Tang, Cheng; Tang, Shenglan; Squire, S Bertel; Tolhurst, Rachel

    2008-01-01

    Background China is facing a significant tuberculosis epidemic among rural-to-urban migrants, which poses a threat to TB control. This study aimed to understand the health seeking behaviour of and health systems responses to migrants and permanent urban residents suffering from chronic cough, in order to identify the factors influencing delays for both groups in receiving a TB diagnosis in urban China. Methods Combining a prospective cohort study of adult suspect TB patients and a qualitative study, the Piot model was used to analyze the health seeking behaviour of TB suspects among migrants and permanent urban residents, the factors influencing their decision and the responses by general health providers. Methods included a patient survey, focus group discussions with migrants in the general population, qualitative interviews with migrant and permanent resident TB suspects and TB patients as well as key stakeholders related to TB control and the management of migrants. Results Sixty eight percent of migrants delayed for more than two weeks before seeking care for symptoms suggestive of TB, compared to 54% of residents (p < 0.01). When they first decided to seek professional care, migrants were 1.5 times more likely than residents to use less expensive, community-level health services. Only 5% were ultimately referred to a TB dispensary. Major reasons for both patient and provider delay included lack of knowledge and mistrust of the TB control programme, lack of knowledge about TB (patients), and profit-seeking behaviour (providers). In the follow up survey, 61% of the migrants and 41% of the residents who still had symptoms gave up continuing to seek professional care, with a statistically significant difference between the two groups (p < 0.05). Conclusion Rural-to-urban migrants are more likely than permanent residents to delay in seeking care for symptoms suggestive of TB in urban Chongqing. 'Patient-' and 'provider-' related factors interact to pose barriers

  4. Biomarkers that Discriminate Multiple Myeloma Patients with or without Skeletal Involvement Detected Using SELDI-TOF Mass Spectrometry and Statistical and Machine Learning Tools

    Directory of Open Access Journals (Sweden)

    Sudeepa Bhattacharyya

    2006-01-01

    Full Text Available Multiple Myeloma (MM is a severely debilitating neoplastic disease of B cell origin, with the primary source of morbidity and mortality associated with unrestrained bone destruction. Surface enhanced laser desorption/ionization time-of-flight mass spectrometry (SELDI-TOF MS was used to screen for potential biomarkers indicative of skeletal involvement in patients with MM. Serum samples from 48 MM patients, 24 with more than three bone lesions and 24 with no evidence of bone lesions were fractionated and analyzed in duplicate using copper ion loaded immobilized metal affinity SELDI chip arrays. The spectra obtained were compiled, normalized, and mass peaks with mass-to-charge ratios (m/z between 2000 and 20,000 Da identified. Peak information from all fractions was combined together and analyzed using univariate statistics, as well as a linear, partial least squares discriminant analysis (PLS-DA, and a non-linear, random forest (RF, classification algorithm. The PLS-DA model resulted in prediction accuracy between 96–100%, while the RF model was able to achieve a specificity and sensitivity of 87.5% each. Both models as well as multiple comparison adjusted univariate analysis identified a set of four peaks that were the most discriminating between the two groups of patients and hold promise as potential biomarkers for future diagnostic and/or therapeutic purposes.

  5. [Diagnostic performance of T-SPOT.TB on peripheral blood in combination with adenosine deaminase on pleural fluid for the diagnosis of tuberculous pleurisy within different age group].

    Science.gov (United States)

    Xu, H Y; Zhang, D Q; Ye, J R; Su, S S; Xie, Y P; Chen, C S; Li, Y P

    2017-06-27

    Objective: To evaluate the performance of T cell enzyme-linked immuno-spot assay (T-SPOT) on peripheral blood in combination with adenosine deaminase (ADA) on pleural fluid for diagnosis of tuberculous (TB) pleurisy within different age groups. Methods: The data of patients with pleural effusion from the Department of Pulmonary and Critical Care Medicine of the First Affiliated Hospital of Wenzhou Medical University from April 2012 to November 2016 were retrospectively analyzed, and the diagnoses of these patients were histopathologically confirmed through medical thoracoscopy. The cases who had confirmed diagnosis, in the same time, received peripheral blood T-SPOT.TB were enrolled. The performance of peripheral blood T-SPOT.TB in combination with pleural fluid ADA on diagnosing TB pleurisy in the younger patients (16-59 years old) and elderly patients (≥60 years old) were analyzed respectively. The sensitivity, specificity and the receiver operating characteristic (ROC) curve were adopted for statistical analysis. Results: A total of 448 cases were finally enrolled, 341(76.1%) confirmed with TB pleurisy, 224 males, 117 females, (47±19) years old; and 107 (23.9%) classified as non-TB pleurisy, 65 males, 42 females, (61±14) years old. There were 285 cases who were classified as younger group, and the other 163 cases were classified as elderly group. The sensitivity and specificity of peripheral blood T-SPOT.TB were 85.4% (204/239) and 71.7% (33/46) in the younger patients, 76.5% (78/102) and 59.0% (36/61) respectively in the elderly patients. The sensitivity of peripheral blood T-SPOT.TB in the younger patients was significantly higher than that in the elderly patients ( P =0.047). The sensitivity and specificity were 99.2% and 95.7% in combination with peripheral blood T-SPOT.TB and pleural fluid ADA respectively in the younger patients. The area under ROC curve (AUC) of T-SPOT.TB in the younger patients was 0.833, AUC of T-SPOT.TB combined with ADA was 0

  6. tb diagnostics challenges of tb diagnosis and treatment in south africa

    African Journals Online (AJOL)

    2007-06-01

    Jun 1, 2007 ... resultant 8 - 9 million cases of active tuberculosis (TB) and 1.6 million deaths annually.1 The tools used for diagnosis of TB have .... memory. We have shown that the 3-day INF- secretion from. PBMCs co-incubated with Mtb antigens is similar in both HIV- negative and HIV-positive controls, but the secretion ...

  7. Conjoint alcohol and tobacco use among tuberculosis patients in ...

    African Journals Online (AJOL)

    Objective. To determine the prevalence of, and factors associated with conjoint alcohol and tobacco use among tuberculosis (TB) patients in South Africa (SA). Methods. In a cross-sectional survey, 4 900 (54.5% men, 45.5% women) consecutively selected TB patients (including new TB and new TB retreatment patients) ...

  8. Fatigued patients with multiple sclerosis can be discriminated from healthy controls by the recordings of a newly developed measurement system (FAMOS)

    DEFF Research Database (Denmark)

    Yu, Fei; Bilberg, Arne; Dalgas, Ulrik

    2013-01-01

    during the execution of functional (36 m walk test, 5- and 50-repetition sit-to-stand test) and cognitive (short-term memory tests) tests. Furthermore, oxygen saturation (SPO(2)) was measured during the functional and cognitive tests and during rest periods between these tests. RESULTS: Recordings from...... FAMOS indicate that fatigued MS patients have reduced standard deviation (SD) of the heart rate (HR) during the short-term memory test, reduced high frequency (HF) component power spectrum (representing parasympathetic activation) at rest after walk test, and higher ratio of low frequency (LF) to HF (LF....../HF) during 50-repetition sit-to-stand test. CONCLUSIONS: FAMOS recordings can discriminate fatigued MS patients from healthy controls. The data indicate that fatigued MS patients have vagus nerve dysfunction during cognitive tests and disturbed sympathovagal balance during stressful physical tests. [Box: see...

  9. The rate of TB-HIV co-infection depends on the prevalence of HIV infection in a community

    Directory of Open Access Journals (Sweden)

    Chekol Luelseged T

    2008-07-01

    Full Text Available Abstract Background A complex interaction exists between tuberculosis (TB and human immunodeficiency virus (HIV infection at an individual and community level. Limited knowledge about the rate of HIV infection in TB patients and the general population compromises the planning, resource allocation and prevention and control activities. The aim of this study was to determine the rate of HIV infection in TB patients and its correlation with the rate HIV infection in pregnant women attending antenatal care (ANC in Southern Ethiopia. Methods All TB patients and pregnant women attending health institutions for TB diagnosis and treatment and ANC were consecutively enrolled in 2004 – 2005. TB diagnosis, treatment and HIV testing were done according to the national guidelines. Blood samples were collected for anonymous HIV testing. We used univariate and multivariate logistic regression analysis to determine the risk factors for HIV infection and linear regression analysis to determine the correlation between HIV infection in TB patients and pregnant women. Results Of the 1308 TB patients enrolled, 226 (18% (95%CI: 15.8 – 20.0 were HIV positive. The rate of HIV infection was higher in TB patients from urban 25% (73/298 than rural areas 16% (149/945 [AOR = 1.78, 95%CI: 1.27–2.48]. Of the 4199 pregnant women attending ANC, 155 (3.8% [95%CI: 3.2–4.4] were HIV positive. The rate of HIV infection was higher in pregnant women from urban (7.5% (80/1066 than rural areas (2.5% (75/3025 [OR = 3.19, 95% CI: 2.31–4.41]. In the study participants attending the same health institutions, the rate of HIV infection in pregnant women correlated with the rate of HIV infection in TB patients (R2 = 0.732. Conclusion The rate of HIV infection in TB patients and pregnant women was higher in study participants from urban areas. The rate of HIV infection in TB patients was associated with the prevalence of HIV infection in pregnant women attending ANC.

  10. Professional nurses' views regarding stigma and discrimination in the care of HIV and AIDS patients in rural hospitals of the Limpopo province, South Africa.

    Science.gov (United States)

    Manganye, Bumani S; Maluleke, Thelmah X; Lebese, Rachel T

    2013-03-01

    The aim of the study was to determine the views of professional nurses on the manifestations of HIV and AIDS stigma and discrimination and their influence on the quality of care rendered to people living with HIV and AIDS in three rural hospitals of Limpopo province, South Africa. The study was qualitative, exploratory, descriptive and contextual in nature. The population included all professional nurses registered with the South African Nursing Council who were working with confirmed HIV-positive patients in the three hospitals and had received specialised training in voluntary counselling and testing (VCT), antiretrovirals (ARV), prevention of mother-to-child transmission (PMTCT) and couple counselling. A purposive sampling method was used to select both the wards and participants, based on set criteria. A total of 9 wards (6 adult medical and 3 maternity) and 37 participants were selected. Focus group discussions and semi-structured and key informant interviews were conducted. Data were analysed using a combination of data analysis guidelines from different sources. Results revealed that professional nurses were aware of the existence of HIV and AIDS stigma and discrimination in their wards and regarded these as bad and improper care of HIV-positive patients. Behaviour included leaving care of HIV patients to junior members of staff with limited skills and knowledge of HIV and AIDS; showing HIV-positive patients that their disease was dangerous and contagious; judgmental behaviour towards and stereotyping of HIV-positive patients; and regarding patients with HIV and AIDS as uncooperative and problematic in the wards.

  11. [Plasma fatty acid metabolic profiles for traditional Chinese medicine syndrome differentiation in diabetic patients using uncorrelated linear discriminant analysis].

    Science.gov (United States)

    Xu, Wenjuan; Zhang, Liangxiao; Huang, Yuhong; Yang, Qianxu; Xiao, Hongbin; Zhang, Deqin

    2012-09-01

    Diabetes is a common metabolic syndrome which presents a serious threat to human health. Traditional Chinese medicine (TCM) has been widely paid attention to its advantages and characteristics in the diagnosis and the treatment of diabetes. A strategy of classifying five TCM syndromes in diabetes (Qi-deficiency, Yin-deficiency, Qi- and Yin-deficiency, Damp heat and Blood stasis) was employed based on plasma fatty acid metabolic profiles, lipid metabolism indicators and chemometrics methods. Using orthogonal signal correction-partial least squares (OSC-PLS) method, the five syndromes were obviously distinguished from those of the health control, which confirmed there existed metabolite differences in different traditional Chinese medicine syndromes. Furthermore, a new method, uncorrelated linear discriminant analysis (ULDA), was applied in the discrimination of health control, TCM deficiency syndromes (Qi-deficiency, Yin-deficiency, Qi- and Yin-deficiency) and TCM empirical syndromes (Damp heat, Blood stasis), which demonstrated better clustering results, the correct rate reached 95.7%. The four potential biomarkers, C20: 2, C20: 5, triglycerides (TG) and high density lipoprotein (HDL), performed large contributions to the classification which can provide important information assisting TCM clinical diagnosis.

  12. The Use of Xpert MTB/Rif for Active Case Finding among TB Contacts in North West Province, South Africa

    Directory of Open Access Journals (Sweden)

    Limakatso Lebina

    2016-01-01

    Full Text Available Introduction. Tuberculosis is a major cause of morbidity and mortality especially in high HIV burden settings. Active case finding is one strategy to potentially reduce TB disease burden. Xpert MTB/Rif has recently been recommended for diagnosis of TB. Methods. Pragmatic randomized trial to compare diagnosis rate and turnaround time for laboratory testing for Xpert MTB/Rif with TB microscopy and culture in household contacts of patients recently diagnosed with TB. Results. 2464 household contacts enrolled into the study from 768 active TB index cases. 1068 (44% were unable to give sputum, but 24 of these were already on TB treatment. 863 (53% participants sputum samples were tested with smear and culture and 2.7% (23/863; CI: 1.62–3.78 were diagnosed with active TB. Xpert MTB/Rif was used in 515 (21% participants; active TB was diagnosed in 1.6% (8/515; CI: 0.52–2.68. Discussion and Conclusions. Additional 31 cases were diagnosed with contact tracing of household members. When Xpert MTB/Rif is compared with culture, there is no significant difference in diagnostic yield.

  13. Native T1 in discrimination of acute and convalescent stages in patients with clinical diagnosis of myocarditis: a proposed diagnostic algorithm using CMR.

    Science.gov (United States)

    Hinojar, Rocio; Foote, Lucy; Arroyo Ucar, Eduardo; Jackson, Thomas; Jabbour, Andrew; Yu, Chung-Yao; McCrohon, Jane; Higgins, David M; Carr-White, Gerry; Mayr, Manuel; Nagel, Eike; Puntmann, Valentina O

    2015-01-01

    This study investigated whether T1 mapping by cardiac magnetic resonance (CMR) reflects the clinical evolution of disease in myocarditis and supports its diagnosis independently of the disease stages. Acute viral myocarditis is characterized by a range of intracellular changes due to viral replication and extracellular spill of debris within days of viral infection. Convalescence may be characterized by a chronic low-grade inflammation leading to ventricular remodelling, but also a complete resolution of myocardial changes. Patients with clinical diagnosis of viral myocarditis (N = 165) underwent routine clinical CMR protocol (1.5- and 3.0-T) for assessment of cardiac function and structure, and tissue characterization with T2-weighted imaging and late gadolinium enhancement. T1 mapping was obtained in a mid-ventricular short-axis slice before and >20 min after administration of 0.2 mmol/kg of gadobutrol. Compared with control subjects (n = 40), T1 indexes were increased in patients with myocarditis. Patients with acute symptoms (n = 61) had higher values of T1 indexes compared with patients in clinical convalescence (n = 67). Native T1 is an independent discriminator between health and disease, as well as a discriminator between acute and convalescent stage of the disease. Native T1- was superior to T2-weighted imaging and late gadolinium enhancement with high diagnostic accuracy and positive and negative predictive values. Using pre-defined cutoff values for normal ranges, we demonstrated that acute myocarditis can be independently identified by native T1 of >5 SD above the mean of normal range, whereas convalescence is best defined by either abnormal native T1 (>2 SD) or presence of late gadolinium enhancement. We prospectively tested a new diagnostic algorithm in an independent dataset of patients with clinical diagnosis of myocarditis and achieved similar diagnostic performance. The new diagnostic algorithm using native T1 can reliably discriminate

  14. Cough Due to TB and Other Chronic Infections: CHEST Guideline and Expert Panel Report.

    Science.gov (United States)

    Field, Stephen K; Escalante, Patricio; Fisher, Dina A; Ireland, Belinda; Irwin, Richard S

    2018-02-01

    Cough is common in pulmonary TB and other chronic respiratory infections. Identifying features that predict whether pulmonary TB is the cause would help target appropriate individuals for rapid and cost-effective screening, potentially limiting disease progression and preventing transmission to others. A systematic literature search for individual studies to answer eight key questions (KQs) was conducted according to established Chest Organization methods by using the following databases: MEDLINE via PubMed, Embase, Scopus, and the Cochrane Database of Systematic Reviews from January 1, 1984, to April 2014. Searches for KQ 1 and KQ 3 were updated in February 2016. An updated KQ 2 search was undertaken in March 2017. Even where TB prevalence is greatest, most individuals with cough do not have pulmonary TB. There was no evidence that 1, 3, or 4 weeks' duration were better predictors than cough lasting ≥ 2 weeks to screen for pulmonary TB. In people living with HIV (PLWHIV), screening for fever, night sweats, hemoptysis, and/or weight loss in addition to cough (any World Health Organization [WHO]-endorsed symptom) increases the diagnostic sensitivity for TB. Although the diagnostic accuracy of symptom-based screening remains low, the negative predictive value of the WHO-endorsed symptom screen in PLWHIV may help to risk-stratify individuals who are not close TB contacts and who do not require further testing for pulmonary TB in resource-limited settings. However, pregnant PLWHIV are more likely to be asymptomatic, and the WHO-endorsed symptom screen is not sensitive enough to be reliable. Combined with passive case finding (PCF), active case finding (ACF) identifies pulmonary TB cases earlier and possibly when less advanced. Whether outcomes are improved or transmission is reduced is unclear. Screening asymptomatic patients is cost-effective only in populations with a very high TB prevalence. The Xpert MTB/RIF assay on sputum is more cost-effective than

  15. Addressing challenges in scaling up TB and HIV treatment integration in rural primary healthcare clinics in South Africa (SUTHI): a cluster randomized controlled trial protocol.

    Science.gov (United States)

    Naidoo, Kogieleum; Gengiah, Santhanalakshmi; Yende-Zuma, Nonhlanhla; Padayatchi, Nesri; Barker, Pierre; Nunn, Andrew; Subrayen, Priashni; Abdool Karim, Salim S

    2017-11-13

    A large and compelling clinical evidence base has shown that integrated TB and HIV services leads to reduction in human immunodeficiency virus (HIV)- and tuberculosis (TB)-associated mortality and morbidity. Despite official policies and guidelines recommending TB and HIV care integration, its poor implementation has resulted in TB and HIV remaining the commonest causes of death in several countries in sub-Saharan Africa, including South Africa. This study aims to reduce mortality due to TB-HIV co-infection through a quality improvement strategy for scaling up of TB and HIV treatment integration in rural primary healthcare clinics in South Africa. The study is designed as an open-label cluster randomized controlled trial. Sixteen clinic supervisors who oversee 40 primary health care (PHC) clinics in two rural districts of KwaZulu-Natal, South Africa will be randomized to either the control group (provision of standard government guidance for TB-HIV integration) or the intervention group (provision of standard government guidance with active enhancement of TB-HIV care integration through a quality improvement approach). The primary outcome is all-cause mortality among TB-HIV patients. Secondary outcomes include time to antiretroviral therapy (ART) initiation among TB-HIV co-infected patients, as well as TB and HIV treatment outcomes at 12 months. In addition, factors that may affect the intervention, such as conditions in the clinic and staff availability, will be closely monitored and documented. This study has the potential to address the gap between the establishment of TB-HIV care integration policies and guidelines and their implementation in the provision of integrated care in PHC clinics. If successful, an evidence-based intervention comprising change ideas, tools, and approaches for quality improvement could inform the future rapid scale up, implementation, and sustainability of improved TB-HIV integration across sub-Sahara Africa and other resource

  16. Visual discrimination among patients with depression and schizophrenia and healthy individuals using semiquantitative color-coded fast spin-echo T1-weighted magnetic resonance imaging

    Energy Technology Data Exchange (ETDEWEB)

    Sasaki, Makoto; Kudo, Kohsuke; Narumi, Shinsuke [Iwate Medical University, Advanced Medical Research Center, Morioka (Japan); Shibata, Eri; Ohtsuka, Kotaro; Endoh, Jin; Sakai, Akio [Iwate Medical University, Department of Neuropsychiatry, Morioka (Japan)

    2010-02-15

    Fast spin-echo (FSE) T1-weighted (T1W) magnetic resonance imaging (MRI) at 3T, which is sensitive to neuromelanin-related contrast, can quantitatively detect signal alterations in the locus ceruleus (LC) and the substantia nigra pars compacta (SNc) of depressive and schizophrenic patients; however, its qualitative diagnostic performance remains unknown. We investigated whether visual interpretation of semiquantitative color maps can be used for discriminating between depressive and schizophrenic patients and healthy individuals. We retrospectively examined 23 patients with major depression, 23 patients with schizophrenia, and 23 age-matched healthy controls by using a FSE-T1W MRI technique. Semiquantitative color maps of sections through the LC and SNc were visually interpreted by nine raters using a continuous confidence rating scale for receiver operating characteristic (ROC) analysis. The area under the ROC curve (Az), which reflects the performance in differentiating between depressive patients and controls, was 0.88, and the sensitivity and specificity at the maximum likelihood were 76% and 83%, respectively. In contrast, the Az value, sensitivity, and specificity values between schizophrenics and controls and between depressives and schizophrenics were 0.66 and 0.69, 42% and 48%, and 82% and 84%, respectively. Semiquantitative, color-coded FSE-T1W MRI at 3T can be used for visually differentiating depressive patients from healthy individuals with a substantially high likelihood, but this technique cannot be applied to distinguish schizophrenic patients from the other two groups. (orig.)

  17. Visual discrimination among patients with depression and schizophrenia and healthy individuals using semiquantitative color-coded fast spin-echo T1-weighted magnetic resonance imaging

    International Nuclear Information System (INIS)

    Sasaki, Makoto; Kudo, Kohsuke; Narumi, Shinsuke; Shibata, Eri; Ohtsuka, Kotaro; Endoh, Jin; Sakai, Akio

    2010-01-01

    Fast spin-echo (FSE) T1-weighted (T1W) magnetic resonance imaging (MRI) at 3T, which is sensitive to neuromelanin-related contrast, can quantitatively detect signal alterations in the locus ceruleus (LC) and the substantia nigra pars compacta (SNc) of depressive and schizophrenic patients; however, its qualitative diagnostic performance remains unknown. We investigated whether visual interpretation of semiquantitative color maps can be used for discriminating between depressive and schizophrenic patients and healthy individuals. We retrospectively examined 23 patients with major depression, 23 patients with schizophrenia, and 23 age-matched healthy controls by using a FSE-T1W MRI technique. Semiquantitative color maps of sections through the LC and SNc were visually interpreted by nine raters using a continuous confidence rating scale for receiver operating characteristic (ROC) analysis. The area under the ROC curve (Az), which reflects the performance in differentiating between depressive patients and controls, was 0.88, and the sensitivity and specificity at the maximum likelihood were 76% and 83%, respectively. In contrast, the Az value, sensitivity, and specificity values between schizophrenics and controls and between depressives and schizophrenics were 0.66 and 0.69, 42% and 48%, and 82% and 84%, respectively. Semiquantitative, color-coded FSE-T1W MRI at 3T can be used for visually differentiating depressive patients from healthy individuals with a substantially high likelihood, but this technique cannot be applied to distinguish schizophrenic patients from the other two groups. (orig.)

  18. Discrimination and Anti-discrimination in Denmark

    DEFF Research Database (Denmark)

    Olsen, Tore Vincents

    The purpose of this report is to describe and analyse Danish anti-discrimination legislation and the debate about discrimination in Denmark in order to identify present and future legal challenges. The main focus is the implementation of the EU anti-discrimination directives in Danish law...

  19. Multi-quasiparticle excitations in 145Tb

    International Nuclear Information System (INIS)

    Zheng Yong; Zhou Xiaohong; Zhang Yuhu; Liu Minliang; Guo Yingxiang; Lei Xiangguo; Kusakari, H.; Sugawara, M.

    2004-01-01

    High-spin states in 145 Tb have been populated using the 118 Sn( 32 S, 1p4n) reaction at a beam energy of 165 MeV. The level scheme of 145 Tb has been established for the first time. The level scheme shows characteristics of spherical or slightly oblate nucleus. Based on the systematic trends of the level structure in the neighboring N=80 isotones, the level structure in 145 Tb below 2 MeV excitation is well explained by coupling an h 11/2 valence proton to the even-even 144 Gd core. Above 2 MeV excitation, most of the yrast levels are interpreted with multi-quasiparticle shell-model configurations. (authors)

  20. Identification of a discriminative metabolomic fingerprint of potential clinical relevance in saliva of patients with periodontitis using 1H nuclear magnetic resonance (NMR) spectroscopy

    Science.gov (United States)

    Levy, Pierre; Jungo, Sébastien; Botosoa, Eliot; Duchemann, Boris; Le Moyec, Laurence; Bernaudin, Jean-François; Guez, Dominique

    2017-01-01

    Periodontitis is characterized by the loss of the supporting tissues of the teeth in an inflammatory-infectious context. The diagnosis relies on clinical and X-ray examination. Unfortunately, clinical signs of tissue destruction occur late in the disease progression. Therefore, it is mandatory to identify reliable biomarkers to facilitate a better and earlier management of this disease. To this end, saliva represents a promising fluid for identification of biomarkers as metabolomic fingerprints. The present study used high-resolution 1H-nuclear magnetic resonance (NMR) spectroscopy coupled with multivariate statistical analysis to identify the metabolic signature of active periodontitis. The metabolome of stimulated saliva of 26 patients with generalized periodontitis (18 chronic and 8 aggressive) was compared to that of 25 healthy controls. Principal Components Analysis (PCA), performed with clinical variables, indicated that the patient population was homogeneous, demonstrating a strong correlation between the clinical and the radiological variables used to assess the loss of periodontal tissues and criteria of active disease. Orthogonal Projection to Latent Structure (OPLS) analysis showed that patients with periodontitis can be discriminated from controls on the basis of metabolite concentrations in saliva with satisfactory explained variance (R2X = 0.81 and R2Y = 0.61) and predictability (Q2Y = 0.49, CV-AUROC = 0.94). Interestingly, this discrimination was irrespective of the type of generalized periodontitis, i.e. chronic or aggressive. Among the main discriminating metabolites were short chain fatty acids as butyrate, observed in higher concentrations, and lactate, γ-amino-butyrate, methanol, and threonine observed in lower concentrations in periodontitis. The association of lactate, GABA, and butyrate to generate an aggregated variable reached the best positive predictive value for diagnosis of periodontitis. In conclusion, this pilot study showed that 1H

  1. Identification of a discriminative metabolomic fingerprint of potential clinical relevance in saliva of patients with periodontitis using 1H nuclear magnetic resonance (NMR spectroscopy.

    Directory of Open Access Journals (Sweden)

    Matthias Rzeznik

    Full Text Available Periodontitis is characterized by the loss of the supporting tissues of the teeth in an inflammatory-infectious context. The diagnosis relies on clinical and X-ray examination. Unfortunately, clinical signs of tissue destruction occur late in the disease progression. Therefore, it is mandatory to identify reliable biomarkers to facilitate a better and earlier management of this disease. To this end, saliva represents a promising fluid for identification of biomarkers as metabolomic fingerprints. The present study used high-resolution 1H-nuclear magnetic resonance (NMR spectroscopy coupled with multivariate statistical analysis to identify the metabolic signature of active periodontitis. The metabolome of stimulated saliva of 26 patients with generalized periodontitis (18 chronic and 8 aggressive was compared to that of 25 healthy controls. Principal Components Analysis (PCA, performed with clinical variables, indicated that the patient population was homogeneous, demonstrating a strong correlation between the clinical and the radiological variables used to assess the loss of periodontal tissues and criteria of active disease. Orthogonal Projection to Latent Structure (OPLS analysis showed that patients with periodontitis can be discriminated from controls on the basis of metabolite concentrations in saliva with satisfactory explained variance (R2X = 0.81 and R2Y = 0.61 and predictability (Q2Y = 0.49, CV-AUROC = 0.94. Interestingly, this discrimination was irrespective of the type of generalized periodontitis, i.e. chronic or aggressive. Among the main discriminating metabolites were short chain fatty acids as butyrate, observed in higher concentrations, and lactate, γ-amino-butyrate, methanol, and threonine observed in lower concentrations in periodontitis. The association of lactate, GABA, and butyrate to generate an aggregated variable reached the best positive predictive value for diagnosis of periodontitis. In conclusion, this pilot study

  2. Feeling touch on the own hand restores the capacity to visually discriminate it from someone else' hand: Pathological embodiment receding in brain-damaged patients.

    Science.gov (United States)

    Fossataro, Carlotta; Bruno, Valentina; Gindri, Patrizia; Pia, Lorenzo; Berti, Anna; Garbarini, Francesca

    2017-06-23

    The sense of body ownership, i.e., the belief that a specific body part belongs to us, can be selectively impaired in brain-damaged patients. Recently, a pathological form of embodiment has been described in patients who, when the examiner's hand is located in a body-congruent position, systematically claim that it is their own hand (E+ patients). This paradoxical behavior suggests that, in these patients, the altered sense of body ownership also affects their capacity of visually discriminating the body-identity details of the own and the alien hand, even when both hands are clearly visible on the table. Here, we investigated whether, in E+ patients with spared tactile sensibility, a coherent body ownership could be restored by introducing a multisensory conflict between what the patients feel on the own hand and what they see on the alien hand. To this aim, we asked the patients to rate their sense of body ownership over the alien hand, either after segregated tactile stimulations of the own hand (out of view) and of the alien hand (visible) or after synchronous and asynchronous tactile stimulations of both hands, as in the rubber hand illusion set-up. Our results show that, when the tactile sensation perceived on the patient's own hand was in conflict with visual stimuli observed on the examiner's hand, E+ patients noticed the conflict and spontaneously described visual details of the (visible) examiner's hand (e.g., the fingers length, the nails shape, the skin color…), to conclude that it was not their own hand. These data represent the first evidence that, in E+ patients, an incongruent visual-tactile stimulation of the own and of the alien hand reduces, at least transitorily, the delusional body ownership over the alien hand, by restoring the access to the perceptual self-identity system, where visual body identity details are stored. Copyright © 2017 Elsevier Ltd. All rights reserved.

  3. QuantiFERON–TB Gold In-Tube test performance in Denmark

    DEFF Research Database (Denmark)

    Hermansen, Thomas; Lillebaek, Troels; Hansen, Ann-Brit E

    2014-01-01

    BACKGROUND: Little is known about the QuantiFERON-TB Gold In-Tube Test (QFT) in extreme age groups. The test performance has been reported to be impaired in children and elderly, but reports are diverging. The aim of this study was to evaluate QFT performance in patients with and without Tubercul......BACKGROUND: Little is known about the QuantiFERON-TB Gold In-Tube Test (QFT) in extreme age groups. The test performance has been reported to be impaired in children and elderly, but reports are diverging. The aim of this study was to evaluate QFT performance in patients with and without...

  4. Tuberculosis among HIV-positive patients across Europe

    DEFF Research Database (Denmark)

    Kruk, Alexey; Bannister, Wendy; Podlekareva, Daria

    2011-01-01

    To describe temporal changes in the incidence rate of tuberculosis (TB) (pulmonary or extrapulmonary) among HIV-positive patients in western Europe and risk factors of TB across Europe.......To describe temporal changes in the incidence rate of tuberculosis (TB) (pulmonary or extrapulmonary) among HIV-positive patients in western Europe and risk factors of TB across Europe....

  5. High Field Magnetization of Tb Single Crystals

    DEFF Research Database (Denmark)

    Roeland, L. W.; Cock, G. J.; Lindgård, Per-Anker

    1975-01-01

    The magnetization of Tb single crystals was measured in magnetic fields to 34T along the hard direction at temperature of 1.8, 4.2, 65.5 and 77K, and along with easy direction at 4.2 and 77K. The data are compared with the results of a self-consistent spin wave calculation using a phenomenological...

  6. Tuberculosis: Learn the Signs and Symptoms of TB Disease

    Science.gov (United States)

    ... this? Submit What's this? Submit Button Past Emails Tuberculosis (TB) Disease: Symptoms and Risk Factors Language: English ( ... Español (Spanish) Recommend on Facebook Tweet Share Compartir Tuberculosis (TB) is a disease caused by bacteria that ...

  7. Pulse duration discriminator

    International Nuclear Information System (INIS)

    Kosakovskij, L.F.

    1980-01-01

    Basic circuits of a discriminator for discrimination of pulses with the duration greater than the preset one, and of a multifunctional discriminator allowing to discriminate pulses with the duration greater (tsub(p)>tsub(s)) and lesser (tsub(p) tsub(s) and with the duration tsub(p) [ru

  8. Utility of the plasma level of suPAR in monitoring risk of mortality during TB treatment

    DEFF Research Database (Denmark)

    Rabna, Paulo; Andersen, Andreas; Wejse, Christian

    2012-01-01

    Objective: To investigate whether changes in the plasma level of soluble urokinase plasminogen activator receptor (suPAR) can be used to monitor tuberculosis (TB) treatment efficacy. Design: This prospective cohort study included 278 patients diagnosed with active pulmonary TB and followed...... that elevated suPAR level at time of initiation of TB treatment is associated with increased risk of mortality. Furthermore, increased suPAR levels after one month of treatment was associated with increased risk of mortality during the remaining 7-month treatment period....

  9. The Badness of Discrimination

    DEFF Research Database (Denmark)

    Lippert-Rasmussen, Kasper

    2006-01-01

    The most blatant forms of discrimination are morally outrageous and very obviously so; but the nature and boundaries of discrimination are more controversial, and it is not clear whether all forms of discrimination are morally bad; nor is it clear why objectionable cases of discrimination are bad....... In this paper I address these issues. First, I offer a taxonomy of discrimination. I then argue that discrimination is bad, when it is, because it harms people. Finally, I criticize a rival, disrespect-based account according to which discrimination is bad regardless of whether it causes harm....

  10. [18F]-fluorodeoxyglucose positron emission tomography can contribute to discriminate patients with poor prognosis in hormone receptor-positive breast cancer.

    Directory of Open Access Journals (Sweden)

    Sung Gwe Ahn

    Full Text Available Patients with hormone receptor-positive breast cancer typically show favorable survival. However, identifying individuals at high risk of recurrence among these patients is a crucial issue. We tested the hypothesis that [18F]-fluorodeoxyglucose positron emission tomography (FDG-PET scans can help predict prognosis in patients with hormone receptor-positive breast cancer.Between April 2004 and December 2008, 305 patients with hormone receptor-positive breast cancer who underwent FGD-PET were enrolled. Patients with luminal B subtype were identified by positivity for human epidermal growth factor receptor-2 (HER2 or high Ki67 (≥14% according to criteria recently recommended by the St. Gallen panelists. The cut-off value of SUVmax was defined using the time-dependent receiver operator characteristic curve for recurrence-free survival (RFS.At a median follow up of 6.23 years, continuous SUVmax was a significant prognostic factor with a hazard ratio (HR of 1.21 (p = 0.021. The cut-off value of SUVmax was defined as 4. Patients with luminal B subtype (n = 82 or high SUVmax (n = 107 showed a reduced RFS (p = 0.031 and 0.002, respectively. In multivariate analysis for RFS, SUVmax carried independent prognostic significance (p = 0.012 whereas classification with immunohistochemical markers did not (p = 0.274. The Harell c-index was 0.729. High SUVmax was significantly associated with larger tumor size, positive nodes, HER2 positivity, high Ki67 (≥14%, high tumor grade, and luminal B subtype.Among patients with hormone receptor-positive breast cancer, FDG-PET can help discriminate patients at high risk of tumor relapse.

  11. A Pencil Rescues Impaired Performance on a Visual Discrimination Task in Patients with Medial Temporal Lobe Lesions

    Science.gov (United States)

    Knutson, Ashley R.; Hopkins, Ramona O.; Squire, Larry R.

    2013-01-01

    We tested proposals that medial temporal lobe (MTL) structures support not just memory but certain kinds of visual perception as well. Patients with hippocampal lesions or larger MTL lesions attempted to identify the unique object among twin pairs of objects that had a high degree of feature overlap. Patients were markedly impaired under the more…

  12. Chest Radiographs for Pediatric TB Diagnosis: Interrater Agreement and Utility

    NARCIS (Netherlands)

    Kaguthi, G.; Nduba, V.; Nyokabi, J.; Onchiri, F.; Gie, R.; Borgdorff, M.

    2014-01-01

    The chest radiograph (CXR) is considered a key diagnostic tool for pediatric tuberculosis (TB) in clinical management and endpoint determination in TB vaccine trials. We set out to compare interrater agreement for TB diagnosis in western Kenya. A pediatric pulmonologist and radiologist (experts), a

  13. Assessment of the Diagnostic Potential of Clinotech TB Screen Test ...

    African Journals Online (AJOL)

    The Clinotech TB Screen test, a 3rd generation multi-antigen rapid chromatographic immunoassay for detection of IgG antibodies in serum against recombinant protein antigens 38kDa, 16kDa and 6kDa, was assessed for its diagnostic potential for diagnosis of active pulmonary TB in routine TB control programme in Abia ...

  14. Vertical skeletal changes after extraction and non-extraction treatment in matched class I patients identified by a discriminant analysis: cephalometric appraisal and Procrustes superimposition

    Directory of Open Access Journals (Sweden)

    Philipp Beit

    2017-12-01

    Full Text Available Abstract Background In the long-lasting debate of extraction versus non-extraction treatment, the impact of extractions on the skeletal vertical dimension remains rather unclear. The aim of this retrospective research study was to obtain a bias-free sample of morphologically similar borderline patients treated with or without extraction of the four first premolars and to retrospectively evaluate the vertical changes that occurred. Methods A borderline sample of 83 patients, 41 treated with four first premolar extractions and 42 treated without, was obtained by means of discriminant analysis applied to a previously investigated parent sample of 542 class I patients. The pretreatment and posttreatment cephalometric radiographs were analyzed digitally, and seven measurements were assessed for vertical skeletal changes. Also, average tracings between the two treatment groups were evaluated using the Procrustes superimposition method. Results The variables of SN to Go-Gn and Y-axis showed adjusted intergroup differences of − 0.91° and − 1.11° (P = 0.04. Comparing the mean intra-group differences of all the variables simultaneously, a significant difference was found between the two treatment groups (overall P value = 0.04. In the extraction group, only the gonial angle showed a significant decrease (P = 0.01 while the overall P value evaluating the intra-group differences between pre- and posttreatment was significant (overall P value < 0.01. In the non-extraction group, the variable of N-ANS/N-Me showed a significant decrease (P = 0.02 and the overall P value evaluating the intra-group differences between pre- and posttreatment was also significant (overall P value < 0.01. Differences in treatment duration were assessed using a log-normal model and showed that extraction treatment lasted significantly longer than non-extraction treatment (P < 0.01. Conclusions The borderline group of patients identified by the

  15. Prostate Cancer Patients-Negative Biopsy Controls Discrimination by Untargeted Metabolomics Analysis of Urine by LC-QTOF: Upstream Information on Other Omics

    Science.gov (United States)

    Fernández-Peralbo, M. A.; Gómez-Gómez, E.; Calderón-Santiago, M.; Carrasco-Valiente, J.; Ruiz-García, J.; Requena-Tapia, M. J.; Luque de Castro, M. D.; Priego-Capote, F.

    2016-12-01

    The existing clinical biomarkers for prostate cancer (PCa) diagnosis are far from ideal (e.g., the prostate specific antigen (PSA) serum level suffers from lack of specificity, providing frequent false positives leading to over-diagnosis). A key step in the search for minimum invasive tests to complement or replace PSA should be supported on the changes experienced by the biochemical pathways in PCa patients as compared to negative biopsy control individuals. In this research a comprehensive global analysis by LC-QTOF was applied to urine from 62 patients with a clinically significant PCa and 42 healthy individuals, both groups confirmed by biopsy. An unpaired t-test (p-value < 0.05) provided 28 significant metabolites tentatively identified in urine, used to develop a partial least squares discriminant analysis (PLS-DA) model characterized by 88.4 and 92.9% of sensitivity and specificity, respectively. Among the 28 significant metabolites 27 were present at lower concentrations in PCa patients than in control individuals, while only one reported higher concentrations in PCa patients. The connection among the biochemical pathways in which they are involved (DNA methylation, epigenetic marks on histones and RNA cap methylation) could explain the concentration changes with PCa and supports, once again, the role of metabolomics in upstream processes.

  16. Pathologic Nodal Classification Is the Most Discriminating Prognostic Factor for Disease-Free Survival in Rectal Cancer Patients Treated With Preoperative Chemoradiotherapy and Curative Resection

    International Nuclear Information System (INIS)

    Kim, Tae Hyun; Chang, Hee Jin; Kim, Dae Yong

    2010-01-01

    Purpose: We retrospectively evaluated the effects of clinical and pathologic factors on disease-free survival (DFS) with the aim of identifying the most discriminating factor predicting DFS in rectal cancer patients treated with preoperative chemoradiotherapy (CRT) and curative resection. Methods and Materials: The study involved 420 patients who underwent preoperative CRT and curative resection between August 2001 and October 2006. Gender, age, distance from the anal verge, histologic type, histologic grade, pretreatment carcinoembryonic antigen (CEA) level, cT, cN, cStage, circumferential resection margin, type of surgery, preoperative chemotherapy, adjuvant chemotherapy, ypT, ypN, ypStage, and tumor regression grade (TRG) were analyzed to identify prognostic factors associated with DFS. To compare the discriminatory prognostic ability of four tumor response-related pathologic factors (ypT, ypN, ypStage, and TRG), the Akaike information criteria were calculated. Results: The 5-year DFS rate was 75.4%. On univariate analysis, distance from the anal verge, histologic type, histologic grade, pretreatment CEA level, cT, circumferential resection margin, type of surgery, preoperative chemotherapeutic regimen, ypT, ypN, ypStage, and TRG were significantly associated with DFS. Multivariate analysis showed that the four parameters ypT, ypN, ypStage, and TRG were, consistently, significant prognostic factors for DFS. The ypN showed the lowest Akaike information criteria value for DFS, followed by ypStage, ypT, and TRG, in that order. Conclusion: In our study, ypT, ypN, ypStage, and TRG were important prognostic factors for DFS, and ypN was the most discriminating factor.

  17. Serum Calprotectin Versus Acute-Phase Reactants in the Discrimination of Inflammatory Disease Activity in Rheumatoid Arthritis Patients Receiving Tumor Necrosis Factor Inhibitors.

    Science.gov (United States)

    Inciarte-Mundo, José; Victoria Hernández, Maria; Ruiz-Esquide, Virginia; Raquel Cabrera-Villalba, Sonia; Ramirez, Julio; Cuervo, Andrea; Pascal, Mariona; Yagüe, Jordi; Cañete, Juan D; Sanmarti, Raimon

    2016-07-01

    To compare the accuracy of serum calprotectin and acute-phase reactants (C-reactive protein [CRP] and erythrocyte sedimentation rate [ESR]) in stratifying disease activity in rheumatoid arthritis (RA) patients receiving tumor necrosis factor inhibitors (TNFi), and to correlate calprotectin levels with TNFi trough serum levels. We conducted a cross-sectional study of 87 RA patients receiving adalimumab, etanercept (ETN), or infliximab (IFX); 56 psoriatic arthritis (PsA) patients and 40 healthy blood donors were included as controls. Associations between calprotectin, CRP, and ESR and composite articular indices (Disease Activity Score in 28 joints [DAS28], Simplified Disease Activity Index [SDAI], and Clinical Disease Activity Index) were analyzed by correlation and linear regression and the accuracy and discriminatory capacity of calprotectin by receiver operator characteristic curves (area under the curve [AUC]). Calprotectin levels correlated better with all composite activity indices than CRP and ESR (all r coefficients >0.70). Calprotectin levels were significantly lower in RA and PsA patients in clinical remission compared with those with low disease activity for all articular indices. In RA, ESR discriminated between remission and low disease activity only when using DAS28, and CRP only with SDAI. In RA patients in remission/low disease activity, calprotectin but not CRP or ESR distinguished between patients with no swollen joints and those with ≥1 swollen joint (1.74 μg/ml versus 3.04 μg/ml; P = 0.010). Using DAS28 ≥2.6 as the reference variable, calprotectin showed an AUC of 0.92; the best cutoff was ≥2.47 μg/ml with a likelihood ratio of 6.3 (95% confidence interval 2.5-15.8). Calprotectin serum levels inversely correlated with trough serum drug levels of ETN (ρ = -0.671, P acute-phase reactants, even in patients with low inflammatory activity. © 2016, American College of Rheumatology.

  18. Impact of Xpert MTB/RIF for TB diagnosis in a primary care clinic with high TB and HIV prevalence in South Africa: a pragmatic randomised trial.

    Directory of Open Access Journals (Sweden)

    Helen S Cox

    2014-11-01

    Full Text Available Xpert MTB/RIF is approved for use in tuberculosis (TB and rifampicin-resistance diagnosis. However, data are limited on the impact of Xpert under routine conditions in settings with high TB burden.A pragmatic prospective cluster-randomised trial of Xpert for all individuals with presumptive (symptomatic TB compared to the routine diagnostic algorithm of sputum microscopy and limited use of culture was conducted in a large TB/HIV primary care clinic. The primary outcome was the proportion of bacteriologically confirmed TB cases not initiating TB treatment by 3 mo after presentation. Secondary outcomes included time to TB treatment and mortality. Unblinded randomisation occurred on a weekly basis. Xpert and smear microscopy were performed on site. Analysis was both by intention to treat (ITT and per protocol. Between 7 September 2010 and 28 October 2011, 1,985 participants were assigned to the Xpert (n = 982 and routine (n = 1,003 diagnostic algorithms (ITT analysis; 882 received Xpert and 1,063 routine (per protocol analysis. 13% (32/257 of individuals with bacteriologically confirmed TB (smear, culture, or Xpert did not initiate treatment by 3 mo after presentation in the Xpert arm, compared to 25% (41/167 in the routine arm (ITT analysis, risk ratio 0.51, 95% CI 0.33-0.77, p = 0.0052. The yield of bacteriologically confirmed TB cases among patients with presumptive TB was 17% (167/1,003 with routine diagnosis and 26% (257/982 with Xpert diagnosis (ITT analysis, risk ratio 1.57, 95% CI 1.32-1.87, p<0.001. This difference in diagnosis rates resulted in a higher rate of treatment initiation in the Xpert arm: 23% (229/1,003 and 28% (277/982 in the routine and Xpert arms, respectively (ITT analysis, risk ratio 1.24, 95% CI 1.06-1.44, p = 0.013. Time to treatment initiation was improved overall (ITT analysis, hazard ratio 0.76, 95% CI 0.63-0.92, p = 0.005 and among HIV-infected participants (ITT analysis, hazard ratio 0.67, 95% CI 0.53-0.85, p = 0

  19. Transmission of Mycobacterium tuberculosis from patients who are nucleic acid amplification test- negative.

    Science.gov (United States)

    Xie, Yingda L; Cronin, Wendy A; Proschan, Michael; Oatis, Richard; Cohn, Silvia; Curry, Scott R; Golub, Jonathan E; Barry Iii, Clifton E; Dorman, Susan E

    2018-04-24

    Among adults with signs and symptoms of pulmonary tuberculosis (TB), recognition of transmissible TB has implications for airborne infection isolation and public health activities. Sputum smear-negative TB patients account for around one-fifth of tuberculosis transmission. The tuberculosis transmission risk of TB patients with negative results on nucleic acid amplification (NAA) testing of respiratory specimens has not been established. We sought to estimate the tuberculosis transmission risk of NAA test-negative TB patients. We retrospectively reviewed Maryland TB program data from 2004 to 2009 during which NAA testing by the Mycobacterium Tuberculosis Direct Test (MTD) was performed routinely. Patients with sputum Mycobacterium tuberculosis (M.tb) isolates having matching genotypes were assigned to clusters. Transmission sequence was approximated by collection order of individuals' first culture-positive specimens. Minimum transmission risks of NAA (MTD)-negative TB patients and of smear-negative TB patients were estimated based on individuals' positions within clusters. Among 809 patients with culture-confirmed TB, M.tb genotypes were available for 782 (96.7%). For NAA-negative TB patients the minimum transmission risk estimate was 5.1% (95% CI 0-11.4). For smear-negative TB patients the minimum transmission risk estimate was 11.2% (95% CI 7.2-15.3). Minimum transmission risk of NAA-negative TB patients was lower than that of smear-negative TB patients. However, transmission risk of NAA-negative TB patients appears to not be negligible.

  20. FAKTOR-FAKTOR YANG BERPENGARUH TERHADAP KEJADIAN TB PARU DEWASA DI INDONESIA (ANALISIS DATA RISET KESEHATAN DASAR TAHUN 2010

    Directory of Open Access Journals (Sweden)

    Rukmini Rukmini

    2012-11-01

    Full Text Available Background: The statement of WHO, there were 22 countries classified as high burden of TB Pulmonary, including Indonesia. The detection of smear positive (BTA+ patients in Indonesia is still low and filtering suspect rate also decreased since 2007 until 2010. It is required to improve the detection patient of tuberculosis. Objective: This study aimed to assess the adult pulmonary TB risk factors that influence the disease's incidence in Indonesia. Methods: This observational analytic studies was conducted on March-June 2011. Data source from secondary data of basic health research 2010, that were individuals 15 years performed sputum examination. Data of cases were 183 people with smear positive and control of 366 people with negative smear. Those are household members and neighbors cases who had never been diagnosed of TB cases by health personnel. This was analyzed with logistic regression. Result: Multivariate analysis showed that risk factors associated with adult pulmonary tuberculosis were age (OR= 0.473, p = 0.018, gender (OR= 1.613, p = 0.027, lighting energy (OR= 1.804, p = 0.032, nutrition status (OR= 2.101, p = 0.009 and household contact with TB patients (OR= 4.355, p = 0.000. The TB risk factors that most influenced the disease's incidence is household contact with TB patients.  Keywords: tuberculosis of lung, BTA (+, risk factors

  1. Phosphorescence quantum yield determination with time-gated fluorimeter and Tb(III)-acetylacetonate as luminescence reference

    Energy Technology Data Exchange (ETDEWEB)

    Penzkofer, A., E-mail: alfons.penzkofer@physik.uni-regensburg.de [Fakultät für Physik, Universität Regensburg, Universitätsstrasse 31, D-93053 Regensburg (Germany)

    2013-03-29

    Highlights: ► Procedure for absolute phosphorescence quantum yield measurement is described. ► Experimental setup for absolute luminescence quantum yield standard calibration. ► Tb(acac){sub 3} proposed as phosphorescence quantum yield reference standard. ► Luminescence quantum yield of Tb(acac){sub 3} in cyclohexane measured. ► Luminescence lifetime of Tb(acac){sub 3} in cyclohexane measured. - Abstract: Phosphorescence quantum yield measurements of fluorescent and phosphorescent samples require the use of time-gated fluorimeters in order to discriminate against the fluorescence contribution. As reference standard a non-fluorescent luminescent compound is needed for absolute phosphorescence quantum yield determination. For this purpose the luminescence behavior of the rare earth chelate terbium(III)-acetylacetonate (Tb(acac){sub 3}) was studied (determination of luminescence quantum yield and luminescence lifetime). The luminescence quantum yield of Tb(acac){sub 3} was determined by using an external light source and operating the fluorimeter in chemo/bioluminescence mode with a fluorescent dye (rhodamine 6G in methanol) as reference standard. A procedure is developed for absolute luminescence (phosphorescence) quantum yield determination of samples under investigation with a time-gated fluorimeter using a non-fluorescent luminescent compound of known luminescence quantum yield and luminescence lifetime.

  2. Intact and cleaved forms of the urokinase receptor enhance discrimination of cancer from non-malignant conditions in patients presenting with symptoms related to colorectal cancer.

    Science.gov (United States)

    Lomholt, A F; Høyer-Hansen, G; Nielsen, H J; Christensen, I J

    2009-09-15

    Colorectal cancer (CRC) is a leading cause of cancer-related morbidity and mortality in developed countries. It is known that early detection results in improved survival, and consequently there is a need for improved diagnostic tools in CRC. The plasma level of soluble urokinase plasminogen activator receptor (suPAR) was proposed as a marker in CRC patients. This study was undertaken to evaluate the individual molecular forms of suPAR as discriminators in a group of patients undergoing endoscopical examination following symptoms related to colorectal cancer. In a case-control study comprising 308 patients undergoing endoscopical examination following CRC-related symptoms, 77 CRC patients with adenocarcinoma were age and gender matched to: 77 patients with adenomas; 77 with other non-malignant findings, and 77 with no findings. The different uPAR forms were measured in citrate plasma collected before endoscopical examination, using three different Time Resolved - Fluorescence Immuno Assays (TR-FIA's). All soluble uPAR forms were found to be significantly higher in cancer patients than in patients presenting with other non-malignant findings; uPAR(I) P=0.0006, suPAR(I-III) P<0.0001 and suPAR(I-III)+(II-III) P<0.0001, whereas no significant difference was found when performing similar comparisons for patients presenting with adenomas. The odds ratio (OR) for the compari